Cost-Effectiveness of Sensor-Augmented Pump Therapy with Low Glucose Suspend Versus Standard Insulin Pump Therapy in Two Different Patient Populations with Type 1 Diabetes in France.

PubMed

Roze, Stéphane; Smith-Palmer, Jayne; Valentine, William; Payet, Vincent; de Portu, Simona; Papo, Natalie; Cucherat, Michel; Hanaire, Helene

2016-02-01

Sensor-augmented pump therapy (SAP) provides a useful adjunct relative to continuous subcutaneous insulin infusion (CSII) alone. It can provide early warning of the onset of hyperglycemia and hypoglycemia and has the functionality to suspend insulin delivery if sensor glucose levels fall below a predefined threshold. The aim was to assess the cost-effectiveness of SAP with low glucose suspend (LGS) versus CSII alone in type 1 diabetes. Cost-effectiveness analysis was performed using the CORE Diabetes Model, using published clinical input data. The analysis was performed in two cohorts: one with uncontrolled glycated hemoglobin at baseline and one at elevated risk for hypoglycemic events. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon; future costs and clinical outcomes were discounted at 4% per annum. In patients with uncontrolled glycated hemoglobin at baseline, SAP + LGS resulted in improved discounted quality-adjusted life expectancy (QALE) versus CSII (10.55 quality-adjusted life-years [QALYs] vs. 9.36 QALYs) but higher mean lifetime direct costs (€84,972 vs. €49,171) resulting in an incremental cost-effectiveness ratio (ICER) of €30,163 per QALY gained. In patients at elevated risk for hypoglycemia, the ICER was €22,005 per QALY gained for SAP + LGS versus CSII as lifetime costs were higher (€88,680 vs. €57,097), but QALE was also higher (18.46 QALYs vs. 18.30 QALYs). In France, projected improvements in outcomes with SAP + LGS versus CSII translated into an ICER generally considered as good value for money, particularly in patients who experience frequent and/or problematic hypoglycemic events.

Hypoglycemia and blood glucose fluctuations in the application of a sensor-augmented insulin pump.

PubMed

Luo, Pei; Cheng, Qianpeng; Chen, Bin; Li, Yang; Wu, Jinxiao; Zhang, Xingguang; Jiao, Xiumin; Zhao, Jing; Lv, Xiaofeng

2013-12-01

The purpose of this study was to understand the effect of sensor-augmented insulin pump (SAP) use on hypoglycemia and blood glucose (BG) fluctuations. Sixty patients with type 2 diabetes mellitus were randomly assigned to three groups of treatment with SAP, continuous subcutaneous insulin infusion (CSII), or multiple daily injection (MDI) therapy for 6 days. Parameters of glycemic control that were determined included mean BG concentration (MBG), SD of BG (SDBG), mean amplitude of glycemic excursions (MAGE), absolute means of daily differences (MODD), 24-h area under the curve at 10 h (AUC10), 24-h area under the curve at 3.9 h (AUC3.9), and Low Blood Glucose Index (LBGI). No significant differences were observed among the three groups in terms of MBG, SDBG, MAGE, or MODD at the beginning of treatment. The MBG, SDBG, MAGE, MODD, and total AUC10 of the SAP group improved over the 4 days of the intervention compared with the CSII and MDI groups; however, no significant differences were observed among the three groups in terms of total AUC3.9 and LBGI. Compared with CSII and MDI therapy, SAP therapy was able to rapidly lower mean BG and reduce BG level fluctuations with no increased risks of hypoglycemia.

Analysis of glucose responses to automated insulin suspension with sensor-augmented pump therapy.

PubMed

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

2012-07-01

The advent of sensor-augmented pump therapy with a low-glucose suspend (LGS) function (Medtronic Paradigm Veo System), allowing insulin to be automatically suspended for up to 2 h when sensor glucose falls below a preset threshold, has the potential to reduce the duration of hypoglycemia. In this article, we analyzed blood glucose profiles following a full 2-h insulin suspension activated by the LGS function, as well as examined different patterns of use among patients. Data from a cohort of participants using the Veo System for up to 6 months were analyzed to determine the time and duration of insulin suspension activated by the LGS function. We further evaluated overnight suspend events with no patient response occurring prior to 3:00 a.m., which allowed us to determine the pattern of sensor glucose values with no patient intervention during and after the period of insulin suspension. There were 3,128 LGS events during the 2,493 days evaluated. The median duration was 11.2 min, and 36% of events occurred overnight. There were 126 full 2-h suspend events that occurred overnight with no patient response, occurring before 3:00 a.m. For these events, the mean sensor glucose at the end of the 2-h suspend period was 99 ± 6 mg/dL ([means ± SE] 5.5 ± 0.3 mmol/L). The mean sensor glucose 2 h after insulin delivery resumed was 155 ± 10 mg/dL (8.6 ± 0.6 mmol/L). There were no episodes of severe hypoglycemia or diabetic ketoacidosis. Analyses of sensor glucose patterns following insulin suspension activated by LGS suggest that this technology is safe and unlikely to be associated with adverse outcomes.

Keeping Up with the Diabetes Technology: 2016 Endocrine Society Guidelines of Insulin Pump Therapy and Continuous Glucose Monitor Management of Diabetes.

PubMed

Galderisi, Alfonso; Schlissel, Elise; Cengiz, Eda

2017-09-23

Decades after the invention of insulin pump, diabetes management has encountered a technology revolution with the introduction of continuous glucose monitoring, sensor-augmented insulin pump therapy and closed-loop/artificial pancreas systems. In this review, we discuss the significance of the 2016 Endocrine Society Guidelines for insulin pump therapy and continuous glucose monitoring and summarize findings from relevant diabetes technology studies that were conducted after the publication of the 2016 Endocrine Society Guidelines. The 2016 Endocrine Society Guidelines have been a great resource for clinicians managing diabetes in this new era of diabetes technology. There is good body of evidence indicating that using diabetes technology systems safely tightens glycemic control while managing both type 1 and type 2 diabetes. The first-generation diabetes technology systems will evolve as we gain more experience and collaboratively work to improve them with an ultimate goal of keeping people with diabetes complication and burden-free until the cure for diabetes becomes a reality.

Automatic Adaptation of Basal Insulin Using Sensor-Augmented Pump Therapy.

PubMed

Herrero, Pau; Bondia, Jorge; Giménez, Marga; Oliver, Nick; Georgiou, Pantelis

2018-03-01

People with insulin-dependent diabetes rely on an intensified insulin regimen. Despite several guidelines, they are usually impractical and fall short in achieving optimal glycemic outcomes. In this work, a novel technique for automatic adaptation of the basal insulin profile of people with diabetes on sensor-augmented pump therapy is presented. The presented technique is based on a run-to-run control law that overcomes some of the limitations of previously proposed methods. To prove its validity, an in silico validation was performed. Finally, the artificial intelligence technique of case-based reasoning is proposed as a potential solution to deal with variability in basal insulin requirements. Over a period of 4 months, the proposed run-to-run control law successfully adapts the basal insulin profile of a virtual population (10 adults, 10 adolescents, and 10 children). In particular, average percentage time in target [70, 180] mg/dl was significantly improved over the evaluated period (first week versus last week): 70.9 ± 11.8 versus 91.1 ± 4.4 (adults), 46.5 ± 11.9 versus 80.1 ± 10.9 (adolescents), 49.4 ± 12.9 versus 73.7 ± 4.1 (children). Average percentage time in hypoglycemia (<70 mg/dl) was also significantly reduced: 9.7 ± 6.6 versus 0.9 ± 1.2 (adults), 10.5 ± 8.3 versus 0.83 ± 1.0 (adolescents), 10.9 ± 6.1 versus 3.2 ± 3.5 (children). When compared against an existing technique over the whole evaluated period, the presented approach achieved superior results on percentage of time in hypoglycemia: 3.9 ± 2.6 versus 2.6 ± 2.2 (adults), 2.9 ± 1.9 versus 2.0 ± 1.5 (adolescents), 4.6 ± 2.8 versus 3.5 ± 2.0 (children), without increasing the percentage time in hyperglycemia. The present study shows the potential of a novel technique to effectively adjust the basal insulin profile of a type 1 diabetes population on sensor-augmented insulin pump therapy.

Insulin pump therapy with automated insulin suspension in response to hypoglycemia: reduction in nocturnal hypoglycemia in those at greatest risk.

PubMed

Choudhary, Pratik; Shin, John; Wang, Yongyin; Evans, Mark L; Hammond, Peter J; Kerr, David; Shaw, James A M; Pickup, John C; Amiel, Stephanie A

2011-09-01

To evaluate a sensor-augmented insulin pump with a low glucose suspend (LGS) feature that automatically suspends basal insulin delivery for up to 2 h in response to sensor-detected hypoglycemia. The LGS feature of the Paradigm Veo insulin pump (Medtronic, Inc., Northridge, CA) was tested for 3 weeks in 31 adults with type 1 diabetes. There were 166 episodes of LGS: 66% of daytime LGS episodes were terminated within 10 min, and 20 episodes lasted the maximum 2 h. LGS use was associated with reduced nocturnal duration ≤2.2 mmol/L in those in the highest quartile of nocturnal hypoglycemia at baseline (median 46.2 vs. 1.8 min/day, P = 0.02 [LGS-OFF vs. LGS-ON]). Median sensor glucose was 3.9 mmol/L after 2-h LGS and 8.2 mmol/L at 2 h after basal restart. Use of an insulin pump with LGS was associated with reduced nocturnal hypoglycemia in those at greatest risk and was well accepted by patients.

Model-Based Sensor-Augmented Pump Therapy

PubMed Central

Grosman, Benyamin; Voskanyan, Gayane; Loutseiko, Mikhail; Roy, Anirban; Mehta, Aloke; Kurtz, Natalie; Parikh, Neha; Kaufman, Francine R.; Mastrototaro, John J.; Keenan, Barry

2013-01-01

Background In insulin pump therapy, optimization of bolus and basal insulin dose settings is a challenge. We introduce a new algorithm that provides individualized basal rates and new carbohydrate ratio and correction factor recommendations. The algorithm utilizes a mathematical model of blood glucose (BG) as a function of carbohydrate intake and delivered insulin, which includes individualized parameters derived from sensor BG and insulin delivery data downloaded from a patient’s pump. Methods A mathematical model of BG as a function of carbohydrate intake and delivered insulin was developed. The model includes fixed parameters and several individualized parameters derived from the subject’s BG measurements and pump data. Performance of the new algorithm was assessed using n = 4 diabetic canine experiments over a 32 h duration. In addition, 10 in silico adults from the University of Virginia/Padova type 1 diabetes mellitus metabolic simulator were tested. Results The percentage of time in glucose range 80–180 mg/dl was 86%, 85%, 61%, and 30% using model-based therapy and [78%, 100%] (brackets denote multiple experiments conducted under the same therapy and animal model), [75%, 67%], 47%, and 86% for the control experiments for dogs 1 to 4, respectively. The BG measurements obtained in the simulation using our individualized algorithm were in 61–231 mg/dl min–max envelope, whereas use of the simulator’s default treatment resulted in BG measurements 90–210 mg/dl min–max envelope. Conclusions The study results demonstrate the potential of this method, which could serve as a platform for improving, facilitating, and standardizing insulin pump therapy based on a single download of data. PMID:23567006

Home Use of Day-and-Night Hybrid Closed-Loop Insulin Delivery in Suboptimally Controlled Adolescents With Type 1 Diabetes: A 3-Week, Free-Living, Randomized Crossover Trial.

PubMed

Tauschmann, Martin; Allen, Janet M; Wilinska, Malgorzata E; Thabit, Hood; Acerini, Carlo L; Dunger, David B; Hovorka, Roman

2016-11-01

This study evaluated the feasibility, safety, and efficacy of day-and-night hybrid closed-loop insulin delivery in adolescents with type 1 diabetes under free-living conditions. In an open-label randomized crossover study, 12 suboptimally controlled adolescents on insulin pump therapy (mean ± SD age 14.6 ± 3.1 years; HbA 1c 69 ± 8 mmol/mol [8.5 ± 0.7%]; duration of diabetes 7.8 ± 3.5 years) underwent two 21-day periods in which hybrid closed-loop insulin delivery was compared with sensor-augmented insulin pump therapy in random order. During the closed-loop intervention, a model predictive algorithm automatically directed insulin delivery between meals and overnight. Participants used a bolus calculator to administer prandial boluses. The proportion of time that sensor glucose was in the target range (3.9-10 mmol/L; primary end point) was increased during the closed-loop intervention compared with sensor-augmented insulin pump therapy by 18.8 ± 9.8 percentage points (mean ± SD; P < 0.001), the mean sensor glucose level was reduced by 1.8 ± 1.3 mmol/L (P = 0.001), and the time spent above target was reduced by 19.3 ± 11.3 percentage points (P < 0.001). The time spent with sensor glucose levels below 3.9 mmol/L was low and comparable between interventions (median difference 0.4 [interquartile range -2.2 to 1.3] percentage points; P = 0.33). Improved glucose control during closed-loop was associated with increased variability of basal insulin delivery (P < 0.001) and an increase in the total daily insulin dose (53.5 [39.5-72.1] vs. 51.5 [37.6-64.3] units/day; P = 0.006). Participants expressed positive attitudes and experience with the closed-loop system. Free-living home use of day-and-night closed-loop in suboptimally controlled adolescents with type 1 diabetes is safe, feasible, and improves glucose control without increasing the risk of hypoglycemia. Larger and longer studies are warranted. © 2016 by the American Diabetes Association.

Cost-effectiveness of sensor-augmented pump therapy versus standard insulin pump therapy in patients with type 1 diabetes in Denmark.

PubMed

Roze, S; de Portu, S; Smith-Palmer, J; Delbaere, A; Valentine, W; Ridderstråle, M

2017-06-01

The use of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes (T1D) has increased in recent years. Sensor-augmented pump therapy (SAP) with low glucose suspend (LGS) (allowing temporary suspension of insulin delivery if blood glucose level falls below a pre-defined threshold level) provides additional benefits over CSII alone, but is associated with higher acquisition costs. Therefore, a cost-effectiveness analysis of SAP+LGS versus CSII in patients with T1D was performed. Analyses were performed using the CORE Diabetes Model in two different patient cohorts in Denmark, one with hyperglycemia at baseline and one with increased risk for hypoglycemic events. Clinical input data were sourced from published literature. The analysis was performed over a lifetime time horizon from a societal perspective. Future costs and clinical outcomes were discounted at 3% per annum. In patients who were hyperglycemic at baseline the use of SAP+LGS versus CSII resulted in improved quality-adjusted life expectancy (12.44 versus 10.99 quality-adjusted life years [QALYs]) but higher mean lifetime costs (DKK 2,027,316 versus DKK 1,801,293) leading to an incremental cost-effectiveness ratio (ICER) of DKK 156,082 per QALY gained. For patients at increased risk for hypoglycemic events the ICER for SAP+LGS versus CSII was DKK 89,868 per QALY gained. The ICER for SAP+LGS versus CSII falls below commonly cited willingness-to-pay thresholds. Therefore, in Denmark, the use of SAP+LGS is likely to be considered cost-effective relative to CSII for patients with T1D who are either hyperglycemic, despite CSII use, or who experience frequent severe hypoglycemic events. Copyright © 2017 Elsevier B.V. All rights reserved.

[From insulin pump and continuous glucose monitoring to the artificial pancreas].

PubMed

Apablaza, Pamela; Soto, Néstor; Codner, Ethel

2017-05-01

Technology for diabetes care has undergone major development during recent decades. These technological advances include continuous subcutaneous insulin infusion (CSII), also known as insulin pumps, and real-time continuous glucose monitoring system (RT-CGMS). The integration of CSII and RT-CGMS into a single device has led to sensor-augmented pump therapy and more recently, a technology that has automated delivery of basal insulin therapy, known as hybrid system. These new technologies have led to benefits in attaining better metabolic control and decreasing the incidence of severe hypoglycemia, especially in patients with type 1 diabetes. This review describes the types of technologies currently available or under investigation for these purposes, their benefits and disadvantages, recommendations and the appropriate patient selection for their use. The clinical use of the hybrid system and artificial pancreas seem to be possible in the near future.

Randomized trial of a dual-hormone artificial pancreas with dosing adjustment during exercise compared with no adjustment and sensor-augmented pump therapy.

PubMed

Jacobs, P G; El Youssef, J; Reddy, R; Resalat, N; Branigan, D; Condon, J; Preiser, N; Ramsey, K; Jones, M; Edwards, C; Kuehl, K; Leitschuh, J; Rajhbeharrysingh, U; Castle, J R

2016-11-01

To test whether adjusting insulin and glucagon in response to exercise within a dual-hormone artificial pancreas (AP) reduces exercise-related hypoglycaemia. In random order, 21 adults with type 1 diabetes (T1D) underwent three 22-hour experimental sessions: AP with exercise dosing adjustment (APX); AP with no exercise dosing adjustment (APN); and sensor-augmented pump (SAP) therapy. After an overnight stay and 2 hours after breakfast, participants exercised for 45 minutes at 60% of their maximum heart rate, with no snack given before exercise. During APX, insulin was decreased and glucagon was increased at exercise onset, while during SAP therapy, subjects could adjust dosing before exercise. The two primary outcomes were percentage of time spent in hypoglycaemia (<3.9 mmol/L) and percentage of time spent in euglycaemia (3.9-10 mmol/L) from the start of exercise to the end of the study. The mean (95% confidence interval) times spent in hypoglycaemia (<3.9 mmol/L) after the start of exercise were 0.3% (-0.1, 0.7) for APX, 3.1% (0.8, 5.3) for APN, and 0.8% (0.1, 1.4) for SAP therapy. There was an absolute difference of 2.8% less time spent in hypoglycaemia for APX versus APN (p = .001) and 0.5% less time spent in hypoglycaemia for APX versus SAP therapy (p = .16). Mean time spent in euglycaemia was similar across the different sessions. Adjusting insulin and glucagon delivery at exercise onset within a dual-hormone AP significantly reduces hypoglycaemia compared with no adjustment and performs similarly to SAP therapy when insulin is adjusted before exercise. © 2016 John Wiley & Sons Ltd.

Living with sensor-augmented pump therapy in type 1 diabetes: adolescents' and parents' search for harmony.

PubMed

Rashotte, Judy; Tousignant, Kelley; Richardson, Christine; Fothergill-Bourbonnais, Frances; Nakhla, Meranda M; Olivier, Patricia; Lawson, Margaret L

2014-08-01

Adolescents have difficulty successfully sustaining use of continuous glucose monitoring even when it is introduced to experienced pump users. However, little is known about how adolescents and parents perceive and manage sensor-augmented pump therapy (SAPT) in daily life. The purpose of this study was to explore adolescents' and parents' daily experience of living with SAPT. We used an interpretive phenomenological study design. We conducted in-depth, digitally recorded interviews with 7 adolescents and 9 parents recruited through 1 Canadian pediatric diabetes program. Adolescents who participated were 13 to 17 years of age with type 1 diabetes mellitus and had experience (current or past) living with SAPT. Transcripts of the interviews were subjected to a thematic analysis guided by the procedure outlined by Colaizzi. The overarching theme, seeking harmony, reflected adolescents' and parents' daily struggles with balancing multiple tensions that arose from managing SAPT and harmonizing seemingly opposing choices that were brought to the fore, while also struggling to live with both wellness and chronic illness. Four themes constituted the struggle to find harmony living with diabetes managed with SAPT: struggling with hopes and expectations for SAPT, being ready for SAPT, living the burdens of continuous glucose monitoring and creating partnerships. Healthcare providers can facilitate adolescent and parental decision-making about the optimal timing for SAPT introduction. Success with SAPT requires exploration of adolescent and parental expectations for SAPT as well as the degree to which parents have previously fostered their adolescent's involvement in and responsibility for diabetes management. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY 2018 POSITION STATEMENT ON INTEGRATION OF INSULIN PUMPS AND CONTINUOUS GLUCOSE MONITORING IN PATIENTS WITH DIABETES MELLITUS.

PubMed

Grunberger, George; Handelsman, Yehuda; Bloomgarden, Zachary T; Fonseca, Vivian A; Garber, Alan J; Haas, Richard A; Roberts, Victor L; Umpierrez, Guillermo E

2018-03-01

This document represents the official position of the American Association of Clinical Endocrinologists and American College of Endocrinology. Where there are no randomized controlled trials or specific U.S. FDA labeling for issues in clinical practice, the participating clinical experts utilized their judgment and experience. Every effort was made to achieve consensus among the committee members. Position statements are meant to provide guidance, but they are not to be considered prescriptive for any individual patient and cannot replace the judgment of a clinician. AACE/ACE Task Force on Integration of Insulin Pumps and Continuous Glucose Monitoring in the Management of Patients With Diabetes Mellitus Chair George Grunberger, MD, FACP, FACE Task Force Members Yehuda Handelsman, MD, FACP, FNLA, MACE Zachary T. Bloomgarden, MD, MACE Vivian A. Fonseca, MD, FACE Alan J. Garber, MD, PhD, FACE Richard A. Haas, MD, FACE Victor L. Roberts, MD, MBA, FACP, FACE Guillermo E. Umpierrez, MD, CDE, FACP, FACE Abbreviations: AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology A1C = glycated hemoglobin BGM = blood glucose monitoring CGM = continuous glucose monitoring CSII = continuous subcutaneous insulin infusion DM = diabetes mellitus FDA = Food & Drug Administration MDI = multiple daily injections T1DM = type 1 diabetes mellitus T2DM = type 2 diabetes mellitus SAP = sensor-augmented pump SMBG = self-monitoring of blood glucose STAR 3 = Sensor-Augmented Pump Therapy for A1C Reduction phase 3 trial.

Long-Term Efficacy and Safety of Sensor Augmented Insulin Pump Therapy with Low-Glucose Suspend Feature in Patients with Type 1 Diabetes.

PubMed

Gómez, Ana María; Marín Carrillo, Lisseth Fernanda; Muñoz Velandia, Oscar Mauricio; Rondón Sepúlveda, Martín Alonso; Arévalo Correa, Carol M; Mora Garzón, Edwin; Cuervo Diaz, Maria Camila; Henao Carrillo, Diana Cristina

2017-02-01

Literature supports short-term efficacy and safety of Sensor Augmented Insulin Pump (SAP) therapy in patients with type 1 diabetes (T1D). However, no data are available showing long-term outcomes. Our study describes the long-term outcomes of SAP therapy with low-glucose suspend feature (SAP+LGS) in hypoglycemia in a Colombian population with T1D and hypoglycemia. A cohort study was conducted with T1D patients receiving SAP+LGS therapy who initiated this therapy because of hypoglycemia at San Ignacio University Hospital diabetes center in Bogotá, Colombia. Glycated hemoglobin (A1c) was assessed at least every 6 months, severe hypoglycemia (SH) and hypoglycemia unawareness (HU) incidence yearly. Adherence to therapy was also evaluated. One hundred eleven patients were included in the analysis. Total daily insulin dose was reduced during follow-up (mean difference -0.22 U/kg; 95% confidence interval [CI] -0.18 to -0.26; P < 0.001). A1c levels were reduced from a baseline value of 8.8% ± 1.9% to 7.5% ± 1.0% at 5 months (mean difference -1.3%; 95% CI -1.09 to -1.50; P < 0.001) and 7.1% ± 0.8% (mean difference -1.7%; 95% CI -1.59 to -1.90; P < 0.001) at the end of follow-up (47 months on average). The incidence of SH and HU episodes decreased significantly since the first year, and this effect was maintained over time (P < 0.001). SAP+LGS therapy in T1D patients with hypoglycemia led to a significant and sustained decrease in A1c during long periods of follow-up, as well as a significant reduction in SH and HU. Future randomized clinical trials are desired.

Prevention of hypoglycemia by using low glucose suspend function in sensor-augmented pump therapy.

PubMed

Danne, Thomas; Kordonouri, Olga; Holder, Martin; Haberland, Holger; Golembowski, Sven; Remus, Kerstin; Bläsig, Sara; Wadien, Tanja; Zierow, Susanne; Hartmann, Reinhard; Thomas, Andreas

2011-11-01

Severe hypoglycemic episodes are a barrier for achieving optimal glycemic control. Sensor-augmented pump (SAP) therapy with insulin in combination with a novel mechanism of automatic insulin shutoff (low glucose suspend [LGS]) can be used to prevent and reduce hypoglycemia. In a prospective study, we investigated the effect of the LGS algorithm on the frequency of hypoglycemia in children and adolescents with type 1 diabetes under real-life conditions. Twenty-one patients with type 1 diabetes (10.8±3.8 years old, duration of diabetes 5.9±3.0 years, pump therapy for 3.7±1.7 years, glycated hemoglobin level 7.8±1.1%) from three pediatric centers used the Paradigm(®) Veo(™) system (Medtronic Minimed, Northridge, CA) during two subseqent time periods: SAP without LGS for 2 weeks and then SAP with LGS enabled for 6 weeks. The primary objective was to assess the frequency of hypoglycemic episodes when using the LGS feature with an insulin delivery shutoff of a maximum of 2 h at a sensor glucose level below 70 mg/dL (3.9 mmol/L). In total, 1,298 LGS alerts occurred (853 shorter than 5 min). Forty-two percent of LGS activations (>5 min) lasted less than 30 min, whereas 24% had a duration of 2 h. The number of hypoglycemic excursions (average/day) was reduced during SAP+LGS (<70 mg/L, 1.27±0.75 vs. 0.95±0.49, P=0.010; ≤40 mg/dL, 0.28±0.18 vs. 0.13±0.14, P=0.005) as was the time spent in hypoglycemia (average minutes/day, 101±68 vs. 58±33, P=0.002) without significant difference in the mean glucose level (145±23 vs. 148±19 mg/dL). No episodes of severe hyperglycemia or diabetic ketoacidosis were observed following LGS activation. The present investigation provides evidence that SAP with LGS reduces the frequency of hypoglycemia without compromising safety.

Continuous Glucose Monitoring: Impact on Hypoglycemia.

PubMed

van Beers, Cornelis A J; DeVries, J Hans

2016-11-01

The necessity of strict glycemic control is unquestionable. However, hypoglycemia remains a major limiting factor in achieving satisfactory glucose control, and evidence is mounting to show that hypoglycemia is not benign. Over the past decade, evidence has consistently shown that real-time continuous glucose monitoring improves glycemic control in terms of lowering glycated hemoglobin levels. However, real-time continuous glucose monitoring has not met the expectations of the diabetes community with regard to hypoglycemia prevention. The earlier trials did not demonstrate any effect on either mild or severe hypoglycemia and the effect of real-time continuous glucose monitoring on nocturnal hypoglycemia was often not reported. However, trials specifically designed to reduce hypoglycemia in patients with a high hypoglycemia risk have demonstrated a reduction in hypoglycemia, suggesting that real-time continuous glucose monitoring can prevent hypoglycemia when it is specifically used for that purpose. Moreover, the newest generation of diabetes technology currently available commercially, namely sensor-augmented pump therapy with a (predictive) low glucose suspend feature, has provided more convincing evidence for hypoglycemia prevention. This article provides an overview of the hypoglycemia outcomes of randomized controlled trials that investigate the effect of real-time continuous glucose monitoring alone or sensor-augmented pump therapy with a (predictive) low glucose suspend feature. Furthermore, several possible explanations are provided why trials have not shown a reduction in severe hypoglycemia. In addition, existing evidence is presented of real-time continuous glucose monitoring in patients with impaired awareness of hypoglycemia who have the highest risk of severe hypoglycemia. © 2016 Diabetes Technology Society.

Continuous Glucose Monitoring

PubMed Central

van Beers, Cornelis A. J.; DeVries, J. Hans

2016-01-01

The necessity of strict glycemic control is unquestionable. However, hypoglycemia remains a major limiting factor in achieving satisfactory glucose control, and evidence is mounting to show that hypoglycemia is not benign. Over the past decade, evidence has consistently shown that real-time continuous glucose monitoring improves glycemic control in terms of lowering glycated hemoglobin levels. However, real-time continuous glucose monitoring has not met the expectations of the diabetes community with regard to hypoglycemia prevention. The earlier trials did not demonstrate any effect on either mild or severe hypoglycemia and the effect of real-time continuous glucose monitoring on nocturnal hypoglycemia was often not reported. However, trials specifically designed to reduce hypoglycemia in patients with a high hypoglycemia risk have demonstrated a reduction in hypoglycemia, suggesting that real-time continuous glucose monitoring can prevent hypoglycemia when it is specifically used for that purpose. Moreover, the newest generation of diabetes technology currently available commercially, namely sensor-augmented pump therapy with a (predictive) low glucose suspend feature, has provided more convincing evidence for hypoglycemia prevention. This article provides an overview of the hypoglycemia outcomes of randomized controlled trials that investigate the effect of real-time continuous glucose monitoring alone or sensor-augmented pump therapy with a (predictive) low glucose suspend feature. Furthermore, several possible explanations are provided why trials have not shown a reduction in severe hypoglycemia. In addition, existing evidence is presented of real-time continuous glucose monitoring in patients with impaired awareness of hypoglycemia who have the highest risk of severe hypoglycemia. PMID:27257169

Effectiveness of early intensive therapy on β-cell preservation in type 1 diabetes.

PubMed

Buckingham, Bruce; Beck, Roy W; Ruedy, Katrina J; Cheng, Peiyao; Kollman, Craig; Weinzimer, Stuart A; DiMeglio, Linda A; Bremer, Andrew A; Slover, Robert; Tamborlane, William V

2013-12-01

To assess effectiveness of inpatient hybrid closed-loop control (HCLC) followed by outpatient sensor-augmented pump (SAP) therapy initiated within 7 days of diagnosis of type 1 diabetes on the preservation of β-cell function at 1 year. Sixty-eight individuals (mean age 13.3 ± 5.7 years; 35% female, 92% Caucasian) were randomized to HCLC followed by SAP therapy (intensive group; N = 48) or to the usual-care group treated with multiple daily injections or insulin pump therapy (N = 20). Primary outcome was C-peptide concentrations during mixed-meal tolerance tests at 12 months. Intensive-group participants initiated HCLC a median of 6 days after diagnosis for a median duration of 71.3 h, during which median participant mean glucose concentration was 140 mg/dL (interquartile range 134-153 mg/dL). During outpatient SAP, continuous glucose monitor (CGM) use decreased over time, and at 12 months, only 33% of intensive participants averaged sensor use ≥6 days/week. In the usual-care group, insulin pump and CGM use were initiated prior to 12 months by 15 and 5 participants, respectively. Mean HbA1c levels were similar in both groups throughout the study. At 12 months, the geometric mean (95% CI) of C-peptide area under the curve was 0.43 (0.34-0.52) pmol/mL in the intensive group and 0.52 (0.32-0.75) pmol/mL in the usual-care group (P = 0.49). Thirty-seven (79%) intensive and 16 (80%) usual-care participants had a peak C-peptide concentration ≥0.2 pmol/mL (P = 0.30). In new-onset type 1 diabetes, HCLC followed by SAP therapy did not provide benefit in preserving β-cell function compared with current standards of care.

Outpatient 60-hour day-and-night glucose control with dual-hormone artificial pancreas, single-hormone artificial pancreas, or sensor-augmented pump therapy in adults with type 1 diabetes: An open-label, randomised, crossover, controlled trial.

PubMed

Haidar, Ahmad; Messier, Virginie; Legault, Laurent; Ladouceur, Martin; Rabasa-Lhoret, Rémi

2017-05-01

To assess whether the dual-hormone (insulin and glucagon) artificial pancreas reduces hypoglycaemia compared to the single-hormone (insulin alone) artificial pancreas in outpatient settings during the day and night. In a randomized, three-way, crossover trial we compared the dual-hormone artificial pancreas, the single-hormone artificial pancreas and sensor-augmented pump therapy (control) in 23 adults with type 1 diabetes. Each intervention was applied from 8 AM Day 1 to 8 PM Day 3 (60 hours) in outpatient free-living conditions. The primary outcome was time spent with sensor glucose levels below 4.0 mmol/L. A P value of less than .017 was regarded as significant. The median difference between the dual-hormone system and the single-hormone system was -2.3% (P = .072) for time spent below 4.0 mmol/L, -1.3% (P = .017) for time below 3.5 mmol/L, and -0.7% (P = .031) for time below 3.3 mmol/L. Both systems reduced (P < .017) hypoglycaemia below 4.0, 3.5 and 3.3 mmol/L compared to control therapy, but reductions were larger with the dual-hormone system than with the single-hormone system (medians -4.0% vs -3.4% for 4.0 mmol/L; -2.7% vs -2.2% for 3.5 mmol/L; and -2.2% vs -1.2% for 3.3 mmol/L). There were 34 hypoglycaemic events (<3.0 mmol/L for 20 minutes) with control therapy, 14 with the single-hormone system and 6 with the dual-hormone system. These differences in hypoglycaemia were observed while mean glucose level was low and comparable in all interventions (P = NS). The dual-hormone artificial pancreas had the lowest risk of hypoglycaemia, but the differences were not statistically significant. Larger studies are needed. © 2017 John Wiley & Sons Ltd.

Effects of performing morning versus afternoon exercise on glycemic control and hypoglycemia frequency in type 1 diabetes patients on sensor-augmented insulin pump therapy.

PubMed

Gomez, Ana Maria; Gomez, Claudia; Aschner, Pablo; Veloza, Angelica; Muñoz, Oscar; Rubio, Claudia; Vallejo, Santiago

2015-05-01

Although physical exercise (PE) is recommended for individuals with type 1 diabetes (DM1), participation in exercise is challenging because it increases the risk of severe hypoglycemia and the available therapeutic options to prevent it frequently result in hyperglycemia. There is no clear recommendation about the best timing for exercise. The aim of this study was to compare the risk of hypoglycemia after morning or afternoon exercise sessions up to 36 hours postworkout. This randomized crossover study enrolled subjects with DM1, older than 18 years of age, on sensor-augmented insulin pump (SAP) therapy. Participants underwent 2 moderate-intensity exercise sessions; 1 in the morning and 1 in the afternoon, separated by a 7 to 14 day wash-out period. Continuous glucose monitoring (CGM) data were collected 24 hours before, during and 36 hours after each session. Thirty-five subjects (mean age 30.31 ± 12.66 years) participated in the study. The rate of hypoglycemia was significantly lower following morning versus afternoon exercise sessions (5.6 vs 10.7 events per patient, incidence rate ratio, 0.52; 95% CI, 0.43-0.63; P < .0001). Most hypoglycemic events occurred 15-24 hours after the session. On days following morning exercise sessions, there were 20% more CGM readings in near-euglycemic range (70-200 mg/dL) than on days prior to morning exercise (P = .003). Morning exercise confers a lower risk of late-onset hypoglycemia than afternoon exercise and improves metabolic control on the subsequent day. © 2015 Diabetes Technology Society.

Sensor-Augmented Insulin Pumps and Hypoglycemia Prevention in Type 1 Diabetes.

PubMed

Steineck, Isabelle; Ranjan, Ajenthen; Nørgaard, Kirsten; Schmidt, Signe

2017-01-01

Hypoglycemia can lead to seizures, unconsciousness, or death. Insulin pump treatment reduces the frequency of severe hypoglycemia compared with multiple daily injections treatment. The addition of a continuous glucose monitor, so-called sensor-augmented pump (SAP) treatment, has the potential to further limit the duration and severity of hypoglycemia as the system can detect and in some systems act on impending and prevailing low blood glucose levels. In this narrative review we summarize the available knowledge on SAPs with and without automated insulin suspension, in relation to hypoglycemia prevention. We present evidence from randomized trials, observational studies, and meta-analyses including nonpregnant individuals with type 1 diabetes mellitus. We also outline concerns regarding SAPs with and without automated insulin suspension. There is evidence that SAP treatment reduces episodes of moderate and severe hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that SAPs both with and without automated suspension reduces the frequency of severe hypoglycemic events compared with insulin pumps without continuous glucose monitoring.

Interventions That Restore Awareness of Hypoglycemia in Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis.

PubMed

Yeoh, Ester; Choudhary, Pratik; Nwokolo, Munachiso; Ayis, Salma; Amiel, Stephanie A

2015-08-01

Impaired awareness of hypoglycemia (IAH) increases the risk of severe hypoglycemia (SH) sixfold and affects 30% of adults with type 1 diabetes (T1D). This systematic review and meta-analysis looks at the educational, technological, and pharmacological interventions aimed at restoring hypoglycemia awareness (HA) in adults with T1D. We searched The Cochrane Library, MEDLINE, Embase, Science Citation Index Expanded, Social Sciences Citation Index, PsycINFO, and CINAHL from inception until 1 October 2014. Included studies described HA status at baseline. Outcome measures were SH rates, change in HA, counterregulatory hormone responses, and glycemic control. Forty-three studies (18 randomized controlled trials, 25 before-and-after studies) met the inclusion criteria, comprising 27 educational, 11 technological, and 5 pharmacological interventions. Educational interventions included structured diabetes education on flexible insulin therapy, including psychotherapeutic and behavioral techniques. These were able to reduce SH and improve glycemic control, with greater benefit from the latter two techniques in improving IAH. Technological interventions (insulin pump therapy, continuous glucose monitoring, and sensor-augmented pump) reduced SH, improved glycemic control, and restored awareness when used in combination with structured education and frequent contact. Pharmacological studies included four insulin studies and one noninsulin study, but with low background SH prevalence rates. This review provides evidence for the effectiveness of a stepped-care approach in the management of patients with IAH, initially with structured diabetes education in flexible insulin therapy, which may incorporate psychotherapeutic and behavioral therapies, progressing to diabetes technology, incorporating sensors and insulin pumps, in those with persisting need. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis.

PubMed

Yeh, Hsin-Chieh; Brown, Todd T; Maruthur, Nisa; Ranasinghe, Padmini; Berger, Zackary; Suh, Yong D; Wilson, Lisa M; Haberl, Elisabeth B; Brick, Jessica; Bass, Eric B; Golden, Sherita Hill

2012-09-04

Patients with diabetes mellitus need information about the effectiveness of innovations in insulin delivery and glucose monitoring. To review how intensive insulin therapy (multiple daily injections [MDI] vs. rapid-acting analogue-based continuous subcutaneous insulin infusion [CSII]) or method of monitoring (self-monitoring of blood glucose [SMBG] vs. real-time continuous glucose monitoring [rt-CGM]) affects outcomes in types 1 and 2 diabetes mellitus. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials through February 2012 without language restrictions. 33 randomized, controlled trials in children or adults that compared CSII with MDI (n=19), rt-CGM with SMBG (n=10), or sensor-augmented insulin pump use with MDI and SMBG (n=4). 2 reviewers independently evaluated studies for eligibility and quality and serially abstracted data. In randomized, controlled trials, MDI and CSII showed similar effects on hemoglobin A1c (HbA1c) levels and severe hypoglycemia in children or adults with type 1 diabetes mellitus and adults with type 2 diabetes mellitus. In adults with type 1 diabetes mellitus, HbA1c levels decreased more with CSII than with MDI, but 1 study heavily influenced these results. Compared with SMBG, rt-CGM achieved a lower HbA1c level (between-group difference of change, 0.26% [95% CI, 0.33% to 0.19%]) without any difference in severe hypoglycemia. Sensor-augmented insulin pump use decreased HbA1c levels more than MDI and SMBG did in persons with type 1 diabetes mellitus (between-group difference of change, 0.68% [CI, 0.81% to 0.54%]). Little evidence was available on other outcomes. Many studies were small, of short duration, and limited to white persons with type 1 diabetes mellitus. Continuous subcutaneous insulin infusion and MDI have similar effects on glycemic control and hypoglycemia, except CSII has a favorable effect on glycemic control in adults with type 1 diabetes mellitus. For glycemic control, rt-CGM is superior to SMBG and sensor-augmented insulin pumps are superior to MDI and SMBG without increasing the risk for hypoglycemia. Agency for Healthcare Research and Quality.

Evaluation of the Adherence to Continuous Glucose Monitoring in the Management of Type 1 Diabetes Patients on Sensor-Augmented Pump Therapy: The SENLOCOR Study.

PubMed

Picard, Sylvie; Hanaire, Hélène; Baillot-Rudoni, Sabine; Gilbert-Bonnemaison, Elisabeth; Not, Didier; Reznik, Yves; Guerci, Bruno

2016-03-01

Continuous glucose monitoring (CGM) and sensor-augmented pump (SAP) therapy improve glucose control provided good adherence. In France, not only diabetologists, nurses, and dieticians but also nurses employed by homecare providers (HCPNs) are together involved in the initiation and/or follow-up of continuous subcutaneous insulin injection (CSII) and SAP training. The SENLOCOR Study is an observational study designed to assess SAP adherence over 6 months (primary objective). Secondary objectives included the impact of SAP on metabolic control and patients' satisfaction. CGM initiation (M0) was performed within 3 months after CSII. CGM adherence, defined by sensor wear >70% of the time, glycated hemoglobin (HbA1c) levels, and satisfaction questionnaires were collected at inclusion and at 3 (M3) and 6 (M6) months. The analysis population was 234 patients, including 27 children. Of the physicians, 88.0% were involved in SAP education for the whole cohort (median time, 45 min), whereas HCPNs were involved in CGM training for 190 patients (81.2%) (median time: at M0, 156 min; at M3, 20 min). Good adherence was obtained in 86.1% (M0-M3) and 68.9% (M3-M6) of the patients. The HbA1c level decreased from 8.16 ± 1.35% (M0) to 7.67 ± 1.01% (M6) in 189 patients (change, -0.48%; 95% confidence interval, -0.64, -0.33). The percentage of patients who experienced severe hypoglycemia decreased from 20.7% (M0) to 13.6% (M3) and 13.3% (M6). Satisfaction scores were high. In patients with type 1 diabetes, a 6-month training on SAP involving a multidisciplinary team, and especially HCPNs, improved metabolic control with a high level of adherence and satisfaction.

Cost-effectiveness of sensor-augmented pump therapy in two different patient populations with type 1 diabetes in Italy.

PubMed

Nicolucci, A; Rossi, M C; D'Ostilio, D; Delbaere, A; de Portu, S; Roze, S

2018-07-01

Sensor-augmented pump therapy (SAP) combines real time continuous glucose monitoring (CGM) with Continuous Subcutaneous Insulin Infusion (CSII) and provides additional benefits beyond those provided by CSII alone. SAP with automated insulin suspension provides early warning of the onset of hyperglycemia and hypoglycemia and has the functionality to suspend insulin delivery if sensor glucose levels are predicted to fall below a predefined threshold. Aim of this study was to assess the cost-effectiveness of SAP with automated insulin suspension versus CSII alone in type 1 diabetes. Cost-effectiveness analysis was performed using the CORE Diabetes Model. The analysis was performed in two different cohorts: one with high baseline HbA1c and one at elevated risk for hypoglycemic events. Clinical input data were sourced from published data. The analysis was conducted from a societal perspective over a lifetime time horizon; costs and clinical outcomes were discounted at 3% per year. In patients with poor glycemic control, SAP with automated insulin suspension resulted in improved discounted quality-adjusted life expectancy (QALY) versus CSII (12.44 QALYs vs. 10.99 QALYs) but higher mean total lifetime costs (€324,991 vs. €259,852), resulting in an incremental cost effectiveness ratio (ICER) of €44,982 per QALY gained. In patients at elevated risk for hypoglycemia, the ICER was €33,692 per QALY gained for SAP versus CSII. In Italy, the use of SAP with automated insulin suspension is associated with projected improvements in outcomes as compared to CSII. These benefits translate into an ICER usually considered as good value for money, particularly in patients at elevated risk of hypoglycemia. Copyright © 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Night glucose control with MD-Logic artificial pancreas in home setting: a single blind, randomized crossover trial-interim analysis.

PubMed

Nimri, Revital; Muller, Ido; Atlas, Eran; Miller, Shahar; Kordonouri, Olga; Bratina, Natasa; Tsioli, Christiana; Stefanija, Magdalena A; Danne, Thomas; Battelino, Tadej; Phillip, Moshe

2014-03-01

Artificial pancreas (AP) systems have shown an improvement in glucose control and a reduced risk of nocturnal hypoglycemia under controlled conditions but remain to be evaluated under daily-life conditions. To assess the feasibility, safety, and efficacy of the MD-Logic AP in controlling nocturnal glucose levels in the patient's home. Two-arm study, each covering four consecutive nights comparing the MD-Logic AP ('closed-loop' arm) with sensor-augmented pump therapy ('control' arm). Fifteen patients (mean age 19 ± 10.4 yr, A1c 7.5 ± 0.5% or 58 ± 5.9 mmol/mol, diabetes duration 9.9 ± 8.2 yr) were randomly assigned either to 'Group A' (first 'closed-loop', then 'control' arm) or to 'Group B' (vice versa). Investigators were masked to treatment intervention. Primary endpoints were the time spent with glucose levels below 70 mg/dL and the percentage of nights in which the mean overnight glucose levels were within 90-140 mg/dL. Endpoint analyses were based on unmodified sensor glucose readings of the four study nights. Time of glucose levels spent below 70 mg/dL was significantly shorter on the closed-loop nights than on control nights, median and interquartile range 3.8 (0, 11.6) and 48.7 (0.6, 67.9) min, respectively; p = 0.0034. The percentage of individual nights in which mean overnight glucose level was within 90-140 mg/dL was 67 (33, 88), and 50 (25, 75), under closed-loop and control nights, respectively, with no statistical difference. Secondary endpoint analyses demonstrated significant improvements in hypoglycemia parameters. No serious adverse events were reported. This interim analysis demonstrates the feasibility, safety, and efficiency of the MD-Logic AP system in home use, and demonstrates an improvement over sensor-augmented pump therapy. (ClinicalTrials.gov identifier NCT01726829). © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Overnight glucose control with an automated, unified safety system in children and adolescents with type 1 diabetes at diabetes camp.

PubMed

Ly, Trang T; Breton, Marc D; Keith-Hynes, Patrick; De Salvo, Daniel; Clinton, Paula; Benassi, Kari; Mize, Benton; Chernavvsky, Daniel; Place, Jéróme; Wilson, Darrell M; Kovatchev, Boris P; Buckingham, Bruce A

2014-08-01

To determine the safety and efficacy of an automated unified safety system (USS) in providing overnight closed-loop (OCL) control in children and adolescents with type 1 diabetes attending diabetes summer camps. The Diabetes Assistant (DIAS) USS used the Dexcom G4 Platinum glucose sensor (Dexcom) and t:slim insulin pump (Tandem Diabetes Care). An initial inpatient study was completed for 12 participants to evaluate safety. For the main camp study, 20 participants with type 1 diabetes were randomized to either OCL or sensor-augmented therapy (control conditions) per night over the course of a 5- to 6-day diabetes camp. Subjects completed 54 OCL nights and 52 control nights. On an intention-to-treat basis, with glucose data analyzed regardless of system status, the median percent time in range, from 70-150 mg/dL, was 62% (29, 87) for OCL nights versus 55% (25, 80) for sensor-augmented pump therapy (P = 0.233). A per-protocol analysis allowed for assessment of algorithm performance. The median percent time in range, from 70-150 mg/dL, was 73% (50, 89) for OCL nights (n = 41) versus 52% (24, 83) for control conditions (n = 39) (P = 0.037). There was less time spent in the hypoglycemic range <50, <60, and <70 mg/dL during OCL compared with the control period (P = 0.019, P = 0.009, and P = 0.023, respectively). The DIAS USS algorithm is effective in improving time spent in range as well as reducing nocturnal hypoglycemia during the overnight period in children and adolescents with type 1 diabetes in a diabetes camp setting. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Cost-effectiveness analysis of sensor-augmented pump therapy with low glucose-suspend in patients with type 1 diabetes mellitus and high risk of hypoglycemia in Spain.

PubMed

Conget, Ignacio; Martín-Vaquero, Pilar; Roze, Stéphane; Elías, Isabel; Pineda, Cristina; Álvarez, María; Delbaere, Alexis; Ampudia-Blasco, Francisco Javier

2018-05-19

To compare the cost-effectiveness of sensor-augmented pump therapy (SAP) [continuous subcutaneous insulin infusion (CSII) plus real-time continuous glucose monitoring (RT-CGM)] with low glucose suspend (MiniMed™ Veo™) and CSII alone in patients with type 1 diabetes mellitus (T1DM) at high risk of hypoglycemia in Spain. The IQVIA CORE Diabetes Model was used to estimate healthcare outcomes as life-years gained (LYGs) and quality-adjusted life years (QALYs), and to project lifetime costs. Information about efficacy, resource utilization, and unit costs (€2016) was taken from published sources and validated by an expert panel. Analyses were performed from both the Spanish National Health System (NHS) perspective and the societal perspective. From the NHS perspective, SAP with low glucose suspend was associated to a €47,665 increase in direct healthcare costs and to increases of 0.19 LYGs and 1.88 QALYs, both discounted, which resulted in an incremental cost-effectiveness ratio (ICER) of €25,394/QALY. From the societal perspective, SAP with low glucose suspend increased total costs (including direct and indirect healthcare costs) by €41,036, with a resultant ICER of €21,862/QALY. Considering the willingness-to-pay threshold of €30,000/QALY in Spain, SAP with low glucose suspend represents a cost-effective option from both the NHS and societal perspectives. Sensitivity analyses confirmed the robustness of the model. From both the Spanish NHS perspective and the societal perspective, SAP with low glucose suspend is a cost-effective option for the treatment of T1DM patients at high risk of hypoglycemia. Copyright © 2018 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

Long-term health economic benefits of sensor-augmented pump therapy vs continuous subcutaneous insulin infusion alone in type 1 diabetes: a U.K. perspective.

PubMed

Roze, Stéphane; Smith-Palmer, Jayne; Valentine, William J; Cook, Mark; Jethwa, Manisha; de Portu, Simona; Pickup, John C

2016-01-01

Continuous subcutaneous insulin infusion (CSII) is an important treatment option for type 1 diabetes patients unable to achieve adequate glycemic control with multiple daily injections (MDI). Combining CSII with continuous glucose monitoring (CGM) in sensor-augmented pump therapy (SAP) with a low glucose-suspend (LGS) feature may further improve glycemic control and reduce the frequency of hypoglycemia. A cost-effectiveness analysis of SAP + LGS vs. CSII plus self-monitoring of blood glucose (SMBG) was performed to determine the health economic benefits of SAP + LGS in type 1 diabetes patients using CSII in the U.K. Cost-effectiveness analysis was performed using the CORE diabetes model. Treatment effects were sourced from the literature, where SAP + LGS was associated with a projected HbA1c reduction of -1.49% vs. -0.62% for CSII, and a reduced frequency of severe hypoglycemia. The time horizon was that of patient lifetimes; future costs and clinical outcomes were discounted at 3.5% and 1.5% per annum, respectively. Projected outcomes showed that SAP + LGS was associated with higher mean quality-adjusted life expectancy (17.9 vs. 14.9 quality-adjusted life years [QALYs], SAP + LGS vs. CSII), and higher life expectancy (23.8 vs. 21.9 years), but higher mean lifetime direct costs (GBP 125,559 vs. GBP 88,991), leading to an incremental cost-effectiveness ratio (ICER) of GBP 12,233 per QALY gained for SAP + LGS vs. CSII. Findings of the base-case analysis remained robust in sensitivity analyses. For UK-based type 1 diabetes patients with poor glycemic control, the use of SAP + LGS is likely to be cost-effective compared with CSII plus SMBG.

Sensor-Augmented Insulin Pumps and Hypoglycemia Prevention in Type 1 Diabetes

PubMed Central

Steineck, Isabelle; Ranjan, Ajenthen; Nørgaard, Kirsten; Schmidt, Signe

2016-01-01

Hypoglycemia can lead to seizures, unconsciousness, or death. Insulin pump treatment reduces the frequency of severe hypoglycemia compared with multiple daily injections treatment. The addition of a continuous glucose monitor, so-called sensor-augmented pump (SAP) treatment, has the potential to further limit the duration and severity of hypoglycemia as the system can detect and in some systems act on impending and prevailing low blood glucose levels. In this narrative review we summarize the available knowledge on SAPs with and without automated insulin suspension, in relation to hypoglycemia prevention. We present evidence from randomized trials, observational studies, and meta-analyses including nonpregnant individuals with type 1 diabetes mellitus. We also outline concerns regarding SAPs with and without automated insulin suspension. There is evidence that SAP treatment reduces episodes of moderate and severe hypoglycemia compared with multiple daily injections plus self-monitoring of blood glucose. There is some evidence that SAPs both with and without automated suspension reduces the frequency of severe hypoglycemic events compared with insulin pumps without continuous glucose monitoring. PMID:28264173

Time and frequency pump-probe multiplexing to enhance the signal response of Brillouin optical time-domain analyzers.

PubMed

Soto, Marcelo A; Ricchiuti, Amelia Lavinia; Zhang, Liang; Barrera, David; Sales, Salvador; Thévenaz, Luc

2014-11-17

A technique to enhance the response and performance of Brillouin distributed fiber sensors is proposed and experimentally validated. The method consists in creating a multi-frequency pump pulse interacting with a matching multi-frequency continuous-wave probe. To avoid nonlinear cross-interaction between spectral lines, the method requires that the distinct pump pulse components and temporal traces reaching the photo-detector are subject to wavelength-selective delaying. This way the total pump and probe powers launched into the fiber can be incrementally boosted beyond the thresholds imposed by nonlinear effects. As a consequence of the multiplied pump-probe Brillouin interactions occurring along the fiber, the sensor response can be enhanced in exact proportion to the number of spectral components. The method is experimentally validated in a 50 km-long distributed optical fiber sensor augmented to 3 pump-probe spectral pairs, demonstrating a signal-to-noise ratio enhancement of 4.8 dB.

“Let the Algorithm Do the Work”: Reduction of Hypoglycemia Using Sensor-Augmented Pump Therapy with Predictive Insulin Suspension (SmartGuard) in Pediatric Type 1 Diabetes Patients

PubMed Central

Kordonouri, Olga; Holder, Martin; Remus, Kerstin; Kieninger-Baum, Dorothee; Wadien, Tanja; Danne, Thomas

2017-01-01

Abstract Background: A sensor-augmented insulin pump (SAP) using the MiniMed® 640G system with SmartGuard™ technology allows an automatic stop of insulin delivery based on prediction of low glucose levels. Since pediatric patients are particularly prone to hypoglycemia, this device may offer additional protection beyond conventional sensor-augmented therapy. Methods: This prospective, pediatric multicenter user evaluation assessed 6 weeks of SAP with SmartGuard (threshold setting for hypoglycemia: 70 mg/dL) compared to a preceding period of 2 weeks with SAP only. The primary outcome was the potential reduction in the frequency of hypoglycemic episodes and hypoglycemic intensity (area under the curve [AUC] and time <70 mg/dL). Results: The study included 24 patients with at least 3 months of insulin pump use (average age: 11.6 ± 5.1 years, 15 female, average type 1 diabetes duration: 7.5 ± 4.2 years, mean ± SD) who had on average 3.2 ± 1.0 predictive suspensions/patient/day. The mean sensor glucose minimum during suspension was 78 ± 6 mg/dL and the average suspension time was 155 ± 47 min/day. Use of SmartGuard in patients treated as per the protocol (n = 18) reduced the number of instances in which the glucose level was <70 mg/dL (1.02 ± 0.52 to 0.72 ± 0.36; P = 0.027), as well as AUC <70 mg/dL (0.76 ± 0.73 to 0.38 ± 0.24; P = 0.027) and the time/day the level fell below 70 mg/dL (73 ± 56 to 31 ± 22 min). The reduction of hypoglycemia was not associated with a significant change in mean glucose concentration (171 ± 26 to 180 ± 19 mg/dL, P = 0.111) and HbA1c (7.5% ± 0.5% to 7.6% ± 0.7%, (P = 0.329). Manual resumption of insulin delivery followed by carbohydrate intake resulted in significantly higher glucose levels 1 h after suspension compared to SmartGuard suspensions with automatic resume (190.8 ± 26.5 vs. 138.7 ± 10.3 mg/dL; P < 0.001). Conclusions: SmartGuard technology significantly reduced the risk for hypoglycemia in pediatric type 1 diabetes patients without increasing HbA1c. Patients must be educated that when using combining predictive low-glucose insulin suspension technology, extra carbohydrate intake in response to an alarm combined with manual resumption is likely to cause rebound hyperglycemia. The best results were achieved when the user did not interfere with pump operation. PMID:28099035

"Let the Algorithm Do the Work": Reduction of Hypoglycemia Using Sensor-Augmented Pump Therapy with Predictive Insulin Suspension (SmartGuard) in Pediatric Type 1 Diabetes Patients.

PubMed

Biester, Torben; Kordonouri, Olga; Holder, Martin; Remus, Kerstin; Kieninger-Baum, Dorothee; Wadien, Tanja; Danne, Thomas

2017-03-01

A sensor-augmented insulin pump (SAP) using the MiniMed ® 640G system with SmartGuard™ technology allows an automatic stop of insulin delivery based on prediction of low glucose levels. Since pediatric patients are particularly prone to hypoglycemia, this device may offer additional protection beyond conventional sensor-augmented therapy. This prospective, pediatric multicenter user evaluation assessed 6 weeks of SAP with SmartGuard (threshold setting for hypoglycemia: 70 mg/dL) compared to a preceding period of 2 weeks with SAP only. The primary outcome was the potential reduction in the frequency of hypoglycemic episodes and hypoglycemic intensity (area under the curve [AUC] and time <70 mg/dL). The study included 24 patients with at least 3 months of insulin pump use (average age: 11.6 ± 5.1 years, 15 female, average type 1 diabetes duration: 7.5 ± 4.2 years, mean ± SD) who had on average 3.2 ± 1.0 predictive suspensions/patient/day. The mean sensor glucose minimum during suspension was 78 ± 6 mg/dL and the average suspension time was 155 ± 47 min/day. Use of SmartGuard in patients treated as per the protocol (n = 18) reduced the number of instances in which the glucose level was <70 mg/dL (1.02 ± 0.52 to 0.72 ± 0.36; P = 0.027), as well as AUC <70 mg/dL (0.76 ± 0.73 to 0.38 ± 0.24; P = 0.027) and the time/day the level fell below 70 mg/dL (73 ± 56 to 31 ± 22 min). The reduction of hypoglycemia was not associated with a significant change in mean glucose concentration (171 ± 26 to 180 ± 19 mg/dL, P = 0.111) and HbA1c (7.5% ± 0.5% to 7.6% ± 0.7%, (P = 0.329). Manual resumption of insulin delivery followed by carbohydrate intake resulted in significantly higher glucose levels 1 h after suspension compared to SmartGuard suspensions with automatic resume (190.8 ± 26.5 vs. 138.7 ± 10.3 mg/dL; P < 0.001). SmartGuard technology significantly reduced the risk for hypoglycemia in pediatric type 1 diabetes patients without increasing HbA1c. Patients must be educated that when using combining predictive low-glucose insulin suspension technology, extra carbohydrate intake in response to an alarm combined with manual resumption is likely to cause rebound hyperglycemia. The best results were achieved when the user did not interfere with pump operation.

CONTINUOUS GLUCOSE MONITORING: A CONSENSUS CONFERENCE OF THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY.

PubMed

Fonseca, Vivian A; Grunberger, George; Anhalt, Henry; Bailey, Timothy S; Blevins, Thomas; Garg, Satish K; Handelsman, Yehuda; Hirsch, Irl B; Orzeck, Eric A; Roberts, Victor Lawrence; Tamborlane, William

2016-08-01

Barriers to continuous glucose monitoring (CGM) use continue to hamper adoption of this valuable technology for the management of diabetes. The American Association of Clinical Endocrinologists and the American College of Endocrinology convened a public consensus conference February 20, 2016, to review available CGM data and propose strategies for expanding CGM access. Conference participants agreed that evidence supports the benefits of CGM in type 1 diabetes and that these benefits are likely to apply whenever intensive insulin therapy is used, regardless of diabetes type. CGM is likely to reduce healthcare resource utilization for acute and chronic complications, although real-world analyses are needed to confirm potential cost savings and quality of life improvements. Ongoing technological advances have improved CGM accuracy and usability, but more innovations in human factors, data delivery, reporting, and interpretation are needed to foster expanded use. The development of a standardized data report using similar metrics across all devices would facilitate clinician and patient understanding and utilization of CGM. Expanded CGM coverage by government and private payers is an urgent need. CGM improves glycemic control, reduces hypoglycemia, and may reduce overall costs of diabetes management. Expanding CGM coverage and utilization is likely to improve the health outcomes of people with diabetes. A1C = glycated hemoglobin AACE = American Association of Clinical Endocrinologists ACE = American College of Endocrinology ASPIRE = Automation to Simulate Pancreatic Insulin Response CGM = continuous glucose monitoring HRQOL = health-related quality of life ICER = incremental cost-effectiveness ratio JDRF = Juvenile Diabetes Research Foundation MARD = mean absolute relative difference MDI = multiple daily injections QALY = quality-adjusted life years RCT = randomized, controlled trial SAP = sensor-augmented pump SMBG = self-monitoring of blood glucose STAR = Sensor-Augmented Pump Therapy for A1C Reduction T1D = type 1 diabetes T2D = type 2 diabetes.

New technologies in the treatment of type 1 diabetes.

PubMed

Schmidt, Signe

2013-11-01

Type 1 diabetes is a chronic condition characterized by insufficient production of insulin, a hormone needed for proper control of blood glucose levels. People with type 1 diabetes must monitor their blood glucose throughout the day using a glucose meter or a continuous glucose monitor, calculate how much insulin is needed to maintain normal blood glucose levels, and administer the insulin dose by pen injection or insulin pump infusion into the subcutaneous tissue. In recent years, several new technologies for the treatment of type 1 diabetes have been developed. This PhD thesis covers two studies of the effects of commercially available technologies--sensor-augmented pump therapy and automated insulin bolus calculators--when used in clinical practice. Both studies demonstrated that these technologies have the potential to improve diabetes care. In addition, two in-clinic studies related to emerging technologies--closed-loop glucose control and virtual simulation environments--are included in the thesis. The results of these experiments provided proof of concept and will serve as a basis for further research in these fields.

Hypoglycemia Reduction and Changes in Hemoglobin A1c in the ASPIRE In-Home Study.

PubMed

Weiss, Ram; Garg, Satish K; Bode, Bruce W; Bailey, Timothy S; Ahmann, Andrew J; Schultz, Kenneth A; Welsh, John B; Shin, John J

2015-08-01

ASPIRE In-Home randomized 247 subjects with type 1 diabetes to sensor-augmented pump therapy with or without the Threshold Suspend (TS) feature, which interrupts insulin delivery at a preset sensor glucose value. We studied the effects of TS on nocturnal hypoglycemia (NH) in relation to baseline hemoglobin A1c (A1C) and change in A1C during the study. NH event rates and mean area under curve (AUC) of NH events were evaluated at different levels of baseline A1C (<7%, 7-8%, and >8%) and at different levels of changes in A1C (less than -0.3% [decreased], -0.3% to 0.3% [stable], and >0.3% [increased]), in the TS Group compared with the Control Group (sensor-augmented pump only). In the TS Group, 27.9% of the NH events were accompanied by a confirmatory blood glucose value, compared with 39.3% in the Control Group. Among subjects with baseline A1C levels of <7% or 7-8%, those in the TS Group had significantly lower NH event rates than those in the Control Group (P=0.001 and P=0.004, respectively). Among subjects with decreased or stable A1C levels, those in the TS Group had significantly lower NH event rates, and the events had lower AUCs (P≤0.001 for each). Among subjects with increased A1C levels, those in the TS Group had NH events with significantly lower AUCs (P<0.001). Use of the TS feature was associated with decreases in the rate and severity (as measured by AUC) of NH events in many subjects, including those with low baseline A1C levels and those whose A1C values decreased during the study period. Use of the TS feature can help protect against hypoglycemia in those wishing to intensify diabetes management to achieve target glucose levels.

Hypoglycemia Reduction and Changes in Hemoglobin A1c in the ASPIRE In-Home Study

PubMed Central

Weiss, Ram; Garg, Satish K.; Bode, Bruce W.; Bailey, Timothy S.; Ahmann, Andrew J.; Schultz, Kenneth A.; Welsh, John B.

2015-01-01

Abstract Background: ASPIRE In-Home randomized 247 subjects with type 1 diabetes to sensor-augmented pump therapy with or without the Threshold Suspend (TS) feature, which interrupts insulin delivery at a preset sensor glucose value. We studied the effects of TS on nocturnal hypoglycemia (NH) in relation to baseline hemoglobin A1c (A1C) and change in A1C during the study. Materials and Methods: NH event rates and mean area under curve (AUC) of NH events were evaluated at different levels of baseline A1C (<7%, 7–8%, and >8%) and at different levels of changes in A1C (less than −0.3% [decreased], −0.3% to 0.3% [stable], and >0.3% [increased]), in the TS Group compared with the Control Group (sensor-augmented pump only). Results: In the TS Group, 27.9% of the NH events were accompanied by a confirmatory blood glucose value, compared with 39.3% in the Control Group. Among subjects with baseline A1C levels of <7% or 7–8%, those in the TS Group had significantly lower NH event rates than those in the Control Group (P=0.001 and P=0.004, respectively). Among subjects with decreased or stable A1C levels, those in the TS Group had significantly lower NH event rates, and the events had lower AUCs (P≤0.001 for each). Among subjects with increased A1C levels, those in the TS Group had NH events with significantly lower AUCs (P<0.001). Conclusions: Use of the TS feature was associated with decreases in the rate and severity (as measured by AUC) of NH events in many subjects, including those with low baseline A1C levels and those whose A1C values decreased during the study period. Use of the TS feature can help protect against hypoglycemia in those wishing to intensify diabetes management to achieve target glucose levels. PMID:26237308

Unique Challenges of Type 1 Diabetes in the Preschool Population.

PubMed

Coshway, Loyal K; Hoffman, Robert P

2017-01-01

Extremely young children aged ≤6 years old represent a unique population among patients with type 1 diabetes in terms of glycemic variation, diabetes management and complications. We describe distinct features of diabetes care and outcomes in preschool age children. We searched PubMed, Google Scholar, and authors' bibliographies in order to extract articles specific to type 1 diabetes in preschool age children. The preschool age group is beset by many challenges to diabetes care, including more frequent hypo- and hyperglycemia, hypoglycemia unawareness, decreased residual beta cell function, and greater long-term neurocognitive effects from severe hypoglycemia and chronic hyperglycemia. Randomized controlled trials show that equally good metabolic control can be obtained with multiple daily injections or an insulin pump. Several non-randomized trials, including an 8 year longitudinal study, show lower hemoglobin A1C and decreased hypoglycemia on insulin pumps. Sensor augmented pump therapy resulted in superior A1C as long as sensors were used regularly. In contrast to adults, continuous glucose monitoring has little to no impact on A1C, although parents appreciate the improved monitoring for hypoglycemia. Children with onset of diabetes prior to age 5 are at risk for younger onset of microalbuminuria, however do not develop earlier onset retinopathy than children diagnosed after 5 years. Both severe hypoglycemia and chronic hyperglycemia have negative impact on neurocognition. Special knowledge about this young population is helpful for practitioners and parents. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Prevention of Insulin-Induced Hypoglycemia in Type 1 Diabetes with Predictive Low Glucose Management System.

PubMed

Abraham, Mary B; de Bock, Martin; Paramalingam, Nirubasini; O'Grady, Michael J; Ly, Trang T; George, Carly; Roy, Anirban; Spital, Glenn; Karula, Sophy; Heels, Kristine; Gebert, Rebecca; Fairchild, Jan M; King, Bruce R; Ambler, Geoffrey R; Cameron, Fergus; Davis, Elizabeth A; Jones, Timothy W

2016-07-01

Sensor-augmented pump therapy (SAPT) with algorithms to predict impending low blood glucose and suspend insulin delivery has the potential to reduce hypoglycemia exposure. The aim of this study was to determine whether predictive low glucose management (PLGM) system is effective in preventing insulin-induced hypoglycemia in controlled experiments. Two protocols were used to induce hypoglycemia in an in-clinic environment. (A) Insulin bolus: Insulin was administered as a manual bolus through the pump. (B) Increased basal insulin: Hypoglycemia was induced by increasing basal rates overnight to 180%. For both protocols, participants were randomized and studied on 2 separate days; a control day with SAPT alone and an intervention day with SAPT and PLGM activated. The predictive algorithm was programmed to suspend basal insulin infusion when sensor glucose was predicted to be <80 mg/dL in 30 min. The primary outcome was the requirement for hypoglycemia treatment (symptomatic hypoglycemia or plasma glucose <50 mg/dL) and was compared in both control and intervention arms. With insulin bolus, 24/28 participants required hypoglycemia treatment with SAPT alone compared to 5/28 participants when PLGM was activated (P ≤ 0.001). With increased basal rates, all the eight SAPT-alone participants required treatment for hypoglycemia compared to only one with SAPT and PLGM. There was no post pump-suspend hyperglycemia with insulin bolus (P = 0.4) or increased basal rates (P = 0.69) in participants with 2-h pump suspension on intervention days. SAPT with PLGM reduced the requirement for hypoglycemia treatment following insulin-induced hypoglycemia in an in-clinic setting.

Predictors of Hypoglycemia in the ASPIRE In-Home Study and Effects of Automatic Suspension of Insulin Delivery.

PubMed

Weiss, Ram; Garg, Satish K; Bergenstal, Richard M; Klonoff, David C; Bode, Bruce W; Bailey, Timothy S; Thrasher, James; Schwartz, Frank; Welsh, John B; Kaufman, Francine R

2015-05-18

Hypoglycemia varies between patients with type 1 diabetes and is the main obstacle to therapy intensification. We investigated known and potential risk factors for hypoglycemia in subjects with type 1 diabetes. In the ASPIRE In-Home study (NCT01497938), a randomized trial of the threshold suspend (TS) feature of sensor-augmented insulin pump (SAP) therapy, subjects' propensity to nocturnal hypoglycemia (NH) was established in a 2-week run-in phase and assessed in a 3-month study phase via continuous glucose monitoring. Categorical variables were tested for association with NH rates in both phases. Elevated rates of NH were significantly associated with baseline A1C ≤7%, with bolus insulin deliveries unassisted by the bolus estimation calculator, and with assignment to the control group during the study phase. Routine use of the TS feature and the bolus estimation calculator are strategies that may reduce the risk of NH. © 2015 Diabetes Technology Society.

Day and Night Closed-Loop Control Using the Integrated Medtronic Hybrid Closed-Loop System in Type 1 Diabetes at Diabetes Camp.

PubMed

Ly, Trang T; Roy, Anirban; Grosman, Benyamin; Shin, John; Campbell, Alex; Monirabbasi, Salman; Liang, Bradley; von Eyben, Rie; Shanmugham, Satya; Clinton, Paula; Buckingham, Bruce A

2015-07-01

To evaluate the feasibility and efficacy of a fully integrated hybrid closed-loop (HCL) system (Medtronic MiniMed Inc., Northridge, CA), in day and night closed-loop control in subjects with type 1 diabetes, both in an inpatient setting and during 6 days at diabetes camp. The Medtronic MiniMed HCL system consists of a fourth generation (4S) glucose sensor, a sensor transmitter, and an insulin pump using a modified proportional-integral-derivative (PID) insulin feedback algorithm with safety constraints. Eight subjects were studied over 48 h in an inpatient setting. This was followed by a study of 21 subjects for 6 days at diabetes camp, randomized to either the closed-loop control group using the HCL system or to the group using the Medtronic MiniMed 530G with threshold suspend (control group). The overall mean sensor glucose percent time in range 70-180 mg/dL was similar between the groups (73.1% vs. 69.9%, control vs. HCL, respectively) (P = 0.580). Meter glucose values between 70 and 180 mg/dL were also similar between the groups (73.6% vs. 63.2%, control vs. HCL, respectively) (P = 0.086). The mean absolute relative difference of the 4S sensor was 10.8 ± 10.2%, when compared with plasma glucose values in the inpatient setting, and 12.6 ± 11.0% compared with capillary Bayer CONTOUR NEXT LINK glucose meter values during 6 days at camp. In the first clinical study of this fully integrated system using an investigational PID algorithm, the system did not demonstrate improved glucose control compared with sensor-augmented pump therapy alone. The system demonstrated good connectivity and improved sensor performance. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Numerical and clinical precision of continuous glucose monitoring in Colombian patients treated with insulin infusion pump with automated suspension in hypoglycemia.

PubMed

Gómez, Ana M; Marín Sánchez, Alejandro; Muñoz, Oscar M; Colón Peña, Christian Alejandro

2015-12-01

Insulin pump therapy associated with continuous glucose monitoring has shown a positive clinical impact on diabetes control and reduction of hypoglycemia episodes. There are descriptions of the performance of this device in other populations, but its precision and accuracy in Colombia and Latin America are unknown, especially in the routine outpatient setting. Data from 33 type 1 and type 2 diabetes patients with sensor-augmented pump therapy with threshold suspend automation, MiniMed Paradigm® Veo™ (Medtronic, Northridge, California), managed at Hospital Universitario San Ignacio (Bogotá, Colombia) and receiving outpatient treatment, were analyzed. Simultaneous data from continuous glucose monitoring and capillary blood glucose were compared, and their precision and accuracy were calculating with different methods, including Clarke error grid. Analyses included 2,262 continuous glucose monitoring -reference paired glucose values. A mean absolute relative difference of 20.1% was found for all measurements, with a value higher than 23% for glucose levels ≤75mg/dL. Global compliance with the ISO criteria was 64.9%. It was higher for values >75mg/dl (68.3%, 1,308 of 1,916 readings), than for those ≤ 75mg/dl (49.4%, 171 of 346 readings). Clinical accuracy, as assessed by the Clarke error grid, showed that 91.77% of data were within the A and B zones (75.6% in hypoglycemia). A good numerical accuracy was found for continuous glucose monitoring in normo and hyperglycemia situations, with low precision in hypoglycemia. The clinical accuracy of the device was adequate, with no significant safety concerns for patients. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Development of a real-time and quantitative thrombus sensor for an extracorporeal centrifugal blood pump by near-infrared light

PubMed Central

Sakota, Daisuke; Fujiwara, Tatsuki; Ohuchi, Katsuhiro; Kuwana, Katsuyuki; Yamazaki, Hiroyuki; Kosaka, Ryo; Nishida, Masahiro; Mizuno, Tomohiro; Arai, Hirokuni; Maruyama, Osamu

2017-01-01

We developed an optical thrombus sensor for a monopivot extracorporeal centrifugal blood pump. In this study, we investigated its quantitative performance for thrombus detection in acute animal experiments of left ventricular assist using the pump on pathogen-free pigs. Optical fibers were set in the driver unit of the pump. The incident light at the near-infrared wavelength of 810 nm was aimed at the pivot bearing, and the resulting scattered light was guided to the optical fibers. The detected signal was analyzed to obtain the thrombus formation level. As a result, real-time and quantitative monitoring of the thrombus surface area on the pivot bearing was achieved with an accuracy of 3.6 ± 2.3 mm2. In addition, the sensing method using the near-infrared light was not influenced by changes in the oxygen saturation and the hematocrit. It is expected that the developed sensor will be useful for optimal anticoagulation management for long-term extracorporeal circulation therapies. PMID:29359096

Development of a real-time and quantitative thrombus sensor for an extracorporeal centrifugal blood pump by near-infrared light.

PubMed

Sakota, Daisuke; Fujiwara, Tatsuki; Ohuchi, Katsuhiro; Kuwana, Katsuyuki; Yamazaki, Hiroyuki; Kosaka, Ryo; Nishida, Masahiro; Mizuno, Tomohiro; Arai, Hirokuni; Maruyama, Osamu

2018-01-01

We developed an optical thrombus sensor for a monopivot extracorporeal centrifugal blood pump. In this study, we investigated its quantitative performance for thrombus detection in acute animal experiments of left ventricular assist using the pump on pathogen-free pigs. Optical fibers were set in the driver unit of the pump. The incident light at the near-infrared wavelength of 810 nm was aimed at the pivot bearing, and the resulting scattered light was guided to the optical fibers. The detected signal was analyzed to obtain the thrombus formation level. As a result, real-time and quantitative monitoring of the thrombus surface area on the pivot bearing was achieved with an accuracy of 3.6 ± 2.3 mm 2 . In addition, the sensing method using the near-infrared light was not influenced by changes in the oxygen saturation and the hematocrit. It is expected that the developed sensor will be useful for optimal anticoagulation management for long-term extracorporeal circulation therapies.

Automated hybrid closed-loop control with a proportional-integral-derivative based system in adolescents and adults with type 1 diabetes: individualizing settings for optimal performance.

PubMed

Ly, Trang T; Weinzimer, Stuart A; Maahs, David M; Sherr, Jennifer L; Roy, Anirban; Grosman, Benyamin; Cantwell, Martin; Kurtz, Natalie; Carria, Lori; Messer, Laurel; von Eyben, Rie; Buckingham, Bruce A

2017-08-01

Automated insulin delivery systems, utilizing a control algorithm to dose insulin based upon subcutaneous continuous glucose sensor values and insulin pump therapy, will soon be available for commercial use. The objective of this study was to determine the preliminary safety and efficacy of initialization parameters with the Medtronic hybrid closed-loop controller by comparing percentage of time in range, 70-180 mg/dL (3.9-10 mmol/L), mean glucose values, as well as percentage of time above and below target range between sensor-augmented pump therapy and hybrid closed-loop, in adults and adolescents with type 1 diabetes. We studied an initial cohort of 9 adults followed by a second cohort of 15 adolescents, using the Medtronic hybrid closed-loop system with the proportional-integral-derivative with insulin feed-back (PID-IFB) algorithm. Hybrid closed-loop was tested in supervised hotel-based studies over 4-5 days. The overall mean percentage of time in range (70-180 mg/dL, 3.9-10 mmol/L) during hybrid closed-loop was 71.8% in the adult cohort and 69.8% in the adolescent cohort. The overall percentage of time spent under 70 mg/dL (3.9 mmol/L) was 2.0% in the adult cohort and 2.5% in the adolescent cohort. Mean glucose values were 152 mg/dL (8.4 mmol/L) in the adult cohort and 153 mg/dL (8.5 mmol/L) in the adolescent cohort. Closed-loop control using the Medtronic hybrid closed-loop system enables adaptive, real-time basal rate modulation. Initializing hybrid closed-loop in clinical practice will involve individualizing initiation parameters to optimize overall glucose control. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hypoglycemia Prevention and User Acceptance of an Insulin Pump System with Predictive Low Glucose Management.

PubMed

Choudhary, Pratik; Olsen, Birthe S; Conget, Ignacio; Welsh, John B; Vorrink, Linda; Shin, John J

2016-05-01

The MiniMed 640G sensor-augmented insulin pump system (Medtronic, Inc., Northridge, CA) can automatically suspend insulin delivery in advance of predicted hypoglycemia and restart it upon recovery. The aims of this analysis were to determine the rate at which predicted hypoglycemia was avoided with this strategy, as well as to assess user acceptance of the system and its insulin management features. Forty subjects with type 1 diabetes used the system for 4 weeks. We retrospectively evaluated performance of the system, using downloaded pump and sensor data, and evaluated user acceptance via questionnaires. There were 2,322 suspend before low events (2.1 per subject-day). The mean (± SD) duration of pump suspension events was 56.4 ± 9.6 min, and the mean subsequent sensor glucose (SG) nadir was 71.8 ± 5.2 mg/dL. SG values following 1,930 (83.1%) of the predictive suspensions did not reach the preset low limit. Nadir SG values of ≤50 and ≤60 mg/dL were seen in 207 (8.9%) and 356 (15.3%) of the predictive suspensions, respectively. Blood glucose (BG) and SG values before and during the study were comparable (P > 0.05). The mean absolute relative difference between paired SG and BG values was 10.9 ± 13.8%. Subjects felt confident using the system, agreed that it helped protect them from hypoglycemia, and wished to continue using it. Automatic insulin pump suspension as implemented in the MiniMed 640G system can help patients avoid hypoglycemia, without significantly increasing hyperglycemia.

Symptom overlap between laryngopharyngeal reflux and glottic insufficiency in vocal fold atrophy patients.

PubMed

Patel, Anju K; Mildenhall, Nicholas R; Kim, William; Carroll, Thomas L

2014-04-01

To determine in true vocal fold (TVF) atrophy patients if symptoms of throat clearing and mucus sensation, attributed to laryngopharyngeal reflux (LPR), are due to glottic insufficiency. Is the TVF atrophy population being prescribed proton pump inhibitors unnecessarily? A retrospective review of patients with TVF atrophy but no other underlying laryngeal pathology seen at a tertiary voice center from July 2009 to May 2012 was conducted. Patient demographics, symptoms, LPR diagnosis, interventions, and pre-intervention and post-intervention Voice Handicap Index-10 (VHI) and Reflux Symptom Index (RSI) scores were recorded. Twenty-six patients met inclusion criteria, and 85% were treated for LPR. Throat clearing and mucus sensation (85%), dysphonia (54%), and globus sensation (46%) were recorded. Interventions included LPR medical management (65%), vocal fold augmentation (23%), and voice therapy (12%). Reflux Symptom Index scores improved in all groups. Voice Handicap Index-10 and RSI scores normalized in patients treated with augmentation. Globus was never present in patients who received augmentation. Throat clearing and mucus sensation may be due to underlying glottic insufficiency and changes of the aging larynx rather than LPR. High VHI and RSI scores normalized with TVF augmentation. Further work is needed to evaluate symptom presentation and risk versus benefit of treatment options, especially if it avoids unnecessary proton pump inhibitor trials.

Safety and efficacy of the predictive low glucose management system in the prevention of hypoglycaemia: protocol for randomised controlled home trial to evaluate the Suspend before low function

PubMed Central

Abraham, M B; Nicholas, J A; Ly, T T; Roby, H C; Paramalingam, N; Fairchild, J; King, B R; Ambler, G R; Cameron, F; Davis, E A; Jones, T W

2016-01-01

Introduction Innovations with sensor-augmented pump therapy (SAPT) to reduce hypoglycaemia in patients with type 1 diabetes are an ongoing area of research. The predictive low glucose management (PLGM) system incorporates continuous glucose sensor data into an algorithm and suspends basal insulin before the occurrence of hypoglycaemia. The system was evaluated in in-clinic studies, and has informed the parameters of a larger home trial to study its efficacy and safety in real life. Methods and analysis The aim of this report is to describe the study design and outcome measures for the trial. This is a 6-month, multicentre, randomised controlled home trial to test the PLGM system in children and adolescents with type 1 diabetes. The system is available in the Medtronic MiniMed 640G pump as the ‘Suspend before low’ feature. Following a run-in period, participants are randomised to either the control arm with SAPT alone or the intervention arm with SAPT and Suspend before low. The primary aim of this study is to evaluate the time spent hypoglycaemic (sensor glucose <3.5 mmol/L) with and without the system. The secondary aims are to determine the number of hypoglycaemic events, the time spent hyperglycaemic, and to evaluate safety with ketosis and changes in glycated haemoglobin. The study also aims to assess the changes in counter-regulatory hormone responses to hypoglycaemia evaluated by a hyperinsulinaemic hypoglycaemic clamp in a subgroup of patients with impaired awareness. Validated questionnaires are used to measure the fear of hypoglycaemia and the impact on the quality of life to assess burden of the disease. Ethics and dissemination Ethics committee permissions were gained from respective Institutional Review boards. The findings of the study will provide high quality evidence of the ability of the system in the prevention of hypoglycaemia in real life. Trial registration number ACTRN12614000510640, Pre-results. PMID:27084290

Reflection type skin friction meter

NASA Technical Reports Server (NTRS)

Bandyopadhyay, Promode R. (Inventor); Weinstein, Leonard M. (Inventor)

1993-01-01

A housing block is provided having an upper surface conforming to the test surface of a model or aircraft. An oil film is supplied upstream of a transparent wedge window located in this upper surface by an oil pump system located external to the housing block. A light source located within the housing block supplies a light beam which passes through this transparent window and is reflected back through the transparent window by the upper surface of the oil film to a photo-sensitive position sensor located within the housing. This position sensor allows the slope history of the oil film caused by and aerodynamic flow to be determined. The skin friction is determined from this slope history. Internally located mirrors augment and sensitize the reflected beam as necessary before reaching the position sensor. In addition, a filter may be provided before this sensor to filter the beam.

Integrating Predictive Modeling with Control System Design for Managed Aquifer Recharge and Recovery Applications

NASA Astrophysics Data System (ADS)

Drumheller, Z. W.; Regnery, J.; Lee, J. H.; Illangasekare, T. H.; Kitanidis, P. K.; Smits, K. M.

2014-12-01

Aquifers around the world show troubling signs of irreversible depletion and seawater intrusion as climate change, population growth, and urbanization led to reduced natural recharge rates and overuse. Scientists and engineers have begun to re-investigate the technology of managed aquifer recharge and recovery (MAR) as a means to increase the reliability of the diminishing and increasingly variable groundwater supply. MAR systems offer the possibility of naturally increasing groundwater storage while improving the quality of impaired water used for recharge. Unfortunately, MAR systems remain wrought with operational challenges related to the quality and quantity of recharged and recovered water stemming from a lack of data-driven, real-time control. Our project seeks to ease the operational challenges of MAR facilities through the implementation of active sensor networks, adaptively calibrated flow and transport models, and simulation-based meta-heuristic control optimization methods. The developed system works by continually collecting hydraulic and water quality data from a sensor network embedded within the aquifer. The data is fed into an inversion algorithm, which calibrates the parameters and initial conditions of a predictive flow and transport model. The calibrated model is passed to a meta-heuristic control optimization algorithm (e.g. genetic algorithm) to execute the simulations and determine the best course of action, i.e., the optimal pumping policy for current aquifer conditions. The optimal pumping policy is manually or autonomously applied. During operation, sensor data are used to assess the accuracy of the optimal prediction and augment the pumping strategy as needed. At laboratory-scale, a small (18"H x 46"L) and an intermediate (6'H x 16'L) two-dimensional synthetic aquifer were constructed and outfitted with sensor networks. Data collection and model inversion components were developed and sensor data were validated by analytical measurements.

Effectiveness of a Predictive Algorithm in the Prevention of Exercise-Induced Hypoglycemia in Type 1 Diabetes.

PubMed

Abraham, Mary B; Davey, Raymond; O'Grady, Michael J; Ly, Trang T; Paramalingam, Nirubasini; Fournier, Paul A; Roy, Anirban; Grosman, Benyamin; Kurtz, Natalie; Fairchild, Janice M; King, Bruce R; Ambler, Geoffrey R; Cameron, Fergus; Jones, Timothy W; Davis, Elizabeth A

2016-09-01

Sensor-augmented pump therapy (SAPT) with a predictive algorithm to suspend insulin delivery has the potential to reduce hypoglycemia, a known obstacle in improving physical activity in patients with type 1 diabetes. The predictive low glucose management (PLGM) system employs a predictive algorithm that suspends basal insulin when hypoglycemia is predicted. The aim of this study was to determine the efficacy of this algorithm in the prevention of exercise-induced hypoglycemia under in-clinic conditions. This was a randomized, controlled cross-over study in which 25 participants performed 2 consecutive sessions of 30 min of moderate-intensity exercise while on basal continuous subcutaneous insulin infusion on 2 study days: a control day with SAPT alone and an intervention day with SAPT and PLGM. The predictive algorithm suspended basal insulin when sensor glucose was predicted to be below the preset hypoglycemic threshold in 30 min. We tested preset hypoglycemic thresholds of 70 and 80 mg/dL. The primary outcome was the requirement for hypoglycemia treatment (symptomatic hypoglycemia with plasma glucose <63 mg/dL or plasma glucose <50 mg/dL) and was compared in both control and intervention arms. Results were analyzed in 19 participants. In the intervention arm with both thresholds, only 6 participants (32%) required treatment for hypoglycemia compared with 17 participants (89%) in the control arm (P = 0.003). In participants with a 2-h pump suspension on intervention days, the plasma glucose was 84 ± 12 and 99 ± 24 mg/dL at thresholds of 70 and 80 mg/dL, respectively. SAPT with PLGM reduced the need for hypoglycemia treatment after moderate-intensity exercise in an in-clinic setting.

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

PubMed

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

2017-06-01

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

The effects of inpatient hybrid closed-loop therapy initiated within 1 week of type 1 diabetes diagnosis.

PubMed

Buckingham, Bruce A; Beck, Roy W; Ruedy, Katrina J; Cheng, Peiyao; Kollman, Craig; Weinzimer, Stuart A; DiMeglio, Linda A; Bremer, Andrew A; Slover, Robert; Cantwell, Martin

2013-05-01

This article describes our experience with inpatient hybrid closed-loop control (HCLC) initiated shortly after the diagnosis of type 1 diabetes in a randomized trial designed to assess the effectiveness of inpatient HCLC followed by outpatient sensor-augmented pump (SAP) therapy on the preservation of β-cell function. Forty-eight individuals with newly diagnosed type 1 diabetes and positive pancreatic autoantibodies (7.8-37.7 years old) received inpatient HCLC therapy for up to 93 h, initiated within 7 days of diagnosis. On initiation of HCLC, mean glucose concentration was 240±100 mg/dL. During the first day of HCLC, median of the participant's mean glucose concentrations fell rapidly to 146 mg/dL, a level of control that was sustained on Days 2 and 3 (138 mg/dL and 139 mg/dL, respectively). By Day 3, the median percentage of glucose values >250 and <60 mg/dL was <1%. During the first 2 weeks of SAP treatment at home, the median participant mean glucose level was 126 mg/dL (interquartile range, 117, 137 mg/dL), and the median percentage of values between 71 and 180 mg/dL was 85% (interquartile range, 80%, 90%). Inpatient HCLC followed by outpatient SAP therapy can provide a safe and effective means to rapidly reverse glucose toxicity and establish near-normal glycemic control in patients with newly diagnosed type 1 diabetes.

Quality of life and technology: impact on children and families with diabetes.

PubMed

Hirose, Masakazu; Beverly, Elizabeth A; Weinger, Katie

2012-12-01

Ensuring quality of life (QOL) while maintaining glycemic control within targets is an important challenge in type 1 and type 2 diabetes treatment. For children with diabetes, QOL includes enjoying meals, feeling safe in school, and perceiving positive, supportive relationships with parents, siblings, and friends. Yet many treatment-related and psychosocial barriers can interfere with a child's QOL and their ability to manage diabetes effectively. Diabetes management also imposes considerable lifestyle demands that are difficult and often frustrating for children to negotiate at a young age. Recent advances in diabetes medications and technologies have improved glycemic control in children with diabetes. Two widely used technologies are the insulin pump and continuous glucose monitoring (CGM) system. These technologies provide patients with more flexibility in their daily life and information about glucose fluctuations. Several studies report improvements in glycemic control in children with type 1 diabetes using the insulin pump or sensor-augmented pump therapy. Importantly, these technologies may impact QOL for children and families with diabetes, although they are rarely used or studied in the treatment of children with type 2 diabetes. Further, emerging closed loop and web- and phone-based technologies have great potential for supporting diabetes self-management and perhaps QOL. A deeper understanding and appreciation of the impact of diabetes technology on children's and parents' QOL is critical for both the medical and psychological care of diabetes. Thus, the purpose of this review is to discuss the impact of new diabetes technologies on QOL in children, adolescents and families with type 1 diabetes.

Insulin therapy in children and adolescents with type 1 diabetes.

PubMed

Malik, Faisal S; Taplin, Craig E

2014-04-01

Treatment of type 1 diabetes mellitus (T1DM) requires lifelong administration of exogenous insulin. The primary goal of treatment of T1DM in children and adolescents is to maintain near-normoglycemia through intensive insulin therapy, avoid acute complications, and prevent long-term microvascular and macrovascular complications, while facilitating as close to a normal life as possible. Effective insulin therapy must, therefore, be provided on the basis of the needs, preferences, and resources of the individual and the family for optimal management of T1DM. To achieve target glycemic control, the best therapeutic option for patients with T1DM is basal-bolus therapy either with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Many formulations of insulin are available to help simulate endogenous insulin secretion as closely as possible in an effort to eliminate the symptoms and complications of hyperglycemia, while minimizing the risk of hypoglycemia secondary to therapy. When using MDI, basal insulin requirements are given as an injection of long- or intermediate-acting insulin analogs, while meal-related glucose excursions are controlled with bolus injections of rapid-acting insulin analogs. Alternatively, CSII can be used, which provides a 24-h preselected but adjustable basal rate of rapid-acting insulin, along with patient-activated mealtime bolus doses, eliminating the need for periodic injections. Both MDI treatment and CSII therapy must be supported by comprehensive education that is appropriate for the individual needs of the patient and family before and after initiation. Current therapies still do not match the endogenous insulin profile of pancreatic β-cells, and all still pose risks of suboptimal control, hypoglycemia, and ketosis in children and adolescents. The safety and success of a prescribed insulin regimen is, therefore, dependent on self-monitoring of blood glucose and/or a continuous glucose monitoring system to avoid critical hypoglycemia and glucose variability. Regardless of the mode of insulin therapy, doses should be adapted on the basis of the daily pattern of blood glucose, through regular review and reassessment, and patient factors such as exercise and pubertal status. New therapy options such as sensor-augmented insulin pump therapy, which integrates CSII with a continuous glucose sensor, along with emerging therapies such as the artificial pancreas, will likely continue to improve safe insulin therapy in the near future.

Augmented thermal bus

NASA Technical Reports Server (NTRS)

Schrage, Dean S. (Inventor)

1993-01-01

The present invention is directed to an augmented thermal bus. In the present design a plurity of thermo-electric heat pumps are used to couple a source plate to a sink plate. Each heat pump is individually controlled by a model based controller. The controller coordinates the heat pump to maintain isothermality in the source.

Augmented Thermal Bus

NASA Technical Reports Server (NTRS)

Schrage, Dean S. (Inventor)

1996-01-01

The present invention is directed to an augmented thermal bus. In the present design a plurality of thermo-electric heat pumps are used to couple a source plate to a sink plate. Each heat pump is individually controlled by a model based controller. The controller coordinates the heat pumps to maintain isothermality in the source.

Resource utilization with insulin pump therapy for type 2 diabetes mellitus.

PubMed

Lynch, Peter M; Riedel, Aylin Altan; Samant, Navendu; Fan, Ying; Peoples, Tim; Levinson, Jennifer; Lee, Scott W

2010-01-01

To evaluate the effects of switching from multiple daily injection (MDI) therapy to insulin pump therapy, also called continuous subcutaneous insulin infusion (CSII), on antidiabetic drug and healthcare resource utilization. This study was a retrospective analysis of administrative claims data from a large geographically diverse health plan in the United States from January 1, 2005, through April 30, 2008. Changes in antidiabetic drug use, antidiabetic drug switching and augmentation, and healthcare utilization during the baseline period and after CSII initiation were assessed using paired t test. There were 3649 possible subjects, of whom 943 met the criteria for analysis. The mean number of antidiabetic drugs used decreased by 46% after CSII initiation, and the mean reduction in antidiabetic drug utilization was 0.67; both were statistically significant. More than one-third of subjects who were taking antidiabetic drugs before CSII initiation discontinued oral therapy after CSII initiation. The number of subjects using multiple antidiabetic drugs significantly decreased after CSII initiation by 58%, and rates of switching or augmenting significantly decreased from 42% at baseline to 25% after CSII initiation.The rates of emergency department visits and inpatient admissions significantly decreased, and the rate of ambulatory visits significantly increased. CSII was associated with significant decreases in antidiabetic drug and healthcare resource utilization, contributing to stability of care. The evidence from this study indicates that CSII should be considered as an option for patients with type 2 diabetes mellitus who are using MDI and are experiencing a high degree of antidiabetic drug and healthcare resource utilization.

Home use of a bihormonal bionic pancreas versus insulin pump therapy in adults with type 1 diabetes: a multicentre randomised crossover trial

PubMed Central

El-Khatib, Firas H; Balliro, Courtney; Hillard, Mallory A; Magyar, Kendra L; Ekhlaspour, Laya; Sinha, Manasi; Mondesir, Debbie; Esmaeili, Aryan; Hartigan, Celia; Thompson, Michael J; Malkani, Samir; Lock, J Paul; Harlan, David M; Clinton, Paula; Frank, Eliana; Wilson, Darrell M; DeSalvo, Daniel; Norlander, Lisa; Ly, Trang; Buckingham, Bruce A; Diner, Jamie; Dezube, Milana; Young, Laura A; Goley, April; Kirkman, M Sue; Buse, John B; Zheng, Hui; Selagamsetty, Rajendranath R; Damiano, Edward R; Russell, Steven J

2017-01-01

Summary Background The safety and effectiveness of a continuous, day-and-night automated glycaemic control system using insulin and glucagon has not been shown in a free-living, home-use setting. We aimed to assess whether bihormonal bionic pancreas initialised only with body mass can safely reduce mean glycaemia and hypoglycaemia in adults with type 1 diabetes who were living at home and participating in their normal daily routines without restrictions on diet or physical activity. Methods We did a random-order crossover study in volunteers at least 18 years old who had type 1 diabetes and lived within a 30 min drive of four sites in the USA. Participants were randomly assigned (1:1) in blocks of two using sequentially numbered sealed envelopes to glycaemic regulation with a bihormonal bionic pancreas or usual care (conventional or sensor-augmented insulin pump therapy) first, followed by the opposite intervention. Both study periods were 11 days in length, during which time participants continued all normal activities, including athletics and driving. The bionic pancreas was initialised with only the participant’s body mass. Autonomously adaptive dosing algorithms used data from a continuous glucose monitor to control subcutaneous delivery of insulin and glucagon. The coprimary outcomes were the mean glucose concentration and time with continuous glucose monitoring (CGM) glucose concentration less than 3·3 mmol/L, analysed over days 2–11 in participants who completed both periods of the study. This trial is registered with ClinicalTrials.gov, number NCT02092220. Findings We randomly assigned 43 participants between May 6, 2014, and July 3, 2015, 39 of whom completed the study: 20 who were assigned to bionic pancreas first and 19 who were assigned to the comparator first. The mean CGM glucose concentration was 7·8 mmol/L (SD 0·6) in the bionic pancreas period versus 9·0 mmol/L (1·6) in the comparator period (difference 1·1 mmol/L, 95% CI 0·7–1·6; p<0·0001), and the mean time with CGM glucose concentration less than 3·3 mmol/L was 0·6% (0·6) in the bionic pancreas period versus 1·9% (1·7) in the comparator period (difference 1·3%, 95% CI 0·8–1·8; p<0·0001). The mean nausea score on the Visual Analogue Scale (score 0–10) was greater during the bionic pancreas period (0·52 [SD 0·83]) than in the comparator period (0·05 [0·17]; difference 0·47, 95% CI 0·21–0·73; p=0·0024). Body mass and laboratory parameters did not differ between periods. There were no serious or unexpected adverse events in the bionic pancreas period of the study. Interpretation Relative to conventional and sensor-augmented insulin pump therapy, the bihormonal bionic pancreas, initialised only with participant weight, was able to achieve superior glycaemic regulation without the need for carbohydrate counting. Larger and longer studies are needed to establish the long-term benefits and risks of automated glycaemic management with a bihormonal bionic pancreas. Funding National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, and National Center for Advancing Translational Sciences. PMID:28007348

Home use of a bihormonal bionic pancreas versus insulin pump therapy in adults with type 1 diabetes: a multicentre randomised crossover trial.

PubMed

El-Khatib, Firas H; Balliro, Courtney; Hillard, Mallory A; Magyar, Kendra L; Ekhlaspour, Laya; Sinha, Manasi; Mondesir, Debbie; Esmaeili, Aryan; Hartigan, Celia; Thompson, Michael J; Malkani, Samir; Lock, J Paul; Harlan, David M; Clinton, Paula; Frank, Eliana; Wilson, Darrell M; DeSalvo, Daniel; Norlander, Lisa; Ly, Trang; Buckingham, Bruce A; Diner, Jamie; Dezube, Milana; Young, Laura A; Goley, April; Kirkman, M Sue; Buse, John B; Zheng, Hui; Selagamsetty, Rajendranath R; Damiano, Edward R; Russell, Steven J

2017-01-28

The safety and effectiveness of a continuous, day-and-night automated glycaemic control system using insulin and glucagon has not been shown in a free-living, home-use setting. We aimed to assess whether bihormonal bionic pancreas initialised only with body mass can safely reduce mean glycaemia and hypoglycaemia in adults with type 1 diabetes who were living at home and participating in their normal daily routines without restrictions on diet or physical activity. We did a random-order crossover study in volunteers at least 18 years old who had type 1 diabetes and lived within a 30 min drive of four sites in the USA. Participants were randomly assigned (1:1) in blocks of two using sequentially numbered sealed envelopes to glycaemic regulation with a bihormonal bionic pancreas or usual care (conventional or sensor-augmented insulin pump therapy) first, followed by the opposite intervention. Both study periods were 11 days in length, during which time participants continued all normal activities, including athletics and driving. The bionic pancreas was initialised with only the participant's body mass. Autonomously adaptive dosing algorithms used data from a continuous glucose monitor to control subcutaneous delivery of insulin and glucagon. The coprimary outcomes were the mean glucose concentration and time with continuous glucose monitoring (CGM) glucose concentration less than 3·3 mmol/L, analysed over days 2-11 in participants who completed both periods of the study. This trial is registered with ClinicalTrials.gov, number NCT02092220. We randomly assigned 43 participants between May 6, 2014, and July 3, 2015, 39 of whom completed the study: 20 who were assigned to bionic pancreas first and 19 who were assigned to the comparator first. The mean CGM glucose concentration was 7·8 mmol/L (SD 0·6) in the bionic pancreas period versus 9·0 mmol/L (1·6) in the comparator period (difference 1·1 mmol/L, 95% CI 0·7-1·6; p<0·0001), and the mean time with CGM glucose concentration less than 3·3 mmol/L was 0·6% (0·6) in the bionic pancreas period versus 1·9% (1·7) in the comparator period (difference 1·3%, 95% CI 0·8-1·8; p<0·0001). The mean nausea score on the Visual Analogue Scale (score 0-10) was greater during the bionic pancreas period (0·52 [SD 0·83]) than in the comparator period (0·05 [0·17]; difference 0·47, 95% CI 0·21-0·73; p=0·0024). Body mass and laboratory parameters did not differ between periods. There were no serious or unexpected adverse events in the bionic pancreas period of the study. Relative to conventional and sensor-augmented insulin pump therapy, the bihormonal bionic pancreas, initialised only with participant weight, was able to achieve superior glycaemic regulation without the need for carbohydrate counting. Larger and longer studies are needed to establish the long-term benefits and risks of automated glycaemic management with a bihormonal bionic pancreas. National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health, and National Center for Advancing Translational Sciences. Copyright © 2017 Elsevier Ltd. All rights reserved.

Temperature and pressure fiber-optic sensors applied to minimally invasive diagnostics and therapies

NASA Astrophysics Data System (ADS)

Hamel, Caroline; Pinet, Éric

2006-02-01

We present how fiber-optic temperature or pressure sensors could be applied to minimally invasive diagnostics and therapies. For instance a miniature pressure sensor based on micro-optical mechanical systems (MOMS) could solve most of the problems associated with fluidic pressure transduction presently used for triggering purposes. These include intra-aortic balloon pumping (IABP) therapy and other applications requiring detection of fast and/or subtle fluid pressure variations such as for intracranial pressure monitoring or for urology diagnostics. As well, miniature temperature sensors permit minimally invasive direct temperature measurement in diagnostics or therapies requiring energy transfer to living tissues. The extremely small size of fiber-optic sensors that we have developed allows quick and precise in situ measurements exactly where the physical parameters need to be known. Furthermore, their intrinsic immunity to electromagnetic interference (EMI) allows for the safe use of EMI-generating therapeutic or diagnostic equipments without compromising the signal quality. With the trend of ambulatory health care and the increasing EMI noise found in modern hospitals, the use of multi-parameter fiber-optic sensors will improve constant patient monitoring without any concern about the effects of EMI disturbances. The advantages of miniature fiberoptic sensors will offer clinicians new monitoring tools that open the way for improved diagnostic accuracy and new therapeutic technologies.

Ubiquitous Wireless Smart Sensing and Control. Pumps and Pipes JSC: Uniquely Houston

NASA Technical Reports Server (NTRS)

Wagner, Raymond

2013-01-01

Need new technologies to reliably and safely have humans interact within sensored environments (integrated user interfaces, physical and cognitive augmentation, training, and human-systems integration tools).Areas of focus include: radio frequency identification (RFID), motion tracking, wireless communication, wearable computing, adaptive training and decision support systems, and tele-operations. The challenge is developing effective, low cost/mass/volume/power integrated monitoring systems to assess and control system, environmental, and operator health; and accurately determining and controlling the physical, chemical, and biological environments of the areas and associated environmental control systems.

The automatic regulation of the basal dose on the insulin pump for the treatment of patients that have diabetes type 1

PubMed Central

Mehanović, Sifet; Mujić, Midhat

2010-01-01

Diabetes mellitus type 1 is a chronic metabolic disorder, and its main characteristic is Hyperglycemia. It usually occurs in the early years because of the absolute or relative absence of the active insulin that is caused by the autoimmune disease of the β cells of the pancreas. Despite the numerous researches and efforts of the scientists, the therapy for Diabetes type 1 is based on the substitution of insulin. Even though the principles of the therapy have not changed so much, still some important changes have occurred in the production and usage of insulin. Lately, the insulin pumps are more frequent in the therapy for Diabetes type 1. The functioning of the pump is based on the continuing delivery of insulin in a small dose (“the basal dose”), that keeps the level of glycemia in the blood constant. The increase of glycemia during the meal is reduced with the additional dose of insulin (“the bolus dose”). The use of the insulin pumps and the continuing glucose sensors has provided an easier and more efficient monitoring of the diabetes, a better metabolic control and a better life quality for the patient and his/her family. This work presents the way of automatic regulation of the basal dose of insulin through the synthesis of the functions of the insulin pump and the continuing glucose sensor. The aim is to give a contribution to the development of the controlling algorithm on the insulin pump for the automatic regulation of the glucose concentration in the blood. This could be a step further which is closer to the delivery of the dose of insulin that is really needed for the basic needs of the organism, and a significant contribution is given to the development of the artificial pancreas. PMID:20507288

The automatic regulation of the basal dose on the insulin pump for the treatment of patients that have Diabetes type 1.

PubMed

Mehanović, Sifet; Mujić, Midhat

2010-05-01

Diabetes mellitus type 1 is a chronic metabolic disorder, and its main characteristic is Hyperglycemia. It usually occurs in the early years because of the absolute or relative absence of the active insulin that is caused by the autoimmune disease of the beta cells of the pancreas. Despite the numerous researches and efforts of the scientists, the therapy for Diabetes type 1 is based on the substitution of insulin. Even though the principles of the therapy have not changed so much, still some important changes have occurred in the production and usage of insulin. Lately, the insulin pumps are more frequent in the therapy for Diabetes type 1. The functioning of the pump is based on the continuing delivery of insulin in a small dose ("the basal dose"), that keeps the level of glycemia in the blood constant. The increase of glycemia during the meal is reduced with the additional dose of insulin ("the bolus dose"). The use of the insulin pumps and the continuing glucose sensors has provided an easier and more efficient monitoring of the diabetes, a better metabolic control and a better life quality for the patient and his/her family. This work presents the way of automatic regulation of the basal dose of insulin through the synthesis of the functions of the insulin pump and the continuing glucose sensor. The aim is to give a contribution to the development of the controlling algorithm on the insulin pump for the automatic regulation of the glucose concentration in the blood. This could be a step further which is closer to the delivery of the dose of insulin that is really needed for the basic needs of the organism, and a significant contribution is given to the development of the artificial pancreas.

Accuracy of a new real-time continuous glucose monitoring algorithm.

PubMed

Keenan, D Barry; Cartaya, Raymond; Mastrototaro, John J

2010-01-01

Through minimally invasive sensor-based continuous glucose monitoring (CGM), individuals can manage their blood glucose (BG) levels more aggressively, thereby improving their hemoglobin A1c level, while reducing the risk of hypoglycemia. Tighter glycemic control through CGM, however, requires an accurate glucose sensor and calibration algorithm with increased performance at lower BG levels. Sensor and BG measurements for 72 adult and adolescent subjects were obtained during the course of a 26-week multicenter study evaluating the efficacy of the Paradigm REAL-Time (PRT) sensor-augmented pump system (Medtronic Diabetes, Northridge, CA) in an outpatient setting. Subjects in the study arm performed at least four daily finger stick measurements. A retrospective analysis of the data set was performed to evaluate a new calibration algorithm utilized in the Paradigm Veo insulin pump (Medtronic Diabetes) and to compare these results to performance metrics calculated for the PRT. A total of N = 7193 PRT sensor downloads for 3 days of use, as well as 90,472 temporally and nonuniformly paired data points (sensor and meter values), were evaluated, with 5841 hypoglycemic and 15,851 hyperglycemic events detected through finger stick measurements. The Veo calibration algorithm decreased the overall mean absolute relative difference by greater than 0.25 to 15.89%, with hypoglycemia sensitivity increased from 54.9% in the PRT to 82.3% in the Veo (90.5% with predictive alerts); however, hyperglycemia sensitivity was decreased only marginally from 86% in the PRT to 81.7% in the Veo. The Veo calibration algorithm, with sensor error reduced significantly in the 40- to 120-mg/dl range, improves hypoglycemia detection, while retaining accuracy at high glucose levels. 2010 Diabetes Technology Society.

The efficacy of a lidocaine-infused pain pump for postoperative analgesia following elective augmentation mammaplasty or abdominoplasty.

PubMed

Chavez-Abraham, Victor; Barr, Jason S; Zwiebel, Paul C

2011-08-01

Postoperative pain management following aesthetic plastic surgery traditionally has been achieved by systemic administration of several narcotic pain medications. Because this method can lead to undesirable side effects such as sedation, nausea, vomiting, and respiratory depression, a more efficacious method of postoperative analgesia with fewer side effects needs to be implemented in outpatient cosmetic surgery. From March of 2003 until December of 2008, 690 patients underwent augmentation mammaplasty and 215 patients underwent abdominoplasty. All of these patients were equipped with an elastomeric continuous infusion pump postoperatively and were prescribed oral narcotics. Prior to 2003, patients were prescribed only oral narcotics postoperatively. A retrospective chart review of patients before and after implementation of the pain pump was undertaken to review the perceived pain patients experienced postoperatively with and without the pump. The self-administration of oral narcotics was also assessed. Patients equipped with the pain pump experienced a statistically significant decrease in perceived pain compared to those without the pump (augmentation mammaplasty: 2.27 vs. 3.68, p < 0.05; abdominoplasty: 2.81 vs. 4.32, p < 0.05). Similarly, patients with the pump saw a statistically significant decrease in the use of the oral narcotic Vicodin™ at 72 h postoperatively (5 mg hydrocodone/500 mg acetaminophen, Abbott Laboratories, Abbott Park, IL) (augmentation mammaplasty: 26.5 mg/2650 mg vs. 49 mg/4900 mg, p < 0.01; abdominoplasty: 29.5 mg/2950 mg vs. 56.5 mg/5650 mg, p < 0.01). The utilization of a continuous-infusion pain pump following augmentation mammaplasty or abdominoplasty is an efficacious method to significantly reduce both the amount of pain patients experience and the quantity of narcotics used postoperatively.

Safety and efficacy of the predictive low glucose management system in the prevention of hypoglycaemia: protocol for randomised controlled home trial to evaluate the Suspend before low function.

PubMed

Abraham, M B; Nicholas, J A; Ly, T T; Roby, H C; Paramalingam, N; Fairchild, J; King, B R; Ambler, G R; Cameron, F; Davis, E A; Jones, T W

2016-04-15

Innovations with sensor-augmented pump therapy (SAPT) to reduce hypoglycaemia in patients with type 1 diabetes are an ongoing area of research. The predictive low glucose management (PLGM) system incorporates continuous glucose sensor data into an algorithm and suspends basal insulin before the occurrence of hypoglycaemia. The system was evaluated in in-clinic studies, and has informed the parameters of a larger home trial to study its efficacy and safety in real life. The aim of this report is to describe the study design and outcome measures for the trial. This is a 6-month, multicentre, randomised controlled home trial to test the PLGM system in children and adolescents with type 1 diabetes. The system is available in the Medtronic MiniMed 640G pump as the 'Suspend before low' feature. Following a run-in period, participants are randomised to either the control arm with SAPT alone or the intervention arm with SAPT and Suspend before low. The primary aim of this study is to evaluate the time spent hypoglycaemic (sensor glucose <3.5 mmol/L) with and without the system. The secondary aims are to determine the number of hypoglycaemic events, the time spent hyperglycaemic, and to evaluate safety with ketosis and changes in glycated haemoglobin. The study also aims to assess the changes in counter-regulatory hormone responses to hypoglycaemia evaluated by a hyperinsulinaemic hypoglycaemic clamp in a subgroup of patients with impaired awareness. Validated questionnaires are used to measure the fear of hypoglycaemia and the impact on the quality of life to assess burden of the disease. Ethics committee permissions were gained from respective Institutional Review boards. The findings of the study will provide high quality evidence of the ability of the system in the prevention of hypoglycaemia in real life. ACTRN12614000510640, Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effectiveness of MiniMed 640G with SmartGuard® System for prevention of hypoglycemia in pediatric patients with type 1 diabetes mellitus.

PubMed

Villafuerte Quispe, Beatriz; Martín Frías, María; Roldán Martín, M Belén; Yelmo Valverde, Rosa; Álvarez Gómez, M Ángeles; Barrio Castellanos, Raquel

2017-04-01

Treatment with the MiniMed 640G-SmartGuard ® system (640G-SG, sensor-augmented insulin pump system with low predicted glucose suspension feature) has been shown to decrease risk of hypoglycemia without altering metabolic control in patients with T1DM. The study purpose was to assess the impact of 640G-SG on hipoglycemia frequency and on metabolic control in a pediatric population with T1DM. A retrospective study on 21 children treated with 640G-SG. HbA1C, mean blood glucose (mg/dl), glucose variation coefficient, frequency of hypoglycemia (<70mg/dl) and hyperglycemia (>180mg/dl), daily capillary blood glucose measurements, ketosis/diabetic ketoacidosis, and severe hypoglycemic episodes were analyzed and compared before and during use of the system. Fasting blood glucose, frequency of sensor use and number and duration of system suspension events were also assessed in the last month of use of the system. All patients used the system continuously (5.0±2.1 months), with a median sensor use of 92%. Significant decreases were seen in hypoglycemia frequency (10.4±5.2% to 7.6±3.3%, p=.044) and number of capillary blood glucose measurements (11.3±2,2 to 8.1±2,1, p<.001), and there was no increase in hyperglycemia frequency (p=.65). Mean system suspension time was 3.1±1.2hours/day (37.3% of overnight stops). Changes in HbA1c, mean blood glucose, and variation coefficient were not significant. No patient experienced diabetic ketoacidosis or severe hypoglycemia. The sensor-augmented pump with the predictive low glucose suspension management system, as implemented in the 640G-SG system, can help avoid risk of hypoglycemia without significantly affecting metabolic control or causing diabetic ketoacidosis, and decrease the burden of additional capillary blood glucose measurements in our pediatric cohort. Copyright © 2017 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

Novel Surgical Treatments for Gastroesophageal Reflux Disease: Systematic Review of Magnetic Sphincter Augmentation and Electric Stimulation Therapy

PubMed Central

Stanak, Michal; Erdos, Judit; Hawlik, Katharina; Birsan, Tudor

2018-01-01

Electric stimulation therapy (EST) and magnetic sphincter augmentation (MSA) represent novel methods for the surgical treatment of gastroesophageal reflux disease (GERD). The aim of this review was to assess the effectiveness and safety of EST and magnetic sphincter augmentation device (MSAD) comapred to laparoscopic fundoplication (LF) and proton pump inhibitor therapy (in case of EST). We performed a systematic literature search without restrictions on publication dates in five electronic databases (MEDLINE, EMBASE, the Cochrane library, PubMed, and Centre for Reviews and Dissemination), complemented by hand search, search in trial registries, and documentation provided by the manufacturers. No study passed inclusion criteria for analyzing EST effectiveness. Concerning safety, lead erosion through the esophagus and trocar perforation of the small bowel occurred in 2.4% of patients (in one study). Only the registry study fulfilled inclusion criteria for effectiveness analysis of MSAD. The crucial outcome of GERD-health-related quality of life (HRQL) score improved from 20 to 3 points in MSAD patients, and from 23 to 3.5 points in LF patients. However, the LF patients were in a more severe stage of the disease. The results yield indefinite conclusions about the use of both MSAD and EST. Clinical effectiveness and safety of both MSAD and EST are not sufficiently proven and are yet to be supported by high quality evidence from randomized controlled trials.

Automatically augmenting lifelog events using pervasively generated content from millions of people.

PubMed

Doherty, Aiden R; Smeaton, Alan F

2010-01-01

In sensor research we take advantage of additional contextual sensor information to disambiguate potentially erroneous sensor readings or to make better informed decisions on a single sensor's output. This use of additional information reinforces, validates, semantically enriches, and augments sensed data. Lifelog data is challenging to augment, as it tracks one's life with many images including the places they go, making it non-trivial to find associated sources of information. We investigate realising the goal of pervasive user-generated content based on sensors, by augmenting passive visual lifelogs with "Web 2.0" content collected by millions of other individuals.

Context-Aware Based Efficient Training System Using Augmented Reality and Gravity Sensor for Healthcare Services

NASA Astrophysics Data System (ADS)

Kim, Seoksoo; Jung, Sungmo; Song, Jae-Gu; Kang, Byong-Ho

As augmented reality and a gravity sensor is of growing interest, siginificant developement is being made on related technology, which allows application of the technology in a variety of areas with greater expectations. In applying Context-aware to augmented reality, it can make useful programs. A traning system suggested in this study helps a user to understand an effcienct training method using augmented reality and make sure if his exercise is being done propery based on the data collected by a gravity sensor. Therefore, this research aims to suggest an efficient training environment that can enhance previous training methods by applying augmented reality and a gravity sensor.

Technology to optimize pediatric diabetes management and outcomes.

PubMed

Markowitz, Jessica T; Harrington, Kara R; Laffel, Lori M B

2013-12-01

Technology for diabetes management is rapidly developing and changing. With each new development, there are numerous factors to consider, including medical benefits, impact on quality of life, ease of use, and barriers to use. It is also important to consider the interaction between developmental stage and technology. This review considers a number of newer diabetes-related technologies and explores issues related to their use in the pediatric diabetes population (including young adults), with a focus on psychosocial factors. Areas include trend technology in blood glucose monitoring, continuous glucose monitoring, sensor-augmented insulin pumps and low glucose suspend functions, internet applications including videoconferencing, mobile applications (apps), text messaging, and online gaming.

[Analogies between heart and respiratory muscle failure. Importance to clinical practice].

PubMed

Köhler, D

2009-01-01

Heart failure is an established diagnosis. Respiratory muscle or ventilatory pump failure, however, is less well known. The latter becomes obvious through hypercapnia, caused by hypoventilation. The respiratory centre tunes into hypercapnea in order to prevent the danger of respiratory muscle overload (hypercapnic ventilatory failure). Hypoventilation will consecutively cause hypoxemia but this will not be responsible for performance limitation. One therefore has to distinguish primary hypoxemia evolving from diseases in the lung parenchyma. Here hypoxemia is the key feature and compensatory hyperventilation usually decreases PaCO2 levels. The cardiac as well as the respiratory pump adapt to an inevitable burden caused by chronic disease. In either case organ muscle mass will increase. If the burden exceeds the range of possible physiological adaptation, compensatory mechanisms will set in that are similar in both instances. During periods of overload either muscle system is mainly fueled by muscular glycogen. In the recovery phase (e. g. during sleep) stores are replenished, which can be recognized by down-regulation of the blood pressure in case of the cardiac pumb or by augmentation of hypercapnia through hypoventilation in case of the respiratory pump. The main function of cardiac and respiratory pump is maintenance of oxygen transport. The human body has developed certain compensatory mechanisms to adapt to insufficient oxygen supply especially during periods of overload. These mechanisms include shift of the oxygen binding curve, expression of respiratory chain isoenzymes capable of producing ATP at lower partial pressures of oxygen and the development of polyglobulia. Medically or pharmacologically the cardiac pump can be unloaded with beta blockers, the respiratory pump by application of inspired oxygen. Newer forms of therapy augment the process of recovery. The heart can be supported through bypass surgery or intravascular pump systems, while respiratory muscles may be supported through elective ventilatory support (mainly non-invasive) in the patient's home. The latter treatment in particular will increase patient endurance and quality of life and decrease mortality. Heart and respiratory pump failure share many common features. Since both take care of oxygen supply to the body, their function and compensatory mechanisms are closely related and linked.

The use and efficacy of continuous glucose monitoring in type 1 diabetes treated with insulin pump therapy: a randomised controlled trial.

PubMed

Battelino, T; Conget, I; Olsen, B; Schütz-Fuhrmann, I; Hommel, E; Hoogma, R; Schierloh, U; Sulli, N; Bolinder, J

2012-12-01

The aim of this multicentre, randomised, controlled crossover study was to determine the efficacy of adding continuous glucose monitoring (CGM) to insulin pump therapy (CSII) in type 1 diabetes. Children and adults (n = 153) on CSII with HbA(1c) 7.5-9.5% (58.5-80.3 mmol/mol) were randomised to (CGM) a Sensor On or Sensor Off arm for 6 months. After 4 months' washout, participants crossed over to the other arm for 6 months. Paediatric and adult participants were separately electronically randomised through the case report form according to a predefined randomisation sequence in eight secondary and tertiary centres. The primary outcome was the difference in HbA(1c) levels between arms after 6 months. Seventy-seven participants were randomised to the On/Off sequence and 76 to the Off/On sequence; all were included in the primary analysis. The mean difference in HbA(1c) was -0.43% (-4.74 mmol/mol) in favour of the Sensor On arm (8.04% [64.34 mmol/mol] vs 8.47% [69.08 mmol/mol]; 95% CI -0.32%, -0.55% [-3.50, -6.01 mmol/mol]; p < 0.001). Following cessation of glucose sensing, HbA(1c) reverted to baseline levels. Less time was spent with sensor glucose <3.9 mmol/l during the Sensor On arm than in the Sensor Off arm (19 vs 31 min/day; p = 0.009). The mean number of daily boluses increased in the Sensor On arm (6.8 ± 2.5 vs 5.8 ± 1.9, p < 0.0001), together with the frequency of use of the temporary basal rate (0.75 ± 1.11 vs 0.26 ± 0.47, p < 0.0001) and manual insulin suspend (0.91 ± 1.25 vs 0.70 ± 0.75, p < 0.018) functions. Four vs two events of severe hypoglycaemia occurred in the Sensor On and Sensor Off arm, respectively (p = 0.40). Continuous glucose monitoring was associated with decreased HbA(1c) levels and time spent in hypoglycaemia in individuals with type 1 diabetes using CSII. More frequent self-adjustments of insulin therapy may have contributed to these effects.

Management of Gastroesophageal Reflux Disease.

PubMed

Gyawali, C Prakash; Fass, Ronnie

2018-01-01

Management of gastroesophageal reflux disease (GERD) commonly starts with an empiric trial of proton pump inhibitor (PPI) therapy and complementary lifestyle measures, for patients without alarm symptoms. Optimization of therapy (improving compliance and timing of PPI doses), or increasing PPI dosage to twice daily in select circumstances, can reduce persistent symptoms. Patients with continued symptoms can be evaluated with endoscopy and tests of esophageal physiology, to better determine their disease phenotype and optimize treatment. Laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic therapies can benefit patients with well-characterized GERD. Patients with functional diseases that overlap with or mimic GERD can also be treated with neuromodulators (primarily antidepressants), or psychological interventions (psychotherapy, hypnotherapy, cognitive and behavioral therapy). Future approaches to treatment of GERD include potassium-competitive acid blockers, reflux-reducing agents, bile acid binders, injection of inert substances into the esophagogastric junction, and electrical stimulation of the lower esophageal sphincter. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Pump, and earth-testable spacecraft capillary heat transport loop using augmentation pump and check valves

NASA Technical Reports Server (NTRS)

Baker, David (Inventor)

1998-01-01

A spacecraft includes heat-generating payload equipment, and a heat transport system with a cold plate thermally coupled to the equipment and a capillary-wick evaporator, for evaporating coolant liquid to cool the equipment. The coolant vapor is coupled to a condenser and in a loop back to the evaporator. A heated coolant reservoir is coupled to the loop for pressure control. If the wick is not wetted, heat transfer will not begin or continue. A pair of check valves are coupled in the loop, and the heater is cycled for augmentation pumping of coolant to and from the reservoir. This augmentation pumping, in conjunction with the check valves, wets the wick. The wick liquid storage capacity allows the augmentation pump to provide continuous pulsed liquid flow to assure continuous vapor transport and a continuously operating heat transport system. The check valves are of the ball type to assure maximum reliability. However, any type of check valve can be used, including designs which are preloaded in the closed position. The check valve may use any ball or poppet material which resists corrosion. For optimum performance during testing on Earth, the ball or poppet would have neutral buoyancy or be configured in a closed position when the heat transport system is not operating. The ball may be porous to allow passage of coolant vapor.

SIRRACT: An international randomized clinical trial of activity feedback during inpatient stroke rehabilitation enabled by wireless sensing

PubMed Central

Dorsch, Andrew K.; Thomas, Seth; Xu, Xiaoyu; Kaiser, William; Dobkin, Bruce H.

2014-01-01

Background Walking-related disability is the most frequent reason for inpatient stroke rehabilitation. Task-related practice is a critical component for improving patient outcomes. Objective To test the feasibility of providing quantitative feedback about daily walking performance and motivating greater skills practice via remote sensing. Methods In this phase III randomized, single blind clinical trial, patients participated in conventional therapies while wearing wireless sensors (tri-axial accelerometers) at both ankles. Activity-recognition algorithms calculated the speed, distance, and duration of walking bouts. Three times a week, therapists provided either feedback about performance on a 10-meter walk (speed-only) or walking speed feedback plus a review of walking activity recorded by the sensors (augmented). Primary outcomes at discharge included total daily walking time, derived from the sensors, and a timed 15-meter walk. Results Sixteen rehabilitation centers in 11 countries enrolled 135 participants over 15 months. Sensors recorded more than 1800 days of therapy, 37,000 individual walking bouts, and 2.5 million steps. No significant differences were found between the two feedback groups in daily walking time (15.1±13.1min vs. 16.6±14.3min, p=0.54) or 15-meter walking speed (0.93±0.47m/s vs. 0.91±0.53m/s, p=0.96). Remarkably, 30% of participants decreased their total daily walking time over their rehabilitation stay. Conclusions In this first trial of remote monitoring of inpatient stroke rehabilitation, augmented feedback beyond speed alone did not increase the time spent practicing or improve walking outcomes. Remarkably modest time was spent walking. Wireless sensing, however, allowed clinicians to audit skills practice and provided ground truth regarding changes in clinically important, mobility-related activities. PMID:25261154

Left Atrial Pressure Monitoring With an Implantable Wireless Pressure Sensor After Implantation of a Left Ventricular Assist Device

PubMed Central

Baranowski, Jacek; Delshad, Baz; Ahn, Henrik

2017-01-01

After implantation of a continuous-flow left ventricular assist device (LVAD), left atrial pressure (LAP) monitoring allows for the precise management of intravascular volume, inotropic therapy, and pump speed. In this case series of 4 LVAD recipients, we report the first clinical use of this wireless pressure sensor for the long-term monitoring of LAP during LVAD support. A wireless microelectromechanical system pressure sensor (Titan, ISS Inc., Ypsilanti, MI) was placed in the left atrium in four patients at the time of LVAD implantation. Titan sensor LAP was measured in all four patients on the intensive care unit and in three patients at home. Ramped speed tests were performed using LAP and echocardiography in three patients. The left ventricular end-diastolic diameter (cm), flow (L/min), power consumption (W), and blood pressure (mm Hg) were measured at each step. Measurements were performed over 36, 84, 137, and 180 days, respectively. The three discharged patients had equipment at home and were able to perform daily recordings. There were significant correlations between sensor pressure and pump speed, LV and LA size and pulmonary capillary wedge pressure, respectively (r = 0.92–0.99, p < 0.05). There was no device failure, and there were no adverse consequences of its use. PMID:27676410

Enhancing cell and gene therapy manufacture through the application of advanced fluorescent optical sensors (Review).

PubMed

Harrison, Richard P; Chauhan, Veeren M

2017-12-15

Cell and gene therapies (CGTs) are examples of future therapeutics that can be used to cure or alleviate the symptoms of disease, by repairing damaged tissue or reprogramming defective genetic information. However, despite the recent advancements in clinical trial outcomes, the path to wide-scale adoption of CGTs remains challenging, such that the emergence of a "blockbuster" therapy has so far proved elusive. Manufacturing solutions for these therapies require the application of scalable and replicable cell manufacturing techniques, which differ markedly from the existing pharmaceutical incumbent. Attempts to adopt this pharmaceutical model for CGT manufacture have largely proved unsuccessful. The most significant challenges facing CGT manufacturing are process analytical testing and quality control. These procedures would greatly benefit from improved sensory technologies that allow direct measurement of critical quality attributes, such as pH, oxygen, lactate and glucose. In turn, this would make manufacturing more robust, replicable and standardized. In this review, the present-day state and prospects of CGT manufacturing are discussed. In particular, the authors highlight the role of fluorescent optical sensors, focusing on their strengths and weaknesses, for CGT manufacture. The review concludes by discussing how the integration of CGT manufacture and fluorescent optical sensors could augment future bioprocessing approaches.

Method and apparatus for sampling low-yield wells

DOEpatents

Last, George V.; Lanigan, David C.

2003-04-15

An apparatus and method for collecting a sample from a low-yield well or perched aquifer includes a pump and a controller responsive to water level sensors for filling a sample reservoir. The controller activates the pump to fill the reservoir when the water level in the well reaches a high level as indicated by the sensor. The controller deactivates the pump when the water level reaches a lower level as indicated by the sensors. The pump continuously activates and deactivates the pump until the sample reservoir is filled with a desired volume, as indicated by a reservoir sensor. At the beginning of each activation cycle, the controller optionally can select to purge an initial quantity of water prior to filling the sample reservoir. The reservoir can be substantially devoid of air and the pump is a low volumetric flow rate pump. Both the pump and the reservoir can be located either inside or outside the well.

Technology to Optimize Pediatric Diabetes Management and Outcomes

PubMed Central

Harrington, Kara R.; Laffel, Lori M. B.

2013-01-01

Technology for diabetes management is rapidly developing and changing. With each new development, there are numerous factors to consider, including medical benefits, impact on quality of life, ease of use, and barriers to use. It is also important to consider the interaction between developmental stage and technology. This review considers a number of newer diabetes-related technologies and explores issues related to their use in the pediatric diabetes population (including young adults), with a focus on psychosocial factors. Areas include trend technology in blood glucose monitoring, continuous glucose monitoring, sensor-augmented insulin pumps and low glucose suspend functions, internet applications including videoconferencing, mobile applications (apps), including text messaging, and online gaming. PMID:24046146

An Actor-Critic based controller for glucose regulation in type 1 diabetes.

PubMed

Daskalaki, Elena; Diem, Peter; Mougiakakou, Stavroula G

2013-02-01

A novel adaptive approach for glucose control in individuals with type 1 diabetes under sensor-augmented pump therapy is proposed. The controller, is based on Actor-Critic (AC) learning and is inspired by the principles of reinforcement learning and optimal control theory. The main characteristics of the proposed controller are (i) simultaneous adjustment of both the insulin basal rate and the bolus dose, (ii) initialization based on clinical procedures, and (iii) real-time personalization. The effectiveness of the proposed algorithm in terms of glycemic control has been investigated in silico in adults, adolescents and children under open-loop and closed-loop approaches, using announced meals with uncertainties in the order of ±25% in the estimation of carbohydrates. The results show that glucose regulation is efficient in all three groups of patients, even with uncertainties in the level of carbohydrates in the meal. The percentages in the A+B zones of the Control Variability Grid Analysis (CVGA) were 100% for adults, and 93% for both adolescents and children. The AC based controller seems to be a promising approach for the automatic adjustment of insulin infusion in order to improve glycemic control. After optimization of the algorithm, the controller will be tested in a clinical trial. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Continuous glucose monitoring systems for type 1 diabetes mellitus.

PubMed

Langendam, Miranda; Luijf, Yoeri M; Hooft, Lotty; Devries, J Hans; Mudde, Aart H; Scholten, Rob J P M

2012-01-18

Self-monitoring of blood glucose is essential to optimise glycaemic control in type 1 diabetes mellitus. Continuous glucose monitoring (CGM) systems measure interstitial fluid glucose levels to provide semi-continuous information about glucose levels, which identifies fluctuations that would not have been identified with conventional self-monitoring. Two types of CGM systems can be defined: retrospective systems and real-time systems. Real-time systems continuously provide the actual glucose concentration on a display. Currently, the use of CGM is not common practice and its reimbursement status is a point of debate in many countries. To assess the effects of CGM systems compared to conventional self-monitoring of blood glucose (SMBG) in patients with diabetes mellitus type 1. We searched The Cochrane Library, MEDLINE, EMBASE and CINAHL for the identification of studies. Last search date was June 8, 2011. Randomised controlled trials (RCTs) comparing retrospective or real-time CGM with conventional self-monitoring of blood glucose levels or with another type of CGM system in patients with type 1 diabetes mellitus. Primary outcomes were glycaemic control, e.g. level of glycosylated haemoglobin A1c (HbA1c) and health-related quality of life. Secondary outcomes were adverse events and complications, CGM derived glycaemic control, death and costs. Two authors independently selected the studies, assessed the risk of bias and performed data-extraction. Although there was clinical and methodological heterogeneity between studies an exploratory meta-analysis was performed on those outcomes the authors felt could be pooled without losing clinical merit. The search identified 1366 references. Twenty-two RCTs meeting the inclusion criteria of this review were identified. The results of the meta-analyses (across all age groups) indicate benefit of CGM for patients starting on CGM sensor augmented insulin pump therapy compared to patients using multiple daily injections of insulin (MDI) and standard monitoring blood glucose (SMBG). After six months there was a significant larger decline in HbA1c level for real-time CGM users starting insulin pump therapy compared to patients using MDI and SMBG (mean difference (MD) in change in HbA1c level -0.7%, 95% confidence interval (CI) -0.8% to -0.5%, 2 RCTs, 562 patients, I(2)=84%). The risk of hypoglycaemia was increased for CGM users, but CIs were wide and included unity (4/43 versus 1/35; RR 3.26, 95% CI 0.38 to 27.82 and 21/247 versus 17/248; RR 1.24, 95% CI 0.67 to 2.29). One study reported the occurrence of ketoacidosis from baseline to six months; there was however only one event. Both RCTs were in patients with poorly controlled diabetes.For patients starting with CGM only, the average decline in HbA1c level six months after baseline was also statistically significantly larger for CGM users compared to SMBG users, but much smaller than for patients starting using an insulin pump and CGM at the same time (MD change in HbA1c level -0.2%, 95% CI -0.4% to -0.1%, 6 RCTs, 963 patients, I(2)=55%). On average, there was no significant difference in risk of severe hypoglycaemia or ketoacidosis between CGM and SMBG users. The confidence interval however, was wide and included a decreased as well as an increased risk for CGM users compared to the control group (severe hypoglycaemia: 36/411 versus 33/407; RR 1.02, 95% CI 0.65 to 1.62, 4 RCTs, I(2)=0% and ketoacidosis: 8/411 versus 8/407; RR 0.94, 95% CI 0.36 to 2.40, 4 RCTs, I(2)=0%).Health-related quality of life was reported in five of the 22 studies. In none of these studies a significant difference between CGM and SMBG was found. Diabetes complications, death and costs were not measured.There were no studies in pregnant women with diabetes type 1 and in patients with hypoglycaemia unawareness. There is limited evidence for the effectiveness of real-time continuous glucose monitoring (CGM) use in children, adults and patients with poorly controlled diabetes. The largest improvements in glycaemic control were seen for sensor-augmented insulin pump therapy in patients with poorly controlled diabetes who had not used an insulin pump before. The risk of severe hypoglycaemia or ketoacidosis was not significantly increased for CGM users, but as these events occurred infrequent these results have to be interpreted cautiously.There are indications that higher compliance of wearing the CGM device improves glycosylated haemoglobin A1c level (HbA1c) to a larger extent. 

Expert system for online surveillance of nuclear reactor coolant pumps

DOEpatents

Gross, Kenny C.; Singer, Ralph M.; Humenik, Keith E.

1993-01-01

An expert system for online surveillance of nuclear reactor coolant pumps. This system provides a means for early detection of pump or sensor degradation. Degradation is determined through the use of a statistical analysis technique, sequential probability ratio test, applied to information from several sensors which are responsive to differing physical parameters. The results of sequential testing of the data provide the operator with an early warning of possible sensor or pump failure.

Effects of intra-aortic counterpulsation on aortic wall energetics and damping: in vivo experiments.

PubMed

Fischer, Edmundo I Cabrera; Bia, Daniel; Camus, Juan M; Zócalo, Yanina; de Forteza, Eduardo; Armentano, Ricardo L

2008-01-01

Intra-aortic balloon pumping (IABP) could modify the arterial biomechanics; however, its effects on arterial wall properties have not been fully explored. This dynamical study was designed to characterize the pressure-dependent and smooth muscle-dependent effects of IABP on aortic wall energetics in an in vivo animal model. Intra-aortic balloon pumping (1:2) was performed in six anesthetized sheep in which aortic pressure and diameter signals were measured in basal, augmented (during balloon inflation), and assisted (postaugmented) beats. Energy dissipation values in augmented and assisted beats were significantly higher than those observed in basal state (p < 0.05). Assisted beats showed a significant increase of wall damping with respect to basal and augmented beats (p < 0.05). Intra-aortic balloon pumping resulted in a significant increase of pulse wave velocity (p < 0.05) in augmented beats with respect to basal state (6.3 +/- 0.8 vs. 5.2 +/- 0.5 m x s(-1)); whereas values observed in assisted beats were significantly (p < 0.05) lower than those observed in augmented beats (4.9 +/- 0.5 vs. 6.3 +/- 0.8 m x s(-1)). Our findings show that IABP determined the pressure and smooth muscle-dependent changes in arterial wall energetics and damping properties in this animal model.

Peristaltic pump-based low range pressure sensor calibration system

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

Vinayakumar, K. B.; Department of Electronic Systems Engineering, Indian Institute of Science, Bangalore 5600012; Naveen Kumar, G.

2015-11-15

Peristaltic pumps were normally used to pump liquids in several chemical and biological applications. In the present study, a peristaltic pump was used to pressurize the chamber (positive as well negative pressures) using atmospheric air. In the present paper, we discuss the development and performance study of an automatic pressurization system to calibrate low range (millibar) pressure sensors. The system includes a peristaltic pump, calibrated pressure sensor (master sensor), pressure chamber, and the control electronics. An in-house developed peristaltic pump was used to pressurize the chamber. A closed loop control system has been developed to detect and adjust the pressuremore » leaks in the chamber. The complete system has been integrated into a portable product. The system performance has been studied for a step response and steady state errors. The system is portable, free from oil contaminants, and consumes less power compared to existing pressure calibration systems. The veracity of the system was verified by calibrating an unknown diaphragm based pressure sensor and the results obtained were satisfactory.« less

Peristaltic pump-based low range pressure sensor calibration system

NASA Astrophysics Data System (ADS)

Vinayakumar, K. B.; Naveen Kumar, G.; Nayak, M. M.; Dinesh, N. S.; Rajanna, K.

2015-11-01

Peristaltic pumps were normally used to pump liquids in several chemical and biological applications. In the present study, a peristaltic pump was used to pressurize the chamber (positive as well negative pressures) using atmospheric air. In the present paper, we discuss the development and performance study of an automatic pressurization system to calibrate low range (millibar) pressure sensors. The system includes a peristaltic pump, calibrated pressure sensor (master sensor), pressure chamber, and the control electronics. An in-house developed peristaltic pump was used to pressurize the chamber. A closed loop control system has been developed to detect and adjust the pressure leaks in the chamber. The complete system has been integrated into a portable product. The system performance has been studied for a step response and steady state errors. The system is portable, free from oil contaminants, and consumes less power compared to existing pressure calibration systems. The veracity of the system was verified by calibrating an unknown diaphragm based pressure sensor and the results obtained were satisfactory.

Three-Dimensional Sensor Common Operating Picture (3-D Sensor COP)

DTIC Science & Technology

2017-01-01

created. Additionally, a 3-D model of the sensor itself can be created. Using these 3-D models, along with emerging virtual and augmented reality tools...augmented reality 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT UU 18. NUMBER OF PAGES 20 19a...iii Contents List of Figures iv 1. Introduction 1 2. The 3-D Sensor COP 2 3. Virtual Sensor Placement 7 4. Conclusions 10 5. References 11

Experimental measurements of energy augmentation for mechanical circulatory assistance in a patient-specific Fontan model.

PubMed

Chopski, Steven G; Rangus, Owen M; Moskowitz, William B; Throckmorton, Amy L

2014-09-01

A mechanical blood pump specifically designed to increase pressure in the great veins would improve hemodynamic stability in adolescent and adult Fontan patients having dysfunctional cavopulmonary circulation. This study investigates the impact of axial-flow blood pumps on pressure, flow rate, and energy augmentation in the total cavopulmonary circulation (TCPC) using a patient-specific Fontan model. The experiments were conducted for three mechanical support configurations, which included an axial-flow impeller alone in the inferior vena cava (IVC) and an impeller with one of two different protective stent designs. All of the pump configurations led to an increase in pressure generation and flow in the Fontan circuit. The increase in IVC flow was found to augment pulmonary arterial flow, having only a small impact on the pressure and flow in the superior vena cava (SVC). Retrograde flow was neither observed nor measured from the TCPC junction into the SVC. All of the pump configurations enhanced the rate of power gain of the cavopulmonary circulation by adding energy and rotational force to the fluid flow. We measured an enhancement of forward flow into the TCPC junction, reduction in IVC pressure, and only minimally increased pulmonary arterial pressure under conditions of pump support. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

An Overview of Insulin Pumps and Glucose Sensors for the Generalist

PubMed Central

McAdams, Brooke H.; Rizvi, Ali A.

2016-01-01

Continuous subcutaneous insulin, or the insulin pump, has gained popularity and sophistication as a near-physiologic programmable method of insulin delivery that is flexible and lifestyle-friendly. The introduction of continuous monitoring with glucose sensors provides unprecedented access to, and prediction of, a patient’s blood glucose levels. Efforts are underway to integrate the two technologies, from “sensor-augmented” and “sensor-driven” pumps to a fully-automated and independent sensing-and-delivery system. Implantable pumps and an early-phase “bionic pancreas” are also in active development. Fine-tuned “pancreas replacement” promises to be one of the many avenues that offers hope for individuals suffering from diabetes. Although endocrinologists and diabetes specialists will continue to maintain expertise in this field, it behooves the primary care physician to have a working knowledge of insulin pumps and sensors to ensure optimal clinical care and decision-making for their patients. PMID:26742082

Randomised, prospective, medico-economic nationwide French study of islet transplantation in patients with severely unstable type 1 diabetes: the STABILOT study protocol.

PubMed

Lablanche, Sandrine; David-Tchouda, Sandra; Margier, Jennifer; Schir, Edith; Wojtusciszyn, Anne; Borot, Sophie; Kessler, Laurence; Morelon, Emmanuel; Thivolet, Charles; Pattou, François; Vantyghem, Marie Christine; Berney, Thierry; Benhamou, Pierre-Yves

2017-02-20

Islet transplantation may be an appropriate treatment option for patients with severely unstable type 1 diabetes experiencing major glucose variability with severe hypoglycaemia despite intensive insulin therapy. Few data are available on the costs associated with islet transplantation in relation to its benefits. The STABILOT study proposes to assess the economic impact of islet transplantation in comparison with the current best medical treatment defined as sensor-augmented pump (SAP) therapy. The trial will adopt an open-label, randomised, multicentred design. The study will include 30 patients with severely unstable type 1 diabetes. Eligible participants will be 18-65 years old, with type 1 diabetes duration >5 years, a negative basal or stimulated C-peptide, and severe instability defined by persistent, recurrent and disabling severe hypoglycaemia, despite optimised medical treatment. Participants will be randomised into two groups: one group with immediate registration for islet transplantation, and one group with delayed registration for 1 year while patients receive SAP therapy. The primary endpoint will be the incremental cost-utility ratio at 1 year between islet transplantation and SAP therapy. Perspectives of both the French Health Insurance System and the hospitals will be retained. Ethical approval has been obtained at all sites. The trial has been approved by ClinicalTrials.gov (Trial registration ID NCT02854696). All participants will sign a free and informed consent form before randomisation. Results of the study will be communicated during national and international meetings in the field of diabetes and transplantation. A publication will be sought in journals usually read by physicians involved in diabetes care, transplantation and internal medicine. NCT02854696; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial.

PubMed

Platz, T; Eickhof, C; van Kaick, S; Engel, U; Pinkowski, C; Kalok, S; Pause, M

2005-10-01

To study the effects of augmented exercise therapy time for arm rehabilitation as either Bobath therapy or the impairment-oriented training (Arm BASIS training) in stroke patients with arm severe paresis. Single blind, multicentre randomized control trial. Three inpatient neurorehabilitation centres. Sixty-two anterior circulation ischaemic stroke patients. Random assignment to three group: (A) no augmented exercise therapy time, (B) augmented exercise therapy time as Bobath therapy and (C) augmented exercise therapy time as Arm BASIS training. Fugl-Meyer arm motor score. Secondary measure: Action Research Arm Test (ARA). Ancillary measures: Fugl-Meyer arm sensation and joint motion/pain scores and the Ashworth Scale (elbow flexors). An overall effect of augmented exercise therapy time on Fugl-Meyer scores after four weeks was not corroborated (mean and 95% confidence interval (CI) of change scores: no augmented exercise therapy time (n=20) 8.8, 5.2-12.3; augmented exercise therapy time (n=40) 9.9, 6.8-13.9; p = 0.2657). The group who received the augmented exercise therapy time as Arm BASIS training (n=20) had, however, higher gains than the group receiving the augmented exercise therapy time as Bobath therapy (n=20) (mean and 95% CI of change scores: Bobath 7.2, 2.6-11.8; BASIS 12.6, 8.4-16.8; p = 0.0432). Passive joint motion/pain deteriorated less in the group who received BASIS training (mean and 95% CI of change scores: Bobath -3.2, -5.2 to -1.1; BASIS 0.1, -1.8-2.0; p = 0.0090). ARA, Fugl-Meyer arm sensation, and Ashworth Scale scores were not differentially affected. The augmented exercise therapy time as Arm BASIS training enhanced selective motor control. Type of training was more relevant for recovery of motor control than therapeutic time spent.

Decentralized safety concept for closed-loop controlled intensive care.

PubMed

Kühn, Jan; Brendle, Christian; Stollenwerk, André; Schweigler, Martin; Kowalewski, Stefan; Janisch, Thorsten; Rossaint, Rolf; Leonhardt, Steffen; Walter, Marian; Kopp, Rüdger

2017-04-01

This paper presents a decentralized safety concept for networked intensive care setups, for which a decentralized network of sensors and actuators is realized by embedded microcontroller nodes. It is evaluated for up to eleven medical devices in a setup for automated acute respiratory distress syndrome (ARDS) therapy. In this contribution we highlight a blood pump supervision as exemplary safety measure, which allows a reliable bubble detection in an extracorporeal blood circulation. The approach is validated with data of animal experiments including 35 bubbles with a size between 0.05 and 0.3 ml. All 18 bubbles with a size down to 0.15 ml are successfully detected. By using hidden Markov models (HMMs) as statistical method the number of necessary sensors can be reduced by two pressure sensors.

Human grasp assist device and method of use

NASA Technical Reports Server (NTRS)

Linn, Douglas Martin (Inventor); Ihrke, Chris A. (Inventor); Diftler, Myron A. (Inventor)

2012-01-01

A grasp assist device includes a glove portion having phalange rings, contact sensors for measuring a grasping force applied by an operator wearing the glove portion, and a tendon drive system (TDS). The device has flexible tendons connected to the phalange rings for moving the rings in response to feedback signals from the sensors. The TDS is connected to each of the tendons, and applies an augmenting tensile force thereto via a microcontroller adapted for determining the augmenting tensile force as a function of the grasping force. A method of augmenting a grasping force of an operator includes measuring the grasping force using the sensors, encoding the grasping force as the feedback signals, and calculating the augmenting tensile force as a function of the feedback signals using the microcontroller. The method includes energizing at least one actuator of a tendon drive system (TDS) to thereby apply the augmenting tensile force.

Initial clinical trial of a closed loop, fully automatic intra-aortic balloon pump.

PubMed

Kantrowitz, A; Freed, P S; Cardona, R R; Gage, K; Marinescu, G N; Westveld, A H; Litch, B; Suzuki, A; Hayakawa, H; Takano, T

1992-01-01

A new generation, closed loop, fully automatic intraaortic balloon pump (CL-IABP) system continuously optimizes diastolic augmentation by adjusting balloon pump parameters beat by beat without operator intervention. In dogs in sinus rhythm and with experimentally induced arrhythmias, the new CL-IABP system provided safe, effective augmentation. To investigate the system's suitability for clinical use, 10 patients meeting standard indications for IABP were studied. The patients were pumped by the fully automatic IABP system for an average of 20 hr (range, 1-48 hr). At start-up, the system optimized pumping parameters within 7-20 sec. Evaluation of 186 recordings made at hourly intervals showed that inflation began within 20 msec of the dicrotic notch 99% of the time. In 100% of the recordings, deflation straddled the first half of ventricular ejection. Peak pressure across the balloon membrane averaged 55 mmHg and, in no case, exceeded 100 mmHg. Examination of the data showed that as soon as the system was actuated it provided consistently beneficial diastolic augmentation without any further operator intervention. Eight patients improved and two died (one of irreversible cardiogenic shock and one of ischemic cardiomyopathy). No complications were attributable to the investigational aspects of the system. A fully automated IABP is feasible in the clinical setting, and it may have advantages relative to current generation IABP systems.

Fluid pumping apparatus

DOEpatents

West, Phillip B.

2006-01-17

A method and apparatus suitable for coupling seismic or other downhole sensors to a borehole wall in high temperature and pressure environments. In one embodiment, one or more metal bellows mounted to a sensor module are inflated to clamp the sensor module within the borehole and couple an associated seismic sensor to a borehole wall. Once the sensing operation is complete, the bellows are deflated and the sensor module is unclamped by deflation of the metal bellows. In a further embodiment, a magnetic drive pump in a pump module is used to supply fluid pressure for inflating the metal bellows using borehole fluid or fluid from a reservoir. The pump includes a magnetic drive motor configured with a rotor assembly to be exposed to borehole fluid pressure including a rotatable armature for driving an impeller and an associated coil under control of electronics isolated from borehole pressure.

Review article: relationship between the metabolism and efficacy of proton pump inhibitors--focus on rabeprazole.

PubMed

Horn, J

2004-11-01

Proton pump inhibitors are now considered the mainstay of treatment for acid-related disease. Although all proton pump inhibitors are highly effective, the antisecretory effects of different drugs in this class are not completely consistent across patients. One reason for this is the acid-suppressing effect of Helicobacter pylori infection, which may augment the actions of proton pump inhibitors. A second important reason for interpatient variability of the effects of proton pump inhibitors on acid secretion involves genetically determined differences in the metabolism of these drugs. This article focuses on the impact of genetic polymorphism of cytochrome P450 (CYP)2C19 on the pharmacokinetics and pharmacodynamics of proton pump inhibitors, particularly rabeprazole. Results reviewed indicate that the metabolism and pharmacokinetics of rabeprazole differ significantly from those of other proton pump inhibitors. Most importantly, the clearance of rabeprazole is largely nonenzymatic and less dependent on CYP2C19 than other drugs in its class. This results in greater consistency of pharmacokinetics for rabeprazole across a wide range of patients with acid-related disease, particularly those with different CYP2C19 genotypes. The pharmacodynamic profile for rabeprazole is also characterized by more rapid suppression of gastric acid secretion than with other proton pump inhibitors, which is also independent of CYP2C19 genotype. The favourable pharmacokinetic/pharmacodynamic profile for rabeprazole has been shown to result in high eradication rates for H. pylori in both normal and poor metabolizers. Pharmacodynamic results have also suggested that rabeprazole may be better suited than omeprazole as on-demand therapy for symptomatic gastro-oesophageal reflux disease. Finally, the use of rabeprazole is not complicated by clinically significant drug-drug interactions of the type that have been reported for omeprazole.

Wireless Sensor for Measuring Pump Efficiency: Small Business Voucher Project with KCF Technologies

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

Fugate, David L.; Liu, Xiaobing; Gehl, Anthony C.

This document is to fulfill the final report requirements for the Small Business Voucher (SBV) CRADA project with ORNL and KCF Technologies (CRADA/NFE-16-06133). Pumping systems account for nearly 20% of the world’s electrical energy demand and range from 25-50% of the energy usage in many industrial and building power plants. The energy cost is the largest element in the total cost of owning a pump (~40%). In response to a recent DOE mandate for improved pump efficiency pump manufacturers are preparing for the changes that the impending regulations will bring, including design improvements. This mandate also establishes a need formore » new low cost pump efficiency measurement systems. The standard industry definition of pump efficiency is the mechanical water horsepower delivered divided by the electrical horsepower input to the motor. KCF Technologies has developed a new sensor measurement technique to estimate fluid pump efficiency using a thermodynamic approach. KCF Technologies applied for a SBV grant with ORNL as the research partner. KCF needed a research partner with the proper facilities to demonstrate the efficacy of its wireless sensor unit for measuring pump efficiency. The ORNL Building Technologies Research and Integration Center (BTRIC) test resources were used to test and demonstrate the successful measurement of pump efficiency with the KCF sensor technology. KCF is now working on next steps to commercialize this sensing technology.« less

Comparison of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional insulin pump therapy for glycaemic control in patients with type 1 diabetes: an open-label randomised controlled crossover trial.

PubMed

Haidar, Ahmad; Legault, Laurent; Messier, Virginie; Mitre, Tina Maria; Leroux, Catherine; Rabasa-Lhoret, Rémi

2015-01-01

The artificial pancreas is an emerging technology for the treatment of type 1 diabetes and two configurations have been proposed: single-hormone (insulin alone) and dual-hormone (insulin and glucagon). We aimed to delineate the usefulness of glucagon in the artificial pancreas system. We did a randomised crossover trial of dual-hormone artificial pancreas, single-hormone artificial pancreas, and conventional insulin pump therapy (continuous subcutaneous insulin infusion) in participants aged 12 years or older with type 1 diabetes. Participants were assigned in a 1:1:1:1:1:1 ratio with blocked randomisation to the three interventions and attended a research facility for three 24-h study visits. During visits when the patient used the single-hormone artificial pancreas, insulin was delivered based on glucose sensor readings and a predictive dosing algorithm. During dual-hormone artificial pancreas visits, glucagon was also delivered during low or falling glucose. During conventional insulin pump therapy visits, patients received continuous subcutaneous insulin infusion. The study was not masked. The primary outcome was the time for which plasma glucose concentrations were in the target range (4·0-10·0 mmol/L for 2 h postprandially and 4·0-8·0 mmol/L otherwise). Hypoglycaemic events were defined as plasma glucose concentration of less than 3·3 mmol/L with symptoms or less than 3·0 mmol/L irrespective of symptoms. Analysis was by modified intention to treat, in which we included data for all patients who completed at least two visits. A p value of less than 0·0167 (0·05/3) was regarded as significant. This trial is registered with ClinicalTrials.gov, number NCT01754337. The mean proportion of time spent in the plasma glucose target range over 24 h was 62% (SD 18), 63% (18), and 51% (19) with single-hormone artificial pancreas, dual-hormone artificial pancreas, and conventional insulin pump therapy, respectively. The mean difference in time spent in the target range between single-hormone artificial pancreas and conventional insulin pump therapy was 11% (17; p=0·002) and between dual-hormone artificial pancreas and conventional insulin pump therapy was 12% (21; p=0·00011). There was no difference (15; p=0·75) in the proportion of time spent in the target range between the single-hormone and dual-hormone artificial pancreas systems. There were 52 hypoglycaemic events with conventional insulin pump therapy (12 of which were symptomatic), 13 with the single-hormone artificial pancreas (five of which were symptomatic), and nine with the dual-hormone artificial pancreas (0 of which were symptomatic); the number of nocturnal hypoglycaemic events was 13 (0 symptomatic), 0, and 0, respectively. Single-hormone and dual-hormone artificial pancreas systems both provided better glycaemic control than did conventional insulin pump therapy. The single-hormone artificial pancreas might be sufficient for hypoglycaemia-free overnight glycaemic control. Canadian Diabetes Association; Fondation J A De Sève; Juvenile Diabetes Research Foundation; and Medtronic. Copyright © 2015 Elsevier Ltd. All rights reserved.

Brady Geothermal Field Well Pumping Data During Deployment

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

Kurt Feigl

Contains pumping data associated with the wells used in the 2016 Spring Campaign led partially by UW - Madison, LBNL, and LLNL scientists. The well coordinates and the depths to the pressure sensors used in the pumping wells can be found at the link "Coordinates and Sensor Depths" below.

An Energy Saving System for a Beam Pumping Unit

PubMed Central

Lv, Hongqiang; Liu, Jun; Han, Jiuqiang; Jiang, An

2016-01-01

Beam pumping units are widely used in the oil production industry, but the energy efficiency of this artificial lift machinery is generally low, especially for the low-production well and high-production well in the later stage. There are a number of ways for energy savings in pumping units, with the periodic adjustment of stroke speed and rectification of balance deviation being two important methods. In the paper, an energy saving system for a beam pumping unit (ESS-BPU) based on the Internet of Things (IoT) was proposed. A total of four types of sensors, including load sensor, angle sensor, voltage sensor, and current sensor, were used to detect the operating conditions of the pumping unit. Data from these sensors was fed into a controller installed in an oilfield to adjust the stroke speed automatically and estimate the degree of balance in real-time. Additionally, remote supervision could be fulfilled using a browser on a computer or smartphone. Furthermore, the data from a practical application was recorded and analyzed, and it can be seen that ESS-BPU is helpful in reducing energy loss caused by unnecessarily high stroke speed and a poor degree of balance. PMID:27187402

Impact of flash glucose monitoring on hypoglycaemia in adults with type 1 diabetes managed with multiple daily injection therapy: a pre-specified subgroup analysis of the IMPACT randomised controlled trial.

PubMed

Oskarsson, Per; Antuna, Ramiro; Geelhoed-Duijvestijn, Petronella; Krӧger, Jens; Weitgasser, Raimund; Bolinder, Jan

2018-03-01

Evidence for the effectiveness of interstitial glucose monitoring in individuals with type 1 diabetes using multiple daily injection (MDI) therapy is limited. In this pre-specified subgroup analysis of the Novel Glucose-Sensing Technology and Hypoglycemia in Type 1 Diabetes: a Multicentre, Non-masked, Randomised Controlled Trial' (IMPACT), we assessed the impact of flash glucose technology on hypoglycaemia compared with capillary glucose monitoring. This multicentre, prospective, non-masked, RCT enrolled adults from 23 European diabetes centres. Individuals were eligible to participate if they had well-controlled type 1 diabetes (diagnosed for ≥5 years), HbA 1c ≤ 58 mmol/mol [7.5%], were using MDI therapy and on their current insulin regimen for ≥3 months, reported self-monitoring of blood glucose on a regular basis (equivalent to ≥3 times/day) for ≥2 months and were deemed technically capable of using flash glucose technology. Individuals were excluded if they were diagnosed with hypoglycaemia unawareness, had diabetic ketoacidosis or myocardial infarction in the preceding 6 months, had a known allergy to medical-grade adhesives, used continuous glucose monitoring (CGM) within the previous 4 months or were currently using CGM or sensor-augmented pump therapy, were pregnant or planning pregnancy or were receiving steroid therapy for any disorders. Following 2 weeks of blinded (to participants and investigator) sensor wear by all participants, participants with sensor data for more than 50% of the blinded wear period (or ≥650 individual sensor results) were randomly assigned, in a 1:1 ratio by a central interactive web response system (IWRS) using the biased-coin minimisation method, to flash sensor-based glucose monitoring (intervention group) or self-monitoring of capillary blood glucose (control group). The control group had two further 14 day blinded sensor-wear periods at the 3 and 6 month time points. Participants, investigators and staff were not masked to group allocation. The primary outcome was the change in time in hypoglycaemia (<3.9 mmol/l) between baseline and 6 months in the full analysis set. Between 4 September 2014 and 12 February 2015, 167 participants using MDI were enrolled. After screening and the baseline phase, participants were randomised to intervention (n = 82) and control groups (n = 81). One woman from each group was excluded owing to pregnancy; the full analysis set included 161 randomised participants. At 6 months, mean time in hypoglycaemia was reduced by 46.0%, from 3.44 h/day to 1.86 h/day in the intervention group (baseline adjusted mean change, -1.65 h/day), and from 3.73 h/day to 3.66 h/day in the control group (baseline adjusted mean change, 0.00 h/day), with a between-group difference of -1.65 (95% CI -2.21, -1.09; p < 0.0001). For participants in the intervention group, the mean ± SD daily sensor scanning frequency was 14.7 ± 10.7 (median 12.3) and the mean number of self-monitored blood glucose tests performed per day reduced from 5.5 ± 2.0 (median 5.4) at baseline to 0.5 ± 1.0 (median 0.1). The baseline frequency of self-monitored blood glucose tests by control participants was maintained (from 5.6 ± 1.9 [median 5.2] to 5.5 ± 2.6 [median 5.1] per day). Treatment satisfaction and perception of hypo/hyperglycaemia were improved compared with control. No device-related hypoglycaemia or safety-related issues were reported. Nine serious adverse events were reported for eight participants (four in each group), none related to the device. Eight adverse events for six of the participants in the intervention group were also reported, which were related to sensor insertion/wear; four of these participants withdrew because of the adverse event. Use of flash glucose technology in type 1 diabetes controlled with MDI therapy significantly reduced time in hypoglycaemia without deterioration of HbA 1c , and improved treatment satisfaction. ClinicalTrials.gov NCT02232698 FUNDING: Abbott Diabetes Care, Witney, UK.

The SNaP system: biomechanical and animal model testing of a novel ultraportable negative-pressure wound therapy system.

PubMed

Fong, Kenton D; Hu, Dean; Eichstadt, Shaundra; Gupta, Deepak M; Pinto, Moshe; Gurtner, Geoffrey C; Longaker, Michael T; Lorenz, H Peter

2010-05-01

Negative-pressure wound therapy is traditionally achieved by attaching an electrically powered pump to a sealed wound bed and applying subatmospheric pressure by means of gauze or foam. The Smart Negative Pressure (SNaP) System (Spiracur, Inc., Sunnyvale, Calif.) is a novel ultraportable negative-pressure wound therapy system that does not require an electrically powered pump. Negative pressure produced by the SNaP System, and a powered pump, the wound vacuum-assisted closure advanced-therapy system (Kinetic Concepts, Inc., San Antonio, Texas), were compared in vitro using bench-top pressure sensor testing and microstrain and stress testing with pressure-sensitive film and micro-computed tomographic scan analysis. In addition, to test in vivo efficacy, 10 rats underwent miniaturized SNaP (mSNaP) device placement on open wounds. Subject rats were randomized to a system activation group (approximately -125 mmHg) or a control group (atmospheric pressure). Wound measurements and histologic data were collected for analysis. Bench measurement revealed nearly identical negative-pressure delivery and mechanical strain deformation patterns between both systems. Wounds treated with the mSNaP System healed faster, with decreased wound size by postoperative day 7 (51 percent versus 12 percent reduction; p < 0.05) and had more rapid complete reepithelialization (21 days versus 32 days; p < 0.05). The mSNaP device also induced robust granulation tissue formation. The SNaP System and an existing electrically powered negative-pressure wound therapy system have similar biomechanical properties and functional wound-healing benefits. The potential clinical efficacy of the SNaP device for the treatment of wounds is supported.

Protocol for a randomised crossover trial to evaluate patient and nurse satisfaction with electronic and elastomeric portable infusion pumps for the continuous administration of antibiotic therapy in the home: the Comparing Home Infusion Devices (CHID) study

PubMed Central

Ryan, Melissa K; Ritchie, Brett; Sluggett, Janet K; Sluggett, Andrew J; Ralton, Lucy; Reynolds, Karen J

2017-01-01

Introduction Previous studies comparing satisfaction with electronic and elastomeric infusion pumps are limited, and improvements in size and usability of electronic pumps have since occurred. The Comparing Home Infusion Devices (CHID) study plans to assess patient and nurse satisfaction with an elastomeric and electronic pump for delivering intravenous antibiotic treatment in the home. Secondary objectives are to determine pump-related complications and actual antibiotic dose administered, evaluate temperature variation and compare pump operating costs. Methods and analysis The CHID study will be a randomised, crossover trial. A trained research nurse will recruit patients with infectious disease aged ≥18 years and prescribed ≥8 days of continuous intravenous antibiotic therapy from the Royal Adelaide Hospital (RAH) (Adelaide, Australia). Patients will be randomised to receive treatment at home via an elastomeric (Baxter Infusor) or an electronic (ambIT Continuous) infusion pump for 4–7 days, followed by the other for a further 4–7 days. Patient satisfaction will be assessed by a 10-item survey to be completed at the end of each arm. Nurse satisfaction will be assessed by a single 24-item survey. Patient logbooks and case notes from clinic visits will be screened to identify complications. Pumps/infusion bags will be weighed to estimate the volume of solution delivered. Temperature sensors will record skin and ambient temperatures during storage and use of the pumps throughout the infusion period. Costs relating to pumps, consumables, antibiotics and servicing will be determined. Descriptive statistics will summarise study data. Ethics and dissemination This study has been approved by the RAH Human Research Ethics Committee (HREC/16/RAH/133 R20160420, version 6.0, 5 September 2016). Study results will be disseminated through peer-reviewed publications and conference presentations. The CHID study will provide key insights into patient and provider satisfaction with elastomeric and electronic infusion pumps and inform future device selection. Trial registration number ACTRN12617000251325; Pre-results. PMID:28760798

Protocol for a randomised crossover trial to evaluate patient and nurse satisfaction with electronic and elastomeric portable infusion pumps for the continuous administration of antibiotic therapy in the home: the Comparing Home Infusion Devices (CHID) study.

PubMed

Hobbs, Jodie G; Ryan, Melissa K; Ritchie, Brett; Sluggett, Janet K; Sluggett, Andrew J; Ralton, Lucy; Reynolds, Karen J

2017-07-31

Previous studies comparing satisfaction with electronic and elastomeric infusion pumps are limited, and improvements in size and usability of electronic pumps have since occurred. The Comparing Home Infusion Devices (CHID) study plans to assess patient and nurse satisfaction with an elastomeric and electronic pump for delivering intravenous antibiotic treatment in the home. Secondary objectives are to determine pump-related complications and actual antibiotic dose administered, evaluate temperature variation and compare pump operating costs. The CHID study will be a randomised, crossover trial. A trained research nurse will recruit patients with infectious disease aged ≥18 years and prescribed ≥8 days of continuous intravenous antibiotic therapy from the Royal Adelaide Hospital (RAH) (Adelaide, Australia). Patients will be randomised to receive treatment at home via an elastomeric (Baxter Infusor) or an electronic (ambIT Continuous) infusion pump for 4-7 days, followed by the other for a further 4-7 days. Patient satisfaction will be assessed by a 10-item survey to be completed at the end of each arm. Nurse satisfaction will be assessed by a single 24-item survey. Patient logbooks and case notes from clinic visits will be screened to identify complications. Pumps/infusion bags will be weighed to estimate the volume of solution delivered. Temperature sensors will record skin and ambient temperatures during storage and use of the pumps throughout the infusion period. Costs relating to pumps, consumables, antibiotics and servicing will be determined. Descriptive statistics will summarise study data. This study has been approved by the RAH Human Research Ethics Committee (HREC/16/RAH/133 R20160420, version 6.0, 5 September 2016). Study results will be disseminated through peer-reviewed publications and conference presentations. The CHID study will provide key insights into patient and provider satisfaction with elastomeric and electronic infusion pumps and inform future device selection. ACTRN12617000251325; Pre-results. © 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.

Benefit assessment of solar-augmented natural gas systems

NASA Technical Reports Server (NTRS)

Davis, E. S.; French, R. L.; Sohn, R. L.

1980-01-01

Report details how solar-energy-augmented system can reduce natural gas consumption by 40% to 70%. Applications discussed include: domestic hot water system, solar-assisted gas heat pumps, direct heating from storage tank. Industrial uses, solar-assisted appliances, and economic factors are discussed.

Sensor-Aware Recognition and Tracking for Wide-Area Augmented Reality on Mobile Phones

PubMed Central

Chen, Jing; Cao, Ruochen; Wang, Yongtian

2015-01-01

Wide-area registration in outdoor environments on mobile phones is a challenging task in mobile augmented reality fields. We present a sensor-aware large-scale outdoor augmented reality system for recognition and tracking on mobile phones. GPS and gravity information is used to improve the VLAD performance for recognition. A kind of sensor-aware VLAD algorithm, which is self-adaptive to different scale scenes, is utilized to recognize complex scenes. Considering vision-based registration algorithms are too fragile and tend to drift, data coming from inertial sensors and vision are fused together by an extended Kalman filter (EKF) to achieve considerable improvements in tracking stability and robustness. Experimental results show that our method greatly enhances the recognition rate and eliminates the tracking jitters. PMID:26690439

Sensor-Aware Recognition and Tracking for Wide-Area Augmented Reality on Mobile Phones.

PubMed

Chen, Jing; Cao, Ruochen; Wang, Yongtian

2015-12-10

Wide-area registration in outdoor environments on mobile phones is a challenging task in mobile augmented reality fields. We present a sensor-aware large-scale outdoor augmented reality system for recognition and tracking on mobile phones. GPS and gravity information is used to improve the VLAD performance for recognition. A kind of sensor-aware VLAD algorithm, which is self-adaptive to different scale scenes, is utilized to recognize complex scenes. Considering vision-based registration algorithms are too fragile and tend to drift, data coming from inertial sensors and vision are fused together by an extended Kalman filter (EKF) to achieve considerable improvements in tracking stability and robustness. Experimental results show that our method greatly enhances the recognition rate and eliminates the tracking jitters.

A pilot study of factors associated with glycaemic control in adults with Type 1 diabetes mellitus on insulin pump therapy.

PubMed

Wen, W; Frampton, R; Wright, K; Fattore, S; Shadbolt, B; Perampalam, S

2016-02-01

To identify the knowledge and management factors associated with glycaemic control among adults with Type 1 diabetes mellitus treated with insulin pump therapy. A cross-sectional study of adults with Type 1 diabetes mellitus on insulin pump therapy for at least 12 months (n = 50, 18-70 years old) was undertaken between December 2013 and May 2014. A new questionnaire was developed to evaluate participants' knowledge and management related to insulin pump therapy, and were correlated with insulin pump data, HbA1c and frequency of hypoglycaemia. Participants who changed their insulin pump settings when indicated had significantly better glycaemic control than those who did not (P = 0.04). Multivariate logistic regression analysis found that better overall insulin pump therapy management was a significant predictor of better glycaemic control (odds ratio 4.45, 95% confidence interval 1.61-12.3; P = 0.004) after adjusting for potential confounders including age, gender, duration of diabetes and insulin pump therapy. However, overall insulin pump therapy knowledge was not a significant predictor of glycaemic control (P = 0.058). There was no significant association between frequency of hypoglycaemia and insulin pump therapy knowledge or management. We identified some key knowledge and management factors associated with glycaemic control in adults with Type 1 diabetes mellitus on insulin pump therapy using a newly designed questionnaire. The pilot study assessed the clinical utility of this evaluation tool, which may facilitate provision of targeted education to insulin pump therapy users to achieve optimal glycaemic control. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

A computerized system to evaluate volumetric infusion pumps.

PubMed

Kobayashi, S; Ogata, T

1992-01-01

A computerized system was developed to examine the performance characteristics of infusion pumps. This system collects solution delivered by an infusion pump through an intravenous needle into a collection vessel. Using an inductor-type weight sensor and a semiconductor type of strain-gauge pressure sensor, the weight of the collection vessel and the pressure at the needle were monitored over a specific period (the sampling time), and changes in pressure, flow rate, and volume of fluid were calculated. This system was applied to five volumetric infusion pumps with different pumping mechanisms. Test conditions involved two different solutions, two sizes of needle gauge, and seven flow rates, for a total of 28 measurements per pump. Results showed considerable variation in the infusion pumps' performances based on differences in these indices. Use of an inductance weight sensor as a means to evaluate gravimetric performance appears to be an improvement over conventional methods, which use analytical balances for data generation. The results indicate that this system will be useful in evaluating the performances of commercially available infusion pumps as well as those in development.

Therapeutics: Alpha-1 Antitrypsin Augmentation Therapy.

PubMed

Campos, Michael; Lascano, Jorge

2017-01-01

Subjects with alpha-1 antitrypsin deficiency who develop pulmonary disease are managed following general treatment guidelines, including disease management interventions. In addition, administration of intravenous infusions of alpha-1 proteinase inhibitor (augmentation therapy) at regular schedules is a specific therapy for individuals with AATD with pulmonary involvement.This chapter summarizes the manufacturing differences of commercially available formulations and the available evidence of the effects of augmentation therapy. Biologically, there is clear evidence of in vivo local antiprotease effects in the lung and systemic immunomodulatory effects. Clinically, there is cumulative evidence of slowing lung function decline and emphysema progression. The optimal dose of augmentation therapy is being revised as well as more individualized assessment of who needs this therapy.

Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump

MedlinePlus

... and Consumer Devices Brochure - Home Healthcare Medical Devices: Infusion Therapy - Getting the Most Out of Your Pump ... therapy. What do you do before using your infusion pump? Read your pump's Instructions for Use and ...

Microfabricated optically pumped magnetometer arrays for biomedical imaging

NASA Astrophysics Data System (ADS)

Perry, A. R.; Sheng, D.; Krzyzewski, S. P.; Geller, S.; Knappe, S.

2017-02-01

Optically-pumped magnetometers have demonstrated magnetic field measurements as precise as the best superconducting quantum interference device magnetometers. Our group develops miniature alkali atom-based magnetic sensors using microfabrication technology. Our sensors do not require cryogenic cooling, and can be positioned very close to the sample, making these sensors an attractive option for development in the medical community. We will present our latest chip-scale optically-pumped gradiometer developed for array applications to image magnetic fields from the brain noninvasively. These developments should lead to improved spatial resolution, and potentially sensitive measurements in unshielded environments.

New, Virtually Wall-less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery.

PubMed

von Segesser, Ludwig Karl; Berdajs, Denis; Abdel-Sayed, Saad; Tozzi, Piergiorgio; Ferrari, Enrico; Maisano, Francesco

2016-01-01

Inadequate venous drainage during minimally invasive cardiac surgery becomes most evident when the blood trapped in the pulmonary circulation floods the surgical field. The present study was designed to assess the in vivo performance of new, thinner, virtually wall-less, venous cannulas designed for augmented venous drainage in comparison to traditional thin-wall cannulas. Remote cannulation was realized in 5 bovine experiments (74.0 ± 2.4 kg) with percutaneous venous access over the wire, serial dilation up to 18 F and insertion of either traditional 19 F thin wall, wire-wound cannulas, or through the same access channel, new, thinner, virtually wall-less, braided cannulas designed for augmented venous drainage. A standard minimal extracorporeal circuit set with a centrifugal pump and a hollow fiber membrane oxygenator, but no in-line reservoir was used. One hundred fifty pairs of pump-flow and required pump inlet pressure values were recorded with calibrated pressure transducers and a flowmeter calibrated by a volumetric tank and timer at increasing pump speed from 1500 RPM to 3500 RPM (500-RPM increments). Pump flow accounted for 1.73 ± 0.85 l/min for wall-less versus 1.17 ± 0.45 l/min for thin wall at 1500 RPM, 3.91 ± 0.86 versus 3.23 ± 0.66 at 2500 RPM, 5.82 ± 1.05 versus 4.96 ± 0.81 at 3500 RPM. Pump inlet pressure accounted for 9.6 ± 9.7 mm Hg versus 4.2 ± 18.8 mm Hg for 1500 RPM, -42.4 ± 26.7 versus -123 ± 51.1 at 2500 RPM, and -126.7 ± 55.3 versus -313 ± 116.7 for 3500 RPM. At the well-accepted pump inlet pressure of -80 mm Hg, the new, thinner, virtually wall-less, braided cannulas provide unmatched venous drainage in vivo. Early clinical analyses have confirmed these findings.

Method and apparatus for coupling seismic sensors to a borehole wall

DOEpatents

West, Phillip B.

2005-03-15

A method and apparatus suitable for coupling seismic or other downhole sensors to a borehole wall in high temperature and pressure environments. In one embodiment, one or more metal bellows mounted to a sensor module are inflated to clamp the sensor module within the borehole and couple an associated seismic sensor to a borehole wall. Once the sensing operation is complete, the bellows are deflated and the sensor module is unclamped by deflation of the metal bellows. In a further embodiment, a magnetic drive pump in a pump module is used to supply fluid pressure for inflating the metal bellows using borehole fluid or fluid from a reservoir. The pump includes a magnetic drive motor configured with a rotor assembly to be exposed to borehole fluid pressure including a rotatable armature for driving an impeller and an associated coil under control of electronics isolated from borehole pressure.

Day-and-night glycaemic control with closed-loop insulin delivery versus conventional insulin pump therapy in free-living adults with well controlled type 1 diabetes: an open-label, randomised, crossover study.

PubMed

Bally, Lia; Thabit, Hood; Kojzar, Harald; Mader, Julia K; Qerimi-Hyseni, Jehona; Hartnell, Sara; Tauschmann, Martin; Allen, Janet M; Wilinska, Malgorzata E; Pieber, Thomas R; Evans, Mark L; Hovorka, Roman

2017-04-01

Tight control of blood glucose concentration in people with type 1 diabetes predisposes to hypoglycaemia. We aimed to investigate whether day-and-night hybrid closed-loop insulin delivery can improve glucose control while alleviating the risk of hypoglycaemia in adults with HbA 1c below 7·5% (58 mmol/mol). In this open-label, randomised, crossover study, we recruited adults (aged ≥18 years) with type 1 diabetes and HbA 1c below 7·5% from Addenbrooke's Hospital (Cambridge, UK) and Medical University of Graz (Graz, Austria). After a 2-4 week run-in period, participants were randomly assigned (1:1), using web-based randomly permuted blocks of four, to receive insulin via the day-and-night hybrid closed-loop system or usual pump therapy for 4 weeks, followed by a 2-4 week washout period and then the other intervention for 4 weeks. Treatment interventions were unsupervised and done under free-living conditions. During the closed-loop period, a model-predictive control algorithm directed insulin delivery, and prandial insulin delivery was calculated with a standard bolus wizard. The primary outcome was the proportion of time when sensor glucose concentration was in target range (3·9-10·0 mmol/L) over the 4 week study period. Analyses were by intention to treat. This study is registered with ClinicalTrials.gov, number NCT02727231, and is completed. Between March 21 and June 24, 2016, we recruited 31 participants, of whom 29 were randomised. One participant withdrew during the first closed-loop period because of dissatisfaction with study devices and glucose control. The proportion of time when sensor glucose concentration was in target range was 10·5 percentage points higher (95% CI 7·6-13·4; p<0·0001) during closed-loop delivery compared with usual pump therapy (65·6% [SD 8·1] when participants used usual pump therapy vs 76·2% [6·4] when they used closed-loop). Compared with usual pump therapy, closed-loop delivery also reduced the proportion of time spent in hypoglycaemia: the proportion of time with glucose concentration below 3·5 mmol/L was reduced by 65% (53-74, p<0·0001) and below 2·8 mmol/L by 76% (59-86, p<0·0001). No episodes of serious hypoglycaemia or other serious adverse events occurred. Use of day-and-night hybrid closed-loop insulin delivery under unsupervised, free-living conditions for 4 weeks in adults with type 1 diabetes and HbA 1c below 7·5% is safe and well tolerated, improves glucose control, and reduces hypoglycaemia burden. Larger and longer studies are warranted. Swiss National Science Foundation (P1BEP3_165297), JDRF, UK National Institute for Health Research Cambridge Biomedical Research Centre, and Wellcome Strategic Award (100574/Z/12/Z). 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.

Effect of artificial pancreas systems on glycaemic control in patients with type 1 diabetes: a systematic review and meta-analysis of outpatient randomised controlled trials.

PubMed

Weisman, Alanna; Bai, Johnny-Wei; Cardinez, Marina; Kramer, Caroline K; Perkins, Bruce A

2017-07-01

Closed-loop artificial pancreas systems have been in development for several years, including assessment in numerous varied outpatient clinical trials. We aimed to summarise the efficacy and safety of artificial pancreas systems in outpatient settings and explore the clinical and technical factors that can affect their performance. We did a systematic review and meta-analysis of randomised controlled trials comparing artificial pancreas systems (insulin only or insulin plus glucagon) with conventional pump therapy (continuous subcutaneous insulin infusion [CSII] with blinded continuous glucose monitoring [CGM] or unblinded sensor-augmented pump [SAP] therapy) in adults and children with type 1 diabetes. We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies published from 1946, to Jan 1, 2017. We excluded studies not published in English, those involving pregnant women or participants who were in hospital, and those testing adjunct medications other than glucagon. The primary outcome was the mean difference in percentage of time blood glucose concentration remained in target range (3·9-10 mmol/L or 3·9-8 mmol/L, depending on the study), assessed by random-effects meta-analysis. This study is registered with PROSPERO, number 2015:CRD42015026854. We identified 984 reports; after exclusions, 27 comparisons from 24 studies (23 crossover and one parallel design) including a total of 585 participants (219 in adult studies, 265 in paediatric studies, and 101 in combined studies) were eligible for analysis. Five comparisons assessed dual-hormone (insulin and glucagon), two comparisons assessed both dual-hormone and single-hormone (insulin only), and 20 comparisons assessed single-hormone artificial pancreas systems. Time in target was 12·59% higher with artificial pancreas systems (95% CI 9·02-16·16; p<0·0001), from a weighted mean of 58·21% for conventional pump therapy (I 2 =84%). Dual-hormone artificial pancreas systems were associated with a greater improvement in time in target range compared with single-hormone systems (19·52% [95% CI 15·12-23·91] vs 11·06% [6·94 to 15·18]; p=0·006), although six of seven comparisons compared dual-hormone systems to CSII with blinded CGM, whereas 21 of 22 single-hormone comparisons had SAP as the comparator. Single-hormone studies had higher heterogeneity than dual-hormone studies (I 2 79% vs 66%). Bias assessment characteristics were incompletely reported in 12 of 24 studies, no studies masked participants to the intervention assignment, and masking of outcome assessment was not done in 12 studies and was unclear in 12 studies. Artificial pancreas systems uniformly improved glucose control in outpatient settings, despite heterogeneous clinical and technical factors. None. Copyright © 2017 Elsevier Ltd. All rights reserved.

Thermomechanical piston pump development

NASA Technical Reports Server (NTRS)

Sabelman, E. E.

1971-01-01

A thermally powered reciprocating pump has been devised to replace or augment an electric pump for the transport of temperature-control fluid on the Thermoelectric Outer Planet Spacecraft (TOPS). The thermally powered pump operates cyclically by extracting heat energy from the fluid by means of a vapor-pressure expansion system and by using the heat to perform the mechanical work of pumping. A feasibility test unit has been constructed to provide an output of 7 cu in during a 10- to 100-second cycle. It operates with a fluid input temperature of 200 to 300 F and a heat sink temperature of 0 to 30 F.

Multi-model data fusion to improve an early warning system for hypo-/hyperglycemic events.

PubMed

Botwey, Ransford Henry; Daskalaki, Elena; Diem, Peter; Mougiakakou, Stavroula G

2014-01-01

Correct predictions of future blood glucose levels in individuals with Type 1 Diabetes (T1D) can be used to provide early warning of upcoming hypo-/hyperglycemic events and thus to improve the patient's safety. To increase prediction accuracy and efficiency, various approaches have been proposed which combine multiple predictors to produce superior results compared to single predictors. Three methods for model fusion are presented and comparatively assessed. Data from 23 T1D subjects under sensor-augmented pump (SAP) therapy were used in two adaptive data-driven models (an autoregressive model with output correction - cARX, and a recurrent neural network - RNN). Data fusion techniques based on i) Dempster-Shafer Evidential Theory (DST), ii) Genetic Algorithms (GA), and iii) Genetic Programming (GP) were used to merge the complimentary performances of the prediction models. The fused output is used in a warning algorithm to issue alarms of upcoming hypo-/hyperglycemic events. The fusion schemes showed improved performance with lower root mean square errors, lower time lags, and higher correlation. In the warning algorithm, median daily false alarms (DFA) of 0.25%, and 100% correct alarms (CA) were obtained for both event types. The detection times (DT) before occurrence of events were 13.0 and 12.1 min respectively for hypo-/hyperglycemic events. Compared to the cARX and RNN models, and a linear fusion of the two, the proposed fusion schemes represents a significant improvement.

Augmented reality guidance system for peripheral nerve blocks

NASA Astrophysics Data System (ADS)

Wedlake, Chris; Moore, John; Rachinsky, Maxim; Bainbridge, Daniel; Wiles, Andrew D.; Peters, Terry M.

2010-02-01

Peripheral nerve block treatments are ubiquitous in hospitals and pain clinics worldwide. State of the art techniques use ultrasound (US) guidance and/or electrical stimulation to verify needle tip location. However, problems such as needle-US beam alignment, poor echogenicity of block needles and US beam thickness can make it difficult for the anesthetist to know the exact needle tip location. Inaccurate therapy delivery raises obvious safety and efficacy issues. We have developed and evaluated a needle guidance system that makes use of a magnetic tracking system (MTS) to provide an augmented reality (AR) guidance platform to accurately localize the needle tip as well as its projected trajectory. Five anesthetists and five novices performed simulated nerve block deliveries in a polyvinyl alcohol phantom to compare needle guidance under US alone to US placed in our AR environment. Our phantom study demonstrated a decrease in targeting attempts, decrease in contacting of critical structures, and an increase in accuracy of 0.68 mm compared to 1.34mm RMS in US guidance alone. Currently, the MTS uses 18 and 21 gauge hypodermic needles with a 5 degree of freedom sensor located at the needle tip. These needles can only be sterilized using an ethylene oxide process. In the interest of providing clinicians with a simple and efficient guidance system, we also evaluated attaching the sensor at the needle hub as a simple clip-on device. To do this, we simultaneously performed a needle bending study to assess the reliability of a hub-based sensor.

Augmentation of the posterior maxilla: a proposed hierarchy of treatment selection.

PubMed

Fugazzotto, Paul A

2003-11-01

Literature is reviewed that discusses treatment results following Cauldwel Luc approach sinus augmentation therapy or osteotome sinus augmentation therapy, with and without simultaneous implant placement. A hierarchy of treatment selection for the augmentation of the posterior maxilla, based upon quantity and position of residual alveolar bone crestal to the floor of the sinus, is proposed.

NASA Tech Briefs, April 2002. Volume 26, No. 4

NASA Technical Reports Server (NTRS)

2002-01-01

The contents include: 1) Application Briefs; 2) Sneak Preview of Sensors Expo; 3) The Complexity of the Diagnosis Problem; 4) Design Concepts for the ISS TransHab Module; 5) Characteristics of Supercritical Transitional Mixing Layers; 6) Electrometer for Triboelectric Evaluation of Materials; 7) Infrared CO2 Sensor With Built-In Calibration Chambers; 8) Solid-State Potentiometric CO Sensor; 9) Planetary Rover Absolute Heading Detection Using a Sun Sensor; 10) Concept for Utilizing Full Areas of STJ Photodetector Arrays; 11) Development of Cognitive Sensors; 12) Enabling Higher-Voltage Operation of SOl CMOS Transistors; 13) Estimating Antenna-Pointing Errors From Beam Squints; 14) Advanced-Fatigue-Crack-Growth and Fracture- Mechanics Program; 15) Software for Sequencing Spacecraft Actions; 16) Program Distributes and Tracks Organizational Memoranda; 16) Flat Membrane Device for Dehumidification of Air; 17) Inverted Hindle Mount Reduces Sag of a Large, Precise Mirror; 18) Heart-Pump-Outlet/Cannula Coupling; 19) Externally Triggered Microcapsules Release Drugs In Situ; 20) Combinatorial Drug Design Augmented by Information Theory; 21) Multiple-Path-Length Optical Absorbance Cell; 22) Model of a Fluidized Bed Containing a Mixture of Particles; 23) Refractive Secondary Concentrators for Solar Thermal Systems; 24) Cold Flow Calorimeter; 25) Methodology for Tracking Hazards and Predicting Failures; 26) Estimating Heterodyne-Interferometer Polarization Leakage; 27) An Efficient Algorithm for Propagation of Temporal- Constraint Networks; 28) Software for Continuous Replanning During Execution; 29) Surface-Launched Explorers for Reconnaissance/Scouting; 30) Firmware for a Small Motion-Control Processor; 31) Gear Bearings and Gear-Bearing Transmissions; and 32) Linear Dynamometer With Variable Stroke and Frequency.

Identifiability of Additive Actuator and Sensor Faults by State Augmentation

NASA Technical Reports Server (NTRS)

Joshi, Suresh; Gonzalez, Oscar R.; Upchurch, Jason M.

2014-01-01

A class of fault detection and identification (FDI) methods for bias-type actuator and sensor faults is explored in detail from the point of view of fault identifiability. The methods use state augmentation along with banks of Kalman-Bucy filters for fault detection, fault pattern determination, and fault value estimation. A complete characterization of conditions for identifiability of bias-type actuator faults, sensor faults, and simultaneous actuator and sensor faults is presented. It is shown that FDI of simultaneous actuator and sensor faults is not possible using these methods when all sensors have unknown biases. The fault identifiability conditions are demonstrated via numerical examples. The analytical and numerical results indicate that caution must be exercised to ensure fault identifiability for different fault patterns when using such methods.

Risperidone added to parent training and stimulant medication: effects on attention-deficit/hyperactivity disorder, oppositional defiant disorder, conduct disorder, and peer aggression.

PubMed

Gadow, Kenneth D; Arnold, L Eugene; Molina, Brooke S G; Findling, Robert L; Bukstein, Oscar G; Brown, Nicole V; McNamara, Nora K; Rundberg-Rivera, E Victoria; Li, Xiaobai; Kipp, Heidi L; Schneider, Jayne; Farmer, Cristan A; Baker, Jennifer L; Sprafkin, Joyce; Rice, Robert R; Bangalore, Srihari S; Butter, Eric M; Buchan-Page, Kristin A; Hurt, Elizabeth A; Austin, Adrienne B; Grondhuis, Sabrina N; Aman, Michael G

2014-09-01

In this study, we aimed to expand on our prior research into the relative efficacy of combining parent training, stimulant medication, and placebo (Basic therapy) versus parent training, stimulant, and risperidone (Augmented therapy) by examining treatment effects for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and peer aggression, symptom-induced impairment, and informant discrepancy. Children (6-12 years of age; N = 168) with severe physical aggression, ADHD, and co-occurring ODD/CD received an open trial of parent training and stimulant medication for 3 weeks. Participants failing to show optimal clinical response were randomly assigned to Basic or Augmented therapy for an additional 6 weeks. Compared with Basic therapy, children receiving Augmented therapy experienced greater reduction in parent-rated ODD severity (p = .002, Cohen's d = 0.27) and peer aggression (p = .02, Cohen's d = 0.32) but not ADHD or CD symptoms. Fewer children receiving Augmented (16%) than Basic (40%) therapy were rated by their parents as impaired by ODD symptoms at week 9/endpoint (p = .008). Teacher ratings indicated greater reduction in ADHD severity (p = .02, Cohen's d = 0.61) with Augmented therapy, but not for ODD or CD symptoms or peer aggression. Although both interventions were associated with marked symptom reduction, a relatively large percentage of children were rated as impaired for at least 1 targeted disorder at week 9/endpoint by parents (Basic 47%; Augmented 27%) and teachers (Basic 48%; Augmented 38%). Augmented therapy was superior to Basic therapy in reducing severity of ADHD and ODD symptoms, peer aggression, and symptom-induced impairment, but clinical improvement was generally context specific, and effect sizes ranged from small to moderate. Clinical trial registration information-Treatment of Severe Childhood Aggression (The TOSCA Study); http://clinicaltrials.gov/; NCT00796302. Copyright © 2014 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Performance of a solar augmented heat pump

NASA Astrophysics Data System (ADS)

Bedinger, A. F. G.; Tomlinson, J. J.; Reid, R. L.; Chaffin, D. J.

Performance of a residential size solar augmented heat pump is reported for the 1979-1980 heating season. The facility located in Knoxville, Tennessee, has a measured heat load coefficient of 339.5 watt/C (644 BTU/hr- F). The solar augmented heat pump system consists of 7.4 cu m of one inch diameter crushed limestone. The heat pump is a nominal 8.8 KW (2 1/2 ton) high efficiency unit. The system includes electric resistance heaters to give the option of adding thermal energy to the pebble bed storage during utility off-peak periods, thus offering considerable load management capability. A 15 KW electric resistance duct heater is used to add thermal energy to the pebble bin as required during off-peak periods. Hourly thermal performance and on site weather data was taken for the period November 1, 1979, to April 13, 1980. Thermal performance data consists of heat flow summations for all modes of the system, pebble bed temperatures, and space temperature. Weather data consists of dry bulb temperature, dew point temperature, total global insolation (in the plane of the collector), and wind speed and direction. An error analysis was performed and the least accurate of the measurements was determined to be the heat flow at 5%. Solar system thermal performance factor was measured to be 8.77. The heat pump thermal performance factor was 1.64. Total system seasonal performance factor was measured to be 1.66. Using a modified version of TRNSYS, the thermal performance of this system was simulated. When simulation results were compared with data collected onsite, the predicted heat flow and power consumption generally were within experimental accuracy.

Wave energy patterns of counterpulsation: a novel approach with wave intensity analysis.

PubMed

Lu, Pong-Jeu; Yang, Chi-Fu Jeffrey; Wu, Meng-Yu; Hung, Chun-Hao; Chan, Ming-Yao; Hsu, Tzu-Cheng

2011-11-01

In counterpulsation, diastolic augmentation increases coronary blood flow and systolic unloading reduces left ventricular afterload. We present a new approach with wave intensity analysis to revisit and explain counterpulsation principles. In an acute porcine model, a standard intra-aortic balloon pump was placed in descending aorta in 4 pigs. We measured pressure and velocity with probes in left anterior descending artery and aorta during and without intra-aortic balloon pump assistance. Wave intensities of aortic and left coronary waves were derived from pressure and flow measurements with synchronization correction. We identified predominating waves in counterpulsation. In the aorta, during diastolic augmentation, intra-aortic balloon inflation generated a backward compression wave, with a "pushing" effect toward the aortic root that translated to a forward compression wave into coronary circulation. During systolic unloading, intra-aortic balloon pump deflation generated a backward expansion wave that "sucked" blood from left coronary bed into the aorta. While this backward expansion wave translated to reduced left ventricular afterload, the "sucking" effect resulted in left coronary blood steal, as demonstrated by a forward expansion wave in left anterior descending coronary flow. The waves were sensitive to inflation and deflation timing, with just 25 ms delay from standard deflation timing leading to weaker forward expansion wave and less coronary regurgitation. Intra-aortic balloon pumps generate backward-traveling waves that predominantly drive aortic and coronary blood flow during counterpulsation. Wave intensity analysis of arterial circulations may provide a mechanism to explain diastolic augmentation and systolic unloading of intra-aortic balloon pump counterpulsation. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Advanced helium magnetometer for space applications

NASA Technical Reports Server (NTRS)

Slocum, Robert E.

1987-01-01

The goal of this effort was demonstration of the concepts for an advanced helium magnetometer which meets the demands of future NASA earth orbiting, interplanetary, solar, and interstellar missions. The technical effort focused on optical pumping of helium with tunable solid state lasers. We were able to demonstrate the concept of a laser pumped helium magnetometer with improved accuracy, low power, and sensitivity of the order of 1 pT. A number of technical approaches were investigated for building a solid state laser tunable to the helium absorption line at 1083 nm. The laser selected was an Nd-doped LNA crystal pumped by a diode laser. Two laboratory versions of the lanthanum neodymium hexa-aluminate (LNA) laser were fabricated and used to conduct optical pumping experiments in helium and demonstrate laser pumped magnetometer concepts for both the low field vector mode and the scalar mode of operation. A digital resonance spectrometer was designed and built in order to evaluate the helium resonance signals and observe scalar magnetometer operation. The results indicate that the laser pumped sensor in the VHM mode is 45 times more sensitive than a lamp pumped sensor for identical system noise levels. A study was made of typical laser pumped resonance signals in the conventional magnetic resonance mode. The laser pumped sensor was operated as a scalar magnetometer, and it is concluded that magnetometers with 1 pT sensitivity can be achieved with the use of laser pumping and stable laser pump sources.

Risperidone Added to Parent Training and Stimulant Medication: Effects on Attention-Deficit/Hyperactivity Disorder, Oppositional Defiant Disorder, Conduct Disorder, and Peer Aggression

PubMed Central

Gadow, Kenneth D.; Arnold, L. Eugene; Molina, Brooke S.G.; Findling, Robert L.; Bukstein, Oscar G.; Brown, Nicole V.; McNamara, Nora K.; Rundberg-Rivera, E. Victoria; Li, Xiaobai; Kipp, Heidi; Schneider, Jayne; Farmer, Cristan A.; Baker, Jennifer; Sprafkin, Joyce; Rice, Robert R.; Bangalore, Srihari S.; Butter, Eric M.; Buchan-Page, Kristin A.; Hurt, Elizabeth A.; Austin, Adrienne B.; Grondhuis, Sabrina N.; Aman, Michael G.

2014-01-01

Objective In this study, we aimed to expand on our prior research into the relative efficacy of combining parent training, stimulant medication and placebo (Basic) versus parent training, stimulant, and risperidone (Augmented) therapy by examining treatment effects for attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms and peer aggression, symptom-induced—impairment, and informant discrepancy. Method Children (6-12 years; N=168) with severe physical aggression, ADHD, and co-occurring ODD/CD received an open trial of parent training and stimulant medication for 3 weeks. Participants failing to show optimal clinical response were randomly assigned to Basic or Augmented therapy for an additional 6 weeks. Results Compared with Basic therapy, children receiving Augmented therapy experienced greater reduction in parent-rated ODD severity (p=.02, Cohen's d=0.27) and peer aggression (p=.02, Cohen's d=0.32), but not ADHD or CD symptoms. Fewer children receiving Augmented (16%) than Basic (40%) therapy were rated by their parents as impaired by ODD symptoms at Week 9/endpoint (p=.008). Teacher ratings indicated greater reduction in ADHD severity (p=.02, Cohen's d =0.61) with Augmented therapy, but not for ODD or CD symptoms or peer aggression. Although both interventions were associated with marked symptom reduction, a relatively large percentage of children were rated impaired for at least one targeted disorder at Week 9/endpoint by parents (Basic 47%; Augmented 27%) and teachers (Basic 48%; Augmented 38%). Conclusion Augmented was superior to Basic therapy in reducing severity of ADHD and ODD symptoms, peer aggression, and symptom-induced impairment, but clinical improvement was generally context-specific, and effect sizes ranged from small to moderate. PMID:25151418

On the feasibility of closed-loop control of intra-aortic balloon pumping

NASA Technical Reports Server (NTRS)

Clark, J. W., Jr.; Bourland, H. M.; Kane, G. R.

1973-01-01

A closed-loop control scheme for the control of intra-aortic balloon pumping has been developed and tested in dog experiments. A performance index reflecting the general objectives of balloon-assist pumping is developed and a modified steepest ascent control algorithm is utilized for the selection of a proper operating point for the balloon during its pumping cycle. This paper attempts to indicate the feasibility of closed-loop control of balloon pumping, and particularly its flexibility in achieving both diastolic augmentation of mean aortic pressure and control of the level of end-diastolic pressure (EDP) an important factor in reducing heart work.

An Expert Opinion on Advanced Insulin Pump Use in Youth with Type 1 Diabetes.

PubMed

Bode, Bruce W; Kaufman, Francine R; Vint, Nan

2017-03-01

Among children and adolescents with type 1 diabetes mellitus, the use of insulin pump therapy has increased since its introduction in the early 1980s. Optimal management of type 1 diabetes mellitus depends on sufficient understanding by patients, their families, and healthcare providers on how to use pump technology. The goal for the use of insulin pump therapy should be to advance proficiency over time from the basics taught at the initiation of pump therapy to utilizing advanced settings to obtain optimal glycemic control. However, this goal is often not met, and appropriate understanding of the full features of pump technology can be lacking. The objective of this review is to provide an expert perspective on the advanced features and use of insulin pump therapy, including practical guidelines for the successful use of insulin pump technology, and other considerations specific to patients and healthcare providers.

NASA Tech Briefs, January 2004

NASA Technical Reports Server (NTRS)

2004-01-01

Topics covered include: Multisensor Instrument for Real-Time Biological Monitoring; Sensor for Monitoring Nanodevice-Fabrication Plasmas; Backed Bending Actuator; Compact Optoelectronic Compass; Micro Sun Sensor for Spacecraft; Passive IFF: Autonomous Nonintrusive Rapid Identification of Friendly Assets; Finned-Ladder Slow-Wave Circuit for a TWT; Directional Radio-Frequency Identification Tag Reader; Integrated Solar-Energy-Harvesting and -Storage Device; Event-Driven Random-Access-Windowing CCD Imaging System; Stroboscope Controller for Imaging Helicopter Rotors; Software for Checking State-charts; Program Predicts Broadband Noise from a Turbofan Engine; Protocol for a Delay-Tolerant Data-Communication Network; Software Implements a Space-Mission File-Transfer Protocol; Making Carbon-Nanotube Arrays Using Block Copolymers: Part 2; Modular Rake of Pitot Probes; Preloading To Accelerate Slow-Crack-Growth Testing; Miniature Blimps for Surveillance and Collection of Samples; Hybrid Automotive Engine Using Ethanol-Burning Miller Cycle; Fabricating Blazed Diffraction Gratings by X-Ray Lithography; Freeze-Tolerant Condensers; The StarLight Space Interferometer; Champagne Heat Pump; Controllable Sonar Lenses and Prisms Based on ERFs; Measuring Gravitation Using Polarization Spectroscopy; Serial-Turbo-Trellis-Coded Modulation with Rate-1 Inner Code; Enhanced Software for Scheduling Space-Shuttle Processing; Bayesian-Augmented Identification of Stars in a Narrow View; Spacecraft Orbits for Earth/Mars-Lander Radio Relay; and Self-Inflatable/Self-Rigidizable Reflectarray Antenna.

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

PubMed

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

2014-07-01

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

Flashback Detection Sensor for Hydrogen Augmented Natural Gas Combustion

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

Thornton, J.D.; Chorpening, B.T.; Sidwell, T.

2007-05-01

The use of hydrogen augmented fuel is being investigated by various researchers as a method to extend the lean operating limit, and potentially reduce thermal NOx formation in natural gas fired lean premixed (LPM) combustion systems. The resulting increase in flame speed during hydrogen augmentation, however, increases the propensity for flashback in LPM systems. Real-time in-situ monitoring of flashback is important for the development of control strategies for use of hydrogen augmented fuel in state-of-the-art combustion systems, and for the development of advanced hydrogen combustion systems. The National Energy Technology Laboratory (NETL) and Woodward Industrial Controls are developing a combustionmore » control and diagnostics sensor (CCADS), which has already been demonstrated as a useful sensor for in-situ monitoring of natural gas combustion, including detection of important combustion events such as flashback and lean blowoff. Since CCADS is a flame ionization sensor technique, the low ion concentration produced in pure hydrogen combustion raises concerns of whether CCADS can be used to monitor flashback in hydrogen augmented combustion. This paper discusses CCADS tests conducted at 0.2-0.6 MPa (2-6 atm), demonstrating flashback detection with fuel compositions up to 80% hydrogen (by volume) mixed with natural gas. NETL’s Simulation Validation (SimVal) combustor offers full optical access to pressurized combustion during these tests. The CCADS data and high-speed video show the reaction zone moves upstream into the nozzle as the hydrogen fuel concentration increases, as is expected with the increased flame speed of the mixture. The CCADS data and video also demonstrate the opportunity for using CCADS to provide the necessary in-situ monitor to control flashback and lean blowoff in hydrogen augmented combustion applications.« less

Race, socioeconomic status, and treatment center are associated with insulin pump therapy in youth in the first year following diagnosis of type 1 diabetes

USDA-ARS?s Scientific Manuscript database

Increasing numbers of children and adolescents with type 1 diabetes (T1D) have been placed on insulin pump therapy. Nevertheless, data are limited regarding patterns of pump use during the first year of treatment and the clinical and socioeconomic factors associated with early use of pump therapy. T...

Terbutaline pump maintenance therapy after threatened preterm labour for reducing adverse neonatal outcomes.

PubMed

Chawanpaiboon, Saifon; Laopaiboon, Malinee; Lumbiganon, Pisake; Sangkomkamhang, Ussanee S; Dowswell, Therese

2014-03-23

After successful inhibition of threatened preterm labour women are at high risk of recurrent preterm labour. Terbutaline pump maintenance therapy has been used to reduce adverse neonatal outcomes. This review replaces an earlier Cochrane review, published in 2002, which is no longer being updated by the team. To determine the effectiveness of terbutaline pump maintenance therapy after threatened preterm labour in reducing adverse neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 January 2014) and reference lists of retrieved studies. Randomised controlled trials comparing terbutaline pump therapy with alternative therapy, placebo, or no therapy after arrest of threatened preterm labour. Two review authors independently assessed the studies for inclusion and then extracted data as eligible for inclusion in qualitative and quantitative synthesis (meta-analysis). Four studies were included with a total of 234 women randomised. The overall methodological quality of the included studies was mixed; two studies provided very little information on study methods, there was high sample attrition in one study and in three studies the risk of performance bias was high. We found no strong evidence that terbutaline maintenance therapy offered any advantages over saline placebo or oral terbutaline maintenance therapy in reducing adverse neonatal outcomes by prolonging pregnancy among women with arrested preterm labour. The mean difference (MD) for gestational age at birth was -0.14 weeks (95% confidence interval (CI) -1.66 to 1.38) for terbutaline pump therapy compared with saline placebo pump for two trials combined. One trial reported a risk ratio (RR) of 1.17 (95% CI 0.79 to 1.73) for preterm birth (less than 37 completed weeks) and a RR of 0.97 (95% CI 0.51 to 1.84) of very preterm birth (less than 34 completed weeks) for terbutaline pump compared with saline placebo pump. We found no evidence that terbutaline pump therapy was associated with statistically significant reductions in infant respiratory distress syndrome, or neonatal intensive care unit admission compared with placebo. Compared with oral terbutaline, we found no evidence that pump therapy increased the rate of therapy continuation, or reduced the rate of infant complications or maternal hospital re-admissions. One study suggested that pump therapy resulted in significantly increased weekly cost/woman, $580 versus $12.50 (P < 0.01). No data were reported on long-term infant outcomes. We found no evidence that terbutaline pump maintenance therapy decreased adverse neonatal outcomes. Taken together with the lack of evidence of benefit, its substantial expense and the lack of information on the safety of the therapy do not support its use in the management of arrested preterm labour. Future use should only be in the context of well-conducted, adequately powered randomised controlled trials.

Continuous subcutaneous insulin infusion therapy for Type 1 diabetes mellitus in children.

PubMed

Mavinkurve, M; Quinn, A; O'Gorman, C S

2016-05-01

Continuous subcutaneous insulin pump therapy (CSII or pump therapy) is a well-recognised treatment option for Type 1 diabetes mellitus (T1DM) in paediatrics. It is especially suited to children because it optimises control by improving flexibility across age-specific lifestyles. The NICE guidelines (2008) recognise that pump therapy is advantageous and that it should be utilised to deliver best practice. In Ireland, the National Clinical Program for Diabetes will increase the availability and uptake of CSII in children and thus more clinicians are likely to encounter children using CSII therapy. This is a narrative review which discusses the basic principles of pump therapy and focuses on aspects of practical management. Insulin pump management involves some basic yet important principles which optimise the care of diabetes in children. This review addresses the principles of insulin pump management in children which all health care professionals involved in caring for the child with diabetes, shoud be familiar with.

Augmentation of UK Space Debris Observing Capabilities Using Univiersity Optical Telescopes

NASA Astrophysics Data System (ADS)

Herridge, Philip; Brown, David; Crowther, Richard

2013-08-01

The study of space debris requires a range of different sensors. Debris population monitoring requires survey, follow-on and characterisation capable sensors. In order to fully participate in space debris measurement the range of sensors available to the UK Space Agency needs to be augmented with additional capability. One source of untapped resource resides within the UK university sector. This paper discusses investigation into extending the optical sensor diversity available to the UK for participation in study of the debris environment through a collaboration between Space Insight Limited, a commercial company providing Space Situational Awareness (SSA) services to the UK Space Agency, and the Astronomy Group at the University of St Andrews.

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

PubMed

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

2016-05-01

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

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

PubMed Central

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

2016-01-01

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

Optical Sensors Using Stimulated Brillouin Scattering

NASA Technical Reports Server (NTRS)

Christensen, Caleb A (Inventor); Zavriyev, Anton (Inventor)

2017-01-01

A method for enhancing a sensitivity of an optical sensor having an optical cavity counter-propagates beams of pump light within the optical cavity to produce scattered light based on Stimulated Brillouin Scattering (SBS). The properties of the pump light are selected to generate fast-light conditions for the scattered light, such that the scattered light includes counter-propagating beams of fast light. The method prevents the pump light from resonating within the optical cavity, while allowing the scattered light to resonate within the optical cavity. At least portions of the scattered light are interfered outside of the optical cavity to produce a beat note for a measurement of the optical sensor. The disclosed method is particularly applicable to optical gyroscopes.

Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes.

PubMed

Karges, Beate; Schwandt, Anke; Heidtmann, Bettina; Kordonouri, Olga; Binder, Elisabeth; Schierloh, Ulrike; Boettcher, Claudia; Kapellen, Thomas; Rosenbauer, Joachim; Holl, Reinhard W

2017-10-10

Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. To determine whether rates of severe hypoglycemia and diabetic ketoacidosis are lower with insulin pump therapy compared with insulin injection therapy in children, adolescents, and young adults with type 1 diabetes. Population-based cohort study conducted between January 2011 and December 2015 in 446 diabetes centers participating in the Diabetes Prospective Follow-up Initiative in Germany, Austria, and Luxembourg. Patients with type 1 diabetes younger than 20 years and diabetes duration of more than 1 year were identified. Propensity score matching and inverse probability of treatment weighting analyses with age, sex, diabetes duration, migration background (defined as place of birth outside of Germany or Austria), body mass index, and glycated hemoglobin as covariates were used to account for relevant confounders. Type 1 diabetes treated with insulin pump therapy or with multiple (≥4) daily insulin injections. Primary outcomes were rates of severe hypoglycemia and diabetic ketoacidosis during the most recent treatment year. Secondary outcomes included glycated hemoglobin levels, insulin dose, and body mass index. Of 30 579 patients (mean age, 14.1 years [SD, 4.0]; 53% male), 14 119 used pump therapy (median duration, 3.7 years) and 16 460 used insulin injections (median duration, 3.6 years). Patients using pump therapy (n = 9814) were matched with 9814 patients using injection therapy. Pump therapy, compared with injection therapy, was associated with lower rates of severe hypoglycemia (9.55 vs 13.97 per 100 patient-years; difference, -4.42 [95% CI, -6.15 to -2.69]; P < .001) and diabetic ketoacidosis (3.64 vs 4.26 per 100 patient-years; difference, -0.63 [95% CI, -1.24 to -0.02]; P = .04). Glycated hemoglobin levels were lower with pump therapy than with injection therapy (8.04% vs 8.22%; difference, -0.18 [95% CI, -0.22 to -0.13], P < .001). Total daily insulin doses were lower for pump therapy compared with injection therapy (0.84 U/kg vs 0.98 U/kg; difference, -0.14 [-0.15 to -0.13], P < .001). There was no significant difference in body mass index between both treatment regimens. Similar results were obtained after propensity score inverse probability of treatment weighting analyses in the entire cohort. Among young patients with type 1 diabetes, insulin pump therapy, compared with insulin injection therapy, was associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and with better glycemic control during the most recent year of therapy. These findings provide evidence for improved clinical outcomes associated with insulin pump therapy compared with injection therapy in children, adolescents, and young adults with type 1 diabetes.

Cardiac cycle-synchronized electrical muscle stimulator for lower limb training with the potential to reduce the heart's pumping workload

PubMed Central

Matsuse, Hiroo; Akimoto, Ryuji; Kamiya, Shiro; Moritani, Toshio; Sasaki, Motoki; Ishizaki, Yuta; Ohtsuka, Masanori; Nakayoshi, Takaharu; Ueno, Takafumi; Shiba, Naoto; Fukumoto, Yoshihiro

2017-01-01

Background The lower limb muscle may play an important role in decreasing the heart’s pumping workload. Aging and inactivity cause atrophy and weakness of the muscle, leading to a loss of the heart-assisting role. An electrical lower limb muscle stimulator can prevent atrophy and weakness more effectively than conventional resistance training; however, it has been reported to increase the heart’s pumping workload in some situations. Therefore, more effective tools should be developed. Methods We newly developed a cardiac cycle-synchronized electrical lower limb muscle stimulator by combining a commercially available electrocardiogram monitor and belt electrode skeletal muscle electrical stimulator, making it possible to achieve strong and wide but not painful muscle contractions. Then, we tested the stimulator in 11 healthy volunteers to determine whether the special equipment enabled lower limb muscle training without harming the hemodynamics using plethysmography and a percutaneous cardiac output analyzer. Results In 9 of 11 subjects, the stimulator generated diastolic augmentation waves on the dicrotic notches and end-diastolic pressure reduction waves on the plethysmogram waveforms of the brachial artery, showing analogous waveforms in the intra-aortic balloon pumping heart-assisting therapy. The heart rate, stroke volume, and cardiac output significantly increased during the stimulation. There was no change in the systolic or diastolic blood pressure during the stimulation. Conclusion Cardiac cycle-synchronized electrical muscle stimulation for the lower limbs may enable muscle training without harmfully influencing the hemodynamics and with a potential to reduce the heart’s pumping workload, suggesting a promising tool for effectively treating both locomotor and cardiovascular disorders. PMID:29117189

Oxygen concentration sensor for an internal combustion engine

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

Nakajima, T.; Okada, Y.; Mieno, T.

1988-09-29

This patent describes an oxygen concentration sensor, comprising: an oxygen ion conductive solid electrolyte member forming a gas diffusion restricted region into which a measuring gas is introduced; a pair of electrodes sandwiching the solid electrolyte member; pump current supply means applying a pump voltage to the pair of electrodes through a current detection element to generate a pump current; and a heater element connected to the solid electrolyte member for heating the solid electrolyte member for heating the solid electrolyte member when a heater current is supplied from a heater current source; wherein the oxygen concentration sensor detects anmore » oxygen concentration in the measuring gas in terms of a current value of the pump current supplied through the current detection element and controls oxygen concentration in the gas diffusion restricted region by conducting oxygen ions through the solid electrolyte member in accordance to the flow of the pump current; and wherein the current detection element is connected to the electrode of the pair of electrodes facing the gas diffusion restricted region for insuring that the current value is representative of the pump current and possible leakage current from the heater current.« less

Scalable Deployment of Advanced Building Energy Management Systems

DTIC Science & Technology

2013-05-01

150  Figure J.5 Sensor Schema...151  Figure J.6 Temperature Sensor Schema...augments an existing BMS with additional sensors /meters and uses a reduced-order model and diagnostic software to make performance deviations visible

A fault isolation method based on the incidence matrix of an augmented system

NASA Astrophysics Data System (ADS)

Chen, Changxiong; Chen, Liping; Ding, Jianwan; Wu, Yizhong

2018-03-01

A new approach is proposed for isolating faults and fast identifying the redundant sensors of a system in this paper. By introducing fault signal as additional state variable, an augmented system model is constructed by the original system model, fault signals and sensor measurement equations. The structural properties of an augmented system model are provided in this paper. From the viewpoint of evaluating fault variables, the calculating correlations of the fault variables in the system can be found, which imply the fault isolation properties of the system. Compared with previous isolation approaches, the highlights of the new approach are that it can quickly find the faults which can be isolated using exclusive residuals, at the same time, and can identify the redundant sensors in the system, which are useful for the design of diagnosis system. The simulation of a four-tank system is reported to validate the proposed method.

Platform for a Hydrocarbon Exhaust Gas Sensor Utilizing a Pumping Cell and a Conductometric Sensor

PubMed Central

Biskupski, Diana; Geupel, Andrea; Wiesner, Kerstin; Fleischer, Maximilian; Moos, Ralf

2009-01-01

Very often, high-temperature operated gas sensors are cross-sensitive to oxygen and/or they cannot be operated in oxygen-deficient (rich) atmospheres. For instance, some metal oxides like Ga2O3 or doped SrTiO3 are excellent materials for conductometric hydrocarbon detection in the rough atmosphere of automotive exhausts, but have to be operated preferably at a constant oxygen concentration. We propose a modular sensor platform that combines a conductometric two-sensor-setup with an electrochemical pumping cell made of YSZ to establish a constant oxygen concentration in the ambient of the conductometric sensor film. In this paper, the platform is introduced, the two-sensor-setup is integrated into this new design, and sensing performance is characterized. Such a platform can be used for other sensor principles as well. PMID:22423212

Augmented Feedback System to Support Physical Therapy of Non-specific Low Back Pain

NASA Astrophysics Data System (ADS)

Brodbeck, Dominique; Degen, Markus; Stanimirov, Michael; Kool, Jan; Scheermesser, Mandy; Oesch, Peter; Neuhaus, Cornelia

Low back pain is an important problem in industrialized countries. Two key factors limit the effectiveness of physiotherapy: low compliance of patients with repetitive movement exercises, and inadequate awareness of patients of their own posture. The Backtrainer system addresses these problems by real-time monitoring of the spine position, by providing a framework for most common physiotherapy exercises for the low back, and by providing feedback to patients in a motivating way. A minimal sensor configuration was identified as two inertial sensors that measure the orientation of the lower back at two points with three degrees of freedom. The software was designed as a flexible platform to experiment with different hardware, and with various feedback modalities. Basic exercises for two types of movements are provided: mobilizing and stabilizing. We developed visual feedback - abstract as well as in the form of a virtual reality game - and complemented the on-screen graphics with an ambient feedback device. The system was evaluated during five weeks in a rehabilitation clinic with 26 patients and 15 physiotherapists. Subjective satisfaction of subjects was good, and we interpret the results as encouraging indication for the adoption of such a therapy support system by both patients and therapists.

Impeller behavior and displacement of the VentrAssist implantable rotary blood pump.

PubMed

Chung, Michael K H; Zhang, Nong; Tansley, Geoff D; Woodard, John C

2004-03-01

The VentrAssist implantable rotary blood pump, intended for long-term ventricular assist, is under development and is currently being tested for its rotor-dynamic stability. The pump is of the centrifugal type and consists of a shaftless impeller, also acting as the rotor of the brushless DC motor. The impeller remains passively suspended in the pump cavity by hydrodynamic forces, resulting from the small clearances between the impeller outside surfaces and the pump cavity. In the older version of the pump tested, these small clearances range from approximately 50 microm to 230 microm; the displacement of the impeller relative to the pump cavity is unknown in use. This article presents two experiments: the first measured displacement of the impeller using eddy-current proximity sensors and laser proximity sensors. The second experiment used Hall-effect proximity sensors to measure the displacement of the impeller relative to the pump cavity. All transducers were calibrated prior to commencement of the experiments. Voltage output from the transducers was converted into impeller movement in five degrees of freedom (x, y, z, theta(x), and theta(y)). The sixth degree of freedom, the rotation about the impeller axis (theta(z)), was determined by the commutation performed by the motor controller. The impeller displacement was found to be within the acceptable range of 8 micro m to 222 microm, avoiding blood damage and contact between the impeller and cavity walls. Thus the impeller was hydrodynamically suspended within the pump cavity and results were typical of centrifugal pump behavior. This research will be the basis for further investigation into the stiffness and damping coefficient of the pump's hydrodynamic bearing.

A power management system for energy harvesting and wireless sensor networks application based on a novel charge pump circuit

NASA Astrophysics Data System (ADS)

Aloulou, R.; De Peslouan, P.-O. Lucas; Mnif, H.; Alicalapa, F.; Luk, J. D. Lan Sun; Loulou, M.

2016-05-01

Energy Harvesting circuits are developed as an alternative solution to supply energy to autonomous sensor nodes in Wireless Sensor Networks. In this context, this paper presents a micro-power management system for multi energy sources based on a novel design of charge pump circuit to allow the total autonomy of self-powered sensors. This work proposes a low-voltage and high performance charge pump (CP) suitable for implementation in standard complementary metal oxide semiconductor (CMOS) technologies. The CP design was implemented using Cadence Virtuoso with AMS 0.35μm CMOS technology parameters. Its active area is 0.112 mm2. Consistent results were obtained between the measured findings of the chip testing and the simulation results. The circuit can operate with an 800 mV supply and generate a boosted output voltage of 2.835 V with 1 MHz as frequency.

Identifiability of Additive, Time-Varying Actuator and Sensor Faults by State Augmentation

NASA Technical Reports Server (NTRS)

Upchurch, Jason M.; Gonzalez, Oscar R.; Joshi, Suresh M.

2014-01-01

Recent work has provided a set of necessary and sucient conditions for identifiability of additive step faults (e.g., lock-in-place actuator faults, constant bias in the sensors) using state augmentation. This paper extends these results to an important class of faults which may affect linear, time-invariant systems. In particular, the faults under consideration are those which vary with time and affect the system dynamics additively. Such faults may manifest themselves in aircraft as, for example, control surface oscillations, control surface runaway, and sensor drift. The set of necessary and sucient conditions presented in this paper are general, and apply when a class of time-varying faults affects arbitrary combinations of actuators and sensors. The results in the main theorems are illustrated by two case studies, which provide some insight into how the conditions may be used to check the theoretical identifiability of fault configurations of interest for a given system. It is shown that while state augmentation can be used to identify certain fault configurations, other fault configurations are theoretically impossible to identify using state augmentation, giving practitioners valuable insight into such situations. That is, the limitations of state augmentation for a given system and configuration of faults are made explicit. Another limitation of model-based methods is that there can be large numbers of fault configurations, thus making identification of all possible configurations impractical. However, the theoretical identifiability of known, credible fault configurations can be tested using the theorems presented in this paper, which can then assist the efforts of fault identification practitioners.

Immune Response Augmentation in Metastasized Breast Cancer by Localized Therapy Utilizing Biocompatible Magnetic Fluids

DTIC Science & Technology

2008-08-01

SUBJECT TERMS Cancer therapy by localized immune response, Magneto -rehological Fluids 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT...Metastasized Breast Cancer by Localized Therapy utilizing Biocompatible Magnetic Fluids PRINCIPAL INVESTIGATOR: Cahit Evrensel...2008 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Immune Response Augmentation in Metastasized Breast Cancer by Localized Therapy utilizing

Effectiveness of SmartGuard Technology in the Prevention of Nocturnal Hypoglycemia After Prolonged Physical Activity.

PubMed

Petruzelkova, Lenka; Pickova, Klara; Sumnik, Zdenek; Soupal, Jan; Obermannova, Barbora

2017-05-01

The prevention of postexercise nocturnal hypoglycemia after prolonged physical activity using sensor-augmented pump (SAP) therapy with predictive low-glucose management (PLGM) has not been well studied. We conducted a study at a pediatric diabetes camp to determine whether a SAP with PLGM reduces the frequency of nocturnal hypoglycemia after prolonged physical activity more effectively than a SAP with a carbohydrate intake algorithm. During a 1-week sport camp, 20 children (aged 10-13 years) with type 1 diabetes (T1D) managed by SAP therapy either with (n = 7) or without PLGM (n = 13) were studied. The hypoglycemia management strategy and the continuous glucose monitoring (CGM)/PLGM settings were standardized. The incidence, severity, and duration of hypoglycemia and carbohydrate intake were documented and compared. The PLGM system was activated on 78% of all nights (once per night on average). No difference was found between the SAP and PLGM groups in the mean overnight glucose curve or mean morning glucose (7.8 ± 2 mmol/L vs. 7.4 ± 3 mmol/L). There was no difference in the frequency and severity of hypoglycemia. However, the SAP group consumed significantly more carbohydrates to prevent and treat hypoglycemia than those in the PLGM group; the values were 10 ± 2 and 1 ± 2 gS (P < 0.0001) in the SAP and PLGM groups, respectively. Moreover, the SAP group spent a significantly longer time in hypoglycemia (64 ± 2 min vs. 38 ± 2 min, P < 0.05). We observed a difference in the time distribution of nocturnal hypoglycemia (10 to 12 p.m. in the PLGM group and 3 to 7 a.m. in the SAP group, P < 0.05). With PLGM system, euglycemia after prolonged physical activity was largely maintained with a minimal carbohydrate intake.

Outpatient Closed-Loop Control with Unannounced Moderate Exercise in Adolescents Using Zone Model Predictive Control

PubMed Central

Huyett, Lauren M.; Ly, Trang T.; Forlenza, Gregory P.; Reuschel-DiVirgilio, Suzette; Messer, Laurel H.; Wadwa, R. Paul; Gondhalekar, Ravi; Doyle, Francis J.; Pinsker, Jordan E.; Maahs, David M.; Buckingham, Bruce A.

2017-01-01

Abstract Background: The artificial pancreas (AP) has the potential to improve glycemic control in adolescents. This article presents the first evaluation in adolescents of the Zone Model Predictive Control and Health Monitoring System (ZMPC+HMS) AP algorithms, and their first evaluation in a supervised outpatient setting with frequent exercise. Materials and Methods: Adolescents with type 1 diabetes underwent 3 days of closed-loop control (CLC) in a hotel setting with the ZMPC+HMS algorithms on the Diabetes Assistant platform. Subjects engaged in twice-daily exercise, including soccer, tennis, and bicycling. Meal size (unrestricted) was estimated and entered into the system by subjects to trigger a bolus, but exercise was not announced. Results: Ten adolescents (11.9–17.7 years) completed 72 h of CLC, with data on 95 ± 14 h of sensor-augmented pump (SAP) therapy before CLC as a comparison to usual therapy. The percentage of time with continuous glucose monitor (CGM) 70–180 mg/dL was 71% ± 10% during CLC, compared to 57% ± 16% during SAP (P = 0.012). Nocturnal control during CLC was safe, with 0% (0%, 0.6%) of time with CGM <70 mg/dL compared to 1.1% (0.0%, 14%) during SAP. Despite large meals (estimated up to 120 g carbohydrate), only 8.0% ± 6.9% of time during CLC was spent with CGM >250 mg/dL (16% ± 14% during SAP). The system remained connected in CLC for 97% ± 2% of the total study time. No adverse events or severe hypoglycemia occurred. Conclusions: The use of the ZMPC+HMS algorithms is feasible in the adolescent outpatient environment and achieved significantly more time in the desired glycemic range than SAP in the face of unannounced exercise and large announced meal challenges. PMID:28459617

Effect of Continuous Glucose Monitoring on Glycemic Control, Acute Admissions, and Quality of Life: A Real-World Study.

PubMed

Charleer, Sara; Mathieu, Chantal; Nobels, Frank; De Block, Christophe; Radermecker, Regis P; Hermans, Michel P; Taes, Youri; Vercammen, Chris; T'Sjoen, Guy; Crenier, Laurent; Fieuws, Steffen; Keymeulen, Bart; Gillard, Pieter

2018-03-01

Randomized controlled trials evaluating real-time continuous glucose monitoring (RT-CGM) patients with type 1 diabetes (T1D) show improved glycemic control, but limited data are available on real-world use. To assess impact of RT-CGM in real-world settings on glycemic control, hospital admissions, work absenteeism, and quality of life (QOL). Prospective, observational, multicenter, cohort study. A total of 515 adults with T1D on continuous subcutaneous insulin infusion (CSII) therapy starting in the Belgian RT-CGM reimbursement program. Initiation of RT-CGM reimbursement. Hemoglobin A1c (HbA1c) evolution from baseline to 12 months. Between September 1, 2014, and December 31, 2016, 515 adults entered the reimbursement system. Over this period, 417 (81%) patients used RT-CGM for at least 12 months. Baseline HbA1c was 7.7 ± 0.9% (61 ± 9.8 mmol/mol) and decreased to 7.4 ± 0.8% (57 ± 8.7 mmol/mol) at 12 months (P < 0.0001). Subjects who started RT-CGM because of insufficient glycemic control showed stronger decrease in HbA1c at 4, 8, and 12 months compared with patients who started because of hypoglycemia or pregnancy. In the year preceding reimbursement, 16% of patients were hospitalized for severe hypoglycemia or ketoacidosis in contrast to 4% (P < 0.0005) the following year, with decrease in admission days from 54 to 18 per 100 patient years (P < 0.0005). In the same period, work absenteeism decreased and QOL improved significantly, with strong decline in fear of hypoglycemia. Sensor-augmented pump therapy in patients with T1D followed in specialized centers improves HbA1c, fear of hypoglycemia, and QOL, whereas work absenteeism and admissions for acute diabetes complications decreased.

Novel diode laser-based sensors for gas sensing applications

NASA Technical Reports Server (NTRS)

Tittel, F. K.; Lancaster, D. G.; Richter, D.

2000-01-01

The development of compact spectroscopic gas sensors and their applications to environmental sensing will be described. These sensors employ mid-infrared difference-frequency generation (DFG) in periodically poled lithium niobate (PPLN) crystals pumped by two single-frequency solid state lasers such as diode lasers, diode-pumped solid state, and fiber lasers. Ultrasensitive, highly selective, and real-time measurements of several important atmospheric trace gases, including carbon monoxide, nitrous oxide, carbon dioxide, formaldehyde [correction of formaldehye], and methane, have been demonstrated.

Association of Insulin Pump Therapy vs Insulin Injection Therapy With Severe Hypoglycemia, Ketoacidosis, and Glycemic Control Among Children, Adolescents, and Young Adults With Type 1 Diabetes

PubMed Central

Karges, Beate; Schwandt, Anke; Heidtmann, Bettina; Kordonouri, Olga; Binder, Elisabeth; Schierloh, Ulrike; Boettcher, Claudia; Kapellen, Thomas; Rosenbauer, Joachim; Holl, Reinhard W.

2017-01-01

Importance Insulin pump therapy may improve metabolic control in young patients with type 1 diabetes, but the association with short-term diabetes complications is unclear. Objective To determine whether rates of severe hypoglycemia and diabetic ketoacidosis are lower with insulin pump therapy compared with insulin injection therapy in children, adolescents, and young adults with type 1 diabetes. Design, Setting, and Participants Population-based cohort study conducted between January 2011 and December 2015 in 446 diabetes centers participating in the Diabetes Prospective Follow-up Initiative in Germany, Austria, and Luxembourg. Patients with type 1 diabetes younger than 20 years and diabetes duration of more than 1 year were identified. Propensity score matching and inverse probability of treatment weighting analyses with age, sex, diabetes duration, migration background (defined as place of birth outside of Germany or Austria), body mass index, and glycated hemoglobin as covariates were used to account for relevant confounders. Exposures Type 1 diabetes treated with insulin pump therapy or with multiple (≥4) daily insulin injections. Main Outcomes and Measures Primary outcomes were rates of severe hypoglycemia and diabetic ketoacidosis during the most recent treatment year. Secondary outcomes included glycated hemoglobin levels, insulin dose, and body mass index. Results Of 30 579 patients (mean age, 14.1 years [SD, 4.0]; 53% male), 14 119 used pump therapy (median duration, 3.7 years) and 16 460 used insulin injections (median duration, 3.6 years). Patients using pump therapy (n = 9814) were matched with 9814 patients using injection therapy. Pump therapy, compared with injection therapy, was associated with lower rates of severe hypoglycemia (9.55 vs 13.97 per 100 patient-years; difference, −4.42 [95% CI, −6.15 to −2.69]; P < .001) and diabetic ketoacidosis (3.64 vs 4.26 per 100 patient-years; difference, −0.63 [95% CI, −1.24 to −0.02]; P = .04). Glycated hemoglobin levels were lower with pump therapy than with injection therapy (8.04% vs 8.22%; difference, −0.18 [95% CI, −0.22 to −0.13], P < .001). Total daily insulin doses were lower for pump therapy compared with injection therapy (0.84 U/kg vs 0.98 U/kg; difference, −0.14 [−0.15 to −0.13], P < .001). There was no significant difference in body mass index between both treatment regimens. Similar results were obtained after propensity score inverse probability of treatment weighting analyses in the entire cohort. Conclusions and Relevance Among young patients with type 1 diabetes, insulin pump therapy, compared with insulin injection therapy, was associated with lower risks of severe hypoglycemia and diabetic ketoacidosis and with better glycemic control during the most recent year of therapy. These findings provide evidence for improved clinical outcomes associated with insulin pump therapy compared with injection therapy in children, adolescents, and young adults with type 1 diabetes. PMID:29049584

Significant Effect of Valproate Augmentation Therapy in Patients With Schizophrenia

PubMed Central

Tseng, Ping-Tao; Chen, Yen-Wen; Chung, Weilun; Tu, Kun-Yu; Wang, Hung-Yu; Wu, Ching-Kuan; Lin, Pao-Yen

2016-01-01

Abstract Valproate is an anticonvulsant, which is also widely used for treating psychiatric disorders. Some clinical trials have demonstrated benefits of valproate augmentation therapy in schizophrenia. Previous meta-analysis showed inconsistent findings because of limited literature at that time. The aim of this study is to update the newer published data by conducting a meta-analysis of clinical efficacy of valproate augmentation therapy in patients with schizophrenia or schizoaffective disorder. Data sources include electronic research through platform of PubMed. Study eligibility criteria, participants, and interventions were as follows: the inclusion criteria included articles discussing comparisons of the treatment effect in schizophrenic patients treated with antipsychotic augmented with valproate and antipsychotics with/without placebo; articles on clinical trials in humans. The exclusion criteria were case reports or series and nonclinical trials. We compared the effect between antipsychotic treatment with valproate augmentation and antipsychotic monotherapy. Data from clinical trials were pooled by random-effects model, and possible confounding variables were examined through meta-regression and subgroup analysis. Data from 11 articles including 889 patients were included into current meta-analysis. We found patients treated with antipsychotics with valproate augmentation showed significantly more improvement in total psychopathology than those treated with antipsychotics only (P = 0.02). Results from open trials, but not from randomized controlled trials (P = 0.20), showed significant improvement (P = 0.01). In addition, the significance only persisted in the studies conducted with a shorter treatment duration (P < 0.001) rather than longer treatment duration (P = 0.23). There is no difference in the dropout rate between valproate augmentation and antipsychotic treatment only (P = 0.14). We could not perform a detailed meta-analysis for every category of antipsychotics, long-term effect, and safety profiles of valproate augmentation therapy in maintenance treatment, safety in pregnant patients, and subtype of schizophrenia. Our meta-analysis highlights the significantly better treatment effect with valproate augmentation therapy in patients with schizophrenia or schizoaffective disorder, and provides important evidence for supporting the practice of valproate augmentation therapy in these patients. PMID:26825886

Evidence-Informed Clinical Practice Recommendations for Treatment of Type 1 Diabetes Complicated by Problematic Hypoglycemia

PubMed Central

Choudhary, Pratik; Rickels, Michael R.; Senior, Peter A.; Vantyghem, Marie-Christine; Maffi, Paola; Kay, Thomas W.; Keymeulen, Bart; Inagaki, Nobuya; Saudek, Frantisek; Lehmann, Roger

2015-01-01

Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, or major fear and maladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patients with problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3–6 months. If targets are not met, one diabetes technology—continuous subcutaneous insulin infusion or continuous glucose monitoring—should be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies. PMID:25998294

[Insulin pump therapy in children, adolescents and adults].

PubMed

Stadler, Marietta; Zlamal-Fortunat, Sandra; Schütz-Fuhrmann, Ingrid; Rami-Merhar, Birgit; Fröhlich-Reiterer, Elke; Hofer, Sabine; Mader, Julia; Resl, Michael; Kautzky-Willer, Alexandra; Weitgasser, Raimund; Prager, Rudolf; Bischof, Martin

2016-04-01

This position statement is based on the current evidence available on the safety and benefits of continuous subcutaneous insulin pump therapy (CSII) in diabetes with an emphasis on the effects of CSII on glycemic control, hypoglycaemia rates, occurrence of ketoacidosis, quality of life and the use of insulin pump therapy in pregnancy. The current article represents the recommendations of the Austrian Diabetes Association for the clinical praxis of insulin pump treatment in children, adolescents and adults.

High aspect ratio, remote controlled pumping assembly

DOEpatents

Brown, Steve B.; Milanovich, Fred P.

1995-01-01

A miniature dual syringe-type pump assembly which has a high aspect ratio and which is remotely controlled, for use such as in a small diameter penetrometer cone or well packer used in water contamination applications. The pump assembly may be used to supply and remove a reagent to a water contamination sensor, for example, and includes a motor, gearhead and motor encoder assembly for turning a drive screw for an actuator which provides pushing on one syringe and pulling on the other syringe for injecting new reagent and withdrawing used reagent from an associated sensor.

Heat transfer enhancement and pumping power optimization using CuO-water nanofluid through rectangular corrugated pipe

NASA Astrophysics Data System (ADS)

Salehin, Musfequs; Ehsan, Mohammad Monjurul; Islam, A. K. M. Sadrul

2017-06-01

Heat transfer enhancement by corrugation in fluid domain is a popular method. The rate of improvement is more when it is used highly thermal conductive fluid as heating or cooling medium. In this present study, heat transfer augmentation was investigated numerically by implementing corrugation in the fluid domain and nanofluid as the base fluid in the turbulent forced convection regime. Finite volume method (FVM) was applied to solve the continuity, momentum and energy equations. All the numerical simulations were considered for single phase flow. A rectangle corrugated pipe with 5000 W/m2 constant heat flux subjected to the corrugated wall was considered as the fluid domain. In the range of Reynolds number 15000 to 40000, thermo-physical and hydrodynamic behavior was investigated by using CuO-water nanofluid from 1% to 5% volume fraction as the base fluid through the corrugated fluid domain. Corrugation justification was performed by changing the amplitude of the corrugation and the corrugation wave length for obtaining the increased heat transfer rate with minimum pumping power. For using CuO-water nanofluid, augmentation was also found more in the rectangle corrugated pipe both in heat transfer and pumping power requirement with the increase of Reynolds number and the volume fraction of nanofluid. For the increased pumping power, optimization of pumping power by using nanofluid was also performed for economic finding.

Analysis of managed aquifer recharge for retiming streamflow in an alluvial river

NASA Astrophysics Data System (ADS)

Ronayne, Michael J.; Roudebush, Jason A.; Stednick, John D.

2017-01-01

Maintenance of low flows during dry periods is critical for supporting ecosystem function in many rivers. Managed aquifer recharge is one method that can be used to augment low flows in rivers that are hydraulically connected to an alluvial groundwater system. In this study, we performed numerical modeling to evaluate a managed recharge operation designed to retime streamflow in the South Platte River, northeastern Colorado (USA). Modeling involved the simulation of spatially and temporally variable groundwater-surface water exchange, as well as streamflow routing in the river. Periodic solutions that incorporate seasonality were developed for two scenarios, a natural base case scenario and an active management scenario that included groundwater pumping and managed recharge. A framework was developed to compare the scenarios by analyzing changes in head-dependent inflows and outflows to/from the aquifer, which was used to interpret the simulated impacts on streamflow. The results clearly illustrate a retiming of streamflow. Groundwater pumping near the river during winter months causes a reduction in streamflow during those months. Delivery of the pumped water to recharge ponds, located further from the river, has the intended effect of augmenting streamflow during low-flow summer months. Higher streamflow is not limited to the target time period, however, which highlights an inefficiency of flow augmentation projects that rely on water retention in the subsurface.

Risk factors for discontinuation of insulin pump therapy in pediatric and young adult patients.

PubMed

Kostev, Karel; Rockel, Timo; Rosenbauer, Joachim; Rathmann, Wolfgang

2014-12-01

Previous studies have shown that only a small number of pediatric and young adult patients discontinue pump therapy, but risk factors for discontinuation are unclear. To identify characteristics of pediatric and young adult patients with pump therapy which are associated with discontinuation of treatment. Retrospective cohort study using a representative nationwide database (LRx; IMS Health) in Germany covering >80% of all prescriptions to members of statutory health insurances in 2008-2011. All patients (age group <25 years) with new prescriptions of insulin pumps were identified (2009-2010) and were followed for 12 months. Overall, 2452 new pump users were identified, of whom 177 (7.2%) switched to other forms of insulin therapy within 12 months. In multivariate logistic regression, younger age (<6 years; reference 18 to <25 years: Odds ratio, OR, 95% CI: 0.36; 0.17-0.74) and use of teflon needles (reference steel needles: OR, 95% CI: 0.59; 0.41-0.83) were related to a lower odds of pump discontinuation. A non-significant trend was found for male sex (OR, 95% CI: 0.75; 0.52-1.08). Prescriptions of thyroid therapeutics (ATC H03A: OR, 95% CI: 1.79; 1.23-2.61) and antiepileptics (N03: OR, 95% CI: 3.14; 1.49-6.59) were significantly associated with discontinuation of pump therapy. About 93% of pediatric and young adult patients maintained insulin pump therapy within 12 months. Age <6 years, male sex and teflon needle use were associated with a lower risk of discontinuation. Thyroid therapy (indicating autoimmunity) and antiepileptic drug prescriptions were associated with a higher likelihood for discontinuation of insulin pump treatment. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

40 CFR 60.482-2a - Standards: Pumps in light liquid service.

Code of Federal Regulations, 2011 CFR

2011-07-01

... routed to a process or fuel gas system or connected by a closed vent system to a control device that... sensor that will detect failure of the seal system, the barrier fluid system, or both. (4)(i) Each pump... indications of liquids dripping as a leak. (5)(i) Each sensor as described in paragraph (d)(3) is checked...

Fast Markerless Tracking for Augmented Reality in Planar Environment

NASA Astrophysics Data System (ADS)

Basori, Ahmad Hoirul; Afif, Fadhil Noer; Almazyad, Abdulaziz S.; AbuJabal, Hamza Ali S.; Rehman, Amjad; Alkawaz, Mohammed Hazim

2015-12-01

Markerless tracking for augmented reality should not only be accurate but also fast enough to provide a seamless synchronization between real and virtual beings. Current reported methods showed that a vision-based tracking is accurate but requires high computational power. This paper proposes a real-time hybrid-based method for tracking unknown environments in markerless augmented reality. The proposed method provides collaboration of vision-based approach with accelerometers and gyroscopes sensors as camera pose predictor. To align the augmentation relative to camera motion, the tracking method is done by substituting feature-based camera estimation with combination of inertial sensors with complementary filter to provide more dynamic response. The proposed method managed to track unknown environment with faster processing time compared to available feature-based approaches. Moreover, the proposed method can sustain its estimation in a situation where feature-based tracking loses its track. The collaboration of sensor tracking managed to perform the task for about 22.97 FPS, up to five times faster than feature-based tracking method used as comparison. Therefore, the proposed method can be used to track unknown environments without depending on amount of features on scene, while requiring lower computational cost.

Sensor-Augmented Virtual Labs: Using Physical Interactions with Science Simulations to Promote Understanding of Gas Behavior

NASA Astrophysics Data System (ADS)

Chao, Jie; Chiu, Jennifer L.; DeJaegher, Crystal J.; Pan, Edward A.

2016-02-01

Deep learning of science involves integration of existing knowledge and normative science concepts. Past research demonstrates that combining physical and virtual labs sequentially or side by side can take advantage of the unique affordances each provides for helping students learn science concepts. However, providing simultaneously connected physical and virtual experiences has the potential to promote connections among ideas. This paper explores the effect of augmenting a virtual lab with physical controls on high school chemistry students' understanding of gas laws. We compared students using the augmented virtual lab to students using a similar sensor-based physical lab with teacher-led discussions. Results demonstrate that students in the augmented virtual lab condition made significant gains from pretest and posttest and outperformed traditional students on some but not all concepts. Results provide insight into incorporating mixed-reality technologies into authentic classroom settings.

Optical fiber grating vibration sensor for vibration monitoring of hydraulic pump

NASA Astrophysics Data System (ADS)

Zhang, Zhengyi; Liu, Chuntong; Li, Hongcai; He, Zhenxin; Zhao, Xiaofeng

2017-06-01

In view of the existing electrical vibration monitoring traditional hydraulic pump vibration sensor, the high false alarm rate is susceptible to electromagnetic interference and is not easy to achieve long-term reliable monitoring, based on the design of a beam of the uniform strength structure of the fiber Bragg grating (FBG) vibration sensor. In this paper, based on the analysis of the vibration theory of the equal strength beam, the principle of FBG vibration tuning based on the equal intensity beam is derived. According to the practical application of the project, the structural dimensions of the equal strength beam are determined, and the optimization design of the vibrator is carried out. The finite element analysis of the sensor is carried out by ANSYS, and the first order resonant frequency is 94.739 Hz. The vibration test of the sensor is carried out by using the vibration frequency of 35 Hz and the vibration source of 50 Hz. The time domain and frequency domain analysis results of test data show that the sensor has good dynamic response characteristics, which can realize the accurate monitoring of the vibration frequency and meet the special requirements of vibration monitoring of hydraulic pump under specific environment.

Sliding Mode Observer-Based Current Sensor Fault Reconstruction and Unknown Load Disturbance Estimation for PMSM Driven System.

PubMed

Zhao, Kaihui; Li, Peng; Zhang, Changfan; Li, Xiangfei; He, Jing; Lin, Yuliang

2017-12-06

This paper proposes a new scheme of reconstructing current sensor faults and estimating unknown load disturbance for a permanent magnet synchronous motor (PMSM)-driven system. First, the original PMSM system is transformed into two subsystems; the first subsystem has unknown system load disturbances, which are unrelated to sensor faults, and the second subsystem has sensor faults, but is free from unknown load disturbances. Introducing a new state variable, the augmented subsystem that has sensor faults can be transformed into having actuator faults. Second, two sliding mode observers (SMOs) are designed: the unknown load disturbance is estimated by the first SMO in the subsystem, which has unknown load disturbance, and the sensor faults can be reconstructed using the second SMO in the augmented subsystem, which has sensor faults. The gains of the proposed SMOs and their stability analysis are developed via the solution of linear matrix inequality (LMI). Finally, the effectiveness of the proposed scheme was verified by simulations and experiments. The results demonstrate that the proposed scheme can reconstruct current sensor faults and estimate unknown load disturbance for the PMSM-driven system.

Magnetometer-augmented IMU simulator: in-depth elaboration.

PubMed

Brunner, Thomas; Lauffenburger, Jean-Philippe; Changey, Sébastien; Basset, Michel

2015-03-04

The location of objects is a growing research topic due, for instance, to the expansion of civil drones or intelligent vehicles. This expansion was made possible through the development of microelectromechanical systems (MEMS), inexpensive and miniaturized inertial sensors. In this context, this article describes the development of a new simulator which generates sensor measurements, giving a specific input trajectory. This will allow the comparison of pose estimation algorithms. To develop this simulator, the measurement equations of every type of sensor have to be analytically determined. To achieve this objective, classical kinematic equations are used for the more common sensors, i.e., accelerometers and rate gyroscopes. As nowadays, the MEMS inertial measurement units (IMUs) are generally magnetometer-augmented, an absolute world magnetic model is implemented. After the determination of the perfect measurement (through the error-free sensor models), realistic error models are developed to simulate real IMU behavior. Finally, the developed simulator is subjected to different validation tests.

Magnetometer-Augmented IMU Simulator: In-Depth Elaboration

PubMed Central

Brunner, Thomas; Lauffenburger, Jean-Philippe; Changey, Sébastien; Basset, Michel

2015-01-01

The location of objects is a growing research topic due, for instance, to the expansion of civil drones or intelligent vehicles. This expansion was made possible through the development of microelectromechanical systems (MEMS), inexpensive and miniaturized inertial sensors. In this context, this article describes the development of a new simulator which generates sensor measurements, giving a specific input trajectory. This will allow the comparison of pose estimation algorithms. To develop this simulator, the measurement equations of every type of sensor have to be analytically determined. To achieve this objective, classical kinematic equations are used for the more common sensors, i.e., accelerometers and rate gyroscopes. As nowadays, the MEMS inertial measurement units (IMUs) are generally magnetometer-augmented, an absolute world magnetic model is implemented. After the determination of the perfect measurement (through the error-free sensor models), realistic error models are developed to simulate real IMU behavior. Finally, the developed simulator is subjected to different validation tests. PMID:25746095

Development of Chemically Amplified Optical Sensors for Continuous Blood Glucose Monitoring Final Report CRADA No. TSB-1162-95

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

Lane, Stephen M.; Mastrototaro, John J.

Diabetes is a chronic disease that affects 14 million people in the U.S. and more than 110 million people worldwide. Each year in this country 27,000 diabetic patients become blind, 15,000 have kidney failure, and over 54,000 have peripheral limb amputations. In 1992, total healthcare costs in the U.S. for diabetes were more than $105 billion, approximately 15% of our healthcare budget. Conventional therapy for the most severe form of diabetes, insulin-dependent diabetes mellitus (IDDM) or Type I diabetes, is to administer one or two injections per day of various forms of insulin while monitoring blood glucose levels twice ormore » three times daily with commercial glucometers that require blood samples. Near normal blood sugar levels (glycemic control) is difficult to achieve with conventional therapy. In the fall of 1993, the results of the 10-year $165 million Diabetes Control and Complications Trial (DCCT) were published which showed that intensive insulin management would lead to dramatically fewer cases of retinopathy (which leads to blindness), nephropathy (which leads to kidney failure), and neuropathy (which can lead to limb amputations) [New England Journal of Medicine, Vo1239, No.14 977-986 (1993)]. If existing commercial insulin pumps could be combined with a continuous glucose sensor, a more physiological and fine-tuned therapy could be provided - in effect, an artificial biomechanical pancreas would be available. Existing research suggested that such a development would dramatically improve glucose control, thus greatly reducing morbidity and mortality from this disease. MiniMed Technologies in Sylmar, CA, identified a number of optically based sensor strategies as well as candidate chemical reactions that could be used to implement a minimally invasive opto-chemical glucose sensor. LLNL evaluated these sensor strategies and chemical reactions. These evaluations were the first steps leading to development of a sensor of considerable importance that could maintain near normal physiological glycemic levels, thus dramatically reducing the risk of the microvascular complications mentioned above.« less

MANAGEMENT OF DIABETES DURING AIR TRAVEL: A SYSTEMATIC LITERATURE REVIEW OF CURRENT RECOMMENDATIONS AND THEIR SUPPORTING EVIDENCE.

PubMed

Pavela, James; Suresh, Rahul; Blue, Rebecca S; Mathers, Charles H; Belalcazar, L Maria

2018-02-01

Individuals with diabetes are increasingly seeking pretravel advice, but updated professional recommendations remain scant. We performed a systematic review on diabetes management during air travel to summarize current recommendations, assess supporting evidence, and identify areas of future research. A systematic review of the English literature on diabetes management during air travel was undertaken utilizing PubMed and MEDLINE. Publications regarding general travel advice; adjustment of insulin and noninsulin therapies; and the use of insulin pumps, glucometers and subcutaneous glucose sensors at altitude were included. Gathered information was used to create an updated summary of glucose-lowering medication adjustment during air travel. Sixty-one publications were identified, most providing expert opinion and few offering primary data (47 expert opinion, 2 observational studies, 2 case reports, 10 device studies). General travel advice was uniform, with increasing attention to preflight security. Indications for oral antihyperglycemic therapy adjustments varied. There were few recommendations on contemporary agents and on nonhypoglycemic adverse events. There was little consensus on insulin adjustment protocols, many antedating current insulin formulations. Most publications advocated adjusting insulin pump time settings after arrival; however, there was disagreement on timing and rate adjustments. Glucometers and subcutaneous glucose sensors were reported to be less accurate at altitude, but not to an extent that would preclude their clinical use. Recommendations for diabetes management during air travel vary significantly and are mostly based on expert opinion. Data from systematic investigation on glucose-lowering medication adjustment protocols may support the development of a future consensus statement. CSII = continuous subcutaneous insulin infusion (device) DPP-4 = dipeptidyl peptidase 4 EGA = error grid analysis GDH = glucose dehydrogenase GOX = glucose oxidase GLP1 = glucagon-like peptide-1 NPH = neutral protamine Hagedorn SGLT2 = sodium-glucose cotransporter-2.

Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation: clinical feasibility and integration as an adjunct therapy.

PubMed

Hoermann, Simon; Ferreira Dos Santos, Luara; Morkisch, Nadine; Jettkowski, Katrin; Sillis, Moran; Devan, Hemakumar; Kanagasabai, Parimala S; Schmidt, Henning; Krüger, Jörg; Dohle, Christian; Regenbrecht, Holger; Hale, Leigh; Cutfield, Nicholas J

2017-07-01

New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke. We evaluated components of the therapeutic intervention, from the patients' and the therapists' points of view in a clinical feasibility study at a rehabilitation centre. We also assessed the integration of ART as an adjunct therapy for the clinical rehabilitation of subacute patients at two different hospitals. The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted. Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. Implications for Rehabilitation Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation.

Accuracy of a Fourth-Generation Subcutaneous Continuous Glucose Sensor

PubMed Central

Garg, Satish K.; Brazg, Ronald; Bode, Bruce W.; Bailey, Timothy S.; Slover, Robert H.; Sullivan, Ashley; Huang, Suiying; Shin, John; Lee, Scott W.; Kaufman, Francine R.

2017-01-01

Abstract Background: This study evaluated the accuracy and performance of a fourth-generation subcutaneous glucose sensor (Guardian™ Sensor 3) in the abdomen and arm. Methods: Eighty-eight subjects (14–75 years of age, mean ± standard deviation [SD] of 42.0 ± 19.1 years) with type 1 or type 2 diabetes participated in the study. Subjects wore two sensors in the abdomen that were paired with either a MiniMed™ 640G insulin pump, or an iPhone® or iPod® touch® running a glucose monitoring mobile application (Guardian Connect system) and a third sensor in the arm, which was connected to a glucose sensor recorder (GSR). Subjects were also asked to undergo in-clinic visits of 12–14 h on study days 1, 3, and 7 for frequent blood glucose sample testing using a Yellow Springs Instrument (YSI) reference. Results: The overall mean absolute relative difference (MARD ± SD) between abdomen sensor glucose (SG) and YSI reference values was 9.6% ± 9.0% and 9.4% ± 9.8% for the MiniMed 640G insulin pump and Guardian Connect system, respectively; and 8.7% ± 8.0% between arm SG and YSI reference values. The percentage of SG values within 20% agreement of the YSI reference value (for YSI >80 mg/dL) was 90.7% with the MiniMed 640G insulin pump, 91.8% with the Guardian Connect system, and 93.1% for GSR-connected arm sensors. Mean functional sensor life, when calibrating 3–4 times/day, was 145.9 ± 39.3 h for sensors paired with the MiniMed 640G insulin pump, 146.1 ± 41.6 h for sensors paired with the Guardian Connect system, and 147.6 ± 40.4 h for sensors connected to the GSR. Responses to survey questions regarding sensor comfort and ease of use were favorable. Conclusions: The Guardian Sensor 3 glucose sensor, whether located in abdomen or the arm, provided accurate glucose readings when compared with the YSI reference and demonstrated functional life commensurate with the intended 7-day use. ClinicalTrials.gov: NCT02246582 PMID:28700272

Accuracy of a Fourth-Generation Subcutaneous Continuous Glucose Sensor.

PubMed

Christiansen, Mark P; Garg, Satish K; Brazg, Ronald; Bode, Bruce W; Bailey, Timothy S; Slover, Robert H; Sullivan, Ashley; Huang, Suiying; Shin, John; Lee, Scott W; Kaufman, Francine R

2017-08-01

This study evaluated the accuracy and performance of a fourth-generation subcutaneous glucose sensor (Guardian ™ Sensor 3) in the abdomen and arm. Eighty-eight subjects (14-75 years of age, mean ± standard deviation [SD] of 42.0 ± 19.1 years) with type 1 or type 2 diabetes participated in the study. Subjects wore two sensors in the abdomen that were paired with either a MiniMed ™ 640G insulin pump, or an iPhone ® or iPod ® touch ® running a glucose monitoring mobile application (Guardian Connect system) and a third sensor in the arm, which was connected to a glucose sensor recorder (GSR). Subjects were also asked to undergo in-clinic visits of 12-14 h on study days 1, 3, and 7 for frequent blood glucose sample testing using a Yellow Springs Instrument (YSI) reference. The overall mean absolute relative difference (MARD ± SD) between abdomen sensor glucose (SG) and YSI reference values was 9.6% ± 9.0% and 9.4% ± 9.8% for the MiniMed 640G insulin pump and Guardian Connect system, respectively; and 8.7% ± 8.0% between arm SG and YSI reference values. The percentage of SG values within 20% agreement of the YSI reference value (for YSI >80 mg/dL) was 90.7% with the MiniMed 640G insulin pump, 91.8% with the Guardian Connect system, and 93.1% for GSR-connected arm sensors. Mean functional sensor life, when calibrating 3-4 times/day, was 145.9 ± 39.3 h for sensors paired with the MiniMed 640G insulin pump, 146.1 ± 41.6 h for sensors paired with the Guardian Connect system, and 147.6 ± 40.4 h for sensors connected to the GSR. Responses to survey questions regarding sensor comfort and ease of use were favorable. The Guardian Sensor 3 glucose sensor, whether located in abdomen or the arm, provided accurate glucose readings when compared with the YSI reference and demonstrated functional life commensurate with the intended 7-day use. ClinicalTrials.gov : NCT02246582.

Augmented post-remission therapy for a minimal residual disease-defined high-risk subgroup of children and young people with clinical standard-risk and intermediate-risk acute lymphoblastic leukaemia (UKALL 2003): a randomised controlled trial.

PubMed

Vora, Ajay; Goulden, Nick; Mitchell, Chris; Hancock, Jeremy; Hough, Rachael; Rowntree, Clare; Moorman, Anthony V; Wade, Rachel

2014-07-01

No randomised study has shown whether stratification of treatment by minimal residual disease (MRD) response improves outcome in children and young people with acute lymphoblastic leukaemia (ALL). We assessed whether children and young people with clinical standard and intermediate-risk ALL who have persistent MRD at the end of induction therapy benefit from augmented post-remission therapy. Between Oct 1, 2003, and June 30, 2011, we enrolled eligible patients aged 1-24 years and initially categorised them into clinical standard-risk, intermediate-risk, and high-risk groups on the basis of a combination of National Cancer Institute criteria, cytogenetics, and early morphological response to induction therapy. Clinical standard-risk and intermediate-risk patients with MRD of 0·01% or higher at day 29 of induction (MRD high risk) were randomly assigned (1:1) to standard therapy (treatment regimens A and B) or augmented post-remission therapy (regimen C). Compared with standard therapy, the augmented treatment regimen (regimen C) included an additional eight doses of pegylated asparaginase, 18 doses of vincristine, and escalated-dose intravenous methotrexate without folinic acid rescue during interim maintenance courses. Computer randomisation was used for treatment allocation and was balanced for sex, age (<10 years vs ≥10 years), and white blood cell count at diagnosis (<50 × 10(9)/L vs ≥50 × 10(9)/L) by minimisation. Patients, clinicians, and data analysts were not masked to treatment allocation. The primary outcomes were event-free survival and overall survival. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN07355119. 533 MRD high-risk patients were randomly assigned to receive standard (n=266) or augmented (n=267) post-remission therapy. After a median follow-up of 70 months (IQR 52-91), 5-year event-free survival was better in the augmented treatment group (89·6% [95% CI 85·9-93·3]) than in the standard group (82·8% [78·1-87·5]; odds ratio [OR] 0·61 [95% CI 0·39-0·98], p=0·04). Overall survival at 5 years was numerically, but not significantly, higher in the augmented treatment group (92·9% [95% CI 89·8-96·0]) than in the standard therapy group (88·9% [85·0-92·8]; OR 0·67 [95% CI 0·38-1·17], p=0·16). More adverse events occurred in the augmented treatment group than in the standard group (asparaginase-related hypersensitivity in 18 [6·7%] in the augmented group vs two [0·8%] in the standard group and asparaginase-related pancreatitis in eight [3·0%] vs one [0·4%]; intravenous methotrexate-related mucositis in 11 [4·1%] vs three [1·1%] and methotrexate-related stomatitis in 48 [18·0%] vs 12 [4·5%]). Our findings suggest that children and young people with acute lymphoblastic leukaemia and 0·01% or more MRD at the end of remission induction therapy could benefit from augmented post-remission therapy. However, the asparaginase and intravenous methotrexate used in the augmented treatment regimen is associated with more adverse events than is the standard post-remission treatment regimen. Medical Research Council and Leukaemia and Lymphoma Research. Copyright © 2014 Elsevier Ltd. All rights reserved.

Frostless heat pump having thermal expansion valves

DOEpatents

Chen, Fang C [Knoxville, TN; Mei, Viung C [Oak Ridge, TN

2002-10-22

A heat pump system having an operable relationship for transferring heat between an exterior atmosphere and an interior atmosphere via a fluid refrigerant and further having a compressor, an interior heat exchanger, an exterior heat exchanger, a heat pump reversing valve, an accumulator, a thermal expansion valve having a remote sensing bulb disposed in heat transferable contact with the refrigerant piping section between said accumulator and said reversing valve, an outdoor temperature sensor, and a first means for heating said remote sensing bulb in response to said outdoor temperature sensor thereby opening said thermal expansion valve to raise suction pressure in order to mitigate defrosting of said exterior heat exchanger wherein said heat pump continues to operate in a heating mode.

Health monitoring with optical fiber sensors: from human body to civil structures

NASA Astrophysics Data System (ADS)

Pinet, Éric; Hamel, Caroline; Glišić, Branko; Inaudi, Daniele; Miron, Nicolae

2007-04-01

Although structural health monitoring and patient monitoring may benefit from the unique advantages of optical fiber sensors (OFS) such as electromagnetic interferences (EMI) immunity, sensor small size and long term reliability, both applications are facing different realities. This paper presents, with practical examples, several OFS technologies ranging from single-point to distributed sensors used to address the health monitoring challenges in medical and in civil engineering fields. OFS for medical applications are single-point, measuring mainly vital parameters such as pressure or temperature. In the intra-aortic balloon pumping (IABP) therapy, a miniature OFS can monitor in situ aortic blood pressure to trigger catheter balloon inflation/deflation in counter-pulsation with heartbeats. Similar sensors reliably monitor the intracranial pressure (ICP) of critical care patients, even during surgical interventions or examinations under medical resonance imaging (MRI). Temperature OFS are also the ideal monitoring solution for such harsh environments. Most of OFS for structural health monitoring are distributed or have long gage length, although quasi-distributed short gage sensors are also used. Those sensors measure mainly strain/load, temperature, pressure and elongation. SOFO type deformation sensors were used to monitor and secure the Bolshoi Moskvoretskiy Bridge in Moscow. Safety of Plavinu dam built on clay and sand in Latvia was increased by monitoring bitumen joints displacement and temperature changes using SMARTape and Temperature Sensitive Cable read with DiTeSt unit. A similar solution was used for monitoring a pipeline built in an unstable area near Rimini in Italy.

High aspect ratio, remote controlled pumping assembly

DOEpatents

Brown, S.B.; Milanovich, F.P.

1995-11-14

A miniature dual syringe-type pump assembly is described which has a high aspect ratio and which is remotely controlled, for use such as in a small diameter penetrometer cone or well packer used in water contamination applications. The pump assembly may be used to supply and remove a reagent to a water contamination sensor, for example, and includes a motor, gearhead and motor encoder assembly for turning a drive screw for an actuator which provides pushing on one syringe and pulling on the other syringe for injecting new reagent and withdrawing used reagent from an associated sensor. 4 figs.

A microfluidic circulatory system integrated with capillary-assisted pressure sensors.

PubMed

Chen, Yangfan; Chan, Ho Nam; Michael, Sean A; Shen, Yusheng; Chen, Yin; Tian, Qian; Huang, Lu; Wu, Hongkai

2017-02-14

The human circulatory system comprises a complex network of blood vessels interconnecting biologically relevant organs and a heart driving blood recirculation throughout this system. Recreating this system in vitro would act as a bridge between organ-on-a-chip and "body-on-a-chip" and advance the development of in vitro models. Here, we present a microfluidic circulatory system integrated with an on-chip pressure sensor to closely mimic human systemic circulation in vitro. A cardiac-like on-chip pumping system is incorporated in the device. It consists of four pumping units and passive check valves, which mimic the four heart chambers and heart valves, respectively. Each pumping unit is independently controlled with adjustable pressure and pump rate, enabling users to control the mimicked blood pressure and heartbeat rate within the device. A check valve is located downstream of each pumping unit to prevent backward leakage. Pulsatile and unidirectional flow can be generated to recirculate within the device by programming the four pumping units. We also report an on-chip capillary-assisted pressure sensor to monitor the pressure inside the device. One end of the capillary was placed in the measurement region, while the other end was sealed. Time-dependent pressure changes were measured by recording the movement of the liquid-gas interface in the capillary and calculating the pressure using the ideal gas law. The sensor covered the physiologically relevant blood pressure range found in humans (0-142.5 mmHg) and could respond to 0.2 s actuation time. With the aid of the sensor, the pressure inside the device could be adjusted to the desired range. As a proof of concept, human normal left ventricular and arterial pressure profiles were mimicked inside this device. Human umbilical vein endothelial cells (HUVECs) were cultured on chip and cells can respond to mechanical forces generated by arterial-like flow patterns.

Apparatus and method for biological purification of waste

DOEpatents

Lucido, John A.; Keenan, Daniel; Premuzic, Eugene T.; Lin, Mow S.; Shelenkova, Ludmila

1998-11-24

An apparatus is disclosed for containing a microorganism culture in an active exponential growth and delivering a supply of microorganisms to an environment containing wastes for bio-augmenting the biodegradation of the wastes. The apparatus comprises a bioreactor and an operably connected controller. The bioreactor has a bioreactor chamber for containing a supply of microorganisms, a second chamber for containing a supply of water and inorganic nutrients, and a third chamber for containing a supply of organic nutrients. The bioreactor is operably connected to the controller in which a first pump is operably connected in fluid communication between the bioreactor chamber and the second chamber and third chamber, and a second pump is operably connected in fluid communication between the bioreactor chamber and the environment containing wastes to be biodegraded. The controller further includes a timer and regulator operably connected to the first and second pumps to effectively maintain the microorganisms in exponential growth in the bioreactor chamber and to deliver microorganisms to an environment to be treated. Also, disclosed is a method for bio-augmenting the biodegradation of wastes.

Apparatus and method for biological purification of waste

DOEpatents

Lucido, J.A.; Keenan, D.; Premuzic, E.T.; Lin, M.S.; Shelenkova, L.

1998-11-24

An apparatus is disclosed for containing a microorganism culture in an active exponential growth and delivering a supply of microorganisms to an environment containing wastes for bio-augmenting the biodegradation of the wastes. The apparatus comprises a bioreactor and an operably connected controller. The bioreactor has a bioreactor chamber for containing a supply of microorganisms, a second chamber for containing a supply of water and inorganic nutrients, and a third chamber for containing a supply of organic nutrients. The bioreactor is operably connected to the controller in which a first pump is operably connected in fluid communication between the bioreactor chamber and the second chamber and third chamber, and a second pump is operably connected in fluid communication between the bioreactor chamber and the environment containing wastes to be biodegraded. The controller further includes a timer and regulator operably connected to the first and second pumps to effectively maintain the microorganisms in exponential growth in the bioreactor chamber and to deliver microorganisms to an environment to be treated. Also, disclosed is a method for bio-augmenting the biodegradation of wastes. 7 figs.

Method for biological purification

DOEpatents

Lucido, John A.; Keenan, Daniel; Premuzic, Eugene T.; Lin, Mow S.; Shelenkova, Ludmila

2001-03-27

An apparatus is disclosed for containing a microorganism culture in an active exponential growth and delivering a supply of microorganisms to an environment containing wastes for bio-augmenting the biodegradation of the wastes. The apparatus comprises a bioreactor and an operably connected controller. The bioreactor has a bioreactor chamber for containing a supply of microorganisms, a second chamber for containing a supply of water and inorganic nutrients, and a third chamber for containing a supply of organic nutrients. The bioreactor is operably connected to the controller in which a first pump is operably connected in fluid communication between the bioreactor chamber and the second chamber and third chamber, and a second pump is operably connected in fluid communication between the bioreactor chamber and the environment containing wastes to be biodegraded. The controller further includes a timer and regulator operably connected to the first and second pumps to effectively maintain the microorganisms in exponential growth in the bioreactor chamber and to deliver microorganisms to an environment to be treated. Also, disclosed is a method for bio-augmenting the biodegradation of wastes.

D-Cycloserine Augmentation of Cognitive-Behavioral Therapy: Directions for Pilot Research in Pediatric Obsessive-Compulsive Disorder

ERIC Educational Resources Information Center

Storch, Eric A.; McKay, Dean; Reid, Jeannette M.; Geller, Daniel A.; Goodman, Wayne K.; Lewin, Adam B.; Murphy, Tanya K.

2010-01-01

This paper discusses a recent translational success in combining behavioral psychotherapy with a novel medication, d-cycloserine (DCS), to augment cognitive-behavioral therapy (CBT) for anxiety disorders. The literature on behavioral theory of exposure-based therapies is provided, followed by a discussion of the role of DCS in enhancing extinction…

Prediction of Driver’s Intention of Lane Change by Augmenting Sensor Information Using Machine Learning Techniques

PubMed Central

Kim, Il-Hwan; Bong, Jae-Hwan; Park, Jooyoung; Park, Shinsuk

2017-01-01

Driver assistance systems have become a major safety feature of modern passenger vehicles. The advanced driver assistance system (ADAS) is one of the active safety systems to improve the vehicle control performance and, thus, the safety of the driver and the passengers. To use the ADAS for lane change control, rapid and correct detection of the driver’s intention is essential. This study proposes a novel preprocessing algorithm for the ADAS to improve the accuracy in classifying the driver’s intention for lane change by augmenting basic measurements from conventional on-board sensors. The information on the vehicle states and the road surface condition is augmented by using an artificial neural network (ANN) models, and the augmented information is fed to a support vector machine (SVM) to detect the driver’s intention with high accuracy. The feasibility of the developed algorithm was tested through driving simulator experiments. The results show that the classification accuracy for the driver’s intention can be improved by providing an SVM model with sufficient driving information augmented by using ANN models of vehicle dynamics. PMID:28604582

[Insulin pump in type 2 diabetes: B-cell focused treatment].

PubMed

Picková, Klára; Rušavý, Zdeněk

Type 2 diabetes is a disorder characterized by insulin resistance and progressive deterioration of B-cell insulin secretion. B-cell protective strategies for lowering glucolipotoxicity by rapid achievement of normoglycemia using exogenous insulin improve their function and prolong diabetes remission. Insulin pump is an effective treatment method in newly diagnosed diabetes, where even short-term pump therapy is B-cell protective. Combination therapy with insulin pump and antidiabetics targeting the incretin system acts in synergy to protect the B-cell. While the positive effect of insulin pump is apparent even a year after stopping the therapy, the effect of incretins lasts only while on the medication. Short-term insulin treatment, especially delivered by insulin pump, is an effective method of B-cell protection in recent type 2 diabetes.Key words: B-cell function - diabetes mellitus - insulin pump - insulin resistance - type 2 diabetes.

Closed loop insulin delivery in diabetes.

PubMed

Battelino, Tadej; Omladič, Jasna Šuput; Phillip, Moshe

2015-06-01

The primary goal of type 1 diabetes treatment is attaining near-normal glucose values. This currently remains out of reach for most people with type 1 diabetes despite intensified insulin treatment in the form of insulin analogues, educational interventions, continuous glucose monitoring, and sensor augmented insulin pump. The main remaining problem is risk of hypoglycaemia, which cannot be sufficiently reduced in all patient groups. Additionally, patients' burn-out often develops with years of tedious day-to-day diabetes management, rendering available diabetes-related technology less efficient. Over the past 40 years, several attempts have been made towards computer-programmed insulin delivery in the form of closed loop, with faster developments especially in the past decade. Automated insulin delivery has reduced human error in glycaemic control and considerably lessened the burden of routine self-management. In this chapter, data from randomized controlled trials with closed-loop insulin delivery that included type 1 diabetes population are summarized, and an evidence-based vision for possible routine utilization of closed loop is provided. Copyright © 2015 Elsevier Ltd. All rights reserved.

High precision innovative micropump for artificial pancreas

NASA Astrophysics Data System (ADS)

Chappel, E.; Mefti, S.; Lettieri, G.-L.; Proennecke, S.; Conan, C.

2014-03-01

The concept of artificial pancreas, which comprises an insulin pump, a continuous glucose meter and a control algorithm, is a major step forward in managing patient with type 1 diabetes mellitus. The stability of the control algorithm is based on short-term precision micropump to deliver rapid-acting insulin and to specific integrated sensors able to monitor any failure leading to a loss of accuracy. Debiotech's MEMS micropump, based on the membrane pump principle, is made of a stack of 3 silicon wafers. The pumping chamber comprises a pillar check-valve at the inlet, a pumping membrane which is actuated against stop limiters by a piezo cantilever, an anti-free-flow outlet valve and a pressure sensor. The micropump inlet is tightly connected to the insulin reservoir while the outlet is in direct communication with the patient skin via a cannula. To meet the requirement of a pump dedicated to closed-loop application for diabetes care, in addition to the well-controlled displacement of the pumping membrane, the high precision of the micropump is based on specific actuation profiles that balance effect of pump elasticity in low-consumption push-pull mode.

Benefits of three-month continuous glucose monitoring for persons with diabetes using insulin pumps and sensors.

PubMed

Peterson, Karolina; Zapletalova, Jana; Kudlova, Pavla; Matuskova, Veronika; Bartek, Josef; Novotny, Dalibor; Chlup, Rudolf

2009-03-01

The latest Paradigm 722 insulin pump, Medtronic MiniMed, USA, enables daily reading of 288 interstitial fluid glucose concentrations determined by a sensor inserted into subcutaneous tissue; the sensor signals are transmitted into the insulin pump, enabling the patient to see real-time glucose concentration on the display and adapt further treatment. To assess the evolution of HbA1c over the course of a 3-month period in two cohorts of persons with type 1 (n=39) or type 2 (n=3) diabetes (PWD): 1) PWD on Paradigm 722 using sensors for continuous glucose monitoring (CGM group), 2) PWD on other types of insulin pumps performing intensive self-monitoring as before (3 to 6 times/d) on glucometer Linus, Wellion, Agamatrix (control group). Compliant PWDs using insulin pump with insulin aspart for several previous months were included in the study. Seventeen were put on Paradigm 722 with CGM and 25 were included in the control group. Paired t-test and the statistical program SPSS v.15.0 were used to analyze the data. There was no significant difference in age between the two groups (P=0.996), in diabetes duration (P=0.482) or in daily insulin dose (P=0.469). In the CGM group (but not in the control group) HbA1c/IFCC dropped from 6.98+/-0.43 % to 5.98+/-0.36 % (P=0.006) within 1 month and remained reduced. The use of the Paradigm 722 insulin pump with CGM resulted in significant improvement in HbA1c which appeared within one month and remained throughout the whole 3-month study period. No significant improvement in HbA1c was seen in the control group.

Impact of insulin pumps on glycaemic control in a pump-naïve paediatric regional population.

PubMed

de Bock, Martin; Gunn, Alistair Jan; Holt, Jean-Ann; Derraik, José G B; Reed, Peter; Cutfield, Wayne; Mouat, Fran; Hofman, Paul; Jefferies, Craig

2012-03-01

To examine the clinical impact of insulin-pump therapy for children with type 1 diabetes mellitus (T1DM) in a regional paediatric service, Auckland, New Zealand. Retrospective analysis of children with T1DM from the Starship paediatric diabetes database who started on insulin-pump therapy from 2002 to 2008 compared with the whole T1DM population and with an equal number of non-pump patients matched by age, sex, ethnicity and duration of diabetes. From 621 subjects with 6680 clinic visits, 75 children were treated with insulin-pump therapy for more than 12 months. Transitioning to insulin-pump treatment was associated with an improvement in HbA1c compared with baseline (-0.3%/year, P < 0.001) for up to 3 years. In contrast, despite similar deprivation scores, non-pump controls showed a continuing trend to higher HbA1C values (+0.2%/year, P < 0.01). The risk of severe hypoglycaemia fell after pump start (from 27 (0-223) to 5 (0-0.91) events/100 patient years) with no change in non-pump controls; the rate of diabetic ketoacidosis remained low in both groups. In a pump-naïve regional paediatric population, insulin-pump therapy for T1DM was safe and effective, and associated with sustained improvements in HbA1c and lower risk of hypoglycaemia. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Comprehensive and Critical Literature Review on Insitu Micro-Sensors for Application in Tribology

DTIC Science & Technology

1994-04-01

Electroosmotic flow provides a pumping method that is convenient for small capillaries. Electrophoretic separation is shown to be useful. On the left hand...analysis systems on glass chips (1 centimeter by 2 centimeters or larger) that utilize electroosmotic pumping to drive fluid flow and electrophoretic...elucidate the interaction mechanism. Additionally, using two types of sensors in a mixed array increases selectivity by providing different information

A new technique to control brushless motor for blood pump application.

PubMed

Fonseca, Jeison; Andrade, Aron; Nicolosi, Denys E C; Biscegli, José F; Legendre, Daniel; Bock, Eduardo; Lucchi, Júlio César

2008-04-01

This article presents a back-electromotive force (BEMF)-based technique of detection for sensorless brushless direct current motor (BLDCM) drivers. The BLDCM has been chosen as the energy converter in rotary or pulsatile blood pumps that use electrical motors for pumping. However, in order to operate properly, the BLDCM driver needs to know the shaft position. Usually, that information is obtained through a set of Hall sensors assembled close to the rotor and connected to the electronic controller by wires. Sometimes, a large distance between the motor and controller makes the system susceptible to interference on the sensor signal because of winding current switching. Thus, the goal of the sensorless technique presented in this study is to avoid this problem. First, the operation of BLDCM was evaluated on the electronic simulator PSpice. Then, a BEMF detector circuitry was assembled in our laboratories. For the tests, a sensor-dependent system was assembled where the direct comparison between the Hall sensors signals and the detected signals was performed. The obtained results showed that the output sensorless detector signals are very similar to the Hall signals at speeds of more than 2500 rpm. Therefore, the sensorless technique is recommended as a responsible or redundant system to be used in rotary blood pumps.

Visually augmented targeted combination light therapy for acne vulgaris: a case report.

PubMed

Yazdi, Alireza; Lyons, Colin-William; Roberts, Niamh

2017-10-31

Acne vulgaris is a common skin disease. Pharmacological modalities for treatment are proven to be efficacious but have limitations. Light therapy for acne vulgaris has shown promise in previous studies. This case report and its accompanying images show how a novel approach of visually augmented high fluence light therapy has been used to good effect. A 26-year-old Caucasian woman with acne vulgaris resistant to treatment with topical therapy underwent three sessions of combination potassium titanyl phosphate laser (532 nm)/neodymium-doped: yttrium aluminum garnet laser (1064 nm) light therapy with visually augmented narrow spot size and high fluence. A 73% reduction in total inflammatory lesions was evident 6 months after the initial treatment. This case report illustrates that there may be utility in this novel approach of narrow spot size, magnification-assisted, high fluence targeted combination laser therapy for inflammatory acne.

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

PubMed Central

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

2014-01-01

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

Immune Response Augmentation in Metastasized Breast Cancer by Localized Therapy Utilizing Biocompatible Magnetic Fluids. Addendum

DTIC Science & Technology

2009-08-01

Metastasized Breast Cancer by Localized Therapy Utilizing Biocompatible Magnetic Fluids PRINCIPAL INVESTIGATOR: Cahit A. Evrensel...AND SUBTITLE 5a. CONTRACT NUMBER Immune Response Augmentation in Metastasized Breast Cancer by Localized Therapy Utilizing Biocompatible... Magneto -rheological Fluid (MRF) iron nano-particles were synthesized using the reverse micelle technique and coated with poly(NIPAAm). The size

Research on fission fragment excitation of gases and nuclear pumping of lasers

NASA Technical Reports Server (NTRS)

Schneider, R. T.; Davie, R. N.; Davis, J. F.; Fuller, J. L.; Paternoster, R. R.; Shipman, G. R.; Sterritt, D. E.; Helmick, H. H.

1974-01-01

Experimental investigations of fission fragment excited gases are reported along with a theoretical analysis of population inversions in fission fragment excited helium. Other studies reported include: nuclear augmentation of gas lasers, direct nuclear pumping of a helium-xenon laser, measurements of a repetitively pulsed high-power CO2 laser, thermodynamic properties of UF6 and UF6/He mixtures, and nuclear waste disposal utilizing a gaseous core reactor.

Sliding Mode Observer-Based Current Sensor Fault Reconstruction and Unknown Load Disturbance Estimation for PMSM Driven System

PubMed Central

Li, Xiangfei; Lin, Yuliang

2017-01-01

This paper proposes a new scheme of reconstructing current sensor faults and estimating unknown load disturbance for a permanent magnet synchronous motor (PMSM)-driven system. First, the original PMSM system is transformed into two subsystems; the first subsystem has unknown system load disturbances, which are unrelated to sensor faults, and the second subsystem has sensor faults, but is free from unknown load disturbances. Introducing a new state variable, the augmented subsystem that has sensor faults can be transformed into having actuator faults. Second, two sliding mode observers (SMOs) are designed: the unknown load disturbance is estimated by the first SMO in the subsystem, which has unknown load disturbance, and the sensor faults can be reconstructed using the second SMO in the augmented subsystem, which has sensor faults. The gains of the proposed SMOs and their stability analysis are developed via the solution of linear matrix inequality (LMI). Finally, the effectiveness of the proposed scheme was verified by simulations and experiments. The results demonstrate that the proposed scheme can reconstruct current sensor faults and estimate unknown load disturbance for the PMSM-driven system. PMID:29211017

Experiences of children/young people and their parents, using insulin pump therapy for the management of type 1 diabetes: qualitative review.

PubMed

Alsaleh, F M; Smith, F J; Taylor, K M

2012-04-01

Advances in medical technology have made insulin pumps an attractive treatment option for patients with type 1 diabetes and in particular for children and young people. Previous studies have accounted the experiences and views of children/young people and their parents for the use of the injection therapy, but very few have focused on the use of insulin pumps. The objective of this review was to identify studies that explore the experiences of children/young people and their parents on the transition from injections to insulin pump therapy, in the context of their social life. A systematic literature search was conducted, and six studies meeting the inclusion and exclusion criteria were identified.   Views and perspectives from the studies identified mainly focused on: introduction to the pump; reasons for the transition to pump therapy; advantages and disadvantages of this treatment option; and impact on quality of life (QoL). Parents and/or children reported that they learned about pump therapy either formally from a healthcare professional or informally from a friend or the internet. Many reasons were identified for the transition, the most important being the pursuit of stable and controlled blood sugar levels and the desire for a more flexible lifestyle. Participants highlighted the advantages of insulin pumps in terms of improved diabetes control. Moreover, there was a positive impact on the QoL, as insulin pumps provided children greater flexibility in lifestyles especially with regards to meals and socialization. In contrast, psychosocial issues such as pump visibility and physical restrictions were highlighted as disadvantages. Issues such as day-to-day management were also discussed. Exploring children/young people's perspectives on the use of pump therapy for managing their diabetes, and parental reflections in caring for those children is important as it provides evidence informing policy for the wider implementation of this technology in the management of diabetes in children. However, the review revealed that there is a scarcity of data in this area and that further research is needed. © 2011 Blackwell Publishing Ltd.

Low-dose or standard-dose proton pump inhibitors for maintenance therapy of gastro-oesophageal reflux disease: a cost-effectiveness analysis.

PubMed

You, J H S; Lee, A C M; Wong, S C Y; Chan, F K L

2003-03-15

Studies on the use of low-dose proton pump inhibitor for the maintenance therapy of gastro-oesophageal reflux disease have shown that it might be comparable with standard-dose proton pump inhibitor treatment and superior to standard-dose histamine-2 receptor antagonist therapy. To compare the impact of standard-dose histamine-2 receptor antagonist, low-dose proton pump inhibitor and standard-dose proton pump inhibitor treatment for the maintenance therapy of gastro-oesophageal reflux disease on symptom control and health care resource utilization from the perspective of a public health organization in Hong Kong. A Markov model was designed to simulate, over 12 months, the economic and clinical outcomes of gastro-oesophageal reflux disease patients treated with standard-dose histamine-2 receptor antagonist, low-dose proton pump inhibitor and standard-dose proton pump inhibitor. The transition probabilities were derived from the literature. Resource utilization was retrieved from a group of gastro-oesophageal reflux disease patients in Hong Kong. Sensitivity analysis was conducted to examine the robustness of the model. The standard-dose proton pump inhibitor strategy was associated with the highest numbers of symptom-free patient-years (0.954 years) and quality-adjusted life-years gained (0.999 years), followed by low-dose proton pump inhibitor and standard-dose histamine-2 receptor antagonist. The direct medical cost per patient in the standard-dose proton pump inhibitor group (904 US dollars) was lower than those of the low-dose proton pump inhibitor and standard-dose histamine-2 receptor antagonist groups. The standard-dose proton pump inhibitor strategy appears to be the most effective and least costly for the maintenance management of patients with gastro-oesophageal reflux disease in Hong Kong.

Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia.

PubMed

Choudhary, Pratik; Rickels, Michael R; Senior, Peter A; Vantyghem, Marie-Christine; Maffi, Paola; Kay, Thomas W; Keymeulen, Bart; Inagaki, Nobuya; Saudek, Frantisek; Lehmann, Roger; Hering, Bernhard J

2015-06-01

Problematic hypoglycemia, defined as two or more episodes per year of severe hypoglycemia or as one episode associated with impaired awareness of hypoglycemia, extreme glycemic lability, or major fear and maladaptive behavior, is a challenge, especially for patients with long-standing type 1 diabetes. Individualized therapy for such patients should include a composite target: optimal glucose control without problematic hypoglycemia. Therefore, we propose a tiered, four-stage algorithm based on evidence of efficacy given the limitations of educational, technological, and transplant interventions. All patients with problematic hypoglycemia should undergo structured or hypoglycemia-specific education programs (stage 1). Glycemic and hypoglycemia treatment targets should be individualized and reassessed every 3-6 months. If targets are not met, one diabetes technology-continuous subcutaneous insulin infusion or continuous glucose monitoring-should be added (stage 2). For patients with continued problematic hypoglycemia despite education (stage 1) and one diabetes technology (stage 2), sensor-augmented insulin pumps preferably with an automated low-glucose suspend feature and/or very frequent contact with a specialized hypoglycemia service can reduce hypoglycemia (stage 3). For patients whose problematic hypoglycemia persists, islet or pancreas transplant should be considered (stage 4). This algorithm provides an evidence-informed approach to resolving problematic hypoglycemia; it should be used as a guide, with individual patient circumstances directing suitability and acceptability to ensure the prudent use of technology and scarce transplant resources. Standardized reporting of hypoglycemia outcomes and inclusion of patients with problematic hypoglycemia in studies of new interventions may help to guide future therapeutic strategies. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Natural and Synthetic Polymers as Inhibitors of Drug Efflux Pumps

PubMed Central

2007-01-01

Inhibition of efflux pumps is an emerging approach in cancer therapy and drug delivery. Since it has been discovered that polymeric pharmaceutical excipients such as Tweens® or Pluronics® can inhibit efflux pumps, various other polymers have been investigated regarding their potential efflux pump inhibitory activity. Among them are polysaccharides, polyethylene glycols and derivatives, amphiphilic block copolymers, dendrimers and thiolated polymers. In the current review article, natural and synthetic polymers that are capable of inhibiting efflux pumps as well as their application in cancer therapy and drug delivery are discussed. PMID:17896100

Proceedings of the Augmented VIsual Display (AVID) Research Workshop

NASA Technical Reports Server (NTRS)

Kaiser, Mary K. (Editor); Sweet, Barbara T. (Editor)

1993-01-01

The papers, abstracts, and presentations were presented at a three day workshop focused on sensor modeling and simulation, and image enhancement, processing, and fusion. The technical sessions emphasized how sensor technology can be used to create visual imagery adequate for aircraft control and operations. Participants from industry, government, and academic laboratories contributed to panels on Sensor Systems, Sensor Modeling, Sensor Fusion, Image Processing (Computer and Human Vision), and Image Evaluation and Metrics.

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

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

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

1979-12-31

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

Performance Of The IEEE 802.15.4 Protocol As The Marker Of Augmented Reality In Museum

NASA Astrophysics Data System (ADS)

Kurniawan Saputro, Adi; Sumpeno, Surya; Hariadi, Mochamad

2018-04-01

Museum is a place to keep the historic objects and historical education center to introduce the nation’s culture. Utilizing technology in a museum to become a smart city is a challenge. Internet of thing (IOT) is a technological advance in Information and communication (ICT) that can be applied in the museum The current ICT development is not only a transmission medium, but Augmented Reality technology is also being developed. Currently, Augmented Reality technology creates virtual objects into the real world using markers or images. In this study, researcher used signals to make virtual objects appear in the real world using the IEEE 802.14.5 protocol replacing the Augmented Reality marker. RSSI and triangulation are used as a substitute microlocation for AR objects. The result is the performance of Wireless Sensor Network could be used for data transmission in the museum. LOS research at a distance of 15 meters with 1000 ms delay found 1.4% error rate and NLOS with 2.3% error rate. So it can be concluded that utilization technology (IOT) using signal wireless sensor network as a replace for marker augmented reality can be used in museum

40 CFR 63.1331 - Equipment leak provisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... pump or seal whereby polymer fluid used to provide lubrication and/or cooling of the pump or agitator... limited to, a rupture disk indicator, magnetic sensor, motion detector on the pressure relief valve stem...

Study on stable equilibrium of levitated impeller in rotary pump with passive magnetic bearings.

PubMed

Qian, K X; Wan, F K; Ru, W M; Zeng, P; Yuan, H Y

2006-01-01

It is widely acknowledged that the permanent maglev cannot achieve stable equilibrium; the authors have developed, however, a stable permanent maglev centrifugal blood pump. Permanent maglev needs no position detection and feedback control of the rotor, nevertheless the eccentric distance (ED) and vibration amplitude (VA) of the levitator have been measured to demonstrate the levitation and to investigate the factors affecting levitation. Permanent maglev centrifugal impeller pump has a rotor and a stator. The rotor is driven by stator coil and levitated by two passive magnetic bearings. The rotor position is measured by four Hall sensors, which are distributed evenly and peripherally on the end of the stator against the magnetic ring of the bearing on the rotor. The voltage differences of the sensors due to different distances between the sensors and the magnetic ring are converted into ED. The results verify that the rotor can be disaffiliated from the stator if the rotating speed and the flow rate of the pump are large enough, that is, the maximal ED will reduce to about half of the gap between the rotor and the stator. In addition, the gap between rotor and stator and the viscosity of the fluid to be pumped also affect levitation. The former has an optimal value of approximately 2% of the radius of the rotor. For the latter, levitation stability is better with higher viscosity, meaning smaller ED and VA. The pressure to be pumped has no effect on levitation.

Vitamin K3 Induces the Expression of the Stenotrophomonas maltophilia SmeVWX Multidrug Efflux Pump.

PubMed

Blanco, P; Corona, F; Sánchez, M B; Martínez, J L

2017-05-01

Stenotrophomonas maltophilia is an opportunistic pathogen with increasing prevalence, which is able to cause infections in immunocompromised patients or in those with a previous pathology. The treatment of the infections caused by this bacterium is often complicated due to the several intrinsic antibiotic resistance mechanisms that it presents. Multidrug efflux pumps are among the best-studied mechanisms of S. maltophilia antibiotic resistance. Some of these efflux pumps have a basal expression level but, in general, their expression is often low and only reaches high levels when the local regulator is mutated or bacteria are in the presence of an effector. In the current work, we have developed a yellow fluorescent protein (YFP)-based sensor with the aim to identify effectors able to trigger the expression of SmeVWX, an efflux pump that confers resistance to quinolones, chloramphenicol, and tetracycline when it is expressed at high levels. With this purpose in mind, we tested a variety of different compounds and analyzed the fluorescence signal given by the expression of YFP under the control of the smeVWX promoter. Among the tested compounds, vitamin K 3 , which is a compound belonging to the 2-methyl-1,4-naphthoquinone family, is produced by plants in defense against infection, and has increasing importance in human therapy, was able to induce the expression of the SmeVWX efflux pump. In addition, a decrease in the susceptibility of S. maltophilia to ofloxacin and chloramphenicol was observed in the presence of vitamin K 3 , in both wild-type and smeW -deficient strains. Copyright © 2017 American Society for Microbiology.

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

PubMed Central

Gilgen, Emily

2014-01-01

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

A cluster randomised trial, cost-effectiveness analysis and psychosocial evaluation of insulin pump therapy compared with multiple injections during flexible intensive insulin therapy for type 1 diabetes: the REPOSE Trial.

PubMed

Heller, Simon; White, David; Lee, Ellen; Lawton, Julia; Pollard, Daniel; Waugh, Norman; Amiel, Stephanie; Barnard, Katharine; Beckwith, Anita; Brennan, Alan; Campbell, Michael; Cooper, Cindy; Dimairo, Munyaradzi; Dixon, Simon; Elliott, Jackie; Evans, Mark; Green, Fiona; Hackney, Gemma; Hammond, Peter; Hallowell, Nina; Jaap, Alan; Kennon, Brian; Kirkham, Jackie; Lindsay, Robert; Mansell, Peter; Papaioannou, Diana; Rankin, David; Royle, Pamela; Smithson, W Henry; Taylor, Carolin

2017-04-01

Insulin is generally administered to people with type 1 diabetes mellitus (T1DM) using multiple daily injections (MDIs), but can also be delivered using infusion pumps. In the UK, pumps are recommended for patients with the greatest need and adult use is less than in comparable countries. Previous trials have been small, of short duration and have failed to control for training in insulin adjustment. To assess the clinical effectiveness and cost-effectiveness of pump therapy compared with MDI for adults with T1DM, with both groups receiving equivalent structured training in flexible insulin therapy. Pragmatic, multicentre, open-label, parallel-group cluster randomised controlled trial, including economic and psychosocial evaluations. After participants were assigned a group training course, courses were randomly allocated in pairs to either pump or MDI. Eight secondary care diabetes centres in the UK. Adults with T1DM for > 12 months, willing to undertake intensive insulin therapy, with no preference for pump or MDI, or a clinical indication for pumps. Pump or MDI structured training in flexible insulin therapy, followed up for 2 years. MDI participants used insulin analogues. Pump participants used a Medtronic Paradigm ® Veo TM (Medtronic, Watford, UK) with insulin aspart (NovoRapid, Novo Nordisk, Gatwick, UK). Primary outcome - change in glycated haemoglobin (HbA 1c ) at 2 years in participants whose baseline HbA 1c was ≥ 7.5% (58 mmol/mol). Key secondary outcome - proportion of participants with HbA 1c ≤ 7.5% at 2 years. Other outcomes at 6, 12 and 24 months - moderate and severe hypoglycaemia; insulin dose; body weight; proteinuria; diabetic ketoacidosis; quality of life (QoL); fear of hypoglycaemia; treatment satisfaction; emotional well-being; qualitative interviews with participants and staff (2 weeks), and participants (6 months); and ICERs in trial and modelled estimates of cost-effectiveness. We randomised 46 courses comprising 317 participants: 267 attended a Dose Adjustment For Normal Eating course (132 pump; 135 MDI); 260 were included in the intention-to-treat analysis, of which 235 (119 pump; 116 MDI) had baseline HbA 1c of ≥ 7.5%. HbA 1c and severe hypoglycaemia improved in both groups. The drop in HbA 1c % at 2 years was 0.85 on pump and 0.42 on MDI. The mean difference (MD) in HbA 1c change at 2 years, at which the baseline HbA 1c was ≥ 7.5%, was -0.24% [95% confidence interval (CI) -0.53% to 0.05%] in favour of the pump ( p  = 0.098). The per-protocol analysis showed a MD in change of -0.36% (95% CI -0.64% to -0.07%) favouring pumps ( p  = 0.015). Pumps were not cost-effective in the base case and all of the sensitivity analyses. The pump group had greater improvement in diabetes-specific QoL diet restrictions, daily hassle plus treatment satisfaction, statistically significant at 12 and 24 months and supported by qualitative interviews. Blinding of pump therapy was not possible, although an objective primary outcome was used. Adding pump therapy to structured training in flexible insulin therapy did not significantly enhance glycaemic control or psychosocial outcomes in adults with T1DM. To understand why few patients achieve a HbA 1c of < 7.5%, particularly as glycaemic control is worse in the UK than in other European countries. Current Controlled Trials ISRCTN61215213. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 20. See the NIHR Journals Library website for further project information.

46 CFR 153.565 - Special requirement for temperature sensors.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 5 2012-10-01 2012-10-01 false Special requirement for temperature sensors. 153.565... Equipment Special Requirements § 153.565 Special requirement for temperature sensors. If a cargo listed in table 1 of this part refers to this section, temperature sensors must be used to monitor the cargo pump...

46 CFR 153.565 - Special requirement for temperature sensors.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 5 2013-10-01 2013-10-01 false Special requirement for temperature sensors. 153.565... Equipment Special Requirements § 153.565 Special requirement for temperature sensors. If a cargo listed in table 1 of this part refers to this section, temperature sensors must be used to monitor the cargo pump...

46 CFR 153.565 - Special requirement for temperature sensors.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 5 2014-10-01 2014-10-01 false Special requirement for temperature sensors. 153.565... Equipment Special Requirements § 153.565 Special requirement for temperature sensors. If a cargo listed in table 1 of this part refers to this section, temperature sensors must be used to monitor the cargo pump...

Benefits of ambulatory axillary intra-aortic balloon pump for circulatory support as bridge to heart transplant.

PubMed

Umakanthan, Ramanan; Hoff, Steven J; Solenkova, Natalia; Wigger, Mark A; Keebler, Mary E; Lenneman, Andrew; Leacche, Marzia; Disalvo, Thomas G; Ooi, Henry; Naftilan, Allen J; Byrne, John G; Ahmad, Rashid M

2012-05-01

Axillary intra-aortic balloon pump therapy has been described as a bridge to transplant. Advantages over femoral intra-aortic balloon pump therapy include reduced incidence of infection and enhanced patient mobility. We identified the patients who would benefit most from this therapy while awaiting heart transplantation. We conducted a single-center, retrospective observational study to evaluate outcomes from axillary intra-aortic balloon pump therapy. These included hemodynamic parameters, duration of support, and success in bridging to transplant. We selected patients on the basis of history of sternotomy, elevated panel-reactive antibody, and small body habitus. Patients were made to ambulate aggressively beginning on postoperative day 1. Between September 2007 and September 2010, 18 patients underwent axillary intra-aortic balloon pump therapy. All patients had the devices placed through the left axillary artery with a Hemashield side graft (Boston Scientific, Natick, Mass). Before axillary placement, patients underwent femoral placement to demonstrate hemodynamic benefit. Duration of support ranged from 5 to 63 days (median = 19 days). There was marked improvement in ambulatory potential and hemodynamic parameters, with minimal blood transfusion requirements. There were no device-related infections. Some 72% of the patients (13/18) were successfully bridged to transplantation. Axillary intra-aortic balloon pump therapy provides excellent support for selected patients as a bridge to transplant. The majority of the patients were successfully bridged to transplant and discharged. Although this therapy has been described in previous studies, this is the largest series to incorporate a regimen of aggressive ambulation with daily measurements of distances walked. Copyright © 2012. Published by Mosby, Inc.

Sensor fusion and augmented reality with the SAFIRE system

NASA Astrophysics Data System (ADS)

Saponaro, Philip; Treible, Wayne; Phelan, Brian; Sherbondy, Kelly; Kambhamettu, Chandra

2018-04-01

The Spectrally Agile Frequency-Incrementing Reconfigurable (SAFIRE) mobile radar system was developed and exercised at an arid U.S. test site. The system can detect hidden target using radar, a global positioning system (GPS), dual stereo color cameras, and dual stereo thermal cameras. An Augmented Reality (AR) software interface allows the user to see a single fused video stream containing the SAR, color, and thermal imagery. The stereo sensors allow the AR system to display both fused 2D imagery and 3D metric reconstructions, where the user can "fly" around the 3D model and switch between the modalities.

Augmentation therapy for alpha-1 antitrypsin deficiency: towards a personalised approach

PubMed Central

2013-01-01

Background Intravenous augmentation therapy is the only specific treatment available for emphysema associated with alpha-1 antitrypsin deficiency. Despite large observational studies and limited interventional studies there remains controversy about the efficacy of this treatment due to the impracticality of conducting adequately powered studies to evaluate the rate of decline in lung function, due to the low prevalence and the slow progression of the disease. However, measurement of lung density by computed tomography is a more specific and sensitive marker of the evolution of emphysema and two small placebo-controlled clinical trials have provided evidence supporting a reduction in the rate of decline in lung density with augmentation therapy. The problem Where augmentation therapy has become available there has been little consideration of a structured approach to therapy which is often introduced on the basis of functional impairment at diagnosis. Data from registries have shown a great variability in the evolution of lung disease according to patient acquisition and the presence of recognised risk factors. Avoidance of risk factors may, in many cases, stabilise the disease. Since augmentation therapy itself will at best preserve the presenting level of lung damage yet require intravenous administration for life with associated costs, identification of patients at risk of continued rapid or long term progression is essential to select those for whom this treatment can be most appropriate and hence generally more cost-effective. This represents a major reconsideration of the current practice in order to develop a consistent approach to management world wide. Purpose of this review The current review assesses the evidence for efficacy of augmentation therapy and considers how the combination of age, physiological impairment, exacerbation history and rate of decline in spirometry and other measures of emphysema may be used to improve therapeutic decision making, until a reliable predictive biomarker of the evolution of lung impairment can be identified. In addition, individual pharmacokinetic studies may permit the selection of the best regimen of administration for those who need it. Summary The rarity and variable characteristics of the disease imply the need for an individualised approach to therapy in specialised centres with sufficient experience to apply a systematic approach to monitoring and management. PMID:24063809

Modeling the interaction between the intra-aortic balloon pump and the cardiovascular system: the effect of timing.

PubMed

Schampaert, Stéphanie; Rutten, Marcel C M; van T Veer, Marcel; van Nunen, Lokien X; Tonino, Pim A L; Pijls, Nico H J; van de Vosse, Frans N

2013-01-01

Because of the large number of interaction factors involved, the effects of the intra-aortic balloon pump (IABP) have not been investigated deeply. To enhance its clinical efficiency and to better define indications for use, advanced models are required to test the interaction between the IABP and the cardiovascular system. A patient with mild blood pressure depression and a lowered cardiac output is modeled in a lumped parameter computational model, developed with physiologically representative elements for relevant components of circulation and device. IABP support is applied, and the moments of balloon inflation and deflation are varied around their conventional timing modes. For validation purposes, timing is adapted within acceptable ranges in ten patients undergoing IABP therapy for typical clinical indications. In both model and patients, the IABP induces a diastolic blood pressure augmentation as well as a systolic reduction in afterload. The support capabilities of the IABP benefit the most when the balloon is deflated simultaneously with ventricular contraction, whereas inflation before onset of diastole unconditionally interferes with ejection. The physiologic response makes the model an excellent tool for testing the interaction between the IABP and the cardiovascular system, and how alterations of specific IABP parameters (i.e., timing) affect this coupling.

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

PubMed

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

2012-03-01

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

Assessment of solar-assisted gas-fired heat pump systems

NASA Technical Reports Server (NTRS)

Lansing, F. L.

1981-01-01

As a possible application for the Goldstone Energy Project, the performance of a 10 ton heat pump unit using a hybrid solar gas energy source was evaluated in an effort to optimize the solar collector size. The heat pump system is designed to provide all the cooling and/or heating requirements of a selected office building. The system performance is to be augmented in the heating mode by utilizing the waste heat from the power cycle. A simplified system analysis is described to assess and compute interrrelationships of the engine, heat pump, and solar and building performance parameters, and to optimize the solar concentrator/building area ratio for a minimum total system cost. In addition, four alternative heating cooling systems, commonly used for building comfort, are described; their costs are compared, and are found to be less competitive with the gas solar heat pump system at the projected solar equipment costs.

Comparison of therapy augmentation and deviation rates from the recommended once-daily dosing regimen between LDX and commonly prescribed long-acting stimulants for the treatment of ADHD in youth and adults.

PubMed

Setyawan, Juliana; Hodgkins, Paul; Guérin, Annie; Gauthier, Geneviève; Cloutier, Martin; Wu, Eric; Erder, M Haim

2013-10-01

To compare therapy augmentation and deviation rates from the recommended once-daily dosing regimen in Attention Deficit Hyperactivity Disorder (ADHD) patients initiated on lisdexamfetamine (LDX) vs other once-daily Food and Drug Administration (FDA) approved stimulants. ADHD patients initiated on a long-acting ADHD stimulant medication (index medication) in/after 2007 were selected from a large U.S. administrative claims database. Patients were required to be persistent for ≥90 days and continuously enrolled in their healthcare plan for ≥12 months following treatment initiation date. Based on age and previous treatment status, patients were classified into treatment-naïve children and adolescents (6-17 years old), previously treated children and adolescents, treatment-naïve adults (≥18 years old), and previously treated adults. Furthermore, patients were classified into four mutually exclusive treatment groups, based on index medication: lisdexamfetamine (LDX), osmotic release methylphenidate hydrochloride long-acting (OROS MPH), other methylphenidate/dexmethylphenidate long-acting (MPH LA), and amphetamine/dextroamphetamine long-acting (AMPH LA). The average daily consumption was measured as the quantity of index medication supplied in the 12-month study period divided by the total number of days of supply. Therapy augmentation was defined as the use of another ADHD medication concomitantly with the index medication for ≥28 consecutive days. Therapy augmentation and deviation rates from the recommended once-daily dosing regimen were compared between treatment groups using multivariate logistic regression models. Compared to the other treatment groups, LDX patients were less likely to augment with another ADHD medication (range odds ratios [OR]; 1.28-3.30) and to deviate from the recommended once-daily dosing regimen (range OR; 1.73-4.55), except for previously treated adult patients, where therapy augmentation differences were not statistically significant when compared to OROS MPH and MPH LA patients. This study did not control for ADHD severity. Overall, compared to LDX-treated patients, patients initiated on other ADHD medications were equally or more likely to have a therapy augmentation and more likely to deviate from the recommended once-daily dosing regimen.

The effects of weekly augmentation therapy in patients with PiZZ α1-antitrypsin deficiency

PubMed Central

Schmid, ST; Koepke, J; Dresel, M; Hattesohl, A; Frenzel, E; Perez, J; Lomas, DA; Miranda, E; Greulich, T; Noeske, S; Wencker, M; Teschler, H; Vogelmeier, C; Janciauskiene, S; Koczulla, AR

2012-01-01

Background The major concept behind augmentation therapy with human α1-antitrypsin (AAT) is to raise the levels of AAT in patients with protease inhibitor phenotype ZZ (Glu342Lys)-inherited AAT deficiency and to protect lung tissues from proteolysis and progression of emphysema. Objective To evaluate the short-term effects of augmentation therapy (Prolastin®) on plasma levels of AAT, C-reactive protein, and chemokines/cytokines. Materials and methods Serum and exhaled breath condensate were collected from individuals with protease inhibitor phenotype ZZ AAT deficiency-related emphysema (n = 12) on the first, third, and seventh day after the infusion of intravenous Prolastin. Concentrations of total and polymeric AAT, interleukin-8 (IL-8), monocyte chemotactic protein-1, IL-6, tumor necrosis factor-α, vascular endothelial growth factor, and C-reactive protein were determined. Blood neutrophils and primary epithelial cells were also exposed to Prolastin (1 mg/mL). Results There were significant fluctuations in serum (but not in exhaled breath condensate) levels of AAT polymers, IL-8, monocyte chemotactic protein-1, IL-6, tumor necrosis factor-α, and vascular endothelial growth factor within a week of augmentation therapy. In general, augmented individuals had higher AAT and lower serum levels of IL-8 than nonaugmented subjects. Prolastin added for 3 hours to neutrophils from protease inhibitor phenotype ZZ individuals in vitro reduced IL-8 release but showed no effect on cytokine/chemokine release from human bronchial epithelial cells. Conclusion Within a week, augmentation with Prolastin induced fluctuations in serum levels of AAT polymers and cytokine/chemokines but specifically lowered IL-8 levels. It remains to be determined whether these effects are related to the Prolastin preparation per se or to the therapeutic efficacy of augmentation with AAT. PMID:23055718

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

Tricaud, Christophe; Ernst, Timothy C.; Zigan, James A.

The disclosure provides a waste heat recovery system with a system and method for calculation of the net output torque from the waste heat recovery system. The calculation uses inputs from existing pressure and speed sensors to create a virtual pump torque sensor and a virtual expander torque sensor, and uses these sensors to provide an accurate net torque output from the WHR system.

The role of insulin pump therapy for type 2 diabetes mellitus.

PubMed

Landau, Zohar; Raz, Itamar; Wainstein, Julio; Bar-Dayan, Yosefa; Cahn, Avivit

2017-01-01

Many patients with type 2 diabetes fail to achieve adequate glucose control despite escalation of treatment and combinations of multiple therapies including insulin. Patients with long-standing type 2 diabetes often suffer from the combination of severe insulin deficiency in addition to insulin resistance, thereby requiring high doses of insulin delivered in multiple injections to attain adequate glycemic control. Insulin-pump therapy was first introduced in the 1970s as an approach to mimic physiological insulin delivery and attain normal glucose in patients with type 1 diabetes. The recent years have seen an increase in the use of this technology for patients with type 2 diabetes. This article summarizes the clinical studies evaluating insulin pump use in patients with type 2 diabetes and discusses the benefits and shortcomings of pump therapy in this population. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

UHF front-end feeding RFID-based body sensor networks by exploiting the reader signal

NASA Astrophysics Data System (ADS)

Pasca, M.; Colella, R.; Catarinucci, L.; Tarricone, L.; D'Amico, S.; Baschirotto, A.

2016-05-01

This paper presents an integrated, high-sensitivity UHF radio frequency identification (RFID) power management circuit for body sensor network applications. The circuit consists of a two-stage RF-DC Dickson's rectifier followed by an integrated five-stage DC-DC Pelliconi's charge pump driven by an ultralow start-up voltage LC oscillator. The DC-DC charge pump interposed between the RF-DC rectifier and the output load provides the RF to load isolation avoiding losses due to the diodes reverse saturation current. The RF-DC rectifier has been realized on FR4 substrate, while the charge pump and the oscillator have been realized in 180 nm complementary metal oxide semiconductor (CMOS) technology. Outdoor measurements demonstrate the ability of the power management circuit to provide 400 mV output voltage at 14 m distance from the UHF reader, in correspondence of -25 dBm input signal power. As demonstrated in the literature, such output voltage level is suitable to supply body sensor network nodes.

Laboratory-based validation of the baseline sensors of the ITER diagnostic residual gas analyzer

NASA Astrophysics Data System (ADS)

Klepper, C. C.; Biewer, T. M.; Marcus, C.; Andrew, P.; Gardner, W. L.; Graves, V. B.; Hughes, S.

2017-10-01

The divertor-specific ITER Diagnostic Residual Gas Analyzer (DRGA) will provide essential information relating to DT fusion plasma performance. This includes pulse-resolving measurements of the fuel isotopic mix reaching the pumping ducts, as well as the concentration of the helium generated as the ash of the fusion reaction. In the present baseline design, the cluster of sensors attached to this diagnostic's differentially pumped analysis chamber assembly includes a radiation compatible version of a commercial quadrupole mass spectrometer, as well as an optical gas analyzer using a plasma-based light excitation source. This paper reports on a laboratory study intended to validate the performance of this sensor cluster, with emphasis on the detection limit of the isotopic measurement. This validation study was carried out in a laboratory set-up that closely prototyped the analysis chamber assembly configuration of the baseline design. This includes an ITER-specific placement of the optical gas measurement downstream from the first turbine of the chamber's turbo-molecular pump to provide sufficient light emission while preserving the gas dynamics conditions that allow for \\textasciitilde 1 s response time from the sensor cluster [1].

Effect of proton pump inhibitors on markers of risk for high-grade dysplasia and oesophageal cancer in Barrett's oesophagus.

PubMed

Hillman, L C; Chiragakis, L; Shadbolt, B; Kaye, G L; Clarke, A C

2008-02-15

It has been shown that the presence on diagnosis of endoscopic macroscopic markers indicates a high-risk group for Barrett's oesophagus. To determine whether proton pump inhibitor therapy prior to diagnosis of Barrett's oesophagus influences markers for risk development of subsequent high-grade dysplasia/adenocarcinoma. A review of all patients with Barrett's oesophagus entering a surveillance programme was undertaken. Five hundred and two patients diagnosed with Barrett's oesophagus were assessed on diagnosis for endoscopic macroscopic markers or low-grade dysplasia. Subsequent development of high-grade dysplasia/adenocarcinoma was documented. The relationship between the initiation of proton pump inhibitor therapy prior to the diagnosis of BE and the presence of macroscopic markers or low-grade dysplasia at entry was determined. Fourteen patients developed high-grade dysplasia/adenocarcinoma during surveillance. Patients who entered without prior proton pump inhibitor therapy were 3.4 times (95% CI: 1.98-5.85) more likely to have a macroscopic marker or low-grade dysplasia than those patients already on a proton pump inhibitor. Use of proton pump inhibitor therapy prior to diagnosis of Barrett's oesophagus significantly reduced the presence of markers used to stratify patient risk. Widespread use of proton pump inhibitors will confound surveillance strategies for patients with Barrett's oesophagus based on entry characteristics but is justified because of the lower risk of neoplastic progression.

Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions

PubMed Central

Meuret, Alicia E.; Wolitzky-Taylor, Kate B.; Twohig, Michael P.; Craske, Michelle G.

2012-01-01

Although cognitive-behavioral treatments for panic disorder have demonstrated efficacy, a considerable number of patients terminate treatment prematurely or remain symtpomatic. Cognitive and biobehavioral coping skills are taught to improve exposure therapy outcomes but evidence for an additive effect is largely lacking. Current methodologies used to study the augmenting effects of coping skills test the degree to which the delivery of coping skills enhances outcomes. However, they do not assess the degree to which acquisition of coping skills and their application during exposure therapy augment outcomes. We examine the extant evidence on the role of traditional coping skills in augmenting exposure for panic disorder, discuss the limitations of existing research, and offer recommendations for methodological advances. PMID:22440065

Nanostructures: a platform for brain repair and augmentation

PubMed Central

Vidu, Ruxandra; Rahman, Masoud; Mahmoudi, Morteza; Enachescu, Marius; Poteca, Teodor D.; Opris, Ioan

2014-01-01

Nanoscale structures have been at the core of research efforts dealing with integration of nanotechnology into novel electronic devices for the last decade. Because the size of nanomaterials is of the same order of magnitude as biomolecules, these materials are valuable tools for nanoscale manipulation in a broad range of neurobiological systems. For instance, the unique electrical and optical properties of nanowires, nanotubes, and nanocables with vertical orientation, assembled in nanoscale arrays, have been used in many device applications such as sensors that hold the potential to augment brain functions. However, the challenge in creating nanowires/nanotubes or nanocables array-based sensors lies in making individual electrical connections fitting both the features of the brain and of the nanostructures. This review discusses two of the most important applications of nanostructures in neuroscience. First, the current approaches to create nanowires and nanocable structures are reviewed to critically evaluate their potential for developing unique nanostructure based sensors to improve recording and device performance to reduce noise and the detrimental effect of the interface on the tissue. Second, the implementation of nanomaterials in neurobiological and medical applications will be considered from the brain augmentation perspective. Novel applications for diagnosis and treatment of brain diseases such as multiple sclerosis, meningitis, stroke, epilepsy, Alzheimer's disease, schizophrenia, and autism will be considered. Because the blood brain barrier (BBB) has a defensive mechanism in preventing nanomaterials arrival to the brain, various strategies to help them to pass through the BBB will be discussed. Finally, the implementation of nanomaterials in neurobiological applications is addressed from the brain repair/augmentation perspective. These nanostructures at the interface between nanotechnology and neuroscience will play a pivotal role not only in addressing the multitude of brain disorders but also to repair or augment brain functions. PMID:24999319

Development of a flow feedback pulse duplicator system with rhesus monkey arterial input impedance characteristics

NASA Technical Reports Server (NTRS)

Schaub, J. D.; Koenig, S. C.; Schroeder, M. J.; Ewert, D. L.; Drew, G. A.; Swope, R. D.; Convertino, V. A. (Principal Investigator)

1999-01-01

An in vitro pulsatile pump flow system that is capable of producing physiologic pressures and flows in a mock circulatory system tuned to reproduce the first nine harmonics of the input impedance of a rhesus monkey was developed and tested. The system was created as a research tool for evaluating cardiovascular function and for the design, testing, and evaluation of electrical-mechanical cardiovascular models and chronically implanted sensors. The system possesses a computerized user interface for controlling a linear displacement pulsatile pump in a controlled flow loop format to emulate in vivo cardiovascular characteristics. Evaluation of the pump system consisted of comparing its aortic pressure and flow profiles with in vivo rhesus hemodynamic waveforms in the time and frequency domains. Comparison of aortic pressure and flow data between the pump system and in vivo data showed good agreement in the time and frequency domains, however, the pump system produced a larger pulse pressure. The pump system can be used for comparing cardiovascular parameters with predicted cardiovascular model values and for evaluating such items as vascular grafts, heart valves, biomaterials, and sensors. This article describes the development and evaluation of this feedback controlled cardiovascular dynamics simulation modeling system.

Flow Components in a NaK Test Loop Designed to Simulate Conditions in a Nuclear Surface Power Reactor

NASA Astrophysics Data System (ADS)

Polzin, Kurt A.; Godfroy, Thomas J.

2008-01-01

A test loop using NaK as the working fluid is presently in use to study material compatibility effects on various components that comprise a possible nuclear reactor design for use on the lunar surface. A DC electromagnetic (EM) pump has been designed and implemented as a means of actively controlling the NaK flow rate through the system and an EM flow sensor is employed to monitor the developed flow rate. These components allow for the matching of the flow rate conditions in test loops with those that would be found in a full-scale surface-power reactor. The design and operating characteristics of the EM pump and flow sensor are presented. In the EM pump, current is applied to a set of electrodes to produce a Lorentz body force in the fluid. A measurement of the induced voltage (back-EMF) in the flow sensor provides the means of monitoring flow rate. Both components are compact, employing high magnetic field strength neodymium magnets thermally coupled to a water-cooled housing. A vacuum gap limits the heat transferred from the high temperature NaK tube to the magnets and a magnetically-permeable material completes the magnetic circuit. The pump is designed to produce a pressure rise of 34.5 kPa, and the flow sensor's predicted output is roughly 20 mV at the loop's nominal flow rate of 0.114 m3/hr.

Flow Components in a NaK Test Loop Designed to Simulate Conditions in a Nuclear Surface Power Reactor

NASA Technical Reports Server (NTRS)

Polzin, Kurt A.; Godfroy, Thomas J.

2008-01-01

A test loop using NaK as the working fluid is presently in use to study material compatibility effects on various components that comprise a possible nuclear reactor design for use on the lunar surface. A DC electromagnetic (EM) pump has been designed and implemented as a means of actively controlling the NaK flow rate through the system and an EM flow sensor is employed to monitor the developed flow rate. These components allow for the matching of the flow rate conditions in test loops with those that would be found in a full-scale surface-power reactor. The design and operating characteristics of the EM pump and flow sensor are presented. In the EM pump, current is applied to a set of electrodes to produce a Lorentz body force in the fluid. A measurement of the induced voltage (back-EMF) in the flow sensor provides the means of monitoring flow rate. Both components are compact, employing high magnetic field strength neodymium magnets thermally coupled to a water-cooled housing. A vacuum gap limits the heat transferred from the high temperature NaK tube to the magnets and a magnetically-permeable material completes the magnetic circuit. The pump is designed to produce a pressure rise of 5 psi, and the flow sensor's predicted output is roughly 20 mV at the loop's nominal flow rate of 0.5 GPM.

Superior performance of a paraaortic counterpulsation device compared to the intraaortic balloon pump.

PubMed

Terrovitis, John V; Charitos, Christos E; Tsolakis, Elias J; Dolou, Paraskevi; Pierrakos, Charalampos N; Siafakas, Kostas X; Nanas, John N

2003-12-01

The purpose of this study was to compare the hemodynamic effectiveness of a 30-ml stroke volume paraaortic counterpulsation device (PACD), presenting the advantages of ease of implantation and driving by a standard intraaortic balloon pump (IABP) console (Datascope 96, Datascope Corp., Montvale, NJ, USA) to that of a 40-ml IABP, in the setting of experimental heart failure. In an acute heart failure model, the IABP was placed in the descending aorta and the PACD in the ascending aorta of eight pigs. Both devices were driven by the same system, and hemodynamic measurements were obtained with and without mechanical assistance. The two pumps significantly reduced the systolic and end-diastolic aortic pressures, but the PACD reduced the latter more effectively (42.6 +/- 18.1% vs 11.0 +/- 9.9%, p = 0.0001). Both pumps provided significant aortic diastolic augmentation, but the counterpulsation wave of the PACD was significantly greater (augmentation of 44.8 +/- 22.2% vs 37.6 +/- 15.6%, p = 0.031). Both lowered the end-diastolic left ventricular pressure with a trend toward PACD superiority (24.2 +/- 13.7% vs 19.7 +/- 13.5%, p = 0.064). It is concluded that the PACD, even with smaller stroke volume, is more effective than the IABP. The simplicity of its implantation, together with the ability of the standard IABP consoles to control its function, make it a promising device for mechanical assistance of the failing heart.

Patients and animal models of CNGβ1-deficient retinitis pigmentosa support gene augmentation approach

PubMed Central

Petersen-Jones, Simon M.; Occelli, Laurence M.; Winkler, Paige A.; Lee, Winston; Sparrow, Janet R.; Tsukikawa, Mai; Boye, Sanford L.; Chiodo, Vince; Capasso, Jenina E.; Becirovic, Elvir; Schön, Christian; Seeliger, Mathias W.; Levin, Alex V.; Hauswirth, William W.

2017-01-01

Retinitis pigmentosa (RP) is a major cause of blindness that affects 1.5 million people worldwide. Mutations in cyclic nucleotide-gated channel β 1 (CNGB1) cause approximately 4% of autosomal recessive RP. Gene augmentation therapy shows promise for treating inherited retinal degenerations; however, relevant animal models and biomarkers of progression in patients with RP are needed to assess therapeutic outcomes. Here, we evaluated RP patients with CNGB1 mutations for potential biomarkers of progression and compared human phenotypes with those of mouse and dog models of the disease. Additionally, we used gene augmentation therapy in a CNGβ1-deficient dog model to evaluate potential translation to patients. CNGB1-deficient RP patients and mouse and dog models had a similar phenotype characterized by early loss of rod function and slow rod photoreceptor loss with a secondary decline in cone function. Advanced imaging showed promise for evaluating RP progression in human patients, and gene augmentation using adeno-associated virus vectors robustly sustained the rescue of rod function and preserved retinal structure in the dog model. Together, our results reveal an early loss of rod function in CNGB1-deficient patients and a wide window for therapeutic intervention. Moreover, the identification of potential biomarkers of outcome measures, availability of relevant animal models, and robust functional rescue from gene augmentation therapy support future work to move CNGB1-RP therapies toward clinical trials. PMID:29202463

An analytical study of hybrid ejector/internal combustion engine-driven heat pumps

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

Murphy, R.W.

1988-01-01

Because ejectors can combine high reliability with low maintenance cost in a package requiring little capital investment, they may provide attractive heat pumping capability in situations where the importance of their inefficiencies is minimized. One such concept, a hybrid system in which an ejector driven by engine reject heat is used to increase the performance of an internal combustion engine-driven heat pump, was analyzed by modifying an existing ejector heat pump model and combining it with generic compressor and internal combustion engine models. Under the model assumptions for nominal cooling mode conditions, the results showed that hybrid systems could providemore » substantial performance augmentation/emdash/up to 17/percent/ increase in system coefficient of performance for a parallel arrangement of an enhanced ejector with the engine-driven compressor. 4 refs., 4 figs., 4 tabs.« less

The effect of silicone implants on the diagnosis, prognosis, and treatment of breast cancer.

PubMed

Handel, Neal

2007-12-01

Because of the prevalence of breast cancer, many augmented women eventually will develop the disease. This article reviews what is known about the effect of implants on the detection, prognosis, and treatment of carcinoma of the breast. Observations were made on 4082 breast cancer patients (3953 nonaugmented and 129 augmented) treated over a 23-year time span. Findings in the two groups were compared and differences analyzed statistically. Mammograms of all women with palpable lesions were reviewed to assess mammographic sensitivity in patients with and without implants. Cosmetic outcomes in augmented patients treated with breast conservation therapy were reviewed. Augmented patients presented more frequently with palpable lesions, invasive tumors, axillary nodal metastases, and false-negative mammograms. However, there was no significant difference in stage of disease, tumor size, recurrence rates, or survival between the two groups. Augmented patients treated with breast conservation therapy often experienced poor cosmetic results and frequently required reoperation. Despite the diminished sensitivity of mammography in women with implants, augmented and nonaugmented patients are diagnosed at a similar stage of disease and have a comparable prognosis. Implants may impair mammography but appear to facilitate tumor detection on physical examination. Magnetic resonance imaging and breast ultrasound may be useful adjuncts, but conventional mammography remains the most reliable tool for diagnosing early breast cancer in augmented patients. Breast implants do not interfere with mastectomy or breast reconstruction but may compromise the outcome of breast conservation therapy.

A cluster randomised trial, cost-effectiveness analysis and psychosocial evaluation of insulin pump therapy compared with multiple injections during flexible intensive insulin therapy for type 1 diabetes: the REPOSE Trial.

PubMed Central

Heller, Simon; White, David; Lee, Ellen; Lawton, Julia; Pollard, Daniel; Waugh, Norman; Amiel, Stephanie; Barnard, Katharine; Beckwith, Anita; Brennan, Alan; Campbell, Michael; Cooper, Cindy; Dimairo, Munyaradzi; Dixon, Simon; Elliott, Jackie; Evans, Mark; Green, Fiona; Hackney, Gemma; Hammond, Peter; Hallowell, Nina; Jaap, Alan; Kennon, Brian; Kirkham, Jackie; Lindsay, Robert; Mansell, Peter; Papaioannou, Diana; Rankin, David; Royle, Pamela; Smithson, W Henry; Taylor, Carolin

2017-01-01

BACKGROUND Insulin is generally administered to people with type 1 diabetes mellitus (T1DM) using multiple daily injections (MDIs), but can also be delivered using infusion pumps. In the UK, pumps are recommended for patients with the greatest need and adult use is less than in comparable countries. Previous trials have been small, of short duration and have failed to control for training in insulin adjustment. OBJECTIVE To assess the clinical effectiveness and cost-effectiveness of pump therapy compared with MDI for adults with T1DM, with both groups receiving equivalent structured training in flexible insulin therapy. DESIGN Pragmatic, multicentre, open-label, parallel-group cluster randomised controlled trial, including economic and psychosocial evaluations. After participants were assigned a group training course, courses were randomly allocated in pairs to either pump or MDI. SETTING Eight secondary care diabetes centres in the UK. PARTICIPANTS Adults with T1DM for > 12 months, willing to undertake intensive insulin therapy, with no preference for pump or MDI, or a clinical indication for pumps. INTERVENTIONS Pump or MDI structured training in flexible insulin therapy, followed up for 2 years. MDI participants used insulin analogues. Pump participants used a Medtronic Paradigm(®) Veo(TM) (Medtronic, Watford, UK) with insulin aspart (NovoRapid, Novo Nordisk, Gatwick, UK). MAIN OUTCOME MEASURES Primary outcome - change in glycated haemoglobin (HbA1c) at 2 years in participants whose baseline HbA1c was ≥ 7.5% (58 mmol/mol). Key secondary outcome - proportion of participants with HbA1c ≤ 7.5% at 2 years. Other outcomes at 6, 12 and 24 months - moderate and severe hypoglycaemia; insulin dose; body weight; proteinuria; diabetic ketoacidosis; quality of life (QoL); fear of hypoglycaemia; treatment satisfaction; emotional well-being; qualitative interviews with participants and staff (2 weeks), and participants (6 months); and ICERs in trial and modelled estimates of cost-effectiveness. RESULTS We randomised 46 courses comprising 317 participants: 267 attended a Dose Adjustment For Normal Eating course (132 pump; 135 MDI); 260 were included in the intention-to-treat analysis, of which 235 (119 pump; 116 MDI) had baseline HbA1c of ≥ 7.5%. HbA1c and severe hypoglycaemia improved in both groups. The drop in HbA1c% at 2 years was 0.85 on pump and 0.42 on MDI. The mean difference (MD) in HbA1c change at 2 years, at which the baseline HbA1c was ≥ 7.5%, was -0.24% [95% confidence interval (CI) -0.53% to 0.05%] in favour of the pump (p = 0.098). The per-protocol analysis showed a MD in change of -0.36% (95% CI -0.64% to -0.07%) favouring pumps (p = 0.015). Pumps were not cost-effective in the base case and all of the sensitivity analyses. The pump group had greater improvement in diabetes-specific QoL diet restrictions, daily hassle plus treatment satisfaction, statistically significant at 12 and 24 months and supported by qualitative interviews. LIMITATION Blinding of pump therapy was not possible, although an objective primary outcome was used. CONCLUSION Adding pump therapy to structured training in flexible insulin therapy did not significantly enhance glycaemic control or psychosocial outcomes in adults with T1DM. RESEARCH PRIORITY To understand why few patients achieve a HbA1c of < 7.5%, particularly as glycaemic control is worse in the UK than in other European countries. TRIAL REGISTRATION Current Controlled Trials ISRCTN61215213. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 20. See the NIHR Journals Library website for further project information. PMID:28440211

Aeroacoustic Characteristics of a Rectangular Multi-Element Supersonic Jet Mixer-Ejector Nozzle

NASA Technical Reports Server (NTRS)

Raman, Ganesh; Taghavi, Ray

1996-01-01

This paper provides a unique, detailed evaluation of the acoustics and aerodynamics of a rectangular multi-element supersonic jet mixer-ejector noise suppressor. The performance of such mixer-ejectors is important in aircraft engine application for noise suppression and thrust augmentation. In contrast to most prior experimental studies on ejectors that reported either aerodynamic or acoustic data, our work documents both types of data. We present information on the mixing, pumping, ejector wall pressure distribution, thrust augmentation and noise suppression characteristics of four simple, multi-element, jet mixer-ejector configurations. The four configurations included the effect of ejector area ratio (AR = ejector area/primary jet area) and the effect of non-parallel ejector walls. We also studied in detail the configuration that produced the best noise suppression characteristics. Our results show that ejector configurations that produced the maximum maximum pumping (entrained flow per secondary inlet area) also exhibited the lowest wall pressures in the inlet region, and the maximum thrust augmentation. When cases having the same total mass flow were compared, we found that noise suppression trends corresponded with those for pumping. Surprisingly, the mixing (quantified by the peak Mach number, and flow uniformity) at the ejector exit exhibited no relationship to the noise suppression at moderate primary jet fully expanded Mach numbers (Mj is less than 1.4). However, the noise suppression dependence on the mixing was apparent at higher Mj. The above observations are justified by noting that the mixing at the ejector exit is ot a strong factor in determining the radiated noise when noise produced internal to the ejector dominates the noise field outside the ejector.

Applied Augmented Reality for High Precision Maintenance

NASA Astrophysics Data System (ADS)

Dever, Clark

Augmented Reality had a major consumer breakthrough this year with Pokemon Go. The underlying technologies that made that app a success with gamers can be applied to improve the efficiency and efficacy of workers. This session will explore some of the use cases for augmented reality in an industrial environment. In doing so, the environmental impacts and human factors that must be considered will be explored. Additionally, the sensors, algorithms, and visualization techniques used to realize augmented reality will be discussed. The benefits of augmented reality solutions in industrial environments include automated data recording, improved quality assurance, reduction in training costs and improved mean-time-to-resolution. As technology continues to follow Moore's law, more applications will become feasible as performance-per-dollar increases across all system components.

Fetal magnetocardiography measurements with an array of microfabricated optically pumped magnetometers

NASA Astrophysics Data System (ADS)

Alem, Orang; Sander, Tilmann H.; Mhaskar, Rahul; LeBlanc, John; Eswaran, Hari; Steinhoff, Uwe; Okada, Yoshio; Kitching, John; Trahms, Lutz; Knappe, Svenja

2015-06-01

Following the rapid progress in the development of optically pumped magnetometer (OPM) technology for the measurement of magnetic fields in the femtotesla range, a successful assembly of individual sensors into an array of nearly identical sensors is within reach. Here, 25 microfabricated OPMs with footprints of 1 cm3 were assembled into a conformal array. The individual sensors were inserted into three flexible belt-shaped holders and connected to their respective light sources and electronics, which reside outside a magnetically shielded room, through long optical and electrical cables. With this setup the fetal magnetocardiogram of a pregnant woman was measured by placing two sensor belts over her abdomen and one belt over her chest. The fetal magnetocardiogram recorded over the abdomen is usually dominated by contributions from the maternal magnetocardiogram, since the maternal heart generates a much stronger signal than the fetal heart. Therefore, signal processing methods have to be applied to obtain the pure fetal magnetocardiogram: orthogonal projection and independent component analysis. The resulting spatial distributions of fetal cardiac activity are in good agreement with each other. In a further exemplary step, the fetal heart rate was extracted from the fetal magnetocardiogram. Its variability suggests fetal activity. We conclude that microfabricated optically pumped magnetometers operating at room temperature are capable of complementing or in the future even replacing superconducting sensors for fetal magnetocardiography measurements.

Alpha-1 antitrypsin augmentation therapy decreases miR-199a-5p, miR-598 and miR-320a expression in monocytes via inhibition of NFκB.

PubMed

Hassan, Tidi; de Santi, Chiara; Mooney, Catherine; McElvaney, Noel G; Greene, Catherine M

2017-10-23

Alpha-1 antitrypsin (AAT) augmentation therapy involves infusion of plasma-purified AAT to AAT deficient individuals. Whether treatment affects microRNA expression has not been investigated. This study's objectives were to evaluate the effect of AAT augmentation therapy on altered miRNA expression in monocytes and investigate the mechanism. Monocytes were isolated from non-AAT deficient (MM) and AAT deficient (ZZ) individuals, and ZZs receiving AAT. mRNA (qRT-PCR, microarray), miRNA (miRNA profiling, qRT-PCR), and protein (western blotting) analyses were performed. Twenty one miRNAs were differentially expressed 3-fold between ZZs and MMs. miRNA validation studies demonstrated that in ZZ monocytes receiving AAT levels of miR-199a-5p, miR-598 and miR-320a, which are predicted to be regulated by NFκB, were restored to levels similar to MMs. Validated targets co-regulated by these miRNAs were reciprocally increased in ZZs receiving AAT in vivo and in vitro. Expression of these miRNAs could be increased in ZZ monocytes treated ex vivo with an NFκB agonist and decreased by NFκB inhibition. p50 and p65 mRNA and protein were significantly lower in ZZs receiving AAT than untreated ZZs. AAT augmentation therapy inhibits NFκB and decreases miR-199a-5p, miR-598 and miR-320a in ZZ monocytes. These NFκB-inhibitory properties may contribute to the anti-inflammatory effects of AAT augmentation therapy.

D-Cycloserine Augmentation of Cognitive Behavioral Group Therapy of Social Anxiety Disorder: Prognostic and Prescriptive Variables

PubMed Central

Smits, Jasper A. J.; Hofmann, Stefan G.; Rosenfield, David; DeBoer, Lindsey B.; Costa, Paul T.; Simon, Naomi M.; O'Cleirigh, Conall; Meuret, Alicia E.; Marques, Luana; Otto, Michael W.; Pollack, Mark H.

2014-01-01

Objective The aim of the current study was to identify individual characteristics that (1) predict symptom improvement with group cognitive behavioral therapy (CBT) for social anxiety disorder (SAD; i.e., prognostic variables) or (2) moderate the effects of d-cycloserine vs. placebo augmentation of CBT for SAD (i.e., prescriptive variables). Method Adults with SAD (N=169) provided Liebowitz Social Anxiety Scale (LSAS) scores in a trial evaluating DCS augmentation of group CBT. Rate of symptom improvement during therapy and posttreatment symptom severity were evaluated using multilevel modeling. As predictors of these two parameters, we selected the range of variables assessed at baseline (demographic characteristics, clinical characteristics, personality traits). Using step-wise analyses, we first identified prognostic and prescriptive variables within each of these domains and then entered these significant predictors simultaneously in one final model. Results African American ethnicity and cohabitation status were associated with greater overall rates of improvement during therapy and lower posttreatment severity. Higher initial severity was associated with a greater improvement during therapy, but also higher posttreatment severity (the greater improvement was not enough to overcome the initial higher severity). D-cycloserine augmentation was evident only among individuals low in conscientiousness and high in agreeableness. Conclusions African American ethnicity, cohabitation status, and initial severity are prognostic of favorable CBT outcomes in SAD. D-cycloserine augmentation appears particularly useful for patients low in conscientiousness and high in agreeableness. These findings can guide clinicians in making decisions about treatment strategies and can help direct research on the mechanisms of these treatments. PMID:23937345

Attention bias modification augments cognitive-behavioral group therapy for social anxiety disorder: a randomized controlled trial.

PubMed

Lazarov, Amit; Marom, Sofi; Yahalom, Naomi; Pine, Daniel S; Hermesh, Haggai; Bar-Haim, Yair

2017-12-20

Cognitive-behavioral group therapy (CBGT) is a first-line treatment for social anxiety disorder (SAD). However, since many patients remain symptomatic post-treatment, there is a need for augmenting procedures. This randomized controlled trial (RCT) examined the potential augmentation effect of attention bias modification (ABM) for CBGT. Fifty patients with SAD from three therapy groups were randomized to receive an 18-week standard CBGT with either ABM designed to shift attention away from threat (CBGT + ABM), or a placebo protocol not designed to modify threat-related attention (CBGT + placebo). Therapy groups took place in a large mental health center. Clinician and self-report measures of social anxiety and depression were acquired pre-treatment, post-treatment, and at 3-month follow-up. Attention bias was assessed at pre- and post-treatment. Patients randomized to the CBGT + ABM group, relative to those randomized to the CBGT + placebo group, showed greater reductions in clinician-rated SAD symptoms post-treatment, with effects maintained at 3-month follow-up. Group differences were not evident for self-report or attention-bias measures, with similar reductions in both groups. Finally, reduction in attention bias did not mediate the association between group and reduction in Liebowitz Social Anxiety Scale Structured Interview (LSAS) scores. This is the first RCT to examine the possible augmenting effect of ABM added to group-based cognitive-behavioral therapy for adult SAD. Training patients' attention away from threat might augment the treatment response to standard CBGT in SAD, a possibility that could be further evaluated in large-scale RCTs.

The impact of baseline hemoglobin A1c levels prior to initiation of pump therapy on long-term metabolic control.

PubMed

Pinhas-Hamiel, Orit; Tzadok, Michal; Hirsh, Galit; Boyko, Valentina; Graph-Barel, Chana; Lerner-Geva, Liat; Reichman, Brian

2010-07-01

This study was done to identify factors influencing long-term metabolic control in youth with type 1 diabetes mellitus (T1DM) treated with an insulin pump. Data were obtained from retrospective chart review of 113 patients (52 males) with T1DM treated with an insulin pump for up to 7 years. Their mean +/- SD age at diagnosis of T1DM was 9.7 +/- 5.1 years, and that at pump therapy initiation was 13.8 +/- 6.1 years. Linear trends and changes in hemoglobin A1c (HbA1c) levels following pump insertion were evaluated according to gender, metabolic control prior to initiation of pump therapy, time from diagnosis of diabetes until pump therapy, age at initiation, and the duration of pump treatment. Mean HbA1c levels of patients with good baseline metabolic control (HbA1c level 9%) control groups (8.1 +/- 0.9% and 8.2 +/- 1.1%, respectively; P < 0.001). However, with time a significant trend for increasing HbA1c level was demonstrated in the group with good metabolic control (P value for trend = 0.004). HbA1c levels of patients with poor baseline metabolic control decreased significantly immediately after pump initiation (9.4 +/- 1.6% vs. 8.0 +/- 1.2%, P = 0.0001) and thereafter remained stable (P value for trend = 0.54). In the multivariable analyses, baseline HbA1c level

Augmenting Antidepressant Medication Treatment of Depressed Women with Emotionally Focused Therapy for Couples: A Randomized Pilot Study

ERIC Educational Resources Information Center

Denton, Wayne H.; Wittenborn, Andrea K.; Golden, Robert N.

2012-01-01

This is the first study to evaluate adding emotionally focused therapy for couples (EFT) to antidepressant medication in the treatment of women with major depressive disorder and comorbid relationship discord. Twenty-four women and their male partners were randomized to 6 months of medication management alone (MM) or MM augmented with EFT (MM +…

Development of a Proof of Concept Low Temperature Superfluid Magnetic Pump with Applications

NASA Astrophysics Data System (ADS)

Jahromi, Amir E.

State of the art particle and photon detectors such as Transition Edge Sensors (TES) and Microwave Kinetic Inductance Detectors (MKID) use large arrays of sensors or detectors for space science missions. As the size of these space science detectors increases, future astrophysics missions will require sub-Kelvin coolers over larger areas. This leads to not only increased cooling power requirements, but also a requirement for distributed sub-Kelvin cooling. Development of a proof of concept Superfluid Magnetic Pump is discussed in this work. This novel low temperature, no moving part pump can replace the existing bellows-piston driven 4He or 3He- 4He mixture compressor/circulators used in various sub Kelvin refrigeration systems such as dilution, Superfluid pulse tube, or active magnetic regenerative refrigerators. Due to its superior thermal transport properties this pump can also be used as a simple circulator of sub-Lambda 4He to distribute cooling over large surface areas. The pump discussed in this work was experimentally shown to produce a maximum flow rate of 440 mg/s (averaged over cycle), 665 mg/s (peak) and produced a maximum pressure difference of 2323 Pascal. This pump worked in an "ideal" thermodynamic state: The experimental results matched with the theoretical values predicted by a computer model. Pump curves were developed to map the performance of this pump. This successful demonstration will enable this novel pump to be put to test in suitable sub Kelvin refrigeration systems. Numerical modeling of an Active Magnetic Regenerative Refrigerator (AMRR) that uses the Superfluid Magnetic Pump (SMP) to circulate liquid 3He-4He through a magnetic regenerator is presented as a potential application of such a pump.

Liquid Bismuth Propellant Management System for the Very High Specific Impulse Thruster with Anode Layer

NASA Technical Reports Server (NTRS)

Polzin, K. A.; Markusic, T. E.; Stanojev, B. J.

2007-01-01

Two prototype bismuth propellant feed systems were constructed and operated in conjunction with a propellant vaporizer. One system provided bismuth to a vaporizer using gas pressurization but did not include a means to measure the flow rate. The second system incorporated an electromagnetic pump to provide fine control of the hydrostatic pressure and a new type of in-line flow sensor that was developed for accurate, real-time measurement of the mass flow rate. High-temperature material compatibility was a driving design requirement for the pump and flow sensor, leading to the selection of Macor for the main body of both components. Posttest inspections of both components revealed no degradation of the material. The gas pressurization system demonstrated continuous pressure control over a range from zero to 200 torr. In separate proof-of-concept experiments, the electromagnetic pump produced a linear pressure rise as a function of current that compared favorably with theoretical pump pressure predictions, producing a pressure rise of 10 kPa at 30 A. Preliminary flow sensor operation indicated a bismuth flow rate of 6 mg/s with an uncertainty of plus or minus 6%. An electronics suite containing a real-time controller was successfully used to control the entire system, simultaneously monitoring all power supplies and performing data acquisition duties.

Effects of intra-aortic balloon pump counterpulsation on left ventricular mechanoenergetics in a porcine model of acute ischemic heart failure.

PubMed

Malliaras, Konstantinos; Charitos, Efstratios; Diakos, Nikolaos; Pozios, Iraklis; Papalois, Apostolos; Terrovitis, John; Nanas, John

2014-12-01

We investigated the effects of intra-aortic balloon pump (IABP) counterpulsation on left ventricular (LV) contractility, relaxation, and energy consumption and probed the underlying physiologic mechanisms in 12 farm pigs, using an ischemia-reperfusion model of acute heart failure. During both ischemia and reperfusion, IABP support unloaded the LV, decreased LV energy consumption (pressure-volume area, stroke work), and concurrently improved LV mechanical performance (ejection fraction, stroke volume, cardiac output). During reperfusion exclusively, IABP also improved LV relaxation (tau) and contractility (Emax, PRSW). The beneficial effects of IABP support on LV relaxation and contractility correlated with IABP-induced augmentation of coronary blood flow. In conclusion, we find that during both ischemia and reperfusion, IABP support optimizes LV energetic performance (decreases energy consumption and concurrently improves mechanical performance) by LV unloading. During reperfusion exclusively, IABP support also improves LV contractility and active relaxation, possibly due to a synergistic effect of unloading and augmentation of coronary blood flow.

The Combination of Micro Diaphragm Pumps and Flow Sensors for Single Stroke Based Liquid Flow Control

PubMed Central

Jenke, Christoph; Pallejà Rubio, Jaume; Kibler, Sebastian; Häfner, Johannes; Richter, Martin; Kutter, Christoph

2017-01-01

With the combination of micropumps and flow sensors, highly accurate and secure closed-loop controlled micro dosing systems for liquids are possible. Implementing a single stroke based control mode with piezoelectrically driven micro diaphragm pumps can provide a solution for dosing of volumes down to nanoliters or variable average flow rates in the range of nL/min to μL/min. However, sensor technologies feature a yet undetermined accuracy for measuring highly pulsatile micropump flow. Two miniaturizable in-line sensor types providing electrical readout—differential pressure based flow sensors and thermal calorimetric flow sensors—are evaluated for their suitability of combining them with mircopumps. Single stroke based calibration of the sensors was carried out with a new method, comparing displacement volumes and sensor flow volumes. Limitations of accuracy and performance for single stroke based flow control are described. Results showed that besides particle robustness of sensors, controlling resistive and capacitive damping are key aspects for setting up reproducible and reliable liquid dosing systems. Depending on the required average flow or defined volume, dosing systems with an accuracy of better than 5% for the differential pressure based sensor and better than 6.5% for the thermal calorimeter were achieved. PMID:28368344

A pilot study of cognitive behaviour therapy for panic disorder augmented by panic surfing.

PubMed

Lamplugh, Claire; Berle, David; Milicevic, Denise; Starcevic, Vladan

2008-01-01

This pilot study reports the outcome of cognitive behaviour therapy for panic disorder augmented by panic surfing. This treatment approach encourages acceptance of feelings rather than control of symptoms and anxiety, at the same time also targeting catastrophic misinterpretations, bodily vigilance and safety-seeking behaviours. Eighteen participants completed a brief group treatment for panic disorder incorporating psychoeducation, panic surfing, interoceptive exposure, graded exposure and cognitive restructuring. Significant improvements occurred over the course of this treatment and were maintained at a 1-month follow-up. Results suggest that cognitive behaviour therapy augmented by panic surfing may be effective in the treatment of panic disorder, but there is a need for controlled studies and investigation of the relative contribution of its various components. 2008 John Wiley & Sons, Ltd.

An electrical sensor for long-term monitoring of ultrafine particles in workplaces

NASA Astrophysics Data System (ADS)

Lanki, Timo; Tikkanen, Juha; Janka, Kauko; Taimisto, Pekka; Lehtimäki, Matti

2011-07-01

Pegasor Oy Ltd. (Finland) has developed a diffusion charging measurement device that enables continuous monitoring of fine particle concentration at a low initial and lifecycle cost. The innovation, for which an international process and apparatus patent has been applied for, opens doors for monitoring nanoparticle concentrations in workplaces. The Pegasor Particle Sensor (PPS) operates by electrostatically charging particles passing through the sensor and then measuring the current caused by the charged particles as they leave the sensor. The particles never touch the sensor and so never accumulate on its surfaces or need to be cleaned off. The sensor uses an ejector pump to draw a constant sample flow into the sensing area where it is mixed with the clean, charged pump flow air (provided by an external source). The sample flow containing charged particles passes through the sensor. The current generated by the charge leaving the detection volume is measured and related to the particle surface area. This system is extremely simple and reliable - no contact, no moving parts, and all critical parts of the sensor are constantly cleaned by a stream of fresh, filtered air. Due to the ejector pump, the sample flow, and respectively the sensor response is independent of the flow and pressure conditions around the sampling inlet. Tests with the Pegasor Particle Sensor have been conducted in a laboratory, and at a workplace producing nanoparticles for glass coatings. A new measurement protocol has been designed to ensure that process workers are not exposed to unusually high nanoparticle concentrations at any time during their working day. One sensor is placed inside the process line, and a light alarm system indicates the worker not to open any protective shielding or ventilation systems before concentration inside has reached background levels. The benefits of PPS in industrial hygiene are that the same monitoring technology can be used at the source as well as at the worker breathing zone. Up to eight sensors can be installed in series for centralized monitoring of the whole process in real time.

Hybrid Closed-Loop Insulin Delivery in Type 1 Diabetes During Supervised Outpatient Conditions.

PubMed

Grosman, Benyamin; Ilany, Jacob; Roy, Anirban; Kurtz, Natalie; Wu, Di; Parikh, Neha; Voskanyan, Gayane; Konvalina, Noa; Mylonas, Chrystaleni; Gottlieb, Rebecca; Kaufman, Francine; Cohen, Ohad

2016-05-01

Efficacy and safety of the Medtronic Hybrid Closed-Loop (HCL) system were tested in subjects with type 1 diabetes in a supervised outpatient setting. The HCL system is a prototype research platform that includes a sensor-augmented insulin pump in communication with a control algorithm housed on an Android-based cellular device. Nine subjects with type 1 diabetes (5 female, mean age 53.3 years, mean A1C 7.2%) underwent 9 studies totaling 571 hours of closed-loop control using either default or personalized parameters. The system required meal announcements with estimates of carbohydrate (CHO) intake that were based on metabolic kitchen quantification (MK), dietician estimates (D), or subject estimates (Control). Postprandial glycemia was compared for MK, D, and Control meals. The overall sensor glucose mean was 145 ± 43, the overall percentage time in the range 70-180 mg/dL was 80%, the overall percentage time <70 mg/dL was 0.79%. Compared to intervals of default parameter use (225 hours), intervals of personalized parameter use (346 hours), sensor glucose mean was 158 ± 49 and 137 ± 37 mg/dL (P < .001), respectively, and included more time in range (87% vs 68%) and less time below range (0.54% vs 1.18%). Most subjects underestimated the CHO content of meals, but postprandial glycemia was not significantly different between MK and matched Control meals (P = .16) or between D and matched Control meals (P = .76). There were no episodes of severe hypoglycemia. The HCL system was efficacious and safe during this study. Personally adapted HCL parameters were associated with more time in range and less time below range than default parameters. Accurate estimates of meal CHO did not contribute to improved postprandial glycemia. © 2016 Diabetes Technology Society.

A Context-Aware Ubiquitous Learning Environment for Language Listening and Speaking

ERIC Educational Resources Information Center

Liu, T.-Y.

2009-01-01

This paper reported the results of a study that aimed to construct a sensor and handheld augmented reality (AR)-supported ubiquitous learning (u-learning) environment called the Handheld English Language Learning Organization (HELLO), which is geared towards enhancing students' language learning. The HELLO integrates sensors, AR, ubiquitous…

EFFECT OF CYP2C19 GENETIC POLYMORPHISMS ON THE EFFICACY OF PROTON PUMP INHIBITOR-BASED TRIPLE ERADICATION THERAPY IN SLAVIC PATIENTS WITH PEPTIC ULCERS: A META-ANALYSIS.

PubMed

Denisenko, N P; Sychev, D A; Sizova, Zh M; Rozhkov, A V; Kondrashov, A V

Several meta-analyzes reported the effect of CYP2C19 genetic polymorphisms on the efficacy of proton pump inhibitor-based triple therapy for Helicobacter pylori eradication. Most of the studies which were included in these meta-analyzes were held on Asian population. Thus, there is lack of information about the effect of CYP2C19 genetic polymorphisms on the efficacy of proton pump inhibitor-based triple eradication therapy in Slavic patients with peptic ulcers. The aim of the study - to determine whether CYP2C19 affect the efficacy of proton pump inhibitor-based triple eradica- tion therapy in Slavic patients with peptic ulcers. Data search was performed using Russian index of scientific citation database, Google Scholar and MEDLINE PubMed. Statistics was held in Review Manager v 5.3. The odds ratio (OR) and 95% confidence interval (95% Cl) for eradication of H.pylori was estimated in a fixed-effect model when no heterogeneity across the studies was indicated. Four articles published between 2008 and 2015 were included in meta-analysis (three Russian studies, one Polish study). Eradication rates were significantly lower in CYP2C19 extensive metabolizers of proton pump inhibitors than in a combined group of intermediate and poor metabolizers (OR = 1,90, CI-95% 1,08-3,34, p = 0,03; heterogeneity: 12= 0%, p = 0,74). We also found that proton pump inhibitor-based triple eradication therapy achieved higher rates in poor metabolizers than in a combined group of intermediate and extensive metabolizers of CYP2C19 (OR= 5,48 CI-95% 1,51-19,93, p = 0,01; heterogeneity: F= 0%, p = 0,66). The impact of CYP2C19 genetic polymorphisms on the efficacy of proton pump inhibitor-based triple eradication therapy in Slavic patients appears significant.

Device for quickly sensing the amount of O2 in a combustion product gas

NASA Technical Reports Server (NTRS)

Singh, Jag J. (Inventor); Davis, William T. (Inventor); Puster, Richard L. (Inventor)

1990-01-01

A sensing device comprising an O2 sensor, a pump, a compressor, and a heater is provided to quickly sense the amount of O2 in a combustion product gas. A sample of the combustion product gas is compressed to a pressure slightly above one atmosphere by the compressor. Next, the heater heats the sample between 800 C and 900 C. Next, the pump causes the sample to be flushed against the electrode located in O2 sensor 6000 to 10,000 times per second. Reference air at approximately one atmosphere is provided to the electrode of O2 sensor. Accordingly, the O2 sensor produces a voltage which is proportional to the amount of oxygen in the combustion product gas. This voltage may be used to control the amount of O2 entering into the combustion chamber which produces the combustion product gas.

Hypoglycaemia incidence and recovery during home use of hybrid closed-loop insulin delivery in adults with type 1 diabetes.

PubMed

Ruan, Yue; Bally, Lia; Thabit, Hood; Leelarathna, Lalantha; Hartnell, Sara; Tauschmann, Martin; Wilinska, Malgorzata E; Evans, Mark L; Mader, Julia K; Kojzar, Harald; Dellweg, Sibylle; Benesch, Carsten; Arnolds, Sabine; Pieber, Thomas R; Hovorka, Roman

2018-03-25

Glucose excursion was assessed prior to and post hypoglycaemia to increase understanding of hypoglycaemia incidence and recovery during hybrid closed-loop insulin delivery. We retrospectively analysed data from 60 adults with type 1 diabetes who received, in a crossover randomized design, day-and-night hybrid closed-loop insulin delivery and insulin pump therapy, the latter with or without real-time continuous glucose monitoring. Over 4-week study periods, we identified hypoglycaemic episodes, defined as sensor glucose <3.0 mmol/L, and analysed sensor glucose relative to the onset of hypoglycaemia. We identified 377 hypoglycaemic episodes during hybrid closed-loop intervention vs 662 during control intervention (P < .001), with a predominant reduction of nocturnal hypoglycaemia. The slope of sensor glucose prior to hypoglycaemia was steeper during closed-loop intervention than during control intervention (P < .01), while insulin delivery was reduced (P < .01). During both day and night, participants recovered from hypoglycaemia faster when treated by closed-loop intervention. At 120 minutes post hypoglycaemia, sensor glucose levels were higher during closed-loop intervention compared to the control period (P < .05). In conclusion, closed-loop intervention reduces the risk of hypoglycaemia, particularly overnight, with swift recovery from hypoglycaemia leading to higher 2-hour post-hypoglycaemia glucose levels. © 2018 John Wiley & Sons Ltd.

Integrated Liquid Bismuth Propellant Feed System

NASA Technical Reports Server (NTRS)

Polzin, Kurt A.; Markusic, Thomas E.; Stanojev, Boris J.

2006-01-01

A prototype bismuth propellant feed and control system was constructed and tested. An electromagnetic pump was used in this system to provide fine control of the hydrostatic pressure, and a new type of in-line flow sensor was developed to provide an accurate, real-time measurement of the mass flow rate. High-temperature material compatibility was a driving design requirement for the pump and flow sensor, leading to the selection of macor for the main body of both components. Post-test inspections of both components revealed no cracks or leaking in either. In separate proof-of-concept experiments, the pump produced a linear pressure rise as a function of current that compared favorably with theoretical pump pressure predictions, with a pressure of 10 kPa at 30 A. Flow sensing was successfully demonstrated in a bench-top test using gallium as a substitute liquid metal. A real-time controller was successfully used to control the entire system, simultaneously monitoring all power supplies and performing data acquisition duties.

Variable temperature seat climate control system

DOEpatents

Karunasiri, Tissa R.; Gallup, David F.; Noles, David R.; Gregory, Christian T.

1997-05-06

A temperature climate control system comprises a variable temperature seat, at least one heat pump, at least one heat pump temperature sensor, and a controller. Each heat pump comprises a number of Peltier thermoelectric modules for temperature conditioning the air in a main heat exchanger and a main exchanger fan for passing the conditioned air from the main exchanger to the variable temperature seat. The Peltier modules and each main fan may be manually adjusted via a control switch or a control signal. Additionally, the temperature climate control system may comprise a number of additional temperature sensors to monitor the temperature of the ambient air surrounding the occupant as well as the temperature of the conditioned air directed to the occupant. The controller is configured to automatically regulate the operation of the Peltier modules and/or each main fan according to a temperature climate control logic designed both to maximize occupant comfort during normal operation, and minimize possible equipment damage, occupant discomfort, or occupant injury in the event of a heat pump malfunction.

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.

Safety of the batteries and power units used in insulin pumps: A pilot cross-sectional study by the Association for the Study of Innovative Diabetes Treatment in Japan.

PubMed

Murata, Takashi; Nirengi, Shinsuke; Sakane, Naoki; Kuroda, Akio; Hirota, Yushi; Matsuhisa, Munehide; Namba, Mitsuyoshi; Kobayashi, Tetsuro

2017-10-21

We investigated the safety of the batteries and power units used in insulin pumps in Japan. A self-administered questionnaire was sent to the 201 members of the Association for Innovative Diabetes Treatment in Japan. A total of 56 members responded, and among the 1,499 active devices, 66 had episodes of trouble related to the batteries and power units. The ratio of reported troubles to the number of insulin pumps was significantly higher in insulin pumps with a continuous glucose monitoring sensor compared with insulin pumps without a continuous glucose monitoring sensor (odds ratio 2.82, P < 0.05). The cause and the consequences varied. The brands of the batteries varied; alkaline batteries purchased at drug stores and other shops accounted for 19.7%. Termination of battery life within 72 h of use was reported most frequently (50.0%), suspension of the insulin pump (21.2%) and leakage of the battery fluid (4.5%) followed. A total of 53.2% of the reported insulin pumps needed to be replaced, and 37.1% of them recovered after replacement of the battery. As trouble related to the batteries and power units of insulin pumps was frequent, practical guidance should be provided to respective patients regarding the use of reliable batteries, and to be well prepared for unexpected insulin pump failure. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Fiber-optic anemometer based on single-walled carbon nanotube coated tilted fiber Bragg grating.

PubMed

Zhang, Yang; Wang, Fang; Liu, Zigeng; Duan, Zhihui; Cui, Wenli; Han, Jie; Gu, Yiying; Wu, Zhenlin; Jing, Zhenguo; Sun, Changsen; Peng, Wei

2017-10-02

In this work, a novel and simple optical fiber hot-wire anemometer based on single-walled carbon nanotubes (SWCNTs) coated tilted fiber Bragg grating (TFBG) is proposed and demonstrated. For the hot-wire wind speed sensor design, TFBG is an ideal in-fiber sensing structure due to its unique features. It is utilized as both light coupling and temperature sensing element without using any geometry-modified or uncommon fiber, which simplifies the sensor structure. To further enhance the thermal conversion capability, SWCNTs are coated on the surface of the TFBG instead of traditional metallic materials, which have excellent thermal characteristics. When a laser light is pumped into the sensor, the pump light propagating in the core will be easily coupled into cladding of the fiber via the TFBG and strongly absorbed by the SWCNTs thin film. This absorption acts like a hot-wire raising the local temperature of the fiber, which is accurately detected by the TFBG resonance shift. In the experiments, the sensor's performances were investigated and controlled by adjusting the inherent angle of the TFBG, the thickness of SWCNTs film, and the input power of the pump laser. It was demonstrated that the developed anemometer exhibited significant light absorption efficiency up to 93%, and the maximum temperature of the local area on the fiber was heated up to 146.1°C under the relatively low pump power of 97.76 mW. The sensitivity of -0.3667 nm/(m/s) at wind speed of 1.0 m/s was measured with the selected 12° TFBG and 1.6 μm film.

Adaptive Monocular Visual-Inertial SLAM for Real-Time Augmented Reality Applications in Mobile Devices.

PubMed

Piao, Jin-Chun; Kim, Shin-Dug

2017-11-07

Simultaneous localization and mapping (SLAM) is emerging as a prominent issue in computer vision and next-generation core technology for robots, autonomous navigation and augmented reality. In augmented reality applications, fast camera pose estimation and true scale are important. In this paper, we present an adaptive monocular visual-inertial SLAM method for real-time augmented reality applications in mobile devices. First, the SLAM system is implemented based on the visual-inertial odometry method that combines data from a mobile device camera and inertial measurement unit sensor. Second, we present an optical-flow-based fast visual odometry method for real-time camera pose estimation. Finally, an adaptive monocular visual-inertial SLAM is implemented by presenting an adaptive execution module that dynamically selects visual-inertial odometry or optical-flow-based fast visual odometry. Experimental results show that the average translation root-mean-square error of keyframe trajectory is approximately 0.0617 m with the EuRoC dataset. The average tracking time is reduced by 7.8%, 12.9%, and 18.8% when different level-set adaptive policies are applied. Moreover, we conducted experiments with real mobile device sensors, and the results demonstrate the effectiveness of performance improvement using the proposed method.

Contemporary trends in cardiogenic shock: Incidence, intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group.

PubMed

Rathod, Krishnaraj S; Koganti, Sudheer; Iqbal, M Bilal; Jain, Ajay K; Kalra, Sundeep S; Astroulakis, Zoe; Lim, Pitt; Rakhit, Roby; Dalby, Miles C; Lockie, Tim; Malik, Iqbal S; Knight, Charles J; Whitbread, Mark; Mathur, Anthony; Redwood, Simon; MacCarthy, Philip A; Sirker, Alexander; O'Mahony, Constantinos; Wragg, Andrew; Jones, Daniel A

2018-02-01

Cardiogenic shock remains a major cause of morbidity and mortality in patients with ST-segment elevation myocardial infarction. We aimed to assess the current trends in cardiogenic shock management, looking specifically at the incidence, use of intra-aortic balloon pump therapy and outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. We undertook an observational cohort study of 21,210 ST-segment elevation myocardial infarction patients treated between 2005-2015 at the eight Heart Attack Centres in London, UK. Patients' details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society percutaneous coronary intervention dataset. There were 1890 patients who presented with cardiogenic shock. The primary outcome was all-cause mortality at a median follow-up of 4.1 years (interquartile range: 2.2-5.8 years). Increasing rates of cardiogenic shock were seen over the course of the study with consistently high mortality rates of 45-70%. A total of 685 patients underwent intra-aortic balloon pump insertion during primary percutaneous coronary intervention for cardiogenic shock with decreasing rates over time. Those patients undergoing intra-aortic balloon pump therapy were younger, more likely to have poor left ventricular function and less likely to have had previous percutaneous coronary intervention compared to the control group. Procedural success rates were similar (86.0% vs 87.1%, p=0.292) although crude, in-hospital major adverse cardiac event rates were higher (43.8% vs 33.7%, p<0.0001) in patients undergoing intra-aortic balloon pump therapy. Kaplan-Meier analysis demonstrated significantly higher mortality rates in patients receiving intra-aortic balloon pump therapy (50.9% intra-aortic balloon pump vs 39.9% control, p<0.0001) during the follow-up period. After multivariate Cox analysis (hazard ratio 1.04, 95% confidence interval 0.62-1.89) and the use of propensity matching (hazard ratio: 1.29, 95% confidence interval: 0.68-1.45) intra-aortic balloon pump therapy was not associated with mortality. Cardiogenic shock treated by percutaneous coronary intervention is increasing in incidence and remains a condition associated with high mortality and limited treatment options. Intra-aortic balloon pump therapy was not associated with a long-term survival benefit in this cohort and may be associated with increased early morbidity.

SST Technology Follow-on Program - Phase I, Performance Evaluation of an SST Noise Suppressor Nozzle System. Volume 1. Suppressed Mode.

DTIC Science & Technology

ACOUSTIC INSULATION, *TURBOJET EXHAUST NOZZLES, *JET ENGINE NOISE, REDUCTION, JET TRANSPORT AIRCRAFT, THRUST AUGMENTATION , SUPERSONIC NOZZLES, DUCT...INLETS, CONVERGENT DIVERGENT NOZZLES, SUBSONIC FLOW, SUPERSONIC FLOW, SUPPRESSORS, TURBOJET INLETS, BAFFLES, JET PUMPS, THRUST , DRAG, TEMPERATURE

Antidepressant response to aripiprazole augmentation associated with enhanced FDOPA utilization in striatum: a preliminary PET study

PubMed Central

Conway, Charles R.; Chibnall, John T.; Cumming, Paul; Mintun, Mark A.; Gebara, Marie Anne I.; Perantie, Dana C.; Price, Joseph L.; Cornell, Martha E.; McConathy, Jonathan E.; Gangwani, Sunil; Sheline, Yvette I.

2014-01-01

Several double blind, prospective trials have demonstrated an antidepressant augmentation efficacy of aripiprazole in depressed patients unresponsive to standard antidepressant therapy. Although aripiprazole is now widely used for this indication, and much is known about its receptor-binding properties, the mechanism of its antidepressant augmentation remains ill-defined. In vivo animal studies and in vitro human studies using cloned dopamine dopamine D2 receptors suggest aripiprazole is a partial dopamine agonist; in this preliminary neuroimaging trial, we hypothesized that aripiprazole’s antidepressant augmentation efficacy arises from dopamine partial agonist activity. To test this, we assessed the effects of aripiprazole augmentation on the cerebral utilization of 6-[18F]-fluoro-3,4-dihydroxy-L-phenylalanine (FDOPA) using positron emission tomography (PET). Fourteen depressed patients, who had failed 8 weeks of antidepressant therapy with selective serotonin reuptake inhibitors, underwent FDOPA PET scans before and after aripiprazole augmentation; eleven responded to augmentation. Whole brain, voxel-wise comparisons of pre- and post-aripiprazole scans revealed increased FDOPA trapping in the right medial caudate of augmentation responders. An exploratory analysis of depressive symptoms revealed that responders experienced large improvements only in putatively dopaminergic symptoms of lassitude and inability to feel. These preliminary findings suggest that augmentation of antidepressant response by aripiprazole may be associated with potentiation of dopaminergic activity. PMID:24468015

Augmentation-related brain plasticity

PubMed Central

Di Pino, Giovanni; Maravita, Angelo; Zollo, Loredana; Guglielmelli, Eugenio; Di Lazzaro, Vincenzo

2014-01-01

Today, the anthropomorphism of the tools and the development of neural interfaces require reconsidering the concept of human-tools interaction in the framework of human augmentation. This review analyses the plastic process that the brain undergoes when it comes into contact with augmenting artificial sensors and effectors and, on the other hand, the changes that the use of external augmenting devices produces in the brain. Hitherto, few studies investigated the neural correlates of augmentation, but clues on it can be borrowed from logically-related paradigms: sensorimotor training, cognitive enhancement, cross-modal plasticity, sensorimotor functional substitution, use and embodiment of tools. Augmentation modifies function and structure of a number of areas, i.e., primary sensory cortices shape their receptive fields to become sensitive to novel inputs. Motor areas adapt the neuroprosthesis representation firing-rate to refine kinematics. As for normal motor outputs, the learning process recruits motor and premotor cortices and the acquisition of proficiency decreases attentional recruitment, focuses the activity on sensorimotor areas and increases the basal ganglia drive on the cortex. Augmentation deeply relies on the frontoparietal network. In particular, premotor cortex is involved in learning the control of an external effector and owns the tool motor representation, while the intraparietal sulcus extracts its visual features. In these areas, multisensory integration neurons enlarge their receptive fields to embody supernumerary limbs. For operating an anthropomorphic neuroprosthesis, the mirror system is required to understand the meaning of the action, the cerebellum for the formation of its internal model and the insula for its interoception. In conclusion, anthropomorphic sensorized devices can provide the critical sensory afferences to evolve the exploitation of tools through their embodiment, reshaping the body representation and the sense of the self. PMID:24966816

Ensemble machine learning and forecasting can achieve 99% uptime for rural handpumps

PubMed Central

Thomas, Evan A.

2017-01-01

Broken water pumps continue to impede efforts to deliver clean and economically-viable water to the global poor. The literature has demonstrated that customers’ health benefits and willingness to pay for clean water are best realized when clean water infrastructure performs extremely well (>99% uptime). In this paper, we used sensor data from 42 Afridev-brand handpumps observed for 14 months in western Kenya to demonstrate how sensors and supervised ensemble machine learning could be used to increase total fleet uptime from a best-practices baseline of about 70% to >99%. We accomplish this increase in uptime by forecasting pump failures and identifying existing failures very quickly. Comparing the costs of operating the pump per functional year over a lifetime of 10 years, we estimate that implementing this algorithm would save 7% on the levelized cost of water relative to a sensor-less scheduled maintenance program. Combined with a rigorous system for dispatching maintenance personnel, implementing this algorithm in a real-world program could significantly improve health outcomes and customers’ willingness to pay for water services. PMID:29182673

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

Biewer, Theodore M.; Marcus, Chris; Klepper, C Christopher

The divertor-specific ITER Diagnostic Residual Gas Analyzer (DRGA) will provide essential information relating to DT fusion plasma performance. This includes pulse-resolving measurements of the fuel isotopic mix reaching the pumping ducts, as well as the concentration of the helium generated as the ash of the fusion reaction. In the present baseline design, the cluster of sensors attached to this diagnostic's differentially pumped analysis chamber assembly includes a radiation compatible version of a commercial quadrupole mass spectrometer, as well as an optical gas analyzer using a plasma-based light excitation source. This paper reports on a laboratory study intended to validate themore » performance of this sensor cluster, with emphasis on the detection limit of the isotopic measurement. This validation study was carried out in a laboratory set-up that closely prototyped the analysis chamber assembly configuration of the baseline design. This includes an ITER-specific placement of the optical gas measurement downstream from the first turbine of the chamber's turbo-molecular pump to provide sufficient light emission while preserving the gas dynamics conditions that allow for \\textasciitilde 1 s response time from the sensor cluster [1].« less

No Effects of D-Cycloserine Enhancement in Exposure With Response Prevention Therapy in Panic Disorder With Agoraphobia: A Double-Blind, Randomized Controlled Trial.

PubMed

Hofmeijer-Sevink, Mieke Klein; Duits, Puck; Rijkeboer, Marleen M; Hoogendoorn, Adriaan W; van Megen, Harold J; Vulink, Nienke C; Denys, Damiaan A; van den Hout, Marcel A; van Balkom, Anton J; Cath, Danielle C

2017-10-01

D-cycloserine (DCS) is a partial N-methyl-D-aspartate receptor agonist that potentially augments response to exposure therapy in anxiety disorders by enhancing extinction learning. This randomized, double-blinded, placebo-controlled augmentation trial examined (1) the effectiveness of adding 125 mg of DCS to exposure therapy (before or directly after the first 6 treatment sessions) in patients with panic disorder with agoraphobia and (2) the effectiveness of DCS augmentation preceding exposure relative to DCS augmentation directly postexposure. Fifty-seven patients were allocated to 1 of 3 medication conditions (placebo and pre-exposure and postexposure DCS) as an addition to 6 exposure sessions within a 12-session exposure and response prevention protocol. The primary outcome measure was the mean score on the "alone" subscale of the Mobility Inventory (MI). No differences were found in treatment outcome between DCS and placebo, administered either pre-exposure or postexposure therapy, although at 3-month follow-up, the DCS postexposure group compared with DCS pre-exposure, exhibited greater symptom reduction on the MI-alone subscale. Ancillary analyses in specific subgroups (responders vs nonresponders, early vs late responders, severely vs mildly affected patients) did not reveal any between-group DCS versus placebo differences. Finally, the study did not find an effect of DCS relative to placebo to be specific for successful exposure sessions. This study does not find an effect of augmentation with DCS in patients with severe panic disorder and agoraphobia administered either pretreatment or directly posttreatment sessions. Moreover, no preferential effects are revealed in specific subgroups nor in successful exposure sessions. Yet, a small effect of DCS administration postexposure therapy cannot be ruled out, given the relatively small sample size of this study.

Air Conditioning Overflow Sensor

NASA Technical Reports Server (NTRS)

1996-01-01

The Technology Transfer Office at Stennis Space Center helped a local inventor develop a prototype of an attachment for central air conditioners and heat pumps that helps monitor water levels to prevent condensation overflow. The sensor will indicate a need for drain line maintenance and prevent possible damage caused by drain pan water spillover. An engineer in the Stennis Space Center prototype Development Laboratory used SSC sensor technology in the development of the sensor.

Thrust augmentation nozzle (TAN) concept for rocket engine booster applications

NASA Astrophysics Data System (ADS)

Forde, Scott; Bulman, Mel; Neill, Todd

2006-07-01

Aerojet used the patented thrust augmented nozzle (TAN) concept to validate a unique means of increasing sea-level thrust in a liquid rocket booster engine. We have used knowledge gained from hypersonic Scramjet research to inject propellants into the supersonic region of the rocket engine nozzle to significantly increase sea-level thrust without significantly impacting specific impulse. The TAN concept overcomes conventional engine limitations by injecting propellants and combusting in an annular region in the divergent section of the nozzle. This injection of propellants at moderate pressures allows for obtaining high thrust at takeoff without overexpansion thrust losses. The main chamber is operated at a constant pressure while maintaining a constant head rise and flow rate of the main propellant pumps. Recent hot-fire tests have validated the design approach and thrust augmentation ratios. Calculations of nozzle performance and wall pressures were made using computational fluid dynamics analyses with and without thrust augmentation flow, resulting in good agreement between calculated and measured quantities including augmentation thrust. This paper describes the TAN concept, the test setup, test results, and calculation results.

Meta-analysis: comparative efficacy of different proton-pump inhibitors in triple therapy for Helicobacter pylori eradication.

PubMed

Vergara, M; Vallve, M; Gisbert, J P; Calvet, X

2003-09-15

It is not known whether certain proton-pump inhibitors are more efficacious than others when used in triple therapy for Helicobacter pylori eradication. To compare the efficacy of different proton-pump inhibitors in triple therapy by performing a meta-analysis. A MEDLINE search was performed. Abstracts of the European Helicobacter pylori Study Group and the American Gastroenterological Association congresses from 1996 to 2002 were also examined. Randomized studies with at least two branches of triple therapy that differed only in terms of type of proton-pump inhibitor were included in a meta-analysis using Review Manager 4.1. Fourteen studies were included. Intention-to-treat cure rates were similar for omeprazole and lansoprazole: 74.7% vs. 76%, odds ratio (OR) 0.91 [95% confidence interval (CI) 0.69-1.21] in a total of 1085 patients; for omeprazole and rabeprazole: 77.9% vs. 81.2%, OR 0.81 (95% CI 0.58-1.15) in a total of 825 patients; for omeprazole and esomeprazole: 87.7% vs. 89%, OR 0.89 (95% CI 0.58-1.35) in 833 patients; and for lansoprazole and rabeprazole: 81% vs. 85.7%, OR 0.77 (95% CI 0.48-1.22) in 550 patients. The efficacy of various proton-pump inhibitors seems to be similar when used for H. pylori eradication in standard triple therapy.

Psychotherapy Augmentation through Preconscious Priming

PubMed Central

Borgeat, François; O’Connor, Kieron; Amado, Danielle; St-Pierre-Delorme, Marie-Ève

2013-01-01

Objective: To test the hypothesis that repeated preconscious (masked) priming of personalized positive cognitions could augment cognitive change and facilitate achievement of patients’ goals following a therapy. Methods: Twenty social phobic patients (13 women) completed a 36-weeks study beginning by 12 weeks of group behavioral therapy. After the therapy, they received 6 weeks of preconscious priming and 6 weeks of a control procedure in a randomized cross-over design. The Priming condition involved listening twice daily with a passive attitude to a recording of individualized formulations of appropriate cognitions and attitudes masked by music. The Control condition involved listening to an indistinguishable recording where the formulations had been replaced by random numbers. Changes in social cognitions were measured by the Social Interaction Self Statements Test (SISST). Results: Patients improved following therapy. The Priming procedure was associated with increased positive cognitions and decreased negative cognitions on the SISST while the Control procedure was not. The Priming procedure induced more cognitive change when applied immediately after the group therapy. Conclusion: An effect of priming was observed on social phobia related cognitions in the expected direction. This self administered addition to a therapy could be seen as an augmentation strategy. PMID:23508724

Climate Adaptivity and Field Test of the Space Heating Used Air-Source Transcritical CO2 Heat Pump

NASA Astrophysics Data System (ADS)

Song, Yulong; Ye, Zuliang; Cao, Feng

2017-08-01

In this study, an innovation of air-sourced transcritical CO2 heat pump which was employed in the space heating application was presented and discussed in order to solve the problem that the heating performances of the transcritical CO2 heat pump water heater deteriorated sharply with the augment in water feed temperature. An R134a cycle was adopted as a subcooling device in the proposed system. The prototype of the presented system was installed and supplied hot water for three places in northern China in winter. The field test results showed that the acceptable return water temperature can be increased up to 55°C, while the supply water temperature was raised rapidly by the presented prototype to up to 70°C directly, which was obviously appropriate to the various conditions of heating radiator in space heating application. Additionally, though the heating capacity and power dissipation decreased with the decline in ambient temperature or the augment in water temperature, the presented heat pump system performed efficiently whatever the climate and water feed temperature were. The real time COP of the presented system was generally more than 1.8 in the whole heating season, while the seasonal performance coefficient (SPC) was also appreciable, which signified that the economic efficiency of the presented system was more excellent than other space heating approaches such as fuel, gas, coal or electric boiler. As a result, the novel system will be a promising project to solve the energy issues in future space heating application.

Augmenting Trust Establishment in Dynamic Systems with Social Networks

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

Lagesse, Brent J; Kumar, Mohan; Venkatesh, Svetha

2010-01-01

Social networking has recently flourished in popularity through the use of social websites. Pervasive computing resources have allowed people stay well-connected to each other through access to social networking resources. We take the position that utilizing information produced by relationships within social networks can assist in the establishment of trust for other pervasive computing applications. Furthermore, we describe how such a system can augment a sensor infrastructure used for event observation with information from mobile sensors (ie, mobile phones with cameras) controlled by potentially untrusted third parties. Pervasive computing systems are invisible systems, oriented around the user. As a result,more » many future pervasive systems are likely to include a social aspect to the system. The social communities that are developed in these systems can augment existing trust mechanisms with information about pre-trusted entities or entities to initially consider when beginning to establish trust. An example of such a system is the Collaborative Virtual Observation (CoVO) system fuses sensor information from disaparate sources in soft real-time to recreate a scene that provides observation of an event that has recently transpired. To accomplish this, CoVO must efficently access services whilst protecting the data from corruption from unknown remote nodes. CoVO combines dynamic service composition with virtual observation to utilize existing infrastructure with third party services available in the environment. Since these services are not under the control of the system, they may be unreliable or malicious. When an event of interest occurs, the given infrastructure (bus cameras, etc.) may not sufficiently cover the necessary information (be it in space, time, or sensor type). To enhance observation of the event, infrastructure is augmented with information from sensors in the environment that the infrastructure does not control. These sensors may be unreliable, uncooperative, or even malicious. Additionally, to execute queries in soft real-time, processing must be distributed to available systems in the environment. We propose to use information from social networks to satisfy these requirements. In this paper, we present our position that knowledge gained from social activities can be used to augment trust mechanisms in pervasive computing. The system uses social behavior of nodes to predict a subset that it wants to query for information. In this context, social behavior such as transit patterns and schedules (which can be used to determine if a queried node is likely to be reliable) or known relationships, such as a phone's address book, that can be used to determine networks of nodes that may also be able to assist in retrieving information. Neither implicit nor explicit relationships necessarily imply that the user trusts an entity, but rather will provide a starting place for establishing trust. The proposed framework utilizes social network information to assist in trust establishment when third-party sensors are used for sensing events.« less

Increased erythrocyte Na+ pump and NaK-ATPase activity during lithium therapy.

PubMed

Hokin-Neaverson, M; Burckhardt, W A; Jefferson, J W

1976-05-01

A significant mean increase of 18% in erythrocyte sodium pump activity (p less than 0.01, t test) was observed during lithium treatment, as compared with the activity before lithium treatment was started, in a group of 20 patients who were treated with lithium therapy for a variety of psychiatric conditions. The mean level of erythrocyte membrane ouabain-sensitive ATPase activity in a group of 35 subjects who were receiving lithium therapy was significantly higher than that of a different group of 38 subjects who were not receiving lithium therapy (p less than 0.005, t test). These observations may offer a biochemical mode of action for lithium in the treatment of bipolar affective disorder, since a deficiency of sodium pump activity has been shown to be associated with that disorder.

Compact, diode-pumped, solid-state lasers for next generation defence and security sensors

NASA Astrophysics Data System (ADS)

Silver, M.; Lee, S. T.; Borthwick, A.; McRae, I.; Jackson, D.; Alexander, W.

2015-06-01

Low-cost semiconductor laser diode pump sources have made a dramatic impact in sectors such as advanced manufacturing. They are now disrupting other sectors, such as defence and security (D&S), where Thales UK is a manufacturer of sensor systems for application on land, sea, air and man portable. In this talk, we will first give an overview of the market trends and challenges in the D&S sector. Then we will illustrate how low cost pump diodes are enabling new directions in D&S sensors, by describing two diode pumped, solid- state laser products currently under development at Thales UK. The first is a new generation of Laser Target Designators (LTD) that are used to identify targets for the secure guiding of munitions. Current systems are bulky, expensive and require large battery packs to operate. The advent of low cost diode technology, merged with our novel solid-state laser design, has created a designator that will be the smallest, lowest cost, STANAG compatible laser designator on the market. The LTD delivers greater that 50mJ per pulse up to 20Hz, and has compact dimensions of 125×70×55mm. Secondly, we describe an ultra-compact, eye-safe, solid-state laser rangefinder (LRF) with reduced size, weight and power consumption compared to existing products. The LRF measures 100×55×34mm, weighs 200g, and can range to greater than 10km with a single laser shot and at a reprate of 1Hz. This also leverages off advances in laser pump diodes, but also utilises low cost, high reliability, packaging technology commonly found in the telecoms sector. As is common in the D&S sector, the products are designed to work in extreme environments, such as wide temperature range (-40 to +71°C) and high levels of shock and vibration. These disruptive products enable next- generation laser sensors such as rangefinders, target designators and active illuminated imagers.

Comparison of sensitivity and resolution load sensor at various configuration polymer optical fiber

NASA Astrophysics Data System (ADS)

Arifin, A.; Yusran, Miftahuddin, Abdullah, Bualkar; Tahir, Dahlang

2017-01-01

This study uses a load sensor with a macro-bending on polymer optical fiber loop model which is placed between two plates with a buffer spring. The load sensor with light intensity modulation principle is an infrared LED emits light through the polymer optical fiber then received by the phototransistor and amplifier. Output voltage from the amplifier continued to arduino sequence and displayed on the computer. Load augment on the sensor resulted in an increase of curvature on polymer optical fibers that can cause power losses gets bigger too. This matter will result in the intensity of light that received by phototransistor getting smaller, so that the output voltage that ligable on computer will be getting smaller too. The sensitivity and resolution load sensors analyzed based on configuration with various amount of loops, imperfection on the jacket, and imperfection at the cladding and core of polymer optical fiber. The results showed that the augment on the amount of load, imperfection on the jacket and imperfection on the sheath and core polymer optical fiber can improve the sensitivity and resolution of the load sensor. The best sensors resolution obtained on the number of loops 4 with imperfection 8 on the core and cladding polymer optical fiber that is 0.037 V/N and 0,026 N. The advantages of the load sensor based on polymers optical fiber are easy to make, low cost and simple to use measurement methods.

Precise Haptic Device Co-Location for Visuo-Haptic Augmented Reality.

PubMed

Eck, Ulrich; Pankratz, Frieder; Sandor, Christian; Klinker, Gudrun; Laga, Hamid

2015-12-01

Visuo-haptic augmented reality systems enable users to see and touch digital information that is embedded in the real world. PHANToM haptic devices are often employed to provide haptic feedback. Precise co-location of computer-generated graphics and the haptic stylus is necessary to provide a realistic user experience. Previous work has focused on calibration procedures that compensate the non-linear position error caused by inaccuracies in the joint angle sensors. In this article we present a more complete procedure that additionally compensates for errors in the gimbal sensors and improves position calibration. The proposed procedure further includes software-based temporal alignment of sensor data and a method for the estimation of a reference for position calibration, resulting in increased robustness against haptic device initialization and external tracker noise. We designed our procedure to require minimal user input to maximize usability. We conducted an extensive evaluation with two different PHANToMs, two different optical trackers, and a mechanical tracker. Compared to state-of-the-art calibration procedures, our approach significantly improves the co-location of the haptic stylus. This results in higher fidelity visual and haptic augmentations, which are crucial for fine-motor tasks in areas such as medical training simulators, assembly planning tools, or rapid prototyping applications.

Human Factors and Operations Issues in GPS and WAAS Sensor Approvals A Review and Comparison of FAA and RTCA Documents

DOT National Transportation Integrated Search

1997-07-01

This report is the culmination of the first task in a project to evaluate human factors and operations issues associated : with the integration of Class C Global Positioning System (GPS) sensors and Class Beta GPS/Wide Area Augmentation System : (WAA...

Shape Control of Plates with Piezo Actuators and Collocated Position/Rate Sensors

NASA Technical Reports Server (NTRS)

Balakrishnan, A. V.

1994-01-01

This paper treats the control problem of shaping the surface deformation of a circular plate using embedded piezo-electric actuators and collocated rate sensors. An explicit Linear Quadratic Gaussian (LQG) optimizer stability augmentation compensator is derived as well as the optimal feed-forward control. Corresponding performance evaluation formulas are also derived.

Shape Control of Plates with Piezo Actuators and Collocated Position/Rate Sensors

NASA Technical Reports Server (NTRS)

Balakrishnan, A. V.

1994-01-01

This paper treats the control problem of shaping the surface deformation of a circular plate using embedded piezo-electric actuator and collocated rate sensors. An explicit Linear Quadratic Gaussian (LQG) optimizer stability augmentation compensator is derived as well as the optimal feed-forward control. Corresponding performance evaluation formulas are also derived.

Human factors and operations issues in GPS and WAAS sensor approvals : a review and comparison of FAA and RTCA documents

DOT National Transportation Integrated Search

1997-07-01

This report is the culmination of the first task in a project to evaluate human factors and operations issues associated with the integration of Class C Global Positioning System (GPS) sensors and Class Beta GPS/Wide Area Augmentation System (WAAS) s...

Augmentation treatment in major depressive disorder: focus on aripiprazole

PubMed Central

Nelson, J Craig; Pikalov, Andrei; Berman, Robert M

2008-01-01

Major depressive disorder (MDD) is a disabling psychiatric condition for which effective treatment remains an outstanding need. Antidepressants are currently the mainstay of treatment for depression; however, almost two-thirds of patients will fail to achieve remission with initial treatment. As a result, a range of augmentation and combination strategies have been used in order to improve outcomes for patients. Despite the popularity of these approaches, limited data from double-blind, randomized, placebo-controlled studies are available to allow clinicians to determine which are the most effective augmentation options or which patients are most likely to respond to which options. Recently, evidence has shown that adjunctive therapy with atypical antipsychotics has the potential for beneficial antidepressant effects in the absence of psychotic symptoms. In particular, aripiprazole has shown efficacy as an augmentation option with standard antidepressant therapy in two, large, randomized, double-blind studies. Based on these efficacy and safety data, aripiprazole was recently approved by the FDA as adjunctive therapy for MDD. The availability of this new treatment option should allow more patients with MDD to achieve remission and, ultimately, long-term, successful outcomes. PMID:19183784

Acid suppression and surgical therapy for Barrett's oesophagus.

PubMed

de Jonge, Pieter J F; Spaander, Manon C; Bruno, Marco J; Kuipers, Ernst J

2015-02-01

Gastro-oesophageal reflux disease is a common medical problem in developed countries, and is a risk factor for the development of Barrett's oesophagus and oesophageal adenocarcinoma. Both proton pump inhibitor therapy and antireflux surgery are effective at controlling endoscopic signs and symptoms of gastro-oesophageal reflux in patients with Barrett's oesophagus, but often fail to eliminate pathological oesophageal acid exposure. The current available studies strongly suggest that acid suppressive therapy, both pharmacological as well as surgical acid suppression, can reduce the risk the development and progression in patients with Barrett's oesophagus, but are not capable of complete prevention. No significant differences have been found between pharmacological and surgical therapy. For clinical practice, patients should be prescribed a proton pump inhibitor once daily as maintenance therapy, with the dose guided by symptoms. Antireflux surgery can be a good alternative to proton pump inhibitor therapy, but should be primarily offered to patients with symptomatic reflux, and not to asymptomatic patients with the rationale to protect against cancer. Copyright © 2014 Elsevier Ltd. All rights reserved.

Modular mechatronic system for stationary bicycles interfaced with virtual environment for rehabilitation.

PubMed

Ranky, Richard G; Sivak, Mark L; Lewis, Jeffrey A; Gade, Venkata K; Deutsch, Judith E; Mavroidis, Constantinos

2014-06-05

Cycling has been used in the rehabilitation of individuals with both chronic and post-surgical conditions. Among the challenges with implementing bicycling for rehabilitation is the recruitment of both extremities, in particular when one is weaker or less coordinated. Feedback embedded in virtual reality (VR) augmented cycling may serve to address the requirement for efficacious cycling; specifically recruitment of both extremities and exercising at a high intensity. In this paper a mechatronic rehabilitation bicycling system with an interactive virtual environment, called Virtual Reality Augmented Cycling Kit (VRACK), is presented. Novel hardware components embedded with sensors were implemented on a stationary exercise bicycle to monitor physiological and biomechanical parameters of participants while immersing them in an augmented reality simulation providing the user with visual, auditory and haptic feedback. This modular and adaptable system attaches to commercially-available stationary bicycle systems and interfaces with a personal computer for simulation and data acquisition processes. The complete bicycle system includes: a) handle bars based on hydraulic pressure sensors; b) pedals that monitor pedal kinematics with an inertial measurement unit (IMU) and forces on the pedals while providing vibratory feedback; c) off the shelf electronics to monitor heart rate and d) customized software for rehabilitation. Bench testing for the handle and pedal systems is presented for calibration of the sensors detecting force and angle. The modular mechatronic kit for exercise bicycles was tested in bench testing and human tests. Bench tests performed on the sensorized handle bars and the instrumented pedals validated the measurement accuracy of these components. Rider tests with the VRACK system focused on the pedal system and successfully monitored kinetic and kinematic parameters of the rider's lower extremities. The VRACK system, a virtual reality mechatronic bicycle rehabilitation modular system was designed to convert most bicycles in virtual reality (VR) cycles. Preliminary testing of the augmented reality bicycle system was successful in demonstrating that a modular mechatronic kit can monitor and record kinetic and kinematic parameters of several riders.

Baclofen Pumps: Uses and Complications.

PubMed

Woolf, Seth M; Baum, Carl R

2017-04-01

Intrathecal baclofen therapy, given via an implanted pump in the abdominal wall either as a continuous infusion or bolus dosing, has been used for more than 25 years to treat the spasticity and dystonia associated with various brain and spinal cord conditions. Pediatric clinicians occasionally encounter baclofen pumps, and in the pediatric setting, significant morbidity can arise from their use. This article presents the background, mechanism of action, uses, and complications of intrathecal baclofen therapy and discusses various management strategies should complications occur.

Explosively pumped laser light

DOEpatents

Piltch, Martin S.; Michelotti, Roy A.

1991-01-01

A single shot laser pumped by detonation of an explosive in a shell casing. The shock wave from detonation of the explosive causes a rare gas to luminesce. The high intensity light from the gas enters a lasing medium, which thereafter outputs a pulse of laser light to disable optical sensors and personnel.

New Gas Polarographic Hydrogen Sensor

NASA Technical Reports Server (NTRS)

Dominguez, Jesus A.; Barile, Ron

2004-01-01

Polarography is the measurement of the current that flows in solution as a function of an applied voltage. The actual form of the observed polarographic current depends upon the manner in which the voltage is applied and on the characteristics of the working electrode. The new gas polarographic H2 sensor shows a current level increment with concentration of the gaseous H2 similar to those relating to metal ions in liquid electrolytes in well-known polarography. This phenomenon is caused by the fact that the diffusion of the gaseous H2 through a gas diffusion hole built in the sensor is a rate-determining step in the gaseous-hydrogen sensing mechanism. The diffusion hole artificially limits the diffusion of the gaseous H2 toward the electrode located at the sensor cavity. This gas polarographic H2 sensor. is actually an electrochemical-pumping cell since the gaseous H2 is in fact pumped via the electrochemical driving force generated between the electrodes. Gaseous H2 enters the diffusion hole and reaches the first electrode (anode) located in the sensor cavity to be transformed into an H+ ions or protons; H+ ions pass through the electrolyte and reach the second electrode (cathode) to be reformed to gaseous H2. Gas polarographic 02 sensors are commercially available; a gas polarographic 02 sensor was used to prove the feasibility of building a new gas polarographic H2 sensor.

Devices as destination therapy.

PubMed

Kukuy, Eugene L; Oz, Mehmet C; Rose, Eric A; Naka, Yoshifumi

2003-02-01

The use of circulatory support as destination therapy has been a goal for the treatment of endstage heart failure for several decades. Current investigations are evaluating several circulatory pumps with that particular objective. With continued modification of design, the current and future pumps will become more reliable and provide improved quality of life to patients in need of mechanical circulatory assistance. The new pumps on the horizon specifically address reliability, size, and cost, and are based on the centrifugal system. These devices use the Maglev (Magnetic Levitation) concept that allows for frictionless pumping, low thrombogenicity, minimal noise, and increased durability. Further research with this goal in mind and support from the federal government will be the key to the future use of circulatory assistance as destination therapy for heart failure patients. In addition, the cost-effectiveness of these devices will need to be maintained as the technology improves, as in any new technology that confronts a more intuitive option like the native heart.

Development and flight evaluation of an augmented stability active controls concept with a small tail

NASA Technical Reports Server (NTRS)

1980-01-01

Parasite drag reduction evaluation is composed of wind tunnel tests with a standard L-1011 tail and two reduced area tail configurations. Trim drag reduction is evaluated by rebalancing the airplane for relaxed static stability. This is accomplished by pumping water to tanks in the forward and aft of the airplane to acheive desired center of gravity location. Also, the L-1011 is modified to incorporate term and advanced augmented systems. By using advanced wings and aircraft relaxed static stability significant fuel savings can be realized. An airplane's dynamic stability becomes more sensitive for decreased tail size, relaxed static stability, and advanced wing configurations. Active control pitch augmentation will be used to acheive the required handling qualities. Flight tests will be performed to evaluate the pitch augmentation systems. The effect of elevator downrig on stabilizer/elevator hinge moments will be measured. For control system analysis, the normal acceleration feedback and pitch rate feedback are analyzed.

Outflow monitoring of a pneumatic ventricular assist device using external pressure sensors.

PubMed

Kang, Seong Min; Her, Keun; Choi, Seong Wook

2016-08-25

In this study, a new algorithm was developed for estimating the pump outflow of a pneumatic ventricular assist device (p-VAD). The pump outflow estimation algorithm was derived from the ideal gas equation and determined the change in blood-sac volume of a p-VAD using two external pressure sensors. Based on in vitro experiments, the algorithm was revised to consider the effects of structural compliance caused by volume changes in an implanted unit, an air driveline, and the pressure difference between the sensors and the implanted unit. In animal experiments, p-VADs were connected to the left ventricles and the descending aorta of three calves (70-100 kg). Their outflows were estimated using the new algorithm and compared to the results obtained using an ultrasonic blood flow meter (UBF) (TS-410, Transonic Systems Inc., Ithaca, NY, USA). The estimated and measured values had a Pearson's correlation coefficient of 0.864. The pressure sensors were installed at the external controller and connected to the air driveline on the same side as the external actuator, which made the sensors easy to manage.

Refrigeration system with a compressor-pump unit and a liquid-injection desuperheating line

DOEpatents

Gaul, Christopher J.

2001-01-01

The refrigeration system includes a compressor-pump unit and/or a liquid-injection assembly. The refrigeration system is a vapor-compression refrigeration system that includes an expansion device, an evaporator, a compressor, a condenser, and a liquid pump between the condenser and the expansion device. The liquid pump improves efficiency of the refrigeration system by increasing the pressure of, thus subcooling, the liquid refrigerant delivered from the condenser to the expansion device. The liquid pump and the compressor are driven by a single driving device and, in this regard, are coupled to a single shaft of a driving device, such as a belt-drive, an engine, or an electric motor. While the driving device may be separately contained, in a preferred embodiment, the liquid pump, the compressor, and the driving device (i.e., an electric motor) are contained within a single sealable housing having pump and driving device cooling paths to subcool liquid refrigerant discharged from the liquid pump and to control the operating temperature of the driving device. In another aspect of the present invention, a liquid injection assembly is included in a refrigeration system to divert liquid refrigerant from the discharge of a liquid pressure amplification pump to a compressor discharge pathway within a compressor housing to desuperheat refrigerant vapor to the saturation point within the compressor housing. The liquid injection assembly includes a liquid injection pipe with a control valve to meter the volume of diverted liquid refrigerant. The liquid injection assembly may also include a feedback controller with a microprocessor responsive to a pressure sensor and a temperature sensor both positioned between the compressor to operate the control valve to maintain the refrigerant at or near saturation.

Realization of a Complex Control & Diagnosis System on Simplified Hardware

NASA Astrophysics Data System (ADS)

Stetter, R.; Swamy Prasad, M.

2015-11-01

Energy is an important factor in today's industrial environment. Pump systems account for about 20% of the total industrial electrical energy consumption. Several studies show that with proper monitoring, control and maintenance, the efficiency of pump systems can be increased. Controlling pump systems with intelligent systems can help to reduce a pump's energy consumption by up to one third of its original consumption. The research in this paper was carried out in the scope of a research project which involves modelling and simulation of pump systems. This paper focuses on the future implementation of modelling capabilities in PLCs (programmable logic controllers). The whole project aims to use a pump itself as the sensor rather than introducing external sensors into the system, which would increase the cost considerably. One promising approach for an economic and robust industrial implementation of this intelligence is the use of PLCs. PLCs can be simulated in multiple ways; in this project, Codesys was chosen for several reasons which are explained in this paper. The first part of this paper explains the modelling of a pump itself, the process load of the asynchronous motor with a control system, and the simulation possibilities of the motor in Codesys. The second part describes the simulation and testing of a system realized. The third part elaborates the Codesys system structure and interfacing of the system with external files. The final part consists of comparing the result with an earlier Matlab/SIMULINK model and original test data.

Augmentation of Performance of a Monogroove Heat Pipe with Electrohydrodynamic Conduction Pumping

NASA Astrophysics Data System (ADS)

Jeong, S. I.; Seyed-Yagoobi, J.

2002-11-01

The electrohydrodynamic (EHD) phenomena involve the interaction of electric fields and flow fields in a dielectric fluid medium. There are three types of EHD pumps; induction, ion-drag, and conduction. EHD conduction pump is a new concept which has been explored only recently. Net pumping is achieved by properly utilizing the heterocharge layers present in the vicinity of the electrodes. Several innovative electrode designs have been investigated. This paper presents an electrode design that generates pressure heads on the order of 600 Pa per one electrode pair at 20 kV with less than 0.08 W of electric power. The working fluid is the Refrigerant R-123. An EHD conduction pump consisting of six pairs of electrodes is installed in the liquid line of a mono-grove heat pipe. The heat transport capacity of the heat pipe is measured in the absence and presence of the EHD conduction pump. Significant enhancements in the heat transport capacity of the heat pipe is achieved with the EHD conduction pump operating. Furthermore, the EHD conduction pump provides immediate recovery from the dry-out condition. The EHD conduction pump has many advantages, especially in the micro-gravity environment. It is simple in design, non-mechanical, and lightweight. It provides a rapid control of heat transfer in single-phase and two-phase flows. The electric power consumption is minimal with the very low acoustic noise level.

Is electroconvulsive therapy effective as augmentation in clozapine-resistant schizophrenia?

PubMed

Kittsteiner Manubens, Lucas; Lobos Urbina, Diego; Aceituno, David

2016-10-14

Clozapine is considered to be the most effective antipsychotic drug for patients with treatment resistant schizophrenia, but up to a third of the patients do not respond to this treatment. Various strategies have been tried to augment the effect of clozapine in non-responders, one of these strategies being electroconvulsive therapy. However, its efficacy and safety are not yet clear. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified six systematic reviews including 55 studies, among them six randomized controlled trials addressing clozapine-resistant schizophrenia. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded electroconvulsive therapy probably augments response to clozapine in patients with treatment resistant schizophrenia, but it is not possible to determine if it leads to cognitive adverse effects because the certainty of the evidence is very low.

A cohort of children with type 1 diabetes in Greece: predictors of direct costs of care.

PubMed

Karachaliou, Feneli; Athanasakis, Konstantinos; Tsentidis, Charalabos; Soldatou, Alexandra; Simatos, George; Kyriopoulos, John; Michalakos, Stefanos; Karavanaki, Kyriaki

2017-08-01

To examine the predictors of direct costs of pediatric type 1 diabetes (T1D) in a hospital-based outpatient clinic in Greece. The outpatient records of 89 children and adolescents (mean age: 12.05 ± 5.15 y) with T1D followed in the Second Department of Pediatrics, University of Athens Medical School, were analyzed. The mean ± SD diabetes duration was 4.9 ± 3.88 y (range: 0.25-17) and glycated hemoglobin (HbA1c) was 8.2 ± 1.09% (66 ± 11.9 mmol/mol). A total of 80% of patients were on multiple daily injections regimen, 10% on pump therapy, and 10% on conventional regimen. Total direct costs per patient-year (ppy) were estimated at €2.712 [95% confidence interval (CI): 2.468-2.956]. Supply costs accounted for 73.7% of total costs and were the highest for pump therapy (P < .001). Multivariate linear regression analysis showed that costs were significantly higher for children (1) on multiple daily injections or pump therapy (r = 0.364, P < .001), (2) of older age (r = 0.25, P < .001) and (3) higher daily insulin dose (r = 0.46, P < .001). Patients on pump therapy had significantly higher costs €5.538 (95%CI 4480-6597) compared with patients on multiple daily injections €2.447 (95% CI 2320-2574) and conventional regimen €1.978.5 (95%CI 1682-2275) (P = .0001). Patients on pump therapy had better glycemic control compared with all other patients [HbA1c (mean ± SD): 7.2% ± 1.0 vs 8.3% ±1.5, P = .039]. The total T1D cost in this cohort of Greek children was €2712 ppy. The main factor that predicted direct cost was the use of pump. However, pump therapy was associated with better glycaemic control, which may decrease the risk of total long-term diabetes care cost. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The Status of RPE65 Gene Therapy Trials: Safety and Efficacy

PubMed Central

Pierce, Eric A.; Bennett, Jean

2015-01-01

Several groups have reported the results of clinical trials of gene augmentation therapy for Leber congenital amaurosis (LCA) because of mutations in the RPE65 gene. These studies have used subretinal injection of adeno-associated virus (AAV) vectors to deliver the human RPE65 cDNA to the retinal pigment epithelial (RPE) cells of the treated eyes. In all of the studies reported to date, this approach has been shown to be both safe and effective. The successful clinical trials of gene augmentation therapy for retinal degeneration caused by mutations in the RPE65 gene sets the stage for broad application of gene therapy to treat retinal degenerative disorders. PMID:25635059

Lysosomal Signaling Enhances Mitochondria-Mediated Photodynamic Therapy in A431 Cancer Cells: Role of Iron

PubMed Central

Saggu, Shalini; Hung, Hsin-I; Quiogue, Geraldine; Lemasters, John J.; Nieminen, Anna-Liisa

2015-01-01

In photodynamic therapy (PDT), light activates a photosensitizer added to a tissue, resulting in singlet oxygen formation and cell death. The photosensitizer phthalocyanine 4 (Pc 4) localizes primarily to mitochondrial membranes in cancer cells, resulting in mitochondria-mediated cell death. The aim of this study was to determine how lysosomes contribute to PDT-induced cell killing by mitochondria-targeted photosensitizers such as Pc 4. We monitored cell killing of A431 cells after Pc 4-PDT in the presence and absence of bafilomycin, an inhibitor of the vacuolar proton pump of lysosomes and endosomes. Bafilomycin was not toxic by itself, but greatly enhanced Pc 4-PDT-induced cell killing. To investigate whether iron loading of lysosomes affects bafilomycin-induced killing, cells were incubated with ammonium ferric citrate (30 μm) for 30 h prior to PDT. Ammonium ferric citrate enhanced Pc 4 plus bafilomycin-induced cell killing without having toxicity by itself. Iron chelators (desferrioxamine and starch-desferrioxamine) and the inhibitor of the mitochondrial calcium (and ferrous iron) uniporter, Ru360, protected against Pc 4 plus bafilomycin toxicity. These results support the conclusion that chelatable iron stored in the lysosomes enhances the efficacy of bafilomycin-mediated PDT and that lysosomal disruption augments PDT with Pc 4. PMID:22220628

Inertial Navigation Sensors

DTIC Science & Technology

2010-03-01

Characterization Solutions Enabled by Laser Doppler Vibrometer Measurements, Proc. SPIE, Fifth International Conference on Vibration Measurements by Laser ...commercial capabilities: Ring Laser Gyros, Fiber Optic Gyros, and Micro-Electro-Mechanical Systems (MEMS) gyros and accelerometers. RLGs and FOGs are now...augmentation sensors have been tied into the inertial systems; e.g., GPS, velocity meters, seekers, star trackers, magnetometers, lidar , etc. The

User experience network. Erroneous downstream occlusion alarms may disable Smiths Medical CADD-Solis infusion pumps.

PubMed

2010-10-01

Due to an issue in manufacturing, downstream occlusion (DSO) sensors in some Smiths Medical CADD-Solis infusion pumps may drift out of calibration, potentially resulting in erroneous alarms that disable the units. Hospitals experiencing the problem should return affected units to Smiths Medical for recalibration (free of charge) and should consider testing all their CADD-Solis pumps during routine maintenance to ensure that they alarm appropriately for downstream occlusions.

Control of a rotary pulsatile cardiac assist pump driven by an electric motor without a pressure sensor to avoid collapse of the pump inlet.

PubMed

Trinkl, J; Havlik, P; Mesana, T; Mitsui, N; Morita, S; Demunck, J L; Tourres, J L; Monties, J R

1993-01-01

Our ventricular assist device uses a valveless volumetric pump operating on the Maillard-Wankel rotary principle. It is driven by an electric motor and provides a semi pulsatile flow. At each cycle, blood is actively aspirated into the device, and overpumping results in collapse at the pump inlet. To prevent overpumping, it is necessary to ensure that pump intake does not exceed venous return. Poor long-term reliability rules out the use of current implantable pressure sensors for this purpose. To resolve this problem, we have developed a method of control based on monitoring of the intensity of electric current consumed by the motor. The method consists of real time monitoring of current intensity at the beginning of each pump cycle. A sudden change in intensity indicates underfilling, and motor speed is reduced to prevent collapse. The current consumed by the motor also depends on the afterload, but the form of the signal remains the same when afterload changes. After demonstrating the feasibility of this technique in a simulator, we are now testing it in animals. We were able to detect and prevent collapse due to overpumping by the cardiac assist device. This system also enables us to know the maximum possible assistance and to thus adapt assistance to the user.

Adaptive Monocular Visual–Inertial SLAM for Real-Time Augmented Reality Applications in Mobile Devices

PubMed Central

Piao, Jin-Chun; Kim, Shin-Dug

2017-01-01

Simultaneous localization and mapping (SLAM) is emerging as a prominent issue in computer vision and next-generation core technology for robots, autonomous navigation and augmented reality. In augmented reality applications, fast camera pose estimation and true scale are important. In this paper, we present an adaptive monocular visual–inertial SLAM method for real-time augmented reality applications in mobile devices. First, the SLAM system is implemented based on the visual–inertial odometry method that combines data from a mobile device camera and inertial measurement unit sensor. Second, we present an optical-flow-based fast visual odometry method for real-time camera pose estimation. Finally, an adaptive monocular visual–inertial SLAM is implemented by presenting an adaptive execution module that dynamically selects visual–inertial odometry or optical-flow-based fast visual odometry. Experimental results show that the average translation root-mean-square error of keyframe trajectory is approximately 0.0617 m with the EuRoC dataset. The average tracking time is reduced by 7.8%, 12.9%, and 18.8% when different level-set adaptive policies are applied. Moreover, we conducted experiments with real mobile device sensors, and the results demonstrate the effectiveness of performance improvement using the proposed method. PMID:29112143

H2 Detection via Polarography

NASA Technical Reports Server (NTRS)

Dominquez, Jesus; Barile, Ron

2006-01-01

Polarography is the measurement of the current that flows in solution as a function of an applied voltage. The actual form of the observed polarographic current depends upon the manner in which the voltage is applied and on the characteristics of the working electrode. The new gas polarographic H2 sensor shows a current level increment with concentration of the gaseous H2 similar to those relating to metal ions in liquid electrolytes in well-known polarography. This phenomenon is caused by the fact that the diffusion of the gaseous H2 through a gas diffusion hole built in the sensor is a rate-determining step in the gaseous-hydrogen sensing mechanism. The diffusion hole artificially limits the diffusion of the gaseous H2 toward the electrode located at the sensor cavity. This gas polarographic H2 sensor is actually an electrochemical-pumping cell since the gaseous H2 is in fact pumped via the electrochemical driving force generated between the electrodes. Gaseous H2 enters the diffusion hole and reaches the first electrode (anode) located in the sensor cavity to be transformed into an H ions or protons; H ions pass through the electrolyte and reach the second electrode (cathode) to be reformed to gaseous H2. Gas polarographic O2 sensors are commercially available; a gas polarographic O2 sensor was used to prove the feasibility of building a new gas polarographic H2 sensor.

Smart Multi-Level Tool for Remote Patient Monitoring Based on a Wireless Sensor Network and Mobile Augmented Reality

PubMed Central

González, Fernando Cornelio Jimènez; Villegas, Osslan Osiris Vergara; Ramírez, Dulce Esperanza Torres; Sánchez, Vianey Guadalupe Cruz; Domínguez, Humberto Ochoa

2014-01-01

Technological innovations in the field of disease prevention and maintenance of patient health have enabled the evolution of fields such as monitoring systems. One of the main advances is the development of real-time monitors that use intelligent and wireless communication technology. In this paper, a system is presented for the remote monitoring of the body temperature and heart rate of a patient by means of a wireless sensor network (WSN) and mobile augmented reality (MAR). The combination of a WSN and MAR provides a novel alternative to remotely measure body temperature and heart rate in real time during patient care. The system is composed of (1) hardware such as Arduino microcontrollers (in the patient nodes), personal computers (for the nurse server), smartphones (for the mobile nurse monitor and the virtual patient file) and sensors (to measure body temperature and heart rate), (2) a network layer using WiFly technology, and (3) software such as LabView, Android SDK, and DroidAR. The results obtained from tests show that the system can perform effectively within a range of 20 m and requires ten minutes to stabilize the temperature sensor to detect hyperthermia, hypothermia or normal body temperature conditions. Additionally, the heart rate sensor can detect conditions of tachycardia and bradycardia. PMID:25230306

Smart multi-level tool for remote patient monitoring based on a wireless sensor network and mobile augmented reality.

PubMed

González, Fernando Cornelio Jiménez; Villegas, Osslan Osiris Vergara; Ramírez, Dulce Esperanza Torres; Sánchez, Vianey Guadalupe Cruz; Domínguez, Humberto Ochoa

2014-09-16

Technological innovations in the field of disease prevention and maintenance of patient health have enabled the evolution of fields such as monitoring systems. One of the main advances is the development of real-time monitors that use intelligent and wireless communication technology. In this paper, a system is presented for the remote monitoring of the body temperature and heart rate of a patient by means of a wireless sensor network (WSN) and mobile augmented reality (MAR). The combination of a WSN and MAR provides a novel alternative to remotely measure body temperature and heart rate in real time during patient care. The system is composed of (1) hardware such as Arduino microcontrollers (in the patient nodes), personal computers (for the nurse server), smartphones (for the mobile nurse monitor and the virtual patient file) and sensors (to measure body temperature and heart rate), (2) a network layer using WiFly technology, and (3) software such as LabView, Android SDK, and DroidAR. The results obtained from tests show that the system can perform effectively within a range of 20 m and requires ten minutes to stabilize the temperature sensor to detect hyperthermia, hypothermia or normal body temperature conditions. Additionally, the heart rate sensor can detect conditions of tachycardia and bradycardia.

Performance increase in venous drainage for mini-invasive heart surgery: superiority of self-expanding cannulas.

PubMed

Belkoniene, Mhedi; Abdel-Sayed, Saad; Favre, Julien; von Segesser, Ludwig-Karl

2014-01-01

Originally, the Smartcanula principle (collapsed insertion and expansion in situ) was developed for venous drainage by gravity. However, in minimally invasive surgery, augmentation with either constrained force vortex pumps or vacuum is often used. The current study was set up to assess whether smaller diameters of self-expanding venous cannulas are sufficient in conjunction with venous drainage augmentation resulting in smaller access orifices. To evaluate cannulas intended for cardiopulmonary bypass, an in vitro circuit was set up with silicone tubing between the test cannula encased in a lower reservoir, the centrifugal pump, and after an upper reservoir. Afterload was set arbitrarily at 60 mm Hg using a centrifugal pump. The pressure value was measured using Millar pressure transducers. Flow rate (Q) was measured using an ultrasonic flow meter calibrated with volume tank and timer. Revolutions per minute of the centrifugal pump were calibrated with a stroboscope. Data display and data recording were controlled using a Lab View application. Self-expanding (24F Smartcanula) and control (25F Biomedicus) cannulas were used. Sixty measurements were recorded. At pump speed of 1500, 1570, 2000, 2500, and 3000 rpm, the Q values were 3.6, 5.2, 6.6, 9.3, and 11.8 L/min for the 24F self-expanding cannula and 3, 4.3, 5.4, 7.5, and 9.3 L/min for the control cannula. The pressure values were 3.6, -5.4, -15.9, -45.3, and 80.6 mm Hg. Biomedicus 25F showed Q values from 16% to 19% less as compared with 24F Smartcanula. The pressure values were 6, 7, 4, 2, and 2 times more as compared with 24F Smartcanula. Our experimental evaluation demonstrated the superior performance of the Smartcanula with its self-expanding design in comparison with the reference commercially available standard cannulas. The Smartcanula with its small diameter is particularly welcome for minimally invasive surgery.

Augmented reality visualization of deformable tubular structures for surgical simulation.

PubMed

Ferrari, Vincenzo; Viglialoro, Rosanna Maria; Nicoli, Paola; Cutolo, Fabrizio; Condino, Sara; Carbone, Marina; Siesto, Mentore; Ferrari, Mauro

2016-06-01

Surgical simulation based on augmented reality (AR), mixing the benefits of physical and virtual simulation, represents a step forward in surgical training. However, available systems are unable to update the virtual anatomy following deformations impressed on actual anatomy. A proof-of-concept solution is described providing AR visualization of hidden deformable tubular structures using nitinol tubes sensorized with electromagnetic sensors. This system was tested in vitro on a setup comprised of sensorized cystic, left and right hepatic, and proper hepatic arteries. In the trial session, the surgeon deformed the tubular structures with surgical forceps in 10 positions. The mean, standard deviation, and maximum misalignment between virtual and real arteries were 0.35, 0.22, and 0.99 mm, respectively. The alignment accuracy obtained demonstrates the feasibility of the approach, which can be adopted in advanced AR simulations, in particular as an aid to the identification and isolation of tubular structures. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Quantitative evaluation of hand cranking a roller pump in a crisis management drill.

PubMed

Tomizawa, Yasuko; Tokumine, Asako; Ninomiya, Shinji; Momose, Naoki; Matayoshi, Toru

2008-01-01

The heart-lung machines for open-heart surgery have improved over the past 50 years; they rarely break down and are almost always equipped with backup batteries. The hand-cranking procedure only becomes necessary when a pump breaks down during perfusion or after the batteries have run out. In this study, the performance of hand cranking a roller pump was quantitatively assessed by an objective method using the ECCSIM-Lite educational simulator system. A roller pump connected to an extracorporeal circuit with an oxygenator and with gravity venous drainage was used. A flow sensor unit consisting of electromagnetic sensors was used to measure arterial and venous flow rates, and a built-in pressure sensor was used to measure the water level in the reservoir. A preliminary study of continuous cranking by a team of six people was conducted as a surprise drill. This system was then used at a perfusion seminar. At the seminar, 1-min hand-cranking drills were conducted by volunteers according to a prepared scenario. The data were calculated on site and trend graphs of individual performances were given to the participants as a handout. Preliminary studies showed that each person's performance was different. Results from 1-min drills showed that good performance was not related to the number of clinical cases experienced, years of practice, or experience in hand cranking. Hand cranking to maintain the target flow rate could be achieved without practice; however, manipulating the venous return clamp requires practice. While the necessity of performing hand cranking during perfusion due to pump failure is rare, we believe that it is beneficial for perfusionists and patients to include hand-cranking practice in periodic extracorporeal circulation crisis management drills because a drill allows perfusionists to mentally rehearse the procedures should such a crisis occur.

Brady Well Coordinates and Observation Sensor Depths

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

David Lim

Contains metadata associated with the wells used in the 2016 Spring Campaign led partially by UW - Madison, LBNL, and LLNL scientists. Included with the well coordinates are the depths to the pressure sensors used in observation and pumping wells. Read me files are included for each .csv file.

Overview of benefits, challenges, and requirements of wheeled-vehicle mounted infrared sensors

NASA Astrophysics Data System (ADS)

Miller, John Lester; Clayton, Paul; Olsson, Stefan F.

2013-06-01

Requirements for vehicle mounted infrared sensors, especially as imagers evolve to high definition (HD) format will be detailed and analyzed. Lessons learned from integrations of infrared sensors on armored vehicles, unarmored military vehicles and commercial automobiles will be discussed. Comparisons between sensors for driving and those for situation awareness, targeting and other functions will be presented. Conclusions will be drawn regarding future applications and installations. New business requirements for more advanced digital image processing algorithms in the sensor system will be discussed. Examples of these are smarter contrast/brightness adjustments algorithms, detail enhancement, intelligent blending (IR-Vis) modes, and augmented reality.

Low-Cost, Rugged High-Vacuum System

NASA Technical Reports Server (NTRS)

Sorensen, Paul; Kline-Schoder, Robert

2012-01-01

A need exists for miniaturized, rugged, low-cost high-vacuum systems. Recent advances in sensor technology have led to the development of very small mass spectrometer detectors as well as other analytical instruments such as scanning electron microscopes. However, the vacuum systems to support these sensors remain large, heavy, and power-hungry. To meet this need, a miniaturized vacuum system was developed based on a very small, rugged, and inexpensive-to-manufacture molecular drag pump (MDP). The MDP is enabled by a miniature, very-high-speed (200,000 rpm), rugged, low-power, brushless DC motor optimized for wide temperature operation and long life. The key advantages of the pump are reduced cost and improved ruggedness compared to other mechanical hig-hvacuum pumps. The machining of the rotor and stators is very simple compared to that necessary to fabricate rotor and stator blades for other pump designs. Also, the symmetry of the rotor is such that dynamic balancing of the rotor will likely not be necessary. Finally, the number of parts in the unit is cut by nearly a factor of three over competing designs. The new pump forms the heart of a complete vacuum system optimized to support analytical instruments in terrestrial applications and on spacecraft and planetary landers. The MDP achieves high vacuum coupled to a ruggedized diaphragm rough pump. Instead of the relatively complicated rotor and stator blades used in turbomolecular pumps, the rotor in the MDP consists of a simple, smooth cylinder of aluminum. This will turn at approximately 200,000 rpm inside an outer stator housing. The pump stator comprises a cylindrical aluminum housing with one or more specially designed grooves that serve as flow channels. To minimize the length of the pump, the gas is forced down the flow channels of the outer stator to the base of the pump. The gas is then turned and pulled toward the top through a second set of channels cut into an inner stator housing that surrounds the motor. The compressed gas then flows down channels in the motor housing to the exhaust port of the pump. The exhaust port of the pump is connected to a commercially available diaphragm or scroll pump.

A model of insulin delivery by a controlled release micropump.

PubMed

Allen, D G; Sefton, M V

1986-01-01

A model has been developed to describe the delivery of insulin from a controlled release micropump (CRM). Basal delivery was provided by diffusion due to a concentration difference driving force across the CRM. This was modelled by considering the CRM to be a series of one-dimensional steady-state diffusion resistances. This delivery model was used to size prototypes and identify the piston, foam and the pump outlet as the controlling resistances to basal insulin transport. Augmented delivery by the CRM was achieved by repeated compression of a foam disk by a mild steel piston which was driven by a solenoid (tested voltage range 0-173 V DC; 5 msec "on" time; frequency 20-40 min-1). The increased delivery was attributed to the combination of mixing inside the pump barrel and displacement of barrel contents into the downstream reservoir. This action was approximated by a three-compartment model, which considered the CRM to consist of a well-mixed upstream reservoir and pump barrel (with a downstream reservoir) separated by two resistances: a constant upstream membrane resistance, (KmAm)-1, and a variable downstream mixing rate resistance, (Qd)-1. A least squares fit of the model to experimental data showed Qd to increase with the cube of the force on the piston and linearly with the compression frequency. In agreement with experimental results, the model predicted the upstream membrane to be rate controlling only at augmented pump resistances close to the value (KmAm)-1. These models were used to design an improved prototype (VIII) which is now being evaluated in vivo in pancreatectomized dogs for its efficacy in restoring and sustaining normoglycemia.

Development of an optical fiber flow velocity sensor.

PubMed

Harada, Toshio; Kamoto, Kenji; Abe, Kyutaro; Izumo, Masaki

2009-01-01

A new optical fiber flow velocity sensor was developed by using an optical fiber information network system in sewer drainage pipes. The optical fiber flow velocity sensor operates without electric power, and the signals from the sensor can be transmitted over a long distance through the telecommunication system in the optical fiber network. Field tests were conducted to check the performance of the sensor in conduits in the pumping station and sewage pond managed by the Tokyo Metropolitan Government. Test results confirmed that the velocity sensor can be used for more than six months without any trouble even in sewer drainage pipes.

Improving PTSD Outcomes in OIF/OEF Returnees: A Randomized Clinical Trial of Hydrocortisone Augmentation of Prolonged Exposure Therapy

DTIC Science & Technology

2012-08-01

Melissa D . Altman, PhD will ensure that the ratings are accomplished in a reasonable time frame, and make the results available to the PI and co...Glucocorticoid augmentation of prolonged exposure therapy: rationale and case report. European Journal of Traumatology. 2010(1): 5643. d . Solutions to...Brief Assessment of Cognition in Schizophrenia (BACS): Symbol-Coding Category Fluency: Animal Naming Trail Making Test: Part A Timed paper

Performance and safety of an integrated bihormonal artificial pancreas for fully automated glucose control at home.

PubMed

Blauw, H; van Bon, A C; Koops, R; DeVries, J H

2016-07-01

To assess the performance and safety of an integrated bihormonal artificial pancreas system consisting of one wearable device and two wireless glucose sensor transmitters during short-term daily use at home. Adult patients with type 1 diabetes using an insulin pump were invited to enrol in this randomized crossover study. Treatment with the artificial pancreas started with a day and night in the clinical research centre, followed by 3 days at home. The control period consisted of 4 days of insulin pump therapy at home with blinded continuous glucose monitoring for data collection. Days 2-4 were predefined as the analysis period, with median glucose as the primary outcome. A total of 10 patients completed the study. The median [interquartile range (IQR)] glucose level was similar for the two treatments [7.3 (7.0-7.6) mmol/l for the artificial pancreas vs. 7.7 (7.0-9.0) mmol/l for the control; p = 0.123]. The median (IQR) percentage of time spent in euglycaemia (3.9-10 mmol/l) was longer during use of the artificial pancreas [84.7 (82.2-87.8)% for the artificial pancreas vs. 68.5 (57.9-83.6)% for the control; p = 0.007]. Time in hypoglycaemia was 1.3 (0.2-3.2)% for the artificial pancreas and 2.4 (0.4-10.3)% for the control treatment (p = 0.139). Separate analysis of daytime and night-time showed that the improvements were mainly achieved during the night. The results of this pilot study suggest that our integrated artificial pancreas provides better glucose control than insulin pump therapy in patients with type 1 diabetes at home and that the treatment is safe. © 2016 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

Preliminary Study of a Novel Puborectalis-Like Artificial Anal Sphincter.

PubMed

Jin, Wentian; Yan, Guozheng; Wu, Hao; Lu, Shan; Zhou, Zerun

2017-09-01

Artificial anal sphincter (AAS) is an in situ implanted device that acts as a treatment for fecal incontinence regardless of etiology by augmenting the incompetent sphincteric structures. However, AAS is impeded from becoming a valid therapy by its high rate of ischemic complication and malfunction. This article presents an original puborectalis-like artificial anal sphincter (PAAS) that features a low risk of ischemia necrosis and rectal perception remodeling. The device retains continence by reproducing the action, including the pulling and angulating the rectum, of the puborectalis muscle, which forms the anorectal angle and reduces the required clamping pressure. Three rectal pressure sensors were embedded to maintain the pressure exerted on the rectal wall in a safe range and to monitor the distention of the rectum. A series of in vitro studies were conducted with a porcine rectum, and this PAAS prototype manifested the ability of maintaining continence with a clamping pressure considerably lower than that required by other AAS devices. The pressure sensors exhibit good linearity, and the function of rectal perception remodeling has also revealed high reliability with a success rate of 93.3%. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Development of Hybrid pH sensor for long-term seawater pH monitoring.

NASA Astrophysics Data System (ADS)

Nakano, Y.; Egashira, T.; Miwa, T.; Kimoto, H.

2016-02-01

We have been developing the in situ pH sensor (Hybrid pH sensor: HpHS) for the long-term seawater pH monitoring. We are planning to provide the HpHS for researchers and environmental consultants for observation of the CCS (Carbon dioxide Capture and Storage) monitoring system, the coastal environment monitoring system (e.g. Blue Carbon) and ocean acidification. The HpHS has two types of pH sensors (i.e. potentiometric pH sensor and spectrophotometric pH sensor). The spectrophotometric pH sensor can measure pH correctly and stably, however it needs large power consumption and a lot of reagents in a long period of observation. The pH sensor used m-cresol purple (mCP) as an indicator of pH (Clayton and Byrne, 1993 and Liu et al., 2011). We can choose both coefficients before deployment. On the other hand, although the potentiometric pH sensor is low power consumption and high-speed response (within 10 seconds), drifts in the pH of the potentiometric measurements may possibly occur for a long-term observation. The HpHS can measure in situ pH correctly and stably combining advantage of both pH sensors. The HpHS consists of an aluminum pressure housing with optical cell (main unit) and an aluminum silicon-oil filled, pressure-compensated vessel containing pumps and valves (diaphragm pump and valve unit) and pressure-compensated reagents bags (pH indicator, pure water and Tris buffer or certified reference material: CRM) with an ability to resist water pressure to 3000m depth. The main unit holds system control boards, pump drivers, data storage (micro SD card), LED right source, photodiode, optical cell and pressure proof windows. The HpHS also has an aluminum pressure housing that holds a rechargeable lithium-ion battery or a lithium battery for the power supply (DC 24 V). The HpHS is correcting the value of the potentiometric pH sensor (measuring frequently) by the value of the spectrophotometric pH sensor (measuring less frequently). It is possible to calibrate in situ with Tris buffer or CRM on the spectrophotometric pH sensor. Therefore, the drifts in the value of potentiometric pH measurements can be compensated using the pH value obtained from the spectrophotometric pH measurements. Thereby, the sensor can measure accurately the value of pH over a long period of time with low power consumption.

Evaluation of Pump Discontinuation and Associated Factors in the T1D Exchange Clinic Registry

PubMed Central

Wong, Jenise C.; Boyle, Claire; DiMeglio, Linda A.; Mastrandrea, Lucy D.; Abel, Kimber-Lee; Cengiz, Eda; Cemeroglu, Pinar A.; Aleppo, Grazia; Largay, Joseph F.; Foster, Nicole C.; Beck, Roy W.; Adi, Saleh

2017-01-01

Background: The objectives of this study were to examine factors associated with insulin pump discontinuation among children and adults followed longitudinally for 1 year in the multicenter T1D Exchange clinic registry, and to provide participant-reported reasons for stopping pump therapy. Methods: We longitudinally followed 8935 participants of all ages using an insulin pump at the time of registry enrollment. Logistic regressions were used to identify demographic and clinical factors associated with pump discontinuation. Pump discontinuation was self-reported by participants on a first annual follow-up survey. Results: The overall frequency of pump discontinuation was 3%. Discontinuation was higher in adolescents (4%) and young adults (4%) than in younger children (3%) or older adults (1%). In multivariate analysis of children between 6 and <13 and 13 and <18 years, participants who discontinued pump use were more likely to have higher HbA1c levels at baseline (adjusted P < .001 for both). The top participant-reported reasons for discontinuing the pump included problems with wearability (57%), disliking the pump or feeling anxious (44%), and problems with glycemic control (30%). Conclusions: In T1D Exchange registry participants, insulin pump discontinuation is uncommon, but more prevalent among adolescents and young adults, and youth with poor glycemic control. Given the known benefits of pump therapy, these populations should be targeted for support and education on troubleshooting pump use. Common reasons for discontinuation should also be considered in future device design and technological improvement. PMID:27595711

Evaluation of Pump Discontinuation and Associated Factors in the T1D Exchange Clinic Registry.

PubMed

Wong, Jenise C; Boyle, Claire; DiMeglio, Linda A; Mastrandrea, Lucy D; Abel, Kimber-Lee; Cengiz, Eda; Cemeroglu, Pinar A; Aleppo, Grazia; Largay, Joseph F; Foster, Nicole C; Beck, Roy W; Adi, Saleh

2017-03-01

The objectives of this study were to examine factors associated with insulin pump discontinuation among children and adults followed longitudinally for 1 year in the multicenter T1D Exchange clinic registry, and to provide participant-reported reasons for stopping pump therapy. We longitudinally followed 8935 participants of all ages using an insulin pump at the time of registry enrollment. Logistic regressions were used to identify demographic and clinical factors associated with pump discontinuation. Pump discontinuation was self-reported by participants on a first annual follow-up survey. The overall frequency of pump discontinuation was 3%. Discontinuation was higher in adolescents (4%) and young adults (4%) than in younger children (3%) or older adults (1%). In multivariate analysis of children between 6 and <13 and 13 and <18 years, participants who discontinued pump use were more likely to have higher HbA1c levels at baseline (adjusted P < .001 for both). The top participant-reported reasons for discontinuing the pump included problems with wearability (57%), disliking the pump or feeling anxious (44%), and problems with glycemic control (30%). In T1D Exchange registry participants, insulin pump discontinuation is uncommon, but more prevalent among adolescents and young adults, and youth with poor glycemic control. Given the known benefits of pump therapy, these populations should be targeted for support and education on troubleshooting pump use. Common reasons for discontinuation should also be considered in future device design and technological improvement.

Restless legs syndrome augmentation among Japanese patients receiving pramipexole therapy: Rate and risk factors in a retrospective study

PubMed Central

Takahashi, Masayoshi; Nishida, Shingo; Nakamura, Masaki; Kobayashi, Mina; Matsui, Kentaro; Ito, Eiki; Usui, Akira; Inoue, Yuichi

2017-01-01

To investigate the rate of and risk factors for restless legs syndrome (RLS) augmentation in Japanese patients receiving pramipexole (PPX) treatment. Records of 231 consecutive patients with idiopathic RLS who received PPX therapy for more than one month in a single sleep disorder center were analyzed retrospectively. Augmentation was diagnosed based on the Max Planck Institute criteria; associated factors were identified by logistic regression analysis. Mean age at PPX initiation was 60.6 ± 14.9 years and mean treatment duration was 48.5 ± 26.4 months. Augmentation was diagnosed in 21 patients (9.1%). Daily PPX dose and treatment duration were significantly associated with augmentation. By analyzing the receiver operating characteristic curve, a PPX dose of 0.375 mg/day was found to be the optimal cut-off value for predicting augmentation. After stratifying patients according to PPX treatment duration, at median treatment duration of 46 months, optimal cut-off values for daily doses were 0.375 and 0.500 mg/day for <46 months and ≥46 months of treatment, respectively. The RLS augmentation with PPX treatment in Japanese patients was occurred at rate of 9.1%, being quite compatible with previously reported rates in Caucasian patients. The symptom could appear within a relatively short period after starting the treatment in possibly vulnerable cases even with a smaller drug dose. Our results support the importance of keeping doses of PPX low throughout the RLS treatment course to prevent augmentation. PMID:28264052

Augmenting the Global Positioning System with Foreign Navigation Systems and Alternative Sensors

DTIC Science & Technology

2012-03-01

Patrick Y.C. Hwang . Introduction to Random Signals and Applied Kalman Filtering. John Wiley and Sons, 1997. [4] Dutt, Srilatha Indira, G. Sasi Bhushana Rao...A simulation was then setup for an autonomous aerial vehicle flight through the model using a Kalman Filter to combine the various sensors with GPS...21 2.7 Altimeter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 2.8 Kalman Filtering

Mission planning for large microwave radiometers

NASA Technical Reports Server (NTRS)

Schartel, W. A.

1984-01-01

Earth orbiting, remote sensing platforms that use microwave radiometers as sensors are susceptible to data interpretation difficulties. The capability of the large microwave radiometer (LMR) was augmented with the inclusion of auxillary sensors that expand and enhance the LMR capability. The final system configuration demonstrates a holistic approach in the design of future orbiting remote sensing platforms that use a LMR as the core instrument.

Securing While Sampling in Wireless Body Area Networks With Application to Electrocardiography.

PubMed

Dautov, Ruslan; Tsouri, Gill R

2016-01-01

Stringent resource constraints and broadcast transmission in wireless body area network raise serious security concerns when employed in biomedical applications. Protecting data transmission where any minor alteration is potentially harmful is of significant importance in healthcare. Traditional security methods based on public or private key infrastructure require considerable memory and computational resources, and present an implementation obstacle in compact sensor nodes. This paper proposes a lightweight encryption framework augmenting compressed sensing with wireless physical layer security. Augmenting compressed sensing to secure information is based on the use of the measurement matrix as an encryption key, and allows for incorporating security in addition to compression at the time of sampling an analog signal. The proposed approach eliminates the need for a separate encryption algorithm, as well as the predeployment of a key thereby conserving sensor node's limited resources. The proposed framework is evaluated using analysis, simulation, and experimentation applied to a wireless electrocardiogram setup consisting of a sensor node, an access point, and an eavesdropper performing a proximity attack. Results show that legitimate communication is reliable and secure given that the eavesdropper is located at a reasonable distance from the sensor node and the access point.

Augmented switching linear dynamical system model for gas concentration estimation with MOX sensors in an open sampling system.

PubMed

Di Lello, Enrico; Trincavelli, Marco; Bruyninckx, Herman; De Laet, Tinne

2014-07-11

In this paper, we introduce a Bayesian time series model approach for gas concentration estimation using Metal Oxide (MOX) sensors in Open Sampling System (OSS). Our approach focuses on the compensation of the slow response of MOX sensors, while concurrently solving the problem of estimating the gas concentration in OSS. The proposed Augmented Switching Linear System model allows to include all the sources of uncertainty arising at each step of the problem in a single coherent probabilistic formulation. In particular, the problem of detecting on-line the current sensor dynamical regime and estimating the underlying gas concentration under environmental disturbances and noisy measurements is formulated and solved as a statistical inference problem. Our model improves, with respect to the state of the art, where system modeling approaches have been already introduced, but only provided an indirect relative measures proportional to the gas concentration and the problem of modeling uncertainty was ignored. Our approach is validated experimentally and the performances in terms of speed of and quality of the gas concentration estimation are compared with the ones obtained using a photo-ionization detector.

Augmented Switching Linear Dynamical System Model for Gas Concentration Estimation with MOX Sensors in an Open Sampling System

PubMed Central

Di Lello, Enrico; Trincavelli, Marco; Bruyninckx, Herman; De Laet, Tinne

2014-01-01

In this paper, we introduce a Bayesian time series model approach for gas concentration estimation using Metal Oxide (MOX) sensors in Open Sampling System (OSS). Our approach focuses on the compensation of the slow response of MOX sensors, while concurrently solving the problem of estimating the gas concentration in OSS. The proposed Augmented Switching Linear System model allows to include all the sources of uncertainty arising at each step of the problem in a single coherent probabilistic formulation. In particular, the problem of detecting on-line the current sensor dynamical regime and estimating the underlying gas concentration under environmental disturbances and noisy measurements is formulated and solved as a statistical inference problem. Our model improves, with respect to the state of the art, where system modeling approaches have been already introduced, but only provided an indirect relative measures proportional to the gas concentration and the problem of modeling uncertainty was ignored. Our approach is validated experimentally and the performances in terms of speed of and quality of the gas concentration estimation are compared with the ones obtained using a photo-ionization detector. PMID:25019637

Moving from Virtual Reality Exposure-Based Therapy to Augmented Reality Exposure-Based Therapy: A Review

PubMed Central

Baus, Oliver; Bouchard, Stéphane

2014-01-01

This paper reviews the move from virtual reality exposure-based therapy to augmented reality exposure-based therapy (ARET). Unlike virtual reality (VR), which entails a complete virtual environment (VE), augmented reality (AR) limits itself to producing certain virtual elements to then merge them into the view of the physical world. Although, the general public may only have become aware of AR in the last few years, AR type applications have been around since beginning of the twentieth century. Since, then, technological developments have enabled an ever increasing level of seamless integration of virtual and physical elements into one view. Like VR, AR allows the exposure to stimuli which, due to various reasons, may not be suitable for real-life scenarios. As such, AR has proven itself to be a medium through which individuals suffering from specific phobia can be exposed “safely” to the object(s) of their fear, without the costs associated with programing complete VEs. Thus, ARET can offer an efficacious alternative to some less advantageous exposure-based therapies. Above and beyond presenting what has been accomplished in ARET, this paper covers some less well-known aspects of the history of AR, raises some ARET related issues, and proposes potential avenues to be followed. These include the type of measures to be used to qualify the user’s experience in an augmented reality environment, the exclusion of certain AR-type functionalities from the definition of AR, as well as the potential use of ARET to treat non-small animal phobias, such as social phobia. PMID:24624073

Moving from virtual reality exposure-based therapy to augmented reality exposure-based therapy: a review.

PubMed

Baus, Oliver; Bouchard, Stéphane

2014-01-01

This paper reviews the move from virtual reality exposure-based therapy to augmented reality exposure-based therapy (ARET). Unlike virtual reality (VR), which entails a complete virtual environment (VE), augmented reality (AR) limits itself to producing certain virtual elements to then merge them into the view of the physical world. Although, the general public may only have become aware of AR in the last few years, AR type applications have been around since beginning of the twentieth century. Since, then, technological developments have enabled an ever increasing level of seamless integration of virtual and physical elements into one view. Like VR, AR allows the exposure to stimuli which, due to various reasons, may not be suitable for real-life scenarios. As such, AR has proven itself to be a medium through which individuals suffering from specific phobia can be exposed "safely" to the object(s) of their fear, without the costs associated with programing complete VEs. Thus, ARET can offer an efficacious alternative to some less advantageous exposure-based therapies. Above and beyond presenting what has been accomplished in ARET, this paper covers some less well-known aspects of the history of AR, raises some ARET related issues, and proposes potential avenues to be followed. These include the type of measures to be used to qualify the user's experience in an augmented reality environment, the exclusion of certain AR-type functionalities from the definition of AR, as well as the potential use of ARET to treat non-small animal phobias, such as social phobia.

Is ridge preservation/augmentation at periodontally compromised extraction sockets safe? A retrospective study.

PubMed

Kim, Jung-Ju; Ben Amara, Heithem; Schwarz, Frank; Kim, Hae-Young; Lee, Jung-Won; Wikesjö, Ulf M E; Koo, Ki-Tae

2017-10-01

This study aimed to evaluate the safety of ridge preservation/augmentation procedures when performed at compromised extraction sockets. Patients subject to ridge preservation/augmentation at periodontally compromised sockets at Seoul National University Dental Hospital (SNUDH) were evaluated in a chart review. Tooth extractions due to acute infection were not included in our study as chronically formed lesions are the only lesions that can be detected from radiographic images. If inflammatory symptoms persisted following ridge preservation/augmentation and antimicrobial and anti-inflammatory therapy, the patient was categorized as a re-infection case and implanted biomaterial removed. Of 10,060 patients subject to tooth extractions at SNUDH, 2011 through 2015, 297 cases meeting inclusion criteria were reviewed. The severity and type of lesions were not specific because extracting data was only done by radiographic images and chart records. The review identified eight patients exhibiting inflammatory symptoms that required additional antimicrobial and anti-inflammatory therapy. Within this group, re-infection occurred in two patients requiring biomaterials removal. The final safety rate for the ridge preservation/augmentation was 99.3%. None of the demographic factors, systemic conditions or choice of biomaterial affected the safety of ridge preservation/augmentation. Alveolar ridge preservation/augmentation at periodontally compromised sockets appears safe following thorough removal of infectious source. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Off-pump supra-arterial myotomy for myocardial bridging.

PubMed

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

2008-09-01

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

Optimal placement of actuators and sensors in control augmented structural optimization

NASA Technical Reports Server (NTRS)

Sepulveda, A. E.; Schmit, L. A., Jr.

1990-01-01

A control-augmented structural synthesis methodology is presented in which actuator and sensor placement is treated in terms of (0,1) variables. Structural member sizes and control variables are treated simultaneously as design variables. A multiobjective utopian approach is used to obtain a compromise solution for inherently conflicting objective functions such as strucutal mass control effort and number of actuators. Constraints are imposed on transient displacements, natural frequencies, actuator forces and dynamic stability as well as controllability and observability of the system. The combinatorial aspects of the mixed - (0,1) continuous variable design optimization problem are made tractable by combining approximation concepts with branch and bound techniques. Some numerical results for example problems are presented to illustrate the efficacy of the design procedure set forth.

Design of aquaponics water monitoring system using Arduino microcontroller

NASA Astrophysics Data System (ADS)

Murad, S. A. Z.; Harun, A.; Mohyar, S. N.; Sapawi, R.; Ten, S. Y.

2017-09-01

This paper describes the design of aquaponics water monitoring system using Arduino microcontroller. Arduino Development Environment (IDE) software is used to develop a program for the microcontroller to communicate with multiple sensors and other hardware. The circuit of pH sensor, temperature sensor, water sensor, servo, liquid crystal displays (LCD), peristaltic pump, solar and Global System for Mobile communication (GSM) are constructed and connected to the system. The system powered by a rechargeable battery using solar energy. When the results of pH, temperature and water sensor are out of range, a notification message will be sent to a mobile phone through GSM. If the pH of water is out of range, peristaltic pump is automatic on to maintain back the pH value of water. The water sensor is fixed in the siphon outlet water flow to detect water flow from grow bed to the fish tank. In addition, servo is used to auto feeding the fish for every 12 hours. Meanwhile, the LCD is indicated the pH, temperature, siphon outlet water flow and remaining time for the next feeding cycle. The pH and temperature of water are set in the ranges of 6 to 7 and 25 °C to 30 °C, respectively.

The Future of D-Cycloserine and Other Cognitive Modifiers in Obsessive-Compulsive and Related Disorders

PubMed Central

Sulkowski, Michael L.; Geller, Daniel A.; Lewin, Adam B.; Murphy, Tanya K.; Mittelman, Andrew; Brown, Ashley; Storch, Eric A.

2014-01-01

Variants of exposure therapy are effective for treating obsessive-compulsive and related disorders (OCRDs). However, significant numbers of patients do not respond adequately to exposure therapy resulting in continued distress and functional impairment. Therefore, novel approaches to augmenting exposure therapy are needed to adequately treat non- and partial-responders. Emerging research suggests that interventions that augment learning and memory processes associated with exposure therapy (i.e., extinction training) may display promise in enhancing treatment response in OCRDs. As the most studied example, d-cycloserine (DCS) is a relatively safe cognitive enhancer that appears to accelerate treatment gains associated with exposure therapy. This article reviews research on the use of DCS and other putative cognitive modifiers as they relate to the treatment (or prospective treatment) of obsessive-compulsive disorder and other OCRDs. PMID:25383074

Depressive Symptoms, Emotion Dysregulation, and Bulimic Symptoms in Youth With Type 1 Diabetes: Varying Interactions at Diagnosis and During Transition to Insulin Pump Therapy.

PubMed

Young-Hyman, Deborah L; Peterson, Claire M; Fischer, Sarah; Markowitz, Jessica T; Muir, Andrew B; Laffel, Lori M

2016-07-01

This study evaluated the associations between depressive symptoms, emotion dysregulation and bulimic symptoms in youth with type 1 diabetes (T1D) in the context of the diagnosis and treatment of T1D. Study participants were 103 youth in 2 distinct groups: newly diagnosed (New) or transitioning to pump therapy (continuous subcutaneous insulin infusion [CSII]; "Pump"), who completed questionnaires regarding symptoms of depression, emotion dysregulation, and bulimia. Glycemic control (A1c), height, weight, and questionnaires were evaluated within 10 days of diagnosis (n = 58) or at education/clinic visit before starting insulin utilizing CSII (n = 45). In the newly diagnosed group, only depression accounted for significant variance in bulimia scores (β = .47, P < .01). For the group with disease treatment experience (Pump), but not for the newly diagnosed group (New), greater depressive symptoms and emotion dysregulation were associated with greater bulimic symptoms. Depressive symptoms and emotion dysregulation, an indicator of poor coping/behavioral control, could help explain adoption of disordered eating behaviors in youth with T1D who are transitioning to pump therapy. © 2016 Diabetes Technology Society.

Management of pump thrombosis in patients with left ventricular assist devices.

PubMed

Stulak, John M; Sharma, Shashank; Maltais, Simon

2015-04-01

The gradual evolution of left ventricular assist device (LVAD) therapy has resulted in a durable option for patients as either a bridge to transplantation (BTT) or a destination therapy (DT). Outcomes with current continuous-flow devices continue to demonstrate significant patient benefit, not only in enhanced survival but also in improved functional capacity and quality of life. While the lessening of adverse events through time has resulted in more widespread adoption of this therapy, there continues to be unintended consequences, including, most notably, infection, bleeding, and thrombosis. Beginning in 2011, centers and collaborative groups began to observe a significant increase in the incidence of pump thrombosis with the HeartMate II LVAD (Thoratec Corp., Pleasanton, CA, USA). However, this clinical scourge is not limited to the HeartMate II, as the HeartWare Ventricular Assist System (HVAD; HeartWare Inc., Framingham, MA, USA) has also had these same issues, which led to pump modifications and the appreciation of more strict control of blood pressure and anticoagulation with this pump design. We review the current status of the field of mechanical circulatory support in its approach to diagnosis, management, and prevention of LVAD pump thrombosis.

NQR detection of explosive simulants using RF atomic magnetometers

NASA Astrophysics Data System (ADS)

Monti, Mark C.; Alexson, Dimitri A.; Okamitsu, Jeffrey K.

2016-05-01

Nuclear Quadrupole Resonance (NQR) is a highly selective spectroscopic method that can be used to detect and identify a number of chemicals of interest to the defense, national security, and law enforcement community. In the past, there have been several documented attempts to utilize NQR to detect nitrogen bearing explosives using induction sensors to detect the NQR RF signatures. We present here our work on the NQR detection of explosive simulants using optically pumped RF atomic magnetometers. RF atomic magnetometers can provide an order of magnitude (or more) improvement in sensitivity versus induction sensors and can enable mitigation of RF interference, which has classically has been a problem for conventional NQR using induction sensors. We present the theory of operation of optically pumped RF atomic magnetometers along with the result of laboratory work on the detection of explosive simulant material. An outline of ongoing work will also be presented along with a path for a fieldable detection system.

Fluidic angular velocity sensor

NASA Technical Reports Server (NTRS)

Berdahl, C. M. (Inventor)

1986-01-01

A fluidic sensor providing a differential pressure signal proportional to the angular velocity of a rotary input is described. In one embodiment the sensor includes a fluid pump having an impeller coupled to a rotary input. A housing forming a constricting fluid flow chamber is connected to the fluid input of the pump. The housing is provided with a fluid flow restrictive input to the flow chamber and a port communicating with the interior of the flow chamber. The differential pressure signal measured across the flow restrictive input is relatively noise free and proportional to the square of the angular velocity of the impeller. In an alternative embodiment, the flow chamber has a generally cylindrical configuration and plates having flow restrictive apertures are disposed within the chamber downstream from the housing port. In this embodiment, the differential pressure signal is found to be approximately linear with the angular velocity of the impeller.

Periodontal considerations for esthetics: edentulous ridge augmentation.

PubMed

Rosenberg, E S; Cutler, S A

1993-01-01

Edentulous ridge augmentation is a plastic surgical technique that is performed to improve patient esthetics when unsightly, deformed ridges exist. This article describes the etiology of ridge deformities and the many procedures that can be executed to achieve an esthetic, functional result. Historically, soft-tissue mucogingival techniques were described to augment collapsed ridges. Pedicle grafts, free soft-tissue grafts, and subepithelial connective tissue grafts are predictable forms of therapy. More recently, ridge augmentation techniques were developed that regenerate the lost periodontium. These include allografts, bioglasses, guided tissue regenerative procedures, and tissue expansion.

Analytical sensor redundancy assessment

NASA Technical Reports Server (NTRS)

Mulcare, D. B.; Downing, L. E.; Smith, M. K.

1988-01-01

The rationale and mechanization of sensor fault tolerance based on analytical redundancy principles are described. The concept involves the substitution of software procedures, such as an observer algorithm, to supplant additional hardware components. The observer synthesizes values of sensor states in lieu of their direct measurement. Such information can then be used, for example, to determine which of two disagreeing sensors is more correct, thus enhancing sensor fault survivability. Here a stability augmentation system is used as an example application, with required modifications being made to a quadruplex digital flight control system. The impact on software structure and the resultant revalidation effort are illustrated as well. Also, the use of an observer algorithm for wind gust filtering of the angle-of-attack sensor signal is presented.

Vertical Guidance Performance Analysis of the L1–L5 Dual-Frequency GPS/WAAS User Avionics Sensor

PubMed Central

Jan, Shau-Shiun

2010-01-01

This paper investigates the potential vertical guidance performance of global positioning system (GPS)/wide area augmentation system (WAAS) user avionics sensor when the modernized GPS and Galileo are available. This paper will first investigate the airborne receiver code noise and multipath (CNMP) confidence (σair). The σair will be the dominant factor in the availability analysis of an L1–L5 dual-frequency GPS/WAAS user avionics sensor. This paper uses the MATLAB Algorithm Availability Simulation Tool (MAAST) to determine the required values for the σair, so that an L1–L5 dual-frequency GPS/WAAS user avionics sensor can meet the vertical guidance requirements of APproach with Vertical guidance (APV) II and CATegory (CAT) I over conterminous United States (CONUS). A modified MAAST that includes the Galileo satellite constellation is used to determine under what user configurations WAAS could be an APV II system or a CAT I system over CONUS. Furthermore, this paper examines the combinations of possible improvements in signal models and the addition of Galileo to determine if GPS/WAAS user avionics sensor could achieve 10 m Vertical Alert Limit (VAL) within the service volume. Finally, this paper presents the future vertical guidance performance of GPS user avionics sensor for the United States’ WAAS, Japanese MTSAT-based satellite augmentation system (MSAS) and European geostationary navigation overlay service (EGNOS). PMID:22319263

Can Vacuum Assisted Venous Drainage be Achieved using a Roller Pump in an Emergency? A Pilot Study using Neonatal Circuitry

PubMed Central

Hill, S. L.; Holt, D. W.

2007-01-01

Abstract: There has been much advancement in perfusion technology over its 50 years of progression. One of these techniques is vacuum-assisted venous drainage (VAVD). Many perfusionists augment venous drainage using VAVD, typically from a wall vacuum source. This study explores alternates to providing VAVD if the wall vacuum fails. In two porcine laboratories, ∼36 in. of 3/16-in. tubing was connected to a sucker return port and placed into the roller head next to the arterial pump. The vacuum was monitored with a DLP pressure monitoring system (Medtronic). This system was connected to small-bore tubing and attached to a stopcock on top of the reservoir. The vacuum was regulated using another stopcock connected to a non-filtered luer lock port on top of the reservoir or by a segment of 3 × 0.25-in.-diameter tubing attached to the vent port with a c-clamp. Vacuum drainage was achieved, ranging from −18 mmHg to −71 mmHg by manipulating the stopcock or c-clamp. Changes in venous drainage were seen by volume fluctuations in the venous reservoir. The vacuum was adjusted to account for dramatic changes. Augmented venous drainage using a roller pump can be achieved successfully during cardiopulmonary bypass (CPB). This method of active drainage can be used in lieu of wall suction or during times of emergency if wall suction fails. PMID:18293812

Modular mechatronic system for stationary bicycles interfaced with virtual environment for rehabilitation

PubMed Central

2014-01-01

Background Cycling has been used in the rehabilitation of individuals with both chronic and post-surgical conditions. Among the challenges with implementing bicycling for rehabilitation is the recruitment of both extremities, in particular when one is weaker or less coordinated. Feedback embedded in virtual reality (VR) augmented cycling may serve to address the requirement for efficacious cycling; specifically recruitment of both extremities and exercising at a high intensity. Methods In this paper a mechatronic rehabilitation bicycling system with an interactive virtual environment, called Virtual Reality Augmented Cycling Kit (VRACK), is presented. Novel hardware components embedded with sensors were implemented on a stationary exercise bicycle to monitor physiological and biomechanical parameters of participants while immersing them in an augmented reality simulation providing the user with visual, auditory and haptic feedback. This modular and adaptable system attaches to commercially-available stationary bicycle systems and interfaces with a personal computer for simulation and data acquisition processes. The complete bicycle system includes: a) handle bars based on hydraulic pressure sensors; b) pedals that monitor pedal kinematics with an inertial measurement unit (IMU) and forces on the pedals while providing vibratory feedback; c) off the shelf electronics to monitor heart rate and d) customized software for rehabilitation. Bench testing for the handle and pedal systems is presented for calibration of the sensors detecting force and angle. Results The modular mechatronic kit for exercise bicycles was tested in bench testing and human tests. Bench tests performed on the sensorized handle bars and the instrumented pedals validated the measurement accuracy of these components. Rider tests with the VRACK system focused on the pedal system and successfully monitored kinetic and kinematic parameters of the rider’s lower extremities. Conclusions The VRACK system, a virtual reality mechatronic bicycle rehabilitation modular system was designed to convert most bicycles in virtual reality (VR) cycles. Preliminary testing of the augmented reality bicycle system was successful in demonstrating that a modular mechatronic kit can monitor and record kinetic and kinematic parameters of several riders. PMID:24902780

Sensor Data Qualification System (SDQS) Implementation Study

NASA Technical Reports Server (NTRS)

Wong, Edmond; Melcher, Kevin; Fulton, Christopher; Maul, William

2009-01-01

The Sensor Data Qualification System (SDQS) is being developed to provide a sensor fault detection capability for NASA s next-generation launch vehicles. In addition to traditional data qualification techniques (such as limit checks, rate-of-change checks and hardware redundancy checks), SDQS can provide augmented capability through additional techniques that exploit analytical redundancy relationships to enable faster and more sensitive sensor fault detection. This paper documents the results of a study that was conducted to determine the best approach for implementing a SDQS network configuration that spans multiple subsystems, similar to those that may be implemented on future vehicles. The best approach is defined as one that most minimizes computational resource requirements without impacting the detection of sensor failures.

END-DIASTOLIC FLOW REVERSAL LIMITS THE EFFICACY OF PEDIATRIC INTRAAORTIC BALLOON PUMP COUNTERPULSATION

PubMed Central

Bartoli, Carlo R.; Rogers, Benjamin D.; Ionan, Constantine E.; Koenig, Steven C.; Pantalos, George M.

2013-01-01

OBJECTIVE Counterpulsation with an intraaortic balloon pump (IABP) has not achieved the same successes or clinical use in pediatric patients as in adults. In a pediatric animal model, IABP efficacy was investigated to determine whether IABP timing with a high-fidelity blood pressure signal may improve counterpulsation therapy versus a low-fidelity signal. METHODS In Yorkshire piglets (n=19, 13.0±0.5 kg) with coronary ligation-induced acute ischemic left ventricular failure, pediatric IABPs (5 or 7cc) were placed in the descending thoracic aorta. Inflation and deflation were timed with traditional criteria from low-fidelity (fluid-filled) and high-fidelity (micromanometer) blood pressure signals during 1:1 support. Aortic, carotid, and coronary hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption was calculated from coronary sinus and arterial blood samples. Left ventricular myocardial blood flow and end-organ blood flow were measured with microspheres. RESULTS Despite significant suprasystolic diastolic augmentation and afterload reduction at heart rates of 105±3bmp, left ventricular myocardial blood flow, myocardial oxygen consumption, the myocardial oxygen supply/demand relationship, cardiac output, and end-organ blood flow did not change. Statistically significant end-diastolic coronary, carotid, and aortic flow reversal occurred with IABP deflation. Inflation and deflation timed with a high-fidelity versus low-fidelity signal did not attenuate systemic flow reversal or improve the myocardial oxygen supply/demand relationship. CONCLUSIONS Systemic end-diastolic flow reversal limited counterpulsation efficacy in a pediatric model of acute left ventricular failure. Adjustment of IABP inflation and deflation timing with traditional criteria and a high-fidelity blood pressure waveform did not improve IABP efficacy or attenuate flow reversal. End-diastolic flow reversal may limit the efficacy of IABP counterpulsation therapy in pediatric patients with traditional timing criteria. Investigation of alternative deflation timing strategies is warranted. PMID:24139614

End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation.

PubMed

Bartoli, Carlo R; Rogers, Benjamin D; Ionan, Constantine E; Pantalos, George M

2014-05-01

Counterpulsation with an intra-aortic balloon pump (IABP) has not achieved the same success or clinical use in pediatric patients as in adults. In a pediatric animal model, IABP efficacy was investigated to determine whether IABP timing with a high-fidelity blood pressure signal may improve counterpulsation therapy versus a low-fidelity signal. In Yorkshire piglets (n = 19; weight, 13.0 ± 0.5 kg) with coronary ligation-induced acute ischemic left ventricular failure, pediatric IABPs (5 or 7 mL) were placed in the descending thoracic aorta. Inflation and deflation were timed with traditional criteria from low-fidelity (fluid-filled) and high-fidelity (micromanometer) blood pressure signals during 1:1 support. Aortic, carotid, and coronary hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption was calculated from coronary sinus and arterial blood samples. Left ventricular myocardial blood flow and end-organ blood flow were measured with microspheres. Despite significant suprasystolic diastolic augmentation and afterload reduction at heart rates of 105 ± 3 beats per minute, left ventricular myocardial blood flow, myocardial oxygen consumption, the myocardial oxygen supply/demand relationship, cardiac output, and end-organ blood flow did not change. Statistically significant end-diastolic coronary, carotid, and aortic flow reversal occurred with IABP deflation. Inflation and deflation timed with a high-fidelity versus low-fidelity signal did not attenuate systemic flow reversal or improve the myocardial oxygen supply/demand relationship. Systemic end-diastolic flow reversal limited counterpulsation efficacy in a pediatric model of acute left ventricular failure. Adjustment of IABP inflation and deflation timing with traditional criteria and a high-fidelity blood pressure waveform did not improve IABP efficacy or attenuate flow reversal. End-diastolic flow reversal may limit the efficacy of IABP counterpulsation therapy in pediatric patients with traditional timing criteria. Investigation of alternative deflation timing strategies is warranted. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Can Atypical Antipsychotic Augmentation Reduce Subsequent Treatment Failure More Effectively Among Depressed Patients with a Higher Degree of Treatment Resistance? A Meta-Analysis of Randomized Controlled Trials

PubMed Central

Wang, Hee Ryung; Woo, Young Sup; Ahn, Hyeong Sik; Ahn, Il Min; Kim, Hyun Jung; Bahk, Won-Myong

2015-01-01

Background: Atypical antipsychotic augmentation was demonstrated to be efficacious in treatment-resistant depression (TRD) in previous meta-analyses. We investigate whether there are differences in the effect size of atypical antipsychotic augmentation in major depressive disorder according to the degree of treatment resistance. Methods: A comprehensive search of four databases identified 11 randomized controlled trials. The 11 trials, which included 3 341 participants, were pooled using a random-effects meta-analysis. Results: Atypical antipsychotic augmentation of antidepressant therapy showed superior efficacy compared to antidepressant monotherapy in TRD in terms of both response and remission rates (response, risk ratio [RR] = 1.38, 95% confidence interval [CI] = 1.25 to 1.53; remission, RR = 1.62, 95% CI = 1.42 to 1.85). In addition, regarding response rates in the TRD trials, atypical antipsychotic augmentation exhibited significantly different effect sizes according to the degree of treatment resistance (TRD 1: RR = 1.24; TRD 2: RR = 1.37; TRD 2–4: RR = 1.58). In non-TRD trials, atypical antipsychotic augmentation failed to show superior efficacy over antidepressant monotherapy in terms of remission rates (RR = 0.89; 95% CI = 0.69 to 1.14). Atypical antipsychotic augmentation of antidepressant therapy exhibits greater effect size in patients with a higher degree of treatment resistance. Conclusions: This finding strengthens the rationale for considering atypical antipsychotic augmentation among depressed patients with multiple previous treatment failures in clinical practice. The efficacy of atypical antipsychotic augmentation for non-TRD seems to be different from that for TRD and, thus, further studies of non-TRD populations are needed. PMID:25770098

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

PubMed

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

2018-05-31

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

Athermal fiber laser for the SWARM absolute scalar magnetometer

NASA Astrophysics Data System (ADS)

Fourcault, W.; Léger, J.-M.; Costes, V.; Fratter, I.; Mondin, L.

2017-11-01

The Absolute Scalar Magnetometer (ASM) developed by CEA-LETI/CNES is an optically pumped 4He magnetic field sensor based on the Zeeman effect and an electronic magnetic resonance whose effects are amplified by a laser pumping process [1-2]. Consequently, the role of the laser is to pump the 4He atoms at the D0 transition as well as to allow the magnetic resonance signal detection. The ASM will be the scalar magnetic reference instrument of the three ESA Swarm satellites to be launched in 2012 in order to carry out the best ever survey of the Earth magnetic field and its temporal evolution. The sensitivity and accuracy of this magnetometer based on 4He optical pumping depend directly on the characteristics of its light source, which is the key sub-system of the sensor. We describe in this paper the selected fiber laser architecture and its wavelength stabilization scheme. Its main performance in terms of spectral emission, optical power at 1083 nm and intensity noise characteristics in the frequency bands used for the operation of the magnetometer, are then presented. Environmental testing results (thermal vacuum cycling, vibrations, shocks and ageing) are also reported at the end of this paper.

Optimizing the Use of Aripiprazole Augmentation in the Treatment of Major Depressive Disorder: From Clinical Trials to Clinical Practice

PubMed Central

Han, Changsu; Wang, Sheng-Min; Lee, Soo-Jung; Jun, Tae-Youn

2015-01-01

Major depressive disorder (MDD) is a recurrent, chronic, and devastating disorder leading to serious impairment in functional capacity as well as increasing public health care costs. In the previous decade, switching therapy and dose adjustment of ongoing antidepressants was the most frequently chosen subsequent treatment option for MDD. However, such recommendations were not based on firmly proven efficacy data from well-designed, placebo-controlled, randomized clinical trials (RCTs) but on practical grounds and clinical reasoning. Aripiprazole augmentation has been dramatically increasing in clinical practice owing to its unique action mechanisms as well as proven efficacy and safety from adequately powered and well-controlled RCTs. Despite the increased use of aripiprazole in depression, limited clinical information and knowledge interfere with proper and efficient use of aripiprazole augmentation for MDD. The objective of the present review was to enhance clinicians' current understanding of aripiprazole augmentation and how to optimize the use of this therapy in the treatment of MDD. PMID:26306301

Who gains clinical benefit from using insulin pump therapy? A qualitative study of the perceptions and views of health professionals involved in the Relative Effectiveness of Pumps over MDI and Structured Education (REPOSE) trial.

PubMed

Lawton, J; Kirkham, J; Rankin, D; White, D A; Elliott, J; Jaap, A; Smithson, W H; Heller, S

2016-02-01

To explore health professionals' views about insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] and the types of individuals they thought would gain greatest clinical benefit from using this treatment. In-depth interviews with staff (n = 18) who delivered the Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE) trial. Data were analysed thematically. Staff perceived insulin pumps as offering a better self-management tool to some individuals due to the drip feed of insulin, the ability to alter basal rates and other advanced features. However, staff also noted that, because of the diversity of features on offer, CSII is a more technically complex therapy to execute than multiple daily injections. For this reason, staff described how, alongside clinical criteria, they had tended to select individuals for CSII in routine clinical practice based on their perceptions about whether they possessed the personal and psychological attributes needed to make optimal use of pump technology. Staff also described how their assumptions about personal and psychological suitability had been challenged by working on the REPOSE trial and observing individuals make effective use of CSII who they would not have recommended for this type of therapy in routine clinical practice. Our findings add to those studies that highlight the difficulties of using patient characteristics and variables to predict clinical success using CSII. To promote equitable access to CSII, attitudinal barriers and prejudicial assumptions amongst staff about who is able to make effective use of CSII may need to be addressed. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

"Combined Occlusion and Atropine Therapy" Versus "Augmented Part-Time Patching" in Children with Refractory/Residual Amblyopia: A Pilot Study.

PubMed

Sachdeva, Virender; Mittal, Vaibhev; Gupta, Varun; Gunturu, Rekha; Kekunnaya, Ramesh; Chandrasekharan, Anjali; Chabblani, Preeti Patil; Rao, Harsha L

2016-01-01

To compare the efficacy of combined occlusion and atropine therapy (COAT) and augmented part-time patching for the treatment of unilateral refractory/residual amblyopia. This retrospective study evaluated children between 4 and 11 years with refractory/residual amblyopia who were treated with either additional atropine (COAT group) or increased hours of patching (augmented group). Data were collected on improvement in best-corrected visual acuity (BCVA; logarithm of the minimum angle of resolution [logMAR] units) at each follow-up visit. There were 19 children in the COAT group and 17 children in the augmented group. The baseline BCVA of the amblyopic eye was 0.79 ± 0.36 logMAR in the COAT group and 0.72 ± 0.26 logMAR in augmented group. Children were statistically significantly younger in the COAT group (6.4 ± 2.2 years) compared to the augmented group (8.6 ± 3.3 years, P = 0.02). The mean duration of follow-up was statistically significantly longer in the augmented group (20.2 COAT group; 13.9 months augmented group) (P = 0.03). Compliance was similar in both groups. LogMAR BCVA (adjusted for difference in age and baseline BCVA) was statistically significantly better in the COAT group (0.56 ± 0.04) compared to the augmented group (0.80 ± 0.04) at 3 months (P = 0.000); 6 months (COAT group, 0.50 ± 0.04 vs. augmented group, 0.74 ± 0.04; P = 0.04) and at 1 year (COAT group, 0.42 ± 0.04 vs. augmented group, 0.67 ± 0.04, P = 0.000). There was statistically significantly greater improvement in logMAR BCVA at 6 months in COAT group (0.26 ± 0.15) compared to the augmented group (0.02 ± 0.14), (P = 0.0002). Age, gender, pretreatment BCVA, duration of follow-up, or compliance to patching did not affect improvement in BCVA. COAT may result in greater improvement in BCVA than augmented part-time patching in children with unilateral residual/refractory amblyopia.

Simulated response of the Sparta Aquifer to outcrop area recharge augmentation, southeastern Arkansas

USGS Publications Warehouse

Hays, Phillip D.

2001-01-01

Recharge augmentation by construction of infiltration impoundments is a potential means of increasing aquifer water levels and aquifer yield that is under consideration for the Sparta aquifer in southeastern Arkansas. The aquifer is a major water resource for municipal, industrial, and agricultural uses, and approximately 287 million gallons per day was pumped from the aquifer in Arkansas in 1995; this is double the amount pumped in 1975. Historically, the Sparta aquifer has provided abundant water of high quality. In recent years, however, the demand for water in some areas has resulted in withdrawals from the Sparta that significantly exceed recharge to the aquifer, and considerable declines have occurred in the potentiometric surface. To better manage the Sparta aquifer, water users in Arkansas are evaluating and implementing a variety of management practices and assessing alternative, surface-water sources to reduce stress upon the Sparta aquifer. One approach to managing and maximizing use of the Sparta aquifer is augmenting recharge to the aquifer by construction of infiltration lakes or canals within the recharge area. The basic concept of augmented recharge is simply to increase the amount of water being introduced into the aquifer so that more water will be available for use. Ground-water flow model simulations were conducted to assess the effectiveness of constructing lakes or canals to augment recharge. Results show that construction of five new lakes in the Sparta recharge area upgradient from major pumping centers or construction of a series of canals along the length of the recharge area yield notable benefit to aquifer conditions when compared with simulations entailing no augmentation of recharge. Augmentation of recharge in the Sparta aquifer with emplacement of lakes provides slight increase to aquifer water levels. The presence of the lakes increased simulated aquifer water levels 0.5 foot or more across a broad area comprising all or a substantial part of 19 counties after the 30-year simulation period. Substantial increases of 5 feet or greater are limited to a smaller area proximal to the lakes. Increases of 5 feet or more are seen in El Dorado, Pine Bluff, and Stuttgart. The positive effect of the lakes on aquifer water levels is rapidly realized after emplacement of the lakes. For example, in the El Dorado area more than 3 feet of a total of 8 feet of water-level increase is seen in the first 5 years of the simulation; in the Pine Bluff area 9 feet of a total of 16 feet of increase occurs within 5 years. Sustainable yield from the aquifer could be expected to be increased within the zone of influence of the lakes. Augmentation of recharge in the Sparta aquifer with emplacement of canals provides considerable increase of aquifer water levels. The zone of influence in the aquifer with canal-augmented recharge extends from the recharge area eastward to the Mississippi River. Aquifer water levels exhibit an increase of 5 feet or more across a broad area comprising all or a substantial part of 15 counties. Increases of 20 feet or more are seen in El Dorado, Pine Bluff, and Stuttgart. The amount of water moving into the aquifer is substantially increased under this scenario, and the amount of water removed from storage is decreased, thereby, increasing aquifer conditions considerably. Sustainable yield from the aquifer could be expected to be greater within the zone of influence of the canals as compared to either the scenario without recharge augmentation or recharge augmentation with lakes. The effect of the canal on aquifer water levels is rapidly realized after emplacement of the canals. For example, in the El Dorado area, 22 feet of a total of 30 feet of increase is seen in the first 5 years of the simulation; in the Pine Bluff area, 15 feet of a total of 24 feet of increase occurs within 5 years. As constructed, the model simulations imply that any lakes or canals constructed would maintain exce

Optimising patient safety when using elastomeric pumps to administer outpatient parenteral antibiotic therapy.

PubMed

Oliver, Gemma

2016-10-27

Outpatient parenteral antibiotic therapy (OPAT) is a growing area of practice that has numerous benefits for both patients and the healthcare system. In order for OPAT services to be successful, strategies need to be in place to maximise efficiency while providing safe, high-quality care. The use of elastomeric pumps to deliver intravenous (IV) antibiotics can have many benefits for OPAT services; they are cost-effective, easy to use and allow the patient to be fully ambulant. However, plans need to be put in place to make sure their use is safe and effective. This article discusses the use of elastomeric pumps by a UK-based OPAT team and the governance processes the team put in place to optimise patient safety when using elastomeric pumps to deliver IV antibiotics. Furthermore, with experience of using elastomeric pumps for more than 4 years the OPAT team was asked to evaluate an elastomeric pump new to the UK market: the Accufuser pump (Vygon (UK) Limited). By collecting data on its use it was found to be safe and easy to use. The team felt that the Accufuser pump ran to time in 96% of completed evaluations and considered it to be clinically acceptable in all responses.

Designing affective video games to support the social-emotional development of teenagers with autism spectrum disorders.

PubMed

Khandaker, Mitu

2009-01-01

Autism spectrum disorders (ASD) are a group of developmental neuropsychiatric disorders, comprised of three diagnostic entities - autistic disorder (AD), Asperger's disorder (AS), and Pervasive Developmental Disorder Not Otherwise Specified (including atypical autism) (PDD-NOS). A number of intervention techniques are currently used to reduce some of the associated challenges, with techniques ranging from behavioral therapy to dietary interventions and traditional counseling. This positional paper proposes the use of video games which leverage affective computing technologies as intervention in autism spectrum disorders in the context of the use of traditional play therapy with adolescents, who may feel uncomfortable engaging in traditional play with toys they may be too old for. It aims to explore the potential for greater 'social physics' made possible by affective computing technologies. This involves computationally 'recognizing' emotions in a user, often through the use of multimodal affective sensors, including facial expressions, postural shifts, and physiological signals such as heart rate, skin conductivity, and EEG signals. However, it is suggested that this should be augmented by researching the effect of social game design mechanisms on social-emotional development, particularly for those who experience difficulty with social interaction.

Virtual Reality-Based Center of Mass-Assisted Personalized Balance Training System.

PubMed

Kumar, Deepesh; González, Alejandro; Das, Abhijit; Dutta, Anirban; Fraisse, Philippe; Hayashibe, Mitsuhiro; Lahiri, Uttama

2017-01-01

Poststroke hemiplegic patients often show altered weight distribution with balance disorders, increasing their risk of fall. Conventional balance training, though powerful, suffers from scarcity of trained therapists, frequent visits to clinics to get therapy, one-on-one therapy sessions, and monotony of repetitive exercise tasks. Thus, technology-assisted balance rehabilitation can be an alternative solution. Here, we chose virtual reality as a technology-based platform to develop motivating balance tasks. This platform was augmented with off-the-shelf available sensors such as Nintendo Wii balance board and Kinect to estimate one's center of mass (CoM). The virtual reality-based CoM-assisted balance tasks (Virtual CoMBaT) was designed to be adaptive to one's individualized weight-shifting capability quantified through CoM displacement. Participants were asked to interact with Virtual CoMBaT that offered tasks of varying challenge levels while adhering to ankle strategy for weight shifting. To facilitate the patients to use ankle strategy during weight-shifting, we designed a heel lift detection module. A usability study was carried out with 12 hemiplegic patients. Results indicate the potential of our system to contribute to improving one's overall performance in balance-related tasks belonging to different difficulty levels.

Use of insulin pumps in India: suggested guidelines based on experience and cultural differences.

PubMed

Kesavadev, Jothydev; Das, Ashok Kumar; Unnikrishnan, Ranjit; Joshi, Shashank R; Ramachandran, Ambady; Shamsudeen, Jisha; Krishnan, Gopika; Jothydev, Sunitha; Mohan, Viswanathan

2010-10-01

All type 1 diabetes mellitus (T1DM) subjects and the majority of type 2 diabetes mellitus (T2DM) subjects at one time or another require insulin to sustain life. Syringes and pens are presently the most popular insulin delivery devices. Though in use for more than 3 decades, insulin pumps are now being more commonly used because of their unique ability to continuously infuse insulin, closely mimicking that of physiological secretion from a normal pancreas. Unlike insulin shots with syringes, pump infusion sites need to be changed less frequently. Scientific evidence from published studies have proven added benefit of insulin pumps in improving quality of life, normalizing sugars in recalcitrant diabetes, improving sexual function, and relieving the intractable pain of neuropathy. In the western world, pumps are commonly used with T1DM subjects, whereas in India 80% of pumpers are T2DM subjects. The success of insulin pump therapy depends on selection of the right candidate, extensive education, motivation, and implementing the sophisticated programs with skill. However, all affordable patients are not ideal candidates for pump therapy because for successful continuation of pump therapy other inclusion criteria should also be fulfilled. Among the other indications discussed are a high level of insulin resistance, brittle diabetes, chronic kidney disease on renal replacement therapy, and continuous glucose monitoring pattern strongly suggesting need for a variable basal insulin infusion rate. In International Diabetes Foundation data released in 2009, estimated diabetes prevalence for 2010 is 285 million, representing 6.4% of the world's adult population, with a prediction that by 2030 the number of people with diabetes will have increased to 438 million. Considering this massive growth in T2DM and its propensity after 10–15 years to lead to an insulin-deficient state, available evidence from studies is a compelling indication not to deny the benefits of continuous subcutaneous insulin infusion in selected T2DM subjects. This article aims at suggesting guidelines based on clinical experience and cultural diversity for India and developing countries.

Use of Insulin Pumps in India: Suggested Guidelines Based on Experience and Cultural Differences

PubMed Central

Das, Ashok Kumar; Unnikrishnan, Ranjit; Joshi, Shashank R.; Ramachandran, Ambady; Shamsudeen, Jisha; Krishnan, Gopika; Jothydev, Sunitha; Mohan, Viswanathan

2010-01-01

Abstract All type 1 diabetes mellitus (T1DM) subjects and the majority of type 2 diabetes mellitus (T2DM) subjects at one time or another require insulin to sustain life. Syringes and pens are presently the most popular insulin delivery devices. Though in use for more than 3 decades, insulin pumps are now being more commonly used because of their unique ability to continuously infuse insulin, closely mimicking that of physiological secretion from a normal pancreas. Unlike insulin shots with syringes, pump infusion sites need to be changed less frequently. Scientific evidence from published studies have proven added benefit of insulin pumps in improving quality of life, normalizing sugars in recalcitrant diabetes, improving sexual function, and relieving the intractable pain of neuropathy. In the western world, pumps are commonly used with T1DM subjects, whereas in India 80% of pumpers are T2DM subjects. The success of insulin pump therapy depends on selection of the right candidate, extensive education, motivation, and implementing the sophisticated programs with skill. However, all affordable patients are not ideal candidates for pump therapy because for successful continuation of pump therapy other inclusion criteria should also be fulfilled. Among the other indications discussed are a high level of insulin resistance, brittle diabetes, chronic kidney disease on renal replacement therapy, and continuous glucose monitoring pattern strongly suggesting need for a variable basal insulin infusion rate. In International Diabetes Foundation data released in 2009, estimated diabetes prevalence for 2010 is 285 million, representing 6.4% of the world's adult population, with a prediction that by 2030 the number of people with diabetes will have increased to 438 million. Considering this massive growth in T2DM and its propensity after 10–15 years to lead to an insulin-deficient state, available evidence from studies is a compelling indication not to deny the benefits of continuous subcutaneous insulin infusion in selected T2DM subjects. This article aims at suggesting guidelines based on clinical experience and cultural diversity for India and developing countries. PMID:20807118

Development of a remote digital augmentation system and application to a remotely piloted research vehicle

NASA Technical Reports Server (NTRS)

Edwards, J. W.; Deets, D. A.

1975-01-01

A cost-effective approach to flight testing advanced control concepts with remotely piloted vehicles is described. The approach utilizes a ground based digital computer coupled to the remotely piloted vehicle's motion sensors and control surface actuators through telemetry links to provide high bandwidth feedback control. The system was applied to the control of an unmanned 3/8-scale model of the F-15 airplane. The model was remotely augmented; that is, the F-15 mechanical and control augmentation flight control systems were simulated by the ground-based computer, rather than being in the vehicle itself. The results of flight tests of the model at high angles of attack are discussed.

Parathyroid hormone related to bone regeneration in grafted and nongrafted tooth extraction sockets in rats.

PubMed

Kuroshima, Shinichiro; Al-Salihi, Zeina; Yamashita, Junro

2013-02-01

The quality and quantity of bone formed in tooth extraction sockets impact implant therapy. Therefore, the establishment of a new approach to enhance bone formation and to minimize bone resorption is important for the success of implant therapy. In this study, we investigated whether intermittent parathyroid hormone (PTH) therapy enhanced bone formation in grafted sockets. Tooth extractions of the maxillary first molars were performed in rats, and the sockets were grafted with xenograft. Intermittent PTH was administered either for 7 days before extractions, for 14 days after extractions, or both. The effect of PTH therapy on bone formation in the grafted sockets was assessed using microcomputed tomography at 14 days after extractions. PTH therapy for 7 days before extractions was not effective to augment bone fill, whereas PTH therapy for 14 days after operation significantly augmented bone formation in the grafted sockets. Intermittent PTH therapy starting right after tooth extractions significantly enhanced bone fill in the grafted sockets, suggesting that PTH therapy can be a strong asset for the success of the ridge preservation procedure.

Persistent reflux symptoms cause anxiety, depression, and mental health and sleep disorders in gastroesophageal reflux disease patients

PubMed Central

Kimura, Yoshihide; Kamiya, Takeshi; Senoo, Kyouji; Tsuchida, Kenji; Hirano, Atsuyuki; Kojima, Hisayo; Yamashita, Hiroaki; Yamakawa, Yoshihiro; Nishigaki, Nobuhiro; Ozeki, Tomonori; Endo, Masatsugu; Nakanishi, Kazuhisa; Sando, Motoki; Inagaki, Yusuke; Shikano, Michiko; Mizoshita, Tsutomu; Kubota, Eiji; Tanida, Satoshi; Kataoka, Hiromi; Katsumi, Kohei; Joh, Takashi

2016-01-01

Some patients with gastroesophageal reflux disease experience persistent reflux symptoms despite proton pump inhibitor therapy. These symptoms reduce their health-related quality of life. Our aims were to evaluate the relationship between proton pump inhibitor efficacy and health-related quality of life and to evaluate predictive factors affecting treatment response in Japanese patients. Using the gastroesophageal reflux disease questionnaire, 145 gastroesophageal reflux disease patients undergoing proton pump inhibitor therapy were evaluated and classified as responders or partial-responders. Their health-related quality of life was then evaluated using the 8-item Short Form Health Survey, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale questionnaires. Sixty-nine patients (47.6%) were partial responders. These patients had significantly lower scores than responders in 5/8 subscales and in the mental health component summary of the 8-item Short Form Health Survey. Partial responders had significantly higher Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale scores, including anxiety and depression scores, than those of responders. Non-erosive reflux disease and double proton pump inhibitor doses were predictive factors of partial responders. Persistent reflux symptoms, despite proton pump inhibitor therapy, caused mental health disorders, sleep disorders, and psychological distress in Japanese gastroesophageal reflux disease patients. PMID:27499583

Persistent reflux symptoms cause anxiety, depression, and mental health and sleep disorders in gastroesophageal reflux disease patients.

PubMed

Kimura, Yoshihide; Kamiya, Takeshi; Senoo, Kyouji; Tsuchida, Kenji; Hirano, Atsuyuki; Kojima, Hisayo; Yamashita, Hiroaki; Yamakawa, Yoshihiro; Nishigaki, Nobuhiro; Ozeki, Tomonori; Endo, Masatsugu; Nakanishi, Kazuhisa; Sando, Motoki; Inagaki, Yusuke; Shikano, Michiko; Mizoshita, Tsutomu; Kubota, Eiji; Tanida, Satoshi; Kataoka, Hiromi; Katsumi, Kohei; Joh, Takashi

2016-07-01

Some patients with gastroesophageal reflux disease experience persistent reflux symptoms despite proton pump inhibitor therapy. These symptoms reduce their health-related quality of life. Our aims were to evaluate the relationship between proton pump inhibitor efficacy and health-related quality of life and to evaluate predictive factors affecting treatment response in Japanese patients. Using the gastroesophageal reflux disease questionnaire, 145 gastroesophageal reflux disease patients undergoing proton pump inhibitor therapy were evaluated and classified as responders or partial-responders. Their health-related quality of life was then evaluated using the 8-item Short Form Health Survey, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale questionnaires. Sixty-nine patients (47.6%) were partial responders. These patients had significantly lower scores than responders in 5/8 subscales and in the mental health component summary of the 8-item Short Form Health Survey. Partial responders had significantly higher Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale scores, including anxiety and depression scores, than those of responders. Non-erosive reflux disease and double proton pump inhibitor doses were predictive factors of partial responders. Persistent reflux symptoms, despite proton pump inhibitor therapy, caused mental health disorders, sleep disorders, and psychological distress in Japanese gastroesophageal reflux disease patients.

Method and apparatus for determining the hydraulic conductivity of earthen material

DOEpatents

Sisson, James B.; Honeycutt, Thomas K.; Hubbell, Joel M.

1996-01-01

An earthen material hydraulic conductivity determining apparatus includes, a) a semipermeable membrane having a fore earthen material bearing surface and an opposing rear liquid receiving surface; b) a pump in fluid communication with the semipermeable membrane rear surface, the pump being capable of delivering liquid to the membrane rear surface at a plurality of selected variable flow rates or at a plurality of selected variable pressures; c) a liquid reservoir in fluid communication with the pump, the liquid reservoir retaining a liquid for pumping to the membrane rear surface; and d) a pressure sensor in fluid communication with the membrane rear surface to measure pressure of liquid delivered to the membrane by the pump. Preferably, the pump comprises a pair of longitudinally opposed and aligned syringes which are operable to simultaneously fill one syringe while emptying the other. Methods of determining the hydraulic conductivity of earthen material are also disclosed.

Method and apparatus for determining the hydraulic conductivity of earthen material

DOEpatents

Sisson, J.B.; Honeycutt, T.K.; Hubbell, J.M.

1996-05-28

An earthen material hydraulic conductivity determining apparatus includes: (a) a semipermeable membrane having a fore earthen material bearing surface and an opposing rear liquid receiving surface; (b) a pump in fluid communication with the semipermeable membrane rear surface, the pump being capable of delivering liquid to the membrane rear surface at a plurality of selected variable flow rates or at a plurality of selected variable pressures; (c) a liquid reservoir in fluid communication with the pump, the liquid reservoir retaining a liquid for pumping to the membrane rear surface; and (d) a pressure sensor in fluid communication with the membrane rear surface to measure pressure of liquid delivered to the membrane by the pump. Preferably, the pump comprises a pair of longitudinally opposed and aligned syringes which are operable to simultaneously fill one syringe while emptying the other. Methods of determining the hydraulic conductivity of earthen material are also disclosed. 15 figs.

40 CFR 60.482-2 - Standards: Pumps in light liquid service.

Code of Federal Regulations, 2011 CFR

2011-07-01

...; or (ii) Equipped with a barrier fluid degassing reservoir that is routed to a process or fuel gas... in VOC service. (3) Each barrier fluid system is equipped with a sensor that will detect failure of...) Designate the visual indications of liquids dripping as a leak. (5)(i) Each sensor as described in paragraph...

40 CFR 63.1007 - Pumps in light liquid service standards.

Code of Federal Regulations, 2011 CFR

2011-07-01

... sensor that indicates failure of the seal system, the barrier fluid system, or both. The owner or... reservoir that is routed to a process or fuel gas system or connected by a closed vent system to a control... liquid service. (iv) Each barrier fluid system is equipped with a sensor that will detect failure of the...

40 CFR 65.107 - Standards: Pumps in light liquid service.

Code of Federal Regulations, 2010 CFR

2010-07-01

... frequency of drips and to the sensor that indicates failure of the seal system, the barrier fluid system, or... or fuel gas system or connected by a closed vent system to a control device that complies with the... equipped with a sensor that will detect failure of the seal system, the barrier fluid system, or both. (v...

40 CFR 60.482-2 - Standards: Pumps in light liquid service.

Code of Federal Regulations, 2010 CFR

2010-07-01

...; or (ii) Equipped with a barrier fluid degassing reservoir that is routed to a process or fuel gas... in VOC service. (3) Each barrier fluid system is equipped with a sensor that will detect failure of...) Designate the visual indications of liquids dripping as a leak. (5)(i) Each sensor as described in paragraph...

40 CFR 63.1007 - Pumps in light liquid service standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... sensor that indicates failure of the seal system, the barrier fluid system, or both. The owner or... reservoir that is routed to a process or fuel gas system or connected by a closed vent system to a control... liquid service. (iv) Each barrier fluid system is equipped with a sensor that will detect failure of the...

40 CFR 63.163 - Standards: Pumps in light liquid service.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) Equipped with a barrier fluid degassing reservoir that is routed to a process or fuel gas system or... with a sensor that will detect failure of the seal system, the barrier fluid system, or both. (4) Each... per million or greater is measured, a leak is detected. (5) Each sensor as described in paragraph (e...

40 CFR 63.1026 - Pumps in light liquid service standards.

Code of Federal Regulations, 2010 CFR

2010-07-01

... presence and frequency of drips and to the sensor that indicates failure of the seal system, the barrier... or fuel gas system or connected by a closed-vent system to a control device that complies with the.... (iv) Each barrier fluid system is equipped with a sensor that will detect failure of the seal system...

A study of an assisting robot for mandible plastic surgery based on augmented reality.

PubMed

Shi, Yunyong; Lin, Li; Zhou, Chaozheng; Zhu, Ming; Xie, Le; Chai, Gang

2017-02-01

Mandible plastic surgery plays an important role in conventional plastic surgery. However, its success depends on the experience of the surgeons. In order to improve the effectiveness of the surgery and release the burden of surgeons, a mandible plastic surgery assisting robot, based on an augmented reality technique, was developed. Augmented reality assists surgeons to realize positioning. Fuzzy control theory was used for the control of the motor. During the process of bone drilling, both the drill bit position and the force were measured by a force sensor which was used to estimate the position of the drilling procedure. An animal experiment was performed to verify the effectiveness of the robotic system. The position error was 1.07 ± 0.27 mm and the angle error was 5.59 ± 3.15°. The results show that the system provides a sufficient accuracy with which a precise drilling procedure can be performed. In addition, under the supervision's feedback of the sensor, an adequate safety level can be achieved for the robotic system. The system realizes accurate positioning and automatic drilling to solve the problems encountered in the drilling procedure, providing a method for future plastic surgery.

Infrastructure-Based Sensors Augmenting Efficient Autonomous Vehicle Operations: Preprint

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

Jun, Myungsoo; Markel, Anthony J

Autonomous vehicle technology development relies on an on-board network of fused sensor inputs for safe and efficient operation. The fused sensors offer multiple perspectives of similar information aiding in system decision robustness. The high cost of full systems on individual vehicles is seen as a potential barrier to broad adoption and achieving system energy efficiency gains. Since traffic in autonomous vehicle technology development relies on an on-board network of fused sensor inputs for safe and efficient operation. The fused sensors offer multiple perspectives of similar information aiding in system decision robustness. The high cost of full systems on individual vehiclesmore » is seen as a potential barrier to broad adoption and achieving system energy efficiency gains.« less

Augmenting the senses: a review on sensor-based learning support.

PubMed

Schneider, Jan; Börner, Dirk; van Rosmalen, Peter; Specht, Marcus

2015-02-11

In recent years sensor components have been extending classical computer-based support systems in a variety of applications domains (sports, health, etc.). In this article we review the use of sensors for the application domain of learning. For that we analyzed 82 sensor-based prototypes exploring their learning support. To study this learning support we classified the prototypes according to the Bloom's taxonomy of learning domains and explored how they can be used to assist on the implementation of formative assessment, paying special attention to their use as feedback tools. The analysis leads to current research foci and gaps in the development of sensor-based learning support systems and concludes with a research agenda based on the findings.

Augmenting the Senses: A Review on Sensor-Based Learning Support

PubMed Central

Schneider, Jan; Börner, Dirk; van Rosmalen, Peter; Specht, Marcus

2015-01-01

In recent years sensor components have been extending classical computer-based support systems in a variety of applications domains (sports, health, etc.). In this article we review the use of sensors for the application domain of learning. For that we analyzed 82 sensor-based prototypes exploring their learning support. To study this learning support we classified the prototypes according to the Bloom's taxonomy of learning domains and explored how they can be used to assist on the implementation of formative assessment, paying special attention to their use as feedback tools. The analysis leads to current research foci and gaps in the development of sensor-based learning support systems and concludes with a research agenda based on the findings. PMID:25679313

Fast Kalman Filtering for Relative Spacecraft Position and Attitude Estimation for the Raven ISS Hosted Payload

NASA Technical Reports Server (NTRS)

Galante, Joseph M.; Van Eepoel, John; D'Souza, Chris; Patrick, Bryan

2016-01-01

The Raven ISS Hosted Payload will feature several pose measurement sensors on a pan/tilt gimbal which will be used to autonomously track resupply vehicles as they approach and depart the International Space Station. This paper discusses the derivation of a Relative Navigation Filter (RNF) to fuse measurements from the different pose measurement sensors to produce relative position and attitude estimates. The RNF relies on relative translation and orientation kinematics and careful pose sensor modeling to eliminate dependence on orbital position information and associated orbital dynamics models. The filter state is augmented with sensor biases to provide a mechanism for the filter to estimate and mitigate the offset between the measurements from different pose sensors

Fast Kalman Filtering for Relative Spacecraft Position and Attitude Estimation for the Raven ISS Hosted Payload

NASA Technical Reports Server (NTRS)

Galante, Joseph M.; Van Eepoel, John; D' Souza, Chris; Patrick, Bryan

2016-01-01

The Raven ISS Hosted Payload will feature several pose measurement sensors on a pan/tilt gimbal which will be used to autonomously track resupply vehicles as they approach and depart the International Space Station. This paper discusses the derivation of a Relative Navigation Filter (RNF) to fuse measurements from the different pose measurement sensors to produce relative position and attitude estimates. The RNF relies on relative translation and orientation kinematics and careful pose sensor modeling to eliminate dependence on orbital position information and associated orbital dynamics models. The filter state is augmented with sensor biases to provide a mechanism for the filter to estimate and mitigate the offset between the measurements from different pose sensors.

Insulin pump treatment in children and adolescents with type 1 diabetes.

PubMed

Hofer, S; Meraner, D; Koehle, J

2012-08-01

Within children and adolescents with type 1 diabetes insulin pump treatment is of increasing interest. Frequency of insulin pump therapy shows a rapid and steep increase in toddlers and young children. Insulin pumps allow a close to physiologic insulin delivery due to basal rates programmed over 24 hours with circadian rhythms taken into account. Furthermore, another advantage of technical devices as insulin pumps is the application of extremely small amounts of insulin, as needed in very young children, with the possibility of titration of infusion rates down to 0.01E/h. Dawn Phenomenon and hypoglycemic events are main indications for insulin pump treatment in children and adolescents. A significant reduction of severe hypoglycemia, especially nocturnal hypoglycemia was shown, whereas a reduction of HbA1c and an improvement of metabolic control has been reported in short term and in some but not all long term studies. Ketoacidosis rate did not increase in insulin pump therapy. Complications due to continuous subcutaneous insulin infusion, like local infections and dermatological changes are frequent but were not associated with glycemic control and did not lead to discontinuation of insulin pump treatment. Pump discontinuation rate in general is low, varying from 1% in very young children up to 6% in pubertal adolescent girls. Insulin pump treatment was shown to be safe and efficient and the simplicity of handling the devices as well as an improvement of quality of life may explain the rapid increase of pump treatment in young children and adolescents with type 1 diabetes.

Yohimbine enhancement of exposure therapy for social anxiety disorder: a randomized controlled trial.

PubMed

Smits, Jasper A J; Rosenfield, David; Davis, Michelle L; Julian, Kristin; Handelsman, Pamela R; Otto, Michael W; Tuerk, Peter; Shiekh, Michael; Rosenfield, Ben; Hofmann, Stefan G; Powers, Mark B

2014-06-01

Preclinical and clinical trials suggest that yohimbine may augment extinction learning without significant side effects. However, previous clinical trials have only examined adults with specific phobias. Yohimbine has not yet been investigated in the augmentation of exposure therapy for other anxiety disorders. Adults (n = 40) with a DSM-IV diagnosis of social anxiety disorder were randomized to placebo or yohimbine HCl (10.8 mg) 1 hour before each of four exposure sessions. Outcome measures were collected at baseline, each treatment session, posttreatment, and 1-month follow-up. Yohimbine was well tolerated. Yohimbine augmentation, relative to placebo augmentation, resulted in faster improvement and better outcomes on self-report measures of social anxiety disorder severity (Liebowitz Social Anxiety Scale, d = .53) and depressed mood severity (Beck Depression Inventory, d = .37) but not on the clinician-rated measures (Clinical Global Impressions-Severity Scale, d = .09; Clinical Global Impressions-Improvement Scale, d = .25). Between-group differences on the Liebowitz Social Anxiety Scale were moderated by the level of fear reported at the end of an exposure exercise (end fear), such that the advantage of yohimbine over placebo was only evident among patients who reported low end fear. The results provide moderate support for yohimbine as a therapeutic augmentation strategy for exposure therapy in social anxiety disorder, one that may be especially effective when coupled with successful exposure experiences. Beneficial effects for yohimbine were readily evident for self-report measures but not for clinician-rated outcomes of social anxiety severity and improvement. © 2013 Society of Biological Psychiatry Published by Society of Biological Psychiatry All rights reserved.

Long-distance fiber Bragg grating sensor system with a high optical signal-to-noise ratio based on a tunable fiber ring laser configuration.

PubMed

Rao, Yun-Jiang; Ran, Zeng-Ling; Chen, Rong-Rui

2006-09-15

A novel tunable fiber ring laser configuration with a combination of bidirectional Raman amplification and dual erbium-doped fiber (EDF) amplification is proposed for realizing high optical signal-to-noise ratio (SNR), long-distance, quasi-distributed fiber Bragg grating (FBG) sensing systems with large capacities and low cost. The hybrid Raman-EDF amplification configuration arranged in the ring laser can enhance the optical SNR of FBG sensor signals significantly owing to the good combination of the high gain of the erbium-doped fiber amplifier (EDFA) and the low noise of the Raman amplification. Such a sensing system can support a large number of FBG sensors because of the use of a tunable fiber Fabry-Perot filter located within the ring laser and spatial division multiplexing for expansion of sensor channels. Experimental results show that an excellent optical SNR of approximately 60 dB has been achieved for a 50 km transmission distance with a low Raman pump power of approximately 170 mW at a wavelength of 1455 nm and a low EDFA pump power of approximately 40 mW at a wavelength of 980 nm, which is the highest optical SNR achieved so far for a 50 km long FBG sensor system, to our knowledge.

Designing the modern pump: engineering aspects of continuous subcutaneous insulin infusion software.

PubMed

Welsh, John B; Vargas, Steven; Williams, Gary; Moberg, Sheldon

2010-06-01

Insulin delivery systems attracted the efforts of biological, mechanical, electrical, and software engineers well before they were commercially viable. The introduction of the first commercial insulin pump in 1983 represents an enduring milestone in the history of diabetes management. Since then, pumps have become much more than motorized syringes and have assumed a central role in diabetes management by housing data on insulin delivery and glucose readings, assisting in bolus estimation, and interfacing smoothly with humans and compatible devices. Ensuring the integrity of the embedded software that controls these devices is critical to patient safety and regulatory compliance. As pumps and related devices evolve, software engineers will face challenges and opportunities in designing pumps that are safe, reliable, and feature-rich. The pumps and related systems must also satisfy end users, healthcare providers, and regulatory authorities. In particular, pumps that are combined with glucose sensors and appropriate algorithms will provide the basis for increasingly safe and precise automated insulin delivery-essential steps to developing a fully closed-loop system.

In Vivo Evaluation of Active and Passive Physiological Control Systems for Rotary Left and Right Ventricular Assist Devices.

PubMed

Gregory, Shaun D; Stevens, Michael C; Pauls, Jo P; Schummy, Emma; Diab, Sara; Thomson, Bruce; Anderson, Ben; Tansley, Geoff; Salamonsen, Robert; Fraser, John F; Timms, Daniel

2016-09-01

Preventing ventricular suction and venous congestion through balancing flow rates and circulatory volumes with dual rotary ventricular assist devices (VADs) configured for biventricular support is clinically challenging due to their low preload and high afterload sensitivities relative to the natural heart. This study presents the in vivo evaluation of several physiological control systems, which aim to prevent ventricular suction and venous congestion. The control systems included a sensor-based, master/slave (MS) controller that altered left and right VAD speed based on pressure and flow; a sensor-less compliant inflow cannula (IC), which altered inlet resistance and, therefore, pump flow based on preload; a sensor-less compliant outflow cannula (OC) on the right VAD, which altered outlet resistance and thus pump flow based on afterload; and a combined controller, which incorporated the MS controller, compliant IC, and compliant OC. Each control system was evaluated in vivo under step increases in systemic (SVR ∼1400-2400 dyne/s/cm(5) ) and pulmonary (PVR ∼200-1000 dyne/s/cm(5) ) vascular resistances in four sheep supported by dual rotary VADs in a biventricular assist configuration. Constant speed support was also evaluated for comparison and resulted in suction events during all resistance increases and pulmonary congestion during SVR increases. The MS controller reduced suction events and prevented congestion through an initial sharp reduction in pump flow followed by a gradual return to baseline (5.0 L/min). The compliant IC prevented suction events; however, reduced pump flows and pulmonary congestion were noted during the SVR increase. The compliant OC maintained pump flow close to baseline (5.0 L/min) and prevented suction and congestion during PVR increases. The combined controller responded similarly to the MS controller to prevent suction and congestion events in all cases while providing a backup system in the event of single controller failure. © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Proton Pump Inhibitors in Gastroesophageal Reflux Disease: Friend or Foe.

PubMed

Gyawali, C Prakash

2017-09-01

Proton pump inhibitor (PPI) use in gastroesophageal reflux disease (GERD) has been redefined, in light of recent advances highlighting GERD phenotypes that respond to PPIs, and fresh revelations of potential risks of long-term PPI therapy. Erosive esophagitis predicts excellent response to PPI therapy, but non-erosive reflux disease (NERD) with abnormal reflux parameters on ambulatory reflux monitoring also demonstrates a similar response. In contrast, response is suboptimal in the absence of abnormal reflux parameters. In this setting, if an alternate appropriate indication for PPI therapy does not coexist, risks may outweigh benefits of PPI therapy. Adverse events from long-term PPI therapy continue to be reported, most based on association rather than cause-and-effect. Appropriate indications need to be established before embarking on long-term PPI therapy. Future research will define true risks of long-term PPI therapy, and develop alternate management options for acid peptic diseases.

Hypothalamic-pituitary-thyroid system activity during lithium augmentation therapy in patients with unipolar major depression

PubMed Central

Bschor, Tom; Baethge, Christopher; Adli, Mazda; Lewitzka, Ute; Eichmann, Uta; Bauer, Michael

2003-01-01

Objective Lithium augmentation is an established strategy in the treatment of refractory depression, but little is known about predictors of response and its mode of action. There is increasing evidence that low thyroid function indices within the normal range are associated with a poorer treatment response to antidepressants, but previous studies on the hypothalamic-pituitary-thyroid (HPT) system during lithium augmentation provide inconclusive results and have methodological limitations. This study aimed at exploring the role of thyroid function in lithium augmentation and used a prospective design that included a homogeneous sample of inpatients with unipolar major depressive disorder. Methods In 24 euthyroid patients with a major depressive episode who had not responded to antidepressant monotherapy of at least 4 weeks, we measured serum thyroid-stimulating hormone (TSH), total triiodothyronine (T3) and total thyroxine (T4) before (baseline) and during lithium augmentation therapy (follow-up). The time point of the endocrinological follow-up depended on the status of response, which was assessed weekly with the Hamilton Depression Rating Scale, 17-item version (HDRS17). Responders were reassessed immediately after response was determined, and non-responders after 4 weeks of lithium augmentation. Results There was a statistically significant change in thyroid system activity during lithium augmentation, with an increase of TSH levels and a decrease of peripheral T3 and T4 levels. However, there were no differences in any of the HPT hormones between responders and non-responders at baseline or at follow-up. Conclusions The decrease of thyroid system activity during lithium treatment reflects the well-established “antithyroid” properties of lithium. However, it appears that thyroid status does not predict response to lithium augmentation in euthyroid patients before treatment. PMID:12790161

The effect of direct renin inhibition alone and in combination with ACE inhibition on endothelial function, arterial stiffness, and renal function in type 1 diabetes.

PubMed

Cherney, David Z I; Scholey, James W; Jiang, Shan; Har, Ronnie; Lai, Vesta; Sochett, Etienne B; Reich, Heather N

2012-11-01

Diabetes is associated with renin-angiotensin system (RAS) activation, leading to renal and systemic vascular dysfunction that contribute to end-organ injury and significant morbidity. RAS blockade with ACE inhibitors reduces, but does not abolish, RAS effects. Accordingly, our aim was to determine if direct renin inhibition alone, and in combination with an ACE inhibitor, corrects early hemodynamic abnormalities associated with type 1 diabetes. Arterial stiffness (augmentation index), flow-mediated vasodilatation (FMD), and renal hemodynamic function (inulin and paraaminohippurate clearance) were measured at baseline under clamped euglycemic and hyperglycemic conditions (n = 21). Measures were repeated after 4 weeks of aliskiren therapy and again after aliskiren plus ramipril. Blood pressure-lowering effects of aliskiren were similar during clamped euglycemia and hyperglycemia. Combination therapy augmented this effect under both glycemic conditions (P = 0.0005). Aliskiren reduced arterial stiffness under clamped euglycemic and hyperglycemic conditions, and the effects were augmented by dual RAS blockade (-3.4 ± 11.2 to -8.0 ± 11.5 to -14.3 ± 8.4%, respectively, during euglycemia, P = 0.0001). During clamped euglycemia, aliskiren increased FMD; dual therapy exaggerated this effect (5.1 ± 3.3 to 7.5 ± 3.0 to 10.8 ± 3.5%, repeated-measures ANOVA, P = 0.0001). Aliskiren monotherapy caused renal vasodilatation during clamped hyperglycemia only. In contrast, dual therapy augmented renal vasodilatory effects during clamped euglycemia and hyperglycemia. In patients with uncomplicated type 1 diabetes, aliskiren-based dual RAS blockade is associated with greater arterial compliance, FMD, and renal vasodilatation.

Bardoxolone: augmenting the Yin in chronic kidney disease.

PubMed

Thomas, Merlin C

2011-10-01

Nrf-2 (NF-E2-related factor 2) is a regulator of anti-oxidant, anti-inflammatory and detoxification pathways. Coordinated augmentation of these key defence pathways via Nrf-2 signalling is being investigated for the treatment of chronic diseases, including diabetes and its complications. The first to reach commercial development is the triterpenoid, bardoxolone methyl. In recent clinical trial, bardoxolone rapidly improved kidney function on average by 5-10 ml/min within 4 weeks of therapy. Importantly, this improvement was sustained during one year of active treatment. This suggests that rather that overworking a failing system, bardoxolone appeared to safely augment renal function, at least to one year. If similar improvements in kidney function can be reproduced in the upcoming BEACON trial, it will represent a major advance on conventional therapy and new way to bring balance to the failing kidney.

D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders: A Systematic Review and Meta-analysis of Individual Participant Data.

PubMed

Mataix-Cols, David; Fernández de la Cruz, Lorena; Monzani, Benedetta; Rosenfield, David; Andersson, Erik; Pérez-Vigil, Ana; Frumento, Paolo; de Kleine, Rianne A; Difede, JoAnn; Dunlop, Boadie W; Farrell, Lara J; Geller, Daniel; Gerardi, Maryrose; Guastella, Adam J; Hofmann, Stefan G; Hendriks, Gert-Jan; Kushner, Matt G; Lee, Francis S; Lenze, Eric J; Levinson, Cheri A; McConnell, Harry; Otto, Michael W; Plag, Jens; Pollack, Mark H; Ressler, Kerry J; Rodebaugh, Thomas L; Rothbaum, Barbara O; Scheeringa, Michael S; Siewert-Siegmund, Anja; Smits, Jasper A J; Storch, Eric A; Ströhle, Andreas; Tart, Candyce D; Tolin, David F; van Minnen, Agnes; Waters, Allison M; Weems, Carl F; Wilhelm, Sabine; Wyka, Katarzyna; Davis, Michael; Rück, Christian; Altemus, Margaret; Anderson, Page; Cukor, Judith; Finck, Claudia; Geffken, Gary R; Golfels, Fabian; Goodman, Wayne K; Gutner, Cassidy; Heyman, Isobel; Jovanovic, Tanja; Lewin, Adam B; McNamara, Joseph P; Murphy, Tanya K; Norrholm, Seth; Thuras, Paul

2017-05-01

Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear. To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables. PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked. Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder. Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies. Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25) but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -4.92 to 1.60; P = .32; d = -0.14) or from pretreatment to follow-up (mean difference, -2.98, 95% CI, -5.99 to 0.03; P = .05; d = -0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes. D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response.

A Primer on Insulin Pump Therapy for Health Care Providers.

PubMed

McCrea, Deborah L

2017-12-01

An estimated 1 million people use an insulin pump to manage their diabetes. Few medical professionals understand or feel comfortable caring for people who use an insulin pump. This article will help the medical professional understand the reasons why the insulin pump helps the user to achieve better glycemic control, have more flexibility, and enjoy a better quality of life. Additionally, this article discusses the advantages, disadvantages, candidate selection, contraindications, basic functions, and troubleshooting of the insulin pump. Copyright © 2017 Elsevier Inc. All rights reserved.

Current topics in glycemic control by wearable artificial pancreas or bedside artificial pancreas with closed-loop system.

PubMed

Hanazaki, Kazuhiro; Munekage, Masaya; Kitagawa, Hiroyuki; Yatabe, Tomoaki; Munekage, Eri; Shiga, Mai; Maeda, Hiromichi; Namikawa, Tsutomu

2016-09-01

The incidence of diabetes is increasing at an unprecedented pace and has become a serious health concern worldwide during the last two decades. Despite this, adequate glycemic control using an artificial pancreas has not been established, although the 21st century has seen rapid developments in this area. Herein, we review current topics in glycemic control for both the wearable artificial pancreas for type 1 and type 2 diabetic patients and the bedside artificial pancreas for surgical diabetic patients. In type 1 diabetic patients, nocturnal hypoglycemia associated with insulin therapy remains a serious problem that could be addressed by the recent development of a wearable artificial pancreas. This smart phone-like device, comprising a real-time, continuous glucose monitoring system and insulin pump system, could potentially significantly reduce nocturnal hypoglycemia compared with conventional glycemic control. Of particular interest in this space are the recent inventions of a low-glucose suspend feature in the portable systems that automatically stops insulin delivery 2 h following a glucose sensor value <70 mg/dL and a bio-hormonal pump system consisting of insulin and glucagon pumps. Perioperative tight glycemic control using a bedside artificial pancreas with the closed-loop system has also proved safe and effective for not only avoiding hypoglycemia, but also for reducing blood glucose level variability resulting in good surgical outcomes. We hope that a more sophisticated artificial pancreas with closed-loop system will now be taken up for routine use worldwide, providing enormous relief for patients suffering from uncontrolled hyperglycemia, hypoglycemia, and/or variability in blood glucose concentrations.

Natural Environment Illumination: Coherent Interactive Augmented Reality for Mobile and Non-Mobile Devices.

PubMed

Rohmer, Kai; Jendersie, Johannes; Grosch, Thorsten

2017-11-01

Augmented Reality offers many applications today, especially on mobile devices. Due to the lack of mobile hardware for illumination measurements, photorealistic rendering with consistent appearance of virtual objects is still an area of active research. In this paper, we present a full two-stage pipeline for environment acquisition and augmentation of live camera images using a mobile device with a depth sensor. We show how to directly work on a recorded 3D point cloud of the real environment containing high dynamic range color values. For unknown and automatically changing camera settings, a color compensation method is introduced. Based on this, we show photorealistic augmentations using variants of differential light simulation techniques. The presented methods are tailored for mobile devices and run at interactive frame rates. However, our methods are scalable to trade performance for quality and can produce quality renderings on desktop hardware.

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.

Practice comparisons between accelerated resolution therapy, eye movement desensitization and reprocessing and cognitive processing therapy with case examples.

PubMed

Hernandez, Diego F; Waits, Wendi; Calvio, Lisseth; Byrne, Mary

2016-12-01

Recent outcomes for Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy indicate that as many as 60-72% of patients retain their PTSD diagnosis after treatment with CPT or PE. One emerging therapy with the potential to augment existing trauma focused therapies is Accelerated Resolution Therapy (ART). ART is currently being used along with evidence based approaches at Fort Belvoir Community Hospital and by report has been both positive for clients as well as less taxing on professionals trained in ART. The following is an in-practice theoretical comparison of CPT, EMDR and ART with case examples from Fort Belvoir Community Hospital. While all three approaches share common elements and interventions, ART distinguishes itself through emphasis on the rescripting of traumatic events and the brevity of the intervention. While these case reports are not part of a formal study, they suggest that ART has the potential to augment and enhance the current delivery methods of mental health care in military environments. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Basics of Artificial Antigen Presenting Cells in T Cell-Based Cancer Immunotherapies.

PubMed

Neal, Lillian R; Bailey, Stefanie R; Wyatt, Megan M; Bowers, Jacob S; Majchrzak, Kinga; Nelson, Michelle H; Haupt, Carl; Paulos, Chrystal M; Varela, Juan C

2017-01-01

Adoptive T cell transfer (ACT) can mediate objective responses in patients with advanced malignancies. There have been major advances in this field, including the optimization of the ex vivo generation of tumor-reactive lymphocytes to ample numbers for effective ACT therapy via the use of natural and artificial antigen presenting cells (APCs). Herein we review the basic properties of APCs and how they have been manufactured through the years to augment vaccine and T cell-based cancer therapies. We then discuss how these novel APCs impact the function and memory properties of T cells. Finally, we propose new ways to synthesize aAPCs to augment the therapeutic effectiveness of antitumor T cells for ACT therapy.

The Basics of Artificial Antigen Presenting Cells in T Cell-Based Cancer Immunotherapies

PubMed Central

Neal, Lillian R.; Bailey, Stefanie R.; Wyatt, Megan M.; Bowers, Jacob S.; Majchrzak, Kinga; Nelson, Michelle H.; Haupt, Carl; Paulos, Chrystal M.; Varela, Juan C.

2017-01-01

Adoptive T cell transfer (ACT) can mediate objective responses in patients with advanced malignancies. There have been major advances in this field, including the optimization of the ex vivo generation of tumor-reactive lymphocytes to ample numbers for effective ACT therapy via the use of natural and artificial antigen presenting cells (APCs). Herein we review the basic properties of APCs and how they have been manufactured through the years to augment vaccine and T cell-based cancer therapies. We then discuss how these novel APCs impact the function and memory properties of T cells. Finally, we propose new ways to synthesize aAPCs to augment the therapeutic effectiveness of antitumor T cells for ACT therapy. PMID:28825053

Robotic and artificial intelligence for keyhole neurosurgery: the ROBOCAST project, a multi-modal autonomous path planner.

PubMed

De Momi, E; Ferrigno, G

2010-01-01

The robot and sensors integration for computer-assisted surgery and therapy (ROBOCAST) project (FP7-ICT-2007-215190) is co-funded by the European Union within the Seventh Framework Programme in the field of information and communication technologies. The ROBOCAST project focuses on robot- and artificial-intelligence-assisted keyhole neurosurgery (tumour biopsy and local drug delivery along straight or turning paths). The goal of this project is to assist surgeons with a robotic system controlled by an intelligent high-level controller (HLC) able to gather and integrate information from the surgeon, from diagnostic images, and from an array of on-field sensors. The HLC integrates pre-operative and intra-operative diagnostics data and measurements, intelligence augmentation, multiple-robot dexterity, and multiple sensory inputs in a closed-loop cooperating scheme including a smart interface for improved haptic immersion and integration. This paper, after the overall architecture description, focuses on the intelligent trajectory planner based on risk estimation and human criticism. The current status of development is reported, and first tests on the planner are shown by using a real image stack and risk descriptor phantom. The advantages of using a fuzzy risk description are given by the possibility of upgrading the knowledge on-field without the intervention of a knowledge engineer.

Fluorescent fluid interface position sensor

DOEpatents

Weiss, Jonathan D.

2004-02-17

A new fluid interface position sensor has been developed, which is capable of optically determining the location of an interface between an upper fluid and a lower fluid, the upper fluid having a larger refractive index than a lower fluid. The sensor functions by measurement, of fluorescence excited by an optical pump beam which is confined within a fluorescent waveguide where that waveguide is in optical contact with the lower fluid, but escapes from the fluorescent waveguide where that waveguide is in optical contact with the upper fluid.

Augmenting MFL Tools with Sensors That Assess Coating Condition

DOT National Transportation Integrated Search

2009-03-16

External coatings are routinely used to protect transmission pipelines from corrosion; however, coatings may degrade or disbond over time enabling corrosion to occur. Transmission pipeline operators often use magnetic flux leakage (MFL) in-line inspe...

[Influence of proton pump inhibitors on intestinal fermentative profile: a case-control study].

PubMed

Senderovky, Melisa; Lasa, Juan; Dima, Guillermo; Peralta, Daniel; Argüello, Mariano; Soifer, Luis

2014-01-01

Proton pump inhibitors could have an impact on the results of breath tests performed in patients with irritable bowel syndrome. This impact could be due to the development of small intestine bacterial overgrowth. To compare the prevalence of fermentative profile alterations of irritable bowel syndrome patients exposed and not-exposed to proton pump inhibitor therapy. Subjects with irritable bowel syndrome were enrolled. A validated questionnaire assessing symptom severity as well as proton pump inhibitor treatment was delivered. A lactulose breath test was undertaken by each enrolled subject. Fermentative profile (area under the curve of hydrogen excretion/time) was compared between proton pump inhibitors consumers and non-consumers. Furthermore, small intestine bacterial overgrowth prevalence was compared. Two hundred and twenty five patients were enrolled. No significant differences were found on the fermentative profile between groups [AUC mediana 3,776 (rango 2,124-5,571) vs 4,347 (rango 2,038-5,481), P = 0.3]. Small intestine bacterial overgrowth prevalence was similar as well [33% vs 27.5%]. These differences remained non-significant after adjusting for proton pump inhibitor dose and treatment time. Surprisingly, symptom score was significantly higher in those patients under proton pump inhibitor therapy [28.5 (23-26) vs 23 (15-29), P = 0.01]. Proton pump inhibitors have no significant influence on lactulose breath tests, regardless of the dosage and time of administration.

Evaluating Cellular Instrumentation on Rural Handpumps to Improve Service Delivery-A Longitudinal Study in Rural Rwanda.

PubMed

Nagel, Corey; Beach, Jack; Iribagiza, Chantal; Thomas, Evan A

2015-12-15

In rural sub-Saharan Africa, where handpumps are common, 10-67% are nonfunctional at any one time, and many never get repaired. Increased reliability requires improved monitoring and responsiveness of maintenance providers. In 2014, 181 cellular enabled water pump use sensors were installed in three provinces of Rwanda. In three arms, the nominal maintenance model was compared against a "best practice" circuit rider model, and an "ambulance" service model. In only the ambulance model was the sensor data available to the implementer, and used to dispatch technicians. The study ran for seven months in 2014-2015. In the study period, the nominal maintenance group had a median time to successful repair of approximately 152 days, with a mean per-pump functionality of about 68%. In the circuit rider group, the median time to successful repair was nearly 57 days, with a per-pump functionality mean of nearly 73%. In the ambulance service group, the successful repair interval was nearly 21 days with a functionality mean of nearly 91%. An indicative cost analysis suggests that the cost per functional pump per year is approximately similar between the three models. However, the benefits of reliable water service may justify greater focus on servicing models over installation models.

Design and calibration of a six-axis MEMS sensor array for use in scoliosis correction surgery

NASA Astrophysics Data System (ADS)

Benfield, David; Yue, Shichao; Lou, Edmond; Moussa, Walied A.

2014-08-01

A six-axis sensor array has been developed to quantify the 3D force and moment loads applied in scoliosis correction surgery. Initially this device was developed to be applied during scoliosis correction surgery and augmented onto existing surgical instrumentation, however, use as a general load sensor is also feasible. The development has included the design, microfabrication, deployment and calibration of a sensor array. The sensor array consists of four membrane devices, each containing piezoresistive sensing elements, generating a total of 16 differential voltage outputs. The calibration procedure has made use of a custom built load application frame, which allows quantified forces and moments to be applied and compared to the outputs from the sensor array. Linear or non-linear calibration equations are generated to convert the voltage outputs from the sensor array back into 3D force and moment information for display or analysis.

A Modern Magnetic Implant for Gastroesophageal Reflux Disease.

PubMed

Ganz, Robert A

2017-09-01

A magnetic implant for the treatment of gastroesophageal reflux disease (GERD) was Food and Drug Administration-approved in 2012 and has been extensively evaluated. The device is a ring of magnets that are placed around the gastroesophageal junction, augmenting the native lower esophageal sphincter and preventing reflux yet preserving lower esophageal sphincter physiologic function and allowing belching and vomiting. Magnetic force is advantageous, being permanent and precise, and forces between magnets decrease with esophageal displacement. Multiple patient cohorts have been studied using the magnetic device, and trials establish consistent, long-term improvement in pH data, GERD symptom scores, and proton-pump inhibitor use. A 5-year Food and Drug Administration trial demonstrated that most patients achieved normal pH scores, 85% stopped proton-pump inhibitors, and GERD health-related quality of life symptom scores improved from 27 to 4 at 5 years. Seven studies have compared magnetic augmentation with laparoscopic Nissen fundoplication and demonstrated that the magnetic device achieved comparable efficacy with regard to proton-pump inhibitor cessation, GERD symptom score improvement, and heartburn and regurgitation scores. However, to date there have been no randomized, controlled trials comparing the 2 techniques, and the study cohorts are not necessarily comparable regarding hiatal hernia size, severity of reflux, body mass index scores, or esophagitis scores. Dysphagia incidence was similar in both groups. Reoperation rates and safety profiles were also comparable, but the magnetic device demonstrated significant beneficial differences in allowing belching and vomiting. The magnetic device is safe, with the main adverse event being dysphagia with an approximate 3%-5% chronic incidence. Device removals in clinical trials have been between 0% and 7% and were uneventful. There have been no erosions, perforations, or infections in FDA clinical trials; erosions have rarely been noted in practice. Magnetic augmentation of the lower esophageal sphincter is a safe and effective operation for GERD, and should be considered a surgical option for those seeking a fundic-sparing operation, particularly those with parameters consistent with study cohorts. Additional randomized, controlled trials are underway. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

Continuous intrathecal baclofen infusion by a programmable pump in 131 consecutive patients with severe spasticity of spinal origin.

PubMed

Ordia, Joe I; Fischer, Edward; Adamski, Ellen; Chagnon, Kimberly G; Spatz, Edward L

2002-01-01

We began this study to determine the efficacy and safety of intrathecal baclofen (ITB) delivered by a programmable pump for the treatment of severe spasticity of spinal cord origin. One hundred fifty two patients with severe spasticity of spinal origin, refractory to oral baclofen, or who experienced intolerable side-effects were given a test dose of ITB. Only those who had a satisfactory response were considered to be appropriate for pump implantation. All but one of the 152 patients had a satisfactory response, and the pump was implanted in 131 patients. Pre- and postoperative spasticity scores were compared and analyzed. The mean Ashworth score for rigidity decreased from 4.2 preoperatively to 1.3 (p < 0.0005) on ITB. The spasm score decreased from a mean of 3.4 to 0.6 (p < 0.0005). Reduction of spasticity resulted in improved levels of physical activity, decreased pain, and augmentation of sleep. Drug-related complications included constipation, muscular hypotonia, urinary retention, erectile dysfunction, nausea, dizziness, drowsiness, hypotension and bradycardia as well as tolerance to baclofen. Some patients experienced post-spinal puncture headaches. Catheter-related problems included occlusions, breaks, punctures, and dislodgments. Superficial pump pocket infection, pocket erosion, cerebrospinal fluid (CSF) leak, post-spinal puncture headache, and meningitis were some of the procedure-related complications. Two pumps flipped and another pump valve was stuck. We conclude that long-term intrathecal baclofen by an implanted programmable pump is a safe and effective method of treating severe intractable spinal spasticity.

Augmented renal clearance is not a risk factor for mortality in Enterobacteriaceae bloodstream infections treated with appropriate empiric antimicrobials.

PubMed

Burnham, Jason P; Micek, Scott T; Kollef, Marin H

2017-01-01

The main objective of the study was to assess whether augmented renal clearance was a risk factor for mortality in a cohort of patients with Enterobacteriaceae sepsis, severe sepsis, or septic shock that all received appropriate antimicrobial therapy within 12 hours. Using a retrospective cohort from Barnes-Jewish Hospital, a 1,250-bed teaching hospital, we collected data on individuals with Enterobacteriaceae sepsis, severe sepsis, and septic shock who received appropriate initial antimicrobial therapy between June 2009 and December 2013. Clinical outcomes were compared according to renal clearance, as assessed by Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas, sepsis classification, demographics, severity of illness, and comorbidities. We identified 510 patients with Enterobacteriaceae bacteremia and sepsis, severe sepsis, or septic shock. Sixty-seven patients (13.1%) were nonsurvivors. Augmented renal clearance was uncommon (5.1% of patients by MDRD and 3.0% by CKD-EPI) and was not associated with increased mortality. Our results are limited by the absence of prospective determination of augmented renal clearance. However, in this small cohort, augmented renal clearance as assessed by MDRD and CKD-EPI does not seem to be a risk factor for mortality in patients with Enterobacteriaceae sepsis. Future studies should assess this finding prospectively.

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential.

PubMed

Dame, Don

1996-05-01

Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required. © 1996 International Society for Artificial Organs.

A teaspoon pump for pumping blood with high hydraulic efficiency and low hemolysis potential.

PubMed

Dame, D

1996-06-01

Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.

Insulin pump use compared with intravenous insulin during labour and delivery: the INSPIRED observational cohort study.

PubMed

Drever, E; Tomlinson, G; Bai, A D; Feig, D S

2016-09-01

To assess the safety and efficacy of pump therapy (continuous subcutaneous insulin infusion; CSII) during labour and delivery in women with Type 1 diabetes. A retrospective cohort study of 161 consecutive Type 1 diabetic pregnancies delivered during 2000-2010 at Mount Sinai Hospital, Toronto, Canada. Capillary blood glucose levels during labour and delivery and time in/out of target (target: 4-6 mmol/l) were compared along with neonatal outcomes for three groups: (1) women on pumps who stayed on pumps during labour (pump/pump n = 31), (2) women on pumps who switched to intravenous (IV) insulin infusion during labour (pump/IVn = 25), and (3) women on multiple daily injections who switched to IV insulin infusion during labour (MDIn = 105). There were no significant differences between the mean or median glucose values during labour and delivery across all three groups, and no significant difference in time spent hypoglycaemic. However, women in the pump/pump group had significantly better glycaemic control as defined by mean glucose (5.5 vs. 6.4 mmol/l; P = 0.01), median glucose (5.4 vs. 6.3 mmol/l; P = 0.02), and more time spent in target (60.9% vs. 39.2%; P = 0.06) compared with women in the pump/IV group (after removing one outlier). This study demonstrates that the continuation of CSII therapy during labour and delivery appears safe and efficacious. Moreover, women who choose to continue CSII have better glucose control during delivery than those who switch to IV insulin, suggesting that it should be standard practice to allow women the option of continuing CSII during labour and delivery. © 2016 Diabetes UK.

Impact of new technologies on diabetes care.

PubMed

Giani, Elisa; Scaramuzza, Andrea Enzo; Zuccotti, Gian Vincenzo

2015-07-25

Technologies for diabetes management, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) systems, have improved remarkably over the last decades. These developments are impacting the capacity to achieve recommended hemoglobin A1c levels and assisting in preventing the development and progression of micro- and macro vascular complications. While improvements in metabolic control and decreases in risk of severe and moderate hypoglycemia have been described with use of these technologies, large epidemiological international studies show that many patients are still unable to meet their glycemic goals, even when these technologies are used. This editorial will review the impact of technology on glycemic control, hypoglycemia and quality of life in children and youth with type 1 diabetes. Technologies reviewed include CSII, CGM systems and sensor-augmented insulin pumps. In addition, the usefulness of advanced functions such as bolus profiles, bolus calculators and threshold-suspend features will be also discussed. Moreover, the current editorial will explore the challenges of using these technologies. Indeed, despite the evidence currently available of the potential benefits of using advanced technologies in diabetes management, many patients still report barriers to using them. Finally this article will highlight the importance of future studies tailored toward overcome these barriers to optimizing glycemic control and avoiding severe hypoglycemia.

Engineering challenges for instrumenting and controlling integrated organ-on-chip systems.

PubMed

Wikswo, John P; Block, Frank E; Cliffel, David E; Goodwin, Cody R; Marasco, Christina C; Markov, Dmitry A; McLean, David L; McLean, John A; McKenzie, Jennifer R; Reiserer, Ronald S; Samson, Philip C; Schaffer, David K; Seale, Kevin T; Sherrod, Stacy D

2013-03-01

The sophistication and success of recently reported microfabricated organs-on-chips and human organ constructs have made it possible to design scaled and interconnected organ systems that may significantly augment the current drug development pipeline and lead to advances in systems biology. Physiologically realistic live microHuman (μHu) and milliHuman (mHu) systems operating for weeks to months present exciting and important engineering challenges such as determining the appropriate size for each organ to ensure appropriate relative organ functional activity, achieving appropriate cell density, providing the requisite universal perfusion media, sensing the breadth of physiological responses, and maintaining stable control of the entire system, while maintaining fluid scaling that consists of ~5 mL for the mHu and ~5 μL for the μHu. We believe that successful mHu and μHu systems for drug development and systems biology will require low-volume microdevices that support chemical signaling, microfabricated pumps, valves and microformulators, automated optical microscopy, electrochemical sensors for rapid metabolic assessment, ion mobility-mass spectrometry for real-time molecular analysis, advanced bioinformatics, and machine learning algorithms for automated model inference and integrated electronic control. Toward this goal, we are building functional prototype components and are working toward top-down system integration.

Prolonged utilization of proton pump inhibitors in patients with ischemic and valvular heart disease is associated with surgical treatments, weight loss and aggravates anemia.

PubMed

Boban, Marko; Zulj, Marinko; Persic, Viktor; Medved, Igor; Zekanovic, Drazen; Vcev, Aleksandar

2016-09-15

Proton pump inhibitors (PPIs) are among the commonest drugs used nowadays. The aim of our study was to analyze prolonged utilization of proton pump inhibitors in medical therapy of patients with ischemic and valvular heart disease. Secondly, profile of utilization was scrutinized to patient characteristics and type of cardiovascular treatments. The study included consecutive patients scheduled for cardiovascular rehabilitation 2-6months after index cardiovascular treatment. Two hundred ninety-four patients (n=294/604; 48.7%) have been using proton pump inhibitor in their therapy after index cardiovascular treatment. Cardiovascular treatments were powerfully connected with utilization of PPIs; surgery 5.77 (95%-confidence intervals [CI]: 4.05-8.22; p<0.001) and PCI 0.15 (CI: 0.10-0.22; p<0.001). The odds for having proton pump inhibitor in their chronic therapy were increased for atrial fibrillation 1.87 (CI: 1.08-3.23; p=0.025) and decreased for obesity 0.65 (CI: 0.45-0.96; p=0.035); surviving myocardial infarction 0.49 (CI: 0.29-0.83; p=0.035). Multinomial logistic regression controlled for existence of chronic renal disease found no significant association of renal dysfunction and PPI therapy. The existence of anemia was significantly increased in patients taking PPIs than controls; 6.00 (CI: 3.85-9.33; p<0.001). The use of PPI was also associated with worsening of metabolic profile, in part due to decreased utilization of ACE-inhibitors and statins. PPI consumption correlated with age of patients (Rho=0.216; p<0.001). High proportion of cardiovascular, particularly surgical patients with ischemic and valvular heart disease utilized proton pump inhibitor in prolonged courses. Prolonged courses of PPIs were connected with existence and worsening of red blood count indexes, older age, lesser weight of patients and underutilization of cardioprotective drugs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Can augmented physiotherapy input enhance recovery of mobility after stroke? A randomized controlled trial.

PubMed

2004-08-01

To discover if the provision of additional inpatient physiotherapy after stroke speeds the recovery of mobility. A multisite single-blind randomized controlled trial (RCT) comparing the effects of augmented physiotherapy input with normal input on the recovery of mobility after stroke. Three rehabilitation hospitals in North Glasgow, Scotland. Patients admitted to hospital with a clinical diagnosis of stroke, who were able to tolerate and benefit from mobility rehabilitation. We aimed to provide double the amount of physiotherapy to the augmented group. Primary outcomes were mobility milestones (ability to stand, step and walk), Rivermead Mobility Index (RMI) and walking speed. Seventy patients were recruited. The augmented therapy group received more direct contact with a physiotherapist (62 versus 35 minutes per weekday) and were more active (8.0% versus 4.8% time standing or walking) than normal therapy controls. The augmented group tended to achieve independent walking earlier (hazard ratio 1.48, 95% confidence interval 0.90-2.43; p=0.12) and had higher Rivermead Mobility Index scores at three months (mean difference 1.6; -0.1 to 3.3; p=0.068) but these differences did not reach statistical significance. There was no significant difference in any other outcome. A modest augmented physiotherapy programme resulted in patients having more direct physiotherapy time and being more active. The inability to show statistically significant changes in outcome measures could indicate either that this intervention is ineffective or that our study could not detect modest changes.

Measurement of beam profiles by terahertz sensor card with cholesteric liquid crystals.

PubMed

Tadokoro, Yuzuru; Nishikawa, Tomohiro; Kang, Boyoung; Takano, Keisuke; Hangyo, Masanori; Nakajima, Makoto

2015-10-01

We demonstrate a sensor card with cholesteric liquid crystals (CLCs) for terahertz (THz) waves generated from a nonlinear crystal pumped by a table-top laser. A beam profile of the THz waves is successfully visualized as color change by the sensor card without additional electronic devices, power supplies, and connecting cables. Above the power density of 4.3  mW/cm2, the approximate beam diameter of the THz waves is measured using the hue image that is digitalized from the picture of the sensor card. The sensor card is low in cost, portable, and suitable for various situations such as THz imaging and alignment of THz systems.

Nonreconstruction Options for Treating Medial Ulnar Collateral Ligament Injuries of the Elbow in Overhead Athletes.

PubMed

Clark, Nicholas J; Desai, Vishal S; Dines, Joshua D; Morrey, Mark E; Camp, Christopher L

2018-03-01

This review aims to describe the nonreconstructive options for treating ulnar collateral ligament (UCL) injuries ranging from nonoperative measures, including physical therapy and biologic injections, to ligament repair with and without augmentation. Nonoperative options for UCL injuries include guided physical therapy and biologic augmentation with platelet-rich plasma (PRP). In some patients, repair of the UCL has shown promising return to sport rates by using modern suture and suture anchor techniques. Proximal avulsion injuries have shown the best results after repair. Currently, there is growing interest in augmentation of UCL repair with an internal brace. The treatment of UCL injuries involves complex decision making. UCL reconstruction remains the gold standard for attritional injuries and complete tears, which occur commonly in professional athletes. However, nonreconstructive options have shown promising results for simple avulsion or partial thickness UCL injuries. Future research comparing reconstructive versus nonreconstructive options is necessary.

Augmented reality social story for autism spectrum disorder

NASA Astrophysics Data System (ADS)

Syahputra, M. F.; Arisandi, D.; Lumbanbatu, A. F.; Kemit, L. F.; Nababan, E. B.; Sheta, O.

2018-03-01

Augmented Reality is a technique that can bring social story therapy into virtual world to increase intrinsic motivation of children with Autism Spectrum Disorder(ASD). By looking at the behaviour of ASD who will be difficult to get the focus, the lack of sensory and motor nerves in the use of loads on the hands or other organs will be very distressing children with ASD in doing the right activities, and interpret and understand the social situation in determining a response appropriately. Required method to be able to apply social story on therapy of children with ASD that is implemented with Augmented Reality. The output resulting from this method is 3D animation (three-dimensional animation) of social story by detecting marker located in special book and some simple game which done by using leap motion controller which is useful in reading hand movement in real-time.

NASA Tech Briefs, October 2007

NASA Technical Reports Server (NTRS)

2007-01-01

Topics covered include; Wirelessly Interrogated Position or Displacement Sensors; Ka-Band Radar Terminal Descent Sensor; Metal/Metal Oxide Differential Electrode pH Sensors; Improved Sensing Coils for SQUIDs; Inductive Linear-Position Sensor/Limit-Sensor Units; Hilbert-Curve Fractal Antenna With Radiation- Pattern Diversity; Single-Camera Panoramic-Imaging Systems; Interface Electronic Circuitry for an Electronic Tongue; Inexpensive Clock for Displaying Planetary or Sidereal Time; Efficient Switching Arrangement for (N + 1)/N Redundancy; Lightweight Reflectarray Antenna for 7.115 and 32 GHz; Opto-Electronic Oscillator Using Suppressed Phase Modulation; Alternative Controller for a Fiber-Optic Switch; Strong, Lightweight, Porous Materials; Nanowicks; Lightweight Thermal Protection System for Atmospheric Entry; Rapid and Quiet Drill; Hydrogen Peroxide Concentrator; MMIC Amplifiers for 90 to 130 GHz; Robot Would Climb Steep Terrain; Measuring Dynamic Transfer Functions of Cavitating Pumps; Advanced Resistive Exercise Device; Rapid Engineering of Three-Dimensional, Multicellular Tissues With Polymeric Scaffolds; Resonant Tunneling Spin Pump; Enhancing Spin Filters by Use of Bulk Inversion Asymmetry; Optical Magnetometer Incorporating Photonic Crystals; WGM-Resonator/Tapered-Waveguide White-Light Sensor Optics; Raman-Suppressing Coupling for Optical Parametric Oscillator; CO2-Reduction Primary Cell for Use on Venus; Cold Atom Source Containing Multiple Magneto- Optical Traps; POD Model Reconstruction for Gray-Box Fault Detection; System for Estimating Horizontal Velocity During Descent; Software Framework for Peer Data-Management Services; Autogen Version 2.0; Tracking-Data-Conversion Tool; NASA Enterprise Visual Analysis; Advanced Reference Counting Pointers for Better Performance; C Namelist Facility; and Efficient Mosaicking of Spitzer Space Telescope Images.

Immune-based therapies.

PubMed

Lein, B

1995-12-01

Several immune-based HIV therapy studies presented at the Interscience Conference on Antimicrobial Agents Chemotherapy (ICAAC) are summarized. These studies involve the following therapies: HIV-IT, a gene therapy approach to augmenting the body's anti-HIV responses; interferon-alpha n3, a new formulation of alpha interferon with fewer toxicities; transfer of immune responses from one individual to another, also called passive immune therapy; and interleukin-2 (IL-2) in combination with protease inhibitors.

B-52 stability augmentation system reliability

NASA Technical Reports Server (NTRS)

Bowling, T. C.; Key, L. W.

1976-01-01

The B-52 SAS (Stability Augmentation System) was developed and retrofitted to nearly 300 aircraft. It actively controls B-52 structural bending, provides improved yaw and pitch damping through sensors and electronic control channels, and puts complete reliance on hydraulic control power for rudder and elevators. The system has experienced over 300,000 flight hours and has exhibited service reliability comparable to the results of the reliability test program. Development experience points out numerous lessons with potential application in the mechanization and development of advanced technology control systems of high reliability.

Evidence-based assessment of proton-pump inhibitors in Helicobacter pylori eradication: a systematic review.

PubMed

Nagaraja, Vinayak; Eslick, Guy D

2014-10-28

Peptic ulcer disease continues to be issue especially due to its high prevalence in the developing world. Helicobacter pylori (H. pylori) infection associated duodenal ulcers should undergo eradication therapy. There are many regimens offered for H. pylori eradication which include triple, quadruple, or sequential therapy regimens. The central aim of this systematic review is to evaluate the evidence for H. pylori therapy from a meta-analytical outlook. The consequence of the dose, type of proton-pump inhibitor, and the length of the treatment will be debated. The most important risk factor for eradication failure is resistance to clarithromycin and metronidazole.

The Proton Pump Inhibitor Non-Responder: A Clinical Conundrum

PubMed Central

Hussain, Zilla H; Henderson, Emily E; Maradey-Romerao, Carla; George, Nina; Fass, Ronnie; Lacy, Brian E

2015-01-01

Gastroesophageal reflux disease (GERD) is a highly prevalent chronic condition where in stomach contents reflux into the esophagus causing symptoms, esophageal injury, and subsequent complications. Proton pump inhibitors (PPI) remain the mainstay of therapy for acid suppression. Despite their efficacy, significant proportions of GERD patients are either partial or non-responders to PPI therapy. Patients should be assessed for mechanisms that can lead to PPI failure and may require further evaluation to investigate for alternative causes. This monograph will outline a diagnostic approach to the PPI non-responder, review mechanisms associated with PPI failure, and discuss therapeutic options for those who fail to respond to PPI therapy. PMID:26270485

A Randomized Controlled Trial of Exposure Therapy and Cognitive Restructuring for Posttraumatic Stress Disorder

ERIC Educational Resources Information Center

Bryant, Richard A.; Moulds, Michelle L.; Guthrie, Rachel M.; Dang, Suzanne T.; Mastrodomenico, Julie; Nixon, Reginald D. V.; Felmingham, Kim L.; Hopwood, Sally; Creamer, Mark

2008-01-01

Previous studies have reported that adding cognitive restructuring (CR) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder (PTSD). This study investigated the extent to which CR would augment treatment response when provided with exposure therapy. The authors randomly allocated 118 civilian trauma survivors with…

Gene Augmentation Therapy for a Missense Substitution in the cGMP-Binding Domain of Ovine CNGA3 Gene Restores Vision in Day-Blind Sheep.

PubMed

Gootwine, Elisha; Abu-Siam, Mazen; Obolensky, Alexey; Rosov, Alex; Honig, Hen; Nitzan, Tali; Shirak, Andrey; Ezra-Elia, Raaya; Yamin, Esther; Banin, Eyal; Averbukh, Edward; Hauswirth, William W; Ofri, Ron; Seroussi, Eyal

2017-03-01

Applying CNGA3 gene augmentation therapy to cure a novel causative mutation underlying achromatopsia (ACHM) in sheep. Impaired vision that spontaneously appeared in newborn lambs was characterized by behavioral, electroretinographic (ERG), and histologic techniques. Deep-sequencing reads of an affected lamb and an unaffected lamb were compared within conserved genomic regions orthologous to human genes involved in similar visual impairment. Observed nonsynonymous amino acid substitutions were classified by their deleteriousness score. The putative causative mutation was assessed by producing compound CNGA3 heterozygotes and applying gene augmentation therapy using the orthologous human cDNA. Behavioral assessment revealed day blindness, and subsequent ERG examination showed attenuated photopic responses. Histologic and immunohistochemical examination of affected sheep eyes did not reveal degeneration, and cone photoreceptors expressing CNGA3 were present. Bioinformatics and sequencing analyses suggested a c.1618G>A, p.Gly540Ser substitution in the GMP-binding domain of CNGA3 as the causative mutation. This was confirmed by genetic concordance test and by genetic complementation experiment: All five compound CNGA3 heterozygotes, carrying both p.Arg236* and p.Gly540Ser mutations in CNGA3, were day-blind. Furthermore, subretinal delivery of the intact human CNGA3 gene using an adeno-associated viral vector (AAV) restored photopic vision in two affected p.Gly540Ser homozygous rams. The c.1618G>A, p.Gly540Ser substitution in CNGA3 was identified as the causative mutation for a novel form of ACHM in Awassi sheep. Gene augmentation therapy restored vision in the affected sheep. This novel mutation provides a large-animal model that is valid for most human CNGA3 ACHM patients; the majority of them carry missense rather than premature-termination mutations.

Long-Term Cognitive and Behavioral Therapies, Combined with Augmentative Communication, Are Related to Uncinate Fasciculus Integrity in Autism

ERIC Educational Resources Information Center

Pardini, Matteo; Elia, Maurizio; Garaci, Francesco G.; Guida, Silvia; Coniglione, Filadelfo; Krueger, Frank; Benassi, Francesca; Gialloreti, Leonardo Emberti

2012-01-01

Recent evidence points to white-matter abnormalities as a key factor in autism physiopathology. Using Diffusion Tensor Imaging, we studied white-matter structural properties in a convenience sample of twenty-two subjects with low-functioning autism exposed to long-term augmentative and alternative communication, combined with sessions of cognitive…

Glucose-responsive insulin delivery for type 1 diabetes: The artificial pancreas story.

PubMed

Bally, Lia; Thabit, Hood; Hovorka, Roman

2018-06-15

Insulin replacement therapy is integral to the management of type 1 diabetes, which is characterised by absolute insulin deficiency. Optimal glycaemic control, as assessed by glycated haemoglobin, and avoidance of hyper- and hypoglycaemic excursions have been shown to prevent diabetes-related complications. Insulin pump use has increased considerably over the past decade with beneficial effects on glycaemic control, quality of life and treatment satisfaction. The advent and progress of ambulatory glucose sensor technology has enabled continuous glucose monitoring based on real-time glucose levels to be integrated with insulin therapy. Low glucose and predictive low glucose suspend systems are currently used in clinical practice to mitigate against hypoglycaemia, and provide the first step towards feedback glucose control. The more advanced technology approach, an artificial pancreas or a closed-loop system, gradually increases and decreases insulin delivery in a glucose-responsive fashion to mitigate against hyper- and hypoglycaemia. Randomised outpatient clinical trials over the past 5 years have demonstrated the feasibility, safety and efficacy of the approach, and the recent FDA approval of the first single hormone closed-loop system establishes a new standard of care for people with type 1 diabetes. Copyright © 2017 Elsevier B.V. All rights reserved.

Inkjet-based biopatterning of SDF-1β augments BMP-2-induced repair of critical size calvarial bone defects in mice

PubMed Central

Herberg, Samuel; Kondrikova, Galina; Periyasamy-Thandavan, Sudharsan; Howie, R. Nicole; Elsalanty, Mohammed E.; Weiss, Lee; Campbell, Phil; Hill, William D.; Cray, James J.

2014-01-01

Background A major problem in craniofacial surgery is non-healing bone defects. Autologous reconstruction remains the standard of care for these cases. Bone morphogenetic protein-2 (BMP-2) therapy has proven its clinical utility, although non-targeted adverse events occur due to the high milligram-level doses used. Ongoing efforts explore the use of different growth factors, cytokines, or chemokines, as well as co-therapy to augment healing. Methods Here we utilize inkjet-based biopatterning to load acellular DermaMatrix delivery matrices with nanogram-level doses of BMP-2, stromal cell-derived factor-1β (SDF-1β), transforming growth factor-β1 (TGF-β1), or co-therapies thereof. We tested the hypothesis that bioprinted SDF-1β co-delivery enhances BMP-2 and TGF-β1-driven osteogenesis both in-vitro and in-vivo using a mouse calvarial critical size defect (CSD) model. Results Our data showed that BMP-2 bioprinted in low-doses induced significant new bone formation by four weeks post-operation. TGF-β1 was less effective compared to BMP-2, and SDF-1β therapy did not enhance osteogenesis above control levels. However, co-delivery of BMP-2 + SDF-1β was shown to augment BMP-2-induced bone formation compared to BMP-2 alone. In contrast, co-delivery of TGF-β1 + SDF-1β decreased bone healing compared to TGF-β1 alone. This was further confirmed in vitro by osteogenic differentiation studies using MC3T3-E1 pre-osteoblasts. Conclusions Our data indicates that sustained release delivery of a low-dose growth factor therapy using biopatterning technology can aid in healing CSD injuries. SDF-1β augments the ability for BMP-2 to drive healing, a result confirmed in vivo and in vitro; however, because SDF-1β is detrimental to TGF-β1-driven osteogenesis, its’ effect on osteogenesis is not universal. PMID:25016095

Augmentation and impulsive behaviors in restless legs syndrome: Coexistence or association?

PubMed

Heim, Beatrice; Djamshidian, Atbin; Heidbreder, Anna; Stefani, Ambra; Zamarian, Laura; Pertl, Marie-Theres; Brandauer, Elisabeth; Delazer, Margarete; Seppi, Klaus; Poewe, Werner; Högl, Birgit

2016-07-05

To assess the frequency of impulse control disorders (ICDs) in patients with restless legs syndrome (RLS) with and without augmentation under dopaminergic therapy in a case-control study. Augmentation and ICDs are both serious complications of dopaminergic treatment of RLS but little is known about possible associations between these drug-induced disorders. In total, 58 patients with idiopathic RLS diagnosed according to the International Restless Legs Syndrome Study Group criteria were recruited. Of these, 35 patients had augmentation. The frequency of ICD symptoms was assessed using semi-structural interviews. Demographic variables did not differ between patients with RLS with and without augmentation but those with augmentation took higher dopaminergic medication than patients without augmentation. Twenty-three patients with RLS (39.7%) had ICD symptoms, with 12 patients (20.7%) having definitive ICDs. Patients with augmentation had an increased risk of expressing ICD symptoms (p = 0.007, odds ratio 5.64, 95% confidence interval 1.59-20.02). Patients with RLS with augmentation have an almost 6-fold increased risk of exhibiting ICD symptoms. This implies that augmentation and ICDs are related and may share a common pathophysiology. Moreover, our results have clinical implications, suggesting that patients with RLS with augmentation should be screened for ICD symptoms. © 2016 American Academy of Neurology.

Long-term animal experiments with an intraventricular axial flow blood pump.

PubMed

Yamazaki, K; Kormos, R L; Litwak, P; Tagusari, O; Mori, T; Antaki, J F; Kameneva, M; Watach, M; Gordon, L; Mukuo, H; Umezu, M; Tomioka, J; Outa, E; Griffith, B P; Koyanagai, H

1997-01-01

A miniature intraventricular axial flow blood pump (IVAP) is undergoing in vivo evaluation in calves. The IVAP system consists of a miniature (phi 13.9 mm) axial flow pump that resides within the left ventricular (LV) chamber and a brushless DC motor. The pump is fabricated from titanium alloy, and the pump weight is 170 g. It produces a flow rate of over 5 L/min against 100 mmHg pressure at 9,000 rpm with an 8 W total power consumption. The maximum total efficiency exceeds 17%. A purged lip seal system is used in prototype no. 8, and a newly developed "Cool-Seal" (a low temperature mechanical seal) is used in prototype no. 9. In the Cool-Seal system, a large amount of purge flow is introduced behind the seal faces to augment convective heat transfer, keeping the seal face temperature at a low level for prevention of heat denaturation of blood proteins. The Cool-Seal system consumes < 10 cc purge fluid per day and has greatly extended seal life. The pumps were implanted in three calves (26, 30, and 168 days of support). The pump was inserted through a left thoracotomy at the fifth intercostal space. Two pursestring sutures were placed on the LV apex, and the apex was cored with a myocardial punch. The pump was inserted into the LV with the outlet cannula smoothly passing through the aortic valve without any difficulty. Only 5 min elapsed between the time of chest opening and initiation of pumping. Pump function remained stable throughout in all experiments. No cardiac arrhythmias were detected, even at treadmill exercise tests. The plasma free hemoglobin level remained in the acceptable range. Post mortem examination did not reveal any interference between the pump and the mitral apparatus. No major thromboembolism was detected in the vital organs in Cases 1 or 2, but a few small renal infarcts were detected in Case 3.

Microparticle Flow Sensor

NASA Technical Reports Server (NTRS)

Morrison, Dennis R.

2005-01-01

The microparticle flow sensor (MFS) is a system for identifying and counting microscopic particles entrained in a flowing liquid. The MFS includes a transparent, optoelectronically instrumented laminar-flow chamber (see figure) and a computer for processing instrument-readout data. The MFS could be used to count microparticles (including micro-organisms) in diverse applications -- for example, production of microcapsules, treatment of wastewater, pumping of industrial chemicals, and identification of ownership of liquid products.

The management of gastro-oesophageal reflux disease.

PubMed

Keung, Charlotte; Hebbard, Geoffrey

2016-02-01

If there are no features of serious disease, suspected gastro-oesophageal reflux disease can be initially managed with a trial of a proton pump inhibitor for 4-8 weeks. This should be taken 30-60 minutes before food for optimal effect. Once symptoms are controlled, attempt to withdraw acid suppression therapy. If symptoms recur, use the minimum dose that controls symptoms. Patients who have severe erosive oesophagitis, scleroderma oesophagus or Barrett's oesophagus require long-term treatment with a proton pump inhibitor. Lifestyle modification strategies can help gastro-oesophageal reflux disease. Weight loss has the strongest evidence for efficacy. Further investigation and a specialist referral are required if there is no response to proton pump inhibitor therapy. Atypical symptoms or signs of serious disease also need investigation.

A Passively-Suspended Tesla Pump Left Ventricular Assist Device

PubMed Central

Izraelev, Valentin; Weiss, William J.; Fritz, Bryan; Newswanger, Raymond K.; Paterson, Eric G.; Snyder, Alan; Medvitz, Richard B.; Cysyk, Joshua; Pae, Walter E.; Hicks, Dennis; Lukic, Branka; Rosenberg, Gerson

2009-01-01

The design and initial test results of a new passively suspended Tesla type LAVD blood pump are described. CFD analysis was used in the design of the pump. Overall size of the prototype device is 50 mm in diameter and 75 mm in length. The pump rotor has a density lower than that of blood and when spinning inside the stator in blood it creates a buoyant centering force that suspends the rotor in the radial direction. The axial magnetic force between the rotor and stator restrain the rotor in the axial direction. The pump is capable of pumping up to 10 liters/min at a 70 mmHg head rise at 8000 RPM. The pump has demonstrated a normalized index of hemolysis level below .02 mg/dL for flows between 2 and 9.7 L/min. An inlet pressure sensor has also been incorporated into the inlet cannula wall and will be used for control purposes. One initial in vivo study showed an encouraging result. Further CFD modeling refinements are planned as well as endurance testing of the device. PMID:19770799

Idaho out-of-service verification field operational test

DOT National Transportation Integrated Search

2000-02-01

The Out-of-Service Verification Field Operational Test Project was initiated in 1994. The purpose of the project was to test the feasibility of using sensors and a computerized tracking system to augment the ability of inspectors to monitor and contr...

Position Statement on the management of continuous subcutaneous insulin infusion (CSII): The Italian Lazio experience.

PubMed

Maurizi, Anna R; Suraci, Concetta; Pitocco, Dario; Schiaffini, Riccardo; Tubili, Claudio; Morviducci, Lelio; Giordano, Renato; Manfrini, Silvia; Lauro, Davide; Frontoni, Simona; Pozzilli, Paolo; Buzzetti, Raffaella

2016-01-01

This document has been developed by a group of Italian diabetologists with extensive experience in continuous subcutaneous insulin infusion (CSII) therapy to provide indications for the clinical management of CSII in diabetic patients (both type 1 and type 2) based on delivery mode operating in Italy. Although the potential benefits of pump therapy in achieving glycemic goals is now accepted, such results cannot be obtained without specific knowledge and skills being conveyed to patients during ad hoc educational training. To ensure that these new technologies reach their full effectiveness, as demonstrated theoretically and clinically, a careful assessment of the overall therapeutic and educational process is required, in both qualitative and quantitative terms. Therefore, to ensure the cost-effectiveness of insulin pump therapy and to justify reimbursement of therapy costs by the National Health System in Italy, in this article we present a model for diabetes and healthcare centers to follow that provides for different levels of expertise in the field of CSII therapy. This model will guarantee the provision of excellent care during insulin pump therapies, thus representing the basis for a successful outcome and expansion of this form of insulin treatment in patients with diabetes while also keeping costs under control. © 2015 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

Interaction of different antidepressants with acute and chronic methadone in mice, and possible clinical implications.

PubMed

Schreiber, Shaul; Barak, Yonatan; Hostovsky, Avner; Baratz-Goldstein, Renana; Volis, Ina; Rubovitch, Vardit; Pick, Chaim G

2014-04-01

We studied the interaction of a single dose of different antidepressant medications with a single (acute) dose or implanted mini-pump (chronic) methadone administration in mice, using the hotplate assay. For the acute experiment, subthreshold doses of six antidepressant drugs were administered separately with a single dose of methadone. The addition of a subthreshold dose of desipramine or clomipramine to methadone produced significant augmentation of the methadone effect with each drug (p < 0.05). Fluvoxamine given at a fixed subthreshold dose induced a synergistic effect only with a low methadone dose. Escitalopram, reboxetine and venlafaxine given separately, each at a fixed subthreshold dose, induced no interaction. Possible clinical implications of these findings are that while escitalopram, reboxetine and venlafaxine do not affect methadone's antinociception in mice and are safe to be given together with methadone when indicated, fluvoxamine, clomipramine and desipramine considerably augment methadone-induced effects and should be avoided in this population due to the risk of inducing opiate overdose. For the chromic experiment, when a subthreshold dose of either escitalopram, desipramine or clomipramine was injected to mice following 2 weeks of methadone administration with the mini-pump, none of the antidepressant drugs strengthened methadone's analgesic effect. Further studies are needed before possible clinical implications can be drawn.

Experimental characterization of powered Fontan hemodynamics in an idealized total cavopulmonary connection model

NASA Astrophysics Data System (ADS)

Kerlo, Anna-Elodie M.; Delorme, Yann T.; Xu, Duo; Frankel, Steven H.; Giridharan, Guruprasad A.; Rodefeld, Mark D.; Chen, Jun

2013-08-01

A viscous impeller pump (VIP) based on the Von Karman viscous pump is specifically designed to provide cavopulmonary assist in a univentricular Fontan circulation. The technology will make it possible to biventricularize the univentricular Fontan circulation. Ideally, it will reduce the number of surgeries required for Fontan conversion from three to one early in life, while simultaneously improving physiological conditions. Later in life, it will provide a currently unavailable means of chronic support for adolescent and adult patients with failing Fontan circulations. Computational fluid dynamics simulations demonstrate that the VIP can satisfactorily augment cavopulmonary blood flow in an idealized total cavopulmonary connection (TCPC). When the VIP is deployed at the TCPC intersection as a static device, it stabilizes the four-way flow pattern and is not obstructive to the flow. Experimental studies are carried out to assess performance, hemodynamic characteristics, and flow structures of the VIP in an idealized TCPC model. Stereoscopic particle image velocimetry is applied using index-matched blood analog. Results show excellent performance of the VIP without cavitation and with reduction of the energy losses. The non-rotating VIP smoothes and accelerates flow, and decreases stresses and turbulence in the TCPC. The rotating VIP generates the desired low-pressure Fontan flow augmentation (0-10 mmHg) while maintaining acceptable stress thresholds.

Integrated multimodal human-computer interface and augmented reality for interactive display applications

NASA Astrophysics Data System (ADS)

Vassiliou, Marius S.; Sundareswaran, Venkataraman; Chen, S.; Behringer, Reinhold; Tam, Clement K.; Chan, M.; Bangayan, Phil T.; McGee, Joshua H.

2000-08-01

We describe new systems for improved integrated multimodal human-computer interaction and augmented reality for a diverse array of applications, including future advanced cockpits, tactical operations centers, and others. We have developed an integrated display system featuring: speech recognition of multiple concurrent users equipped with both standard air- coupled microphones and novel throat-coupled sensors (developed at Army Research Labs for increased noise immunity); lip reading for improving speech recognition accuracy in noisy environments, three-dimensional spatialized audio for improved display of warnings, alerts, and other information; wireless, coordinated handheld-PC control of a large display; real-time display of data and inferences from wireless integrated networked sensors with on-board signal processing and discrimination; gesture control with disambiguated point-and-speak capability; head- and eye- tracking coupled with speech recognition for 'look-and-speak' interaction; and integrated tetherless augmented reality on a wearable computer. The various interaction modalities (speech recognition, 3D audio, eyetracking, etc.) are implemented a 'modality servers' in an Internet-based client-server architecture. Each modality server encapsulates and exposes commercial and research software packages, presenting a socket network interface that is abstracted to a high-level interface, minimizing both vendor dependencies and required changes on the client side as the server's technology improves.

Development and human factors analysis of an augmented reality interface for multi-robot tele-operation and control

NASA Astrophysics Data System (ADS)

Lee, Sam; Lucas, Nathan P.; Ellis, R. Darin; Pandya, Abhilash

2012-06-01

This paper presents a seamlessly controlled human multi-robot system comprised of ground and aerial robots of semiautonomous nature for source localization tasks. The system combines augmented reality interfaces capabilities with human supervisor's ability to control multiple robots. The role of this human multi-robot interface is to allow an operator to control groups of heterogeneous robots in real time in a collaborative manner. It used advanced path planning algorithms to ensure obstacles are avoided and that the operators are free for higher-level tasks. Each robot knows the environment and obstacles and can automatically generate a collision-free path to any user-selected target. It displayed sensor information from each individual robot directly on the robot in the video view. In addition, a sensor data fused AR view is displayed which helped the users pin point source information or help the operator with the goals of the mission. The paper studies a preliminary Human Factors evaluation of this system in which several interface conditions are tested for source detection tasks. Results show that the novel Augmented Reality multi-robot control (Point-and-Go and Path Planning) reduced mission completion times compared to the traditional joystick control for target detection missions. Usability tests and operator workload analysis are also investigated.

High performance architecture design for large scale fibre-optic sensor arrays using distributed EDFAs and hybrid TDM/DWDM

NASA Astrophysics Data System (ADS)

Liao, Yi; Austin, Ed; Nash, Philip J.; Kingsley, Stuart A.; Richardson, David J.

2013-09-01

A distributed amplified dense wavelength division multiplexing (DWDM) array architecture is presented for interferometric fibre-optic sensor array systems. This architecture employs a distributed erbium-doped fibre amplifier (EDFA) scheme to decrease the array insertion loss, and employs time division multiplexing (TDM) at each wavelength to increase the number of sensors that can be supported. The first experimental demonstration of this system is reported including results which show the potential for multiplexing and interrogating up to 4096 sensors using a single telemetry fibre pair with good system performance. The number can be increased to 8192 by using dual pump sources.

Very-Low-Cost, Rugged Vacuum System

NASA Technical Reports Server (NTRS)

Kline-Schoder, Robert; Sorensen, Paul; Passow, Christian; Bilski, Steve

2013-01-01

NASA, DoD, DHS, and commercial industry have a need for miniaturized, rugged, low-cost vacuum systems. Recent advances in sensor technology have led to the development of very small mass spectrometer detectors as well as other miniature analytical instruments. However, the vacuum systems to support these sensors remain large, heavy, and power-hungry. To meet this need, a miniaturized vacuum system was created based on a very small, rugged, and inexpensive- to-manufacture molecular drag pump (MDP). The MDP is enabled by the development of a miniature, veryhigh- speed, rugged, low-power, brushless DC motor optimized for wide temperature operation and long life. Such a pump represents an order-of-magnitude reduction in mass, volume, and cost over current, commercially available, state-ofthe- art vacuum pumps. The vacuum system consists of the MDP coupled to a ruggedized rough pump (for terrestrial applications or for planets with substantial atmospheres). The rotor in the MDP consists of a simple smooth cylinder of aluminum spinning at approximately 200,000 RPM inside an outer stator housing. The pump stator comprises a cylindrical aluminum housing with one or more specially designed grooves that serve as flow channels. To minimize the length of the pump, the gas is forced down the flow channels of the outer stator to the base of the pump. The gas is then turned and pulled toward the top through a second set of channels cut into an inner stator housing that surrounds the motor. The compressed gas then flows down channels in the motor housing to the exhaust port of the pump. The exhaust port of the pump is connected to a diaphragm or scroll pump. This pump delivers very high performance in a very small envelope. The design was simplified so that a smaller compression ratio, easier manufacturing process, and enhanced ruggedness can be achieved at the lowest possible cost. The machining of the rotor and stators is very simple compared to that necessary to fabricate TMP (turbo molecular pump) rotor and stator blades. Also, the symmetry of the rotor is such that dynamic balancing of the rotor is greatly simplified. Finally, because of the simplified design, the number of parts in the unit is cut by nearly a factor of three. In fact, there are only five parts, not counting the motor and off-the-shelf screws and O-rings. This reduces the amount of machining and also makes fit-up much simpler while allowing the maintenance of close tolerances.

A robust vision-based sensor fusion approach for real-time pose estimation.

PubMed

Assa, Akbar; Janabi-Sharifi, Farrokh

2014-02-01

Object pose estimation is of great importance to many applications, such as augmented reality, localization and mapping, motion capture, and visual servoing. Although many approaches based on a monocular camera have been proposed, only a few works have concentrated on applying multicamera sensor fusion techniques to pose estimation. Higher accuracy and enhanced robustness toward sensor defects or failures are some of the advantages of these schemes. This paper presents a new Kalman-based sensor fusion approach for pose estimation that offers higher accuracy and precision, and is robust to camera motion and image occlusion, compared to its predecessors. Extensive experiments are conducted to validate the superiority of this fusion method over currently employed vision-based pose estimation algorithms.

Targeting efflux pumps to overcome antifungal drug resistance

PubMed Central

Holmes, Ann R; Cardno, Tony S; Strouse, J Jacob; Ivnitski-Steele, Irena; Keniya, Mikhail V; Lackovic, Kurt; Monk, Brian C; Sklar, Larry A; Cannon, Richard D

2016-01-01

Resistance to antifungal drugs is an increasingly significant clinical problem. The most common antifungal resistance encountered is efflux pump-mediated resistance of Candida species to azole drugs. One approach to overcome this resistance is to inhibit the pumps and chemosensitize resistant strains to azole drugs. Drug discovery targeting fungal efflux pumps could thus result in the development of azole-enhancing combination therapy. Heterologous expression of fungal efflux pumps in Saccharomyces cerevisiae provides a versatile system for screening for pump inhibitors. Fungal efflux pumps transport a range of xenobiotics including fluorescent compounds. This enables the use of fluorescence-based detection, as well as growth inhibition assays, in screens to discover compounds targeting efflux-mediated antifungal drug resistance. A variety of medium- and high-throughput screens have been used to identify a number of chemical entities that inhibit fungal efflux pumps. PMID:27463566

Preliminary design-lift/cruise fan research and technology airplane flight control system

NASA Technical Reports Server (NTRS)

Gotlieb, P.; Lewis, G. E.; Little, L. J.

1976-01-01

This report presents the preliminary design of a stability augmentation system for a NASA V/STOL research and technology airplane. This stability augmentation system is postulated as the simplest system that meets handling qualities levels for research and technology missions flown by NASA test pilots. The airplane studied in this report is a T-39 fitted with tilting lift/cruise fan nacelles and a nose fan. The propulsion system features a shaft interconnecting the three variable pitch fans and three power plants. The mathematical modeling is based on pre-wind tunnel test estimated data. The selected stability augmentation system uses variable gains scheduled with airspeed. Failure analysis of the system illustrates the benign effect of engine failure. Airplane rate sensor failure must be solved with redundancy.

The preliminary design of a lift-cruise fan airplane flight control system

NASA Technical Reports Server (NTRS)

Gotlieb, P.

1977-01-01

This paper presents the preliminary design of a stability augmentation system for a NASA V/STOL research and technology airplane. This stability augmentation system is postulated as the simplest system that meets handling-quality levels for research and technology missions flown by NASA test pilots. The airplane studied in this report is a modified T-39 fitted with tilting lift/cruise fan nacelles and a nose fan. The propulsion system features a shaft that interconnects three variable-pitch fans and three powerplants. The mathematical modeling is based on pre-wind tunnel test estimated data. The selected stability augmentation system uses variable gains scheduled with airspeed. Failure analysis of the system illustrates the benign effect of engine failure. Airplane rate sensor failure must be solved with redundancy.

Inflammatory cytokine response to exercise in alpha-1-antitrypsin deficient COPD patients ‘on’ or ‘off’ augmentation therapy

PubMed Central

2014-01-01

Background There is still limited information on systemic inflammation in alpha-1-antitrypsin-deficient (AATD) COPD patients and what effect alpha-1-antitrypsin augmentation therapy and/or exercise might have on circulating inflammatory cytokines. We hypothesized that AATD COPD patients on augmentation therapy (AATD + AUG) would have lower circulating and skeletal muscle inflammatory cytokines compared to AATD COPD patients not receiving augmentation therapy (AATD-AUG) and/or the typical non-AATD (COPD) patient. We also hypothesized that cytokine response to exercise would be lower in AATD + AUG compared to AATD-AUG or COPD subjects. Methods Arterial and femoral venous concentration and skeletal muscle expression of TNFα, IL-6, IL-1β and CRP were measured at rest, during and up to 4-hours after 50% maximal 1-hour knee extensor exercise in all COPD patient groups, including 2 additional groups (i.e. AATD with normal lung function, and healthy age-/activity-matched controls). Results Circulating CRP was higher in AATD + AUG (4.7 ± 1.6 mg/dL) and AATD-AUG (3.3 ± 1.2 mg/dL) compared to healthy controls (1.5 ± 0.3 mg/dL, p < 0.05), but lower in AATD compared to non-AATD-COPD patients (6.1 ± 2.6 mg/dL, p < 0.05). TNFα, IL-6 and IL-1β were significantly increased by 1.7-, 1.7-, and 4.7-fold, respectively, in non-AATD COPD compared to AATD COPD (p < 0.05), and 1.3-, 1.7-, and 2.2-fold, respectively, compared to healthy subjects (p < 0.05). Skeletal muscle TNFα was on average 3–4 fold greater in AATD-AUG compared to the other groups (p < 0.05). Exercise showed no effect on these cytokines in any of our patient groups. Conclusion These data show that AATD COPD patients do not experience the same chronic systemic inflammation and exhibit reduced inflammation compared to non-AATD COPD patients. Augmentation therapy may help to improve muscle efflux of TNFα and reduce muscle TNFα concentration, but showed no effect on IL-6, IL-1β or CRP. PMID:24975928

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

Cirrito, A.J.

Combustion jet pumps ingest waste heat gases from power plant engines and boilers to boost their pressure for the ultimate low temperature utilization of the captured heat for heating homes, full-year hot houses, sterilization purposes, recreational hot water, absorption refrigeration and the like. Jet pump energy is sustained from the incineration of solids, liquids and gases and vapors or simply from burning fuels. This is the energy needed to transport the reaction products to the point of heat utilization and to optimize the heat transfer to that point. Sequent jet pumps raise and preserve energy levels. Crypto-steady and special jetmore » pumps increase pumping efficiency. The distribution conduit accepts fluidized solids, liquids, gases and vapors in multiphase flow. Temperature modulation and flow augmentation takes place by water injection. Macro solids such as dried sewage waste are removed by cyclone separation. Micro particles remain entrained and pass out with waste condensate just beyond each point of final heat utilization to recharge the water table. The non-condensible gases separated at this point are treated for pollution control. Further, jet pump reactions are controlled to yield fuel gas as necessary to power jet pumps or other use. In all these effects introduced sequentially, the available energy necessary to provide the flow energy, for the continuously distributed heating medium, is first extracted from fuel and fuel-like additions to the stream. As all energy, any way, finally converts to heat, which in this case is retained or recaptured in the flow, the captured heat is practically 90% available at the point of low temperature utilization. The jet pump for coal gasification is also disclosed as are examples of coal gasification and hydrogen production.« less

Augmentation of the Differentiation Response to Antitumor Antimalarials

DTIC Science & Technology

2005-07-01

An impeding challenge to breast cancer drug therapies is the availability of more effective and less toxic chemotherapeutic agents that do not relay...enhanced antiproliferative, differentiation, and histone acetylation responses are achieved during combination therapy with ATRA rather than the...agents for cancer differentiation therapy . We showed that five antiproliferative quinolime compounds in the National Cancer Institute database

Fiberoptic sensors for rocket engine applications

NASA Technical Reports Server (NTRS)

Ballard, R. O.

1992-01-01

A research effort was completed to summarize and evaluate the current level of technology in fiberoptic sensors for possible applications in integrated control and health monitoring (ICHM) systems in liquid propellant engines. The environment within a rocket engine is particuarly severe with very high temperatures and pressures present combined with extremely rapid fluid and gas flows, and high-velocity and high-intensity acoustc waves. Application of fiberoptic technology to rocket engine health monitoring is a logical evolutionary step in ICHM development and presents a significant challenge. In this extremely harsh environment, the additional flexibility of fiberoptic techniques to augment conventional sensor technologies offer abundant future potential.

Evaluation of Flexible Force Sensors for Pressure Monitoring in Treatment of Chronic Venous Disorders.

PubMed

Parmar, Suresh; Khodasevych, Iryna; Troynikov, Olga

2017-08-21

The recent use of graduated compression therapy for treatment of chronic venous disorders such as leg ulcers and oedema has led to considerable research interest in flexible and low-cost force sensors. Properly applied low pressure during compression therapy can substantially improve the treatment of chronic venous disorders. However, achievement of the recommended low pressure levels and its accurate determination in real-life conditions is still a challenge. Several thin and flexible force sensors, which can also function as pressure sensors, are commercially available, but their real-life sensing performance has not been evaluated. Moreover, no researchers have reported information on sensor performance during static and dynamic loading within the realistic test conditions required for compression therapy. This research investigated the sensing performance of five low-cost commercial pressure sensors on a human-leg-like test apparatus and presents quantitative results on the accuracy and drift behaviour of these sensors in both static and dynamic conditions required for compression therapy. Extensive experimental work on this new human-leg-like test setup demonstrated its utility for evaluating the sensors. Results showed variation in static and dynamic sensing performance, including accuracy and drift characteristics. Only one commercially available pressure sensor was found to reliably deliver accuracy of 95% and above for all three test pressure points of 30, 50 and 70 mmHg.

Evaluation of Flexible Force Sensors for Pressure Monitoring in Treatment of Chronic Venous Disorders

PubMed Central

Parmar, Suresh; Khodasevych, Iryna; Troynikov, Olga

2017-01-01

The recent use of graduated compression therapy for treatment of chronic venous disorders such as leg ulcers and oedema has led to considerable research interest in flexible and low-cost force sensors. Properly applied low pressure during compression therapy can substantially improve the treatment of chronic venous disorders. However, achievement of the recommended low pressure levels and its accurate determination in real-life conditions is still a challenge. Several thin and flexible force sensors, which can also function as pressure sensors, are commercially available, but their real-life sensing performance has not been evaluated. Moreover, no researchers have reported information on sensor performance during static and dynamic loading within the realistic test conditions required for compression therapy. This research investigated the sensing performance of five low-cost commercial pressure sensors on a human-leg-like test apparatus and presents quantitative results on the accuracy and drift behaviour of these sensors in both static and dynamic conditions required for compression therapy. Extensive experimental work on this new human-leg-like test setup demonstrated its utility for evaluating the sensors. Results showed variation in static and dynamic sensing performance, including accuracy and drift characteristics. Only one commercially available pressure sensor was found to reliably deliver accuracy of 95% and above for all three test pressure points of 30, 50 and 70 mmHg. PMID:28825672

Assessing the impact of managed aquifer recharge on seasonal low flows in a semi-arid alluvial river

NASA Astrophysics Data System (ADS)

Ronayne, M. J.; Roudebush, J. A.; Stednick, J. D.

2016-12-01

Managed aquifer recharge (MAR) is one strategy that can be used to augment seasonal low flows in alluvial rivers. Successful implementation requires an understanding of spatio-temporal groundwater-surface water exchange. In this study we conducted numerical groundwater modeling to analyze the performance of an existing MAR system in the South Platte River Valley in northeastern Colorado (USA). The engineered system involves a spatial reallocation of water during the winter months; alluvial groundwater is extracted near the river and pumped to upgradient recharge ponds, with the intent of producing a delayed hydraulic response that increases the riparian zone water table (and therefore streamflow) during summer months. Higher flows during the summer are required to improve riverine habitat for threatened species in the Platte River. Modeling scenarios were constrained by surface (streamflow gaging) and subsurface (well data) measurements throughout the study area. We compare two scenarios to analyze the impact of MAR: a natural base case scenario and an active management scenario that includes groundwater pumping and managed recharge. Steady-periodic solutions are used to evaluate the long-term stabilized behavior of the stream-aquifer system with and without pumping/recharge. Streamflow routing is included in the model, which permits quantification of the timing and location of streamflow accretion (increased streamflow associated with MAR). An analysis framework utilizing capture concepts is developed to interpret seasonal changes in head-dependent flows to/from the aquifer, including groundwater-surface water exchange that impacts streamflow. Results demonstrate that accretion occurs during the target low-flow period but is not limited to those months, highlighting an inefficiency that is a function of the aquifer geometry and hydraulic properties. The results of this study offer guidance for other flow augmentation projects that rely on water storage in shallow alluvial aquifers.

[Complications of intrathecal baclofen therapy].

PubMed

Paskhin, D L; Dekopov, A V; Tomsky, A A; Isagulyan, E D; Salova, E M

To analyze complications of intrathecal baclofen therapy and identify high-risk groups. We implanted 52 pumps to spastic patients for chronic intrathecal baclofen infusion. Two groups of patients were distinguished: 23 patients with spinal spasticity (group 1) and 29 patients with cerebral spasticity (group 2). The mean patient age was 37.2±14.6 years in group 1 and 17.3±10.3 years in group 2. Surgery was performed according to a standard procedure. A Medstream (Codman) pump was implanted in 10 cases, and a Synchromed II (Medtronic) pump was implanted in the remaining 42 cases. Complications developed in 12 (23%) patients. We divided complications into 3 groups: baclofen underdose, baclofen overdose, and others. Insufficiency of intrathecal therapy was observed in 7 cases, which was caused by catheter migration (5 cases) and pump dysfunction (2 cases). In one case, baclofen overdose was observed after air travel. Other complications included 4 cases of persistent peri-implant seroma and infectious complications. Groups with a high risk of complications were identified based on an analysis of the results. Patients with severe dystonia of the trunk muscles have an increased risk of spinal catheter migration. Pronounced communicating hydrocephalus is associated with the risk of cerebrospinal fluid leak through a catheter shaft channel. Weakness of the axial musculature can lead to progression of scoliotic deformity. In some cases, chronic intrathecal baclofen therapy can be accompanied by various complications. This technique should be carefully used in patients from high-risk groups.

Augmented awareness

USDA-ARS?s Scientific Manuscript database

The sounds insects make as they move and feed can be amplified 100–1000x by vibration sensor systems, which makes them easily detectable with headphones. In 2008, I visited Mackay and Bundaberg in Queensland to search for greyback canegrub (Dermolepida albohirtum) and other insect pests in sugarcane...

Evaluation of the optical switching characteristics of erbium-doped fibres for the development of a fibre Bragg grating sensor interrogator

NASA Astrophysics Data System (ADS)

Rigas, Evangelos; Correia, R.; Stathopoulos, N. A.; Savaidis, S. P.; James, S. W.; Bhattacharyya, D.; Kirby, P. B.; Tatam, R. P.

2014-05-01

A polling topology that employs optical switching based on the properties of erbium-doped fibres (EDFs) is used to interrogate an array of FBGs. The properties of the EDF are investigated in its pumped and un-pumped states and the EDFs' switching properties are evaluated by comparing them with a high performance electronically controlled MEM optical switch. Potential advantages of the proposed technique are discussed.

Virtual Reality-Based Center of Mass-Assisted Personalized Balance Training System

PubMed Central

Kumar, Deepesh; González, Alejandro; Das, Abhijit; Dutta, Anirban; Fraisse, Philippe; Hayashibe, Mitsuhiro; Lahiri, Uttama

2018-01-01

Poststroke hemiplegic patients often show altered weight distribution with balance disorders, increasing their risk of fall. Conventional balance training, though powerful, suffers from scarcity of trained therapists, frequent visits to clinics to get therapy, one-on-one therapy sessions, and monotony of repetitive exercise tasks. Thus, technology-assisted balance rehabilitation can be an alternative solution. Here, we chose virtual reality as a technology-based platform to develop motivating balance tasks. This platform was augmented with off-the-shelf available sensors such as Nintendo Wii balance board and Kinect to estimate one’s center of mass (CoM). The virtual reality-based CoM-assisted balance tasks (Virtual CoMBaT) was designed to be adaptive to one’s individualized weight-shifting capability quantified through CoM displacement. Participants were asked to interact with Virtual CoMBaT that offered tasks of varying challenge levels while adhering to ankle strategy for weight shifting. To facilitate the patients to use ankle strategy during weight-shifting, we designed a heel lift detection module. A usability study was carried out with 12 hemiplegic patients. Results indicate the potential of our system to contribute to improving one’s overall performance in balance-related tasks belonging to different difficulty levels. PMID:29359128

Ocean Bottom Seismometer Augmentation of the Philippine Sea Experiment (OBSAPS) Cruise Report

DTIC Science & Technology

2011-09-01

single 77.5Hz M-sequence on six OBSAPS receivers: (from bottom to top) the vertical geophone on the North OBS ( blue ), the hydrophone module on the...wet end electronics (pressure sensor, hydrophone and octopus ) to the spare J15-3 S/N 14 and re-deployed the transducer and tow body assembly. We then...our wet end electronics (hydrophone, pressure sensor and octopus ) to the S/N 11 unit and re-deployed. The repaired J15-3 S/N 11 unit performed

MS-BWME: A Wireless Real-Time Monitoring System for Brine Well Mining Equipment

PubMed Central

Xiao, Xinqing; Zhu, Tianyu; Qi, Lin; Moga, Liliana Mihaela; Zhang, Xiaoshuan

2014-01-01

This paper describes a wireless real-time monitoring system (MS-BWME) to monitor the running state of pumps equipment in brine well mining and prevent potential failures that may produce unexpected interruptions with severe consequences. MS-BWME consists of two units: the ZigBee Wireless Sensors Network (WSN) unit and the real-time remote monitoring unit. MS-BWME was implemented and tested in sampled brine wells mining in Qinghai Province and four kinds of indicators were selected to evaluate the performance of the MS-BWME, i.e., sensor calibration, the system's real-time data reception, Received Signal Strength Indicator (RSSI) and sensor node lifetime. The results show that MS-BWME can accurately judge the running state of the pump equipment by acquiring and transmitting the real-time voltage and electric current data of the equipment from the spot and provide real-time decision support aid to help workers overhaul the equipment in a timely manner and resolve failures that might produce unexpected production down-time. The MS-BWME can also be extended to a wide range of equipment monitoring applications. PMID:25340455

The inertial attitude augmentation for ambiguity resolution in SF/SE-GNSS attitude determination.

PubMed

Zhu, Jiancheng; Hu, Xiaoping; Zhang, Jingyu; Li, Tao; Wang, Jinling; Wu, Meiping

2014-06-26

The Unaided Single Frequency/Single Epoch Global Navigation Satellite System (SF/SE GNSS) model is the most challenging scenario for ambiguity resolution in the GNSS attitude determination application. To improve the performance of SF/SE-GNSS ambiguity resolution without excessive cost, the Micro-Electro-Mechanical System Inertial Measurement Unit (MEMS-IMU) is a proper choice for the auxiliary sensor that carries out the inertial attitude augmentation. Firstly, based on the SF/SE-GNSS compass model, the Inertial Derived Baseline Vector (IDBV) is defined to connect the MEMS-IMU attitude measurement with the SF/SE-GNSS ambiguity search space, and the mechanism of inertial attitude augmentation is revealed from the perspective of geometry. Then, through the quantitative description of model strength by Ambiguity Dilution of Precision (ADOP), two ADOPs are specified for the unaided SF/SE-GNSS compass model and its inertial attitude augmentation counterparts, respectively, and a sufficient condition is proposed for augmenting the SF/SE-GNSS model strength with inertial attitude measurement. Finally, in the framework of an integer aperture estimator with fixed failure rate, the performance of SF/SE-GNSS ambiguity resolution with inertial attitude augmentation is analyzed when the model strength is varying from strong to weak. The simulation results show that, in the SF/SE-GNSS attitude determination application, MEMS-IMU can satisfy the requirements of ambiguity resolution with inertial attitude augmentation.

The Inertial Attitude Augmentation for Ambiguity Resolution in SF/SE-GNSS Attitude Determination

PubMed Central

Zhu, Jiancheng; Hu, Xiaoping; Zhang, Jingyu; Li, Tao; Wang, Jinling; Wu, Meiping

2014-01-01

The Unaided Single Frequency/Single Epoch Global Navigation Satellite System (SF/SE GNSS) model is the most challenging scenario for ambiguity resolution in the GNSS attitude determination application. To improve the performance of SF/SE-GNSS ambiguity resolution without excessive cost, the Micro-Electro-Mechanical System Inertial Measurement Unit (MEMS-IMU) is a proper choice for the auxiliary sensor that carries out the inertial attitude augmentation. Firstly, based on the SF/SE-GNSS compass model, the Inertial Derived Baseline Vector (IDBV) is defined to connect the MEMS-IMU attitude measurement with the SF/SE-GNSS ambiguity search space, and the mechanism of inertial attitude augmentation is revealed from the perspective of geometry. Then, through the quantitative description of model strength by Ambiguity Dilution of Precision (ADOP), two ADOPs are specified for the unaided SF/SE-GNSS compass model and its inertial attitude augmentation counterparts, respectively, and a sufficient condition is proposed for augmenting the SF/SE-GNSS model strength with inertial attitude measurement. Finally, in the framework of an integer aperture estimator with fixed failure rate, the performance of SF/SE-GNSS ambiguity resolution with inertial attitude augmentation is analyzed when the model strength is varying from strong to weak. The simulation results show that, in the SF/SE-GNSS attitude determination application, MEMS-IMU can satisfy the requirements of ambiguity resolution with inertial attitude augmentation. PMID:24971472

A portable hypergolic oxidizer vapor sensor for NASA's Space Shuttle program

NASA Technical Reports Server (NTRS)

Helms, W. R.

1978-01-01

The design and performance characteristics of an electrochemical NO2 sensor selected by NASA for the space shuttle program is described. The instrument consists of a sample pump, an electrochemical cell, and control and display electronics. The pump pushes the sample through the electrochemical cell where the vapors are analyzed and an output proportional to the NO2 concentration is produced. The output is displayed on a panel meter, and is also available at a recorder jack. The electrochemical cell is made up of a polypropylene chamber covered with teflon membrane faceplates. Plantinum electrodes are bonded to the faceplates, and the sensing and counter electrodes are potentiostatically controlled at -200 mV with respect to the reference electrode. The cell is filled with electrolyte, consisting of 13.5 cc of 23% solution of KOH.

Operating manual for the R100 digital vibration-time totalizer

USGS Publications Warehouse

Cordes, Edwin H.; Shi, Minghua

1988-01-01

A vibration sensor that monitors the running time of pumps to determine water withdrawal by various public-supply, agricultural, and industrial groups has been developed in response to a need demonstrated by data gathering activities of the U.S. Geological Survey 's National Water Use Information Program. This sensor, the R100 digital vibration-time totalizer, attaches to monitored equipment such as a pump, motor, or pipe facility and senses vibration to determine running time. Battery-powered and packaged for field environment, the R100 can be left unattended for up to 1 year. Time is recorded to the nearest 0.01 hour, or 36 seconds. This operating manual for the R100 digital vibration-time totalizer describes the R100 's principal of operation and gives installation guidelines and instructions for battery replacements. (USGS)

Effects of Environmental Oxygen Content and Dissolved Oxygen on the Surface Tension and Viscosity of Liquid Nickel

NASA Astrophysics Data System (ADS)

SanSoucie, M. P.; Rogers, J. R.; Kumar, V.; Rodriguez, J.; Xiao, X.; Matson, D. M.

2016-07-01

The NASA Marshall Space Flight Center's electrostatic levitation (ESL) laboratory has recently added an oxygen partial pressure controller. This system allows the oxygen partial pressure within the vacuum chamber to be measured and controlled in the range from approximately 10^{-28} {to} 10^{-9} bar, while in a vacuum atmosphere. The oxygen control system installed in the ESL laboratory's main chamber consists of an oxygen sensor, oxygen pump, and a control unit. The sensor is a potentiometric device that determines the difference in oxygen activity in two gas compartments (inside the chamber and the air outside of the chamber) separated by an electrolyte. The pump utilizes coulometric titration to either add or remove oxygen. The system is controlled by a desktop control unit, which can also be accessed via a computer. The controller performs temperature control for the sensor and pump, has a PID-based current loop and a control algorithm. Oxygen partial pressure has been shown to play a significant role in the surface tension of liquid metals. Oxide films or dissolved oxygen may lead to significant changes in surface tension. The effects on surface tension and viscosity by oxygen partial pressure in the surrounding environment and the melt dissolved oxygen content will be evaluated, and the results will be presented. The surface tension and viscosity will be measured at several different oxygen partial pressures while the sample is undercooled. Surface tension and viscosity will be measured using the oscillating droplet method.

Augmented growth inhibition of B16-BL6 melanoma by combined treatment with a selective matrix metalloproteinase inhibitor, MMI-166, and cytotoxic agents.

PubMed

Hojo, Kanji; Maki, Hideo; Sawada, Takuko Yamada; Maekawa, Ryuji; Yoshioka, Takayuki

2002-01-01

MMI-166 is a selective matrix metalloproteinase (MMP) inhibitor. The purpose of this study was to evaluate the antitumor efficacy of the combined treatment of MMI-166 with paclitaxel or carboplatin. Mice bearing B16-BL6 melanoma were treated p.o. with MMI-166 from 1 day after tumor inoculation. The mice were administered i.v. with either paclitaxel or carboplatin at the maximum tolerated dose (MTD). MMI-166 monotherapy inhibited in vivo growth of the B16-BL6 tumor to an extent similar to that of paclitaxel or carboplatin monotherapy. When MMI-166 was combined with paclitaxel or carboplatin, the antitumor efficacy was significantly (p < 0.01) augmented in comparison with either MMI-166 or each cytotoxic agent alone. The hematotoxicity study demonstrated that daily treatment with MMI-166 did not affect the blood cell number in the mice and more importantly the combination of MMI-166 with paclitaxel did not augment the hematotoxicity caused by paclitaxel. An in vitro cytotoxicity study showed that MMI-166 itself has neither direct cytotoxicity against B16-BL6 tumor cells nor does it augment the cytotoxicity of paclitaxel or carboplatin. These results indicate that augmented antitumor activity of the combination treatment was not simply due to the augmentation of direct cytotoxic activity, but was rather an additive effect of the antitumor activities of different mechanisms. They suggest the effectiveness of a combination therapy of MMI-166 with paclitaxel or carboplatin in clinical therapy.

Design and Characterization of a Sensorized Microfluidic Cell-Culture System with Electro-Thermal Micro-Pumps and Sensors for Cell Adhesion, Oxygen, and pH on a Glass Chip.

PubMed

Bonk, Sebastian M; Stubbe, Marco; Buehler, Sebastian M; Tautorat, Carsten; Baumann, Werner; Klinkenberg, Ernst-Dieter; Gimsa, Jan

2015-07-30

We combined a multi-sensor glass-chip with a microfluidic channel grid for the characterization of cellular behavior. The grid was imprinted in poly-dimethyl-siloxane. Mouse-embryonal/fetal calvaria fibroblasts (MC3T3-E1) were used as a model system. Thin-film platinum (Pt) sensors for respiration (amperometric oxygen electrode), acidification (potentiometric pH electrodes) and cell adhesion (interdigitated-electrodes structures, IDES) allowed us to monitor cell-physiological parameters as well as the cell-spreading behavior. Two on-chip electro-thermal micro-pumps (ETμPs) permitted the induction of medium flow in the system, e.g., for medium mixing and drug delivery. The glass-wafer technology ensured the microscopic observability of the on-chip cell culture. Connecting Pt structures were passivated by a 1.2 μm layer of silicon nitride (Si3N4). Thin Si3N4 layers (20 nm or 60 nm) were used as the sensitive material of the pH electrodes. These electrodes showed a linear behavior in the pH range from 4 to 9, with a sensitivity of up to 39 mV per pH step. The oxygen sensors were circular Pt electrodes with a sensor area of 78.5 μm(2). Their sensitivity was 100 pA per 1% oxygen increase in the range from 0% to 21% oxygen (air saturated). Two different IDES geometries with 30- and 50-μm finger spacings showed comparable sensitivities in detecting the proliferation rate of MC3T3 cells. These cells were cultured for 11 days in vitro to test the biocompatibility, microfluidics and electric sensors of our system under standard laboratory conditions.

Manometric Changes to the Lower Esophageal Sphincter After Magnetic Sphincter Augmentation in Patients With Chronic Gastroesophageal Reflux Disease.

PubMed

Warren, Heather F; Louie, Brian E; Farivar, Alexander S; Wilshire, Candice; Aye, Ralph W

2017-07-01

To evaluate the manometric changes, function, and impact of magnetic sphincter augmentation (MSA) on the lower esophageal sphincter (LES). Implantation of a MSA around the gastroesophageal junction has been shown to be a safe and effective therapy for gastroesophageal reflux disease, but its effect on the LES has not been elucidated. Retrospective case control study (n = 121) evaluating manometric changes after MSA. Inclusion criteria consisted of a confirmed diagnosis of gastroesophageal reflux disease by an abnormal esophageal pH study (body mass index <35 kg/m, hiatal hernia <3 cm, and absence of endoscopic Barrett disease). Manometric changes, pH testing, and proton pump inhibitor use were assessed preoperatively and 6 and 12 months after MSA. MSA was associated with an overall increase in the median LES resting pressure (18 pre-MSA vs 23 mm Hg post-MSA; P = 0.0003), residual pressure (4 vs 9 mm Hg; P < 0.0001), and distal esophageal contraction amplitude (80 vs 90 mm Hg; P = 0.02). The percent peristalsis remained unaltered (94% vs 87%; P = 0.71).Overall, patients with a manometrically defective LES were restored 67% of the time to a normal sphincter with MSA. Those with a structurally defective or severely defective LES improved to a normal LES in 77% and 56% of patients, respectively. Only 18% of patients with a normal preoperative manometric LES deteriorated to a lower category. MSA results in significant manometric improvement of the LES without apparent deleterious effects on the esophageal body. A manometrically defective LES can be restored to normal sphincter, whereas a normal LES remains stable.

In vitro reduction of antibacterial activity of tigecycline against multidrug-resistant Acinetobacter baumannii with host stress hormone norepinephrine.

PubMed

Inaba, Masato; Matsuda, Naoyuki; Banno, Hirotsugu; Jin, Wanchun; Wachino, Jun-Ichi; Yamada, Keiko; Kimura, Kouji; Arakawa, Yoshichika

2016-12-01

The host stress hormone norepinephrine (NE), also called noradrenaline, is reported to augment bacterial growth and pathogenicity, but few studies have focused on the effect of NE on the activity of antimicrobials. The aim of this study was to clarify whether NE affects antimicrobial activity against multidrug-resistant Acinetobacter baumannii (MDR-AB). Time-kill studies of tigecycline (TIG) and colistin (COL) against MDR-AB as well as assays for factors contributing to antibiotic resistance were performed using MDR-AB clinical strains both in the presence and absence of 10 µM NE. In addition, expression of three efflux pump genes (adeB, adeJ and adeG) in the presence and absence of NE was analysed by quantitative reverse transcription PCR. Viable bacterial cell counts in TIG-supplemented medium containing NE were significantly increased compared with those in medium without NE. In contrast, NE had little influence on viable bacterial cell counts in the presence of COL. NE-supplemented medium resulted in an ca. 2 log increase in growth and in bacterial cell numbers adhering on polyurethane, silicone and polyvinylchloride surfaces. Amounts of biofilm in the presence of NE were ca. 3-fold higher than without NE. Expression of the adeG gene was upregulated 4-6-fold in the presence of NE. In conclusion, NE augmented factors contributing to antibiotic resistance and markedly reduced the in vitro antibacterial activity of TIG against MDR-AB. These findings suggest that NE treatment may contribute to the failure of TIG therapy in patients with MDR-AB infections. Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

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

PubMed

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

2006-12-01

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

Hydrogen Sensors Boost Hybrids; Today's Models Losing Gas?

NASA Technical Reports Server (NTRS)

2005-01-01

Advanced chemical sensors are used in aeronautic and space applications to provide safety monitoring, emission monitoring, and fire detection. In order to fully do their jobs, these sensors must be able to operate in a range of environments. NASA has developed sensor technologies addressing these needs with the intent of improving safety, optimizing combustion efficiencies, and controlling emissions. On the ground, the chemical sensors were developed by NASA engineers to detect potential hydrogen leaks during Space Shuttle launch operations. The Space Shuttle uses a combination of hydrogen and oxygen as fuel for its main engines. Liquid hydrogen is pumped to the external tank from a storage tank located several hundred feet away. Any hydrogen leak could potentially result in a hydrogen fire, which is invisible to the naked eye. It is important to detect the presence of a hydrogen fire in order to prevent a major accident. In the air, the same hydrogen-leak dangers are present. Stress and temperature changes can cause tiny cracks or holes to form in the tubes that line the Space Shuttle s main engine nozzle. Such defects could allow the hydrogen that is pumped through the nozzle during firing to escape. Responding to the challenges associated with pinpointing hydrogen leaks, NASA endeavored to improve propellant leak-detection capabilities during assembly, pre-launch operations, and flight. The objective was to reduce the operational cost of assembling and maintaining hydrogen delivery systems with automated detection systems. In particular, efforts have been focused on developing an automated hydrogen leak-detection system using multiple, networked hydrogen sensors that are operable in harsh conditions.

The management of gastro-oesophageal reflux disease

PubMed Central

Keung, Charlotte; Hebbard, Geoffrey

2016-01-01

SUMMARY If there are no features of serious disease, suspected gastro-oesophageal reflux disease can be initially managed with a trial of a proton pump inhibitor for 4–8 weeks. This should be taken 30–60 minutes before food for optimal effect. Once symptoms are controlled, attempt to withdraw acid suppression therapy. If symptoms recur, use the minimum dose that controls symptoms. Patients who have severe erosive oesophagitis, scleroderma oesophagus or Barrett’s oesophagus require long-term treatment with a proton pump inhibitor. Lifestyle modification strategies can help gastro-oesophageal reflux disease. Weight loss has the strongest evidence for efficacy. Further investigation and a specialist referral are required if there is no response to proton pump inhibitor therapy. Atypical symptoms or signs of serious disease also need investigation. PMID:27041798

Solid state lasers for use in non-contact temperature measurements

NASA Technical Reports Server (NTRS)

Buoncristiani, A. M.

1989-01-01

The last decade has seen a series of dramatic developments in solid state laser technology. Prominent among these has been the emergence of high power semiconductor laser diode arrays and a deepening understanding of the dynamics of solid state lasers. Taken in tandem these two developments enable the design of laser diode pumped solid state lasers. Pumping solid state lasers with semiconductor diodes relieves the need for cumbersome and inefficient flashlamps and results in an efficient and stable laser with the compactness and reliability. It provides a laser source that can be reliably used in space. These new coherent sources are incorporated into the non-contact measurement of temperature. The primary focus is the development and characterization of new optical materials for use in active remote sensors of the atmosphere. In the course of this effort several new materials and new concepts were studied which can be used for other sensor applications. The general approach to the problem of new non-contact temperature measurements has had two components. The first component centers on passive sensors using optical fibers; an optical fiber temperature sensor for the drop tube was designed and tested at the Marshall Space Flight Center. Work on this problem has given insight into the use of optical fibers, especially new IR fibers, in thermal metrology. The second component of the effort is to utilize the experience gained in the study of passive sensors to examine new active sensor concepts. By active sensor are defined as a sensing device or mechanism which is interrogated in some way be radiation, usually from a laser. The status of solid state lasers as sources for active non-contact temperature sensors are summarized. Some specific electro-optic techniques are described which are applicable to the sensor problems at hand. Work on some of these ideas is in progress while other concepts are still being worked out.

High-brightness displays in integrated weapon sight systems

NASA Astrophysics Data System (ADS)

Edwards, Tim; Hogan, Tim

2014-06-01

In the past several years Kopin has demonstrated the ability to provide ultra-high brightness, low power display solutions in VGA, SVGA, SXGA and 2k x 2k display formats. This paper will review various approaches for integrating high brightness overlay displays with existing direct view rifle sights and augmenting their precision aiming and targeting capability. Examples of overlay display systems solutions will be presented and discussed. This paper will review significant capability enhancements that are possible when augmenting the real-world as seen through a rifle sight with other soldier system equipment including laser range finders, ballistic computers and sensor systems.

Active stability augmentation of large space structures: A stochastic control problem

NASA Technical Reports Server (NTRS)

Balakrishnan, A. V.

1987-01-01

A problem in SCOLE is that of slewing an offset antenna on a long flexible beam-like truss attached to the space shuttle, with rather stringent pointing accuracy requirements. The relevant methodology aspects in robust feedback-control design for stability augmentation of the beam using on-board sensors is examined. It is framed as a stochastic control problem, boundary control of a distributed parameter system described by partial differential equations. While the framework is mathematical, the emphasis is still on an engineering solution. An abstract mathematical formulation is developed as a nonlinear wave equation in a Hilbert space. That the system is controllable is shown and a feedback control law that is robust in the sense that it does not require quantitative knowledge of system parameters is developed. The stochastic control problem that arises in instrumenting this law using appropriate sensors is treated. Using an engineering first approximation which is valid for small damping, formulas for optimal choice of the control gain are developed.

A triaxial accelerometer-based physical-activity recognition via augmented-signal features and a hierarchical recognizer.

PubMed

Khan, Adil Mehmood; Lee, Young-Koo; Lee, Sungyoung Y; Kim, Tae-Seong

2010-09-01

Physical-activity recognition via wearable sensors can provide valuable information regarding an individual's degree of functional ability and lifestyle. In this paper, we present an accelerometer sensor-based approach for human-activity recognition. Our proposed recognition method uses a hierarchical scheme. At the lower level, the state to which an activity belongs, i.e., static, transition, or dynamic, is recognized by means of statistical signal features and artificial-neural nets (ANNs). The upper level recognition uses the autoregressive (AR) modeling of the acceleration signals, thus, incorporating the derived AR-coefficients along with the signal-magnitude area and tilt angle to form an augmented-feature vector. The resulting feature vector is further processed by the linear-discriminant analysis and ANNs to recognize a particular human activity. Our proposed activity-recognition method recognizes three states and 15 activities with an average accuracy of 97.9% using only a single triaxial accelerometer attached to the subject's chest.

Gyro-effect stabilizes unstable permanent maglev centrifugal pump.

PubMed

Qian, Kun-Xi

2007-03-01

According to Earnshaw's Theorem (1839), the passive maglev cannot achieve stable equilibrium and thus an extra coil is needed to make the rotor electrically levitated in a heart pump. The author had developed a permanent maglev centrifugal pump utilizing only passive magnetic bearings, to keep the advantages but to avoid the disadvantages of the electric maglev pumps. The equilibrium stability was achieved by use of so-called "gyro-effect": a rotating body with certain high speed can maintain its rotation stably. This pump consisted of a rotor (driven magnets and an impeller), and a stator with motor coil and pump housing. Two passive magnetic bearings between rotor and stator were devised to counteract the attractive force between the motor coil iron core and the rotor driven magnets. Bench testing with saline demonstrated a levitated rotor under preconditions of higher than 3,250 rpm rotation and more than 1 l/min pumping flow. Rotor levitation was demonstrated by 4 Hall sensors on the stator, with evidence of reduced maximal eccentric distance from 0.15 mm to 0.07 mm. The maximal rotor vibration amplitude was 0.06 mm in a gap of 0.15 mm between rotor and stator. It concluded that Gyro-effect can help passive maglev bearings to achieve stabilization of permanent maglev pump; and that high flow rate indicates good hydraulic property of the pump, which helps also the stability of passive maglev pump.

Predicted Hemodynamic Benefits Of Counterpulsation Therapy Using A Superficial Surgical Approach

PubMed Central

Giridharan, Guruprasad A.; Pantalos, George M.; Litwak, Kenneth N.; Spence, Paul A.; Koenig, Steven C.

2010-01-01

A volume-displacement counterpulsation device (CPD) intended for chronic implantation via a superficial surgical approach is proposed. The CPD is a pneumatically driven sac that fills during native heart systole and empties during diastole through a single, valveless cannula anastomosed to the subclavian artery. Computer simulation was performed to predict and compare the physiological responses of the CPD to the intraaortic balloon pump (IABP) in a clinically relevant model of early stage heart failure. The effect of device stroke volume (0–50 ml) and control modes (timing, duration, morphology) on landmark hemodynamic parameters and the LV pressure–volume relationship were investigated. Simulation results predicted that the CPD would provide hemodynamic benefits comparable to an IABP as evidenced by up to 25% augmentation of peak diastolic aortic pressure, which increases diastolic coronary perfusion by up to 34%. The CPD may also provide up to 34% reduction in LV end-diastolic pressure and 12% reduction in peak systolic aortic pressure, lowering LV workload by up to 26% and increasing cardiac output by up to 10%. This study demonstrated that the superficial CPD technique may be used acutely to achieve similar improvements in hemodynamic function as the IABP in early stage heart failure patients. PMID:16436889

Indocyanine green-augmented diode laser therapy of telangiectatic leg veins: a randomized controlled proof-of-concept trial.

PubMed

Klein, Annette; Bäumler, Wolfgang; Koller, Michael; Shafirstein, Gal; Kohl, Elisabeth A; Landthaler, Michael; Babilas, Philipp

2012-07-01

Telangiectatic leg veins, which affect about 40-50% of adults, represent a frequent cosmetic rather than a medical problem. Besides sclerotherapy, various laser devices are common treatment options. However, complete clearance rates can only be achieved in a small number of patients. In this proof-of-concept study, the safety and efficacy of indocyanine green (ICG)-augmented diode laser therapy (808 nm) was evaluated for the treatment of telangiectatic leg veins. ICG (2 mg/kg body weight) was intravenously administered in 15 female patients (skin type II to III) with telangiectatic leg veins (measuring between 0.25 and 3 mm in diameter). Immediately after ICG injection, diode laser pulses with different radiant exposures (50-110 J/cm(2)) were applied as one single treatment. Safety and efficacy were assessed 1 and 3 months after treatment by a blinded investigator and the patient. Treatments with the pulsed dye laser (PDL) and the diode laser without ICG served as reference therapies. The safety of ICG application and diode laser treatment was excellent in all patients with no persisting side effects. Vessel clearance was dose-dependent. Diode laser treatment at radiant exposures between 100 and 110 J/cm(2) resulted in good vessel clearance, which even improved to excellent after the application of double pulses. Diode laser therapy without ICG and PDL treatment induced poor to moderate clearance of telangiectatic leg veins. ICG-augmented diode laser therapy has proved to be a safe and effective treatment option for telangiectatic leg veins. Copyright © 2012 Wiley Periodicals, Inc.

Augmentation of Deglutitive Thyrohyoid Muscle Shortening by the Shaker Exercise

PubMed Central

Mepani, Rachel; Antonik, Stephen; Massey, Benson; Kern, Mark; Logemann, Jerilyn; Pauloski, Barbara; Rademaker, Alfred; Easterling, Caryn

2010-01-01

Earlier studies of the effect of 6 weeks of the Shaker Exercise have shown significant increase in UES opening and anterior excursion of larynx and hyoid during swallowing in patients with upper esophageal sphincter (UES) dysfunction, resulting in elimination of aspiration and resumption of oral intake. This effect is attributed to strengthening of the suprahyoid muscles, as evidenced by comparison of electromyographic changes in muscle fatigue before and after completion of the exercise regime. The effect of this exercise on thyrohyoid muscle shortening is unknown. Therefore the aim of this study was to determine the effect of the exercise on thyrohyoid muscle shortening. We studied 11 dysphagic patients with UES dysfunction. Six were randomized to traditional swallowing therapy and five to the Shaker Exercise. Videofluoroscopy was used to measure deglutitive thyrohyoid shortening before and after completion of assigned therapy regimen. Maximum thyrohyoid muscle shortening occurred at close temporal proximity to the time of maximal thyroid cartilage excursion. The percent change in thyrohyoid distance from initiation of deglutition to maximal anterior/superior hyoid excursion showed no statistically significant difference between the two groups prior to either therapy (p = 0.54). In contrast, after completion of therapy, the percent change in thyrohyoid distance in the Shaker Exercise group was significantly greater compared to the traditional therapy (p = 0.034). The Shaker Exercise augments the thyrohyoid muscle shortening in addition to strengthening the suprahyoid muscles. The combination of increased thyrohyoid shortening and suprahyoid strengthening contributes to the Shaker Exercise outcome of deglutitive UES opening augmentation. PMID:18685891

In-situ Condition Monitoring of Components in Small Modular Reactors Using Process and Electrical Signature Analysis. Final report, volume 1. Development of experimental flow control loop, data analysis and plant monitoring

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

Upadhyaya, Belle; Hines, J. Wesley; Damiano, Brian

The research and development under this project was focused on the following three major objectives: Objective 1: Identification of critical in-vessel SMR components for remote monitoring and development of their low-order dynamic models, along with a simulation model of an integral pressurized water reactor (iPWR). Objective 2: Development of an experimental flow control loop with motor-driven valves and pumps, incorporating data acquisition and on-line monitoring interface. Objective 3: Development of stationary and transient signal processing methods for electrical signatures, machinery vibration, and for characterizing process variables for equipment monitoring. This objective includes the development of a data analysis toolbox. Themore » following is a summary of the technical accomplishments under this project: - A detailed literature review of various SMR types and electrical signature analysis of motor-driven systems was completed. A bibliography of literature is provided at the end of this report. Assistance was provided by ORNL in identifying some key references. - A review of literature on pump-motor modeling and digital signal processing methods was performed. - An existing flow control loop was upgraded with new instrumentation, data acquisition hardware and software. The upgrading of the experimental loop included the installation of a new submersible pump driven by a three-phase induction motor. All the sensors were calibrated before full-scale experimental runs were performed. - MATLAB-Simulink model of a three-phase induction motor and pump system was completed. The model was used to simulate normal operation and fault conditions in the motor-pump system, and to identify changes in the electrical signatures. - A simulation model of an integral PWR (iPWR) was updated and the MATLAB-Simulink model was validated for known transients. The pump-motor model was interfaced with the iPWR model for testing the impact of primary flow perturbations (upsets) on plant parameters and the pump electrical signatures. Additionally, the reactor simulation is being used to generate normal operation data and data with instrumentation faults and process anomalies. A frequency controller was interfaced with the motor power supply in order to vary the electrical supply frequency. The experimental flow control loop was used to generate operational data under varying motor performance characteristics. Coolant leakage events were simulated by varying the bypass loop flow rate. The accuracy of motor power calculation was improved by incorporating the power factor, computed from motor current and voltage in each phase of the induction motor.- A variety of experimental runs were made for steady-state and transient pump operating conditions. Process, vibration, and electrical signatures were measured using a submersible pump with variable supply frequency. High correlation was seen between motor current and pump discharge pressure signal; similar high correlation was exhibited between pump motor power and flow rate. Wide-band analysis indicated high coherence (in the frequency domain) between motor current and vibration signals. - Wide-band operational data from a PWR were acquired from AMS Corporation and used to develop time-series models, and to estimate signal spectrum and sensor time constant. All the data were from different pressure transmitters in the system, including primary and secondary loops. These signals were pre-processed using the wavelet transform for filtering both low-frequency and high-frequency bands. This technique of signal pre-processing provides minimum distortion of the data, and results in a more optimal estimation of time constants of plant sensors using time-series modeling techniques.« less

Long-term study of tubeless insulin pump therapy compared to multiple daily injections in youth with type 1 diabetes: Data from the German/Austrian DPV registry.

PubMed

Danne, Thomas; Schwandt, Anke; Biester, Torben; Heidtmann, Bettina; Rami-Merhar, Birgit; Haberland, Holger; Müther, Silvia; Khodaverdi, Semik; Haak, Thomas; Holl, Reinhard W

2018-02-15

To examine glycemic control in youth with type 1 diabetes (T1D) who switched from multiple daily injections (MDI) to a tubeless insulin pump (Omnipod Insulin Management System, Insulet Corporation, Billerica, Massachusetts) compared to patients who continued MDI therapy over a 3-year time period. This retrospective analysis of the German/Austrian Diabetes Patienten Verlaufsdokumentation registry included data from 263 centers and 2529 patients <20 years (n = 660 tubeless insulin pump; n = 1869 MDI) who initiated treatment on a tubeless insulin pump as of January 1, 2013 and had 1 year of data preswitch from MDI and 3 years of data postswitch to a tubeless pump. Outcomes included the change in glycated hemoglobin (HbA1c), insulin dose, and body mass index (BMI) SD score (SDS). Youth with T1D who switched from MDI therapy to a tubeless insulin pump showed better glycemic control at 1 year compared to patients who continued MDI treatment, adjusted mean ± SE: 7.5% ± 0.03% (58 mmol/mol) vs 7.7% ± 0.02% (61 mmol/mol); P < .001, with no between-group difference at 2 and 3 years. Total daily insulin dose was lower (P < .001) in the tubeless insulin pump group, 0.80 ± 0.01, 0.81 ± 0.01, and 0.85 ± 0.01 U/kg, vs the MDI group, 0.89 ± 0.01, 0.94 ± 0.01, and 0.97 ± 0.01 U/kg, at 1, 2, and 3 years, respectively (all P < .001). BMI SDS increased in both groups and was not different over time. Treatment with a tubeless insulin pump in youth with T1D was associated with improvements in glycemic control compared to MDI after 1 year and appears to be an effective alternative to MDI. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Twelve-Week 24/7 Ambulatory Artificial Pancreas With Weekly Adaptation of Insulin Delivery Settings: Effect on Hemoglobin A1c and Hypoglycemia.

PubMed

Dassau, Eyal; Pinsker, Jordan E; Kudva, Yogish C; Brown, Sue A; Gondhalekar, Ravi; Dalla Man, Chiara; Patek, Steve; Schiavon, Michele; Dadlani, Vikash; Dasanayake, Isuru; Church, Mei Mei; Carter, Rickey E; Bevier, Wendy C; Huyett, Lauren M; Hughes, Jonathan; Anderson, Stacey; Lv, Dayu; Schertz, Elaine; Emory, Emma; McCrady-Spitzer, Shelly K; Jean, Tyler; Bradley, Paige K; Hinshaw, Ling; Laguna Sanz, Alejandro J; Basu, Ananda; Kovatchev, Boris; Cobelli, Claudio; Doyle, Francis J

2017-12-01

Artificial pancreas (AP) systems are best positioned for optimal treatment of type 1 diabetes (T1D) and are currently being tested in outpatient clinical trials. Our consortium developed and tested a novel adaptive AP in an outpatient, single-arm, uncontrolled multicenter clinical trial lasting 12 weeks. Thirty adults with T1D completed a continuous glucose monitor (CGM)-augmented 1-week sensor-augmented pump (SAP) period. After the AP was started, basal insulin delivery settings used by the AP for initialization were adapted weekly, and carbohydrate ratios were adapted every 4 weeks by an algorithm running on a cloud-based server, with automatic data upload from devices. Adaptations were reviewed by expert study clinicians and patients. The primary end point was change in hemoglobin A 1c (HbA 1c ). Outcomes are reported adhering to consensus recommendations on reporting of AP trials. Twenty-nine patients completed the trial. HbA 1c , 7.0 ± 0.8% at the start of AP use, improved to 6.7 ± 0.6% after 12 weeks (-0.3, 95% CI -0.5 to -0.2, P < 0.001). Compared with the SAP run-in, CGM time spent in the hypoglycemic range improved during the day from 5.0 to 1.9% (-3.1, 95% CI -4.1 to -2.1, P < 0.001) and overnight from 4.1 to 1.1% (-3.1, 95% CI -4.2 to -1.9, P < 0.001). Whereas carbohydrate ratios were adapted to a larger extent initially with minimal changes thereafter, basal insulin was adapted throughout. Approximately 10% of adaptation recommendations were manually overridden. There were no protocol-related serious adverse events. Use of our novel adaptive AP yielded significant reductions in HbA 1c and hypoglycemia. © 2017 by the American Diabetes Association.

Thermal control systems for low-temperature heat rejection on a lunar base

NASA Technical Reports Server (NTRS)

Sridhar, K. R.; Gottmann, Matthias

1992-01-01

One of the important issues in the lunar base architecture is the design of a Thermal Control System (TCS) to reject the low temperature heat from the base. The TCS ensures that the base and all components inside are maintained within the operating temperature range. A significant portion of the total mass of the TCS is due to the radiator. Shading the radiation from the sun and the hot lunar soil could decrease the radiator operating temperature significantly. Heat pumps have been in use for terrestrial applications. To optimize the mass of the heat pump augmented TCS, all promising options have to be evaluated and compared. Careful attention is given to optimizing system operating parameters, working fluids, and component masses. The systems are modeled for full load operation.

Aspirin and omeprazole for secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers.

PubMed

García-Rayado, Guillermo; Sostres, Carlos; Lanas, Angel

2017-08-01

Cardiovascular disease is the most important cause of morbidity and mortality in the world and low-dose aspirin is considered the cornerstone of the cardiovascular disease prevention. However, low-dose aspirin use is associated with gastrointestinal adverse effects in the whole gastrointestinal tract. In this setting, co-therapy with a proton pump inhibitor is the most accepted strategy to reduce aspirin related upper gastrointestinal damage. In addition, some adverse effects have been described with proton pump inhibitors long term use. Areas covered: Low-dose aspirin related beneficial and adverse effects in cardiovascular system and gastrointestinal tract are reviewed. In addition, this manuscript summarizes current data on upper gastrointestinal damage prevention and adverse events with proton pump inhibition. Finally, we discuss the benefit/risk ratio of proton pump inhibitor use in patients at risk of gastrointestinal damage taking low-dose aspirin. Expert commentary: Nowadays, with the current available evidence, the combination of low-dose aspirin with proton pump inhibitor is the most effective therapy for cardiovascular prevention in patients at high gastrointestinal risk. However, further studies are needed to discover new effective strategies with less related adverse events.

The Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE): study protocol for a cluster randomised controlled trial.

PubMed

White, David; Waugh, Norman; Elliott, Jackie; Lawton, Julia; Barnard, Katharine; Campbell, Michael J; Dixon, Simon; Heller, Simon

2014-09-03

People with type 1 diabetes (T1DM) require insulin therapy to sustain life, and need optimal glycaemic control to prevent diabetic ketoacidosis and serious long-term complications. Insulin is generally administered using multiple daily injections but can also be delivered using an infusion pump (continuous subcutaneous insulin infusion), a more costly option with benefits for some patients. The UK National Institute for Health and Care Excellence (NICE) recommend the use of pumps for patients with the greatest need, citing insufficient evidence to approve extension to a wider population. Far fewer UK adults use pumps than in comparable countries. Previous trials of pump therapy have been small and of short duration and failed to control for training in insulin adjustment. This paper describes the protocol for a large randomised controlled trial comparing pump therapy with multiple daily injections, where both groups are provided with high-quality structured education. A multicentre, parallel group, cluster randomised controlled trial among 280 adults with T1DM. All participants attended the week-long dose adjustment for normal eating (DAFNE) structured education course, and receive either multiple daily injections or pump therapy for 2 years. The trial incorporates a detailed mixed-methods psychosocial evaluation and cost-effectiveness analysis. The primary outcome will be the change in glycosylated haemoglobin (HbA1c) at 24 months in those participants whose baseline HbA1c is at or above 7.5% (58 mmol/mol). The key secondary outcome will be the proportion of participants reaching the NICE target of an HbA1c of 7.5% (58 mmol/mol) or less at 24 months. The protocol was approved by the Research Ethics Committee North West, Liverpool East and received Medicines and Healthcare products Regulatory Agency (MHRA) clinical trials authorisation. Each participating centre gave National Health Service R&D approval. We shall disseminate study findings to study participants and through peer reviewed publications and conference presentations, including lay user groups. ISRCTN 61215213. 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.

A Randomized Controlled Trial of Cognitive-Behavioral Therapy for Generalized Anxiety Disorder with Integrated Techniques from Emotion-Focused and Interpersonal Therapies

ERIC Educational Resources Information Center

Newman, Michelle G.; Castonguay, Louis G.; Borkovec, Thomas D.; Fisher, Aaron J.; Boswell, James F.; Szkodny, Lauren E.; Nordberg, Samuel S.

2011-01-01

Objective: Recent models suggest that generalized anxiety disorder (GAD) symptoms may be maintained by emotional processing avoidance and interpersonal problems. Method: This is the first randomized controlled trial to test directly whether cognitive-behavioral therapy (CBT) could be augmented with the addition of a module targeting interpersonal…

Intrathecal Baclofen Therapy for the Treatment of Spasticity in Sjögren-Larsson Syndrome.

PubMed

Hidalgo, Eveline Teresa; Orillac, Cordelia; Hersh, Andrew; Harter, David H; Rizzo, William B; Weiner, Howard L

2017-01-01

Intrathecal baclofen therapy is widely accepted as a treatment option for patients with severe spasticity. The current treatment of spasticity in patients with Sjögren-Larsson syndrome is largely symptomatic, given that no effective causal therapy treatments are available. We report the outcome of 2 patients with Sjögren-Larsson syndrome who had pump implantation for intrathecal baclofen. We observed a positive response, with a decrease of spasticity, reflecting in the Modified Ashworth Scale, and parents and caregivers observed a functional improvement in both patients. One patient experienced skin irritation 15 months after surgery, necessitating pump repositioning. No infection occurred. Our report shows that intrathecal baclofen therapy can have a positive therapeutic effect on spasticity in patients with Sjögren-Larsson syndrome, and therefore may be a promising addition to current treatments.

AAFES Gas Station at Creech Air Force Base Environmental Assessment

DTIC Science & Technology

2009-07-01

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

Thermal analysis and experimental study of end-pumped Nd: YLF laser at 1053 nm

NASA Astrophysics Data System (ADS)

El-Agmy, R. M.; Al-Hosiny, N.

2017-12-01

We have numerically analyzed the thermal effects in Nd: YLF laser rod. The calculations of temperature and stress distributions in the Nd: YLF laser rod was performed with finite element (FE) simulations. The calculations showed that the laser rod could be pumped up to a power of 40 W without fracture caused by thermal stress. The calculated thermal lens power of thermally induced lens in Nd: YLF ( σ-polarization) laser rod was analyzed and validated experimentally with two independent techniques. A Shack-Hartmann wavefront sensor and a Mach-Zehnder interferometer were used for direct measurements of focal thermal lens at different pump powers. The obtained measurements were coinciding with the FE simulations.