Science.gov

Sample records for severe blast impact

  1. Impact of complex blast waves on the human head: a computational study.

    PubMed

    Tan, Long Bin; Chew, Fatt Siong; Tse, Kwong Ming; Chye Tan, Vincent Beng; Lee, Heow Pueh

    2014-12-01

    Head injuries due to complex blasts are not well examined because of limited published articles on the subject. Previous studies have analyzed head injuries due to impact from a single planar blast wave. Complex or concomitant blasts refer to impacts usually caused by more than a single blast source, whereby the blast waves may impact the head simultaneously or consecutively, depending on the locations and distances of the blast sources from the subject, their blast intensities, the sequence of detonations, as well as the effect of blast wave reflections from rigid walls. It is expected that such scenarios will result in more serious head injuries as compared to impact from a single blast wave due to the larger effective duration of the blast. In this paper, the utilization of a head-helmet model for blast impact analyses in Abaqus(TM) (Dassault Systemes, Singapore) is demonstrated. The model is validated against studies published in the literature. Results show that the skull is capable of transmitting the blast impact to cause high intracranial pressures (ICPs). In addition, the pressure wave from a frontal blast may enter through the sides of the helmet and wrap around the head to result in a second impact at the rear. This study recommended better protection at the sides and rear of the helmet through the use of foam pads so as to reduce wave entry into the helmet. The consecutive frontal blasts scenario resulted in higher ICPs compared with impact from a single frontal blast. This implied that blast impingement from an immediate subsequent pressure wave would increase severity of brain injury. For the unhelmeted head case, a peak ICP of 330 kPa is registered at the parietal lobe which exceeds the 235 kPa threshold for serious head injuries. The concurrent front and side blasts scenario yielded lower ICPs and skull stresses than the consecutive frontal blasts case. It is also revealed that the additional side blast would only significantly affect ICPs at

  2. Intrathoracic pressure variations in an anthropomorphic dummy exposed to air blast, blunt impact, and missiles.

    PubMed

    Jönsson, A; Arvebo, E; Schantz, B

    1988-01-01

    Experiments with an anthropomorphic dummy for blast research demonstrated that pressures recorded in the lung model of the dummy could be correlated to primary air blast effects on the lungs of experimental animals. The results presented here were obtained with a dummy of the type mentioned above, but with the lung model modified to improve geometric similarity to man. Blast experiments were performed in a shock tube, and impact experiments in a special impact machine. Experiments with nonpenetrating missiles were performed with small-caliber firearms and the dummy protected by body armor. Severity indices derived from the blast experiments were related to established criteria for primary lung injury in man. Impacts delivered in the impact machine and by nonpenetrating missiles are compared. Relationships between severity of impact based on experiments with animals and primary lung injury in man are discussed.

  3. Blast noise impacts on sleep

    NASA Astrophysics Data System (ADS)

    Nykaza, Edward T.; Pater, Larry L.

    2005-04-01

    Firing large guns during the hours of darkness is essential to combat readiness for the military. At the same time most people are particularly sensitive to noise when sleeping or trying to fall asleep. Laboratory studies done by Griefahn [J. Sound and Vib. 128, 109-119 (1989)] and Luz [see Luz et al., ERDC/CERL, TR-04-26 (2004)] suggest that a time period at night may exist where people are more tolerant to large weapon impulse noise (blast noise) and therefore, are less likely to be awakened from noise events. In the fall of 2004, a field study was conducted around a military installation to determine if such a time period(s) exists. Noise monitors were set up inside and outside of residents homes to record noise levels from live military training activities and actimeters were worn by participants sleeping their natural environment to measure sleep disturbance and awakening. The method and results of this study will be presented. [Work supported by US Army Engineer Research and Development Center CERL.

  4. Impact and Blast Resistance of Sandwich Plates

    NASA Astrophysics Data System (ADS)

    Dvorak, George J.; Bahei-El-Din, Yehia A.; Suvorov, Alexander P.

    Response of conventional and modified sandwich plate designs is examined under static load, impact by a rigid cylindrical or flat indenter, and during and after an exponential pressure impulse lasting for 0.05 ms, at peak pressure of 100 MPa, simulating a nearby explosion. The conventional sandwich design consists of thin outer (loaded side) and inner facesheets made of carbon/epoxy fibrous laminates, separated by a thick layer of structural foam core. In the three modified designs, one or two thin ductile interlayers are inserted between the outer facesheet and the foam core. Materials selected for the interlayers are a hyperelas-tic rate-independent polyurethane;a compression strain and strain rate dependent, elastic-plastic polyurea;and an elastomeric foam. ABAQUS and LS-Dyna software were used in various response simulations. Performance comparisons between the enhanced and conventional designs show that the modified designs provide much better protection against different damage modes under both load regimes. After impact, local facesheet deflection, core compression, and energy release rate of delamination cracks, which may extend on hidden interfaces between facesheet and core, are all reduced. Under blast or impulse loads, reductions have been observed in the extent of core crushing, facesheet delaminations and vibration amplitudes, and in overall deflections. Similar reductions were found in the kinetic energy and in the stored and dissipated strain energy. Although strain rates as high as 10-4/s1 are produced by the blast pressure, peak strains in the interlayers were too low to raise the flow stress in the polyurea to that in the polyurethane, where a possible rate-dependent response was neglected. Therefore, stiff polyurethane or hard rubber interlayers materials should be used for protection of sandwich plate foam cores against both impact and blast-induced damage.

  5. Injury biomechanics, neuropathology, and simplified physics of explosive blast and impact mild traumatic brain injury.

    PubMed

    Bandak, F A; Ling, G; Bandak, A; De Lanerolle, N C

    2015-01-01

    Explosive blast shock waves and blunt impact to the head are two types of loading shown to result in mild traumatic brain injury (mTBI). While mTBI from these two causes shares some common features behaviorally, there are distinct differences in the pathophysiology of the underlying injury mechanisms. Various elucidations have been offered in the literature to explain the organic damage associated with mTBI resulting from both types of loading. The current state of understanding in this field is somewhat limited by the degree of appreciation of the physics and biomechanics governing the effects of explosive blast shock waves and blunt impact on the head, which has resulted in the various approaches to the investigation of the operative brain injury "wounding mechanisms". In this chapter we provide a simplified description of terminology associated with forces on the head from explosive blast shock waves and blunt impact, to assist readers in the field in evaluating interpretations of brain injury "wounding" processes. Remarkably, mTBI from either loading is shown generally to result in only a small loss of neurons, with hippocampal neurons appearing to be particularly vulnerable to explosive blast shock waves. Explosive blast studies in large animal models show a unique pattern of periventricular injury, which is different from the classic diffuse axonal injury. Both astrocyte and microglial activation are also seen in explosive blast as well as impact trauma, but this may be a general secondary brain injury response, nonspecific to explosive blast or blunt trauma. Additionally, while moderate to severe impact closed head injuries sometimes result in petechial hemorrhages or hematomas, they do not appear to be associated with explosive blast mTBI even with repeated exposure to blasts.

  6. Design of armor for protection against blast and impact

    NASA Astrophysics Data System (ADS)

    Rahimzadeh, Tanaz; Arruda, Ellen M.; Thouless, M. D.

    2015-12-01

    The features of blast and impact that can damage a delicate target supported by a structure include both the peak pressure and the impulse delivered to the structure. This study examines how layers of elastic and visco-elastic materials may be assembled to mitigate these features. The impedance mismatch between two elastic layers is known to reduce the pressure, but dissipation is required to mitigate the transmitted impulse in light-weight armor. A novel design concept called impact or blast tuning is introduced in which a multi-layered armor is used to tune the stress waves resulting from an impact or blast to specific frequencies that match the damping frequencies of visco-elastic layers. The material and geometrical parameters controlling the viscous dissipation of the energy within the armor are identified for a simplified one-dimensional system, to provide insight into how the optimal design of multi-use armor might be based on this concept.

  7. Physical Modelling of Mine Blast Impact on Armoured Vehicles

    NASA Astrophysics Data System (ADS)

    Bochorishvili, Nika; Chikhradze, Nikoloz; Mataradze, Edgar; Akhvlediani, Irakli

    2016-10-01

    Studies related to the impact of a mine blast on armoured vehicles focus on aspects such as i) dynamic loads acting on the armoured vehicle at the moment of mine blast; ii) armoured vehicle response under the impact of a dynamic load; iii) dynamic loads acting on the crew and the assessment of potential human traumas. The paper presents similarity criteria for physical modelling of the mine blast under the armoured vehicle and the results of modelling of dynamic behaviour of vehicles. Similarity criteria, established as a result of the analysis of the governing parameters and similarity theory, are adequate to the processes of blast impact on the vehicle. Modelling experiments were conducted in the underground experimental base of the Mining Institute especially designed for the study of explosion processes. Physical modelling can be used for preliminary studies with the purpose of the evaluation of the protective level of armoured vehicles as well as for pre-testing experiments in accordance with STANAG 4569 requirements.

  8. Air blasts generated by rockfall impacts: Analysis of the 1996 Happy Isles event in Yosemite National Park

    USGS Publications Warehouse

    Morrissey, M.M.; Savage, W.Z.; Wieczorek, G.F.

    1999-01-01

    The July 10, 1996, Happy Isles rockfall in Yosemite National Park, California, released 23,000 to 38,000 m3 of granite in four separate events. The impacts of the first two events which involved a 550-m free fall, generated seismic waves and atmospheric pressure waves (air blasts). We focus on the dynamic behavior of the second air blast that downed over 1000 trees, destroyed a bridge, demolished a snack bar, and caused one fatality and several injuries. Calculated velocities for the air blast from a two-phase, finite difference model are compared to velocities estimated from tree damage. From tornadic studies of tree damage, the air blast is estimated to have traveled <108-120 m/s within 50 m from the impact and decreased to <10-20 m/s within 500 m from the impact. The numerical model simulates the two-dimensional propagation of an air blast through a dusty atmosphere with initial conditions defined by the impact velocity and pressure. The impact velocity (105-107 m/s) is estimated from the Colorado Rockfall Simulation Program that simulates rockfall trajectories. The impact pressure (0.5 MPa) is constrained by the kinetic energy of the impact (1010-1012 J) estimated from the seismic energy generated by the impact. Results from the air blast simulations indicate that the second Happy Isles air blast (weak shock wave) traveled with an initial velocity above the local sound speed. The size and location of the first impact are thought to have injected <50 wt % dust into the atmosphere. This amount of dust lowered the local atmospheric sound speed to ???220 m/s. The discrepancy between calculated velocity data and field estimated velocity data (???220 m/s versus ???110 m/s) is attributed to energy dissipated by the downing of trees and additional entrainment of debris into the atmosphere not included in the calculations. Copyright 1999 by the American Geophysical Union.

  9. Air blasts generated by rockfall impacts: Analysis of the 1996 Happy Isles event in Yosemite National Park

    NASA Astrophysics Data System (ADS)

    Morrissey, M. M.; Savage, W. Z.; Wieczorek, G. F.

    1999-10-01

    The July 10, 1996, Happy Isles rockfall in Yosemite National Park, California, released 23,000 to 38,000 m3 of granite in four separate events. The impacts of the first two events which involved a 550-m free fall, generated seismic waves and atmospheric pressure waves (air blasts). We focus on the dynamic behavior of the second air blast that downed over 1000 trees, destroyed a bridge, demolished a snack bar, and caused one fatality and several injuries. Calculated velocities for the air blast from a two-phase, finite difference model are compared to velocities estimated from tree damage. From tornadic studies of tree damage, the air blast is estimated to have traveled <108-120 m/s within 50 m from the impact and decreased to <10-20 m/s within 500 m from the impact. The numerical model simulates the two-dimensional propagation of an air blast through a dusty atmosphere with initial conditions defined by the impact velocity and pressure. The impact velocity (105-107 m/s) is estimated from the Colorado Rockfall Simulation Program that simulates rockfall trajectories. The impact pressure (0.5 MPa) is constrained by the kinetic energy of the impact (1010-1012 J) estimated from the seismic energy generated by the impact. Results from the air blast simulations indicate that the second Happy Isles air blast (weak shock wave) traveled with an initial velocity above the local sound speed. The size and location of the first impact are thought to have injected <50 wt% dust into the atmosphere. This amount of dust lowered the local atmospheric sound speed to ˜220 m/s. The discrepancy between calculated velocity data and field estimated velocity data (˜220 m/s versus ˜110 m/s) is attributed to energy dissipated by the downing of trees and additional entrainment of debris into the atmosphere not included in the calculations.

  10. Functional Status after Blast-Plus-Impact Complex Concussive Traumatic Brain Injury in Evacuated United States Military Personnel

    PubMed Central

    MacDonald, Christine L.; Johnson, Ann M.; Nelson, Elliot C.; Werner, Nicole J.; Fang, Raymond; Flaherty, Stephen F.

    2014-01-01

    Abstract Fundamental questions remain unanswered about the longitudinal impact of blast-plus-impact complex traumatic brain injuries (TBI) from wars in Iraq and Afghanistan. This prospective, observational study investigated measures of clinical outcome in US military personnel evacuated to Landstuhl Regional Medical Center (LRMC) in Germany after such “blast-plus” concussive TBIs. Glasgow Outcome Scale-Extended assessments completed 6–12 months after injury indicated a moderate overall disability in 41/47 (87%) blast-plus TBI subjects and a substantial but smaller number (11/18, 61%, p=0.018) of demographically similar US military controls without TBI evacuated for other medical reasons. Cognitive function assessed with a neuropsychological test battery was not different between blast-plus TBI subjects and controls; performance of both groups was generally in the normal range. No subject was found to have focal neurological deficits. However, 29/47 (57%) of blast-plus subjects with TBI met all criteria for post-traumatic stress disorder (PTSD) versus 5/18 (28%) of controls (p=0.014). PTSD was highly associated with overall disability; 31/34 patients with PTSD versus 19/31 patients who did not meet full PTSD criteria had moderate to severe disability (p=0.0003). Symptoms of depression were also more severe in the TBI group (p=0.05), and highly correlated with PTSD severity (r=0.86, p<0.0001). Thus, in summary, high rates of PTSD and depression but not cognitive impairment or focal neurological deficits were observed 6–12 months after concussive blast-plus-impact complex TBI. Overall disability was substantially greater than typically reported in civilian non-blast concussive (“mild”) patients with TBI, even with polytrauma. The relationship between these clinical outcomes and specific blast-related aspects of brain injuries versus other combat-related factors remains unknown. PMID:24367929

  11. Functional status after blast-plus-impact complex concussive traumatic brain injury in evacuated United States military personnel.

    PubMed

    MacDonald, Christine L; Johnson, Ann M; Nelson, Elliot C; Werner, Nicole J; Fang, Raymond; Flaherty, Stephen F; Brody, David L

    2014-05-15

    Fundamental questions remain unanswered about the longitudinal impact of blast-plus-impact complex traumatic brain injuries (TBI) from wars in Iraq and Afghanistan. This prospective, observational study investigated measures of clinical outcome in US military personnel evacuated to Landstuhl Regional Medical Center (LRMC) in Germany after such "blast-plus" concussive TBIs. Glasgow Outcome Scale-Extended assessments completed 6-12 months after injury indicated a moderate overall disability in 41/47 (87%) blast-plus TBI subjects and a substantial but smaller number (11/18, 61%, p=0.018) of demographically similar US military controls without TBI evacuated for other medical reasons. Cognitive function assessed with a neuropsychological test battery was not different between blast-plus TBI subjects and controls; performance of both groups was generally in the normal range. No subject was found to have focal neurological deficits. However, 29/47 (57%) of blast-plus subjects with TBI met all criteria for post-traumatic stress disorder (PTSD) versus 5/18 (28%) of controls (p=0.014). PTSD was highly associated with overall disability; 31/34 patients with PTSD versus 19/31 patients who did not meet full PTSD criteria had moderate to severe disability (p=0.0003). Symptoms of depression were also more severe in the TBI group (p=0.05), and highly correlated with PTSD severity (r=0.86, p<0.0001). Thus, in summary, high rates of PTSD and depression but not cognitive impairment or focal neurological deficits were observed 6-12 months after concussive blast-plus-impact complex TBI. Overall disability was substantially greater than typically reported in civilian non-blast concussive ("mild") patients with TBI, even with polytrauma. The relationship between these clinical outcomes and specific blast-related aspects of brain injuries versus other combat-related factors remains unknown.

  12. Combat Blast Injuries: Injury Severity and Posttraumatic Stress Disorder Interaction on Career Outcomes in Male Servicemembers

    DTIC Science & Technology

    2013-01-01

    Naval Health Research Center Combat Blast Injuries: Injury Severity and Posttraumatic Stress Disorder Interaction on Career Outcomes in Male...injuries: Injury severity and posttraumatic stress disorder interaction on career outcomes in male servicemembers Susan L. Eskridge, PT, PhD;1...proportions were higher in those with posttraumatic stress disorder (PTSD) than in those without PTSD. There was a significant interaction between PTSD

  13. Primary blast causes mild, moderate, severe and lethal TBI with increasing blast overpressures: Experimental rat injury model

    NASA Astrophysics Data System (ADS)

    Mishra, Vikas; Skotak, Maciej; Schuetz, Heather; Heller, Abi; Haorah, James; Chandra, Namas

    2016-06-01

    Injury severity in blast induced Traumatic Brain Injury (bTBI) increases with blast overpressure (BOP) and impulse in dose-dependent manner. Pure primary blast waves were simulated in compressed gas shock-tubes in discrete increments. Present work demonstrates 24 hour survival of rats in 0–450 kPa (0–800 Pa•s impulse) range at 10 discrete levels (60, 100, 130, 160, 190, 230, 250, 290, 350 and 420 kPa) and determines the mortality rate as a non-linear function of BOP. Using logistic regression model, predicted mortality rate (PMR) function was calculated, and used to establish TBI severities. We determined a BOP of 145 kPa as upper mild TBI threshold (5% PMR). Also we determined 146–220 kPa and 221–290 kPa levels as moderate and severe TBI based on 35%, and 70% PMR, respectively, while BOP above 290 kPa is lethal. Since there are no standards for animal bTBI injury severity, these thresholds need further refinements using histopathology, immunohistochemistry and behavior. Further, we specifically investigated mild TBI range (0–145 kPa) using physiological (heart rate), pathological (lung injury), immuno-histochemical (oxidative/nitrosative and blood-brain barrier markers) as well as blood borne biomarkers. With these additional data, we conclude that mild bTBI occurs in rats when the BOP is in the range of 85–145 kPa.

  14. Primary blast causes mild, moderate, severe and lethal TBI with increasing blast overpressures: Experimental rat injury model

    PubMed Central

    Mishra, Vikas; Skotak, Maciej; Schuetz, Heather; Heller, Abi; Haorah, James; Chandra, Namas

    2016-01-01

    Injury severity in blast induced Traumatic Brain Injury (bTBI) increases with blast overpressure (BOP) and impulse in dose-dependent manner. Pure primary blast waves were simulated in compressed gas shock-tubes in discrete increments. Present work demonstrates 24 hour survival of rats in 0–450 kPa (0–800 Pa∙s impulse) range at 10 discrete levels (60, 100, 130, 160, 190, 230, 250, 290, 350 and 420 kPa) and determines the mortality rate as a non-linear function of BOP. Using logistic regression model, predicted mortality rate (PMR) function was calculated, and used to establish TBI severities. We determined a BOP of 145 kPa as upper mild TBI threshold (5% PMR). Also we determined 146–220 kPa and 221–290 kPa levels as moderate and severe TBI based on 35%, and 70% PMR, respectively, while BOP above 290 kPa is lethal. Since there are no standards for animal bTBI injury severity, these thresholds need further refinements using histopathology, immunohistochemistry and behavior. Further, we specifically investigated mild TBI range (0–145 kPa) using physiological (heart rate), pathological (lung injury), immuno-histochemical (oxidative/nitrosative and blood-brain barrier markers) as well as blood borne biomarkers. With these additional data, we conclude that mild bTBI occurs in rats when the BOP is in the range of 85–145 kPa. PMID:27270403

  15. Impact of Moderate Blast Exposures on Thrombin Biomarkers Assessed by Calibrated Automated Thrombography in Rats

    PubMed Central

    Serebruany, Victor L.; Svetlov, Artem; Hayes, Ronald L.

    2013-01-01

    Abstract Severe blast exposures are frequently complicated with fatal intracranial hemorrhages. However, many more sustain low level blasts without tissue damage detectable by brain imaging. To investigate effects of nonlethal blast on thrombin-related biomarkers, rats were subjected to two different types of head-directed blast: 1) moderate “composite” blast with strong head acceleration or 2) moderate primary blast, without head acceleration. Thrombin generation (TG) ex vivo after blast was studied by calibrated automated thrombography (CAT). In the same blood samples, we assessed maximal concentration of TG (TGmax), start time, peak time, mean time, and concentrations of protein markers for vascular/hemostatic dysfunctions: integrin α/β, soluble endothelial selectin (sE-selectin), soluble intercellular cell adhesion molecule-1 (sICAM-1), and matrix metalloproteinases (MMP)-2, MMP-8, and MMP-13. Blast remarkably affected all TG indices. In animals exposed to “composite” blast, TGmax peaked at 6 h (∼4.5-fold vs. control), sustained at day 1 (∼3.8-fold increase), and declined to a 2-fold increase over control at day 7 post-blast. After primary blast, TGmax also rose to ∼4.2-fold of control at 6 h, dropped to ∼1.7-fold of control at day 1, and then exhibited a slight secondary increase at 2-fold of control at day 7. Other TG indices did not differ significantly between two types of blast exposure. The changes were also observed in other microvascular/inflammatory/hemostatic biomarkers. Integrin α/β and sICAM-1 levels were elevated after both “composite” and primary blast at 6 h, 1 day, and 7 days. sE-selectin exhibited near normal levels after “composite” blast, but increased significantly at 7 days after primary blast; MMP-2, MMP-8, and MMP-13 slightly rose after “composite” blast and significantly increased (∼2-4-fold) after primary blast. In summary, CAT may have a clinical diagnostic utility in combination with selected

  16. Economic and Environmental Impact of Rice Blast Pathogen (Magnaporthe oryzae) Alleviation in the United States

    PubMed Central

    2016-01-01

    Rice blast (Magnaporthe oryzae) is a key concern in combating global food insecurity given the disease is responsible for approximately 30% of rice production losses globally—the equivalent of feeding 60 million people. These losses increase the global rice price and reduce consumer welfare and food security. Rice is the staple crop for more than half the world’s population so any reduction in rice blast would have substantial beneficial effects on consumer livelihoods. In 2012, researchers in the US began analyzing the feasibility of creating blast-resistant rice through cisgenic breeding. Correspondingly, our study evaluates the changes in producer, consumer, and environmental welfare, if all the rice produced in the Mid-South of the US were blast resistant through a process like cisgenics, using both international trade and environmental assessment modeling. Our results show that US rice producers would gain 69.34 million dollars annually and increase the rice supply to feed an additional one million consumers globally by eliminating blast from production in the Mid-South. These results suggest that blast alleviation could be even more significant in increasing global food security given that the US is a small rice producer by global standards and likely experiences lower losses from blast than other rice-producing countries because of its ongoing investment in production technology and management. Furthermore, results from our detailed life cycle assessment (LCA) show that producing blast-resistant rice has lower environmental (fossil fuel depletion, ecotoxicity, carcinogenics, eutrophication, acidification, global warming potential, and ozone depletion) impacts per unit of rice than non-blast resistant rice production. Our findings suggest that any reduction in blast via breeding will have significantly positive impacts on reducing global food insecurity through increased supply, as well as decreased price and environmental impacts in production. PMID

  17. Economic and Environmental Impact of Rice Blast Pathogen (Magnaporthe oryzae) Alleviation in the United States.

    PubMed

    Nalley, Lawton; Tsiboe, Francis; Durand-Morat, Alvaro; Shew, Aaron; Thoma, Greg

    2016-01-01

    Rice blast (Magnaporthe oryzae) is a key concern in combating global food insecurity given the disease is responsible for approximately 30% of rice production losses globally-the equivalent of feeding 60 million people. These losses increase the global rice price and reduce consumer welfare and food security. Rice is the staple crop for more than half the world's population so any reduction in rice blast would have substantial beneficial effects on consumer livelihoods. In 2012, researchers in the US began analyzing the feasibility of creating blast-resistant rice through cisgenic breeding. Correspondingly, our study evaluates the changes in producer, consumer, and environmental welfare, if all the rice produced in the Mid-South of the US were blast resistant through a process like cisgenics, using both international trade and environmental assessment modeling. Our results show that US rice producers would gain 69.34 million dollars annually and increase the rice supply to feed an additional one million consumers globally by eliminating blast from production in the Mid-South. These results suggest that blast alleviation could be even more significant in increasing global food security given that the US is a small rice producer by global standards and likely experiences lower losses from blast than other rice-producing countries because of its ongoing investment in production technology and management. Furthermore, results from our detailed life cycle assessment (LCA) show that producing blast-resistant rice has lower environmental (fossil fuel depletion, ecotoxicity, carcinogenics, eutrophication, acidification, global warming potential, and ozone depletion) impacts per unit of rice than non-blast resistant rice production. Our findings suggest that any reduction in blast via breeding will have significantly positive impacts on reducing global food insecurity through increased supply, as well as decreased price and environmental impacts in production.

  18. Osteolytic bone lesions, severe hypercalcemia without circulating blasts: unusual presentation of childhood acute lymphoblastic leukemia.

    PubMed

    Bechir, Achour; Haifa, Regaieg; Atef, Ben Abdelkader; Emna, Bouslema; Asma, Achour; Nesrine, Ben Sayed; Yosra, Ben Youssef; Abdrrahim, Khelif

    2017-01-01

    Hypercalcemia and severe osteolytic lesions are rare complications of acute lymphoblastic leukemia (ALL) in childhood. We report a case of a 3 years old boy who presented with prolonged fever, nausea, vomiting and increasing lower limbs pain. Skeletal X-rays and CT scan showed severe osteolytic lesions of the skull and extremities. Her physical examination showed multiple cervical lymph nodes. In laboratory tests, he had severe hypercalcemia. Parathyroid hormone (PTH) was not elevated. Despite the absence of circulating blasts, bone marrow biopsy revealed B-precursor (ALL). Hypercalcemia was initially treated with intravenous isotonic sodium chloride solution and diuretics but the serum calcium level normalized only after the beginning of corticosteroids and chemotherapy. The child responded initially to chemotherapy and eventually relapsed and died of septic shock. Acute leukemia must be considered in differential diagnosis in patients with hypercalcemia. A detailed examination even when there no circulating blasts in their peripheral blood smear, and if in doubt bone marrow aspiration should must be taken into consideration.

  19. Osteolytic bone lesions, severe hypercalcemia without circulating blasts: unusual presentation of childhood acute lymphoblastic leukemia

    PubMed Central

    Bechir, Achour; Haifa, Regaieg; Atef, Ben Abdelkader; Emna, Bouslema; Asma, Achour; Nesrine, Ben Sayed; Yosra, Ben Youssef; Abdrrahim, Khelif

    2017-01-01

    Hypercalcemia and severe osteolytic lesions are rare complications of acute lymphoblastic leukemia (ALL) in childhood. We report a case of a 3 years old boy who presented with prolonged fever, nausea, vomiting and increasing lower limbs pain. Skeletal X-rays and CT scan showed severe osteolytic lesions of the skull and extremities. Her physical examination showed multiple cervical lymph nodes. In laboratory tests, he had severe hypercalcemia. Parathyroid hormone (PTH) was not elevated. Despite the absence of circulating blasts, bone marrow biopsy revealed B-precursor (ALL). Hypercalcemia was initially treated with intravenous isotonic sodium chloride solution and diuretics but the serum calcium level normalized only after the beginning of corticosteroids and chemotherapy. The child responded initially to chemotherapy and eventually relapsed and died of septic shock. Acute leukemia must be considered in differential diagnosis in patients with hypercalcemia. A detailed examination even when there no circulating blasts in their peripheral blood smear, and if in doubt bone marrow aspiration should must be taken into consideration. PMID:28690758

  20. Changes in blast zone albedo patterns around new martian impact craters

    NASA Astrophysics Data System (ADS)

    Daubar, I. J.; Dundas, C. M.; Byrne, S.; Geissler, P.; Bart, G. D.; McEwen, A. S.; Russell, P. S.; Chojnacki, M.; Golombek, M. P.

    2016-03-01

    "Blast zones" (BZs) around new martian craters comprise various albedo features caused by the initial impact, including diffuse halos, extended linear and arcuate rays, secondary craters, ejecta patterns, and dust avalanches. We examined these features for changes in repeat images separated by up to four Mars years. Here we present the first comprehensive survey of the qualitative and quantitative changes observed in impact blast zones over time. Such changes are most likely due to airfall of high-albedo dust restoring darkened areas to their original albedo, the albedo of adjacent non-impacted surfaces. Although some sites show drastic changes over short timescales, nearly half of the sites show no obvious changes over several Mars years. Albedo changes are more likely to occur at higher-latitude sites, lower-elevation sites, and at sites with smaller central craters. No correlation was seen between amount of change and Dust Cover Index, relative halo size, or historical regional albedo changes. Quantitative albedo measurements of the diffuse dark halos relative to their surroundings yielded estimates of fading lifetimes for these features. The average lifetime among sites with measurable fading is ∼15 Mars years; the median is ∼8 Mars years for a linear brightening. However, at approximately half of sites with three or more repeat images, a nonlinear function with rapid initial fading followed by a slow increase in albedo provides a better fit to the fading behavior; this would predict even longer lifetimes. The predicted lifetimes of BZs are comparable to those of slope streaks, and considered representative of fading by global atmospheric dust deposition; they last significantly longer than dust devil or rover tracks, albedo features that are erased by different processes. These relatively long lifetimes indicate that the measurement of the current impact rate by Daubar et al. (Daubar, I.J. et al. [2013]. Icarus 225, 506-516. http://dx.doi.org/10.1016/j

  1. Numerical simulation of the blast impact problem using the Direct Simulation Monte Carlo (DSMC) method

    NASA Astrophysics Data System (ADS)

    Sharma, Anupam; Long, Lyle N.

    2004-10-01

    A particle approach using the Direct Simulation Monte Carlo (DSMC) method is used to solve the problem of blast impact with structures. A novel approach to model the solid boundary condition for particle methods is presented. The solver is validated against an analytical solution of the Riemann shocktube problem and against experiments on interaction of a planar shock with a square cavity. Blast impact simulations are performed for two model shapes, a box and an I-shaped beam, assuming that the solid body does not deform. The solver uses domain decomposition technique to run in parallel. The parallel performance of the solver on two Beowulf clusters is also presented.

  2. Several wall-associated kinases participate positively and negatively in basal defense against rice blast fungus.

    PubMed

    Delteil, Amandine; Gobbato, Enrico; Cayrol, Bastien; Estevan, Joan; Michel-Romiti, Corinne; Dievart, Anne; Kroj, Thomas; Morel, J-B

    2016-01-16

    Receptor-like kinases are well-known to play key roles in disease resistance. Among them, the Wall-associated kinases (WAKs) have been shown to be positive regulators of fungal disease resistance in several plant species. WAK genes are often transcriptionally regulated during infection but the pathways involved in this regulation are not known. In rice, the OsWAK gene family is significantly amplified compared to Arabidopsis. The possibility that several WAKs participate in different ways to basal defense has not been addressed. Moreover, the direct requirement of rice OSWAK genes in regulating defense has not been explored. Here we show using rice (Oryza sativa) loss-of-function mutants of four selected OsWAK genes, that individual OsWAKs are required for quantitative resistance to the rice blast fungus, Magnaporthe oryzae. While OsWAK14, OsWAK91 and OsWAK92 positively regulate quantitative resistance, OsWAK112d is a negative regulator of blast resistance. In addition, we show that the very early transcriptional regulation of the rice OsWAK genes is triggered by chitin and is partially under the control of the chitin receptor CEBiP. Finally, we show that OsWAK91 is required for H2O2 production and sufficient to enhance defense gene expression during infection. We conclude that the rice OsWAK genes studied are part of basal defense response, potentially mediated by chitin from fungal cell walls. This work also shows that some OsWAKs, like OsWAK112d, may act as negative regulators of disease resistance.

  3. Blast impact behaviour of concrete with different fibre reinforcement

    NASA Astrophysics Data System (ADS)

    Drdlová, Martina; Čechmánek, René; Řídký, Radek

    2015-09-01

    The paper summarizes the results of the development of special concrete intended for the explosion resistance applications, with the emphasis on minimal secondary fragments formation at the explosion. The fine-grained concrete matrix has been reinforced by various types of short dispersed fibers (metallic, mineral and polymer) of different sizes and by their combination and the effect of the fibre reinforcement on the physico-mechanical properties and blast resistance was observed. The concrete prism specimens have been subjected to the determination of mechanical parameters (compressive and flexural strength at quasi-static load). The blast tests were conducted on the slab specimens prepared from selected mixtures. The material characteristics and explosion test data have been used for numerical investigation, which defined the optimal wall composition and dimensions of the concrete element which should resist the explosion defined by type, size, weight and placement of the blast. In the next step the test elements resistance was verified by real explosion test.

  4. Blast-related mild traumatic brain injury: mechanisms of injury and impact on clinical care.

    PubMed

    Elder, Gregory A; Cristian, Adrian

    2009-04-01

    Mild traumatic brain injury has been called the signature injury of the wars in Iraq and Afghanistan. In both theaters of operation, traumatic brain injury has been a significant cause of mortality and morbidity, with blast-related injury the most common cause. Improvised explosive devices have been the major cause of blast injuries. It is estimated that 10% to 20% of veterans returning from these operations have suffered a traumatic brain injury, and there is concern that blast-related injury may produce adverse long-term health affects and affect the resilience and in-theater performance of troops. Blast-related injury occurs through several mechanisms related to the nature of the blast overpressure wave itself as well as secondary and tertiary injuries. Animal studies clearly show that blast overpressure waves are transmitted to the brain and can cause changes that neuropathologically are most similar to diffuse axonal injury. One striking feature of the mild traumatic brain injury cases being seen in veterans of the wars in Iraq and Afghanistan is the high association of mild traumatic brain injury with posttraumatic stress disorder. The overlap in symptoms between the disorders has made distinguishing them clinically challenging. The high rates of mild traumatic brain injury and posttraumatic stress disorder in the current operations are of significant concern for the long-term health of US veterans with associated economic implications.

  5. Antisymmetric and Symmetric Functionally Graded Plate-Type Structures Impacted by Blast Loading

    DTIC Science & Technology

    2010-09-13

    IMPACTED BY BLAST LOADING Terry Hause, Ph.D. Research Mechanical Engineer U.S. Army RDECOM-TARDEC Warren, MI 48397 Sudhakar, Arepally Deputy...CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Terry Hause, Ph.D.; Sudhakar, Arepally 5d. PROJECT NUMBER 5e. TASK NUMBER

  6. Development of a multimodal blast sensor for measurement of head impact and over-pressurization exposure.

    PubMed

    Chu, Jeffrey J; Beckwith, Jonathan G; Leonard, Daniel S; Paye, Corey M; Greenwald, Richard M

    2012-01-01

    It is estimated that 10-20% of United States soldiers returning from Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) have suffered at least one instance of blast-induced traumatic brain injury (bTBI) with many reporting persistent symptomology and long-term effects. This variation in blast response may be related to the complexity of blast waves and the many mechanisms of injury, including over-pressurization due to the shock wave and potential for blunt impacts to the head from shrapnel or from other indirect impacts (e.g., building, ground, and vehicle). To help differentiate the effects of primary, secondary, and tertiary effects of blast, a custom sensor was developed to simultaneously measure over-pressurization and blunt impact. Moreover, a custom, complementary filter was designed to differentiate the measurements of blunt (low-frequency bandwidth) from over-pressurization (high-frequency bandwidth). The custom sensor was evaluated in the laboratory using a shock tube to simulate shock waves and a drop fixture to simulate head impacts. Both bare sensors and sensor embedded within an ACH helmet coupon were compared to laboratory reference transducers under multiple loading conditions (n = 5) and trials at each condition (n = 3). For all comparative measures, peak magnitude, peak impulse, and cross-correlation measures, R (2) values, were greater than 0.900 indicating excellent agreement of peak measurements and time-series comparisons with laboratory measures.

  7. Non-impact, blast-induced mild TBI and PTSD: concepts and caveats.

    PubMed

    Chen, Yun; Huang, Wei

    2011-01-01

    A volumetric blood surge (rapid physical movement/displacement of blood) is hypothesized to cause the non-impact, mild TBI and battlefield PTSD induced by a blast over-pressure wave. Systematic review of the literature. Articles relating to the fields of blast injury, brain injury and relevant disorders were searched between the years 1968-2010 for keywords such as 'brain injury', 'post-traumatic stress disorder' and 'blast pressure wave'. Articles found through journal and Internet databases were cross-referenced. The blood surge, which is driven by elevated overall pressure in the ventral body cavity after exposure of the torso to blast wave, may move through blood vessels to the low-pressure cranial cavity from the high-pressure ventral body cavity. It dramatically increases cerebral perfusion pressure and causes damage to both tiny cerebral blood vessels and the BBB. Three factors may be critical to the induction of blast-induced brain injuries: (1) the difference in pressure between the ventral body cavity and cranial cavity; (2) blood that acts as a transmission medium to propagate a pressure wave to the brain; and (3) the vulnerability of cerebral blood vessels and the BBB to a sudden fluctuation in perfusion pressure.

  8. Global economic impacts of severe Space Weather.

    NASA Astrophysics Data System (ADS)

    Schulte In Den Baeumen, Hagen; Cairns, Iver

    Coronal mass ejections (CMEs) strong enough to create electromagnetic effects at latitudes below the auroral oval are frequent events, and could have substantial impacts on electric power transmission and telecommunication grids. Modern society’s heavy reliance on these domestic and international networks increases our susceptibility to such a severe Space Weather event. Using a new high-resolution model of the global economy we simulate the economic impact of large CMEs for 3 different planetary orientations. We account for the economic impacts within the countries directly affected as well as the post-disaster economic shock in partner economies through international trade. For the CMEs modeled the total global economic impacts would range from US 380 billion to US 1 trillion. Of this total economic shock 50 % would be felt in countries outside the zone of direct impact, leading to a loss in global GDP of 0.1 - 1 %. A severe Space Weather event could lead to global economic damages of the same order as other weather disasters, climate change, and extreme financial crisis.

  9. Repeat Observations of New Impact Sites on Mars: Changes in Blast Zones

    NASA Astrophysics Data System (ADS)

    Daubar, I.; Geissler, P. E.; McEwen, A. S.; Dundas, C. M.; Byrne, S.

    2012-12-01

    New, dated craters on Mars (Malin et al. 2006, Daubar et al. 2012) are the freshest available examples of impact processes, and some of the only recently-modified surfaces with known ages for the initial surface disturbance. HiRISE has monitored many of these sites over three Mars years. The rates and characteristics of changes at these sites help us understand the initial impact processes and the modification processes that have occurred since. Future applications might include constraining ages of similar impacts that cannot be definitively dated by previous images and measuring variations in the rate of fading over time, perhaps even seasonal variations that would be important for dating dark marks that are only a few Mars years old. New impacts have an extended "blast zone" of (usually) lower albedo surrounding the craters. Blast zones are created by removal of high-albedo surface dust by various atmosphere/surface interactions of the shock waves associated with the descent and impact of the impactor and ejecta (Malin et al. 2006). Their creation could also (in addition?) be related to shock effects on small-scale surface texture. Features vary by site and include diffuse dark halos, dark arcuate or radial rays, light and dark-toned ejecta, slope streaks, and complex combinations thereof. Geissler et al. (2010a) reported that out of 14 sites with repeat imaging, only one site showed significant changes thus far. With 245 known impacts and many more repeat images, we can now extend this study to sites with different ages, target materials, and types of blast features. Surprisingly, some sites still show no detectable changes after three martian years, even after the 2007 global dust storm. In comparison, rover tracks fade on timescales of one martian year (Geissler et al. 2010b). Many other sites show changes, most commonly fading of the blast zone. Fading is most likely due to airfall of dust bringing the blast zones back to the ambient surrounding albedo. In

  10. Impact of pavement conditions on crash severity.

    PubMed

    Li, Yingfeng; Liu, Chunxiao; Ding, Liang

    2013-10-01

    Pavement condition has been known as a key factor related to ride quality, but it is less clear how exactly pavement conditions are related to traffic crashes. The researchers used Geographic Information System (GIS) to link Texas Department of Transportation (TxDOT) Crash Record Information System (CRIS) data and Pavement Management Information System (PMIS) data, which provided an opportunity to examine the impact of pavement conditions on traffic crashes in depth. The study analyzed the correlation between several key pavement condition ratings or scores and crash severity based on a large number of crashes in Texas between 2008 and 2009. The results in general suggested that poor pavement condition scores and ratings were associated with proportionally more severe crashes, but very poor pavement conditions were actually associated with less severe crashes. Very good pavement conditions might induce speeding behaviors and therefore could have caused more severe crashes, especially on non-freeway arterials and during favorable driving conditions. In addition, the results showed that the effects of pavement conditions on crash severity were more evident for passenger vehicles than for commercial vehicles. These results provide insights on how pavement conditions may have contributed to crashes, which may be valuable for safety improvement during pavement design and maintenance. Readers should notice that, although the study found statistically significant effects of pavement variables on crash severity, the effects were rather minor in reality as suggested by frequency analyses. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Computational Hydrocode Study of Target Damage due to Fragment-Blast Impact

    SciTech Connect

    Hatch-Aguilar, T; Najjar, F; Szymanski, E

    2011-03-24

    A target's terminal ballistic effects involving explosively generated fragments, along with the original blast, are of critical importance for many different security and safety related applications. Personnel safety and protective building design are but a few of the practical disciplines that can gain from improved understanding combined loading effects. Traditionally, any engineering level analysis or design effort involving explosions would divide the target damage analysis into two correspondingly critical areas: blast wave and fragment related impact effects. The hypothesis of this paper lies in the supposition that a linear combination of a blast-fragment loading, coupled with an accurate target response description, can lead to a non-linear target damage effect. This non-linear target response could then stand as the basis of defining what a synergistic or combined frag-blast loading might actually look like. The table below, taken from Walters, et. al. categorizes some of the critical parameters driving any combined target damage effect and drives the evaluation of results. Based on table 1 it becomes clear that any combined frag-blast analysis would need to account for the target response matching similar ranges for the mechanics described above. Of interest are the critical times upon which a blast event or fragment impact loading occurs relative to the target's modal response. A blast, for the purposes of this paper is defined as the sudden release of chemical energy from a given material (henceforth referred to as an energetic material) onto its surrounding medium. During the coupling mechanism a discrete or discontinuous shockwave is generated. This shockwave travels outward from the source transferring energy and momentum to any surrounding objects including personnel and engineering structures. From an engineering perspective blast effects are typically characterized by way of physical characteristics such as Peak Pressure (PP), Time of Arrival (TOA

  12. Impact of mount st. Helens eruption on bacteriology of lakes in the blast zone.

    PubMed

    Staley, J T; Lehmicke, L G; Palmer, F E; Peet, R W; Wissmar, R C

    1982-03-01

    Lakes lying within the blast zone of Mount St. Helens showed dramatic increases in heterotrophic bacterial numbers after the eruption of 18 May 1980. The total microscopic counts of bacteria in some of the most severely affected lakes were more than 10 cells per ml, an order of magnitude above the counts in outlying control lakes. Likewise, the numbers of viable bacteria reached levels of more than 10 cells per ml, compated with fewer than 10 cells per ml in control lakes. The CPS medium used for enumeration provided growth of up to 81.5% of the bacteria during sampling of one of the blast zone lakes. The high numbers of bacteria and the efficacy of the viable enumeration procedure are evidence that the lakes have been transformed rapidly from oligotrophy to eutrophy due to the eruption and its aftermath. Organic material leached from the devastated forest vegetation is thought to be responsible for the enrichment of heterotrophs. Total coliform bacteria were found in all of the blast zone lakes, and some lakes contained fecal coliform bacteria. Klebsiella pneumoniae was the predominant total coliform and was also identified as one of the fecal coliform bacteria, although Escherichia coli was the predominant species in that category. Our data indicate that bacterial populations peaked in the outer blast zone lakes in the summer of 1980 and in most of the inner lakes during the summer of 1981.

  13. Emergency health impact of a severe storm.

    PubMed

    Geehr, E C; Salluzzo, R; Bosco, S; Braaten, J; Wahl, T; Wallenkampf, V

    1989-11-01

    A severe, premature snow storm resulted in widespread loss of power, communications, and transportation in a populous region of the Northeast. Staff in hospital emergency departments centered in the path of the storm reported a large number of injuries and many unexpected health effects related to the storm. A retrospective survey of the five major hospital emergency departments serving the most heavily affected urban and suburban areas was undertaken to determine the emergency health impact of the storm and resulting operational problems. Expected findings included a decrease in emergency department visits the day of the storm, followed by a sharp increase the day after. Clean-up activities accounted for a large number of the injuries, most of which were preventable. Unexpected findings include a large number of carbon monoxide poisonings and disposition and staffing problems created by caring for many patients who lost access to customary home health care services. Emergency department staff are encouraged to engage in public education efforts that may reduce serious illness or injury related to severe weather and its aftermath. Moreover, traditional disaster plans may need to be supplemented in anticipation of the disposition and staffing problems created by a growing population of elderly patients who will be cut off from vital home health care services by severe weather.

  14. Effect of Different Rock Models on Hydrocode Simulations of Asteroid Airburst and Impact Blast

    NASA Astrophysics Data System (ADS)

    Robertson, D. K.; Mathias, D.

    2015-12-01

    Ground damage estimates from airburst or ground impact of asteroids depend on the shock waves and blast winds emitted. While semi-analytic models exist and hydrocode simulations of cratering are well studied, there is very little literature on the blast waves from asteroids hitting the Earth. The blast waves depend strongly on the energy deposition rate, which in turn depends on the break-up mechanics of the asteroid either during atmospheric entry or on the ground. This presentation will examine the effect of different rock models on the break-up and energy deposition. The simplest models can assign a single rock strength, chosen to match the burst altitude of previously observed airbursts. Such simple models can provide energy deposition curves that match observations reasonably well, but are not representative of the behaviour of real rock masses. We will compare the failure mechanisms and energy deposition of more sophisticated models including effects such as more realistic yield surfaces that account for tensile, shear, and compressive failure strengths, and size dependent features such as cracks, strength distributions, porosity, and variations in internal composition.

  15. secureBLAST.

    PubMed

    Wiezer, Arnim; Merkl, Rainer

    2003-01-01

    secureBLAST supplements NCBI wwwblast with features necessary to control in an easy manageable way usage of BLAST data sets and their update. The concept we implemented allows to offer on a single BLAST server several data sets with individually configurable access rights. Security is provided by user authentication and encryption of the http traffic via SSL. By using secureBLAST, the administration of users and databases can be done via a web interface. Therefore, secureBLAST is valuable for institutions that have to restrict access to their datasets or just want to administer BLAST servers via a web interface.

  16. Investigating the impact of rice blast disease on the livelihood of the local farmers in greater Mwea region of Kenya.

    PubMed

    Kihoro, Joseph; Bosco, Njoroge J; Murage, Hunja; Ateka, Elijah; Makihara, Daigo

    2013-12-01

    Rice is the most important cereal crop in Kenya coming third after maize and wheat. It forms a very important diet for a majority of families in Kenya. The demand for rice in Kenya has seen a dramatic increase over the last few years while production has remained low. This is because rice production has been faced by serious constraints notably plant diseases of which the most devastating is rice blast. Rice blast is known to cause approximately 60% -100% yield losses. It is caused by an Ascomycete fungus called Magnaporthe Oryzae. The aim of this study was to investigate the impact of rice blast disease on the livelihood of the local farmers in Greater Mwea region and develop a rice blast disease distribution map using GIS approach. The study methodology employed a questionnaire survey which were subjected to sample population of households in the 7 sections with 70 blocks within Mwea region. The collected data was analysed using SAS Version 9.1. Descriptive statistics were used to summarize the household characteristics, the farm characteristics and the farmers' perceptions of rice blast disease. In the questionnaire, farmers' response on whether they had been affected by rice blast disease and the total production per acreage was used to develop an attribute table with GPS points. The GPS points were interpolated to create a geographical distribution map of rice blast disease. From the research findings almost all the farmers' had awareness and knowledge of rice blast disease, 98% of the farmers interviewed were aware of rice blast disease. Out of the 98% with knowledge and awareness 76% have been affected by the disease, while 24% have never been affected. Farmers attributed rice blast disease to a range of different causes, including excessive use of nitrogen fertilizer, water shortage, lack of proper drainage canal and due to climate change. Majority of the farmers interviewed (72%) did not engage themselves in any other socio-economic activity even after

  17. Quarry blasts assessment and their environmental impacts on the nearby oil pipelines, southeast of Helwan City, Egypt

    NASA Astrophysics Data System (ADS)

    Mohamed, Adel M. E.; Mohamed, Abuo El-Ela A.

    2013-06-01

    Ground vibrations induced by blasting in the cement quarries are one of the fundamental problems in the quarrying industry and may cause severe damage to the nearby utilities and pipelines. Therefore, a vibration control study plays an important role in the minimization of environmental effects of blasting in quarries. The current paper presents the influence of the quarry blasts at the National Cement Company (NCC) on the two oil pipelines of SUMED Company southeast of Helwan City, by measuring the ground vibrations in terms of Peak Particle Velocity (PPV). The seismic refraction for compressional waves deduced from the shallow seismic survey and the shear wave velocity obtained from the Multi channel Analysis of Surface Waves (MASW) technique are used to evaluate the closest site of the two pipelines to the quarry blasts. The results demonstrate that, the closest site of the two pipelines is of class B, according to the National Earthquake Hazard Reduction Program (NEHRP) classification and the safe distance to avoid any environmental effects is 650 m, following the deduced Peak Particle Velocity (PPV) and scaled distance (SD) relationship (PPV = 700.08 × SD-1.225) in mm/s and the Air over Pressure (air blast) formula (air blast = 170.23 × SD-0.071) in dB. In the light of prediction analysis, the maximum allowable charge weight per delay was found to be 591 kg with damage criterion of 12.5 mm/s at the closest site of the SUMED pipelines.

  18. Preliminary Study of Realistic Blast Impact on Cultured Brain Slices

    DTIC Science & Technology

    2015-04-01

    and/or multiple impacts in water. 3. Experimental Setup 3.1 The Aquarium Setup A 30.5-cm by 34.5- × 65-cm water-filled polymethylmethacrylate ...sodium bicarbonate PAGE polyacrylamide gel electrophoresis PMMA polymethylmethacrylate RDECOM U.S. Army Research Development and Engineering Command

  19. Chesapeake Bay impact structure: A blast from the past

    USGS Publications Warehouse

    Powars, David S.; Edwards, Lucy E.; Gohn, Gregory S.; Horton, Jr., J. Wright

    2015-10-28

    Since its discovery in the early 1990s, scientists have conducted deep drilling and geophysical surveys of the impact structure to find out more about its size, composition, structure, age, and biological effects and to understand its lingering influences on the regional groundwater system. These efforts culminated in the drilling of a 1-mile-deep, continuously sampled corehole in 2005 by an international group of scientists and agencies.

  20. Numerical simulations of the occupant head response in an infantry vehicle under blunt impact and blast loading conditions.

    PubMed

    Sevagan, Gopinath; Zhu, Feng; Jiang, Binhui; Yang, King H

    2013-07-01

    This article presents the results of a finite element simulation on the occupant head response in an infantry vehicle under two separated loading conditions: (1) blunt impact and (2) blast loading conditions. A Hybrid-III dummy body integrated with a previously validated human head model was used as the surrogate. The biomechanical response of the head was studied in terms of head acceleration due to the impact by a projectile on the vehicle and intracranial pressure caused by blast wave. A series of parametric studies were conducted on the numerical model to analyze the effect of some key parameters, such as seat configuration, impact velocity, and boundary conditions. The simulation results indicate that a properly designed seat and internal surface of the infantry vehicle can play a vital role in reducing the risk of head injury in the current scenarios. Comparison of the kinematic responses under the blunt impact and blast loading conditions reveals that under the current loading conditions, the acceleration pulse in the blast scenario has much higher peak values and frequency than blunt impact case, which may reflect different head response characteristics.

  1. Acid and alkali etching of grit blasted zirconia: Impact on adhesion and osteogenic differentiation of MG63 cells in vitro.

    PubMed

    Gruber, Reinhard; Hedbom, Erik; Bosshardt, Dieter D; Heuberger, Roman; Buser, Daniel

    2012-01-01

    There is a need for evaluating zirconia surface modifications and their potential impact on the biological response of osteogenic cells. Grit blasted zirconia discs were either left untreated or underwent acid or alkaline etching. Adhesion and osteogenic differentiation of MG63 cells was determined after one week of culture. The macro-scaled roughness of the grit blasted zirconia discs, independent of the surface treatment, was within a narrow range and only slightly smoother than titanium discs. However, the alkaline- and acid-etching led to an increase of the micro-roughness of the surface. The surface modifications had no effect on cell spreading and did not cause significant change in the expression of differentiation markers. Thus, in this respective setting, morphologic changes observed upon treatment of grit blasted zirconia discs with acid or alkaline do not translate into changes in MG63 cell adhesion or differentiation and are comparable to findings with anodized titanium discs.

  2. Wound Ballistics Modeling for Blast Loading Blunt Force Impact and Projectile Penetration

    SciTech Connect

    Taylor, Paul A.; Cooper, Candice Frances; Burnett, Damon J.

    2015-09-01

    Light body armor development for the warfighter is based on trial-and-error testing of prototype designs against ballistic projectiles. Torso armor testing against blast is virtually nonexistent but necessary to ensure adequate protection against injury to the heart and lungs. In this report, we discuss the development of a high-fidelity human torso model, it's merging with the existing Sandia Human Head-Neck Model, and development of the modeling & simulation (M&S) capabilities necessary to simulate wound injury scenarios. Using the new Sandia Human Torso Model, we demonstrate the advantage of virtual simulation in the investigation of wound injury as it relates to the warfighter experience. We present the results of virtual simulations of blast loading and ballistic projectile impact to the tors o with and without notional protective armor. In this manner, we demonstrate the ad vantages of applying a modeling and simulation approach to the investigation of wound injury and relative merit assessments of protective body armor without the need for trial-and-error testing.

  3. Recovery in rubble fields: long-term impacts of blast fishing.

    PubMed

    Fox, Helen E; Pet, Jos S; Dahuri, Rokhmin; Caldwell, Roy L

    2003-08-01

    This paper presents initial results from a study of factors that inhibit or enhance hard coral recovery in rubble fields created by blast fishing in Komodo National Park and Bunaken National Park, Indonesia. Within nine sites monitored since 1998, there was no significant natural recovery. Levels of potential source coral larvae were assessed with settlement tiles in the rubble fields and in nearby high coral cover sites. Rubble movement was measured and shown to be detrimental to small scleractinians, especially in high current areas. In shallow water (2-6 m deep), rubble is often overgrown by soft corals and corallimorpharians, which inhibit hard coral survival. There is increased scleractinian recruitment in quadrats cleared of soft coral, and Acropora nubbins transplanted into soft coral fields suffer greater mortality than those transplanted above the soft coral canopy. Gaining an understanding of the prognosis for coral recovery is essential not only in order to assess the long-term impacts of blast fishing, but also to improve management decisions about protection of intact reefs and potential restoration of damaged areas.

  4. Micro CT Analysis of Dynamic Damage in Laminates: Impact vs. blast loading

    NASA Astrophysics Data System (ADS)

    Coles, Laurence A.; Roy, Anish; Silberschmidt, Vadim V.

    2017-05-01

    Dynamic loading is often an unavoidable condition in various applications of carbon-fibre-reinforced polymers and can cause various modes of damage. Realisation of dynamic damage in composites can differ significantly from that under quasi-static loading conditions. A comprehensive study of damage in composites caused by a wide variety of impact and blast loading is currently lacking. The work presents a detailed analysis of damage in specimens of a 2×2 twill weave T300 carbon-fibre/epoxy composite subjected to ballistic loading with both steel and ice projectiles (with energies from 95 J to 865 J at 70-90 m/s and 300-500 m/s, respectively) and air blast (with incident pressures of 0.4 MPa, 0.6 MPa and 0.8 MPa and wave speeds between 650 m/s and 950 m/s). The resultant damage was analysed in-depth based on detailed volumetric data obtained with high-resolution X-ray micro computed tomography.

  5. Wound Ballistics Modeling for Blast Loading Blunt Force Impact and Projectile Penetration.

    SciTech Connect

    Taylor, Paul A.

    2015-11-01

    Light body armor development for the warfighter is based on trial-and-error testing of prototype designs against ballistic projectiles. Torso armor testing against blast is nonexistent but necessary to protect the heart and lungs. In tests against ballistic projectiles, protective apparel is placed over ballistic clay and the projectiles are fired into the armor/clay target. The clay represents the human torso and its behind-armor, permanent deflection is the principal metric used to assess armor protection. Although this approach provides relative merit assessment of protection, it does not examine the behind-armor blunt trauma to crucial torso organs. We propose a modeling and simulation (M&S) capability for wound injury scenarios to the head, neck, and torso of the warfighter. We will use this toolset to investigate the consequences of, and mitigation against, blast exposure, blunt force impact, and ballistic projectile penetration leading to damage of critical organs comprising the central nervous, cardiovascular, and respiratory systems. We will leverage Sandia codes and our M&S expertise on traumatic brain injury to develop virtual anatomical models of the head, neck, and torso and the simulation methodology to capture the physics of wound mechanics. Specifically, we will investigate virtual wound injuries to the head, neck, and torso without and with protective armor to demonstrate the advantages of performing injury simulations for the development of body armor. The proposed toolset constitutes a significant advance over current methods by providing a virtual simulation capability to investigate wound injury and optimize armor design without the need for extensive field testing.

  6. An Experimental and Numerical Study of Hybrid III Dummy Response to Simulated Underbody Blast Impacts.

    PubMed

    Somasundaram, Karthik; Kalra, Anil; Sherman, Don; Begeman, Paul; Yang, King H; Cavanaugh, John M

    2017-08-16

    Anthropometric test devices (ATDs) such as Hybrid III dummy have been widely used in automotive crash tests to evaluate the risks of injury at different body regions. In recent years, researchers have started using automotive ATDs to study the high-speed vertical loading response caused by underbelly blast (UBB) impacts. This study analyzed the Hybrid III dummy responses to short-duration large magnitude vertical acceleration in a laboratory setup. Two unique test conditions were investigated using a horizontal sled system to simulate the UBB loading conditions. The biomechanical response in terms of the pelvis acceleration, chest acceleration, lumbar spine force, head accelerations and neck forces were measured. Subsequently, a series of finite element analyses (FEA) were performed to simulate the physical tests. The correlation between the Hybrid III test and numerical model was evaluated using the CORA version 3.6.1. The score for WSU FE model was 0.878 and 0.790 for loading condition 1 and 2, respectively in which 1.0 indicated a perfect correlation between the experiment and simulation response. With repetitive vertical impacts, the Hybrid III dummy pelvis showed a significant increase in the peak acceleration accompanied by rupture of the pelvis foam and flesh. The revised WSU Hybrid III model indicated high stress concentrations at the same location, providing a possible explanation for the material failure in actual Hybrid III tests.

  7. Dry ice blasting

    NASA Astrophysics Data System (ADS)

    Lonergan, Jeffrey M.

    1992-04-01

    As legal and societal pressures against the use of hazardous waste generating materials has increased, so has the motivation to find safe, effective, and permanent replacements. Dry ice blasting is a technology which uses CO2 pellets as a blasting medium. The use of CO2 for cleaning and stripping operations offers potential for significant environmental, safety, and productivity improvements over grit blasting, plastic media blasting, and chemical solvent cleaning. Because CO2 pellets break up and sublime upon impact, there is no expended media to dispose of. Unlike grit or plastic media blasting which produce large quantities of expended media, the only waste produced by CO2 blasting is the material removed. The quantity of hazardous waste produced, and thus the cost of hazardous waste disposal is significantly reduced.

  8. Underwater Blast Effects From Explosive Severance of Offshore Platform Legs and Well Conductors

    DTIC Science & Technology

    1991-12-15

    pulse were comparable to one another. At 400 feet from the platform, the shock parameters were less than 10 percent of the values expected at the same...armed, and fired by DEMEX International under subcontract to OPI. Underwater explosion data were collected and analyzed to determine the underwater shock...charges were Composition B and were prepared, armed, and fired by DEMEX International-a subcontractor engaged by OPI. The well conductors were severed

  9. Robotic Water Blast Cleaner

    NASA Technical Reports Server (NTRS)

    Sharpe, M. H.; Roberts, M. L.; Hill, W. E.; Jackson, C. H.

    1983-01-01

    Water blasting system under development removes hard, dense, extraneous material from surfaces. High pressure pump forces water at supersonic speed through nozzle manipulated by robot. Impact of water blasts away unwanted material from workpiece rotated on air bearing turntable. Designed for removing thermal-protection material, system is adaptable to such industrial processes as cleaning iron or steel castings.

  10. Robotic Water Blast Cleaner

    NASA Technical Reports Server (NTRS)

    Sharpe, M. H.; Roberts, M. L.; Hill, W. E.; Jackson, C. H.

    1983-01-01

    Water blasting system under development removes hard, dense, extraneous material from surfaces. High pressure pump forces water at supersonic speed through nozzle manipulated by robot. Impact of water blasts away unwanted material from workpiece rotated on air bearing turntable. Designed for removing thermal-protection material, system is adaptable to such industrial processes as cleaning iron or steel castings.

  11. Underbody Blast Models of TBI Caused by Hyper-Acceleration and Secondary Head Impact

    DTIC Science & Technology

    2016-02-01

    silver staining observed in the internal capsule of animals subjected to underbody blasts (Proctor et al., 2014; J Trauma Acute Care Surgery Sep;77(3...was observed at 7 days post-blast, based upon lack of tissue staining with FluoroJade B. We then embarked on a series of G-force dose escalation...silver staining (de Olmos method) of axon fibers present in the internal capsule of rats 7 days following exposure to 100 and 700 G underbody blasts

  12. Investigation of the activity level and radiological impacts of naturally occurring radionuclides in blast furnace slag.

    PubMed

    Uğur, F A; Turhan, S; Sahan, H; Sahan, M; Gören, E; Gezer, F; Yeğingil, Z

    2013-01-01

    The activity level and possible radiological impacts of naturally occurring radionuclides on the health of workers and members of the public, as a result of utilisation of blast furnace slag (BFS) samples as a substitute for aggregate in road construction were investigated by using a gamma-ray spectrometer and potential exposure scenarios given in Radiation Protection 122. The mean activity concentrations of the (226)Ra, (232)Th and (40)K in BFS samples were found to be 152.4, 54.9 and 183.1 Bq kg(-1), respectively. These values are compared with typical values measured in BFS samples from the European Union countries, which are 270, 70 and 240 Bq kg(-1) for (226)Ra, (232)Th and (40)K, respectively. The values of radium equivalent activity index calculated for BFS samples were within the recommended safety limits. The highest total annual effective doses evaluated as 0.9 and 0.4 mSv y(-1) for members of the public and workers, respectively, were lower than the annual limit of 1 mSv y(-1).

  13. New findings on the impact of an explosive VOD on blast results

    SciTech Connect

    Chiappetta, R.F.

    1994-12-31

    An explosive`s velocity of detonation (VOD), can be used to indicate a number of important characteristics regarding the product`s performance under specific field and test conditions. A number of new characteristic and transient VOD curves have been identified in the field, which can be used to evaluate explosive performance, control ground vibration amplitudes and frequencies, select the correct amount and type of stemming for use at the collar and in stem decks, eliminate explosive desensitization, evaluate primer performance, design air deck based blasts, evaluate contaminated explosives and to overcome post blast noxious fumes. Tests were conducted over a six year period in single and multi-hole blasts using laboratory and full scale blast environments. Explosives tested ranged from pure Emulsion to Anfo and various grades of Emulsion/Anfo blends. Field test parameters were; borehole diameter (1 1/2--30 inches), hole depths (10--120 feet), primer size (0.5--6.4 pounds) and the blast environment varied from soft, jelly-like tar sands to some of the hardest iron ore formations. Most tests were instrumented with an array of blast monitoring instrumentation systems consisting of continuous velocity of detonation recorders, high-speed 16 mm cameras, laser-surveying instrumentation and seismographs which were placed in the near and far fields.

  14. Blast injury research models

    PubMed Central

    Kirkman, E.; Watts, S.; Cooper, G.

    2011-01-01

    Blast injuries are an increasing problem in both military and civilian practice. Primary blast injury to the lungs (blast lung) is found in a clinically significant proportion of casualties from explosions even in an open environment, and in a high proportion of severely injured casualties following explosions in confined spaces. Blast casualties also commonly suffer secondary and tertiary blast injuries resulting in significant blood loss. The presence of hypoxaemia owing to blast lung complicates the process of fluid resuscitation. Consequently, prolonged hypotensive resuscitation was found to be incompatible with survival after combined blast lung and haemorrhage. This article describes studies addressing new forward resuscitation strategies involving a hybrid blood pressure profile (initially hypotensive followed later by normotensive resuscitation) and the use of supplemental oxygen to increase survival and reduce physiological deterioration during prolonged resuscitation. Surprisingly, hypertonic saline dextran was found to be inferior to normal saline after combined blast injury and haemorrhage. New strategies have therefore been developed to address the needs of blast-injured casualties and are likely to be particularly useful under circumstances of enforced delayed evacuation to surgical care. PMID:21149352

  15. Biomarkers Affected by Impact Severity during Osteochondral Injury.

    PubMed

    Waters, Nicole Poythress; Stoker, Aaron M; Pfeiffer, Ferris M; Cook, James L

    2015-06-01

    Osteochondral injury elevates the risk for developing posttraumatic osteoarthritis (PTOA). Therefore, our objective was to evaluate the relationship between impact severity during injury to cell viability and biomarkers possibly involved in PTOA. Osteochondral explants (6 mm, n = 72) were harvested from cadaveric femoral condyles (N = 6). Using a test machine, each explant (except for No Impact) was subjected to mechanical impact at a velocity of 100 mm/s to 0.25, 0.5, 0.75, 1.0, or 1.25 mm maximum compression corresponding to Low, Low-Moderate, Moderate, Moderate-High, or High impact groups. Cartilage cell viability, collagen content, and proteoglycan content were assessed at either day 0 or after 12 days of culture. Culture media were assessed for prostaglandin E2 (PGE2); nitric oxide; granulocyte macrophage colony-stimulating factor (GM-CSF); interferon gamma (IFNγ); interleukin (IL)-2, -4, -6, -7, -8, -10, -15, -18; interferon gamma-induced protein 10 (IP-10); keratinocyte-derived chemoattractant (KC); monocyte chemoattractant protein-1 (MCP-1); tumor necrosis factor alpha (TNFα); and matrix metalloproteinase-2, -3, -8, -9, -13. There was increased impact energy absorbed for the High group compared with the Moderate-High group, Moderate group, and Low-Moderate group (p = 0.011, 0.048, 0.008, respectively). At day 0, there was decreased area cell viability for the High group compared with the Low-Moderate group (p = 0.035). At day 1, PGE2 was increased for the High group compared with the Moderate, Low-Moderate, Low, and No Impact groups (p ≤ 0.01). Cumulative PGE2 was increased for the Moderate-High and High groups compared with the Moderate, Low-Moderate, Low, and No Impact groups (p ≤ 0.036). At day 1, MCP-1 was increased for the Moderate-High and High groups compared with the Low and No Impact groups (p ≤ 0.032). Impact to osteochondral explants resulted in multiple levels of severity. PGE2 was sensitive to impact

  16. Neuroimaging, Behavioral, and Psychological Sequelae of Repetitive Combined Blast/Impact Mild Traumatic Brain Injury in Iraq and Afghanistan War Veterans

    PubMed Central

    Cross, Donna J.; Yarnykh, Vasily L.; Richards, Todd; Martin, Nathalie M.; Pagulayan, Kathleen; Hoff, David; Hart, Kim; Mayer, Cynthia; Tarabochia, Matthew; Raskind, Murray A.; Minoshima, Satoshi; Peskind, Elaine R.

    2014-01-01

    Abstract Whether persisting cognitive complaints and postconcussive symptoms (PCS) reported by Iraq and Afghanistan war veterans with blast- and/or combined blast/impact-related mild traumatic brain injuries (mTBIs) are associated with enduring structural and/or functional brain abnormalities versus comorbid depression or posttraumatic stress disorder (PTSD) remains unclear. We sought to characterize relationships among these variables in a convenience sample of Iraq and Afghanistan-deployed veterans with (n=34) and without (n=18) a history of one or more combined blast/impact-related mTBIs. Participants underwent magnetic resonance imaging of fractional anisotropy (FA) and macromolecular proton fraction (MPF) to assess brain white matter (WM) integrity; [18F]-fluorodeoxyglucose positron emission tomography imaging of cerebral glucose metabolism (CMRglu); structured clinical assessments of blast exposure, psychiatric diagnoses, and PTSD symptoms; neurologic evaluations; and self-report scales of PCS, combat exposure, depression, sleep quality, and alcohol use. Veterans with versus without blast/impact-mTBIs exhibited reduced FA in the corpus callosum; reduced MPF values in subgyral, longitudinal, and cortical/subcortical WM tracts and gray matter (GM)/WM border regions (with a possible threshold effect beginning at 20 blast-mTBIs); reduced CMRglu in parietal, somatosensory, and visual cortices; and higher scores on measures of PCS, PTSD, combat exposure, depression, sleep disturbance, and alcohol use. Neuroimaging metrics did not differ between participants with versus without PTSD. Iraq and Afghanistan veterans with one or more blast-related mTBIs exhibit abnormalities of brain WM structural integrity and macromolecular organization and CMRglu that are not related to comorbid PTSD. These findings are congruent with recent neuropathological evidence of chronic brain injury in this cohort of veterans. PMID:24102309

  17. Blast Injury

    PubMed Central

    de Candole, C. A.

    1967-01-01

    The shock wave generated by an explosion (“blast wave”) may cause injury in any or all of the following: (1) direct impact on the tissues of variations in environmental pressure; (2) flying glass and other debris set in motion by it; (3) propulsion of the body. Injuries in the first category affect gas-containing organs (ears, lungs and intestines), and acute death is attributed to air forced into the coronary vessels via damaged pulmonary alveoli. It is estimated that overpressure sufficient to cause lung injury may occur up to five miles from a 20-megaton nuclear explosion. The greatest single hazard from blast is, however, flying glass, and serious wounding from this cause is possible up to 12 miles from an explosion of this magnitude. PMID:6015742

  18. Attenuation of blast pressure behind ballistic protective vests.

    PubMed

    Wood, Garrett W; Panzer, Matthew B; Shridharani, Jay K; Matthews, Kyle A; Capehart, Bruce P; Myers, Barry S; Bass, Cameron R

    2013-02-01

    Clinical studies increasingly report brain injury and not pulmonary injury following blast exposures, despite the increased frequency of exposure to explosive devices. The goal of this study was to determine the effect of personal body armour use on the potential for primary blast injury and to determine the risk of brain and pulmonary injury following a blast and its impact on the clinical care of patients with a history of blast exposure. A shock tube was used to generate blast overpressures on soft ballistic protective vests (NIJ Level-2) and hard protective vests (NIJ Level-4) while overpressure was recorded behind the vest. Both types of vest were found to significantly decrease pulmonary injury risk following a blast for a wide range of conditions. At the highest tested blast overpressure, the soft vest decreased the behind armour overpressure by a factor of 14.2, and the hard vest decreased behind armour overpressure by a factor of 56.8. Addition of body armour increased the 50th percentile pulmonary death tolerance of both vests to higher levels than the 50th percentile for brain injury. These results suggest that ballistic protective body armour vests, especially hard body armour plates, provide substantial chest protection in primary blasts and explain the increased frequency of head injuries, without the presence of pulmonary injuries, in protected subjects reporting a history of blast exposure. These results suggest increased clinical suspicion for mild to severe brain injury is warranted in persons wearing body armour exposed to a blast with or without pulmonary injury.

  19. Determining triglyceride reductions needed for clinical impact in severe hypertriglyceridemia.

    PubMed

    Christian, Jennifer B; Arondekar, Bhakti; Buysman, Erin K; Jacobson, Terry A; Snipes, Rose G; Horwitz, Ralph I

    2014-01-01

    Patients with severe hypertriglyceridemia have an increased risk of cardiovascular disease and pancreatitis. Target triglyceride levels associated with clinical benefit for patients with severe hypertriglyceridemia are not currently known. This study evaluates the association between lower follow-up triglyceride levels and incidence of clinical events for patients with severe hypertriglyceridemia. By using claims data from 2 large US healthcare databases, we conducted a retrospective cohort study and identified 41,210 adults with severe hypertriglyceridemia (triglycerides ≥ 500 mg/dL) between June 2001 and September 2010. The date of the first severe hypertriglyceridemia laboratory result was the index date. Patients were categorized into 1 of 5 triglyceride ranges (<200 mg/dL, 200-299 mg/dL, 300-399 mg/dL, 400-499 mg/dL, and ≥ 500 mg/dL) based on a follow-up triglyceride level assessed 6 to 24 weeks after initial triglyceride levels were measured. Adjusted Cox regression models were developed to evaluate the impact of follow-up triglyceride levels on rates of pancreatitis episodes and cardiovascular events. The mean age of patients was 50 years, 72% were male, and the mean follow-up was 825 days. Patients with severe hypertriglyceridemia with follow-up triglyceride levels <200 mg/dL experienced a lower rate of pancreatitis episodes (adjusted incidence rate ratio, 0.45; 95% confidence interval, 0.34-0.60) and cardiovascular events (adjusted incidence rate ratio, 0.71; 95% confidence interval, 0.64-0.78) with some clinical benefit in adults with severe hypertriglyceridemia with follow-up triglyceride levels 200 to 299 mg/dL and 300 to 399 mg/dL (P < .001 for trend). We observed the greatest impact on clinical events among patients with severe hypertriglyceridemia with the lowest follow-up triglyceride levels. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. The impact of severe burns on skeletal muscle mitochondrial function.

    PubMed

    Porter, Craig; Herndon, David N; Sidossis, Labros S; Børsheim, Elisabet

    2013-09-01

    Severe burns induce a pathophysiological response that affects almost every physiological system within the body. Inflammation, hypermetabolism, muscle wasting, and insulin resistance are all hallmarks of the pathophysiological response to severe burns, with perturbations in metabolism known to persist for several years post injury. Skeletal muscle is the principal depot of lean tissue within the body and as the primary site of peripheral glucose disposal, plays an important role in metabolic regulation. Following a large burn, skeletal muscle functions as and endogenous amino acid store, providing substrates for more pressing functions, such as the synthesis of acute phase proteins and the deposition of new skin. Subsequently, burn patients become cachectic, which is associated with poor outcomes in terms of metabolic health and functional capacity. While a loss of skeletal muscle contractile proteins per se will no doubt negatively impact functional capacity, detriments in skeletal muscle quality, i.e. a loss in mitochondrial number and/or function may be quantitatively just as important. The goal of this review article is to summarise the current understanding of the impact of thermal trauma on skeletal muscle mitochondrial content and function, to offer direction for future research concerning skeletal muscle mitochondrial function in patients with severe burns, and to renew interest in the role of these organelles in metabolic dysfunction following severe burns.

  1. Identifying Severe Weather Impacts and Damage with Google Earth Engine

    NASA Astrophysics Data System (ADS)

    Molthan, A.; Burks, J. E.; Bell, J. R.

    2015-12-01

    Hazards associated with severe convective storms can lead to rapid changes in land surface vegetation. Depending upon the type of vegetation that has been impacted, their impacts can be relatively short lived, such as damage to seasonal crops that are eventually removed by harvest, or longer-lived, such as damage to a stand of trees or expanse of forest that require several years to recover. Since many remote sensing imagers provide their highest spatial resolution bands in the red and near-infrared to support monitoring of vegetation, these impacts can be readily identified as short-term and marked decreases in common vegetation indices such as NDVI, along with increases in land surface temperature that are observed at a reduced spatial resolution. The ability to identify an area of vegetation change is improved by understanding the conditions that are normal for a given time of year and location, along with a typical range of variability in a given parameter. This analysis requires a period of record well beyond the availability of near real-time data. These activities would typically require an analyst to download large volumes of data from sensors such as NASA's MODIS (aboard Terra and Aqua) or higher resolution imagers from the Landsat series of satellites. Google's Earth Engine offers a "big data" solution to these challenges, by providing a streamlined API and option to process the period of record of NASA MODIS and Landsat products through relatively simple Javascript coding. This presentation will highlight efforts to date in using Earth Engine holdings to produce vegetation and land surface temperature anomalies that are associated with damage to agricultural and other vegetation caused by severe thunderstorms across the Central and Southeastern United States. Earth Engine applications will show how large data holdings can be used to map severe weather damage, ascertain longer-term impacts, and share best practices learned and challenges with applying

  2. Impact of dysphagia severity on clinical decision making via telerehabilitation.

    PubMed

    Ward, Elizabeth C; Burns, Clare L; Theodoros, Deborah G; Russell, Trevor G

    2014-04-01

    Recent research supports the proposal that valid and reliable clinical swallow examinations (CSEs) can be conducted via telerehabilitation. However, no studies have explored whether dysphagia severity has an impact on the success of the session or its outcomes. The current study examined how dysphagia severity impacted on either (a) clinical decision making for safety of oral intake or (b) clinician perceptions of CSEs conducted via telerehabilitation. One hundred patients (25 nondysphagics and 25 mild, 25 moderate, and 25 severe dysphagics) were assessed using a telehealth system and methodology reported in prior research. For each assessment, the online and face-to-face (FTF) clinicians simultaneously completed a structured CSE. On session completion, the online clinician indicated level of agreement with two statements regarding the level of rapport and ability to competently assess the patient. In each of the four groups, acceptable levels of agreement were observed between raters for the three primary outcomes (decisions regarding oral/nonoral intake and safe food and fluids) as well as over 90% of the CSE items. Clinicians agreed they could develop good rapport with the majority of patients in all groups. However, for a small but significant (p<0.5) proportion of patents in the severe dysphagic group, clinicians disagreed they were able to satisfactorily and competently assess to the best of their abilities using the telerehabilitation system. Clinical decisions made during and as an outcome of the total CSE were found to be comparable to those made in the FTF environment regardless of dysphagia severity. Clinicians noted some difficulty assessing patients with greater complexity, which occurred in greater numbers in the group with severe dysphagia.

  3. Assessing the Impact of Analytical Error on Perceived Disease Severity.

    PubMed

    Kroll, Martin H; Garber, Carl C; Bi, Caixia; Suffin, Stephen C

    2015-10-01

    The perception of the severity of disease from laboratory results assumes that the results are free of analytical error; however, analytical error creates a spread of results into a band and thus a range of perceived disease severity. To assess the impact of analytical errors by calculating the change in perceived disease severity, represented by the hazard ratio, using non-high-density lipoprotein (nonHDL) cholesterol as an example. We transformed nonHDL values into ranges using the assumed total allowable errors for total cholesterol (9%) and high-density lipoprotein cholesterol (13%). Using a previously determined relationship between the hazard ratio and nonHDL, we calculated a range of hazard ratios for specified nonHDL concentrations affected by analytical error. Analytical error, within allowable limits, created a band of values of nonHDL, with a width spanning 30 to 70 mg/dL (0.78-1.81 mmol/L), depending on the cholesterol and high-density lipoprotein cholesterol concentrations. Hazard ratios ranged from 1.0 to 2.9, a 16% to 50% error. Increased bias widens this range and decreased bias narrows it. Error-transformed results produce a spread of values that straddle the various cutoffs for nonHDL. The range of the hazard ratio obscures the meaning of results, because the spread of ratios at different cutoffs overlap. The magnitude of the perceived hazard ratio error exceeds that for the allowable analytical error, and significantly impacts the perceived cardiovascular disease risk. Evaluating the error in the perceived severity (eg, hazard ratio) provides a new way to assess the impact of analytical error.

  4. Severe-to-fatal head injuries in motor vehicle impacts.

    PubMed

    Yoganandan, Narayan; Baisden, Jamie L; Maiman, Dennis J; Gennarelli, Thomas A; Guan, Yabo; Pintar, Frank A; Laud, Prakash; Ridella, Stephen A

    2010-07-01

    Severe-to-fatal head injuries in motor vehicle environments were analyzed using the United States Crash Injury Research and Engineering Network database for the years 1997-2006. Medical evaluations included details and photographs of injury, and on-scene, trauma bay, emergency room, intensive care unit, radiological, operating room, in-patient, and rehabilitation records. Data were synthesized on a case-by-case basis. X-rays, computed tomography scans, and magnetic resonance images were reviewed along with field evaluations of scene and photographs for the analyses of brain injuries and skull fractures. Injuries to the parenchyma, arteries, brainstem, cerebellum, cerebrum, and loss of consciousness were included. In addition to the analyses of severe-to-fatal (AIS4+) injuries, cervical spine, face, and scalp trauma were used to determine the potential for head contact. Fatalities and survivors were compared using nonparametric tests and confidence intervals for medians. Results were categorized based on the mode of impact with a focus on head contact. Out of the 3178 medical cases and 169 occupants sustaining head injuries, 132 adults were in frontal (54), side (75), and rear (3) crashes. Head contact locations are presented for each mode. A majority of cases clustered around the mid-size anthropometry and normal body mass index (BMI). Injuries occurred at change in velocities (DeltaV) representative of US regulations. Statistically significant differences in DeltaV between fatalities and survivors were found for side but not for frontal impacts. Independent of the impact mode and survivorship, contact locations were found to be superior to the center of gravity of the head, suggesting a greater role for angular than translational head kinematics. However, contact locations were biased to the impact mode: anterior aspects of the frontal bone and face were involved in frontal impacts while temporal-parietal regions were involved in side impacts. Because head

  5. BLOATING IN GASTROPARESIS: SEVERITY, IMPACT, AND ASSOCIATED FACTORS

    PubMed Central

    2011-01-01

    Objectives Bloating is commonly reported in gastroparesis, but its prevalence, impact, and associated factors have not been investigated. We aimed to quantify the prevalence of bloating in gastroparesis and relate its severity to clinical factors and quality of life. Methods Survey, examination, and scintigraphy data were compared in 335 gastroparesis patients from 6 centers of the NIDDK Gastroparesis Clinical Research Consortium. Bloating severity was stratified using Gastroparesis Cardinal Symptom Index (GCSI) bloating subscale scores. Results Bloating of at least mild severity (GCSI ≥2) was reported by 76% of patients. Bloating severity related to female gender (P<0.0001) and overweight status (P=0.04) on regression analysis and correlated with intensity of nausea, postprandial fullness, visible distention, abdominal pain, and altered bowel function (all P<0.05). Disease etiology, smoking status, and gastric emptying did not relate to bloating subset (all P>0.05). Disease-specific quality of life and general measures of well being were progressively impaired with increasing bloating severity (all P<0.001). Among medications, probiotic (P=0.03) and norepinephrine reuptake inhibitor antidepressant (P=0.045) use related to bloating severity; antiemetic use trended higher with worsening bloating (P=0.06). Conclusions Bloating is prevalent in gastroparesis and is severe in many individuals. Bloating severity relates to female gender, body weight, and intensity of other gastroparesis symptoms. The symptom impairs quality of life but is not influenced by gastric emptying rates. Antiemetics, probiotics, and norepinephrine reuptake inhibitor antidepressants may affect reports of bloating. These findings provide insight into this underappreciated symptom of gastroparesis. PMID:21483459

  6. External Foam Layers to Football Helmets Reduce Head Impact Severity

    PubMed Central

    Nakatsuka, Austin S

    2014-01-01

    Current American football helmet design has a rigid exterior with a padded interior. Softening the hard external layer of the helmet may reduce the impact potential of the helmet, providing extra head protection and reducing its use as an offensive device. The objective of this study is to measure the impact reduction potential provided by external foam. We obtained a football helmet with built-in accelerometer-based sensors, placed it on a boxing mannequin and struck it with a weighted swinging pendulum helmet to mimic the forces sustained during a helmet-to-helmet strike. We then applied layers of 1.3 cm thick polyolefin foam to the exterior surface of the helmets and repeated the process. All impact severity measures were significantly reduced with the application of the external foam. These results support the hypothesis that adding a soft exterior layer reduces the force of impact which may be applicable to the football field. Redesigning football helmets could reduce the injury potential of the sport. PMID:25157327

  7. External foam layers to football helmets reduce head impact severity.

    PubMed

    Nakatsuka, Austin S; Yamamoto, Loren G

    2014-08-01

    Current American football helmet design has a rigid exterior with a padded interior. Softening the hard external layer of the helmet may reduce the impact potential of the helmet, providing extra head protection and reducing its use as an offensive device. The objective of this study is to measure the impact reduction potential provided by external foam. We obtained a football helmet with built-in accelerometer-based sensors, placed it on a boxing mannequin and struck it with a weighted swinging pendulum helmet to mimic the forces sustained during a helmet-to-helmet strike. We then applied layers of 1.3 cm thick polyolefin foam to the exterior surface of the helmets and repeated the process. All impact severity measures were significantly reduced with the application of the external foam. These results support the hypothesis that adding a soft exterior layer reduces the force of impact which may be applicable to the football field. Redesigning football helmets could reduce the injury potential of the sport.

  8. Passive blast pressure sensor

    DOEpatents

    King, Michael J.; Sanchez, Roberto J.; Moss, William C.

    2013-03-19

    A passive blast pressure sensor for detecting blast overpressures of at least a predetermined minimum threshold pressure. The blast pressure sensor includes a piston-cylinder arrangement with one end of the piston having a detection surface exposed to a blast event monitored medium through one end of the cylinder and the other end of the piston having a striker surface positioned to impact a contact stress sensitive film that is positioned against a strike surface of a rigid body, such as a backing plate. The contact stress sensitive film is of a type which changes color in response to at least a predetermined minimum contact stress which is defined as a product of the predetermined minimum threshold pressure and an amplification factor of the piston. In this manner, a color change in the film arising from impact of the piston accelerated by a blast event provides visual indication that a blast overpressure encountered from the blast event was not less than the predetermined minimum threshold pressure.

  9. Effectiveness of eye armor during blast loading.

    PubMed

    Bailoor, Shantanu; Bhardwaj, Rajneesh; Nguyen, Thao D

    2015-11-01

    Ocular trauma is one of the most common types of combat injuries resulting from the interaction of military personnel with improvised explosive devices. Ocular blast injury mechanisms are complex, and trauma may occur through various injury mechanisms. However, primary blast injuries (PBI) are an important cause of ocular trauma that may go unnoticed and result in significant damage to internal ocular tissues and visual impairment. Further, the effectiveness of commonly employed eye armor, designed for ballistic and laser protection, in lessening the severity of adverse blast overpressures (BOP) is unknown. In this paper, we employed a three-dimensional (3D) fluid-structure interaction computational model for assessing effectiveness of the eye armor during blast loading on human eyes and validated results against free field blast measurements by Bentz and Grimm (2013). Numerical simulations show that the blast waves focused on the ocular region because of reflections from surrounding facial features and resulted in considerable increase in BOP. We evaluated the effectiveness of spectacles and goggles in mitigating the pressure loading using the computational model. Our results corroborate experimental measurements showing that the goggles were more effective than spectacles in mitigating BOP loading on the eye. Numerical results confirmed that the goggles significantly reduced blast wave penetration in the space between the armor and the eyes and provided larger clearance space for blast wave expansion after penetration than the spectacles. The spectacles as well as the goggles were more effective in reducing reflected BOP at higher charge mass because of the larger decrease in dynamic pressures after the impact. The goggles provided greater benefit of reducing the peak pressure than the spectacles for lower charge mass. However, the goggles resulted in moderate, sustained elevated pressure loading on the eye, that became 50-100% larger than the pressure loading

  10. Emphysematous pyelonephritis: the impact of urolithiasis on disease severity.

    PubMed

    Sanford, Thomas H; Myers, Frank; Chi, Thomas; Bagga, Herman S; Taylor, Andrew G; Stoller, Marshall L

    2016-10-01

    Emphysematous pyelonephritis is a severe infection of the kidney associated with formation of gas in the renal parenchyma and/or collecting system. The purpose of this study was to evaluate outcomes of patients with emphysematous pyelonephritis in a contemporary cohort and to evaluate the impact of urolithiasis on disease severity. A search of all imaging reports at University of California San Francisco (UCSF) for the term "emphysematous pyelonephritis" was undertaken from 2003-2014. Patients were included if there was clinical evidence of infection, no recent urologic instrumentation, and computerized tomography (CT) demonstrating gas in the renal parenchyma or collecting system. Clinical and laboratory variables were obtained from medical records. A total of 14 cases were identified. The majority of patients (57%) had gas confined to the collecting system. Three patients (21%) had gas in the renal parenchyma and 3 patients (21%) had gas extending into perirenal tissues. A total of 8 patients (57%) had concomitant urolithiasis. Seven patients (50%) were managed with antibiotic therapy alone while 6 patients (43%) required percutaneous drainage. No patients required immediate nephrectomy. There were no deaths. Patients with urolithiasis had less severe emphysematous pyelonephritis than patients without urolithiasis (P<0.05). The majority of patients in this study had gas contained within the collecting system and were treated successfully with antibiotics alone. Percutaneous drainage was successfully utilized in patients with more advanced disease. No patients required emergent nephrectomy. Emphysematous pyelonephritis in patients with urolithiasis was less severe than in patients without urolithiasis.

  11. Severity and impact of pain after day-surgery.

    PubMed

    Beauregard, L; Pomp, A; Choinière, M

    1998-04-01

    To assess the intensity, duration and impact of pain after day-surgery interventions. Predictors of pain severity were also evaluated along with the quality of analgesic practices and patient satisfaction. Eighty-nine consecutive day-surgery patients completed self-administered questionnaires before leaving the hospital and at 24, 48 hr and seven days after discharge. The survey instrument was composed of 0-10 pain intensity scales, selected items of the Brief Pain Inventory, of the Patient Outcome Questionnaire and of the Barriers Questionnaire. Analgesic intake in hospital and at home was recorded along with the use of other pain control methods. Forty percent of the patients reported moderate to severe pain during the first 24 hr after hospital discharge. The pain decreased with time but it was severe enough to interfere with daily activities in a substantial number of patients. The best predictor of severe pain at home was inadequate pain control during the first few hours following the surgery. More than 80% of the participants were satisfied with their pain treatment. However, one patient in four (25%) needed contact with a health care provider because of pain at home. Many patients (33% to 51%) reported that instructions about pain control were either unclear or non-existent on several aspects. Medication use was low overall. Thirty-two percent of the patients did not take any pain medication during the first 24 hr after discharge although almost half of them (46%) rated their pain > or = 4. The most common concerns patients had about using pain medication were fear of drug addiction and side effects. The severity and duration of pain after day-surgery should not be underestimated. Aggressive analgesic treatment during the hospital stay should be provided along with take-home analgesia protocols and comprehensive patient education programs.

  12. Severe mortality impact of the 1957 influenza pandemic in Chile.

    PubMed

    Chowell, Gerardo; Simonsen, Lone; Fuentes, Rodrigo; Flores, Jose; Miller, Mark A; Viboud, Cécile

    2017-05-01

    Epidemiological studies of the 1957 influenza pandemic are scarce, particularly from lower-income settings. We analyzed the spatial-temporal mortality patterns of the 1957 influenza pandemic in Chile, including detailed age-specific mortality data from a large city, and investigated risk factors for severe mortality impact across regions. Chile exhibited two waves of excess mortality in winter 1957 and 1959 with a cumulative excess mortality rate of 12 per 10 000, and a ~10-fold mortality difference across provinces. High excess mortality rates were associated with high baseline mortality (R(2) =41.8%; P=.02), but not with latitude (P>.7). Excess mortality rates increased sharply with age. Transmissibility declined from R=1.4-2.1 to R=1.2-1.4 between the two pandemic waves. The estimated A/H2N2 mortality burden in Chile is the highest on record for this pandemic-about three to five times as severe as that experienced in wealthier nations. The global impact of this pandemic may be substantially underestimated from previous studies based on high-income countries. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  13. The impact of environmental factors in severe psychiatric disorders

    PubMed Central

    Schmitt, Andrea; Malchow, Berend; Hasan, Alkomiet; Falkai, Peter

    2014-01-01

    During the last decades, schizophrenia has been regarded as a developmental disorder. The neurodevelopmental hypothesis proposes schizophrenia to be related to genetic and environmental factors leading to abnormal brain development during the pre- or postnatal period. First disease symptoms appear in early adulthood during the synaptic pruning and myelination process. Meta-analyses of structural MRI studies revealing hippocampal volume deficits in first-episode patients and in the longitudinal disease course confirm this hypothesis. Apart from the influence of risk genes in severe psychiatric disorders, environmental factors may also impact brain development during the perinatal period. Several environmental factors such as antenatal maternal virus infections, obstetric complications entailing hypoxia as common factor or stress during neurodevelopment have been identified to play a role in schizophrenia and bipolar disorder, possibly contributing to smaller hippocampal volumes. In major depression, psychosocial stress during the perinatal period or in adulthood is an important trigger. In animal studies, chronic stress or repeated administration of glucocorticoids have been shown to induce degeneration of glucocorticoid-sensitive hippocampal neurons and may contribute to the pathophysiology of affective disorders. Epigenetic mechanisms altering the chromatin structure such as histone acetylation and DNA methylation may mediate effects of environmental factors to transcriptional regulation of specific genes and be a prominent factor in gene-environmental interaction. In animal models, gene-environmental interaction should be investigated more intensely to unravel pathophysiological mechanisms. These findings may lead to new therapeutic strategies influencing epigenetic targets in severe psychiatric disorders. PMID:24574956

  14. Underbody Blast Models of TBI Caused by Hyper-Acceleration and Secondary Head Impact

    DTIC Science & Technology

    2015-02-01

    solution for 35 minutes, reduction agent (formaldehydewith citric acid ) for 2 minutes, bleaching solution (potassium ferricyanide) for 20 minutes...using the two- cycle target labeling kit (Affymetrix) and hybridized to the GeneChip® Rat Gene 2.0 ST arrays (Affymetrix). Samples were processed by...brains immunostained for glial fibrillary acidic protein, was also apparent early after the blast and persisted for at least 30 days. CONCLUSION

  15. Non-Impact, Blast-Induced Mild TBI and PTSD: Concepts and Caveats

    DTIC Science & Technology

    2011-07-01

    has been verified by wound ballistics experiments in animals and finite element simulation of blast loads on the torso. Blood surge caused by...ballistic pressure waves in animals An experimental study of wound ballistics demon- strates that a ballistic pressure wave can cause a remote injury to...surge. This hypothesis has been supported by some experimental data. A volumetric surge of blood moved through the thorax and abdomen has been observed

  16. Emphysematous pyelonephritis: the impact of urolithiasis on disease severity

    PubMed Central

    Myers, Frank; Chi, Thomas; Bagga, Herman S.; Taylor, Andrew G.; Stoller, Marshall L.

    2016-01-01

    Background Emphysematous pyelonephritis is a severe infection of the kidney associated with formation of gas in the renal parenchyma and/or collecting system. The purpose of this study was to evaluate outcomes of patients with emphysematous pyelonephritis in a contemporary cohort and to evaluate the impact of urolithiasis on disease severity. Methods A search of all imaging reports at University of California San Francisco (UCSF) for the term “emphysematous pyelonephritis” was undertaken from 2003–2014. Patients were included if there was clinical evidence of infection, no recent urologic instrumentation, and computerized tomography (CT) demonstrating gas in the renal parenchyma or collecting system. Clinical and laboratory variables were obtained from medical records. Results A total of 14 cases were identified. The majority of patients (57%) had gas confined to the collecting system. Three patients (21%) had gas in the renal parenchyma and 3 patients (21%) had gas extending into perirenal tissues. A total of 8 patients (57%) had concomitant urolithiasis. Seven patients (50%) were managed with antibiotic therapy alone while 6 patients (43%) required percutaneous drainage. No patients required immediate nephrectomy. There were no deaths. Patients with urolithiasis had less severe emphysematous pyelonephritis than patients without urolithiasis (P<0.05). Conclusions The majority of patients in this study had gas contained within the collecting system and were treated successfully with antibiotics alone. Percutaneous drainage was successfully utilized in patients with more advanced disease. No patients required emergent nephrectomy. Emphysematous pyelonephritis in patients with urolithiasis was less severe than in patients without urolithiasis. PMID:27785435

  17. Computational Study of Human Head Response to Primary Blast Waves of Five Levels from Three Directions

    PubMed Central

    Wang, Chenzhi; Pahk, Jae Bum; Balaban, Carey D.; Miller, Mark C.; Wood, Adam R.; Vipperman, Jeffrey S.

    2014-01-01

    Human exposure to blast waves without any fragment impacts can still result in primary blast-induced traumatic brain injury (bTBI). To investigate the mechanical response of human brain to primary blast waves and to identify the injury mechanisms of bTBI, a three-dimensional finite element head model consisting of the scalp, skull, cerebrospinal fluid, nasal cavity, and brain was developed from the imaging data set of a human female. The finite element head model was partially validated and was subjected to the blast waves of five blast intensities from the anterior, right lateral, and posterior directions at a stand-off distance of one meter from the detonation center. Simulation results show that the blast wave directly transmits into the head and causes a pressure wave propagating through the brain tissue. Intracranial pressure (ICP) is predicted to have the highest magnitude from a posterior blast wave in comparison with a blast wave from any of the other two directions with same blast intensity. The brain model predicts higher positive pressure at the site proximal to blast wave than that at the distal site. The intracranial pressure wave invariably travels into the posterior fossa and vertebral column, causing high pressures in these regions. The severities of cerebral contusions at different cerebral locations are estimated using an ICP based injury criterion. Von Mises stress prevails in the cortex with a much higher magnitude than in the internal parenchyma. According to an axonal injury criterion based on von Mises stress, axonal injury is not predicted to be a cause of primary brain injury from blasts. PMID:25409326

  18. Computational study of human head response to primary blast waves of five levels from three directions.

    PubMed

    Wang, Chenzhi; Pahk, Jae Bum; Balaban, Carey D; Miller, Mark C; Wood, Adam R; Vipperman, Jeffrey S

    2014-01-01

    Human exposure to blast waves without any fragment impacts can still result in primary blast-induced traumatic brain injury (bTBI). To investigate the mechanical response of human brain to primary blast waves and to identify the injury mechanisms of bTBI, a three-dimensional finite element head model consisting of the scalp, skull, cerebrospinal fluid, nasal cavity, and brain was developed from the imaging data set of a human female. The finite element head model was partially validated and was subjected to the blast waves of five blast intensities from the anterior, right lateral, and posterior directions at a stand-off distance of one meter from the detonation center. Simulation results show that the blast wave directly transmits into the head and causes a pressure wave propagating through the brain tissue. Intracranial pressure (ICP) is predicted to have the highest magnitude from a posterior blast wave in comparison with a blast wave from any of the other two directions with same blast intensity. The brain model predicts higher positive pressure at the site proximal to blast wave than that at the distal site. The intracranial pressure wave invariably travels into the posterior fossa and vertebral column, causing high pressures in these regions. The severities of cerebral contusions at different cerebral locations are estimated using an ICP based injury criterion. Von Mises stress prevails in the cortex with a much higher magnitude than in the internal parenchyma. According to an axonal injury criterion based on von Mises stress, axonal injury is not predicted to be a cause of primary brain injury from blasts.

  19. The impact response of traditional and BMX-style bicycle helmets at different impact severities.

    PubMed

    DeMarco, Alyssa L; Chimich, Dennis D; Gardiner, John C; Siegmund, Gunter P

    2016-07-01

    Bicycle helmets reduce the frequency and severity of severe to fatal head and brain injuries in bicycle crashes. Our goal here was to measure the impact attenuation performance of common bicycle helmets over a range of impact speeds. We performed 127 drop tests using 13 different bicycle helmet models (6 traditional style helmets and 7 BMX-style helmets) at impact speeds ranging from 1 to 10m/s onto a flat anvil. Helmets were struck on their left front and/or right front areas, a common impact location that was at or just below the test line of most bicycle helmet standards. All but one of the 10 certified helmet models remained below the 300g level at an impact speed of 6m/s, whereas none of the 3 uncertified helmets met this criterion. We found that the helmets with expanded polystyrene liners performed similarly and universally well. The single certified helmet with a polyurethane liner performed below the level expected by the Consumer Product Safety Commission (CPSC) standard at our impact location and the helmet structure failed during one of two supplemental tests of this helmet above the test line. Overall, we found that increased liner thickness generally reduced peak headform acceleration, particularly at higher impact speeds. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Blast Technologies

    DTIC Science & Technology

    2011-06-27

    Team Leader Risa Scherer Blast Mitigation Interior and Laboratory Team Leader Blast Technologies POC’s Government Point Of Contacts (POCs): To...to yield injury assessments at higher fidelities and with higher confidence UNCLASSIFIED UNCLASSIFIED Risa Scherer Blast Mitigation Interior and

  1. Behavioral Outcomes Differ between Rotational Acceleration and Blast Mechanisms of Mild Traumatic Brain Injury

    PubMed Central

    Stemper, Brian D.; Shah, Alok S.; Budde, Matthew D.; Olsen, Christopher M.; Glavaski-Joksimovic, Aleksandra; Kurpad, Shekar N.; McCrea, Michael; Pintar, Frank A.

    2016-01-01

    Mild traumatic brain injury (mTBI) can result from a number of mechanisms, including blunt impact, head rotational acceleration, exposure to blast, and penetration of projectiles. Mechanism is likely to influence the type, severity, and chronicity of outcomes. The objective of this study was to determine differences in the severity and time course of behavioral outcomes following blast and rotational mTBI. The Medical College of Wisconsin (MCW) Rotational Injury model and a shock tube model of primary blast injury were used to induce mTBI in rats and behavioral assessments were conducted within the first week, as well as 30 and 60 days following injury. Acute recovery time demonstrated similar increases over protocol-matched shams, indicating acute injury severity equivalence between the two mechanisms. Post-injury behavior in the elevated plus maze demonstrated differing trends, with rotationally injured rats acutely demonstrating greater activity, whereas blast-injured rats had decreased activity that developed at chronic time points. Similarly, blast-injured rats demonstrated trends associated with cognitive deficits that were not apparent following rotational injuries. These findings demonstrate that rotational and blast injury result in behavioral changes with different qualitative and temporal manifestations. Whereas rotational injury was characterized by a rapidly emerging phenotype consistent with behavioral disinhibition, blast injury was associated with emotional and cognitive differences that were not evident acutely, but developed later, with an anxiety-like phenotype still present in injured animals at our most chronic measurements. PMID:27014184

  2. Behavioral Outcomes Differ between Rotational Acceleration and Blast Mechanisms of Mild Traumatic Brain Injury.

    PubMed

    Stemper, Brian D; Shah, Alok S; Budde, Matthew D; Olsen, Christopher M; Glavaski-Joksimovic, Aleksandra; Kurpad, Shekar N; McCrea, Michael; Pintar, Frank A

    2016-01-01

    Mild traumatic brain injury (mTBI) can result from a number of mechanisms, including blunt impact, head rotational acceleration, exposure to blast, and penetration of projectiles. Mechanism is likely to influence the type, severity, and chronicity of outcomes. The objective of this study was to determine differences in the severity and time course of behavioral outcomes following blast and rotational mTBI. The Medical College of Wisconsin (MCW) Rotational Injury model and a shock tube model of primary blast injury were used to induce mTBI in rats and behavioral assessments were conducted within the first week, as well as 30 and 60 days following injury. Acute recovery time demonstrated similar increases over protocol-matched shams, indicating acute injury severity equivalence between the two mechanisms. Post-injury behavior in the elevated plus maze demonstrated differing trends, with rotationally injured rats acutely demonstrating greater activity, whereas blast-injured rats had decreased activity that developed at chronic time points. Similarly, blast-injured rats demonstrated trends associated with cognitive deficits that were not apparent following rotational injuries. These findings demonstrate that rotational and blast injury result in behavioral changes with different qualitative and temporal manifestations. Whereas rotational injury was characterized by a rapidly emerging phenotype consistent with behavioral disinhibition, blast injury was associated with emotional and cognitive differences that were not evident acutely, but developed later, with an anxiety-like phenotype still present in injured animals at our most chronic measurements.

  3. Blast furnace injection symposium: Proceedings

    SciTech Connect

    1996-12-31

    These proceedings contain 14 papers related to blast furnace injection issues. Topics include coal quality, coal grinding, natural gas injection, stable operation of the blast furnace, oxygen enrichment, coal conveying, and performance at several steel companies. All papers have been processed separately for inclusion on the data base.

  4. Assessment and treatment of common persistent sequelae following blast induced mild traumatic brain injury.

    PubMed

    Schultz, Billie A; Cifu, David X; McNamee, Shane; Nichols, Michelle; Carne, William

    2011-01-01

    The ongoing wars in Iraq and Afghanistan and terrorist activity worldwide have been associated with an increased incidence of blast injuries. While blast injuries share similarities with blunt or penetrating traumatic injuries, there are unique mechanistic elements of blast injury that create increased vulnerability to damage of specific organs. This review highlights the mechanism of blast-related injury, describes the common sequelae of blast exposure that may impact rehabilitation care, and summarizes the intervention strategies for these blast-related sequelae.

  5. Effects of an Early-Time Impact Generated Vapor Blast in the Martian Atmosphere: Formation of High-Latitude Pedestal Craters

    NASA Technical Reports Server (NTRS)

    Wrobel, K. E.; Schultz, P. H.; Crawford, D. A.

    2005-01-01

    Following impact, vapor expansion creates an intense airblast that interacts with the ambient atmosphere. The resulting hemi-spherical shock wave leaves a signature on the surface that is dependent on initial atmospheric and surface conditions. Here we propose that the formation of pedestal craters (craters surrounded by an erosion-resistant pedestal) may be a direct consequence of extreme winds and elevated temperatures generated by such an impact-induced atmospheric blast. Pedestal craters, first recognized in Mariner 9 data, are a unique feature on Mars and likely a signature of near-surface volatiles. They are found at high latitudes (small pedestals, Amazonian to Late Hesperian in age) and in thick equatorial mantling deposits (larger pedestals, early Hesperian to Noachian in age). Previously suggested mechanisms for pedestal crater formation (e.g., wind: ejecta curtain vortices or vapor blast; and ejecta dust: armoring) do not provide a complete picture. The clear evidence for near-surface volatiles at high latitudes requires a re-evaluation of these alternative models. The results presented here suggest that a combined atmospheric blast/thermal model provides a plausible formation hypothesis.

  6. Voluntary Alcohol Intake following Blast Exposure in a Rat Model of Mild Traumatic Brain Injury.

    PubMed

    Lim, Yi Wei; Meyer, Nathan P; Shah, Alok S; Budde, Matthew D; Stemper, Brian D; Olsen, Christopher M

    2015-01-01

    Alcoholism is a frequent comorbidity following mild traumatic brain injury (mTBI), even in patients without a previous history of alcohol dependence. Despite this correlational relationship, the extent to which the neurological effects of mTBI contribute to the development of alcoholism is unknown. In this study, we used a rodent blast exposure model to investigate the relationship between mTBI and voluntary alcohol drinking in alcohol naïve rats. We have previously demonstrated in Sprague Dawley rats that blast exposure leads to microstructural abnormalities in the medial prefrontal cortex (mPFC) and other brain regions that progress from four to thirty days. The mPFC is a brain region implicated in alcoholism and drug addiction, although the impact of mTBI on drug reward and addiction using controlled models remains largely unexplored. Alcohol naïve Sprague Dawley rats were subjected to a blast model of mTBI (or sham conditions) and then tested in several common measures of voluntary alcohol intake. In a seven-week intermittent two-bottle choice alcohol drinking test, sham and blast exposed rats had comparable levels of alcohol intake. In a short access test session at the conclusion of the two-bottle test, blast rats fell into a bimodal distribution, and among high intake rats, blast treated animals had significantly elevated intake compared to shams. We found no effect of blast when rats were tested for an alcohol deprivation effect or compulsive drinking in a quinine adulteration test. Throughout the experiment, alcohol drinking was modest in both groups, consistent with other studies using Sprague Dawley rats. In conclusion, blast exposure had a minimal impact on overall alcohol intake in Sprague Dawley rats, although intake was increased in a subpopulation of blast animals in a short access session following intermittent access exposure.

  7. Voluntary Alcohol Intake following Blast Exposure in a Rat Model of Mild Traumatic Brain Injury

    PubMed Central

    Lim, Yi Wei; Meyer, Nathan P.; Shah, Alok S.; Budde, Matthew D.; Stemper, Brian D.; Olsen, Christopher M.

    2015-01-01

    Alcoholism is a frequent comorbidity following mild traumatic brain injury (mTBI), even in patients without a previous history of alcohol dependence. Despite this correlational relationship, the extent to which the neurological effects of mTBI contribute to the development of alcoholism is unknown. In this study, we used a rodent blast exposure model to investigate the relationship between mTBI and voluntary alcohol drinking in alcohol naïve rats. We have previously demonstrated in Sprague Dawley rats that blast exposure leads to microstructural abnormalities in the medial prefrontal cortex (mPFC) and other brain regions that progress from four to thirty days. The mPFC is a brain region implicated in alcoholism and drug addiction, although the impact of mTBI on drug reward and addiction using controlled models remains largely unexplored. Alcohol naïve Sprague Dawley rats were subjected to a blast model of mTBI (or sham conditions) and then tested in several common measures of voluntary alcohol intake. In a seven-week intermittent two-bottle choice alcohol drinking test, sham and blast exposed rats had comparable levels of alcohol intake. In a short access test session at the conclusion of the two-bottle test, blast rats fell into a bimodal distribution, and among high intake rats, blast treated animals had significantly elevated intake compared to shams. We found no effect of blast when rats were tested for an alcohol deprivation effect or compulsive drinking in a quinine adulteration test. Throughout the experiment, alcohol drinking was modest in both groups, consistent with other studies using Sprague Dawley rats. In conclusion, blast exposure had a minimal impact on overall alcohol intake in Sprague Dawley rats, although intake was increased in a subpopulation of blast animals in a short access session following intermittent access exposure. PMID:25910266

  8. Impact of chronic rhinosinusitis on severe asthma patients

    PubMed Central

    Wang, Chun-Hua; Huang, Chi-Che; Huang, Chien-Chia; Chang, Po-Hung; Chen, Yi-Wei; Wu, Chia-Chen; Wu, Ching-Lung; Kuo, Han-Pin

    2017-01-01

    Coexistence of chronic rhinosinusitis (CRS) with asthma appears to impair asthma control. Type-2 innate lymphoid cells (ILC2s) respond to the cytokines of thymic stromal lymphopoietin (TSLP), interleukin (IL)-25 and IL-33, thus contributing to airway diseases such as CRS and asthma. We investigate whether the augmented Th2-cytokines in CRS might be related to sinonasal tract ILC2s corresponding to enhanced IL-25, IL-33 and TSLP release in severe asthmatics, and be involved in asthma control. Twenty-eight asthmatics (12 non-severe and 16 severe) with CRS receiving nasal surgery were enrolled. The predicted FEV1 inversely associated with CRS severity of CT or endoscopy scores. Higher expression of Th2-driven cytokines (IL-4, IL-5, IL-9, and IL-13), TSLP, IL-25 and IL-33 in nasal tissues was observed in severe asthma. Severe asthmatics had higher ILC2 cell counts in their nasal tissues. ILC2 counts were positively correlated with Th2-cytokines. Nasal surgery significantly improved asthma control and lung function decline in severe asthma and CRS. The higher expression of IL-33/ILC2 axis-directed type 2 immune responses in nasal tissue of CRS brought the greater decline of lung function in severe asthma. ILC2-induced the upregulated activity of Th2-related cytokines in asthmatics with CRS may contribute to a recalcitrant status of asthma control. PMID:28199345

  9. Weather impacts on single-vehicle truck crash injury severity.

    PubMed

    Naik, Bhaven; Tung, Li-Wei; Zhao, Shanshan; Khattak, Aemal J

    2016-09-01

    The focus of this paper is on illustrating the feasibility of aggregating data from disparate sources to investigate the relationship between single-vehicle truck crash injury severity and detailed weather conditions. Specifically, this paper presents: (a) a methodology that combines detailed 15-min weather station data with crash and roadway data, and (b) an empirical investigation of the effects of weather on crash-related injury severities of single-vehicle truck crashes. Random parameters ordinal and multinomial regression models were used to investigate crash injury severity under different weather conditions, taking into account the individual unobserved heterogeneity. The adopted methodology allowed consideration of environmental, roadway, and climate-related variables in single-vehicle truck crash injury severity. Results showed that wind speed, rain, humidity, and air temperature were linked with single-vehicle truck crash injury severity. Greater recorded wind speed added to the severity of injuries in single-vehicle truck crashes in general. Rain and warmer air temperatures were linked to more severe crash injuries in single-vehicle truck crashes while higher levels of humidity were linked to less severe injuries. Random parameters ordered logit and multinomial logit, respectively, revealed some individual heterogeneity in the data and showed that integrating comprehensive weather data with crash data provided useful insights into factors associated with single-vehicle truck crash injury severity. The research provided a practical method that combined comprehensive 15-min weather station data with crash and roadway data, thereby providing useful insights into crash injury severity of single-vehicle trucks. Those insights are useful for future truck driver educational programs and for truck safety in different weather conditions. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.

  10. Effects of Blast Exposure on Subjective and Objective Sleep Measures in Combat Veterans with and without PTSD.

    PubMed

    Stocker, Ryan P J; Paul, Benjamin T E; Mammen, Oommen; Khan, Hassen; Cieply, Marissa A; Germain, Anne

    2016-01-01

    This study examined the extent to which self-reported exposure to blast during deployment to Iraq and Afghanistan affects subjective and objective sleep measures in service members and veterans with and without posttraumatic stress disorder (PTSD). Seventy-one medication-free service members and veterans (mean age = 29.47 ± 5.76 years old; 85% men) completed self-report sleep measures and overnight polysomnographic studies. Four multivariate analyses of variance (MANOVAs) were conducted to examine the impact of blast exposure and PTSD on subjective sleep measures, measures of sleep continuity, non-rapid eye movement (NREM) sleep parameters, and rapid eye movement (REM) sleep parameters. There was no significant Blast × PTSD interaction on subjective sleep measures. Rather, PTSD had a main effect on insomnia severity, sleep quality, and disruptive nocturnal behaviors. There was no significant Blast × PTSD interaction, nor were there main effects of PTSD or Blast on measures of sleep continuity and NREM sleep. A significant PTSD × Blast interaction effect was found for REM fragmentation. The results suggest that, although persistent concussive symptoms following blast exposure are associated with sleep disturbances, self-reported blast exposure without concurrent symptoms does not appear to contribute to poor sleep quality, insomnia, and disruptive nocturnal disturbances beyond the effects of PTSD. Reduced REM sleep fragmentation may be a sensitive index of the synergetic effects of both psychological and physical insults. © 2016 American Academy of Sleep Medicine.

  11. Hot flashes in breast cancer survivors: Frequency, severity and impact.

    PubMed

    Chang, Hao-Yuan; Jotwani, Aparna C; Lai, Yeur-Hur; Jensen, Mark P; Syrjala, Karen L; Fann, Jesse R; Gralow, Julie

    2016-06-01

    To (1) determine the frequency and severity of hot flashes, (2) examine the associations between hot flash frequency and severity and quality of life, and (3) identify the predictors of hot flash activity in breast cancer survivors. The study used a cross-sectional design and mailed survey of 253 breast cancer survivors recruited from a cancer wellness clinic. Participants provided information regarding cancer history, hot flashes, pain intensity, sleep problems, physical functioning, and psychological functioning. About half of the survivors reported at least one hot flash in the past 24 h (45%) or past week (52%). The average frequency of hot flashes was 1.9 in the past 24 h and 1.8 in the past week. Hot flash severity was usually mild or asymptomatic. However, participants with hot flashes reported significantly more sleep problems and higher pain severity than those reporting no hot flashes. Moreover, the severity of hot flashes was associated with more sleep problems, higher pain severity, and more psychological dysfunction. History of hormonal suppression therapy and younger age predicted hot flash activity in the study sample. In breast cancer survivors, hot flashes are common and are associated with unpleasant symptoms and poor quality of life. Research is needed to determine if treatments that reduce the frequency and severity of hot flashes in breast cancer survivors also result in improvements in symptoms such as sleep problems, pain, and psychological dysfunction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Prediction of blast-induced air overpressure: a hybrid AI-based predictive model.

    PubMed

    Jahed Armaghani, Danial; Hajihassani, Mohsen; Marto, Aminaton; Shirani Faradonbeh, Roohollah; Mohamad, Edy Tonnizam

    2015-11-01

    Blast operations in the vicinity of residential areas usually produce significant environmental problems which may cause severe damage to the nearby areas. Blast-induced air overpressure (AOp) is one of the most important environmental impacts of blast operations which needs to be predicted to minimize the potential risk of damage. This paper presents an artificial neural network (ANN) optimized by the imperialist competitive algorithm (ICA) for the prediction of AOp induced by quarry blasting. For this purpose, 95 blasting operations were precisely monitored in a granite quarry site in Malaysia and AOp values were recorded in each operation. Furthermore, the most influential parameters on AOp, including the maximum charge per delay and the distance between the blast-face and monitoring point, were measured and used to train the ICA-ANN model. Based on the generalized predictor equation and considering the measured data from the granite quarry site, a new empirical equation was developed to predict AOp. For comparison purposes, conventional ANN models were developed and compared with the ICA-ANN results. The results demonstrated that the proposed ICA-ANN model is able to predict blast-induced AOp more accurately than other presented techniques.

  13. Coral recruitment and potential recovery of eutrophied and blast fishing impacted reefs in Spermonde Archipelago, Indonesia.

    PubMed

    Sawall, Yvonne; Jompa, Jamaluddin; Litaay, Magdalena; Maddusila, Andi; Richter, Claudio

    2013-09-15

    Coral recruitment was assessed in highly diverse and economically important Spermonde Archipelago, a reef system subjected to land-based sources of siltation/pollution and destructive fishing, over a period of 2 years. Recruitment on settlement tiles reached up to 705 spat m(-2) yr(-1) and was strongest in the dry season (July-October), except off-shore, where larvae settled earlier. Pocilloporidae dominated near-shore, while a more diverse community of Acroporidae, Poritidae and others settled in the less polluted mid-shelf and off-shore reefs. Non-coral fouling community appeared to hardly influence initial coral settlement on the tiles, although, this does not necessarily infer low coral post-settlement mortality, which may be enhanced at the near- and off-shore reefs as indicated by increased abundances of potential space competitors on natural substrate. Blast fishing showed no local reduction in coral recruitment and live hard coral cover increased in oligotrophic reefs, indicating potential for coral recovery, if managed effectively.

  14. When Physics Meets Biology: Low and High-Velocity Penetration, Blunt Impact, and Blast Injuries to the Brain

    PubMed Central

    Young, Leanne; Rule, Gregory T.; Bocchieri, Robert T.; Walilko, Timothy J.; Burns, Jennie M.; Ling, Geoffrey

    2015-01-01

    The incidence of traumatic brain injuries (TBI) in the US has reached epidemic proportions with well over 2 million new cases reported each year. TBI can occur in both civilians and warfighters, with head injuries occurring in both combat and non-combat situations from a variety of threats, including ballistic penetration, acceleration, blunt impact, and blast. Most generally, TBI is a condition in which physical loads exceed the capacity of brain tissues to absorb without injury. More specifically, TBI results when sufficient external force is applied to the head and is subsequently converted into stresses that must be absorbed or redirected by protective equipment. If the stresses are not sufficiently absorbed or redirected, they will lead to damage of extracranial soft tissue and the skull. Complex interactions and kinematics of the head, neck and jaw cause strains within the brain tissue, resulting in structural, anatomical damage that is characteristic of the inciting insult. This mechanical trauma then initiates a neuro-chemical cascade that leads to the functional consequences of TBI, such as cognitive impairment. To fully understand the mechanisms by which TBI occurs, it is critically important to understand the effects of the loading environments created by these threats. In the following, a review is made of the pertinent complex loading conditions and how these loads cause injury. Also discussed are injury thresholds and gaps in knowledge, both of which are needed to design improved protective systems. PMID:25999910

  15. When physics meets biology: low and high-velocity penetration, blunt impact, and blast injuries to the brain.

    PubMed

    Young, Leanne; Rule, Gregory T; Bocchieri, Robert T; Walilko, Timothy J; Burns, Jennie M; Ling, Geoffrey

    2015-01-01

    The incidence of traumatic brain injuries (TBI) in the US has reached epidemic proportions with well over 2 million new cases reported each year. TBI can occur in both civilians and warfighters, with head injuries occurring in both combat and non-combat situations from a variety of threats, including ballistic penetration, acceleration, blunt impact, and blast. Most generally, TBI is a condition in which physical loads exceed the capacity of brain tissues to absorb without injury. More specifically, TBI results when sufficient external force is applied to the head and is subsequently converted into stresses that must be absorbed or redirected by protective equipment. If the stresses are not sufficiently absorbed or redirected, they will lead to damage of extracranial soft tissue and the skull. Complex interactions and kinematics of the head, neck and jaw cause strains within the brain tissue, resulting in structural, anatomical damage that is characteristic of the inciting insult. This mechanical trauma then initiates a neuro-chemical cascade that leads to the functional consequences of TBI, such as cognitive impairment. To fully understand the mechanisms by which TBI occurs, it is critically important to understand the effects of the loading environments created by these threats. In the following, a review is made of the pertinent complex loading conditions and how these loads cause injury. Also discussed are injury thresholds and gaps in knowledge, both of which are needed to design improved protective systems.

  16. NCBI BLAST+ integrated into Galaxy.

    PubMed

    Cock, Peter J A; Chilton, John M; Grüning, Björn; Johnson, James E; Soranzo, Nicola

    2015-01-01

    The NCBI BLAST suite has become ubiquitous in modern molecular biology and is used for small tasks such as checking capillary sequencing results of single PCR products, genome annotation or even larger scale pan-genome analyses. For early adopters of the Galaxy web-based biomedical data analysis platform, integrating BLAST into Galaxy was a natural step for sequence comparison workflows. The command line NCBI BLAST+ tool suite was wrapped for use within Galaxy. Appropriate datatypes were defined as needed. The integration of the BLAST+ tool suite into Galaxy has the goal of making common BLAST tasks easy and advanced tasks possible. This project is an informal international collaborative effort, and is deployed and used on Galaxy servers worldwide. Several examples of applications are described here.

  17. Neuro-glial and systemic mechanisms of pathological responses in rat models of primary blast overpressure compared to "composite" blast.

    PubMed

    Svetlov, Stanislav I; Prima, Victor; Glushakova, Olena; Svetlov, Artem; Kirk, Daniel R; Gutierrez, Hector; Serebruany, Victor L; Curley, Kenneth C; Wang, Kevin K W; Hayes, Ronald L

    2012-01-01

    , particularly when primary blast impacted rats with unprotected body.

  18. Severe injury to near- and far-seated occupants in side impacts by crash severity and belt use.

    PubMed

    Viano, David C; Parenteau, Chantal S

    2010-02-01

    This study investigated the risk of severe-to-fatal injury (MAIS 4+F) to near- and far-seated front occupants in side impacts by belt use and crash severity (delta V). 1993-2007 NASS-CDS was analyzed for front-seat occupants in side impacts while they were either the near-side or far-side occupant by belt use. Light vehicles were included with model year 1994+. Injury severity was subdivided into MAIS 0-2, 3, and 4+F. The risk for MAIS 4+F injury was determined by dividing the number of MAIS 4+F by the number of exposed occupants with known injuries. Individual NASS-CDS cases were downloaded from the 1997-2007 electronic data to evaluate injury patterns causing high relative risks. In 35+ mph side-impact delta Vs, the risk for MAIS 4+F injury was 75.4 +/- 41.0% for unbelted near-side and 48.1 +/- 14.6% for unbelted far-side occupants. The risk was 51.8 +/- 14.8% for belted near-side and 30.9 +/- 8.2% for far-side occupants. Seat belt use was 81.4% effective in preventing MAIS 4+F injury for near-side occupants and 93.5% for far-side occupants. The relative risk (RR) for unbelted compared to belted occupants was 35.9 for far-side occupants in 10-15 mph delta V crashes. The relative risk was 35.1 for near-side occupants in < 10 mph delta V side impacts. The high relative risks were associated with complex, high-speed multi-collision crashes often with occupant impacts on the windshield, steering wheel, or other frontal components and ejection. Seat belt use was more effective in preventing severe injury (MAIS 4+F) to far-side occupants than near-side occupants in < 25 mph delta V impacts. High relative risk for unbelted occupants in low-speed side impacts was explained by the fact that the accidents were high-speed, multi-impact collisions. Severe injury was caused by ejection, impact with the side interior, or impact with the frontal components where airbags sometimes deployed.

  19. Impact of Severity of Autism and Intervention Time-Input on Child Outcomes: Comparison across Several Early Interventions

    ERIC Educational Resources Information Center

    Reed, Phil; Osborne, Lisa

    2012-01-01

    In this article, written by Phil Reed and Lisa Osborne, both from Swansea University, the impact of severity of autism, and the time-input of the treatment programme, on the outcome effectiveness for four early interventions for individuals on the autism spectrum was explored. The four interventions studied were applied behaviour analysis (ABA),…

  20. Impact of Severity of Autism and Intervention Time-Input on Child Outcomes: Comparison across Several Early Interventions

    ERIC Educational Resources Information Center

    Reed, Phil; Osborne, Lisa

    2012-01-01

    In this article, written by Phil Reed and Lisa Osborne, both from Swansea University, the impact of severity of autism, and the time-input of the treatment programme, on the outcome effectiveness for four early interventions for individuals on the autism spectrum was explored. The four interventions studied were applied behaviour analysis (ABA),…

  1. Interaction of Blast and Head Impact in the Generation of Brain Injuries

    DTIC Science & Technology

    2009-08-01

    supported during the acceleration phase in order to eliminate the neck flexion /extension prior to impact. The NDTs were implanted into two columns...al. (1999). Relationship Between Localized Spine Deformation and Cervical Vertebral Motions for Low Speed Rear Impacts Using Human Volunteers. In: Ir

  2. Deficits in Visual System Functional Connectivity after Blast-Related Mild TBI are Associated with Injury Severity and Executive Dysfunction

    DTIC Science & Technology

    2016-08-24

    scheme described below. No score was higher than 4 (the maximum within the mTBI range) in the current sample. Expanding upon the concussion severity...interference score for the Stroop test . Arch. Clin. Neuropsychol. 19:555– 567. Cockerham, G. C., G. L. Goodrich, E. D. Weichel, J. C. Orcutt, J. F. Rizzo...performance on declarative memory tasks. NeuroImage 58:687–697. Graner, J., T. R. Oakes, L. M. French, and G. Riedy. 2013. Functional MRI in the

  3. [Impact of the environment on envenomation incidence and severity].

    PubMed

    Chippaux, Jean-Philippe

    2009-10-01

    Envenomations constitute a serious public health problem in many developing countries. It is related to the hazards of the encounters of venomous animals and human explained by both the venomous animal behaviour and human activities. Severity depends on the toxicity or inoculated amount of the venom and, to a lesser extent, on the management of the envenomation. Man-induced alteration of the environment results in modifications of venomous animals populations both in proportion of species and abundance of specimens. Some species have a higher adaptation capacity and may grow up dramatically. In rural regions, plantations are at great risk of exposure to snakes whereas in suburban areas, scorpions may occur in high density. In some plantations or settlements, incidence may increase by two to ten folds. Local ecological and epidemiological studies allow taking measures to control the venomous animals, prevent the snakebites or scorpion stings and provide antivenoms and better management of the envenomations.

  4. Blast furnace process measurement at Dofasco

    SciTech Connect

    Donaldson, R.J.; Schat, R.R. )

    1993-01-01

    Operation at lower fuel rates requires accurate and reliable measurement of several key process variables. In the early eighties, off-line analysis of Dofasco's operation using a two stage heat and mass balance determined that measurement capability was not adequate for the challenge of a low fuel rate operation. To establish a project plan for obtaining a more efficient operation, a sensitivity analysis of the heat and mass balance was conducted. The results of this analysis enabled Dofasco to target several key parameters for sensor technology improvement. The sensors served two basic functions, thermal control and process monitoring. To optimize capital expenditure, sensors that had a direct impact on process control were upgraded first. These sensors were: Oil Flow, Wind Flow, Charged Weights, Hot Blast Temperature, and Coke Moisture. Following this work, the major process monitoring measurements that were improved included: Top Gap Analysis, Cold Blast Humidity, and Hot Metal Temperature. This paper summarizes the work done to improve these sensors, the system in place to monitor their performance, and the application of these systems for the successful operation of the blast furnace.

  5. The severe acute respiratory syndrome: impact on travel and tourism.

    PubMed

    Wilder-Smith, Annelies

    2006-03-01

    SARS and travel are intricately interlinked. Travelers belonged to those primarily affected in the early stages of the outbreak, travelers became vectors of the disease, and finally, travel and tourism themselves became the victims. The outbreak of SARS created international anxiety because of its novelty, its ease of transmission in certain settings, and the speed of its spread through jet travel, combined with extensive media coverage. The psychological impacts of SARS, coupled with travel restrictions imposed by various national and international authorities, have diminished international travel in 2003, far beyond the limitations to truly SARS hit areas. Governments and press, especially in non SARS affected areas, have been slow to strike the right balance between timely and frequent risk communication and placing risk in the proper context. Screening at airport entry points is costly, has a low yield and is not sufficient in itself. The low yield in detecting SARS is most likely due to a combination of factors, such as travel advisories which resulted in reduced travel to and from SARS affected areas, implementation of effective pre-departure screening at airports in SARS-hit countries, and a rapid decline in new cases at the time when screening was finally introduced. Rather than investing in airport screening measures to detect rare infectious diseases, investments should be used to strengthen screening and infection control capacities at points of entry into the healthcare system. If SARS reoccurs, the subsequent outbreak will be smaller and more easily contained if the lessons learnt from the recent epidemic are applied. Lessons learnt during the outbreak in relation to international travel will be discussed.

  6. Impact of blast induced transitory vibration and air-overpressure/noise on human brain--an experimental study.

    PubMed

    Raina, A K; Baheti, M; Haldar, A; Ramulu, M; Chakraborty, A K; Sahu, P B; Bandopadhayay, C

    2004-04-01

    Human response to blast induced ground vibration and air-overpressure/noise is a major concern of current mining activity. This is because the fact that mines are fast transgressing the habitats and people are getting educated. Consequently the response of humans is changing and expectedly will increase in days to come with no viable and economic alternative to blasting--an essential component of mining. The response of humans can be purely physiological or psychological in nature or combination of both depending upon the situation and conditions of mining. Where physiological response is documented in terms of effects on ears and lungs there is a meager amount or no literature available regarding effects of blasting on the brain. Moreover, the studies on transitory phenomenon like the effects of blasting on humans are rare in comparison to the whole body vibration studies. This study was designed to address the issues as a precursor to a major initiative. The preliminary investigations conducted with the monitoring of EEG responses of humans to vibration and air-overpressure/noise due to blasting revealed that there is no major response of the brain to transitory vibrations and noise.

  7. Impact of fertility treatment on severe maternal morbidity.

    PubMed

    Wang, Erica T; Ozimek, John A; Greene, Naomi; Ramos, Lauren; Vyas, Nina; Kilpatrick, Sarah J; Pisarska, Margareta D

    2016-08-01

    To determine if fertility treatment is associated with increased risk of severe maternal morbidity (SMM) compared with spontaneous pregnancies. Retrospective cohort study. Academic medical center. In 2012, 6,543 women delivered live births >20 weeks gestation at our center. Women were categorized based on mode of conception: in vitro fertilization (IVF), non-IVF fertility treatment (NIFT), or spontaneous pregnancies. None. The main outcome was presence of true SMM, such as eclampsia, respiratory failure, and peripartum hysterectomy. Deliveries were screened with the use of: 1) International Classification of Diseases 9 codes; 2) prolonged postpartum stay; 3) maternal intensive care unit admissions, and 4) blood transfusion. The charts of women meeting the screening criteria were reviewed to identify true SMM based on a previously validated method, recognizing that medical record review is the criterion standard. Of the 6,543 deliveries, 246 (3.8%) were IVF conceptions and 109 (1.7%) NIFT conceptions. Sixty-nine cases of true SMM were identified (1.1%). In multivariate analyses, any fertility treatment (IVF + NIFT) was associated with increased risk of SMM compared with spontaneous conceptions. In a subset analysis of singletons only, the association between any fertility treatment (IVF + NIFT) and SMM was not statistically significant. Overall, fertility treatment increased risk for SMM events. Given the limited sample size, the negative finding with singleton gestations is inconclusive. Larger multicenter studies with accurate documentation of fertility treatment and SMM cases are needed to further clarify the risk associated with singletons. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  8. The Impact of Fertility Treatment on Severe Maternal Morbidity

    PubMed Central

    Wang, Erica T.; Ozimek, John A.; Greene, Naomi; Ramos, Lauren; Vyas, Nina; Kilpatrick, Sarah J.; Pisarska, Margareta D.

    2016-01-01

    Objective To determine if fertility treatment is associated with increased risk of severe maternal morbidity (SMM) compared to spontaneous pregnancies. Design Retrospective cohort study Setting Single academic medical center Patients In 2012, 6543 women delivered live births >20 weeks gestation at our center. Women were categorized based on mode of conception: in vitro fertilization (IVF), non-IVF fertility treatment (NIFT), or spontaneous pregnancies. Interventions None Outcome Measure The main outcome was presence of true SMM, such as eclampsia, respiratory failure, and peripartum hysterectomy. Deliveries were screened using 1) ICD-9 codes, 2) prolonged postpartum stay, 3) maternal ICU admissions, and 4) blood transfusion. The charts of women meeting the screening criteria were reviewed to identify true SMM based on a previously validated method, recognizing that medical record review is the gold standard. Results Of the 6543 deliveries, 246 (3.8%) were IVF conceptions and 109 (1.7%) NIFT conceptions. Sixty nine (1.1%) cases of true SMM were identified. In multivariate analyses, any fertility treatment (IVF + NIFT) was associated with increased risk of SMM compared to spontaneous conceptions (OR 2.40, 95%CI 1.10–5.23). In a subset analysis of singletons only, the association between any fertility treatment (IVF + NIFT) and SMM was not statistically significant (OR 2.11, 95% CI 0.83–5.37, P=0.12). Conclusions Overall, fertility treatment increased risk for SMM events. Given the limited sample size, the negative finding with singleton gestations is inconclusive. Larger multi-center studies with accurate documentation of fertility treatment and SMM cases are needed to further clarify the risk associated with singletons. PMID:27063600

  9. Blast Pressures Induced by the Impact of Kinetic Energy Penetrators on Steel Targets in an Enclosed Range.

    DTIC Science & Technology

    1981-02-01

    heat of detonation of pentolite is Sl k.J/g, so the kinetic energy of the tungsten penetrators is equal to the heat of detonation of...the heat of detonation of pentolite, 5.11 kJ/g. Then the scaled distance curves 3 can be used to predict blast pressure at the instrumented position for...kinetic and chemical energy is 11.8 MJ which equals the heat of detonation of 2.3 kg of pentolite. This would produce a reflected blast pressure of

  10. A Blast from the Past: Community Scale Impacts of Explosives Contaminated Soils after 17 years

    NASA Astrophysics Data System (ADS)

    Via, S. M.; Zinnert, J.; Young, D.

    2014-12-01

    Anthropogenically contaminated soils pose a significant threat to biota across the world. Much of the literature on explosives contaminated soils has focused on individual or species level impacts while the larger plant community is often ignored. Our goal was to fill that gap and investigate impacts on community structure and diversity in an area contaminated with three common explosive compounds (RDX, TNT, Composition B). Community data were collected from an experimental minefield that was cleared 17 years ago, seeded with a surveyed grid of explosive compounds, and allowed to naturally revegetate. Plots within contaminated and reference sites were established. Woody and herbaceous species composition was recorded and species diversity and richness were calculated. Species composition and functional type data were analyzed using cluster analyses, multi-response permutation procedure analyses (MRPP), and detrended correspondence analyses (DCA) to investigate separation of the treatment groups. Classical diversity metrics were similar across treatments; however, cluster analyses and MRPP revealed significant differences in species and functional type composition. DCA of species composition showed no separation of treatment groups while DCA of functional traits showed that the TNT and Comp B plots contained a narrower range of functional traits, primarily due to life history and leaf characteristics, which differentiated them from the other treatment groups;. Differences between reference and contaminant sites in species composition and traits suggests that the presence of soil contaminants act as a physiological filter controlling which plant species establish and prosper. This in turn may have long lasting and significant impacts on the overall community composition and structure. Further research is needed to fully understand the community and ecosystem scale impacts of such contaminants.

  11. Prospectively assessed clinical outcomes in concussive blast vs nonblast traumatic brain injury among evacuated US military personnel.

    PubMed

    Mac Donald, Christine L; Johnson, Ann M; Wierzechowski, Linda; Kassner, Elizabeth; Stewart, Theresa; Nelson, Elliot C; Werner, Nicole J; Zonies, David; Oh, John; Fang, Raymond; Brody, David L

    2014-08-01

    Blast injury has been identified as the signature injury in the conflicts in Iraq and Afghanistan. However it remains to be determined whether fundamental differences may exist between blast-related traumatic brain injury (TBI) and TBI due to other mechanisms. To determine similarities and differences between clinical outcomes in US military personnel with blast-related vs. non-blast-related concussive TBI and to identify the specific domains of impairment that best correlate with overall disability. Prospective cohort study involving active duty US Military personnel evacuated from Iraq or Afghanistan to Landstuhl Regional Medical Center, in Landstuhl, Germany. Four groups of participants were enrolled from 2010 to 2013: (1) blast plus impact complex TBI (n=53), (2) non-blast related TBI with injury due to other mechanisms (n=29), (3) blast-exposed controls evacuated for other medical reasons (n=27) (4) non-blast-exposed controls evacuated for other medical reasons (n=69). All patients with TBI met Department of Defense criteria for concussive (mild) TBI. The study participants were evaluated 6-12 months after injury at Washington University in St Louis. In total, 255 subjects were enrolled in the study, and 183 participated in follow-up evaluations, 5 of whom were disqualified. In-person clinical examinations included evaluation for overall disability, a standardized neurological exam, headache questionnaires, neuropsychological test battery, combat exposure and alcohol use surveys, and structured interview evaluations for post-traumatic stress disorder (PTSD) and depression. Global outcomes, headache severity, neuropsychological performance, and surprisingly even PTSD severity and depression were indistinguishable between the two TBI groups, independent of mechanism of injury. Both TBI groups had higher rates of moderate to severe overall disability than the respective control groups: 41/53 (77%) of blast plus impact TBI and 23/29 (79%) of nonblast TBI vs. 16

  12. The Dynamic Response of Multidirectional Functionally Graded Plates Impacted by Blast Loading

    DTIC Science & Technology

    2013-11-11

    sine half- waves in the corresponding directions. A suitable...the occupants inside. In the case of the hull, a structurally sound hull would protect the occupants from large crushing floor accelerations impacting...0or0   yy N (28) y w y w y w M yy                 000 ~ 0or0  (29) 000 ~ 0or02 www x M y M xyyy        ( 30

  13. Simulation of blast-induced, early-time intracranial wave physics leading to traumatic brain injury.

    SciTech Connect

    Taylor, Paul Allen; Ford, Corey C.

    2008-04-01

    U.S. soldiers are surviving blast and impacts due to effective body armor, trauma evacuation and care. Blast injuries are the leading cause of traumatic brain injury (TBI) in military personnel returning from combat. Understanding of Primary Blast Injury may be needed to develop better means of blast mitigation strategies. The objective of this paper is to investigate the effects of blast direction and strength on the resulting mechanical stress and wave energy distributions generated in the brain.

  14. The Influence of Heavier Football Helmet Faceguards on Head Impact Location and Severity.

    PubMed

    Schmidt, Julianne D; Phan, Tracy T; Courson, Ron W; Reifsteck, Fred; Merritt, Eric D; Brown, Cathleen N

    2017-07-21

    To determine whether players with heavier faceguards have increased odds of sustaining top of the head impacts and head impacts of higher severity. Cohort study. On-field. Thirty-five division I collegiate football players. Faceguard mass was measured. Head impact location and severity (linear acceleration [gravity], rotational acceleration [radian per square second], and Head Impact Technology severity profile [unitless]) were captured for 19 379 total head impacts at practices using the Head Impact Telemetry System. Players' faceguards were categorized as either heavier (>480 g) or lighter (≤480 g) using a median split. Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for sustaining top of the head impacts between faceguard groups using a random intercepts generalized logit model. We compared head impact severity between groups using random intercepts general linear models (α = 0.05). Player position was included in all models. Overall, the 4 head impact locations were equally distributed across faceguard groups (F(3,26) = 2.16, P = 0.117). Football players with heavier faceguards sustained a higher proportion impacts to the top of the head (24.7% vs 17.5%) and had slightly increased odds of sustaining top (OR, 1.72; 95% CI, 1.01-2.94) head impacts rather than front of the head impacts. Football players wearing heavier faceguards might be slightly more prone to sustaining a higher proportion of top of the head impacts, suggesting that greater faceguard mass may make players more likely to lower their head before collision. Individuals involved with equipment selection should consider the potential influence of faceguard design on head impact biomechanics when recommending the use of a heavier faceguard.

  15. Human Injury Criteria for Underwater Blasts

    PubMed Central

    Lance, Rachel M.; Capehart, Bruce; Kadro, Omar; Bass, Cameron R.

    2015-01-01

    Underwater blasts propagate further and injure more readily than equivalent air blasts. Development of effective personal protection and countermeasures, however, requires knowledge of the currently unknown human tolerance to underwater blast. Current guidelines for prevention of underwater blast injury are not based on any organized injury risk assessment, human data or experimental data. The goal of this study was to derive injury risk assessments for underwater blast using well-characterized human underwater blast exposures in the open literature. The human injury dataset was compiled using 34 case reports on underwater blast exposure to 475 personnel, dating as early as 1916. Using severity ratings, computational reconstructions of the blasts, and survival information from a final set of 262 human exposures, injury risk models were developed for both injury severity and risk of fatality as functions of blast impulse and blast peak overpressure. Based on these human data, we found that the 50% risk of fatality from underwater blast occurred at 302±16 kPa-ms impulse. Conservatively, there is a 20% risk of pulmonary injury at a kilometer from a 20 kg charge. From a clinical point of view, this new injury risk model emphasizes the large distances possible for potential pulmonary and gut injuries in water compared with air. This risk value is the first impulse-based fatality risk calculated from human data. The large-scale inconsistency between the blast exposures in the case reports and the guidelines available in the literature prior to this study further underscored the need for this new guideline derived from the unique dataset of actual injuries in this study. PMID:26606655

  16. Effects of Blast Exposure on Subjective and Objective Sleep Measures in Combat Veterans with and without PTSD

    PubMed Central

    Stocker, Ryan P.J.; Paul, Benjamin T.E.; Mammen, Oommen; Khan, Hassen; Cieply, Marissa A.; Germain, Anne

    2016-01-01

    Study Objectives: This study examined the extent to which self-reported exposure to blast during deployment to Iraq and Afghanistan affects subjective and objective sleep measures in service members and veterans with and without posttraumatic stress disorder (PTSD). Methods: Seventy-one medication-free service members and veterans (mean age = 29.47 ± 5.76 years old; 85% men) completed self-report sleep measures and overnight polysomnographic studies. Four multivariate analyses of variance (MANOVAs) were conducted to examine the impact of blast exposure and PTSD on subjective sleep measures, measures of sleep continuity, non-rapid eye movement (NREM) sleep parameters, and rapid eye movement (REM) sleep parameters. Results: There was no significant Blast × PTSD interaction on subjective sleep measures. Rather, PTSD had a main effect on insomnia severity, sleep quality, and disruptive nocturnal behaviors. There was no significant Blast × PTSD interaction, nor were there main effects of PTSD or Blast on measures of sleep continuity and NREM sleep. A significant PTSD × Blast interaction effect was found for REM fragmentation. Conclusions: The results suggest that, although persistent concussive symptoms following blast exposure are associated with sleep disturbances, self-reported blast exposure without concurrent symptoms does not appear to contribute to poor sleep quality, insomnia, and disruptive nocturnal disturbances beyond the effects of PTSD. Reduced REM sleep fragmentation may be a sensitive index of the synergetic effects of both psychological and physical insults. Citation: Stocker RP, Paul BT, Mammen O, Khan H, Cieply MA, Germain A. Effects of blast exposure on subjective and objective sleep measures in combat veterans with and without PTSD. J Clin Sleep Med 2016;12(1):49–56. PMID:26414975

  17. Brain injuries from blast.

    PubMed

    Bass, Cameron R; Panzer, Matthew B; Rafaels, Karen A; Wood, Garrett; Shridharani, Jay; Capehart, Bruce

    2012-01-01

    Traumatic brain injury (TBI) from blast produces a number of conundrums. This review focuses on five fundamental questions including: (1) What are the physical correlates for blast TBI in humans? (2) Why is there limited evidence of traditional pulmonary injury from blast in current military field epidemiology? (3) What are the primary blast brain injury mechanisms in humans? (4) If TBI can present with clinical symptoms similar to those of Post-Traumatic Stress Disorder (PTSD), how do we clinically differentiate blast TBI from PTSD and other psychiatric conditions? (5) How do we scale experimental animal models to human response? The preponderance of the evidence from a combination of clinical practice and experimental models suggests that blast TBI from direct blast exposure occurs on the modern battlefield. Progress has been made in establishing injury risk functions in terms of blast overpressure time histories, and there is strong experimental evidence in animal models that mild brain injuries occur at blast intensities that are similar to the pulmonary injury threshold. Enhanced thoracic protection from ballistic protective body armor likely plays a role in the occurrence of blast TBI by preventing lung injuries at blast intensities that could cause TBI. Principal areas of uncertainty include the need for a more comprehensive injury assessment for mild blast injuries in humans, an improved understanding of blast TBI pathophysiology of blast TBI in animal models and humans, the relationship between clinical manifestations of PTSD and mild TBI from blunt or blast trauma including possible synergistic effects, and scaling between animals models and human exposure to blasts in wartime and terrorist attacks. Experimental methodologies, including location of the animal model relative to the shock or blast source, should be carefully designed to provide a realistic blast experiment with conditions comparable to blasts on humans. If traditional blast scaling is

  18. Neuro-Glial and Systemic Mechanisms of Pathological Responses in Rat Models of Primary Blast Overpressure Compared to “Composite” Blast

    PubMed Central

    Svetlov, Stanislav I.; Prima, Victor; Glushakova, Olena; Svetlov, Artem; Kirk, Daniel R.; Gutierrez, Hector; Serebruany, Victor L.; Curley, Kenneth C.; Wang, Kevin K. W.; Hayes, Ronald L.

    2012-01-01

    , particularly when primary blast impacted rats with unprotected body. PMID:22403567

  19. Wraparound Services: An Effective Intervention for Families Impacted by Severe Mental Illness

    ERIC Educational Resources Information Center

    Kessler, Michelle L.; Ackerson, Barry J.

    2004-01-01

    Children and families impacted by severe mental illness (SMI) have multiple strains that effect family functioning, child safety, and parental rights. Traditional services for children and families struggling with severe mental illness have not achieved success in improving family functioning and keeping families intact. Wraparound is a philosophy…

  20. The Impact of Illness Identity on Recovery from Severe Mental Illness.

    PubMed

    Yanos, Philip T; Roe, David; Lysaker, Paul H

    2010-04-01

    The impact of the experience and diagnosis of mental illness on one's identity has long been recognized; however, little is known about the impact of illness identity, which we define as the set of roles and attitudes that a person has developed in relation to his or her understanding of having a mental illness. The present article proposes a theoretically driven model of the impact of illness identity on the course and recovery from severe mental illness and reviews relevant research. We propose that accepting a definition of oneself as mentally ill and assuming that mental illness means incompetence and inadequacy impact hope and self-esteem, which further impact suicide risk, coping, social interaction, vocational functioning, and symptom severity. Evidence supports most of the predictions made by the model. Implications for psychiatric rehabilitation services are discussed.

  1. The Impact of Illness Identity on Recovery from Severe Mental Illness

    PubMed Central

    Yanos, Philip T.; Roe, David; Lysaker, Paul H.

    2010-01-01

    The impact of the experience and diagnosis of mental illness on one's identity has long been recognized; however, little is known about the impact of illness identity, which we define as the set of roles and attitudes that a person has developed in relation to his or her understanding of having a mental illness. The present article proposes a theoretically driven model of the impact of illness identity on the course and recovery from severe mental illness and reviews relevant research. We propose that accepting a definition of oneself as mentally ill and assuming that mental illness means incompetence and inadequacy impact hope and self-esteem, which further impact suicide risk, coping, social interaction, vocational functioning, and symptom severity. Evidence supports most of the predictions made by the model. Implications for psychiatric rehabilitation services are discussed. PMID:20802840

  2. Does Visual Performance Influence Head Impact Severity Among High School Football Athletes?

    PubMed

    Schmidt, Julianne D; Guskiewicz, Kevin M; Mihalik, Jason P; Blackburn, J Troy; Siegmund, Gunter P; Marshall, Stephen W

    2015-11-01

    To compare the odds of sustaining moderate and severe head impacts, rather than mild, between high school football players with high and low visual performance. Prospective quasi-experimental. Clinical Research Center/On-field. Thirty-seven high school varsity football players. Athletes completed the Nike SPARQ Sensory Station visual assessment before the season. Head impact biomechanics were captured at all practices and games using the Head Impact Telemetry System. Each player was classified as either a high or low performer using a median split for each of the following visual performance measures: visual clarity, contrast sensitivity, depth perception, near-far quickness, target capture, perception span, eye-hand coordination, go/no go, and reaction time. We computed the odds of sustaining moderate and severe head impacts against the reference odds of sustaining mild head impacts across groups of high and low performers for each of the visual performance measures. Players with better near-far quickness had increased odds of sustaining moderate [odds ratios (ORs), 1.27; 95% confidence intervals (CIs), 1.04-1.56] and severe head impacts (OR, 1.45; 95% CI, 1.05-2.01) as measured by Head Impact Technology severity profile. High and low performers were at equal odds on all other measures. Better visual performance did not reduce the odds of sustaining higher magnitude head impacts. Visual performance may play less of a role than expected for protecting against higher magnitude head impacts among high school football players. Further research is needed to determine whether visual performance influences concussion risk. Based on our results, we do not recommend using visual training programs at the high school level for the purpose of reducing the odds of sustaining higher magnitude head impacts.

  3. Impact Depth and the Interaction with Impact Speed Affect the Severity of Contusion Spinal Cord Injury in Rats

    PubMed Central

    Lam, Cameron J.; Assinck, Peggy; Liu, Jie; Tetzlaff, Wolfram

    2014-01-01

    Abstract Spinal cord injury (SCI) biomechanics suggest that the mechanical factors of impact depth and speed affect the severity of contusion injury, but their interaction is not well understood. The primary aim of this work was to examine both the individual and combined effects of impact depth and speed in contusion SCI on the cervical spinal cord. Spinal cord contusions between C5 and C6 were produced in anesthetized rats at impact speeds of 8, 80, or 800 mm/s with displacements of 0.9 or 1.5 mm (n=8/group). After 7 days postinjury, rats were assessed for open-field behavior, euthanized, and spinal cords were harvested. Spinal cord tissue sections were stained for demyelination (myelin-based protein) and tissue sparing (Luxol fast blue). In parallel, a finite element model of rat spinal cord was used to examine the resulting maximum principal strain in the spinal cord during impact. Increasing impact depth from 0.9 to 1.5 mm reduced open-field scores (p<0.01) above 80 mm/s, reduced gray (GM) and white matter (WM) sparing (p<0.01), and increased the amount of demyelination (p<0.01). Increasing impact speed showed similar results at the 1.5-mm impact depth, but not the 0.9-mm impact depth. Linear correlation analysis with finite element analysis strain showed correlations (p<0.001) with nerve fiber damage in the ventral (R2=0.86) and lateral (R2=0.74) regions of the spinal cord and with WM (R2=0.90) and GM (R2=0.76) sparing. The results demonstrate that impact depth is more important in determining the severity of SCI and that threshold interactions exist between impact depth and speed. PMID:24945364

  4. Blast Injuries: From Improvised Explosive Device Blasts to the Boston Marathon Bombing.

    PubMed

    Singh, Ajay K; Ditkofsky, Noah G; York, John D; Abujudeh, Hani H; Avery, Laura A; Brunner, John F; Sodickson, Aaron D; Lev, Michael H

    2016-01-01

    Although most trauma centers have experience with the imaging and management of gunshot wounds, in most regions blast wounds such as the ones encountered in terrorist attacks with the use of improvised explosive devices (IEDs) are infrequently encountered outside the battlefield. As global terrorism becomes a greater concern, it is important that radiologists, particularly those working in urban trauma centers, be aware of the mechanisms of injury and the spectrum of primary, secondary, tertiary, and quaternary blast injury patterns. Primary blast injuries are caused by barotrauma from the initial increased pressure of the explosive detonation and the rarefaction of the atmosphere immediately afterward. Secondary blast injuries are caused by debris carried by the blast wind and most often result in penetrating trauma from small shrapnel. Tertiary blast injuries are caused by the physical displacement of the victim and the wide variety of blunt or penetrating trauma sustained as a result of the patient impacting immovable objects such as surrounding cars, walls, or fences. Quaternary blast injuries include all other injuries, such as burns, crush injuries, and inhalational injuries. Radiography is considered the initial imaging modality for assessment of shrapnel and fractures. Computed tomography is the optimal test to assess penetrating chest, abdominal, and head trauma. The mechanism of blast injuries and the imaging experience of the victims of the Boston Marathon bombing are detailed, as well as musculoskeletal, neurologic, gastrointestinal, and pulmonary injury patterns from blast injuries. ©RSNA, 2016.

  5. The Impact of Heat Waves on Occurrence and Severity of Construction Accidents

    PubMed Central

    Rameezdeen, Rameez; Elmualim, Abbas

    2017-01-01

    The impact of heat stress on human health has been extensively studied. Similarly, researchers have investigated the impact of heat stress on workers’ health and safety. However, very little work has been done on the impact of heat stress on occupational accidents and their severity, particularly in South Australian construction. Construction workers are at high risk of injury due to heat stress as they often work outdoors, undertake hard manual work, and are often project based and sub-contracted. Little is known on how heat waves could impact on construction accidents and their severity. In order to provide more evidence for the currently limited number of empirical investigations on the impact of heat stress on accidents, this study analysed 29,438 compensation claims reported during 2002–2013 within the construction industry of South Australia. Claims reported during 29 heat waves in Adelaide were compared with control periods to elicit differences in the number of accidents reported and their severity. The results revealed that worker characteristics, type of work, work environment, and agency of accident mainly govern the severity. It is recommended that the implementation of adequate preventative measures in small-sized companies and civil engineering sites, targeting mainly old age workers could be a priority for Work, Health and Safety (WHS) policies. PMID:28085067

  6. The Impact of Heat Waves on Occurrence and Severity of Construction Accidents.

    PubMed

    Rameezdeen, Rameez; Elmualim, Abbas

    2017-01-11

    The impact of heat stress on human health has been extensively studied. Similarly, researchers have investigated the impact of heat stress on workers' health and safety. However, very little work has been done on the impact of heat stress on occupational accidents and their severity, particularly in South Australian construction. Construction workers are at high risk of injury due to heat stress as they often work outdoors, undertake hard manual work, and are often project based and sub-contracted. Little is known on how heat waves could impact on construction accidents and their severity. In order to provide more evidence for the currently limited number of empirical investigations on the impact of heat stress on accidents, this study analysed 29,438 compensation claims reported during 2002-2013 within the construction industry of South Australia. Claims reported during 29 heat waves in Adelaide were compared with control periods to elicit differences in the number of accidents reported and their severity. The results revealed that worker characteristics, type of work, work environment, and agency of accident mainly govern the severity. It is recommended that the implementation of adequate preventative measures in small-sized companies and civil engineering sites, targeting mainly old age workers could be a priority for Work, Health and Safety (WHS) policies.

  7. An analysis of the effect of lower extremity strength on impact severity during a backward fall.

    PubMed

    Sandler, R; Robinovitch, S

    2001-12-01

    At least 280 000 hip fractures occur annually in the U.S. at an estimated cost of $9 billion. While over 90 percent of these are caused by falls, only about 2 percent of all falls result in hip fracture. Evidence suggests that the most important determinants of hip fracture risk during a fall are the body's impact velocity and configuration. Accordingly, protective responses for reducing impact velocity and the likelihood for direct impact to the hip, strongly influence fracture risk. One method for reducing the body's impact velocity and kinetic energy during a fall is to absorb energy in the lower extremity muscles during descent, as occurs during sitting and squatting. In the present study, we employed a series of in verted pendulum models to determine: (a) the theoretical effect of this mechanism on impact severity during a backward fall, and (b) the effect on impact severity of age-related declines (or exercise-induced enhancements) in lower extremity strength. Compared to the case of a fall with zero energy absorption in the lower extremity joints, best-case falls (which involved 81 percent activation of ankle and hip muscles, but only 23 percent activation of knees muscles) involved 79 percent attenuation (from 352 J to 74 J) in the body's vertical kinetic energy at impact (KEv), and 48 percent attenuation (from 3.22 to 1.68 m/s) in the downward velocity of the pelvis at impact (v(v)). Among the mechanisms responsible for this were: (1) eccentric contraction of lower extremity muscles during descent, which resulted in up to 150 J of energy absorption; (2) impact with the trunk in an upright configuration, which reduced the change in potential energy associated with the fall by 100 J; and (3) knee extension during the final stage of descent, which "transferred" up to 90 J of impact energy into horizontal (as opposed to vertical) kinetic energy. Declines in joint strength reduced the effectiveness of mechanisms (1) and (3), and thereby increased impact

  8. Impact of physician specialty on classification of physician-perceived patient severity for patients with osteoarthritis.

    PubMed

    Bailey, J; Hawker, G A; Wood, R; Cappelleri, J C; Higgins, V; Joyce, N; Hsu, M-A

    2014-05-01

    Physicians often classify patients' osteoarthritis (OA) severity subjectively. As treatment decisions are influenced by severity classifications, it is important to understand the factors that influence physicians' OA severity ratings. This research sought to empirically identify physician and patient characteristics that lead to a patient being perceived as having more severe OA. Data were analyzed from the OA IX Disease Specific Program, a large cross-sectional survey of OA physicians and patients in Germany, the UK, and USA between September 2011 and January 2012. Eligible, consenting physicians completed a Patient Record Form (PRF) for 10 consecutive OA patients. The PRF asked physicians to report the patient's demographics [age, gender, body mass index (BMI), ethnicity], their assessment of the patients' symptom severity, treatment, probability for surgery, to rate their overall OA severity (mild, moderate or severe) and the factors that had influenced the rating. Chi-squared tests and analysis of variance were used to identify patient characteristics that significantly impacted physicians' OA severity ratings. Controlling for the significant patient characteristics, we then examined the impact of physician specialty on physician's OA severity ratings. Finally, we investigated the differences in physician-reported factors that influenced the physicians' rating of patients' severity between physician specialties. Three hundred and sixty-three physicians [220 primary care physicians (PCPs), 48 rheumatologists, 95 orthopedic surgeons] recruited 3561 patients. Patients with greater age and BMI, worse symptoms and greater health care use were given higher OA severity ratings. Controlling for these factors, orthopedic surgeons rated their OA patients as more severe than PCPs and rheumatologists [adjusted odds ratio (OR) 1.8, 95% confidence interval (CI) 1.4-2.4]. Specialists (rheumatologists and orthopedic surgeons) were more likely than PCPs to use joint spaced

  9. The impact of onabotulinumtoxinA on severe headache days: PREEMPT 56-week pooled analysis.

    PubMed

    Matharu, Manjit; Halker, Rashmi; Pozo-Rosich, Patricia; DeGryse, Ronald; Manack Adams, Aubrey; Aurora, Sheena K

    2017-12-01

    OnabotulinumtoxinA has been shown to reduce headache-days among patients with chronic migraine (CM). The objective of this analysis was to determine whether onabotulinumtoxinA has an impact on headache-day severity in patients with CM among those patients who were deemed non-responders based on reduction in the frequency of headache days alone. Data from the Phase 3 REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical trial program (a 24-week, 2-treatment cycle, double-blind, randomized, placebo-controlled, parallel-group phase, followed by a 32-week, 3-treatment cycle, open-label phase) were pooled for analysis. Patients kept a daily diary to record headache severity on a 4-point scale (from none to severe), and a 6-domain Headache Impact Test (HIT-6) was used to determine the clinical impact of headaches. Analysis was undertaken to assess whether the subset of patients that were headache-day frequency non-responders at week 24 (patients with <50% reduction in headache-day frequency) experienced a reduction in headache severity whilst receiving onabotulinumtoxinA. For headache-day frequency non-responders, significant reductions in the number of severe headache days, average daily headache severity, pooled percentage of severe headache days and headache severity score were observed at week 24 for patients who had received onabotulinumtoxinA compared with those who had received placebo. The between-group differences were reduced and non-significant at week 56. Similarly, headache-day frequency non-responders receiving onabotulinumtoxinA were found to have an improvement in the clinical impact of headaches using results from the HIT-6. These results suggest that even those patients with CM who are deemed non-responders based on analysis of headache frequency alone experience clinically meaningful relief from headache intensity following treatment with onabotulinumtoxinA.

  10. Stuttering severity, psychosocial impact and lexical diversity as predictors of outcome for treatment of stuttering.

    PubMed

    Cook, Susanne; Donlan, Chris; Howell, Peter

    2013-06-01

    This study assessed factors that predicted therapy outcome for children and adolescents who stuttered after attendance at an intensive therapy course. The factors examined were stuttering severity, lexical diversity measured by Type Token Ratio, and psychosocial impact of stuttering on the child's life. Fifty-four children who stuttered (CWS) participated in the study. The hypotheses were: (1) CWS with high initial stuttering severity would be more likely to persist than those with low initial severity; (2) lexical diversity before treatment should be related to therapy outcome; (3) psychosocial factors would affect therapy outcome. The predictions were assessed by linear and logistic regression analyses. Initial stuttering severity was the only significant predictor for stuttering severity after therapy. However, psychosocial impact correlated with improvement in fluency, and lexical diversity correlated with therapy outcome. Only initial stuttering severity was a significant predictor of therapy outcome after an intensive therapy intervention. This is in agreement with the study of Howell and Davis (2011). Readers will get an overview of the literature on risk factors that are considered to predict therapy outcomes for CWS. They will be able to (a) identify what variable represent potential risk factors, (b) describe the psychosocial impact of stuttering, (c) explain how lexical diversity is measured, and (d) describe different assessment instruments used to decide on the outcome of therapy. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Automated Blast Cleaner

    NASA Technical Reports Server (NTRS)

    Pickett, Isaiah R.; Yulfo, Alyce R.

    1992-01-01

    Automatic grit-blasting machine removes melted-layer residue from electrical-discharge-machined surfaces of turbine blades. Automatic control system of machine provides steady flow of grit and maintains blast nozzles at proper distance and in correct orientation perpendicular to surface being blasted, regardless of contour. Eliminates localized excessive blasting and consequent excessive removal of underlying material, blasting of adjacent surfaces, and missed areas.

  12. The real estate factor: quantifying the impact of infarct location on stroke severity.

    PubMed

    Menezes, Nina M; Ay, Hakan; Wang Zhu, Ming; Lopez, Chloe J; Singhal, Aneesh B; Karonen, Jari O; Aronen, Hannu J; Liu, Yawu; Nuutinen, Juho; Koroshetz, Walter J; Sorensen, A Gregory

    2007-01-01

    The severity of the neurological deficit after ischemic stroke is moderately correlated with infarct volume. In the current study, we sought to quantify the impact of location on neurological deficit severity and to delineate this impact from that of volume. We developed atlases consisting of location-weighted values indicating the relative importance in terms of neurological deficit severity for every voxel of the brain. These atlases were applied to 80 first-ever ischemic stroke patients to produce estimates of clinical deficit severity. Each patient had an MRI and National Institutes of Health Stroke Scale (NIHSS) examination just before or soon after hospital discharge. The correlation between the location-based deficit predictions and measured neurological deficit (NIHSS) scores were compared with the correlation obtained using volume alone to predict the neurological deficit. Volume-based estimates of neurological deficit severity were only moderately correlated with measured NIHSS scores (r=0.62). The combination of volume and location resulted in a significantly better correlation with clinical deficit severity (r=0.79, P=0.032). The atlas methodology is a feasible way of integrating infarct size and location to predict stroke severity. It can estimate stroke severity better than volume alone.

  13. Comparison of impact results for several polymeric composites over a wide range of low impact velocities

    NASA Technical Reports Server (NTRS)

    Poe, C. C., Jr.; Portanova, M. A.; Masters, J. E.; Sankar, B. V.; Jackson, Wade C.

    1991-01-01

    Static indentation, falling weight, and ballistic impact tests were conducted in clamped plates made of AS4/3501-6 and IM7/8551-7 prepreg tape. The transversely isotropic plates were nominally 7-mm thick. Pendulum and ballistic tests were also conducted on simply supported plates braided with Celion 12000 fibers and 3501-6 epoxy. The 20 degree braided plates were about 5-mm thick. The impactors had spherical or hemispherical shapes with a 12.7 mm diameter. Residual compression strength and damage size were measured. For a given kinetic energy, damage size was least for IM7/8551-7 and greatest for the braided material. Strengths varied inversely with damage size. For a given damage size, strength loss as a fraction of original strength was least for the braided material and greatest for AS4/3501-6 and IM7/8551-7. Strength loss for IM7/8551-7 and AS4/3501-6 was nearly equal. No significant differences were noticed between damage sizes and residual compression strengths for the static indentation, falling weight, and ballistic tests of AS4/3501-6 and IM7/8551-7. For the braided material, sizes of damage were significantly less and compression strengths were significantly more for the falling weight tests than for the ballistic tests.

  14. Impact of Posttraumatic Stress Disorder and Injury Severity on Recovery in Children with Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Kenardy, Justin; Le Brocque, Robyne; Hendrikz, Joan; Iselin, Greg; Anderson, Vicki; McKinlay, Lynne

    2012-01-01

    The adverse impact on recovery of posttraumatic stress disorder (PTSD) in mild traumatic brain injury (TBI) has been demonstrated in returned veterans. The study assessed this effect in children's health outcomes following TBI and extended previous work by including a full range of TBI severity, and improved assessment of PTSD within a…

  15. The Impact of Autism or Severe Challenging Behaviour on Lifestyle Outcome in Community Housing

    ERIC Educational Resources Information Center

    Felce, David; Perry, Jonathan; Lowe, Kathy; Jones, Edwin

    2011-01-01

    Background: The triad of impairments characteristic of autistic spectrum disorders and severe challenging behaviours are reasonably common among adults with intellectual disabilities. The aim was to investigate whether they had an impact on lifestyle among such adults living in staff-supported community housing. Methods: Data were collected on the…

  16. Impact of Posttraumatic Stress Disorder and Injury Severity on Recovery in Children with Traumatic Brain Injury

    ERIC Educational Resources Information Center

    Kenardy, Justin; Le Brocque, Robyne; Hendrikz, Joan; Iselin, Greg; Anderson, Vicki; McKinlay, Lynne

    2012-01-01

    The adverse impact on recovery of posttraumatic stress disorder (PTSD) in mild traumatic brain injury (TBI) has been demonstrated in returned veterans. The study assessed this effect in children's health outcomes following TBI and extended previous work by including a full range of TBI severity, and improved assessment of PTSD within a…

  17. The Psychological Impact of Abuse on Men and Women with Severe Intellectual Disabilities

    ERIC Educational Resources Information Center

    Rowsell, A. C.; Clare, I. C. H.; Murphy, G. H.

    2013-01-01

    Background: In other populations, the psychological impact of abuse has been conceptualized as Post Traumatic Stress Disorder (PTSD, DSM-IV, American Psychiatric Association (APA), 1994), but little is known about whether this is appropriate for adults with severe intellectual disabilities and very limited communication skills. Methods: An…

  18. Impact of Harmful Algal Blooms on Several Lake Erie Drinking Water Treatment Plants

    EPA Science Inventory

    Recent events in Ohio have demonstrated the challenge treatment facilities face in providing safe drinking water when encountering extreme harmful algal bloom (HAB) events. Over the last two years the impact of HAB-related microcystins on several drinking water treatment facilit...

  19. The Psychological Impact of Abuse on Men and Women with Severe Intellectual Disabilities

    ERIC Educational Resources Information Center

    Rowsell, A. C.; Clare, I. C. H.; Murphy, G. H.

    2013-01-01

    Background: In other populations, the psychological impact of abuse has been conceptualized as Post Traumatic Stress Disorder (PTSD, DSM-IV, American Psychiatric Association (APA), 1994), but little is known about whether this is appropriate for adults with severe intellectual disabilities and very limited communication skills. Methods: An…

  20. Restoration of a Severely Impacted Riparian Wetland System-The Pen Branch Project

    SciTech Connect

    Barton, C.; Nelson, E.A.; Kolka, R.F.; McLeod, K.W.; Conner, W.H.; Lakly, M.; Wigginton, J.; Trettin, C.C.; Wisiniewski, j.

    2000-10-01

    The Pen Banch riparian wetland system was impacted by hot water releases from the reactor operations at the SRS. Several hundred acres of swamp and bottomland forest were destroyed and degraded as a result of thermal effects and sedimentation. The SRS developed a plan to restore the system based upon planting both early and last successional tree species. The goal was to develop a

  1. Impact of Harmful Algal Blooms on Several Lake Erie Drinking Water Treatment Plants

    EPA Science Inventory

    Recent events in Ohio have demonstrated the challenge treatment facilities face in providing safe drinking water when encountering extreme harmful algal bloom (HAB) events. Over the last two years the impact of HAB-related microcystins on several drinking water treatment facilit...

  2. Chondrocyte Viability After a Simulated Blast Exposure.

    PubMed

    Shaw, K Aaron; Johnson, Peter C; Williams, David; Zumbrun, Steven D; Topolski, Richard; Cameron, Craig D

    2017-07-01

    The effects of blast exposure have gained increasing interest in the military medical community with their continued occurrence on the battlefield. The impact of the direct and indirect energy imparted from blasts to hollow viscera, as well as closed head injuries, have been well studied. However, the injury to articular cartilage has not been investigated, despite previous correlations regarding the development of osteoarthritis. The purpose of this study was to assess the degree of injury to articular chondrocytes after exposure to a simulated blast overpressure wave. Fresh juvenile porcine stifle joints were subjected to a simulated blast overpressure wave utilizing a custom fabricated blast simulator with compressed gases, within the reported range of observed battlefield blasts. Chondrocyte viability was assessed with live/dead staining using ethidium homodimer-2 and calcien acetoxymethylester stain and confocal laser scanning microscopy, calculated as a ratio of dead chondrocytes to live chondrocytes. Testing was performed at time points of 2, 4, and 8 hours after blast exposure and was compared with unblasted control samples. Chondrocyte viability decreased after exposure to a blast overpressure wave when compared with control samples. The amount of death was greater closer to the articular surface and dissipated with increasing tissue depth. Chondrocyte death increased with time after exposure. Chondrocyte death is present after exposure to a simulated blast wave. There is an inverse relationship between chondrocyte viability and the depth from the articular surface. Additional studies are needed to further characterize dose and time effects of blast exposure. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  3. Impact of Afterload on the Assessment of Severity of Aortic Stenosis

    PubMed Central

    Kim, Hyung-Kwan; Sohn, Dae-Won

    2012-01-01

    BACKGROUND Aortic stenosis (AS) is increasingly diagnosed in current aging society. Echocardiography is the most important tool in the assessment of AS and its severity. However, load-dependency of Doppler measurement could affect the accuracy of AS severity assessment. We tried to evaluate the impact of afterload on the assessment of AS severity by modification of afterload using pneumatic compression (Pcom). METHODS Forty patients diagnosed as moderate or severe AS [effective orifice area of aortic valve (EOAAV) by continuity equation of < 1.5 cm2] were consecutively enrolled. Patients with severely uncontrolled hypertension, severe left ventricular (LV) dysfunction, and other significant valve disease were excluded. Comprehensive echocardiography was performed at baseline to assess AS severity. Then, pneumatic compression of the lower extremities by 100 mmHg was applied to increase LV afterload. After 3 minutes, echocardiography was repeated to assess AS severity. RESULTS Mean blood pressure was significantly increased under Pcom (p < 0.001), while heart rate remained unchanged. Peak aortic valve velocity (Vmax) was slightly, but significantly decreased under Pcom (p = 0.03). However, Doppler velocity index and EOAAV by continuity equation were not affected by Pcom. CONCLUSION AS severity assessment by echocardiography was not dependent on the change of LV afterload imposed by Pcom. AV Vmax was slightly decreased with LV afterload increment, but these changes were too small to alter treatment plan of AS patients. EOAAV and Doppler velocity index are more stable parameters for AS severity assessment. PMID:22787524

  4. Head Impact Severity Measures for Evaluating Mild Traumatic Brain Injury Risk Exposure

    PubMed Central

    Greenwald, Richard M.; Gwin, Joseph T.; Chu, Jeffrey J.; Crisco, Joseph J.

    2009-01-01

    Objective To quantify sensitivity of various biomechanical measures of head impact (linear acceleration, rotational acceleration, impact duration, impact location) to clinical diagnosis of concussion in American football players and to develop a novel measure of head impact severity which combines these measures into a single score that better predicts the incidence of concussion. Methods On-field head impact data were collected from 449 football players at 13 organizations (n = 289,916) using in-helmet systems of six single axis accelerometers. 1,2,3,4,5 Concussions were diagnosed by medical staff and later associated with impact data. Principal Component Analysis 6, 7 and a weighting coefficient based on impact location were used to transform correlated head impact measures into a new composite variable (wPCS). The predictive power of linear acceleration, rotational acceleration, Head Injury Criteria, and wPCS was quantified using Receiver Operating Characteristic8,9,10 curves. The null hypothesis that a measure was no more predictive than guessing was tested (α=0.05). Additionally, ROC curves for wPCS and classical measures were directly compared to test the hypothesis that wPCS was more predictive of concussion than classic measures (α=0.05). Results When all impacts were considered, every biomechanical measure evaluated was statistically more predictive of concussion than guessing (p < 0.005). However, for the top 1% and 2% of impacts based on linear acceleration, a subset that consisted of 82% of all diagnosed concussions, only wPCS was significantly more predictive of concussion than guessing (p<0.03), and, when compared to each other, wPCS was more predictive of concussion than classical measures for the top 1% and 2% of all data (p < 0.04). Conclusions A weighted combination of several biomechanical inputs, including impact location, is more predictive of concussion than a single biomechanical measure. This study is the first to quantify improvements in

  5. Ten factors that affect the severity of environmental impacts of visitors in protected areas.

    PubMed

    Pickering, Catherine Marina

    2010-02-01

    Protected areas represent the major method for conserving biodiversity. However, visitor use can threaten their conservation value. Based on a review of recent research, I have categorized factors that affect the severity of environmental impacts of visitor use. These factors need to be considered or evaluated when assessing visitor use of sites in protected areas. They are: (i) the conservation value of the site, (ii) its resistance to use, (iii) its recovery from use, (iv) its susceptibility to erosion, (v) the severity of direct impacts associated with specific activities, (vi) the severity of indirect impacts, (vii) the amount of use, (viii) the social and (ix) ecological dimensions to the timing of use, and (x) the total area affected. Although the factors may not be of equal importance or necessarily assessed on an equal scale, they allow people to make more informed assessments of potential impacts, assist in identifying where monitoring may be required, and indicate where additional site- or activity-specific research may be appropriate.

  6. Severe environmental effects of Chicxulub impact imply key role in end-Cretaceous mass extinction

    NASA Astrophysics Data System (ADS)

    Brugger, Julia; Feulner, Georg; Petri, Stefan

    2017-04-01

    66 million years ago, during the most recent of the five severe mass extinctions in Earth's history, non-avian dinosaurs and many other organisms became extinct. The cause of this end-Cretaceous mass extinction is seen in either flood-basalt eruptions or an asteroid impact. Modeling the climatic changes after the Chicxulub asteroid impact allow to assess its contribution to the extinction event and to analyze the short-term and long-term response of the climate and the biosphere to the impact. Existing studies either investigated the effect of dust, which is now believed to play a minor role, or used one-dimensional, non-coupled models. In contrast, we use a coupled climate model to explore the longer lasting cooling due to sulfate aerosols. Based on data from geophysical impact modeling, we set up simulations with different stratospheric residence times for sulfate aerosols. Depending on this residence time, global surface air temperature decreased by at least 26°C, with 3 to 16 years subfreezing temperatures and a recovery time larger than 30 years. Vigorous ocean mixing, caused by the fast cooling of the surface ocean, might have perturbed marine ecosystems by the upwelling of nutrients. The dramatic climatic changes seen in our simulations imply severe environmental effects and therefore a significant contribution of the impact in the end-Cretaceous mass extinction.

  7. Impact of clinical severity on outcomes of mentalisation-based treatment for borderline personality disorder.

    PubMed

    Bateman, Anthony; Fonagy, Peter

    2013-09-01

    Evidence of remission from borderline personality disorder (BPD) without specialised treatment is accumulating. To establish whether specialised treatments are indicated for patients with clinically severe disorder. The impact of clinical severity on outcomes of a randomised controlled trial of mentalisation-based treatment (MBT) was contrasted with structured clinical management (SCM). Severity indicators were defined as severity of comorbid psychiatric syndromes, severity of BPD, severity of personality disturbance and severity of symptom distress. Logistic regressions were used to predict the likelihood of recovery at 18 months, and mixed-effects regression analysis was applied to examine the association of severity and rates of improvement across time in the two treatment groups. None of the severity criteria predicted outcome at the end of treatment on logistic regression. However, testing the significance of distribution of cases of recovery v. non-recovery suggested that multiple Axis II diagnoses and symptom distress influenced outcomes. Borderline personality disorder with significant Axis II comorbidity is a possible but uncertain indicator for specialist treatment. Patients whose only personality disorder diagnosis is BPD do equally well with SCM. Prospective studies are needed.

  8. Impact of personality and depression on quality of life in patients with severe haemophilia in Korea.

    PubMed

    Kim, S-Y; Kim, S-W; Kim, J-M; Shin, I-S; Baek, H-J; Lee, H-S; Hwang, T-J; Yoon, J-S

    2013-09-01

    Among reports on the psychological variables that influence quality of life (QoL), none has addressed the impact of personality on QoL in patients with haemophilia. We investigated the impact of psychosocial variables including depression and personality on QoL in patients with severe haemophilia. A cross-sectional survey examining psychosocial and clinical characteristics was administered to Korean patients with severe haemophilia. Personality traits were ascertained using the 10-item short version of the Big Five Inventory, which quantifies five personality dimensions including extraversion, agreeableness, conscientiousness, neuroticism and openness. Patient QoL and depression were measured by the World Health Organization Quality of Life-abbreviated version and the Beck Depression Inventory (BDI) respectively. Multivariate linear regression analyses were used for each domain to determine the impact of psychological variables on QoL. Of the 53 subjects who consented to participate, 46 cases were finally analysed. Multivariate linear regression analyses demonstrated that agreeableness was significantly and positively associated with the physical health domain of QoL. Openness was independently and positively associated with the psychological and social relationship domains of QoL. BDI scores were significantly and negatively associated with all four domains of the QoL. Persistent pain and joint impairment showed strong associations with all domains in a univariate analysis, but the impact was attenuated after adjusting for psychosocial variables. Personality and depression had strong impacts on QoL independent of physical status in patients with severe haemophilia. Providing psychological screening and intervention are recommended for enhancing QoL in patients with severe haemophilia.

  9. Root causes and impacts of severe accidents at large nuclear power plants.

    PubMed

    Högberg, Lars

    2013-04-01

    The root causes and impacts of three severe accidents at large civilian nuclear power plants are reviewed: the Three Mile Island accident in 1979, the Chernobyl accident in 1986, and the Fukushima Daiichi accident in 2011. Impacts include health effects, evacuation of contaminated areas as well as cost estimates and impacts on energy policies and nuclear safety work in various countries. It is concluded that essential objectives for reactor safety work must be: (1) to prevent accidents from developing into severe core damage, even if they are initiated by very unlikely natural or man-made events, and, recognizing that accidents with severe core damage may nevertheless occur; (2) to prevent large-scale and long-lived ground contamination by limiting releases of radioactive nuclides such as cesium to less than about 100 TBq. To achieve these objectives the importance of maintaining high global standards of safety management and safety culture cannot be emphasized enough. All three severe accidents discussed in this paper had their root causes in system deficiencies indicative of poor safety management and poor safety culture in both the nuclear industry and government authorities.

  10. Blast waves from detonated military explosive reduce GluR1 and synaptophysin levels in hippocampal slice cultures.

    PubMed

    Smith, Marquitta; Piehler, Thuvan; Benjamin, Richard; Farizatto, Karen L; Pait, Morgan C; Almeida, Michael F; Ghukasyan, Vladimir V; Bahr, Ben A

    2016-12-01

    Explosives create shockwaves that cause blast-induced neurotrauma, one of the most common types of traumatic brain injury (TBI) linked to military service. Blast-induced TBIs are often associated with reduced cognitive and behavioral functions due to a variety of factors. To study the direct effects of military explosive blasts on brain tissue, we removed systemic factors by utilizing rat hippocampal slice cultures. The long-term slice cultures were briefly sealed air-tight in serum-free medium, lowered into a 37°C water-filled tank, and small 1.7-gram assemblies of cyclotrimethylene trinitramine (RDX) were detonated 15cm outside the tank, creating a distinct shockwave recorded at the culture plate position. Compared to control mock-treated groups of slices that received equal submerge time, 1-3 blast impacts caused a dose-dependent reduction in the AMPA receptor subunit GluR1. While only a small reduction was found in hippocampal slices exposed to a single RDX blast and harvested 1-2days later, slices that received two consecutive RDX blasts 4min apart exhibited a 26-40% reduction in GluR1, and the receptor subunit was further reduced by 64-72% after three consecutive blasts. Such loss correlated with increased levels of HDAC2, a histone deacetylase implicated in stress-induced reduction of glutamatergic transmission. No evidence of synaptic marker recovery was found at 72h post-blast. The presynaptic marker synaptophysin was found to have similar susceptibility as GluR1 to the multiple explosive detonations. In contrast to the synaptic protein reductions, actin levels were unchanged, spectrin breakdown was not detected, and Fluoro-Jade B staining found no indication of degenerating neurons in slices exposed to three RDX blasts, suggesting that small, sub-lethal explosives are capable of producing selective alterations to synaptic integrity. Together, these results indicate that blast waves from military explosive cause signs of synaptic compromise without

  11. Exploring the impact of access designs on crash injury severity on multilane highways.

    PubMed

    Wang, Zhenyu; Huang, Bing; Lu, Jian; Zhao, Jianyou; Zhang, Yu

    2014-01-01

    Access design is a critical factor that influences the safety and mobility of urban/suburban multilane highways due to the interactions between access movements and through traffic. An effective way for improving the safety and mobility of multilane highways is to control access maneuvers by implementing appropriate access designs. Understanding the impact of access designs on crash injury severity is beneficial for implementing effective countermeasures to mitigate crash injury at access points. Thus, the objectives of this article are to investigate the impact of access designs on crash injury severity and identify contributing factors of crash injury severity at access points of multilane highways. A total of 1830 crash records were collected at 149 access points with different access designs for a period of 3 years (2008-2010) in Florida. A heterogeneous logit model, relaxing the constraint of identical variances across observations in the traditional ordered choice models, was developed to evaluate the impact of access designs on crash injury severity and identify contributing factors. The marginal effects of the developed model were used to interpret the impact of access designs and other contributing factors. At 4-leg access points, given that a crash has occurred, replacing full median openings with closed medians will reduce the probability of severe injury (fatality, incapacitating injury, or nonincapacitating injury) by 9.73 percent; substituting full median openings with directional median openings will reduce the probability of severe injury by 11.02 percent. At 3-leg access points, given that a crash has occurred, closed medians significantly experience a lower risk of severe injury than full median openings; however, there is no evidence that directional median openings are similarly effective. Other contributing factors of crash injury severity at access points were identified as number of lanes, shoulder width, median width, driveway density, left

  12. Dry media blasting with wheat starch

    NASA Astrophysics Data System (ADS)

    Foster, Terry

    1995-04-01

    The brand name TECHNOSTRIP covers several types of installations and facilities. These were developed mainly to meet the requirements of customers in the aeronautic field. The range of products includes: complete self-supporting and semi-automated system for aircraft stripping; large-size blasting booth for semi-automatic stripping; manual blasting booth; and sealed and portable manual stripping head. Wheat starch media was developed for particle blasting stripping and is used in TECHNOSTRIP. This paper reviews its origins and use as well as use of automated facilities, reliability, effects on materials, effects on environment, and utilization examples.

  13. Impact of trauma system preparedness on the outcomes of severe injuries among child populations.

    PubMed

    Afifi, Raouf

    2012-12-01

    Severe child trauma poses a heavy burden upon the public's health and the nations' economies, in terms of mortality, morbidity, and disability. The burden varies by the maturity level of the adopted trauma system. This work aimed to identify the impact of trauma system maturity on the outcomes of care of severely injured children. Discharge data for the hospitalized trauma children in Florida (mature trauma system) and Indiana (immature trauma system) were retrospectively analyzed. All severely injured children, 1-15 years of age with an injury severity score ≥25 during 1999-2000 were included. Assessment involved the differences in specified treatment procedures, survival rates, hospital length of stay, and the need for post-hospital institutional care. Analysis revealed that Indiana children significantly stay longer in hospital, and that no differences in the rates of patient mortality, discharge-home, and selected procedures were found. Trauma system maturity impacts the volume and complexity of interventions, as well as the mortality, morbidity, and disability associated with severe children and adolescent trauma. The cost of such burden could be directed to improving the quality of the state's injury management services.

  14. Impact of Trauma System Preparedness on the Outcomes of Severe Child and Adolescent Injuries.

    PubMed

    Afifi, Raouf

    2015-12-01

    Severe child trauma poses a heavy burden upon the public's health and the nations' economies, in terms of mortality, morbidity, and disability. The burden varies by the maturity level of the adopted trauma system. This work aimed to identify the impact of trauma system maturity upon the outcomes of care of severely injured children. Discharge data for hospitalized trauma children in Florida (mature trauma system) and Indiana (immature trauma system) were retrospectively analyzed. All severely injured children, 1-15 years of age with an injury severity score ≥25 during 1999-2000 were included. Assessment involved the differences in specified treatment procedures, survival rates, hospital length of stay, and the need for post-hospital institutional care. Analysis revealed that Indiana children significantly stay longer in hospital, and that no differences in the rates of patient mortality, discharge home, and selected procedures were found. Trauma system maturity impacts the volume and complexity of interventions, as well as the mortality, morbidity, and disability associated with the severe child and adolescent trauma. The cost of such burden could be directed to improving quality of the state's injury management services.

  15. A headform for testing helmet and mouthguard sensors that measure head impact severity in football players.

    PubMed

    Siegmund, Gunter P; Guskiewicz, Kevin M; Marshall, Stephen W; DeMarco, Alyssa L; Bonin, Stephanie J

    2014-09-01

    A headform is needed to validate and compare helmet- and mouthguard-based sensors that measure the severity and direction of football head impacts. Our goal was to quantify the dynamic response of a mandibular load-sensing headform (MLSH) and to compare its performance and repeatability to an unmodified Hybrid III headform. Linear impactors in two independent laboratories were used to strike each headform at six locations at 5.5 m/s and at two locations at 3.6 and 7.4 m/s. Impact severity was quantified using peak linear acceleration (PLA) and peak angular acceleration (PAA), and direction was quantified using the azimuth and elevation of the PLA. Repeatability was quantified using coefficients of variation (COV) and standard deviations (SD). Across all impacts, PLA was 1.6±1.8 g higher in the MLSH than in the Hybrid III (p=0.002), but there were no differences in PAA (p=0.25), azimuth (p=0.43) and elevation (p=0.11). Both headforms exhibited excellent or acceptable repeatability for PLA (HIII:COV=2.1±0.8%, MLSH:COV=2.0±1.2%, p=0.98), but site-specific repeatability ranging from excellent to poor for PAA (HIII:COV=7.2±4.0%, MLSH:COV=8.3±5.8%, p=0.58). Direction SD were generally <1° and did not vary between headforms. Overall, both headforms are similarly suitable for validating PLA in sensors that measure head impact severity in football players, however their utility for validating sensor PAA values varies with impact location.

  16. Clozapine-induced hypersalivation: an estimate of prevalence, severity and impact on quality of life

    PubMed Central

    Maher, Senan; Cunningham, Aoife; O’Callaghan, Niamh; Byrne, Fintan; Mc Donald, Colm; McInerney, Shane; Hallahan, Brian

    2016-01-01

    Objectives: The objective of this study was to evaluate the prevalence and severity of clozapine-induced hypersalivation, and assess the impact hypersalivation has on global functioning. Methods: Participants attending a dedicated clozapine clinic were invited to undertake a structured interview regarding their experiences of clozapine-induced hypersalivation. Two psychometric instruments to measure hypersalivation, the Nocturnal Hypersalivation Rating Scale and the Drooling Severity and Frequency Scale were used. Results: Clozapine-induced hypersalivation was experienced by 92% of participants, with nocturnal hypersalivation more prevalent compared to daytime hypersalivation (85% versus 48%). Daytime drooling was severe in 18% of cases and was present on a frequent or constant basis for 20% of individuals. Hypersalivation had at least a moderate impact on the quality of life of 15% of study participants. Conclusions: Clozapine-induced hypersalivation is the most prevalent adverse effect experienced by patients treated with clozapine and negatively impacts on quality of life, particularly if daytime drooling is present. The development of further strategies to ameliorate this adverse effect is required given the demonstrated lack of success to date in managing this condition. PMID:27354906

  17. The impact of illness perceptions and disease severity on quality of life in congenital heart disease.

    PubMed

    O'Donovan, Claire E; Painter, Liz; Lowe, Boris; Robinson, Hayley; Broadbent, Elizabeth

    2016-01-01

    Despite an increasing prevalence of adults living with a CHD, little is known about the psychosocial impact of CHD. We sought to investigate the relative impact of disease severity and patients' perceptions about their condition on depression, anxiety, and quality of life over a period of a year. A total of 110 patients aged over 16 years completed an initial questionnaire containing measures for anxiety, depression, quality of life, and illness perceptions when they attended the Adult Congenital Heart Disease Clinic. Cardiologists rated the patients' disease severity and illness course. A year later, patients were invited to complete the same measures. Regression analyses were performed to determine the relative impact of illness perceptions and disease severity on psychological outcomes a year later. At baseline, 23% of the study population had depressive symptoms and 30% had elevated trait anxiety. After controlling for associations with disease-related variables, illness perceptions explained 28% of the variance in depression, 40% anxiety, and 27% overall quality of life at baseline. Baseline illness perceptions bivariately predicted quality of life, cardiac anxiety, and depression 1 year later, and regression analyses controlling for other factors showed that they were significant predictors of outcomes 1 year later. Symptoms of depression and anxiety are common among adults with CHD. Patients' illness perceptions are related to psychological outcomes, especially cross-sectionally. Future research could investigate whether an intervention to discuss patients' perceptions about their CHD can improve mental health and quality of life.

  18. Child and Adult Pedestrian Impact: The Influence of Vehicle Type on Injury Severity

    PubMed Central

    Henary, Basem Y.; Crandall, Jeff; Bhalla, Kavi; Mock, Charles N.; Roudsari, Bahman S.

    2003-01-01

    In the United States, the vehicle fleet is shifting from predominantly passenger cars (automobiles) to SUVs, light trucks, and vans (LTV). This study investigates how pedestrian severe injury and mortality are associated with vehicle type and pedestrian age. The Pedestrian Crash Data Study (PCDS) database for years 1994–1998 was used for a cross-sectional study design. Outcome measures were Injury Severity Score, Maximum Abbreviated Injury Score, Abbreviated Injury Scale, Pedestrian Mortality, Functional Capacity Index and Life Years Lost to Injury. Compared to children, adult pedestrians were more likely to sustain severe injury (OR = 2.81; 95% CI: 1.56–5.06) or mortality (OR = 2.91; 95% CI: 1.10–7.74) when examining all vehicle types. However, after adjusting for vehicle type and impact speed, this association was not statistically significant at p < 0.05. Compared to passenger cars, pedestrians struck by LTV were more likely to have severe injuries (OR = 1.31; 95% CI: 0.88–1.94) or mortality (OR = 1.40; 95% CI: 0.84–2.34) for all pedestrians. Adjusting for pedestrian age, this association was more obvious and significant at lower impact speeds (≤ 30 km/h); odds ratios of severe injury and mortality were 3.34 (p< 0.01) and 1.87 (p= 0.07), respectively. Adults hit by LTV had the highest risk of injury and mortality. These findings indicate that pedestrian age, vehicle engineering design and impact speed are highly contributing to risks of pedestrian injury and mortality. PMID:12941221

  19. The Impact of Body Posture and Sleep Stages on Sleep Apnea Severity in Adults

    PubMed Central

    Eiseman, Nathaniel A.; Westover, M. Brandon; Ellenbogen, Jeffrey M.; Bianchi, Matt T.

    2012-01-01

    Study Objectives: Determining the presence and severity of obstructive sleep apnea (OSA) is based on apnea and hypopnea event rates per hour of sleep. Making this determination presents a diagnostic challenge, given that summary metrics do not consider certain factors that influence severity, such as body position and the composition of sleep stages. Methods: We retrospectively analyzed 300 consecutive diagnostic PSGs performed at our center to determine the impact of body position and sleep stage on sleep apnea severity. Results: The median percent of REM sleep was 16% (reduced compared to a normal value of ~25%). The median percent supine sleep was 65%. Fewer than half of PSGs contained > 10 min in each of the 4 possible combinations of REM/NREM and supine/non-supine. Half of patients had > 2-fold worsening of the apnea-hypopnea index (AHI) in REM sleep, and 60% had > 2-fold worsening of AHI while supine. Adjusting for body position had greater impact on the AHI than adjusting for reduced REM%. Misclassification—specifically underestimation of OSA severity—is attributed more commonly to body position (20% to 40%) than to sleep stage (~10%). Conclusions: Supine-dominance and REM-dominance commonly contribute to AHI underestimation in single-night PSGs. Misclassification of OSA severity can be mitigated in a patient-specific manner by appropriate consideration of these variables. The results have implications for the interpretation of single-night measurements in clinical practice, especially with trends toward home testing devices that may not measure body position or sleep stage. Citation: Eiseman NA; Westover MB; Ellenbogen JM; Bianchi MT. The impact of body posture and sleep stages on sleep apnea severity in adults. J Clin Sleep Med 2012;8(6):655-666. PMID:23243399

  20. Nanoenhanced polyurea as a blast resistant coating for concrete masonry walls

    NASA Astrophysics Data System (ADS)

    Rivera, Heather Kathryn Daniell

    Blast impact is a major concern in the world today. The leading cause of death due to blast impacts is rapidly moving debris. To prevent this many researchers are looking for methods of improved blast resistance for concrete masonry walls. However, many available protective coatings are not flame retardant. This thesis focuses on nanoenhanced polyurea for applications in improving blast resistance, while possessing improved flame retardancy, of concrete masonry walls. The polyurea that is being researched is enhanced with nanoadditives in an effort improve both blast and fire resistance. These materials are dynamically tested and those showing marked improvement are chosen for experimental and computational testing.

  1. The impact of illness in patients with moderate to severe gastro-esophageal reflux disease

    PubMed Central

    El-Dika, Samer; Guyatt, Gordon H; Armstrong, David; Degl'innocenti, Alessio; Wiklund, Ingela; Fallone, Carlo A; Tanser, Lisa; van Zanten, Sander Veldhuyzen; Heels-Ansdell, Diane; Wahlqvist, Peter; Chiba, Naoki; Barkun, Alan N; Austin, Peggy; Schünemann, Holger J

    2005-01-01

    Background Gastro-esophageal reflux disease (GERD) is a common disease. It impairs health related quality of life (HRQL). However, the impact on utility scores and work productivity in patients with moderate to severe GERD is not well known. Methods We analyzed data from 217 patients with moderate to severe GERD (mean age 50, SD 13.7) across 17 Canadian centers. Patients completed three utility instruments – the standard gamble (SG), the feeling thermometer (FT), and the Health Utilities Index 3 (HUI 3) – and several HRQL instruments, including Quality of Life in Reflux and Dyspepsia (QOLRAD) and the Medical Outcomes Short Form-36 (SF-36). All patients received a proton pump inhibitor, esomeprazole 40 mg daily, for four to six weeks. Results The mean scores on a scale from 0 (dead) to 1 (full health) obtained for the FT, SG, and HUI 3 were 0.67 (95% CI, 0.64 to 0.70), 0.76 (95% CI, 0.75 to 0.80), and 0.80 (95% CI, 0.77 to 0.82) respectively. The mean scores on the SF-36 were lower than the previously reported Canadian and US general population mean scores and work productivity was impaired. Conclusion GERD has significant impact on utility scores, HRQL, and work productivity in patients with moderate to severe disease. Furthermore, the FT and HUI 3 provide more valid measurements of HRQL in GERD than the SG. After treatment with esomeprazole, patients showed improved HRQL. PMID:16004616

  2. Impacts of Severe Winter Weather during December 1989 in the Lake Erie Snowbelt.

    NASA Astrophysics Data System (ADS)

    Schmidlin, Thomas W.

    1993-04-01

    December 1989 was the coldest December in over 100 years in the Lake Erie snowbelt of Ohio, Pennsylvania, and New York. Mean temperatures of 9°C were 7°C lower than average and extreme minima reached 30°C. Snow fell on 20 to 25 days of the month and snowfall totals of 100 to 200 cm were twice the December average. Some locations reported record snowfalls and the greatest snow depths of this century. Several segments of society were studied to assess the impacts of this severe winter weather.The severe weather had minimal impacts on school districts. Over half (54%) of the districts had no closures due to snow but costs for snow removal increased for schools. Ski centers reported a 50% to 100% increase in revenues over December 1988 and the best December skiing in many years. Lake ports had higher operating costs and loss of shipments. Costs for snow and ice control on Interstate 90 (I-90) in the snowbelt increased at least $1326 km1 over December 1988, but traffic flow was maintained. Person-hours spent on snow and ice control on I-90 increased 59%. An average of 111 000 kg km1 (200 tons mile1) of salt and grit was spread on I-90, an increase of 50 000 kg km1 (89 tons mile1) over December 1988. Colleges, airports, agriculture, hospitals, urban mass transit, electric utilities, and government agencies had only minor disruptions due to the severe winter weather.

  3. Impact of the severity of chronic periodontal disease on quality of life.

    PubMed

    Meusel, Dayse R D Z; Ramacciato, Juliana C; Motta, Rogério H L; Brito Júnior, Rui B; Flório, Flávia M

    2015-06-01

    We examined the impact of the severity of periodontal disease on quality of life in adults with chronic periodontitis. One hundred patients (age, 30-58 years) who were assisted at the Basic Health Care Unit in the city of Passo Fundo, RS, Brazil underwent clinical examination of all standing teeth, including gingival bleeding on probing, probing depth, and clinical attachment level, and were divided into those with mild/moderate (n = 49; group G1) and severe (n = 51; group G2) chronic periodontitis. The participants were then interviewed, using a structured questionnaire. The Brazilian Oral Health Impact Profile (OHIP-14Br) questionnaire was used to assess oral health-related quality of life. Associations were investigated, and those with a P value of less than 0.2 were tested using multiple logistic regression models. Those with a P value of 0.05 or less were considered significant. There was a significant association between G2 and education level (P = 0.00051). OHIP-14Br score was higher for G2 (24.1) than for G1 (18.2) (P = 0.0455). Severe chronic periodontitis was associated with low education level (≤8 years) (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.2-7.3) and pronunciation difficulties (OR, 3.1; 95% CI, 1.0-9.3). In conclusion, periodontal disease severity was inversely associated with quality of life among Brazilian adults.

  4. Lightweight Energy Absorbers for Blast Containers

    NASA Technical Reports Server (NTRS)

    Balles, Donald L.; Ingram, Thomas M.; Novak, Howard L.; Schricker, Albert F.

    2003-01-01

    Kinetic-energy-absorbing liners made of aluminum foam have been developed to replace solid lead liners in blast containers on the aft skirt of the solid rocket booster of the space shuttle. The blast containers are used to safely trap the debris from small explosions that are initiated at liftoff to sever frangible nuts on hold-down studs that secure the spacecraft to a mobile launch platform until liftoff.

  5. Impact of glaucoma severity and laterality on vision-specific functioning: the Singapore Malay eye study.

    PubMed

    Chan, Errol W; Chiang, Peggy P C; Wong, Tien Y; Saw, Seang M; Loon, Seng C; Aung, Tin; Lamoureux, Ecosse

    2013-02-01

    We determined the impact of glaucoma severity and laterality on vision-specific functioning (VF) in an Asian population. The Singapore Malay Eye Study (SiMES) was a population-based cross-sectional study of 3280 Malays aged 40 to 80 years. VF was assessed using the VF-11 questionnaire. Associations between VF-11 score and glaucoma clinical indices (glaucoma severity in better and worse eyes, and laterality) were determined by multivariate regression modeling. Glaucoma severity was defined as mild, moderate, advanced, and severe based on the Hodapp-Anderson-Parish system. Rasch analysis was used to validate the VF-11 and determine its psychometric properties. Of 926 persons analyzed, 123 had glaucoma (13.3% glaucoma prevalence in analyzed sample). The mean ± SD VF score was 3.64 ± 1.05 log of odds units (Logits). In multivariate models adjusting for sociodemographic, ocular, and systemic variables, poorer VF was associated with increasingly worse eye visual field loss (β = 0.016, 95% confidence interval [CI] 0.004-0.029, P < 0.001), but not that of the better eye (P > 0.05). Compared to controls, VF was reduced in individuals with worse eye advanced and severe glaucoma (β = -0.65, 95% CI -1.03 to -0.28, P < 0.05), but not mild or moderate glaucoma (P > 0.05). Compared to controls, VF was reduced in unilateral (β = -0.29, 95% CI -0.54 to -0.04, P < 0.05), but not bilateral glaucoma (P > 0.05). These associations remained significant after adjusting for presenting and best-corrected visual acuity. Among Singaporean Malays, unilateral, and advanced and severe glaucoma in the worse eye significantly impacts on VF. Identifying early-stage glaucoma, preventing progression, and visual rehabilitation in advanced glaucoma are important aspects of glaucoma management.

  6. Climate Change and Phenology: Empoasca fabae (Hemiptera: Cicadellidae) Migration and Severity of Impact

    PubMed Central

    Lamp, William O.

    2015-01-01

    Climate change can benefit individual species, but when pest species are enhanced by warmer temperatures agricultural productivity may be placed at greater risk. We analyzed the effects of temperature anomaly on arrival date and infestation severity of potato leafhopper, Empoasca fabae Harris, a classic new world long distance migrant, and a significant pest in several agricultural crops. We compiled E. fabae arrival dates and infestation severity data at different states in USA from existing literature reviews and agricultural extension records from 1951–2012, and examined the influence of temperature anomalies at each target state or overwintering range on the date of arrival and severity of infestation. Average E. fabae arrival date at different states reveal a clear trend along the south-north axis, with earliest arrival closest to the overwintering range. E. fabae arrival has advanced by 10 days over the last 62 years. E. fabae arrived earlier in warmer years in relation to each target state level temperature anomaly (3.0 days / °C increase in temperature anomaly). Increased temperature had a significant and positive effect on the severity of infestation, and arrival date had a marginal negative effect on severity. These relationships suggest that continued warming could advance the time of E. fabae colonization and increase their impact on affected crops. PMID:25970705

  7. Climate Change and Phenology: Empoasca fabae (Hemiptera: Cicadellidae) Migration and Severity of Impact.

    PubMed

    Baker, Mitchell B; Venugopal, P Dilip; Lamp, William O

    2015-01-01

    Climate change can benefit individual species, but when pest species are enhanced by warmer temperatures agricultural productivity may be placed at greater risk. We analyzed the effects of temperature anomaly on arrival date and infestation severity of potato leafhopper, Empoasca fabae Harris, a classic new world long distance migrant, and a significant pest in several agricultural crops. We compiled E. fabae arrival dates and infestation severity data at different states in USA from existing literature reviews and agricultural extension records from 1951-2012, and examined the influence of temperature anomalies at each target state or overwintering range on the date of arrival and severity of infestation. Average E. fabae arrival date at different states reveal a clear trend along the south-north axis, with earliest arrival closest to the overwintering range. E. fabae arrival has advanced by 10 days over the last 62 years. E. fabae arrived earlier in warmer years in relation to each target state level temperature anomaly (3.0 days / °C increase in temperature anomaly). Increased temperature had a significant and positive effect on the severity of infestation, and arrival date had a marginal negative effect on severity. These relationships suggest that continued warming could advance the time of E. fabae colonization and increase their impact on affected crops.

  8. Impacts on the deep-sea ecosystem by a severe coastal storm.

    PubMed

    Sanchez-Vidal, Anna; Canals, Miquel; Calafat, Antoni M; Lastras, Galderic; Pedrosa-Pàmies, Rut; Menéndez, Melisa; Medina, Raúl; Company, Joan B; Hereu, Bernat; Romero, Javier; Alcoverro, Teresa

    2012-01-01

    Major coastal storms, associated with strong winds, high waves and intensified currents, and occasionally with heavy rains and flash floods, are mostly known because of the serious damage they can cause along the shoreline and the threats they pose to navigation. However, there is a profound lack of knowledge on the deep-sea impacts of severe coastal storms. Concurrent measurements of key parameters along the coast and in the deep-sea are extremely rare. Here we present a unique data set showing how one of the most extreme coastal storms of the last decades lashing the Western Mediterranean Sea rapidly impacted the deep-sea ecosystem. The storm peaked the 26(th) of December 2008 leading to the remobilization of a shallow-water reservoir of marine organic carbon associated with fine particles and resulting in its redistribution across the deep basin. The storm also initiated the movement of large amounts of coarse shelf sediment, which abraded and buried benthic communities. Our findings demonstrate, first, that severe coastal storms are highly efficient in transporting organic carbon from shallow water to deep water, thus contributing to its sequestration and, second, that natural, intermittent atmospheric drivers sensitive to global climate change have the potential to tremendously impact the largest and least known ecosystem on Earth, the deep-sea ecosystem.

  9. Impacts on the Deep-Sea Ecosystem by a Severe Coastal Storm

    PubMed Central

    Sanchez-Vidal, Anna; Canals, Miquel; Calafat, Antoni M.; Lastras, Galderic; Pedrosa-Pàmies, Rut; Menéndez, Melisa; Medina, Raúl; Company, Joan B.; Hereu, Bernat; Romero, Javier; Alcoverro, Teresa

    2012-01-01

    Major coastal storms, associated with strong winds, high waves and intensified currents, and occasionally with heavy rains and flash floods, are mostly known because of the serious damage they can cause along the shoreline and the threats they pose to navigation. However, there is a profound lack of knowledge on the deep-sea impacts of severe coastal storms. Concurrent measurements of key parameters along the coast and in the deep-sea are extremely rare. Here we present a unique data set showing how one of the most extreme coastal storms of the last decades lashing the Western Mediterranean Sea rapidly impacted the deep-sea ecosystem. The storm peaked the 26th of December 2008 leading to the remobilization of a shallow-water reservoir of marine organic carbon associated with fine particles and resulting in its redistribution across the deep basin. The storm also initiated the movement of large amounts of coarse shelf sediment, which abraded and buried benthic communities. Our findings demonstrate, first, that severe coastal storms are highly efficient in transporting organic carbon from shallow water to deep water, thus contributing to its sequestration and, second, that natural, intermittent atmospheric drivers sensitive to global climate change have the potential to tremendously impact the largest and least known ecosystem on Earth, the deep-sea ecosystem. PMID:22295084

  10. Development of strategies to manage rice blast disease in the USA

    USDA-ARS?s Scientific Manuscript database

    Rice blast disease has been a serious threat to stable rice production in the southern USA. Blast disease has been causing yield losses for decades. Severity of blast epidemics has been always influenced by a combination of the following three factors: 1) rice cultivars deployed with different comb...

  11. Modelling the Source of Blasting for the Numerical Simulation of Blast-Induced Ground Vibrations: A Review

    NASA Astrophysics Data System (ADS)

    Ainalis, Daniel; Kaufmann, Olivier; Tshibangu, Jean-Pierre; Verlinden, Olivier; Kouroussis, Georges

    2017-01-01

    The mining and construction industries have long been faced with considerable attention and criticism in regard to the effects of blasting. The generation of ground vibrations is one of the most significant factors associated with blasting and is becoming increasingly important as mining sites are now regularly located near urban areas. This is of concern to not only the operators of the mine but also residents. Mining sites are subjected to an inevitable compromise: a production blast is designed to fragment the utmost amount of rock possible; however, any increase in the blast can generate ground vibrations which can propagate great distances and cause structural damage or discomfort to residents in surrounding urban areas. To accurately predict the propagation of ground vibrations near these sensitive areas, the blasting process and surrounding environment must be characterised and understood. As an initial step, an accurate model of the source of blast-induced vibrations is required. This paper presents a comprehensive review of the approaches to model the blasting source in order to critically evaluate developments in the field. An overview of the blasting process and description of the various factors which influence the blast performance and subsequent ground vibrations are also presented. Several approaches to analytically model explosives are discussed. Ground vibration prediction methods focused on seed waveform and charge weight scaling techniques are presented. Finally, numerical simulations of the blasting source are discussed, including methods to estimate blasthole wall pressure time-history, and hydrodynamic codes.

  12. Severe Space Weather Events--Understanding Societal and Economic Impacts: A Workshop Report - Extended Summary

    NASA Technical Reports Server (NTRS)

    2009-01-01

    The effects of space weather on modern technological systems are well documented in both the technical literature and popular accounts. Most often cited perhaps is the collapse within 90 seconds of northeastern Canada's Hydro-Quebec power grid during the great geomagnetic storm of March 1989, which left millions of people without electricity for up to 9 hours. This event exemplifies the dramatic impact that severe space weather can have on a technology upon which modern society critically depends. Nearly two decades have passed since the March 1989 event. During that time, awareness of the risks of severe space weather has increased among the affected industries, mitigation strategies have been developed, new sources of data have become available, new models of the space environment have been created, and a national space weather infrastructure has evolved to provide data, alerts, and forecasts to an increasing number of users. Now, 20 years later and approaching a new interval of increased solar activity, how well equipped are we to manage the effects of space weather? Have recent technological developments made our critical technologies more or less vulnerable? How well do we understand the broader societal and economic impacts of severe space weather events? Are our institutions prepared to cope with the effects of a 'space weather Katrina,' a rare, but according to the historical record, not inconceivable eventuality? On May 22 and 23, 2008, a one-and-a-half-day workshop held in Washington, D.C., under the auspices of the National Research Council's (NRC's) Space Studies Board brought together representatives of industry, the federal government, and the social science community to explore these and related questions. The key themes, ideas, and insights that emerged during the presentations and discussions are summarized in 'Severe Space Weather Events--Understanding Societal and Economic Impacts: A Workshop Report' (The National Academies Press, Washington, D

  13. Severe Space Weather Events--Understanding Societal and Economic Impacts: A Workshop Report - Extended Summary

    NASA Technical Reports Server (NTRS)

    2009-01-01

    The effects of space weather on modern technological systems are well documented in both the technical literature and popular accounts. Most often cited perhaps is the collapse within 90 seconds of northeastern Canada's Hydro-Quebec power grid during the great geomagnetic storm of March 1989, which left millions of people without electricity for up to 9 hours. This event exemplifies the dramatic impact that severe space weather can have on a technology upon which modern society critically depends. Nearly two decades have passed since the March 1989 event. During that time, awareness of the risks of severe space weather has increased among the affected industries, mitigation strategies have been developed, new sources of data have become available, new models of the space environment have been created, and a national space weather infrastructure has evolved to provide data, alerts, and forecasts to an increasing number of users. Now, 20 years later and approaching a new interval of increased solar activity, how well equipped are we to manage the effects of space weather? Have recent technological developments made our critical technologies more or less vulnerable? How well do we understand the broader societal and economic impacts of severe space weather events? Are our institutions prepared to cope with the effects of a 'space weather Katrina,' a rare, but according to the historical record, not inconceivable eventuality? On May 22 and 23, 2008, a one-and-a-half-day workshop held in Washington, D.C., under the auspices of the National Research Council's (NRC's) Space Studies Board brought together representatives of industry, the federal government, and the social science community to explore these and related questions. The key themes, ideas, and insights that emerged during the presentations and discussions are summarized in 'Severe Space Weather Events--Understanding Societal and Economic Impacts: A Workshop Report' (The National Academies Press, Washington, D

  14. Characterization and Fine Mapping of a Blast Resistant Gene Pi-jnw1 from the japonica Rice Landrace Jiangnanwan.

    PubMed

    Wang, Ruisen; Fang, Nengyan; Guan, Changhong; He, Wanwan; Bao, Yongmei; Zhang, Hongsheng

    2016-01-01

    Rice blast is a destructive disease caused by Magnaporthe oryzae, and it has a large impact on rice production worldwide. Compared with leaf blast resistance, our understanding of panicle blast resistance is limited. The japonica landrace Jiangnanwan from Taihu Lake region in China shows highly resistance to panicle and leaf blast. In this study, three generations (F2:5, F2:6, F2:7) consisting of 221 RILs (recombination inbreeding lines), developed from the cross of Jiangnanwan and Suyunuo, a susceptible-blast japonica variety, were evaluated for panicle blast resistance in the fields and leaf blast resistance in greenhouse in Nanjing in 2013, 2014 and 2015. A blast resistance gene Pi-jnw1 referring to panicle blast resistance and leaf blast resistance was identified in the three generations and located in the region of RM27273 and RM27381 in chromosome 11. The RIL18 line harboring Pi-jnw1 was selected to be backcrossed with Suyunuo to develop BC2F2 populations. According to the genotyping of 1,150 BC2F2 individuals and panicle blast and leaf blast resistance evaluation of 47 recombinants between RM27150 and RM27381, Pi-jnw1 was finally mapped to the 282 kb region between markers W28 and BS39. This study revealed that Jiangnanwan harboring a panicle blast and leaf blast resistance gene Pi-jnw1 could be a genetic source for breeding new rice cultivars with panicle blast resistance.

  15. Characterization and Fine Mapping of a Blast Resistant Gene Pi-jnw1 from the japonica Rice Landrace Jiangnanwan

    PubMed Central

    Wang, Ruisen; Fang, Nengyan; Guan, Changhong; He, Wanwan; Bao, Yongmei; Zhang, Hongsheng

    2016-01-01

    Rice blast is a destructive disease caused by Magnaporthe oryzae, and it has a large impact on rice production worldwide. Compared with leaf blast resistance, our understanding of panicle blast resistance is limited. The japonica landrace Jiangnanwan from Taihu Lake region in China shows highly resistance to panicle and leaf blast. In this study, three generations (F2:5, F2:6, F2:7) consisting of 221 RILs (recombination inbreeding lines), developed from the cross of Jiangnanwan and Suyunuo, a susceptible-blast japonica variety, were evaluated for panicle blast resistance in the fields and leaf blast resistance in greenhouse in Nanjing in 2013, 2014 and 2015. A blast resistance gene Pi-jnw1 referring to panicle blast resistance and leaf blast resistance was identified in the three generations and located in the region of RM27273 and RM27381 in chromosome 11. The RIL18 line harboring Pi-jnw1 was selected to be backcrossed with Suyunuo to develop BC2F2 populations. According to the genotyping of 1,150 BC2F2 individuals and panicle blast and leaf blast resistance evaluation of 47 recombinants between RM27150 and RM27381, Pi-jnw1 was finally mapped to the 282 kb region between markers W28 and BS39. This study revealed that Jiangnanwan harboring a panicle blast and leaf blast resistance gene Pi-jnw1 could be a genetic source for breeding new rice cultivars with panicle blast resistance. PMID:28036378

  16. Cosmic Blasting Zone

    NASA Image and Video Library

    2005-12-06

    Saturn's impact-pummeled Hyperion stares back at Cassini in this six-image mosaic taken during the spacecraft’s close approach on Sept. 26, 2005. This up-close view shows a low density body blasted by impacts over the eons. Scientists originally believed that the spongy appearance of Hyperion is caused by a phenomenon called thermal erosion, in which dark materials accumulating on crater floors are warmed by sunlight and melt deeper into the surface, allowing surrounding ice to vaporize away. Cassini scientists now think that Hyperion’s unusual appearance can be attributed to the fact that it has an unusually low density for such a large object, giving it weak surface gravity and high porosity. These characteristics help preserve the original shapes of Hyperion’s craters by limiting the amount of impact ejecta coating the moon’s surface. Impactors tend to make craters by compressing the surface material, rather than blasting it out. Further, Hyperion’s weak gravity, and correspondingly low escape velocity, means that what little ejecta is produced has a good chance of escaping the moon altogether. At 280 kilometers, (174 miles) across, Hyperion’s impact-shaped morphology makes it the largest of Saturn's irregularly-shaped moons. Six, clear-filter images were combined to create this mosaic. Images were taken by the Cassini spacecraft narrow-angle camera at a mean distance of about 33,000 kilometers (20,500 miles) from Hyperion and at a sun-Hyperion-spacecraft, or phase, angle of 51 degrees. Image scale is 197 meters per pixel. http://photojournal.jpl.nasa.gov/catalog/PIA07761

  17. The impact of severe burn injury on skeletal muscle mitochondrial function

    PubMed Central

    Porter, Craig; Herndon, David N; Sidossis, Labros S; Borsheim, Elisabet

    2013-01-01

    Severe burn injury induces a pathophysiological response that affects almost every physiological system within the body. Inflammation, hypermetabolism, muscle wasting, and insulin resistance are all hallmarks of the pathophysiological response to burn injury, with perturbations in metabolism known to persist for several years post injury. Skeletal muscle is the main depot of lean tissue within the body and as the primary site of peripheral glucose disposal, plays an important role in metabolic regulation. Following a large burn, skeletal muscle functions as and endogenous amino acid store, providing substrates for more pressing functions post burn, such as the synthesis of acute phase proteins and the deposition of new skin. Subsequently, burn patients become cachexic, which is associated with poor outcomes in terms of metabolic health and functional capacity. While a loss of skeletal muscle contractile proteins per se will no doubt negatively impact functional capacity, detriments in skeletal muscle quality, i.e. a loss in mitochondrial number and/or function may be quantitatively just as important. The goal of this review article is to summarize the current understanding of the impact of burn injury on skeletal muscle mitochondrial content and function, to offer direction for future research concerning skeletal muscle mitochondrial function in patients with severe burns, and to renew interest in the role of these organelles in metabolic dysfunction following burn injury. PMID:23664225

  18. The Influence of Severe Storm Tracks on High Impact Weather in North America

    NASA Astrophysics Data System (ADS)

    Berbery, E. Hugo; Lukens, Katherine

    2017-04-01

    The behavior of Northern Hemisphere (NH) severe storm tracks and their influence on high impact winter weather are diagnostically studied using data from the Climate Forecast System Reanalysis (CFSR) and the Global Precipitation Climatology Project (GPCP). In this study high impact weather is represented by strong low-level winds and intense precipitation. Storm tracks are described by isentropic potential vorticity (IPV) maxima within a Lagrangian framework and are found to correspond with those described in previous studies: three storm tracks are identified over the North Pacific and North Atlantic Oceans as well as over the Mediterranean Sea. The cyclogenesis pattern shows that severe storms (the top 14% of all storms) generally develop along the tracks. The cyclolysis pattern reveals that most cyclones dissipate in the eastern North Pacific and western North Atlantic Oceans. Across the NH, the diabatic heating increases where the storm tracks are present, with the larger heating gradients corresponding to high track density regions, i.e., where the majority of storms tend to propagate. Precipitation intensity related to the severe storm tracks is largest where they are strongest, e.g., over the oceans, and along the west coast of North America. Over North America, it is found that severe storms contribute 40-60% of the precipitation produced by all winter storms. The largest increases in low-level wind speeds are found in the storm track regions which are collocated poleward and eastward of the jet stream maxima over the oceans. The winds in the severe storm track regions almost double in speed from the background wind, particularly in the northeastern North Pacific, the northeastern North Atlantic, and leeward of the Rocky Mountains. Leeward of high orography, the winds intensify and flow southeastward across North America toward the North Atlantic Ocean.

  19. Drug Use Patterns in Severely Mentally Ill Medicare Beneficiaries: Impact of Discontinuities in Drug Coverage

    PubMed Central

    Simoni-Wastila, Linda; Zuckerman, Ilene H; Shaffer, Thomas; Blanchette, Christopher M; Stuart, Bruce

    2008-01-01

    Objective To describe the extent of drug coverage among severely mentally ill Medicare beneficiaries and to determine whether and to what extent discontinuities in prescription drug coverage influence the use of medications used to treat serious mental health conditions. Data Source 1997–2001 Medicare Current Beneficiary Surveys. Study Design We use a zero-inflated negative binomial model to estimate: (1) the probability of not receiving any mental health drug and (2) the number of medications received, adjusting for age, race, income, census region, health status, and comorbidity. Severe mental illness is defined using inpatient and outpatient claims with ICD-9 codes of schizophrenia, other psychotic disorders, bipolar disorders, and major depression. Mental health medications include antidepressants, antipsychotics, mood stabilizers, anxiolytic/sedative-hypnotics, and stimulants. Prescription drug coverage is assessed as full coverage (0 percent discontinuities), no coverage (100 percent discontinuities), or as discontinuous coverage, measured as 1–25, 26–50, and 51–99 percent of time without coverage. Data Collection/Extraction Methods We constructed three 3-year longitudinal cohorts of severely mentally ill Medicare beneficiaries residing in the community (n = 901). Principal Findings Severely mentally ill Medicare beneficiaries with drug coverage discontinuities are more likely than their continuously insured peers not to receive medications used to treat mental health disorders, with the most significant impact seen in the probability of receiving any psychiatric medications. Analysis of two therapeutic classes—antidepressants and antipsychotics—revealed varying impacts of drug gaps on both probability of any drug use, as well as number of medications received among users. Conclusions Severely mentally ill Medicare beneficiaries may be particularly vulnerable to the Medicare Part D drug benefit design and, as such, warrant close evaluation and

  20. Impacts and recovery from severe tropical cyclone Yasi on the Great Barrier Reef.

    PubMed

    Beeden, Roger; Maynard, Jeffrey; Puotinen, Marjetta; Marshall, Paul; Dryden, Jen; Goldberg, Jeremy; Williams, Gareth

    2015-01-01

    Full recovery of coral reefs from tropical cyclone (TC) damage can take decades, making cyclones a major driver of habitat condition where they occur regularly. Since 1985, 44 TCs generated gale force winds (≥17 metres/second) within the Great Barrier Reef Marine Park (GBRMP). Of the hurricane strength TCs (≥H1-Saffir Simpson scale; ≥ category 3 Australian scale), TC Yasi (February, 2011) was the largest. In the weeks after TC Yasi crossed the GBRMP, participating researchers, managers and rangers assessed the extent and severity of reef damage via 841 Reef Health and Impact Surveys at 70 reefs. Records were scaled into five damage levels representing increasingly widespread colony-level damage (1, 2, 3) and reef structural damage (4, 5). Average damage severity was significantly affected by direction (north vs south of the cyclone track), reef shelf position (mid-shelf vs outer-shelf) and habitat type. More outer-shelf reefs suffered structural damage than mid-shelf reefs within 150 km of the track. Structural damage spanned a greater latitudinal range for mid-shelf reefs than outer-shelf reefs (400 vs 300 km). Structural damage was patchily distributed at all distances, but more so as distance from the track increased. Damage extended much further from the track than during other recent intense cyclones that had smaller circulation sizes. Just over 15% (3,834 km2) of the total reef area of the GBRMP is estimated to have sustained some level of coral damage, with ~4% (949 km2) sustaining a degree of structural damage. TC Yasi likely caused the greatest loss of coral cover on the GBR in a 24-hour period since 1985. Severely impacted reefs have started to recover; coral cover increased an average of 4% between 2011 and 2013 at re-surveyed reefs. The in situ assessment of impacts described here is the largest in scale ever conducted on the Great Barrier Reef following a reef health disturbance.

  1. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis.

    PubMed

    Weidemann, Frank; Herrmann, Sebastian; Störk, Stefan; Niemann, Markus; Frantz, Stefan; Lange, Volkmar; Beer, Meinrad; Gattenlöhner, Stefan; Voelker, Wolfram; Ertl, Georg; Strotmann, Jörg M

    2009-08-18

    In this prospective follow-up study, the effect of myocardial fibrosis on myocardial performance in symptomatic severe aortic stenosis was investigated, and the impact of fibrosis on clinical outcome after aortic valve replacement (AVR) was estimated. Fifty-eight consecutive patients with isolated symptomatic severe aortic stenosis underwent extensive baseline characterization before AVR. Standard and tissue Doppler echocardiography and cardiac magnetic resonance imaging (late-enhancement imaging for replacement fibrosis) were performed at baseline and 9 months after AVR. Endomyocardial biopsies were obtained intraoperatively to determine the degree of myocardial fibrosis. Patients were analyzed according to the severity of interstitial fibrosis in cardiac biopsies (severe, n=21; mild, n=15; none, n=22). The extent of histologically determined cardiac fibrosis at baseline correlated closely with New York Heart Association functional class and markers of longitudinal systolic function (all P<0.001) but not global ejection fraction or aortic valve area. Nine months after AVR, the degree of late enhancement remained unchanged, implying that AVR failed to reduce the degree of replacement fibrosis. Patients with no fibrosis experienced a marked improvement in New York Heart Association class from 2.8+/-0.4 to 1.4+/-0.5 (P<0.001). Only parameters of longitudinal systolic function predicted this functional improvement. Four patients with severe fibrosis died during follow-up, but no patient from the other groups died. Myocardial fibrosis is an important morphological substrate of postoperative clinical outcome in patients with severe aortic stenosis and was not reversible after AVR over the 9 months of follow-up examined in this study. Because markers of longitudinal systolic function appear to indicate sensitively both the severity of myocardial fibrosis and the clinical outcome, they may prove valuable for preoperative risk assessment in patients with aortic stenosis.

  2. Impact of Hospital Variables on Case Mix Index as a Marker of Disease Severity

    PubMed Central

    Mendez, Carmen M.; Harrington, Darrell W.; Christenson, Peter

    2014-01-01

    Abstract Case mix index (CMI) has become a standard indicator of hospital disease severity in the United States and internationally. However, CMI was designed to calculate hospital payments, not to track disease severity, and is highly dependent on documentation and coding accuracy. The authors evaluated whether CMI varied by characteristics affecting hospitals' disease severity (eg, trauma center or not). The authors also evaluated whether CMI was lower at public hospitals than private hospitals, given the diminished financial resources to support documentation enhancement at public hospitals. CMI data for a 14-year period from a large public database were analyzed longitudinally and cross-sectionally to define the impact of hospital variables on average CMI within and across hospital groups. Between 1996 and 2007, average CMI declined by 0.4% for public hospitals, while rising significantly for private for-profit (14%) and nonprofit (6%) hospitals. After the introduction of the Medicare Severity Diagnosis Related Group (MS-DRG) system in 2007, average CMI increased for all 3 hospital types but remained lowest in public vs. private for-profit or nonprofit hospitals (1.05 vs. 1.25 vs. 1.20; P<0.0001). By multivariate analysis, teaching hospitals, level 1 trauma centers, and larger hospitals had higher average CMI, consistent with a marker of disease severity, but only for private hospitals. Public hospitals had lower CMI across all subgroups. Although CMI had some characteristics of a disease severity marker, it was lower across all strata for public hospitals. Hence, caution is warranted when using CMI to adjust for disease severity across public vs. private hospitals. (Population Health Management 2014;17:28–34) PMID:23965045

  3. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

    PubMed Central

    Campanharo, Felipe F.; Cecatti, Jose G.; Haddad, Samira M.; Parpinelli, Mary A.; Born, Daniel; Costa, Maria L.; Mattar, Rosiane

    2015-01-01

    Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity. PMID:26650684

  4. Comparing the Financial Impact of Several Hospitals on Their Local Markets.

    PubMed

    Rotarius, Timothy; Liberman, Aaron

    Several studies that measured the financial impact of hospitals on their local markets are examined. Descriptive analyses were performed to ascertain if there are any identifying characteristics and emerging patterns in the data. After hospitals were categorized into small, medium, and large classifications based on the number of employees, various predictive insights were discovered. Smaller hospitals could be expected to contribute approximately 7.3% to the local economy, whereas medium-sized hospitals would likely contribute approximately 11.4% to the financial value of the local market. Finally, larger hospitals may contribute approximately 16% to their local economies.

  5. Burn Severities, Fire Intensities, and Impacts to Major Vegetation Types from the Cerro Grande Fire

    SciTech Connect

    Balice, Randy G.; Bennett, Kathryn D.; Wright, Marjorie A.

    2004-12-15

    The Cerro Grande Fire resulted in major impacts and changes to the ecosystems that were burned. To partially document these effects, we estimated the acreage of major vegetation types that were burned at selected burn severity levels and fire intensity levels. To accomplish this, we adopted independently developed burn severity and fire intensity maps, in combination with a land cover map developed for habitat management purposes, as a basis for the analysis. To provide a measure of confidence in the acreage estimates, the accuracies of these maps were also assessed. In addition, two other maps of comparable quality were assessed for accuracy: one that was developed for mapping fuel risk and a second map that resulted from a preliminary application of an evolutionary computation software system, called GENIE.

  6. The Effect of Injury Severity on Behavior: A Phenotypic Study of Cognitive and Emotional Deficits after Mild, Moderate, and Severe Controlled Cortical Impact Injury in Mice

    PubMed Central

    Washington, Patricia M.; Forcelli, Patrick A.; Wilkins, Tiffany; Zapple, David N.; Parsadanian, Maia

    2012-01-01

    Abstract Traumatic brain injury (TBI) can cause a broad array of behavioral problems including cognitive and emotional deficits. Human studies comparing neurobehavioral outcomes after TBI suggest that cognitive impairments increase with injury severity, but emotional problems such as anxiety and depression do not. To determine whether cognitive and emotional impairments increase as a function of injury severity we exposed mice to sham, mild, moderate, or severe controlled cortical impact (CCI) and evaluated performance on a variety of neurobehavioral tests in the same animals before assessing lesion volume as a histological measure of injury severity. Increasing cortical impact depth successfully produced lesions of increasing severity in our model. We found that cognitive impairments in the Morris water maze increased with injury severity, as did the degree of contralateral torso flexion, a measure of unilateral striatal damage. TBI also caused deficits in emotional behavior as quantified in the forced swim test, elevated-plus maze, and prepulse inhibition of acoustic startle, but these deficits were not dependent on injury severity. Stepwise regression analyses revealed that Morris water maze performance and torso flexion predicted the majority of the variability in lesion volume. In summary, we find that cognitive deficits increase in relation to injury severity, but emotional deficits do not. Our data suggest that the threshold for emotional changes after experimental TBI is low, with no variation in behavioral deficits seen between mild and severe brain injury. PMID:22642287

  7. Evaluation of human response to blasting vibration from excavation of a large scale rock slope: A case study

    NASA Astrophysics Data System (ADS)

    Yan, Peng; Lu, Wenbo; Zhang, Jing; Zou, Yujun; Chen, Ming

    2017-04-01

    Ground vibration, as the most critical public hazard of blasting, has received much attention from the community. Many countries established national standards to suppress vibration impact on structures, but a world-accepted blasting vibration criterion on human safety is still missing. In order to evaluate human response to the vibration from blasting excavation of a large-scale rock slope in China, this study aims to suggest a revised criterion. The vibration frequency was introduced to improve the existing single-factor (peak particle velocity) standard recommended by the United States Bureau of Mines (USBM). The feasibility of the new criterion was checked based on field vibration monitoring and investigation of human reactions. Moreover, the air overpressure or blast effects on human beings have also been discussed. The result indicates that the entire zone of influence can be divided into three subzones: severe-annoyance, light-annoyance and perception zone according to the revised safety standard. Both the construction company and local residents have provided positive comments on this influence degree assessment, which indicates that the presented criterion is suitable for evaluating human response to nearby blasts. Nevertheless, this specific criterion needs more field tests and verifications before it can be

  8. Impact of laughter on air trapping in severe chronic obstructive lung disease

    PubMed Central

    Brutsche, Martin H; Grossman, Paul; Müller, Rebekka E; Wiegand, Jan; Pello; Baty, Florent; Ruch, Willibald

    2008-01-01

    Static and dynamic hyperinflation is an important factor of exertional dyspnea in patients with severe COPD. This proof-of-concept intervention trial sought to study whether laughter can reduce hyperinflation through repetitive expiratory efforts in patients with severe COPD. For small groups of patients with severe COPD (n = 19) and healthy controls (n = 10) Pello the clown performed a humor intervention triggering regular laughter. Plethysmography was done before and up to 24 hours after intervention. Laughing and smiling were quantified with video-analysis. Real-time breathing pattern was assessed with the LifeShirt™, and the psychological impact of the intervention was monitored with self-administered questionnaires. The intervention led to a reduction of TLC in COPD (p = 0.04), but not in controls (p = 0.9). TLC reduction was due to a decline of the residual volume. Four (22 [CI 95% 7 to 46] %) patients were ≥10% responders. The frequency of smiling and TLC at baseline were independent predictors of TLC response. The humor intervention improved cheerfulness, but not seriousness nor bad mood. In conclusion, smiling induced by a humor intervention was able to reduce hyperinflation in patients with severe COPD. A smiling-derived breathing technique might complement pursed-lips breathing in patients with symptomatic obstruction. PMID:18488442

  9. Impact of Helmet Use on Severity of Epidural Hematomas in Cambodia.

    PubMed

    Gupta, Saksham; Iv, Vycheth; Sam, Nang; Vuthy, Din; Klaric, Katherine; Shrime, Mark G; Park, Kee B

    2017-04-01

    Traumatic brain injury is a major cause of morbidity and mortality worldwide, often necessitating neurosurgical intervention to evacuate intracranial bleeding. Since the early 2000s, Cambodia has been undergoing a rapid increase in motorcycle transit and in road traffic accidents, but the prevalence of helmet usage remains low. Epidural hematomas are severe traumatic brain injuries that can necessitate neurosurgical intervention. This is a retrospective cohort study of patients with epidural hematoma secondary to motorcycle accidents who presented to a major national tertiary care center in Phnom Penh, Cambodia, between November 2013 and March 2016. All patients were diagnosed with computed tomography of the head. In this cohort, 21.6% of patients in motorcycle accidents presented with epidural hematoma and 89.1% of patients were men, 47.6% were intoxicated, and were 87.8% were not wearing helmets at the moment of impact. Not wearing a helmet was associated with a 6.90-fold increase in odds of presenting with a moderate-to-severe Glasgow coma scale score and a 3.76-fold increase in odds of requiring craniotomy or craniectomy for evacuation of hematoma. Male sex was also associated with increased odds of higher clinical severity at presentation and indication for craniotomy or craniectomy, and alcohol intoxication at the time of accident was not associated with either. Helmet usage is protective in reducing the severity of presentation and need for neurosurgical intervention for patients with epidural hematoma secondary to motorcycle accidents. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. The impact of dementia severity on caregiver burden in frontotemporal dementia and Alzheimer disease.

    PubMed

    Mioshi, Eneida; Foxe, David; Leslie, Felicity; Savage, Sharon; Hsieh, Sharpley; Miller, Laurie; Hodges, John R; Piguet, Olivier

    2013-01-01

    Caregiver burden is greater in frontotemporal dementia (FTD) than in Alzheimer disease (AD). However, little is known of the impact of the 3 main clinical variants of FTD- behavioral-variant frontotemporal dementia (bvFTD), semantic dementia (SemDem), and progressive nonfluent aphasia (PNFA)-or the role of disease severity in caregiver burden. The Zarit Burden Inventory was used to measure caregiver burden of bvFTD (n=17), SemDem (n=20), PNFA (n=20), and AD (n=19) patients. Symptom duration, caregiver age, and relationship type were matched across groups. Moreover, a number of caregiver (mood, social network) and patient variables (functional disability, behavioral changes, relationship with caregiver, and dementia stage) were addressed to investigate their impact on caregiver burden. Caregivers of bvFTD patients reported the highest burden, whereas SemDem and PNFA caregivers reported burden similar to AD. A regression analysis revealed that caregiver burden in FTD, regardless of subtype, was explained by a model combining disease staging, relationship changes, and caregiver depression. Burden increased with disease severity in FTD. This study is the first to show that caregivers of SemDem, PNFA, and AD patients show similar burden, while confirming that bvFTD caregivers show higher burden than AD caregivers. More importantly, this study demonstrates that burden worsens with disease progression in FTD.

  11. Risk factors affecting fatal bus accident severity: Their impact on different types of bus drivers.

    PubMed

    Feng, Shumin; Li, Zhenning; Ci, Yusheng; Zhang, Guohui

    2016-01-01

    While the bus is generally considered to be a relatively safe means of transportation, the property losses and casualties caused by bus accidents, especially fatal ones, are far from negligible. The reasons for a driver to incur fatalities are different in each case, and it is essential to discover the underlying risk factors of bus fatality severity for different types of drivers in order to improve bus safety. The current study investigates the underlying risk factors of fatal bus accident severity to different types of drivers in the U.S. by estimating an ordered logistic model. Data for the analysis are retrieved from the Buses Involved in Fatal Accidents (BIFA) database from the USA for the years 2006-2010. Accidents are divided into three levels by counting their equivalent fatalities, and the drivers are classified into three clusters by the K-means cluster analysis. The analysis shows that some risk factors have the same impact on different types of drivers, they are: (a) season; (b) day of week; (c) time period; (d) number of vehicles involved; (e) land use; (f) manner of collision; (g) speed limit; (h) snow or ice surface condition; (i) school bus; (j) bus type and seating capacity; (k) driver's age; (l) driver's gender; (m) risky behaviors; and (n) restraint system. Results also show that some risk factors only have impact on the "young and elder drivers with history of traffic violations", they are: (a) section type; (b) number of lanes per direction; (c) roadway profile; (d) wet road surface; and (e) cyclist-bus accident. Notably, history of traffic violations has different impact on different types of bus drivers.

  12. Identification of rice blast resistance genes using international monogenic differentials

    USDA-ARS?s Scientific Manuscript database

    Rice blast disease, caused by the fungal pathogen Magnaporthe oryzae, is one of the most devastating diseases of rice that severely affects crop production in Jilin Province, Northeast China, where temperate japonica rice is primarily grown. In the present study, 44 representative local blast isolat...

  13. Severity of ocean acidification following the end-Cretaceous asteroid impact.

    PubMed

    Tyrrell, Toby; Merico, Agostino; Armstrong McKay, David Ian

    2015-05-26

    Most paleo-episodes of ocean acidification (OA) were either too slow or too small to be instructive in predicting near-future impacts. The end-Cretaceous event (66 Mya) is intriguing in this regard, both because of its rapid onset and also because many pelagic calcifying species (including 100% of ammonites and more than 90% of calcareous nannoplankton and foraminifera) went extinct at this time. Here we evaluate whether extinction-level OA could feasibly have been produced by the asteroid impact. Carbon cycle box models were used to estimate OA consequences of (i) vaporization of up to 60 × 10(15) mol of sulfur from gypsum rocks at the point of impact; (ii) generation of up to 5 × 10(15) mol of NOx by the impact pressure wave and other sources; (iii) release of up to 6,500 Pg C as CO2 from vaporization of carbonate rocks, wildfires, and soil carbon decay; and (iv) ocean overturn bringing high-CO2 water to the surface. We find that the acidification produced by most processes is too weak to explain calcifier extinctions. Sulfuric acid additions could have made the surface ocean extremely undersaturated (Ωcalcite <0.5), but only if they reached the ocean very rapidly (over a few days) and if the quantity added was at the top end of literature estimates. We therefore conclude that severe ocean acidification might have been, but most likely was not, responsible for the great extinctions of planktonic calcifiers and ammonites at the end of the Cretaceous.

  14. Severity of ocean acidification following the end-Cretaceous asteroid impact

    PubMed Central

    Tyrrell, Toby; Armstrong McKay, David Ian

    2015-01-01

    Most paleo-episodes of ocean acidification (OA) were either too slow or too small to be instructive in predicting near-future impacts. The end-Cretaceous event (66 Mya) is intriguing in this regard, both because of its rapid onset and also because many pelagic calcifying species (including 100% of ammonites and more than 90% of calcareous nannoplankton and foraminifera) went extinct at this time. Here we evaluate whether extinction-level OA could feasibly have been produced by the asteroid impact. Carbon cycle box models were used to estimate OA consequences of (i) vaporization of up to 60 × 1015 mol of sulfur from gypsum rocks at the point of impact; (ii) generation of up to 5 × 1015 mol of NOx by the impact pressure wave and other sources; (iii) release of up to 6,500 Pg C as CO2 from vaporization of carbonate rocks, wildfires, and soil carbon decay; and (iv) ocean overturn bringing high-CO2 water to the surface. We find that the acidification produced by most processes is too weak to explain calcifier extinctions. Sulfuric acid additions could have made the surface ocean extremely undersaturated (Ωcalcite <0.5), but only if they reached the ocean very rapidly (over a few days) and if the quantity added was at the top end of literature estimates. We therefore conclude that severe ocean acidification might have been, but most likely was not, responsible for the great extinctions of planktonic calcifiers and ammonites at the end of the Cretaceous. PMID:25964350

  15. Severity of vehicle bumper location in vehicle-to-pedestrian impact accidents.

    PubMed

    Matsui, Yasuhiro; Hitosugi, Masahito; Mizuno, Koji

    2011-10-10

    Pedestrian protection is one of the key topics for safety measures in traffic accidents all over the world. To analyze the relation between the collision site of the vehicle bumper and the severity of the lower extremity injuries, we performed biomechanical experiments. We compared the applied external force and the risks of subsequent injuries between the impact of the center and side positions of the front bumper. These comparisons were performed by practical impact tests with eight typical different types of cars which were typical of the current vehicle fleets. The tests were made using the TRL legform impactor which was a mechanical substitute of a pedestrian lower extremity. The TRL impactor is used all over the world for assessing the safety of car bumpers. It was found that the risks of lower extremity injuries in the impacts at the side positions, in front of the vehicle's side member, were significantly higher than those at the center. In the tests, we found that foam materials around the rigid front cross member had a significant effect on reducing the lower extremity injury risks and especially tibia fracture risk against vehicle bumper center collisions, but had little effect at the sides of the bumper over the vehicle's side members where the foam was thinner. We also found that the front shape of the vehicle affected the risk of ligaments injuries. According to these results, the information of impact locations of cars in vehicle-to-pedestrian traffic accidents is valuable for clinicians to diagnose patients with lower extremity injuries in traffic accidents and for forensic pathologists to analyze the accident reconstruction. Furthermore, the results suggest that testing of the bumper area in front of the main longitudinal beams should be included in the car safety legislation to require pedestrian safety.

  16. Impact of virulence genes on sepsis severity and survival in Escherichia coli bacteremia

    PubMed Central

    Mora-Rillo, Marta; Fernández-Romero, Natalia; Francisco, Carolina Navarro-San; Díez-Sebastián, Jesús; Romero-Gómez, Maria Pilar; Fernández, Francisco Arnalich; López, Jose Ramon Arribas; Mingorance, Jesús

    2015-01-01

    Extraintestinal pathogenic Escherichia coli (ExPEC) are a frequent cause of bacteremia and sepsis, but the role of ExPEC genetic virulence factors (VFs) in sepsis development and outcome is ill-defined. Prospective study including 120 adult patients with E. coli bacteremia to investigate the impact of bacterial and host factors on sepsis severity and mortality. Patients' clinical and demographic data were registered. Phylogenetic background of E. coli isolates was analyzed by SNP pyrosequencing and VFs by PCR. The E. coli isolates presented an epidemic population structure with 6 dominant clones making up to half of the isolates. VF gene profiles were highly diverse. Multivariate analysis for sepsis severity showed that the presence of cnf and blaTEM genes increased the risk of severe illness by 6.75 (95% confidence interval [CI] 1.79–24.71) and 2.59 (95% CI 1.04–6.43) times respectively, while each point in the Pitt score increased the risk by 1.34 (95% CI 1.02–1.76) times. Multivariate analysis for mortality showed that active chemotherapy (OR 17.87, 95% CI 3.35–95.45), McCabe-Jackson Index (OR for rapidly fatal category 120.15, 95% CI 4.19–3446.23), Pitt index (OR 1.78, 95% CI 1.25–2.56) and presence of fyuA gene (OR 8.05, 95% CI 1.37–47.12) were associated to increased mortality while the presence of P fimbriae genes had a protective role (OR 0.094, 95%IC 0.018–0.494). Bacteremic E. coli had a high diversity of genetic backgrounds and VF gene profiles. Bacterial VFs and host determinants had an impact on disease evolution and mortality. PMID:25654604

  17. Budget impact analysis of ustekinumab in the management of moderate to severe psoriasis in Greece

    PubMed Central

    2012-01-01

    Background The purpose of this study was to estimate the annual and per-patient budget impact of the treatment of moderate to severe psoriasis in Greece before and after the introduction of ustekinumab. Methods A budget impact model was constructed from a national health system perspective to depict the clinical and economic aspects of psoriasis treatment over 5 years. The model included drug acquisition, monitoring, and administration costs for both the induction and maintenance years for patients in a treatment mix with etanercept, adalimumab, infliximab, with or without ustekinumab. It also considered the resource utilization for non-responders. Greek treatment patterns and resource utilization data were derived from 110 interviews with dermatologists conducted in February 2009 and evaluated by an expert panel of 18 key opinion leaders. Officially published sources were used to derive the unit costs. Costs of adverse events and indirect costs were excluded from the analysis. Treatment response was defined as the probability of achieving a PASI 50, PASI 75, or PASI 90 response, based on published clinical trial data. Results The inclusion of ustekinumab in the biological treatment mix for moderate to severe psoriasis is predicted to lead to total per-patient savings of €443 and €900 in years 1 and 5 of its introduction, respectively. The cost savings were attributed to reduced administration costs, reduced hospitalizations for non-responders, and improved efficacy. These results were mainly driven by the low number of administrations required with ustekinumab over a 5 year treatment period (22 for ustekinumab, compared with 272 for etanercept, 131 for adalimumab, and 36 for infliximab). Conclusions The inclusion of ustekinumab in the treatment of moderate to severe psoriasis in Greece is anticipated to have short- and long-term health and economic benefits, both on an annual and per-patient basis. PMID:22831458

  18. Blast assessment and optimization for high quarry face-blasting

    SciTech Connect

    Sames, F.; O`Meara, R.

    1996-12-01

    Where applicable, high production benches can improve efficiency in quarrying. Quality control, geological, cost or other considerations might result in the development of quarry benches higher than 30 m and sometimes up to 60 m. Production blasts on high quarry faces require a confident blast design with respect to safety, cost efficiency and minimized environmental effects. Careful pre-blast assessment of the design parameters, blast monitoring of the product performance and the environmental effects and post-blast assessment of the overall blast performance are essential for the successful implementation of the blast design. The blast geometry for high quarry faces and a blast design that often includes multiple explosive charges in a blasthole, make a reliable assessment of the blast parameters difficult. Assessment techniques, their applications and limitations are described and discussed. This will include such methods as blast surveying using laser profiling and borehole deviation measurements, blast monitoring using continuous velocity of detonation measurement systems, high speed photography and seismographs for blast performance and environmental effects. Observations of low frequency airblast and high standard deviations in ground vibration measurements are described and discussed against a background of timing assessment and frequency spectra analysis. Approaches where an optimized design was implemented based on the blast parameter assessment and modeling are presented. An improvement in blast efficiency lies in the combination of blast assessment and blast modeling, whilst adequate documentation supports the process of designing and implementing successful blasts.

  19. The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

    PubMed Central

    Aji, Budi; Yamamoto, Shelby Suzanne; Sauerborn, Rainer

    2014-01-01

    Background Little research has focused on the economic hardship among the insured with severe illnesses and high treatment costs, in particular, the consequence of poorer insurance coverage for high-cost illnesses. Therefore, we presented the case for identifying the experiences of insured patients with severe chronic and acute illnesses. This study identified a qualitative understanding of the economic impact of severe chronic and acute illnesses and household strategies to deal with high treatment costs. Design Interviews were conducted with 19 insured households of three different health insurance programs with a family member that had been hospitalized for severe chronic or acute illnesses in either Banyumas or Margono Sukarjo hospitals in Banyumas, Central Java, Indonesia. A thematic analysis was applied to guide the interpretation of the data. Results Insured households with a family member that had been hospitalized for severe chronic and acute illnesses were greatly affected by the high treatment costs. Four major issues emerged from this qualitative study: insured patients are still burdened with high out-of-pocket payments, households adopt various strategies to cope with the high cost of treatments, households experience financial hardships, and positive and negative perceptions of the insured regarding their health insurance coverage for acute and chronic illnesses. Conclusions Askes and Jamsostek patients faced financial burdens from high cost sharing for hospital amenities, non-covered drugs, and treatments and other indirect costs. Meanwhile, Jamkesmas beneficiaries faced no financial burden for related medical services but were rather burdened with indirect costs for the carers. Households relied on internal resources to cover hospital bills as the first strategy, which included the mobilization of savings, sale of assets, and borrowing of money. External support was tapped secondarily and included financial support from extended family members

  20. Prevalence and Impact of Sleep Disordered Breathing in Patients with Severe Aortic Stenosis

    PubMed Central

    Linhart, Markus; Sinning, Jan-Malte; Ghanem, Alexander; Kozhuppakalam, Finny J.; Fistéra, Rebecca; Hammerstingl, Christoph; Pizarro, Carmen; Grube, Eberhard; Werner, Nikos; Nickenig, Georg; Skowasch, Dirk

    2015-01-01

    Background Unlike the well-established association between sleep disordered breathing (SDB) and chronic heart failure, the relationship between SDB and severe aortic stenosis (AS) is not well investigated. Given the increasing prevalence of AS, and the improving prognosis of high risk AS patients attributable to transcatheter aortic valve implantation (TAVI), the prevalence and impact of SDB needs to be better understood. Methods and Results In this study, 140 patients with severe AS underwent polygraphy prior to TAVI. Clinical and hemodynamic parameters were recorded. Patients were followed for 573±405 days. We found that 99/140 patients (71%) had SDB with a mean apnoea-hypopnoea-index of 24±17/h. SDB was mild in 27%, moderate in 23% and severe in 21% of patients. In addition, 35 patients (25%) had obstructive sleep apnoea (OSA), whereas 64 patients (46%) had central sleep apnoea (CSA). Patients with OSA had predominantly mild SDB (20/38 pts.), and patients with CSA mostly had severe SDB (24/29 pts.). The prevalence and distribution of OSA and CSA were independent of left ventricular function. Overall, 1 and 2 year survival rates (74% and 71%, resp.) did not differ significantly between patients without SDB or those with OSA and CSA (p=0.81). Conclusions SDB, with a preponderance of CSA, was found to be highly prevalent in patients with high-grade AS scheduled for TAVI. SDB prevalence was independent of left ventricular function. Mortality after TAVI was not influenced by the type or severity of SDB. PMID:26214183

  1. The impact of viral dynamics on the clinical severity of infants with respiratory syncytial virus bronchiolitis.

    PubMed

    Zhou, Lili; Xiao, Qiuyan; Zhao, Yao; Huang, Ailong; Ren, Luo; Liu, Enmei

    2015-08-01

    The impact of dynamic respiratory syncytial virus (RSV) load on the clinical severity of hospitalized infants with bronchiolitis has not been clarified. Nasopharyngeal aspirates were obtained from 60 infants who were diagnosed with bronchiolitis within 96 hr of wheezing onset upon admission and on days 3, 5, and 7 in the hospital, and 17 respiratory viruses were detected. The RSV load was quantified by real-time qPCR for RSV subtypes A and B at different time points. Scoring criteria were used to evaluate the degree of severity. A total of 40 infants were determined to be RSV-positive, nine were identified as RSV subtype A (RSVA), and 31 were RSV subtype B (RSVB). The peak RSV load was observed upon admission, and the RSV load decreased significantly over time; in addition, this decrease began to have significant differences on day 5. There was a positive correlation between the RSV load and the clinical score (r(2)  = 0.121 and P < 0.001). According to the clinical scores, the infants in the severe group tended to have higher RSV loads than those in the moderate and mild groups. Multivariate logistic regression models revealed that the viral load on day 3 was independently associated with the degree of severity. This study elucidated that a higher mean RSV load was associated with a more severe disease and a longer duration of hospitalization and symptoms. This study also clarified RSV replication in infants and provides a theoretical basis for specifying an anti-RSV therapy strategy.

  2. Severe forms of schistosomiasis mansoni: epidemiologic and economic impact in Brazil, 2010.

    PubMed

    Nascimento, Gilmara Lima; de Oliveira, Maria Regina Fernandes

    2014-01-01

    Schistosoma mansoni infection is generally asymptomatic at the initial stage. However, patients left untreated can develop severe, potentially fatal clinical disease. In Brazil, S. mansoni transmission occurs in 19 states and, despite the contribution of infection to the cycle of poverty and disease, the economic impact of severe cases is unclear. Our objectives were to estimate the epidemiological burden and the costs of severe stages of S. mansoni in Brazil in 2010. We conducted an epidemiologic descriptive study and a partial economic evaluation of cost-of-illness. The study population was identified from records of notifications, hospitalizations and deaths related to S. mansoni in the respective information systems. The mortality rate for S. mansoni was 0.3 deaths per 100 000 population, which represented 1.1% of the deaths in Brazil from infectious diseases listed in Chapter I of the International Statistical Classification of Disease and Related Health Problems, 10(th) revision (ICD 10), and almost 9.0% of deaths from infection diseases in the state of Pernambuco. We calculated 6419 potential years of life lost (PYLL) to S. mansoni. The costs estimated within the public health sector totaled R$889 049.58 (US$495 016.47) and the costs of productivity losses reached R$ 35 725 332.72 (US$ 19 891 590.86) in terms of salaries lost as a result of premature death or absence from work. The cost-of-illness related to S. mansoni in Brazil was R$ 36 614 382.30 (US$ 20 386 627.12). The severe cases of S. mansoni disease still occurring in Brazil have an important epidemiologic and economic impact, representing a significant loss for society. The development of severe cases of a neglected parasitic disease that is preventable and responsive to primary healthcare intervention should be considered an expression of inequity. Our findings provide important evidence to support the strengthening of public health measures and investment to reduce poverty-related diseases in

  3. The impact of gender on cardiovascular system calcification in very elderly patients with severe aortic stenosis.

    PubMed

    Liyanage, Luckmini; Lee, Nam Ju; Cook, Tessa; Herrmann, Howard C; Jagasia, Dinesh; Litt, Harold; Han, Yuchi

    2016-01-01

    There is an established sex difference in cardiovascular disease among pre-menopausal women and age-matched men, with men having greater susceptibility to cardiovascular and coronary artery disease. Cardiovascular calcification may be linked to the atherosclerotic process and resulting disease, but the sex difference regarding coronary artery disease susceptibility and calcification is incompletely understood. We thought to measure calcium volume in different chest vascular beds in very elderly men and women with severe aortic stenosis (AS). Computed tomography scans of 94 patients with severe AS were calcium volume scored on Aquarius iNtuition Terarecon (Terarecon Inc., CA, USA) work stations. Coronary beds, aortic valve, mitral valve apparatus, and the thoracic aorta were examined. A significant sex difference in the mean total calcium volume of the coronary arteries was found in elderly (p = 0.001), with men having greater levels of calcification. There is also a significant sex difference in the amount of aortic valve calcium (p = 0.003). Furthermore, aortic and coronary calcification was independently correlated with sex. This study demonstrates a significant sex impact on calcification in the coronary beds and aortic valve in elderly patients with severe AS.

  4. Impact of severe malnutrition on short-term mortality and overall survival in head and neck cancer.

    PubMed

    Datema, Frank R; Ferrier, Marciano B; Baatenburg de Jong, Robert J

    2011-09-01

    Basic patient and tumor characteristics impact overall survival of head and neck squamous cell carcinoma patients. Severe malnutrition, defined as weight loss > 10% in 6 months preceding primary tumor diagnosis, impacts overall survival as well. Little attention has been paid to the interaction between severe malnutrition and other relevant prognostic covariables. This study investigates the impact of malnutrition on short-term mortality and overall survival, together with the covariables age, tumor site, gender, TNM-classification, comorbidity and prior tumors. 383 consecutive primary HNSCC patients, diagnosed and treated between 1995 and 1999 were followed until January 2010. Impact of covariables on short-term mortality and overall survival was studied univariately with Kaplan-Meier curves and the log-rank test. Cox-regression and binary logistic regression were used for multivariate analyses. 28 (7.3%) patients were severely malnourished. All covariables, except gender and prior tumors had significant impact on overall survival. The relative risk of severe malnutrition was 1.8 and is comparable to the impact of a T2 tumor, a N1 neck or moderate comorbidity. A univariate relationship between severe malnutrition and short-term mortality was established. Severe malnutrition has an independent impact on overall survival of primary HNSCC patients. There is a clear distinction between patients with and without severe malnutrition from moment of diagnosis until 10 years after. This emphasizes the importance of identification and optimal treatment of malnutrition before, during and after cancer treatment. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. Impacts and Recovery from Severe Tropical Cyclone Yasi on the Great Barrier Reef

    PubMed Central

    Beeden, Roger; Maynard, Jeffrey; Puotinen, Marjetta; Marshall, Paul; Dryden, Jen; Goldberg, Jeremy; Williams, Gareth

    2015-01-01

    Full recovery of coral reefs from tropical cyclone (TC) damage can take decades, making cyclones a major driver of habitat condition where they occur regularly. Since 1985, 44 TCs generated gale force winds (≥17 metres/second) within the Great Barrier Reef Marine Park (GBRMP). Of the hurricane strength TCs (≥H1—Saffir Simpson scale; ≥ category 3 Australian scale), TC Yasi (February, 2011) was the largest. In the weeks after TC Yasi crossed the GBRMP, participating researchers, managers and rangers assessed the extent and severity of reef damage via 841 Reef Health and Impact Surveys at 70 reefs. Records were scaled into five damage levels representing increasingly widespread colony-level damage (1, 2, 3) and reef structural damage (4, 5). Average damage severity was significantly affected by direction (north vs south of the cyclone track), reef shelf position (mid-shelf vs outer-shelf) and habitat type. More outer-shelf reefs suffered structural damage than mid-shelf reefs within 150 km of the track. Structural damage spanned a greater latitudinal range for mid-shelf reefs than outer-shelf reefs (400 vs 300 km). Structural damage was patchily distributed at all distances, but more so as distance from the track increased. Damage extended much further from the track than during other recent intense cyclones that had smaller circulation sizes. Just over 15% (3,834 km2) of the total reef area of the GBRMP is estimated to have sustained some level of coral damage, with ~4% (949 km2) sustaining a degree of structural damage. TC Yasi likely caused the greatest loss of coral cover on the GBR in a 24-hour period since 1985. Severely impacted reefs have started to recover; coral cover increased an average of 4% between 2011 and 2013 at re-surveyed reefs. The in situ assessment of impacts described here is the largest in scale ever conducted on the Great Barrier Reef following a reef health disturbance. PMID:25874718

  6. Experimental animal models for studies on the mechanisms of blast-induced neurotrauma.

    PubMed

    Risling, Mårten; Davidsson, Johan

    2012-01-01

    A blast injury is a complex type of physical trauma resulting from the detonation of explosive compounds and has become an important issue due to the use of improvised explosive devices (IED) in current military conflicts. Blast-induced neurotrauma (BINT) is a major concern in contemporary military medicine and includes a variety of injuries that range from mild to lethal. Extreme forces and their complex propagation characterize BINT. Modern body protection and the development of armored military vehicles can be assumed to have changed the outcome of BINT. Primary blast injuries are caused by overpressure waves whereas secondary, tertiary, and quaternary blast injuries can have more varied origins such as the impact of fragments, abnormal movements, or heat. The characteristics of the blast wave can be assumed to be significantly different in open field detonations compared to explosions in a confined space, such an armored vehicle. Important parameters include peak pressure, duration, and shape of the pulse. Reflections from walls and armor can make the prediction of effects in individual cases very complex. Epidemiological data do not contain information of the comparative importance of the different blast mechanisms. It is therefore important to generate data in carefully designed animal models. Such models can be selective reproductions of a primary blast, penetrating injuries from fragments, acceleration movements, or combinations of such mechanisms. It is of crucial importance that the physical parameters of the employed models are well characterized so that the experiments can be reproduced in different laboratory settings. Ideally, pressure recordings should be calibrated by using the same equipment in several laboratories. With carefully designed models and thoroughly evaluated animal data it should be possible to achieve a translation of data between animal and clinical data. Imaging and computer simulation represent a possible link between experiments

  7. Experimental Animal Models for Studies on the Mechanisms of Blast-Induced Neurotrauma

    PubMed Central

    Risling, Mårten; Davidsson, Johan

    2012-01-01

    A blast injury is a complex type of physical trauma resulting from the detonation of explosive compounds and has become an important issue due to the use of improvised explosive devices (IED) in current military conflicts. Blast-induced neurotrauma (BINT) is a major concern in contemporary military medicine and includes a variety of injuries that range from mild to lethal. Extreme forces and their complex propagation characterize BINT. Modern body protection and the development of armored military vehicles can be assumed to have changed the outcome of BINT. Primary blast injuries are caused by overpressure waves whereas secondary, tertiary, and quaternary blast injuries can have more varied origins such as the impact of fragments, abnormal movements, or heat. The characteristics of the blast wave can be assumed to be significantly different in open field detonations compared to explosions in a confined space, such an armored vehicle. Important parameters include peak pressure, duration, and shape of the pulse. Reflections from walls and armor can make the prediction of effects in individual cases very complex. Epidemiological data do not contain information of the comparative importance of the different blast mechanisms. It is therefore important to generate data in carefully designed animal models. Such models can be selective reproductions of a primary blast, penetrating injuries from fragments, acceleration movements, or combinations of such mechanisms. It is of crucial importance that the physical parameters of the employed models are well characterized so that the experiments can be reproduced in different laboratory settings. Ideally, pressure recordings should be calibrated by using the same equipment in several laboratories. With carefully designed models and thoroughly evaluated animal data it should be possible to achieve a translation of data between animal and clinical data. Imaging and computer simulation represent a possible link between experiments

  8. Vitamin D deficiency and its impact on asthma severity in asthmatic children.

    PubMed

    Esfandiar, Nasrin; Alaei, Fariba; Fallah, Shahrzad; Babaie, Delara; Sedghi, Niloofar

    2016-12-17

    Despite obtaining evidences on association between vitamin D and development of lung in fetus, little is known about vitamin D level and its impact on severity of asthma in children. The present study aimed to assess the relationship between the asthma severity and vitamin D deficiency in asthmatic children. This case-control study was conducted on 106 individuals including asthmatic (n = 53) and healthy children (n = 53) who referred to Mofid hospital in Tehran in 2013. The level of serum vitamin D in both groups was measured by radioimmunoassay method at the reference lab and was categorized as sufficient (> 30 ng/ml), insufficient (20 to 30 ng/ml), or deficient (< 20 ng/ml). The control status of asthma in patients group was classified as controlled, partially controlled, and uncontrolled. In the groups with and without asthma, the prevalence of vitamin D deficiency was 73.6 and 49.1%, and the prevalence of vitamin D insufficiency was 18.9 and 18.9%, while normal vitamin D level was revealed in 7.5 and 32.1%, respectively with a significant difference (p = 0.005). Using the multivariate logistic regression analysis, the presence of asthma was associated with reduced level of vitamin D (OR = 1.068, 95% CI: 1.027-1.110, P = 0.001). In this context, the risk for asthma in the children with vitamin D deficiency was 6.3 times of those with normal vitamin D level. Although the presence of asthma was strongly associated with reduced level of vitamin D in serum, neither severity of asthma nor control status of asthma were associated with vitamin D deficiency. The presence of vitamin D deficiency effectively predict increased risk for childhood asthma; however the severity or control status of this event may not be predicted by confirming vitamin D deficiency.

  9. Treatment with metadoxine and its impact on early mortality in patients with severe alcoholic hepatitis.

    PubMed

    Higuera-de la Tijera, Fátima; Servín-Caamaño, Alfredo I; Cruz-Herrera, Javier; Serralde-Zúñiga, Aurora E; Abdo-Francis, Juan M; Gutiérrez-Reyes, Gabriela; Pérez-Hernández, José L

    2014-01-01

    Despite treatment with glucocorticoids, mortality remains high in patients with severe alcoholic hepatitis. Oxidative stress and depletion of mitochondrial glutathione are implicated factors in liver injury. The aim of this study was to evaluate the impact of the addition of metadoxine, a drug which possesses a multifactorial mechanism of action, including antioxidant properties, to standard treatment with glucocorticoids in patients with severe alcoholic hepatitis. This randomized open label clinical trial was performed in Mexico's General Hospital (Registry Key DIC/10/107/03/043). We randomized 70 patients with severe alcoholic hepatitis. The first group received prednisone (40 mg/day), and the second group received prednisone (40 mg/day) plus metadoxine tablets (500 mg three times daily). The duration of treatment in both groups was 30 days. Survival at 30 and 90 days, development of complications, adverse events and response to treatment (Lille model) were assessed. In the group receiving metadoxine, significant improvements were observed, as follows: survival at 30 days (74.3 vs. 45.7%, P = 0.02); survival at 90 days (68.6 vs. 20.0%, P = 0.0001). There was less development or progression of encephalopathy (28.6 vs. 60.0%, P = 0.008) and hepatorenal syndrome (31.4 vs. 54.3%, P = 0.05), and the response to treatment (Lille model) was higher in the metadoxine group (0.38 vs. 0.63, P = 0.001; 95% CI 0.11 to 0.40). There were no differences between groups regarding the development or progression of variceal hemorrhage or infection. The incidence of adverse events, mainly gastrointestinal, was similar in both groups. Addition of metadoxine to glucocorticoid treatment improves the short-term survival of patients with severe alcoholic hepatitis and diminishes the development or progression of encephalopathy and hepatorenal syndrome.

  10. Impact of bariatric surgery on life expectancy in severely obese patients with diabetes: A Decision analysis

    PubMed Central

    Schauer, Daniel P.; Arterburn, David E.; Livingston, Edward H.; Coleman, Karen J.; Sidney, Steve; Fisher, David; O'Connor, Patrick; Fischer, David; Eckman, Mark H.

    2014-01-01

    Objective To create a decision analytic model to estimate the balance between treatment risks and benefits for severely obese patients with diabetes. Summary Background Data Bariatric surgery leads to many desirable metabolic changes, but long-term impact of bariatric surgery on life expectancy in patients with diabetes has not yet been quantified. Methods We developed a Markov state transition model with multiple Cox proportional hazards models and logistic regression models as inputs to compare bariatric surgery versus no surgical treatment for severely obese diabetic patients. The model is informed by data from three large cohorts: 1) 159,000 severely obese diabetic patients (4,185 had bariatric surgery) from 3 HMO Research Network sites, 2) 23,000 subjects from the Nationwide Inpatient Sample (NIS), and 3) 18,000 subjects from the National Health Interview Survey linked to the National Death Index. Results In our main analyses, we found that a 45 year-old female with diabetes and a BMI of 45 kg/m2 gained an additional 6.7 years of life expectancy with bariatric surgery (38.4 years with surgery vs. 31.7 without). Sensitivity analyses revealed that the gain in life expectancy decreased with increasing BMI, until a BMI of 62 kg/m2 is reached, at which point nonsurgical treatment was associated with greater life expectancy. Similar results were seen for both men and women in all age groups. Conclusions For most severely obese patients with diabetes, bariatric surgery appears to improve life expectancy; however, surgery may reduce life expectancy for the super obese with BMIs over 62 kg/m2. PMID:25844968

  11. Impact of a trauma system on outcome of severely injured patients.

    PubMed

    Shackford, S R; Mackersie, R C; Hoyt, D B; Baxt, W G; Eastman, A B; Hammill, F N; Knotts, F B; Virgilio, R W

    1987-05-01

    We examined the impact of a trauma system on the survival of patients with a Trauma Score of 8 or less. We compared the observed survival with that predicted using a method that calculates the probability of survival (Ps) based on age, physiologic score, and anatomic severity of injury. Of 3394 patients triaged to trauma centers in a 12-month period, 283 (8.3%) had a Trauma Score of 8 or less. Sufficient data were available in 189 patients with blunt trauma to make the survival comparison. The Ps was 18%; the observed survival was 29%. Of 60 patients with penetrating trauma and complete data, the Ps was 8%; the observed survival was 20%. We attribute the improved survival to the integration of prehospital and hospital care and expeditious surgery.

  12. The influence of seatback characteristics on cervical injury risk in severe rear impacts.

    PubMed

    Burnett, Roger; Carter, Jarrod; Roberts, Verne; Myers, Barry

    2004-07-01

    The determination of the optimum seatback characteristics for the mitigation of serious and catastrophic neck injury during high-speed rear-end collisions remains a topic of continued investigation. Despite a number of prior research efforts, both field data and sled test studies have yet to define a single optimal seatback performance criterion. Further, recent developments in seatbacks have introduced new designs into the field that have not been compared to more traditional designs. Analysis of NASS data from 1980 to 1999 demonstrated that at changes in velocity (DeltaV) above 40 kph, rear-end collisions have a dramatically lower risk for catastrophic injury than frontal, near-side or far-side impacts. Unfortunately, owing to the small penetration of newer seatback designs in the automotive fleet, it is not possible to examine the influence of seatback design parameters on serious neck injury using these data alone. Accordingly, seven rear impact HYGE sled tests were conducted using a wide range of seat designs. Upper and lower neck load cells were used to measure neck forces and moments in restrained 50th male Hybrid III anthropomorphic test devices (ATD). Additionally, the neck injury criteria (Nij) was computed. Unlike prior studies that have examined the standard seated ATD or the dramatically out-of-position ATD, these tests were conducted using an ATD seated in non-standard but typical driving position. The results of this study indicate that several descriptions of seatback behavior, such as quasi-static ultimate force are poor predictors of ATD neck loading. It also suggests that, for the severe crash studied, an optimum range of seatback stiffness exists, which appears to be in the mid-range of seatback stiffnesses available in current production vehicles. These data continue to illustrate the complex relationship of seatback design parameters to neck injury risk.

  13. Health impacts and economic losses assessment of the 2013 severe haze event in Beijing area.

    PubMed

    Gao, Meng; Guttikunda, Sarath K; Carmichael, Gregory R; Wang, Yuesi; Liu, Zirui; Stanier, Charles O; Saide, Pablo E; Yu, Man

    2015-04-01

    Haze is a serious air pollution problem in China, especially in Beijing and surrounding areas, affecting visibility, public health and regional climate. In this study, the Weather Research and Forecasting-Chemistry (WRF-Chem) model was used to simulate PM2.5 (particulate matters with aerodynamic diameter≤2.5 μm) concentrations during the 2013 severe haze event in Beijing, and health impacts and health-related economic losses were calculated based on model results. Compared with surface monitoring data, the model results reflected pollution concentrations accurately (correlation coefficients between simulated and measured PM2.5 were 0.7, 0.4, 0.5 and 0.6 in Beijing, Tianjin, Xianghe and Xinglong stations, respectively). Health impacts assessments show that the PM2.5 concentrations in January might cause 690 (95% confidence interval (CI): (490, 890)) premature deaths, 45,350 (95% CI: (21,640, 57,860)) acute bronchitis and 23,720 (95% CI: (17,090, 29,710)) asthma cases in Beijing area. Results of the economic losses assessments suggest that the haze in January 2013 might lead to 253.8 (95% CI: (170.2, 331.2)) million US$ losses, accounting for 0.08% (95% CI: (0.05%, 0.1%)) of the total 2013 annual gross domestic product (GDP) of Beijing. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Biocompatible porcine dermis graft to treat severe cystocele: impact on quality of life and sexuality.

    PubMed

    Vitale, Salvatore Giovanni; Caruso, Salvatore; Rapisarda, Agnese Maria Chiara; Valenti, Gaetano; Rossetti, Diego; Cianci, Stefano; Cianci, Antonio

    2016-01-01

    To study the quality of life (QoL) and sexual function changes of women affected by severe cystocele treated using biocompatible porcine dermis graft. 20 women (ranging in age from 47 to 71 years, mean age 58.7) with third- and fourth-degree cystocele (according to Baden and Walker classification) were enrolled. The Short Form-36 questionnaire to assess QoL was administrated at baseline and 12 months after surgical treatment. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to measure the changes of sexual behavior was used at baseline and 12 months after surgical treatment. Each woman underwent translabial color Doppler ultrasonography to measure the clitoral blood flow before and 12 months after surgical treatment. Women reported QoL improvement (P < 0.001). By PISQ-12, improvement of the behavioral emotive factor score, the physical factor score, the partner-related factor score and of the total score during the 12-month follow-up with respect to baseline experience was observed (P < 0.001). Color Doppler measurement showed that the mean pulsatility index, peak systolic velocity, resistance index and end-diastolic velocity of clitoral arteries did not significantly change (P = NS). Biocompatible porcine dermis graft to treat severe cystocele considerably improves QoL and sexual function, and does not influence clitoral blood flow. Our data could add new information about sexual behavior after prolapse treatment using this kind of graft, particularly about the impact on clitoral blood flow changes.

  15. Impact of Helicobacter pylori infection on severity of psoriasis and response to treatment.

    PubMed

    Onsun, Nahide; Arda Ulusal, Hande; Su, Ozlem; Beycan, Ismet; Biyik Ozkaya, Dilek; Senocak, Mustafa

    2012-01-01

    The aims of this study were to determine the prevalence of H. pylori seropositivity in patients with psoriasis, to evaluate the relationship between PASI (Psoriasis Area and Severity Index) scores and H. pylori infection, and to assess the impact of H. pylori infection on the response to treatment. A total of 300 patients with psoriasis and 150 non-psoriatic healthy controls were enrolled in the study. Patient PASI scores were recorded and H. pylori stool antigen tests performed in both patients and controls. Fifty patients with H. pylori infections were randomly assigned to one of two groups, one of which received acitretin with H. pylori treatment and the other acitretin alone. Statistical analyses were performed using chi-square and logistic regression tests. PASI scores were significantly higher in patients with H. pylori infections. Treatment aimed at eradicating H. pylori infection enhanced the effectiveness of acitretin therapy and shortened response times. Our results suggest that H. pylori infection plays a role in the severity of psoriasis, and that eradicating such infections enhances the effectiveness of psoriasis treatment.

  16. On ballistic parameters of less lethal projectiles influencing the severity of thoracic blunt impacts.

    PubMed

    Pavier, Julien; Langlet, André; Eches, Nicolas; Jacquet, Jean-François

    2015-01-01

    The development and safety certification of less lethal projectiles require an understanding of the influence of projectile parameters on projectile-chest interaction and on the resulting terminal effect. Several energy-based criteria have been developed for chest injury assessment. Many studies consider kinetic energy (KE) or energy density as the only projectile parameter influencing terminal effect. In a common KE range (100-160 J), analysis of the firing tests of two 40 mm projectiles of different masses on animal surrogates has been made in order to investigate the severity of the injuries in the thoracic region. Experimental results have shown that KE and calibre are not sufficient to discriminate between the two projectiles as regards their injury potential. Parameters, such as momentum, shape and impedance, influence the projectile-chest interaction and terminal effect. A simplified finite element model of projectile-structure interaction confirms the experimental tendencies. Within the range of ballistic parameters used, it has been demonstrated that maximum thoracic deflection is a useful parameter to predict the skeletal level of injury, and it largely depends on the projectile pre-impact momentum. However, numerical simulations show that these results are merely valid for the experimental conditions used and cannot be generalised. Nevertheless, the transmitted impulse seems to be a more general factor governing the thorax deflection.

  17. The impact of acute hyponatraemia on severe traumatic brain injury in rats.

    PubMed

    Ke, C; Poon, W S; Ng, H K; Tang, N L; Chan, Y; Wang, J Y; Hsiang, J N

    2000-01-01

    The effect of experimental acute hyponatraemia on severe traumatic brain injury (TBI) was studied in a modified impact-acceleration model. The cortical contusional volume was quantified by image analysis on serial sections, injured axons were visualized and quantified by beta-Amyloid Precursor Protein (beta-APP) immunohistochemical staining. Regional brain water content was estimated by the wet-dry weight method. The experiment was conducted in Group I (injury only) and Group II (injury followed by acute hyponatraemia). Comparison between the two groups showed that acute hyponatraemia significantly increased contusional volume (3.24 +/- 0.70 mm3 vs. 1.80 +/- 0.65 mm3, P = 0.009) and the number of injured axons (128.7 +/- 44.3 vs. 41.7 +/- 50.1, P = 0.04) in the right thalamus & basal ganglia region. Water content of the brain stem region was also significantly increased by acute hyponatraemia (73.71 +/- 0.14% vs. 72.28 +/- 0.93%, P = 0.004). These results suggest that acute hyponatraemia potentiates secondary brain damage in severe TBI by augmentation of both focal contusion and diffuse axonal injury. The injured brain stem region is more susceptible to edema formation induced by experimental acute hyponatraemia.

  18. Impact of caramelization on the glass transition temperature of several caramelized sugars. Part I: Chemical analyses.

    PubMed

    Jiang, Bin; Liu, Yeting; Bhandari, Bhesh; Zhou, Weibiao

    2008-07-09

    This study aims to investigate the relationship between caramelization of several sugars including fructose, glucose, and sucrose and their glass transition temperature (Tg). Differential scanning calorimetry (DSC) was used for creating caramelized sugar samples as well as determining their glass transition temperature, which was found to decrease first and then increase as the holding time at the highest temperature increased. The extent of caramelization was quantified by UV-vis absorbance measurement and high-performance liquid chromatography analysis. Results showed that the amount of small molecules from the degradation of sugar increased very fast at the beginning of heating, and this increase slowed down in the later stage of caramelization. On the other hand, there was a lag phase in the formation of large molecules from the degradation of sugar at the beginning of heating, followed by a fast increase in the later stage of caramelization. The obtained results clearly indicate the impact of melting condition on the T g of sugars through formation of intermediates and end products of caramelization. Generally, when the heating condition is relatively mild, small molecules are formed first by decomposition of the sugar, which leads to a decrease of the overall Tg, and as the heating time becomes longer and/or the heating condition becomes more severe, polymerization takes over and more large molecules are formed, which results in an increase of the overall Tg. Mathematical modeling of the relationship will be presented as part II of the study in a separate paper.

  19. Objective severity does not capture the impact of rosacea, acne scarring and photoaging in patients seeking laser therapy.

    PubMed

    Thomas, C L; Kim, B; Lam, J; Richards, S; See, A; Kalouche, S; Paver, R D; Fernández Peñas, P

    2017-02-01

    Measures of quality of life (QOL) and patient satisfaction are of great importance in dermatology, as both impact upon treatment adherence and health outcomes. Patients' assessment of QOL often differs from their doctors' predictions and their assessments of skin disease severity do not correlate with patients' own perceptions. The development of laser technology has facilitated successful treatment of many skin conditions, but studies on patient satisfaction are lacking. Our aim was to determine the extent of discordance between patient and dermatologist-assessed disease severity and assess the impact of acne scarring, rosacea and photoaging on QOL. Our secondary aim was to assess patient satisfaction with laser therapy. A prospective study of patients undergoing laser treatment for acne scarring, rosacea and photoaging was conducted over 1 year at the Skin & Cancer Foundation Australia. Subjective disease severity was determined using a visual analogue scale (VAS). Two dermatologists determined objective severity using validated grading scales to score photographs. QOL impact was measured by Skindex-16, satisfaction was measured using an amended Comprehensive Satisfaction Questionnaire (PSQ-18). A total of 147 individuals sought laser therapy for acne scarring, rosacea and photoaging. Dermatologists' subjective disease severity correlated weakly with patient-reported severity. All conditions negatively impacted upon QOL. Patients with rosacea had the most symptomatic impact; acne scarring was associated with the greatest self-esteem and social functioning issues; photoaging patients were the least affected. There were significant correlations between subjective severity assessment and Skindex-16 scores. There was notable discordance between dermatologist's skin severity assessment and patient's self-reported QOL impact. Skin conditions can have a profound impact on patient QOL, which is affected by patients' perception of disease severity and not fully

  20. The Framework of a Coastal Hazards Model - A Tool for Predicting the Impact of Severe Storms

    USGS Publications Warehouse

    Barnard, Patrick L.; O'Reilly, Bill; van Ormondt, Maarten; Elias, Edwin; Ruggiero, Peter; Erikson, Li H.; Hapke, Cheryl; Collins, Brian D.; Guza, Robert T.; Adams, Peter N.; Thomas, Julie

    2009-01-01

    The U.S. Geological Survey (USGS) Multi-Hazards Demonstration Project in Southern California (Jones and others, 2007) is a five-year project (FY2007-FY2011) integrating multiple USGS research activities with the needs of external partners, such as emergency managers and land-use planners, to produce products and information that can be used to create more disaster-resilient communities. The hazards being evaluated include earthquakes, landslides, floods, tsunamis, wildfires, and coastal hazards. For the Coastal Hazards Task of the Multi-Hazards Demonstration Project in Southern California, the USGS is leading the development of a modeling system for forecasting the impact of winter storms threatening the entire Southern California shoreline from Pt. Conception to the Mexican border. The modeling system, run in real-time or with prescribed scenarios, will incorporate atmospheric information (that is, wind and pressure fields) with a suite of state-of-the-art physical process models (that is, tide, surge, and wave) to enable detailed prediction of currents, wave height, wave runup, and total water levels. Additional research-grade predictions of coastal flooding, inundation, erosion, and cliff failure will also be performed. Initial model testing, performance evaluation, and product development will be focused on a severe winter-storm scenario developed in collaboration with the Winter Storm Working Group of the USGS Multi-Hazards Demonstration Project in Southern California. Additional offline model runs and products will include coastal-hazard hindcasts of selected historical winter storms, as well as additional severe winter-storm simulations based on statistical analyses of historical wave and water-level data. The coastal-hazards model design will also be appropriate for simulating the impact of storms under various sea level rise and climate-change scenarios. The operational capabilities of this modeling system are designed to provide emergency planners with

  1. Note: A table-top blast driven shock tube

    NASA Astrophysics Data System (ADS)

    Courtney, Michael W.; Courtney, Amy C.

    2010-12-01

    The prevalence of blast-induced traumatic brain injury in conflicts in Iraq and Afghanistan has motivated laboratory scale experiments on biomedical effects of blast waves and studies of blast wave transmission properties of various materials in hopes of improving armor design to mitigate these injuries. This paper describes the design and performance of a table-top shock tube that is more convenient and widely accessible than traditional compression driven and blast driven shock tubes. The design is simple: it is an explosive driven shock tube employing a rifle primer that explodes when impacted by the firing pin. The firearm barrel acts as the shock tube, and the shock wave emerges from the muzzle. The small size of this shock tube can facilitate localized application of a blast wave to a subject, tissue, or material under test.

  2. Note: A table-top blast driven shock tube.

    PubMed

    Courtney, Michael W; Courtney, Amy C

    2010-12-01

    The prevalence of blast-induced traumatic brain injury in conflicts in Iraq and Afghanistan has motivated laboratory scale experiments on biomedical effects of blast waves and studies of blast wave transmission properties of various materials in hopes of improving armor design to mitigate these injuries. This paper describes the design and performance of a table-top shock tube that is more convenient and widely accessible than traditional compression driven and blast driven shock tubes. The design is simple: it is an explosive driven shock tube employing a rifle primer that explodes when impacted by the firing pin. The firearm barrel acts as the shock tube, and the shock wave emerges from the muzzle. The small size of this shock tube can facilitate localized application of a blast wave to a subject, tissue, or material under test.

  3. Relationship between orientation to a blast and pressure wave propagation inside the rat brain.

    PubMed

    Chavko, Mikulas; Watanabe, Tomas; Adeeb, Saleena; Lankasky, Jason; Ahlers, Stephen T; McCarron, Richard M

    2011-01-30

    Exposure to a blast wave generated during an explosion may result in brain damage and related neurological impairments. Several mechanisms by which the primary blast wave can damage the brain have been proposed, including: (1) a direct effect of the shock wave on the brain causing tissue damage by skull flexure and propagation of stress and shear forces; and (2) an indirect transfer of kinetic energy from the blast, through large blood vessels and cerebrospinal fluid (CSF), to the central nervous system. To address a basic question related to the mechanisms of blast brain injury, pressure was measured inside the brains of rats exposed to a low level of blast (~35kPa), while positioned in three different orientations with respect to the primary blast wave; head facing blast, right side exposed to blast and head facing away from blast. Data show different patterns and durations of the pressure traces inside the brain, depending on the rat orientation to blast. Frontal exposures (head facing blast) resulted in pressure traces of higher amplitude and longer duration, suggesting direct transmission and reflection of the pressure inside the brain (dynamic pressure transfer). The pattern of the pressure wave inside the brain in the head facing away from blast exposures assumes contribution of the static pressure, similar to hydrodynamic pressure to the pressure wave inside the brain. Published by Elsevier B.V.

  4. En-route care capability from point of injury impacts mortality after severe wartime injury.

    PubMed

    Morrison, Jonathan J; Oh, John; DuBose, Joseph J; O'Reilly, David J; Russell, Robert J; Blackbourne, Lorne H; Midwinter, Mark J; Rasmussen, Todd E

    2013-02-01

    The objective of this study is to characterize modern point-of-injury (POI) en-route care platforms and to compare mortality among casualties evacuated with conventional military retrieval (CMR) methods to those evacuated with an advanced medical retrieval (AMR) capability. Following a decade of war in Afghanistan, the impact of en-route care capabilities from the POI on mortality is unknown. Casualties evacuated from POI to one level III facility in Afghanistan (July 2008-March 2012) were identified from UK and US trauma registries. Groups comprised those evacuated by a medically qualified provider-led, AMR and those by a medic-led CMR capability. Outcomes were compared per incremental Injury Severity Score (ISS) bins. Most casualties (n = 1054; 61.2%) were in the low-ISS (1-15) bracket in which there was no difference in en-route care time or mortality between AMR and CMR. Casualties in the mid-ISS bracket (16-50) (n = 583; 33.4%) experienced the same median en-route care time (minutes) on AMR and CMR platforms [78 (58) vs 75 (93); P = 0.542] although those on AMR had shorter time to operation [110 (95) vs 117 (126); P < 0.001]. In this mid-ISS bracket, mortality was lower in the AMR than in the CMR group (12.2% vs 18.2%; P = 0.035). In the high-ISS category (51-75) (n = 75; 4.6%), time to operation was lower in the AMR than the CMR group (66 ± 77 vs 113 ± 122; P = 0.013) but there was no difference in mortality. This study characterizes en-route care capabilities from POI in modern combat. Conventional platforms are effective in most casualties with low injury severity. However, a definable injury severity exists for which evacuation with an AMR capability is associated with improved survival.

  5. Early Detection Tool of Intestinal Dysfunction: Impact on Necrotizing Enterocolitis Severity.

    PubMed

    Fox, Jenny R; Thacker, Leroy R; Hendricks-Muñoz, Karen D

    2015-08-01

    The aim of this study is to determine the use of an early clinical signs and symptoms warning tool in early identification of intestinal dysfunction as a clinical strategy to decrease necrotizing enterocolitis (NEC) severity. Using signs and symptoms of 297 infants, of which 33 infants were diagnosed with stage II and III EC intestinal dysfunction, a five clinical category scoring tool (Neonatal Necrotizing Enterocolitis Early Detection Score [NeoNEEDS]) and strategy with abdominal X-ray alert was developed. The categories included behavior, cardiac, respiratory, gastrointestinal, and feeding tolerance. The strategy was tested in a prospective cohort of 72 infants < 1,500 g, utilizing 532 observations between 10/2012 and 9/1/2013. The statistical analysis utilized the Statistical Analysis Software (SAS). The earliest signs and symptoms of intestinal dysfunction (Stage I NEC) were cardiorespiratory baseline changes, p < 0.001. Abdominal distension and/or feeding intolerance were late findings associated with stage II or III NEC. Tool scores ≥ 5 predicted intestinal dysfunction (p < 0.00). Sensitivity was high (95%) with specificity of 82% and positive and negative predictive values of 76% and 95%, respectively. Use of the tool during the study period was associated with decreased NEC severity rates (Bell NEC stage II and III). Cardiorespiratory symptoms precede gastrointestinal symptoms of intestinal dysfunction. Targeting signs and symptoms in an early warning tool to identify intestinal dysfunction can impact NEC severity progression. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  6. Impact of Source Control in Patients With Severe Sepsis and Septic Shock.

    PubMed

    Martínez, María Luisa; Ferrer, Ricard; Torrents, Eva; Guillamat-Prats, Raquel; Gomà, Gemma; Suárez, David; Álvarez-Rocha, Luis; Pozo Laderas, Juan Carlos; Martín-Loeches, Ignacio; Levy, Mitchell M; Artigas, Antonio

    2017-01-01

    Time to clearance of pathogens is probably critical to outcome in septic shock. Current guidelines recommend intervention for source control within 12 hours after diagnosis. We aimed to determine the epidemiology of source control in the management of sepsis and to analyze the impact of timing to source control on mortality. Prospective observational analysis of the Antibiotic Intervention in Severe Sepsis study, a Spanish national multicenter educational intervention to improve antibiotherapy in sepsis. Ninety-nine medical-surgical ICUs in Spain. We enrolled 3,663 patients with severe sepsis or septic shock during three 4-month periods between 2011 and 2013. Source control and hospital mortality. A total of 1,173 patients (32%) underwent source control, predominantly for abdominal, urinary, and soft-tissue infections. Compared with patients who did not require source control, patients who underwent source control were older, with a greater prevalence of shock, major organ dysfunction, bacteremia, inflammatory markers, and lactic acidemia. In addition, compliance with the resuscitation bundle was worse in those undergoing source control. In patients who underwent source control, crude ICU mortality was lower (21.2% vs 25.1%; p = 0.010); after adjustment for confounding factors, hospital mortality was also lower (odds ratio, 0.809 [95% CI, 0.658-0.994]; p = 0.044). In this observational database analysis, source control after 12 hours was not associated with higher mortality (27.6% vs 26.8%; p = 0.789). Despite greater severity and worse compliance with resuscitation bundles, mortality was lower in septic patients who underwent source control than in those who did not. The time to source control could not be linked to survival in this observational database.

  7. The Impact of Muscle Disuse on Muscle Atrophy in Severely Burned Rats

    PubMed Central

    Wu, Xiaowu; Baer, Lisa A; Wolf, Steven E.; Wade, Charles E; Walters, Thomas J.

    2010-01-01

    Background Severe burn induces a sustained hypermetabolic response, which causes long-term loss of muscle mass and decrease in muscle strength. In this study, we sought to determine whether muscle disuse has additional impact on muscle atrophy after severe burn using a rat model combining severe cutaneous burn and hindlimb unloading. Methods Forty Sprague-Dawley rats (≈300g) were randomly assigned to sham ambulatory (S/A), sham hindlimb unloading (S/HLU), burn ambulatory (B/A) or burn hindlimb unloading (B/HLU) groups. Rats received a 40% total body surface (TBSA) full thickness scald burn, and rats with hindlimb unloading were placed in a tail traction system. At day 14, lean body mass (LBM) was determined using DEXA scan, followed by measurement of the isometric mechanical properties in the predominantly fast-twitch plantaris muscle (PL) and the predominantly slow-twitch soleus muscle (SL). Muscle weight (wt), protein wt, and wet/dry wt were determined. Results At day 14, body weight had decreased significantly in all treatment groups; B/HLU resulted in significantly greater loss compared to the B/A, S/HLU and S/A. The losses could be attributed to loss of LBM. PL muscle wt and Po were lowest in the B/HLU group (<0.05 vs. S/A, S/HLU or B/A). SL muscle wt and Po were significantly less in both S/HLU and B/HLU compared that of S/A and B/A; no significant difference was found between S/HLU and B/HLU. Conclusions Cutaneous burn and hindlimb unloading have an additive effect on muscle atrophy, characterized by loss of muscle mass and decrease in muscle strength in both fast (PL) and slow (SL) twitch muscles. Of the two, disuse appeared to be the dominant factor for continuous muscle wasting after acute burn in this model. PMID:20888588

  8. Impact of Metformin Use on Lactate Kinetics in Patients with Severe Sepsis and Septic Shock.

    PubMed

    Park, Joongmin; Hwang, Sung Yeon; Jo, Ik Joon; Jeon, Kyeongman; Suh, Gee Young; Lee, Tae Rim; Yoon, Hee; Cha, Won Chul; Sim, Min Seob; Carriere, Keumhee Chough; Yeon, Seungmin; Shin, Tae Gun

    2017-05-01

    We aimed to evaluate the impact of metformin use on lactate kinetics in patients with severe sepsis and septic shock. We analyzed data from a registry that included patients who presented to the emergency department and met criteria for severe sepsis or septic shock. Patients were divided into two groups based on metformin use. We compared lactate concentrations, lactate clearance (LC), and normalization at 6 h (H6) and 24 h (H24) after the initial (H0) measurement. Propensity score matching, multiple logistic, and linear regression analysis via a generalized estimating equations method were used. Of 1,318 patients, 71 patients were in the metformin use group and all 71 were selected in a one to two propensity matching. Metformin users showed significantly higher lactate levels at H0 (5.3 vs. 4.4 mmol/L) and H6 (3.8 vs. 2.9 mmol/L) in all patients, although in the matched subset, the effect was marginal (H0, 5.3 vs. 4.9 mmol/L; H6, 3.8 vs. 3.2 mmol/L; H24, 2.7 vs. 2.4 mmol/L). Mean LC (H6, 29% vs. 34%; H24, 43% vs. 49%) and normalization rate (H6, 27% vs. 28%; H24, 49% vs. 52%) were also not significantly different. Although metformin use appeared to be associated with higher lactate levels before using the propensity score method, no significant association was found between metformin use and lactate kinetics variables in the balanced matched subset data. Lactate levels in metformin users were initially elevated in the early phase of resuscitation from severe sepsis and septic shock. However, there was no significant difference in lactate levels, LC, and normalization over the initial 24 h period based on metformin use.

  9. Can News Draw Blood The Impact of Media Coverage on the Number and Severity of Terror Attacks

    DTIC Science & Technology

    2016-05-01

    FUNDING NUMBERS Can News Draw Blood? The Impact of Media Coverage on the Number and Severity ofTen·or Attacks 6. AUTHOR(S) K . B eckmann R. D...the short run media coverage on terror on ly has an impact on the severity of terror attacks, while it affects the number of terror attacks in the long...hau l. These observations are consistent with the idea of competition between terrorist groups. 14. SUBJECT TERMS UNIBW, Gennan, terrorism. media

  10. Blast furnace stove control

    SciTech Connect

    Muske, K.R.; Hansen, G.A.; Howse, J.W.; Cagliostro, D.J.; Chaubal, P.C.

    1998-12-31

    This paper outlines the process model and model-based control techniques implemented on the hot blast stoves for the No. 7 Blast Furnace at the Inland Steel facility in East Chicago, Indiana. A detailed heat transfer model of the stoves is developed. It is then used as part of a predictive control scheme to determine the minimum amount of fuel necessary to achieve the blast air requirements. The controller also considers maximum and minimum temperature constraints within the stove.

  11. Family Impact in Intellectual Disability, Severe Mental Health Disorders and Mental Health Disorders in ID. A Comparison

    ERIC Educational Resources Information Center

    Martorell, Almudena; Gutierrez-Recacha, Pedro; Irazabal, Marcia; Marsa, Ferran; Garcia, Mercedes

    2011-01-01

    Family impact (or family burden) is a concept born in the field of mental health that has successfully been exported to the ambit of intellectual disability (ID). However, differences in family impact associated with severe mental health disorders (schizophrenia), to ID or to mental health problems in ID should be expected. Seventy-two adults with…

  12. Family Impact in Intellectual Disability, Severe Mental Health Disorders and Mental Health Disorders in ID. A Comparison

    ERIC Educational Resources Information Center

    Martorell, Almudena; Gutierrez-Recacha, Pedro; Irazabal, Marcia; Marsa, Ferran; Garcia, Mercedes

    2011-01-01

    Family impact (or family burden) is a concept born in the field of mental health that has successfully been exported to the ambit of intellectual disability (ID). However, differences in family impact associated with severe mental health disorders (schizophrenia), to ID or to mental health problems in ID should be expected. Seventy-two adults with…

  13. Impedance Cardiographic (ICG) Assessment of Pregnant Women With Severe Hypertension to Assess Impact of Standard Therapy

    ClinicalTrials.gov

    2013-12-11

    Pregnancy; Proteinuria, With Hypertension (Severe Pre-eclampsia); Delivery; Proteinuria, With Gestational Hypertension (Pre-eclampsia, Severe); Pregnancy; Hypertension, Gestational Hypertension, With Albuminuria (Severe Pre-eclampsia)

  14. General view of blast furnace plant, with blast furnace "A" ...

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

    General view of blast furnace plant, with blast furnace "A" (built in 1907) to the left; in the foreground is the turbo-blower and blast furnace gas-powered electric generating station (built in 1919), looking northwest - Bethlehem Steel Corporation, South Bethlehem Works, Blast Furnace "A", Along Lehigh River, North of Fourth Street, West of Minsi Trail Bridge, Bethlehem, Northampton County, PA

  15. Cervical Injury Risk Resulting From Rotary Wing Impact: Assessment of Injury Based Upon Aviator Size, Helmet Mass Properties and Impact Severity

    DTIC Science & Technology

    2004-10-21

    NAWCADPAX/TR-2004/86 CERVICAL INJURY RISK RESULTING FROM ROTARY WING IMPACT: ASSESSMENT OF INJURY BASED UPON AVIATOR SIZE, HELMET MASS...DEPARTMENT OF THE NAVY NAVAL AIR WARFARE CENTER AIRCRAFT DIVISION PATUXENT RIVER, MARYLAND NAWCADPAX/TR-2004/86 21 October 2004 CERVICAL ... Cervical Injury Risk Resulting From Rotary Wing Impact: Assessment of Injury Based Upon Aviator Size, Helmet Mass Properties and Impact Severity 5b

  16. Blast Load Response of Steel Sandwich Panels with Liquid Encasement

    SciTech Connect

    Dale Karr; Marc Perlin; Benjamin Langhorst; Henry Chu

    2009-10-01

    We describe an experimental investigation of the response of hybrid blast panels for protection from explosive and impact forces. The fundamental notion is to dissipate, absorb, and redirect energy through plastic collapse, viscous dissipation, and inter-particle forces of liquid placed in sub-structural compartments. The panels are designed to absorb energy from an impact or air blast by elastic-plastic collapse of the panel substructure that includes fluid-filled cavities. The fluid contributes to blast effects mitigation by providing increased initial mass and resistance, by dissipation of energy through viscosity and fluid flow, and by redirecting the momentum that is imparted to the system from the impact and blast impulse pressures. Failure and deformation mechanisms of the panels are described.

  17. Clinical Impact of Sample Interference on Intensive Insulin Therapy in Severely Burned Patients: A Pilot Study

    PubMed Central

    Tran, Nam K.; Godwin, Zachary R.; Bockhold, Jennifer C.; Passerini, Anthony G.; Cheng, Julian; Ingemason, Morgan

    2013-01-01

    Objective Severely burned patients benefit from intensive insulin therapy (IIT) for tight glycemic control (TGC). We evaluated the clinical impact of automatic correction of hematocrit and ascorbic acid interference for bedside glucose monitoring performance in critically ill burn patients. Methods The performance of two point-of-care glucose monitoring systems (GMS): (a) GMS1, an autocorrecting device, and (b) GMS2, a non-correcting device were compared. Sixty remnant arterial blood samples were collected in a prospective observational study to evaluate hematocrit and ascorbic acid effects on GMS1 vs. GMS2 accuracy paired against a plasma glucose reference. Next we enrolled 12 patients in a pilot randomized controlled trial (RCT). Patients were randomized 1:1 to receive IIT targeting a TGC interval of 111–151 mg/dL and guided by either GMS1 or GMS2. GMS bias, mean insulin rate, and glycemic variability were calculated. Results In the prospective study, GMS1 results were similar to plasma glucose results (mean bias: −0.75[4.0] mg/dL, n=60, P=0.214). GMS2 results significantly differed from paired plasma glucose results (mean bias: −5.66[18.7] mg/dL, n=60, P=0.048). Ascorbic acid therapy elicited significant GMS2 performance bias (29.2[27.2], P<0.001). RCT results reported lower mean bias (P<0.001), glycemic variability (P<0.05), mean insulin rate (P<0.001), and frequency of hypoglycemia (P<0.001) in the GMS1 group than the GMS2 group. Conclusions Anemia and high dose ascorbic acid therapy negatively impact GMS accuracy and TGC in burn patients. Automatic correction of confounding factors improves glycemic control. Further studies are warranted to determine outcomes associated with accurate glucose monitoring during IIT. PMID:23884048

  18. The impact of Silymarin on improvement of platelet abnormalities in patients with severe preeclampsia

    PubMed Central

    Baghbahadorani, Fahimeh Kaveh; Miraj, Sepideh

    2016-01-01

    Background Preeclampsia is a pregnancy-specific disorder that is associated with an increase in blood pressure and proteinuria; in severe cases, it can cause platelet abnormalities. Silymarin is the extract of Silybum marianum, which is recognized as a safe antioxidant drug. Objective To determine the impact of Silymarin on the improvement of severe preeclampsia in 60 patients with severe preeclampsia. Methods In this double-blind clinical trial study, This study included 60 patients whose pregnancies were terminated because of severe preeclampsia and who were referred to Hajar Hospital in Shahrekord, Iran, from April 2014 to September 2015. The patients were divided randomly into two groups, i.e., a group of 30 patients and a control group of 30 patients. In addition to the current treatments for preeclampsia, The members of the study group were administered 70 mg of Silymarin at three hours and 24 hours after the termination of their pregnancies. The control group received a placebo at the same times. Platelet count tests were compared at the baseline and at 12, 36, and 60 hours post-measurements in the two groups by SPSS software, version 22, by the ANOVA test, and by the independent-samples t-test. Results At the baseline, the two groups were not significantly different in terms of various criteria, such as age, BMI, and platelet counts. There were no significant differences between the two groups regarding the number of platelets at 12, 36, and 60 h after their pregnancies were ended (p > 0.01). Conclusions The results of this study indicated that, although oxidative factors are involved in the incidence of complications of preeclampsia, e.g., thrombocytopenia, merely using an oxidative agent does not alleviate this effect. This indicated that other factors likely are involved in the pathogenesis of this disease. Additional studies are needed to prove the beneficial effects of this drug in the treatment of preeclampsia. Clinical trial registration The trial

  19. Toxicology of blast overpressure.

    PubMed

    Elsayed, N M

    1997-07-25

    Blast overpressure (BOP) or high energy impulse noise, is the sharp instantaneous rise in ambient atmospheric pressure resulting from explosive detonation or firing of weapons. Blasts that were once confined to military and to a lesser extent, occupational settings, are becoming more universal as the civilian population is now increasingly at risk of exposure to BOP from terrorist bombings that are occurring worldwide with greater frequency. Exposure to incident BOP waves can cause auditory and non-auditory damage. The primary targets for BOP damage are the hollow organs, ear, lung and gastrointestinal tract. In addition, solid organs such as heart, spleen and brain can also be injured upon exposure. However, the lung is more sensitive to damage and its injury can lead to death. The pathophysiological responses, and mortality have been extensively studied, but little attention, was given to the biochemical manifestations, and molecular mechanism(s) of injury. The injury from BOP has been, generally, attributed to its external physical impact on the body causing internal mechanical damage. However, a new hypothesis has been proposed based on experiments conducted in the Department of Respiratory Research, Walter Reed Army Institute of Research, and later in the Department of Occupational Health, University of Pittsburgh. This hypothesis suggests that subtle biochemical changes namely, free radical-mediated oxidative stress occur and contribute to BOP-induced injury. Understanding the etiology of these changes may shed new light on the molecular mechanism(s) of injury, and can potentially offer new strategies for treatment. In this symposium. BOP research involving auditory, non-auditory, physiological, pathological, behavioral, and biochemical manifestations as well as predictive modeling and current treatment modalities of BOP-induced injury are discussed.

  20. A multi-mode shock tube for investigation of blast-induced traumatic brain injury.

    PubMed

    Reneer, Dexter V; Hisel, Richard D; Hoffman, Joshua M; Kryscio, Richard J; Lusk, Braden T; Geddes, James W

    2011-01-01

    Blast-induced mild traumatic brain injury (bTBI) has become increasingly common in recent military conflicts. The mechanisms by which non-impact blast exposure results in bTBI are incompletely understood. Current small animal bTBI models predominantly utilize compressed air-driven membrane rupture as their blast wave source, while large animal models use chemical explosives. The pressure-time signature of each blast mode is unique, making it difficult to evaluate the contributions of the different components of the blast wave to bTBI when using a single blast source. We utilized a multi-mode shock tube, the McMillan blast device, capable of utilizing compressed air- and compressed helium-driven membrane rupture, and the explosives oxyhydrogen and cyclotrimethylenetrinitramine (RDX, the primary component of C-4 plastic explosives) as the driving source. At similar maximal blast overpressures, the positive pressure phase of compressed air-driven blasts was longer, and the positive impulse was greater, than those observed for shockwaves produced by other driving sources. Helium-driven shockwaves more closely resembled RDX blasts, but by displacing air created a hypoxic environment within the shock tube. Pressure-time traces from oxyhydrogen-driven shockwaves were very similar those produced by RDX, although they resulted in elevated carbon monoxide levels due to combustion of the polyethylene bag used to contain the gases within the shock tube prior to detonation. Rats exposed to compressed air-driven blasts had more pronounced vascular damage than those exposed to oxyhydrogen-driven blasts of the same peak overpressure, indicating that differences in blast wave characteristics other than peak overpressure may influence the extent of bTBI. Use of this multi-mode shock tube in small animal models will enable comparison of the extent of brain injury with the pressure-time signature produced using each blast mode, facilitating evaluation of the blast wave components

  1. A Multi-Mode Shock Tube for Investigation of Blast-Induced Traumatic Brain Injury

    PubMed Central

    Reneer, Dexter V.; Hisel, Richard D.; Hoffman, Joshua M.; Kryscio, Richard J.; Lusk, Braden T.

    2011-01-01

    Abstract Blast-induced mild traumatic brain injury (bTBI) has become increasingly common in recent military conflicts. The mechanisms by which non-impact blast exposure results in bTBI are incompletely understood. Current small animal bTBI models predominantly utilize compressed air-driven membrane rupture as their blast wave source, while large animal models use chemical explosives. The pressure-time signature of each blast mode is unique, making it difficult to evaluate the contributions of the different components of the blast wave to bTBI when using a single blast source. We utilized a multi-mode shock tube, the McMillan blast device, capable of utilizing compressed air- and compressed helium-driven membrane rupture, and the explosives oxyhydrogen and cyclotrimethylenetrinitramine (RDX, the primary component of C-4 plastic explosives) as the driving source. At similar maximal blast overpressures, the positive pressure phase of compressed air-driven blasts was longer, and the positive impulse was greater, than those observed for shockwaves produced by other driving sources. Helium-driven shockwaves more closely resembled RDX blasts, but by displacing air created a hypoxic environment within the shock tube. Pressure-time traces from oxyhydrogen-driven shockwaves were very similar those produced by RDX, although they resulted in elevated carbon monoxide levels due to combustion of the polyethylene bag used to contain the gases within the shock tube prior to detonation. Rats exposed to compressed air-driven blasts had more pronounced vascular damage than those exposed to oxyhydrogen-driven blasts of the same peak overpressure, indicating that differences in blast wave characteristics other than peak overpressure may influence the extent of bTBI. Use of this multi-mode shock tube in small animal models will enable comparison of the extent of brain injury with the pressure-time signature produced using each blast mode, facilitating evaluation of the blast wave

  2. Age-Related Alteration of Arginase Activity Impacts on Severity of Leishmaniasis

    PubMed Central

    Müller, Ingrid; Hailu, Asrat; Choi, Beak-San; Abebe, Tamrat; Fuentes, Jose M.; Munder, Markus; Modolell, Manuel; Kropf, Pascale

    2008-01-01

    Background The leishmaniases are a group of vector-borne parasitic diseases that represent a major international public health problem; they belong to the most neglected tropical diseases and have one of the highest rates of morbidity and mortality. The clinical outcome of infection with Leishmania parasites depends on a variety of factors such as parasite species, vector-derived products, genetics, behaviour, and nutrition. The age of the infected individuals also appears to be critical, as a significant proportion of clinical cases occur in children; this age-related higher prevalence of disease is most remarkable in visceral leishmaniasis. The mechanisms resulting in this higher incidence of clinical disease in children are poorly understood. We have recently revealed that sustained arginase activity promotes uncontrolled parasite growth and pathology in vivo. Here, we tested the hypothesis that arginase-mediated L-arginine metabolism differs with age. Methodology The age distribution of patients with visceral or cutaneous leishmaniasis was determined in cohorts of patients in our clinics in endemic areas in Ethiopia. To exclude factors that are difficult to control in patients, we assessed the impact of ageing on the manifestations of experimental leishmaniasis. We determined parasite burden, T cell responses, and macrophage effector functions in young and aged mice during the course of infection. Results Our results show that younger mice develop exacerbated lesion pathology and higher parasite burdens than aged mice. This aggravated disease development in younger individuals does not correlate with a change in T helper cytokine profile. To address the underlying mechanisms responsible for the more severe infections in younger mice, we investigated macrophage effector functions. Our results show that macrophages from younger mice do not have an impaired capacity to kill parasites; however, they express significantly higher levels of arginase 1 than aged mice

  3. The impact of menopause on work ability in women with severe menopausal symptoms.

    PubMed

    Geukes, Marije; van Aalst, Mariëlle P; Robroek, Suzan J W; Laven, Joop S E; Oosterhof, Henk

    2016-08-01

    To measure the impact of menopause on work ability in women with severe menopausal symptoms. This cross-sectional study compared the work ability of a sample of otherwise healthy employed Dutch women (n=205) with that of a sample of first-time attendees of a menopause clinic (n=60); both groups were aged 44-60 years. Self-reported questionnaire data assessing work ability (Work Ability Index; WAI) and menopausal symptoms (Greene Climacteric Scale; GCS) were used. Logistic regression analyses were used to examine whether women with severe menopausal symptoms were more likely to have low work ability (defined as a score <37.0 points on the WAI) than were women in the reference group, after adjustment for individual and lifestyle factors. Symptomatic women had significantly higher total GCS scores (mean 26.7 vs 14.2, t=10.8, P<0.001) and significantly lower WAI scores (median 32.0 vs 40.0, U=2380, P<0.001) than the reference group. They were 8.4 times more likely to report low work ability than their healthy counterparts: 76.7% versus 30.2% (OR 8.4, 95% CI 4.1-17.2). Over three-quarters of symptomatic menopausal women report serious problems in dealing with the physical and mental demands of their work (recorded here as low work ability); hence these women might be at risk of prolonged sickness absence from work. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. Plant responses to increasing CO2 reduce estimates of climate impacts on drought severity.

    PubMed

    Swann, Abigail L S; Hoffman, Forrest M; Koven, Charles D; Randerson, James T

    2016-09-06

    Rising atmospheric CO2 will make Earth warmer, and many studies have inferred that this warming will cause droughts to become more widespread and severe. However, rising atmospheric CO2 also modifies stomatal conductance and plant water use, processes that are often are overlooked in impact analysis. We find that plant physiological responses to CO2 reduce predictions of future drought stress, and that this reduction is captured by using plant-centric rather than atmosphere-centric metrics from Earth system models (ESMs). The atmosphere-centric Palmer Drought Severity Index predicts future increases in drought stress for more than 70% of global land area. This area drops to 37% with the use of precipitation minus evapotranspiration (P-E), a measure that represents the water flux available to downstream ecosystems and humans. The two metrics yield consistent estimates of increasing stress in regions where precipitation decreases are more robust (southern North America, northeastern South America, and southern Europe). The metrics produce diverging estimates elsewhere, with P-E predicting decreasing stress across temperate Asia and central Africa. The differing sensitivity of drought metrics to radiative and physiological aspects of increasing CO2 partly explains the divergent estimates of future drought reported in recent studies. Further, use of ESM output in offline models may double-count plant feedbacks on relative humidity and other surface variables, leading to overestimates of future stress. The use of drought metrics that account for the response of plant transpiration to changing CO2, including direct use of P-E and soil moisture from ESMs, is needed to reduce uncertainties in future assessment.

  5. Plant responses to increasing CO2 reduce estimates of climate impacts on drought severity

    PubMed Central

    Koven, Charles D.; Randerson, James T.

    2016-01-01

    Rising atmospheric CO2 will make Earth warmer, and many studies have inferred that this warming will cause droughts to become more widespread and severe. However, rising atmospheric CO2 also modifies stomatal conductance and plant water use, processes that are often are overlooked in impact analysis. We find that plant physiological responses to CO2 reduce predictions of future drought stress, and that this reduction is captured by using plant-centric rather than atmosphere-centric metrics from Earth system models (ESMs). The atmosphere-centric Palmer Drought Severity Index predicts future increases in drought stress for more than 70% of global land area. This area drops to 37% with the use of precipitation minus evapotranspiration (P-E), a measure that represents the water flux available to downstream ecosystems and humans. The two metrics yield consistent estimates of increasing stress in regions where precipitation decreases are more robust (southern North America, northeastern South America, and southern Europe). The metrics produce diverging estimates elsewhere, with P-E predicting decreasing stress across temperate Asia and central Africa. The differing sensitivity of drought metrics to radiative and physiological aspects of increasing CO2 partly explains the divergent estimates of future drought reported in recent studies. Further, use of ESM output in offline models may double-count plant feedbacks on relative humidity and other surface variables, leading to overestimates of future stress. The use of drought metrics that account for the response of plant transpiration to changing CO2, including direct use of P-E and soil moisture from ESMs, is needed to reduce uncertainties in future assessment. PMID:27573831

  6. Plant responses to increasing CO2 reduce estimates of climate impacts on drought severity

    DOE PAGES

    Swann, Abigail L. S.; Hoffman, Forrest M.; Koven, Charles D.; ...

    2016-08-29

    Rising atmospheric CO2 will make Earth warmer, and many studies have inferred that this warming will cause droughts to become more widespread and severe. However, rising atmospheric CO2 also modifies stomatal conductance and plant water use, processes that are often are overlooked in impact analysis. We find that plant physiological responses to CO2 reduce predictions of future drought stress, and that this reduction is captured by using plant-centric rather than atmosphere-centric metrics from Earth system models (ESMs). The atmosphere-centric Palmer Drought Severity Index predicts future increases in drought stress for more than 70% of global land area. This area dropsmore » to 37% with the use of precipitation minus evapo-transpiration (P-E), a measure that represents the water flux available to downstream ecosystems and humans. The two metrics yield consistent estimates of increasing stress in regions where precipitation decreases are more robust (southern North America, northeastern South America, and southern Europe). The metrics produce diverging estimates elsewhere, with P-E predicting decreasing stress across temperate Asia and central Africa. The differing sensitivity of drought metrics to radiative and physiological aspects of increasing CO2 partly explains the divergent estimates of future drought reported in recent studies. Further, use of ESM output in offline models may double-count plant feedbacks on relative humidity and other surface variables, leading to overestimates of future stress. The use of drought metrics that account for the response of plant transpiration to changing CO2, including direct use of P-E and soil moisture from ESMs, is needed to reduce uncertainties in future assessment.« less

  7. Plant responses to increasing CO2 reduce estimates of climate impacts on drought severity

    NASA Astrophysics Data System (ADS)

    Swann, Abigail L. S.; Hoffman, Forrest M.; Koven, Charles D.; Randerson, James T.

    2016-09-01

    Rising atmospheric CO2 will make Earth warmer, and many studies have inferred that this warming will cause droughts to become more widespread and severe. However, rising atmospheric CO2 also modifies stomatal conductance and plant water use, processes that are often are overlooked in impact analysis. We find that plant physiological responses to CO2 reduce predictions of future drought stress, and that this reduction is captured by using plant-centric rather than atmosphere-centric metrics from Earth system models (ESMs). The atmosphere-centric Palmer Drought Severity Index predicts future increases in drought stress for more than 70% of global land area. This area drops to 37% with the use of precipitation minus evapotranspiration (P-E), a measure that represents the water flux available to downstream ecosystems and humans. The two metrics yield consistent estimates of increasing stress in regions where precipitation decreases are more robust (southern North America, northeastern South America, and southern Europe). The metrics produce diverging estimates elsewhere, with P-E predicting decreasing stress across temperate Asia and central Africa. The differing sensitivity of drought metrics to radiative and physiological aspects of increasing CO2 partly explains the divergent estimates of future drought reported in recent studies. Further, use of ESM output in offline models may double-count plant feedbacks on relative humidity and other surface variables, leading to overestimates of future stress. The use of drought metrics that account for the response of plant transpiration to changing CO2, including direct use of P-E and soil moisture from ESMs, is needed to reduce uncertainties in future assessment.

  8. Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury: Incidence and Impact on Outcome.

    PubMed

    Kowalski, Robert G; Haarbauer-Krupa, Juliet K; Bell, Jeneita M; Corrigan, John D; Hammond, Flora M; Torbey, Michel T; Hofmann, Melissa C; Dams-O'Connor, Kristen; Miller, A Cate; Whiteneck, Gale G

    2017-07-01

    Traumatic brain injury (TBI) leads to nearly 300 000 annual US hospitalizations and increased lifetime risk of acute ischemic stroke (AIS). Occurrence of AIS immediately after TBI has not been well characterized. We evaluated AIS acutely after TBI and its impact on outcome. A prospective database of moderate to severe TBI survivors, admitted to inpatient rehabilitation at 22 Traumatic Brain Injury Model Systems centers and their referring acute-care hospitals, was analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. Between October 1, 2007, and March 31, 2015, 6488 patients with TBI were enrolled in the Traumatic Brain Injury Model Systems National Database. One hundred and fifty-nine (2.5%) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score (95% confidence interval, -16.8 to -9.7; P<0.001), a 1.9-point increase in Disability Rating Scale (95% confidence interval, 1.3-2.5; P<0.001), and an 18.3-day increase in posttraumatic amnesia duration (95% confidence interval, 13.1-23.4; P<0.001). Ischemic stroke is observed acutely in 2.5% of moderate to severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events. © 2017 American Heart Association, Inc.

  9. Monitoring the Impacts of Severe Drought on Plant Species in Southern California Chaparral

    NASA Astrophysics Data System (ADS)

    Dennison, P. E.; Coates, A.; Roberts, D. A.; Roth, K. L.

    2015-12-01

    Airborne imaging spectrometer and thermal infrared image data acquired for the Hyperspectral Infrared Imager (HyspIRI) preparatory campaign were used to measure changes in green vegetation fraction and land surface temperature for twelve dominant plant species affected by drought in the Santa Barbara region of California. Relative green vegetation fraction was calculated from seasonally-acquired Airborne Visible Infrared Imaging Spectrometer (AVIRIS) data using pre-drought 2011 AVIRIS data as a baseline. Land surface temperature was retrieved from MODIS-ASTER Simulator (MASTER) data. Deeply rooted tree species, tree species found on more mesic north-facing slopes, and tree species found in riparian areas had the least change in relative green vegetation fraction in 2013 and 2014 (e.g. QUAG and UMCA in the figure below). Coastal sage scrub and chaparral shrub species demonstrated greater variability as well as a long-term decline in relative green vegetation fraction. Three Ceanothus species (CECU, CEME, and CESP in the figure below) had more severe reductions in relative green vegetation fraction in comparison to another common chaparral shrub species, Adenostoma fasciculatum (ADFA). Species formed clusters in the space defined by land surface temperature and relative green vegetation fraction. Declining relative green vegetation fraction corresponded with increasing land surface temperature. Combined, routine acquisition of imaging spectrometer and thermal infrared imagery should provide new opportunities for monitoring drought impacts on ecosystems.

  10. Prominent Human Health Impacts from Several Marine Microbes: History, Ecology, and Public Health Implications

    PubMed Central

    Bienfang, P. K.; DeFelice, S. V.; Laws, E. A.; Brand, L. E.; Bidigare, R. R.; Christensen, S.; Trapido-Rosenthal, H.; Hemscheidt, T. K.; McGillicuddy, D. J.; Anderson, D. M.; Solo-Gabriele, H. M.; Boehm, A. B.; Backer, L. C.

    2011-01-01

    This paper overviews several examples of important public health impacts by marine microbes and directs readers to the extensive literature germane to these maladies. These examples include three types of dinoflagellates (Gambierdiscus spp., Karenia brevis, and Alexandrium fundyense), BMAA-producing cyanobacteria, and infectious microbes. The dinoflagellates are responsible for ciguatera fish poisoning, neurotoxic shellfish poisoning, and paralytic shellfish poisoning, respectively, that have plagued coastal populations over time. Research interest on the potential for marine cyanobacteria to contribute BMAA into human food supplies has been derived by BMAA's discovery in cycad seeds and subsequent implication as the putative cause of amyotrophic lateral sclerosis/parkinsonism dementia complex among the Chamorro people of Guam. Recent UPLC/MS analyses indicate that recent reports that BMAA is prolifically distributed among marine cyanobacteria at high concentrations may be due to analyte misidentification in the analytical protocols being applied for BMAA. Common infectious microbes (including enterovirus, norovirus, Salmonella, Campylobacter, Shigella, Staphylococcus aureus, Cryptosporidium, and Giardia) cause gastrointestinal and skin-related illness. These microbes can be introduced from external human and animal sources, or they can be indigenous to the marine environment. PMID:20976073

  11. Disease severity and treatment in adolescent idiopathic scoliosis: the impact of race and economic status.

    PubMed

    Zavatsky, Joseph M; Peters, Austin J; Nahvi, Farzon A; Bharucha, Neil J; Trobisch, Per D; Kean, Kristin E; Richard, Sandra; Bucello, Yolanda; Valdevit, Antonio; Lonner, Baron S

    2015-05-01

    more limited access plans, irrespective of race (13.6 vs. 14.1, p<.05). There was no difference in Cobb angle at presentation by income or type of insurance. Curve magnitude and percentage of patients with curves in the surgical range were greater in black than in white patients. There was no difference in age on presentation or treatment offered across all racial groups. Black patients were more likely to have surgery as their initial treatment than white patients. While race did have an impact on disease severity in this single surgeon's practice, SES did not. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Successive Impacts Of The Earth by Several Halo CMEs From Active Region NOAA 652

    NASA Astrophysics Data System (ADS)

    Yousef, Shahinaz; El Nawawy, M. S.; El-Nazer, M.; Yousef, Mohamed

    Several Halo CMEs hit the Earth in the second half of July 2004. They were produced by the very large complex active region NOAA 652 (Yousef et al. 2005). For CME details consult the web (ftp://lasco6.nascom.nasa.gov/pub/lasco/status/LASCO_CME_List_004).

    We focus on the 26th -27th of July CME hit. This CME was associated with the long-duration M1 flare at 25/15:14. It made a very fast Sun to Earth transit-just over 31 hours (SGAS 27 July 2004). A greater than 10 MeV proton event began at 25/18:55. Solar wind speed remained elevated from 500 to over 700 km/s. A Severe Geomagnetic storm was observed and the aurora was seen as far as California.

    A strong shock impacted the ACE spacecraft at 26/22:28. A sudden impulse (SI) of 96 nT was observed on the Boulder magnetometer at 22:51. The IMF Bz component was turned negative (-18 nT). Generally speaking, according to de Pater and Lissauer (2001), since a strong CME disturbance in the solar wind is usually preceded by an interplanetary shock followed by an enhanced density and velocity, the field strength first increases when the disturbance hits the magnetosphere, inducing an increase in the ring current. Several hours(up to over 25 hrs) the field strength Dst decreases dramatically during the storm main phase which typically lasts for a day The main phase is caused by an increase in the ring current, resulting from an enhanced particle flow towards the Earth. It is well known that geomagnetic storms tend to occur when IMF is directed southward. Magnetic reconnection occurs between the negative IMF and the magnetosphere thus opens the field lines with one end connected to the Earth (Dungey 1963). This magnetic reconnection allowed the protons and electrons to leak in. The proton and electron flux maximums occurred around the time of geomagnetic storm commencement which lasted for about 27 h (fig. 1). This is in agreement with the statement of Robinson (2003) that large numbers of energetic protons are

  13. Fatigue behavior of Ti6Al4V and 316 LVM blasted with ceramic particles of interest for medical devices.

    PubMed

    Barriuso, S; Chao, J; Jiménez, J A; García, S; González-Carrasco, J L

    2014-02-01

    Grit blasting is used as a cost-effective method to increase the surface roughness of metallic biomaterials, as Ti6Al4V and 316 LVM, to enhance the osteointegration, fixation and stability of implants. Samples of these two alloys were blasted by using alumina and zirconia particles, yielding rough (up to Ra~8μm) and nearly smooth (up to Ra~1μm) surfaces, respectively. In this work, we investigate the sub-surface induced microstructural effects and its correlation with the mechanical properties, with special emphasis in the fatigue behavior. Blasting with zirconia particles increases the fatigue resistance whereas the opposite effect is observed using alumina ones. As in a conventional shot penning process, the use of rounded zirconia particles for blasting led to the development of residual compressive stresses at the surface layer, without zones of stress concentrators. Alumina particles are harder and have an angular shape, which confers a higher capability to abrade the surface, but also a high rate of breaking down on impact. The higher roughness and the presence of a high amount of embedded alumina particles make the blasted alloy prone to crack nucleation. Interestingly, the beneficial or detrimental role of blasting is more intense for the Ti6Al4V alloy than for the 316 steel. It is proposed that this behavior is related to their different strain hardening exponents and the higher mass fraction of particles contaminating the surface. The low value of this exponent for the Ti6Al4V alloy justifies the expected low sub-surface hardening during the severe plastic deformation, enhancing its capability to soft during cyclic loading.

  14. Modelling human eye under blast loading.

    PubMed

    Esposito, L; Clemente, C; Bonora, N; Rossi, T

    2015-01-01

    Primary blast injury (PBI) is the general term that refers to injuries resulting from the mere interaction of a blast wave with the body. Although few instances of primary ocular blast injury, without a concomitant secondary blast injury from debris, are documented, some experimental studies demonstrate its occurrence. In order to investigate PBI to the eye, a finite element model of the human eye using simple constitutive models was developed. The material parameters were calibrated by a multi-objective optimisation performed on available eye impact test data. The behaviour of the human eye and the dynamics of mechanisms occurring under PBI loading conditions were modelled. For the generation of the blast waves, different combinations of explosive (trinitrotoluene) mass charge and distance from the eye were analysed. An interpretation of the resulting pressure, based on the propagation and reflection of the waves inside the eye bulb and orbit, is proposed. The peculiar geometry of the bony orbit (similar to a frustum cone) can induce a resonance cavity effect and generate a pressure standing wave potentially hurtful for eye tissues.

  15. Experimental Studies of Mitigation Materials for Blast Induced Tbi

    NASA Astrophysics Data System (ADS)

    Alley, M. D.; Son, S. F.; Christou, G.; Goel, R.; Young, L.

    2009-12-01

    The objective of this experimental study is to compare the effects of various materials obstructing the flow of a blast wave and the ability of the material to reduce the damage caused by the blast. Several methods of energy transfer in blast wave flows are expected including: material interfaces with impedance mismatches, density changes in a given material, internal shearing, and particle fracture. Our hypothesis is that the greatest energy transfer within the obstructing material will yield the greatest mitigation effects to the blast. Sample configurations of foam were varied to introduce material interfaces and filler materials with varying densities and impedances (liquids and powders). The samples were dynamically loaded using a small scale blast produced by an explosive driven shock tube housing gram-scale explosive charges. The transmitted blast profiles were analyzed for variations in impulse characteristics and frequency components as compared to standard free field profiles. The results showed a rounding effect of the transmitted blast profile for all samples with the effects of the high density fillers surpassing all others tested. These results lead to a conclusion that low porosity, high density materials offer superior attenuation by reducing air blast features and spatially distributing the transmitted wave.

  16. Blast Loading Experiments of Surrogate Models for Tbi Scenarios

    NASA Astrophysics Data System (ADS)

    Alley, M. D.; Son, S. F.

    2009-12-01

    This study aims to characterize the interaction of explosive blast waves through simulated anatomical models. We have developed physical models and a systematic approach for testing traumatic brain injury (TBI) mechanisms and occurrences. A simplified series of models consisting of spherical PMMA shells housing synthetic gelatins as brain simulants have been utilized. A series of experiments was conducted to compare the sensitivity of the system response to mechanical properties of the simulants under high strain-rate explosive blasts. Small explosive charges were directed at the models to produce a realistic blast wave in a scaled laboratory test cell setting. Blast profiles were measured and analyzed to compare system response severity. High-speed shadowgraph imaging captured blast wave interaction with the head model while particle tracking captured internal response for displacement and strain correlation. The results suggest amplification of shock waves inside the head near material interfaces due to impedance mismatches. In addition, significant relative displacement was observed between the interacting materials suggesting large strain values of nearly 5%. Further quantitative results were obtained through shadowgraph imaging of the blasts confirming a separation of time scales between blast interaction and bulk movement. These results lead to the conclusion that primary blast effects could cause TBI occurrences.

  17. Lightweight blast shield

    DOEpatents

    Mixon, Larry C.; Snyder, George W.; Hill, Scott D.; Johnson, Gregory L.; Wlodarski, J. Frank; von Spakovsky, Alexis P.; Emerson, John D.; Cole, James M.; Tipton, John P.

    1991-01-01

    A tandem warhead missile arrangement that has a composite material housing structure with a first warhead mounted at one end and a second warhead mounted near another end of the composite structure with a dome shaped composite material blast shield mounted between the warheads to protect the second warhead from the blast of the first warhead.

  18. Differences in post-injury auditory system pathophysiology after mild blast and non-blast acute acoustic trauma.

    PubMed

    Race, Nicholas; Lai, Jesyin; Shi, Riyi; Bartlett, Edward L

    2017-03-08

    Hearing difficulties are the most commonly reported disabilities among veterans. Blast exposures during explosive events likely play a role, given their propensity to directly damage both peripheral (PAS) and central (CAS) auditory system components. Post-blast PAS pathophysiology has been well-documented in both clinical case reports and laboratory investigations. In contrast, blast-induced CAS dysfunction remains under-studied, but has been hypothesized to contribute to an array of common veteran behavioral complaints including learning, memory, communication, and emotional regulation. This investigation compared the effects of acute blast and non-blast acoustic impulse trauma in adult male Sprague-Dawley rats. An array of audiometric tests were utilized, including distortion product otoacoustic emissions (DPOAE), auditory brainstem responses (ABR), middle latency responses (MLR), and envelope following responses (EFR). Generally, more severe and persistent post-injury central auditory processing (CAP) deficits were observed in blast-exposed animals throughout the auditory neuraxis, spanning from the cochlea to the cortex. DPOAE and ABR results captured cochlear and auditory nerve/brainstem deficits, respectively. EFRs demonstrated temporal processing impairments suggestive of functional damage to regions in the auditory brainstem and the inferior colliculus. MLRs captured thalamocortical transmission and cortical activation impairments. Taken together, the results suggest blast-induced CAS dysfunction may play a complementary pathophysiologic role to maladaptive neuroplasticity of PAS origin. Even mild blasts can produce lasting hearing impairments that can be assessed with non-invasive electrophysiology, allowing these measurements to serve as simple, effective diagnostics.

  19. Impacts of the 2014 severe drought on the Microcystis bloom in San Francisco Estuary.

    PubMed

    Lehman, P W; Kurobe, T; Lesmeister, S; Baxa, D; Tung, A; Teh, S J

    2017-03-01

    The increased frequency and intensity of drought with climate change may cause an increase in the magnitude and toxicity of freshwater cyanobacteria harmful algal blooms (CHABs), including Microcystis blooms, in San Francisco Estuary, California. As the fourth driest year on record in San Francisco Estuary, the 2014 drought provided an opportunity to directly test the impact of severe drought on cyanobacteria blooms in SFE. A field sampling program was conducted between July and December 2014 to sample a suite of physical, chemical, and biological variables at 10 stations in the freshwater and brackish reaches of the estuary. The 2014 Microcystis bloom had the highest biomass and toxin concentration, earliest initiation, and the longest duration, since the blooms began in 1999. Median chlorophyll a concentration increased by 9 and 12 times over previous dry and wet years, respectively. Total microcystin concentration also exceeded that in previous dry and wet years by a factor of 11 and 65, respectively. Cell abundance determined by quantitative PCR indicated the bloom contained multiple potentially toxic cyanobacteria species, toxic Microcystis and relatively high total cyanobacteria abundance. The bloom was associated with extreme nutrient concentrations, including a 20-year high in soluble reactive phosphorus concentration and low to below detection levels of ammonium. Stable isotope analysis suggested the bloom varied with both inorganic and organic nutrient concentration, and used ammonium as the primary nitrogen source. Water temperature was a primary controlling factor for the bloom and was positively correlated with the increase in both total and toxic Microcystis abundance. In addition, the early initiation and persistence of warm water temperature coincided with the increased intensity and duration of the Microcystis bloom from the usual 3 to 4 months to 8 months. Long residence time was also a primary factor controlling the magnitude and persistence of

  20. Aggressive surgical interventions for severe stroke: Impact on quality of life, caregiver burden and family outcomes.

    PubMed

    Green, Theresa; Demchuk, Andrew; Newcommon, Nancy

    2015-01-01

    Decompressive hemicraniectomy, clot evacuation, and aneurysmal interventions are considered aggressive surgical therapeutic options for treatment of massive cerebral artery infarction (MCA), intracerebral hemorrhage (ICH), and severe subarachnoid hemorrhage (SAH) respectively. Although these procedures are saving lives, little is actually known about the impact on outcomes other than short-term survival and functional status. The purpose of this study was to gain a better understanding of personal and social consequences of surviving these aggressive surgical interventions in order to aid acute care clinicians in helping family members make difficult decisions about undertaking such interventions. An exploratory mixed method study using a convergent parallel design was conducted to examine functional recovery (NIHSS, mRS & BI), cognitive status (Montreal Cognitive Assessment Scale, MoCA), quality of life (Euroqol 5-D), and caregiver outcomes (Bakas Caregiver Outcome Scale, BCOS) in a cohort of patients and families who had undergone aggressive surgical intervention for severe stroke between the years 2000-2007 Data were analyzed using descriptive statistics, univariate and multivariate analysis of variance, and multivariate logistic regression. Content analysis was used to analyze the qualitative interviews conducted with stroke survivors and family members. Twenty-seven patients and 13 spouses participated in this study. Based on patient MOCA scores, overall cognitive status was 25.18 (range 23.4-26.9); current functional outcomes scores: NIHSS 2.22, mRS 1.74, and BI 88.5. EQ-5D scores revealed no significant differences between patients and caregivers (p = 0.585) and caregiver outcomes revealed no significant diferences between male/female caregivers or patient diagnostic group (MCA, SAH, ICH; p = 0.103). Overall, patients and families were satisfied with quality of life and decisions made at the time of the initial stroke. There was consensus among study

  1. Dusty Blast Wave in Cassiopeia A

    NASA Astrophysics Data System (ADS)

    Borkowski, Kazimierz J.; Williams, B. J.; Reynolds, S. P.

    2006-09-01

    The Spitzer Space Telescope has revealed infrared emission from dust in the blast wave of the youngest Galactic supernova remnant Cas A. This fast 6000 km/s blast wave is sweeping up circumstellar material expelled by the Cas A supernova progenitor prior to its explosion, presumably in a slow and dense wind in its final red supergiant (RSG) evolutionary stage. Dust in the blast wave was detected through imaging at 24 and 70 microns with the Multiband Imaging Photometer for Spitzer (MIPS). We use a collisionally-heated dust model to interpret these MIPS observations. In this model, silicate grains are heated and destroyed in collisions with fast thermal electrons and ions in the blast wave. We consider a wide range in grain radii in the preshock gas, from 0.001 to 0.25 microns, with grains distributed as a power law in radius with an index of -3.5. We measured MIPS fluxes and their ratios in several regions in the north and south, and derived dust masses and plasma densities by comparing them with the dust models. The dust masses are 0.0001 solar masses in the south and several times higher in the north, while estimated electron densities range from 3 per cc in the south up to 20 per cc in the north. In order to estimate dust/gas mass ratios, we also examined Chandra X-ray spectra of the blast wave. We modeled them successfully with a combination of a thermal plane shock and a nonthermal synchrotron "srcut" model. The estimated gas masses are about 1000 times larger than dust masses. Our inferred dust content implies large depletions of several refractory elements onto dust grains in the stellar outflow of the Cas A RSG progenitor. We discuss how such depletions affect X-ray spectra produced within the dusty blast wave of Cas A.

  2. Impact of an outbreak of severe acute respiratory syndrome on a hospital in Taiwan, ROC

    PubMed Central

    Tsai, M; Arnold, J; Chuang, C; Chi, C; Liu, C; Yang, Y

    2004-01-01

    Study objective: To estimate the impact of the severe acute respiratory syndrome (SARS) outbreak in early 2003 on a tertiary care hospital in Taiwan, ROC. Methods: The study estimated the utilisation of resources related to infection control, SARS related medical services, and routine medical services, and SARS related medical outcomes at National Cheng Kung University Hospital (NCKUH) from 25 March to 16 June 2003 through a cross sectional survey of hospital records. Results: A mean of 5100 persons per day (95%CI 4580 to 5610) underwent fever screening at the outpatient and emergency department (ED) entrances to the hospital, of which 35 per day (95% CI 30 to 40) were referred for further evaluation for suspected or probable SARS. ED isolation surge capacity was created via 12 new beds outside the ED: eight for SARS assessment, three for patients awaiting inhospital bed assignment, and one for resuscitation. A total of 382 patients were fully evaluated for suspected or probable SARS outside the ED, of which 27 were admitted. The mean numbers of outpatient clinic patient visits, ED visits, ED trauma patient visits, ED admissions, hospital admissions, and operative procedures decreased during the outbreak. Thirty eight patients were hospitalised with suspected SARS, of which three received the final diagnosis of probable SARS. Two patients with probable SARS died. No cases of nosocomial SARS transmission occurred. Conclusions: This SARS outbreak was associated with substantial use of hospital and ED resources aimed at infection control, comparatively less use of resources related to the medical care of patients with suspected or probable SARS, and decreased use of routine medical services. PMID:15107369

  3. Haemoglobin responses to transfusion in severe iron deficiency anaemia: potential impact of gastrointestinal disorders.

    PubMed

    Bosch, X; Montori, E; Guerra-García, M; Costa-Rodríguez, J; Quintanilla, M H; Tolosa-Chapasian, P E; Moreno, P; Guasch, N; López-Soto, A

    2017-04-01

    Red blood cell (RBC) transfusion may be justified in iron deficiency anaemia (IDA) when an increase in oxygen delivery is needed, as sometimes occurs in subjects with haemoglobin <8·0 mg/dL, serious comorbidities or at risk of cardiovascular instability. Earlier investigations showed that some patients with severe IDA requiring transfusion had lower than expected post-transfusion haemoglobin levels with poorer clinical outcomes than other patients. After hypothesizing that haemoglobin responses to transfusion were different and that the underlying gastrointestinal (GI) disorders causing IDA could be a confounder explaining this association, these responses were analysed in a prospective cohort of IDA adults referred for outpatient GI investigation. Transfused patients with proven IDA, baseline haemoglobin at referral <9·0 g/dL and no extraintestinal bleeding were eligible. To assess a homogeneous population, only GI disorders known to cause occult bleeding were considered. Haemoglobin increments per 100 mL of RBCs were investigated. In total, 2818 patients were enrolled over 10·5 years. On multivariable regression, diffuse angiodysplasias and GI cancer independently predicted for reduced increments in post-transfusion haemoglobin [adjusted regression coefficients: -0·082 (95% confidence interval, -0·093 to -0·072) and -0·073 (95% confidence interval, -0·081 to -0·066), respectively, P < 0·001 in both]. Haemoglobin responses in the remaining bleeding disorders were adequate and agreed with the principle that one RBC unit increases the haemoglobin an average of 1 g/dL. The potential differential impact of GI disorders on changes in haemoglobin levels after RBC transfusion could be useful for transfusing physicians, especially for diagnostic purposes. © 2017 International Society of Blood Transfusion.

  4. Genetic predisposition in NAFLD and NASH: impact on severity of liver disease and response to treatment.

    PubMed

    Dongiovanni, Paola; Anstee, Quentin M; Valenti, Luca

    2013-01-01

    Liver fat deposition related to systemic insulin resistance defines non-alcoholic fatty liver disease (NAFLD) which, when associated with oxidative hepatocellular damage, inflammation, and activation of fibrogenesis, i.e. non-alcoholic steatohepatitis (NASH), can progress towards cirrhosis and hepatocellular carcinoma. Due to the epidemic of obesity, NAFLD is now the most frequent liver disease and the leading cause of altered liver enzymes in Western countries. Epidemiological, familial, and twin studies provide evidence for an element of heritability of NAFLD. Genetic modifiers of disease severity and progression have been identified through genome-wide association studies. These include the Patatin-like phosholipase domain-containing 3 (PNPLA3) gene variant I148M as a major determinant of inter-individual and ethnicity-related differences in hepatic fat content independent of insulin resistance and serum lipid concentration. Association studies confirm that the I148M polymorphism is also a strong modifier of NASH and progressive hepatic injury. Furthermore, a few large multicentre case-control studies have demonstrated a role for genetic variants implicated in insulin signalling, oxidative stress, and fibrogenesis in the progression of NAFLD towards fibrosing NASH, and confirm that hepatocellular fat accumulation and insulin resistance are key operative mechanisms closely involved in the progression of liver damage. It is now important to explore the molecular mechanisms underlying these associations between gene variants and progressive liver disease, and to evaluate their impact on the response to available therapies. It is hoped that this knowledge will offer further insights into pathogenesis, suggest novel therapeutic targets, and could help guide physicians towards individualised therapy that improves clinical outcome.

  5. Impact of Stress-Induced Diabetes on Outcomes in Severely Burned Children

    PubMed Central

    Finnerty, Celeste C.; Ali, Arham; McClean, Josef; Benjamin, Nicole; Clayton, Robert P.; Andersen, Clark R.; Mlcak, Ronald P.; Suman, Oscar E.; Meyer, Walter; Herndon, David N.

    2014-01-01

    Background Post-burn hyperglycemia leads to graft failure, multiple organ failure, and death. A hyperinsulinemic-euglycemic clamp is used to keep serum glucose between 60-110mg/dL. Because of frequent hypoglycemic episodes, a less stringent sliding scale insulin protocol is used to maintain serum glucose levels between 80-160mg/dL following elevations above 180mg/dL. Study Design We randomized pediatric patients with massive burns into two groups – patients receiving sliding scale insulin to lower blood glucose levels (n=145) and those receiving no insulin (n = 98) to determine the differences in morbidity and mortality. Patients 0-18 years old with burns covering ≥30% of the total body surface area and not randomized to receive anabolic agents were included in this study. Endpoints included glucose levels, infections, resting energy expenditure (REE), lean body mass, bone mineral content (BMC), fat mass, muscle strength, and serum inflammatory cytokines, hormones, and liver enzymes. Results Maximal glucose levels occurred within 6 days of burn injury. Blood glucose levels were age dependent with older children requiring more insulin, p<0.05. Daily maximum and daily minimum, but not 6am,glucose levels were significantly different based on treatment group, p<0.05. Insulin significantly increased REE and improved BMC, p<0.05. Each additional wound infection increased incidence of hyperglycemia, p=0.004. There was no mortality in patients not receiving insulin, only in patients who received insulin (p<0.004). Muscle strength was increased in patients receiving insulin (p<0.05). Conclusions A subset of severely burned children develops burn-induced hyperglycemia. Length of stay was reduced in the no insulin group, and there were no deaths in this group. Administration of insulin positively impacted BMC and muscle strength, but increased REE, hypoglycemic episodes, and mortality. New glucose-lowering strategies may be needed. PMID:24655871

  6. Seismic safety in conducting large-scale blasts

    NASA Astrophysics Data System (ADS)

    Mashukov, I. V.; Chaplygin, V. V.; Domanov, V. P.; Semin, A. A.; Klimkin, M. A.

    2017-09-01

    In mining enterprises to prepare hard rocks for excavation a drilling and blasting method is used. With the approach of mining operations to settlements the negative effect of large-scale blasts increases. To assess the level of seismic impact of large-scale blasts the scientific staff of Siberian State Industrial University carried out expertise for coal mines and iron ore enterprises. Determination of the magnitude of surface seismic vibrations caused by mass explosions was performed using seismic receivers, an analog-digital converter with recording on a laptop. The registration results of surface seismic vibrations during production of more than 280 large-scale blasts at 17 mining enterprises in 22 settlements are presented. The maximum velocity values of the Earth’s surface vibrations are determined. The safety evaluation of seismic effect was carried out according to the permissible value of vibration velocity. For cases with exceedance of permissible values recommendations were developed to reduce the level of seismic impact.

  7. Blasting response of the Eiffel Tower

    NASA Astrophysics Data System (ADS)

    Horlyck, Lachlan; Hayes, Kieran; Caetano, Ryan; Tahmasebinia, Faham; Ansourian, Peter; Alonso-Marroquin, Fernando

    2016-08-01

    A finite element model of the Eiffel Tower was constructed using Strand7 software. The model replicates the existing tower, with dimensions justified through the use of original design drawings. A static and dynamic analysis was conducted to determine the actions of the tower under permanent, imposed and wind loadings, as well as under blast pressure loads and earthquake loads due to an explosion. It was observed that the tower utilises the full axial capacity of individual members by acting as a `truss of trusses'. As such, permanent and imposed loads are efficiently transferred to the primary columns through compression, while wind loads induce tensile forces in the windward legs and compressive forces in the leeward. Under blast loading, the tower experienced both ground vibrations and blast pressures. Ground vibrations induced a negligibly small earthquake loading into the structure which was ignored in subsequent analyses. The blast pressure was significant, and a dynamic analysis of this revealed that further research is required into the damping qualities of the structure due to soil and mechanical properties. In the worst case scenario, the blast was assumed to completely destroy several members in the adjacent leg. Despite this weakened condition, it was observed that the tower would still be able to sustain static loads, at least for enough time for occupant evacuation. Further, an optimised design revealed the structure was structurally sound under a 46% reduction of the metal tower's mass.

  8. Shape Optimization of Plates to Mitigate the Effects of Air Blast Loading

    DTIC Science & Technology

    2009-06-21

    has been given to analysis of metallic and composite panels, subject to both blast and ballistic loads. Regarding designing for impact mitigation...water. Yen, Skaags and Cheeseman [5] present an experimentally validated dynamic analysis procedure utilizing Ls- Dyna and the ConWep air blast function...orientations in a laminated composite to absorb energy while maintaining stiffness. Further details on effectiveness of blast mitigation solutions in a

  9. Numerical Study of the Reduction Process in an Oxygen Blast Furnace

    NASA Astrophysics Data System (ADS)

    Zhang, Zongliang; Meng, Jiale; Guo, Lei; Guo, Zhancheng

    2016-02-01

    Based on computational fluid dynamics, chemical reaction kinetics, principles of transfer in metallurgy, and other principles, a multi-fluid model for a traditional blast furnace was established. The furnace conditions were simulated with this multi-fluid mathematical model, and the model was verified with the comparison of calculation and measurement. Then a multi-fluid model for an oxygen blast furnace in the gasifier-full oxygen blast furnace process was established based on this traditional blast furnace model. With the established multi-fluid model for an oxygen blast furnace, the basic characteristics of iron ore reduction process in the oxygen blast furnace were summarized, including the changing process of the iron ore reduction degree and the compositions of the burden, etc. The study found that compared to the traditional blast furnace, the magnetite reserve zone in the furnace shaft under oxygen blast furnace condition was significantly reduced, which is conducive to the efficient operation of blast furnace. In order to optimize the oxygen blast furnace design and operating parameters, the iron ore reduction process in the oxygen blast furnace was researched under different shaft tuyere positions, different recycling gas temperatures, and different allocation ratios of recycling gas between the hearth tuyere and the shaft tuyere. The results indicate that these three factors all have a substantial impact on the ore reduction process in the oxygen blast furnace. Moderate shaft tuyere position, high recycling gas temperature, and high recycling gas allocation ratio between hearth and shaft could significantly promote the reduction of iron ore, reduce the scope of the magnetite reserve zone, and improve the performance of oxygen blast furnace. Based on the above findings, the recommendations for improvement of the oxygen blast furnace design and operation were proposed.

  10. Paint removal using wheat starch blast media

    NASA Astrophysics Data System (ADS)

    Foster, Terry; Oestreich, John

    1993-03-01

    A review of the Wheat Starch Blasting technology is presented. Laboratory evaluations covering Almen Arc testing on bare 2024-T3 aluminum and magnesium, as well as crack detection on 7075-T6 bare aluminum, are discussed. Comparisons with Type V plastic media show lower residual stresses are achieved on aluminum and magnesium with wheat starch media. Dry blasting effects on the detection of cracks confirms better crack visibility with wheat starch media versus Type V or Type II plastic media. Testing of wheat starch media in several composite test programs, including fiberglass, Kevlar, and graphite-epoxy composites, showed no fiber damage. Process developments and production experience at the first U.S. aircraft stripping facility are also reviewed. Corporate and regional aircraft are being stripped in this three nozzle dry blast hanger.

  11. The impact-acceleration model of head injury: injury severity predicts motor and cognitive performance after trauma.

    PubMed

    Beaumont, A; Marmarou, A; Czigner, A; Yamamoto, M; Demetriadou, K; Shirotani, T; Marmarou, C; Dunbar, J

    1999-12-01

    This study examines neuropsychological dysfunction after varying severities of the Impact Acceleration Model of diffuse traumatic brain injury. Adult rats (340 g-400 g) were divided into five groups, and exposed to varying degrees of Impact Acceleration Injury (1 m, 2 m, 2.1 m/500 g and second insult). After injury, animals were allowed to recover; acute neurological reflexes, beam walk score, beam balance score, inclined plane score, and Morris Water Maze score were then assessed at multiple time points. Injury of all severities caused significant motor and cognitive deficits. With milder injuries these effects were transient; however, with more severe injuries no recovery in function was seen. The addition of hypoxia and hypotension made a moderate injury worse than a severe injury. The acute neurological reflexes, the beam balance test and the inclined plane test distinguished between the more severely injured groups, but were affected less by mild injury. The beam walk test was sensitive to mild injury, but appeared unable to distinguish between the severe groups. The Morris Water Maze was sensitive for all injury groups, but appeared to adopt a different response profile with secondary insult. This study has for the first time characterized the degree of motor and cognitive deficits in rodents exposed to differing severities of Impact Acceleration Injury. These data confirm that the tests considered, and the Injury Model used, provide a useful system for the consideration of potential therapies which might ameliorate neuropsychological deficits in diffuse brain injury.

  12. Rapid Release of Tissue Enzymes into Blood after Blast Exposure: Potential Use as Biological Dosimeters

    PubMed Central

    Arun, Peethambaran; Oguntayo, Samuel; Alamneh, Yonas; Honnold, Cary; Wang, Ying; Valiyaveettil, Manojkumar; Long, Joseph B.; Nambiar, Madhusoodana P.

    2012-01-01

    Explosive blast results in multiple organ injury and polytrauma, the intensity of which varies with the nature of the exposure, orientation, environment and individual resilience. Blast overpressure alone may not precisely indicate the level of body or brain injury after blast exposure. Assessment of the extent of body injury after blast exposure is important, since polytrauma and systemic factors significantly contribute to blast-induced traumatic brain injury. We evaluated the activity of plasma enzymes including aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatine kinase (CK) at different time points after blast exposure using a mouse model of single and repeated blast exposures to assess the severity of injury. Our data show that activities of all the enzymes in the plasma were significantly increased as early as 1 h after blast exposure. The elevated enzyme activity remained up to 6 h in an overpressure dose-dependent manner and returned close to normal levels at 24 h. Head-only blast exposure with body protection showed no increase in the enzyme activities suggesting that brain injury alone does not contribute to the systemic increase. In contrast to plasma increase, AST, ALT and LDH activity in the liver and CK in the skeletal muscle showed drastic decrease at 6 h after blast exposures. Histopathology showed mild necrosis at 6 h and severe necrosis at 24 h after blast exposures in liver and no changes in the skeletal muscle suggesting that the enzyme release from the tissue to plasma is probably triggered by transient cell membrane disruption from shockwave and not due to necrosis. Overpressure dependent transient release of tissue enzymes and elevation in the plasma after blast exposure suggest that elevated enzyme activities in the blood can be potentially used as a biological dosimeter to assess the severity of blast injury. PMID:22493674

  13. The impact of several craniotomies on transcranial motor evoked potential monitoring during neurosurgery.

    PubMed

    Tomio, Ryosuke; Akiyama, Takenori; Toda, Masahiro; Ohira, Takayuki; Yoshida, Kazunari

    2017-09-01

    OBJECTIVE Transcranial motor evoked potential (tMEP) monitoring is popular in neurosurgery; however, the accuracy of tMEP can be impaired by craniotomy. Each craniotomy procedure and changes in the CSF levels affects the current spread. The aim of this study was to investigate the influence of several craniotomies on tMEP monitoring by using C3-4 transcranial electrical stimulation (TES). METHODS The authors used the finite element method to visualize the electric field in the brain, which was generated by TES, using realistic 3D head models developed from T1-weighted MR images. Surfaces of 5 layers of the head (brain, CSF, skull, subcutaneous fat, and skin layer) were separated as accurately as possible. The authors created 5 models of the head, as follows: normal head; frontotemporal craniotomy; parietal craniotomy; temporal craniotomy; and occipital craniotomy. The computer simulation was investigated by finite element methods, and clinical recordings of the stimulation threshold level of upper-extremity tMEP (UE-tMEP) during neurosurgery were also studied in 30 patients to validate the simulation study. RESULTS Bone removal during the craniotomy positively affected the generation of the electric field in the motor cortex if the motor cortex was just under the bone at the margin of the craniotomy window. This finding from the authors' simulation study was consistent with clinical reports of frontotemporal craniotomy cases. A major decrease in CSF levels during an operation had a significantly negative impact on the electric field when the motor cortex was exposed to air. The CSF surface level during neurosurgery depends on the body position and location of the craniotomy. The parietal craniotomy and temporal craniotomy were susceptible to the effect of the changing CSF level, based on the simulation study. A marked increase in the threshold following a decrease in CSF was actually recorded in clinical reports of the UE-tMEP threshold from a temporal craniotomy

  14. Use of the Impact on Family Scale in Children with Tic Disorders: Descriptive Data, Validity, and Tic Severity Impact

    ERIC Educational Resources Information Center

    Woods, Douglas W.; Himle, Michael B.; Osmon, David C.

    2005-01-01

    Individuals with tic disorders are at risk for experiencing functional impairment in a variety of domains. However, the impact of tic disorders on family functioning remains unclear partly because psychometrically sound assessment instruments with normative data from a tic disorder population do not exist. The current study provides preliminary…

  15. Use of the Impact on Family Scale in Children with Tic Disorders: Descriptive Data, Validity, and Tic Severity Impact

    ERIC Educational Resources Information Center

    Woods, Douglas W.; Himle, Michael B.; Osmon, David C.

    2005-01-01

    Individuals with tic disorders are at risk for experiencing functional impairment in a variety of domains. However, the impact of tic disorders on family functioning remains unclear partly because psychometrically sound assessment instruments with normative data from a tic disorder population do not exist. The current study provides preliminary…

  16. Moderate blast exposure results in increased IL-6 and TNFα in peripheral blood.

    PubMed

    Gill, Jessica; Motamedi, Vida; Osier, Nicole; Dell, Kristine; Arcurio, Lindsay; Carr, Walter; Walker, Peter; Ahlers, Stephen; LoPresti, Mathew; Yarnell, Angela

    2017-10-01

    A unique cohort of military personnel exposed to isolated blast was studied to explore acute peripheral cytokine levels, with the aim of identifying blast-specific biomarkers. Several cytokines, including interleukin (IL) 6, IL-10 and tumor necrosis factor alpha (TNFα) have been linked to pre-clinical blast exposure, but remained unstudied in clinical blast exposure. To address this gap, blood samples from 62 military personnel were obtained at baseline, and daily, during a 10-day blast-related training program; changes in the peripheral concentrations of IL-6, IL-10 and TNFα were evaluated using an ultrasensitive assay. Two groups of trainees were matched on age, duration of military service, and previous history of blast exposure(s), resulting in moderate blast cases and no/low blast controls. Blast exposures were measured using helmet sensors that determined the average peak pressure in pounds per square inch (psi). Moderate blast cases had significantly elevated concentrations of IL-6 (F1,60=18.81, p<0.01) and TNFα (F1,60=12.03, p<0.01) compared to no/low blast controls; levels rebounded to baseline levels the day after blast. On the day of the moderate blast exposure, the extent of the overpressure (psi) in those exposed correlated with IL-6 (r=0.46, p<0.05) concentrations. These findings indicate that moderate primary blast exposure results in changes, specifically acute and transient increases in peripheral inflammatory markers which may have implications for neuronal health. Published by Elsevier Inc.

  17. [The impact exerted by the severity of recreational drug abuse on the different components of the executive function].

    PubMed

    Verdejo, A; Orozco-Giménez, C; Meersmans Sánchez-Jofré, M; Aguilar de Arcos, F; Pérez-García, M

    A number of neuropsychological studies have shown the relationship between severity of drug abuse and the executive functioning of substance abusers, along with its negative impact on treatment results. The aim of this study is to examine the relationship between severity of consumption of alcohol, cannabis, cocaine, heroin, amphetamines and ecstasy on the executive processes of fluency, working memory, response inhibition, concept formation and decision-making. Forty poly-substance abusers participated in this study. In a series of setwise regression analyses we introduced the standardized scores of a severity index as predictor variables, and the raw scores of five indexes sensitive to executive functioning as dependent variables: the Ruff Figural Fluency Test (RFFT), the Letter Number Sequencing subtest (LyN), the 5 Digit Test (5DT), the Category Test (TC) and the Gambling Task (GT). Best subsets of predictors for each dependent variable were included in multiple regression models. We obtained significant relationships between severity of heroin and ecstasy abuse and RFFT performance; between severity of alcohol, cocaine, heroin and amphetamines and LyN performance; between severity of alcohol, cannabis, cocaine, heroin and ecstasy and 5DT performance; and between severity of heroin and amphetamines and TC performance. These results show the significant influence of severity of drug abuse on executive impairment, which may have a negative impact on treatment results.

  18. Laboratory Validation of Two Wearable Sensor Systems for Measuring Head Impact Severity in Football Players.

    PubMed

    Siegmund, Gunter P; Guskiewicz, Kevin M; Marshall, Stephen W; DeMarco, Alyssa L; Bonin, Stephanie J

    2016-04-01

    Wearable sensors can measure head impact frequency and magnitude in football players. Our goal was to quantify the impact detection rate and validity of the direction and peak kinematics of two wearable sensors: a helmet system (HITS) and a mouthguard system (X2). Using a linear impactor, modified Hybrid-III headform and one helmet model, we conducted 16 impacts for each system at 12 helmet sites and 5 speeds (3.6-11.2 m/s) (N = 896 tests). Peak linear and angular accelerations (PLA, PAA), head injury criteria (HIC) and impact directions from each device were compared to reference sensors in the headform. Both sensors detected ~96% of impacts. Median angular errors for impact directions were 34° for HITS and 16° for X2. PLA, PAA and HIC were simultaneously valid at 2 sites for HITS (side, oblique) and one site for X2 (side). At least one kinematic parameter was valid at 2 and 7 other sites for HITS and X2 respectively. Median relative errors for PLA were 7% for HITS and -7% for X2. Although sensor validity may differ for other helmets and headforms, our analyses show that data generated by these two sensors need careful interpretation.

  19. Impact of the lateral blast on the spatial pattern and grain size characteristics of the 18 May 1980 Mount St. Helens fallout deposit

    NASA Astrophysics Data System (ADS)

    Eychenne, Julia; Cashman, Katharine; Rust, Alison; Durant, Adam

    2015-09-01

    The 18 May 1980 eruption of Mount St. Helens started with a lateral blast that fed a pyroclastic surge, which then uplifted to form a co-blast plume. Thirty minutes later, Plinian activity started at the vent and fluctuated in intensity for ~9 h. The resulting fallout deposit, documented to > 600 km from vent, presents some striking features: (1) displacement of the overall deposit to the north of the vent, (2) a secondary thickness and mass maximum at ~300 km from vent, (3) a total grain size distribution dominated by fine ash (62 wt % of the deposit < 63 µm), and (4) individual grain size distributions that vary dramatically in the crosswind direction from strongly bimodal in the south to skewed unimodal in the north. Results from a new deconvolution of the individual grain size distributions show that they are a combination of a coarse subpopulation that decreases in size with distance from vent and a constant fine subpopulation with a mean of ˜15 µm. Relative proportions of each subpopulation vary asymmetrically in the crosswind directions, with the fine subpopulation preponderant toward the north and the coarse one dominating the south of the deposit, both reach their absolute maxima in mass on the deposit axis. Componentry analyses of selected samples show that blast-derived material is greatly enriched toward the north of the deposit. These results indicate that the co-blast plume dispersed fine-grained material over great distances and dominated the fine subpopulation. Comparison with reanalysis data of atmospheric wind fields and satellite images of the spreading ash cloud suggests contrasting ash transport and depositional processes for the (early) co-blast plume and the (later) vent-derived Plinian plumes. The co-blast plume is displaced to the north; it had a high overshoot height, and eastward dispersion via strong winds low in the stratosphere (~10-15 km). The Plinian plumes were lower and dispersed most of the material to the southeast as the

  20. The Impact of Child Symptom Severity on Stress among Parents of Children with ASD: The Moderating Role of Coping Styles

    ERIC Educational Resources Information Center

    Lyons, Amy M.; Leon, Scott C.; Roecker Phelps, Carolyn E.; Dunleavy, Alison M.

    2010-01-01

    We examined the impact of autism severity and parental coping strategies on stress in parents of children with ASD. Children's autism symptoms and parental coping strategies (task-oriented, emotion-oriented, social diversion, and distraction) were evaluated as predictors of four types of parental stress (parent and family problems, pessimism,…

  1. The Impact of Child Symptom Severity on Stress among Parents of Children with ASD: The Moderating Role of Coping Styles

    ERIC Educational Resources Information Center

    Lyons, Amy M.; Leon, Scott C.; Roecker Phelps, Carolyn E.; Dunleavy, Alison M.

    2010-01-01

    We examined the impact of autism severity and parental coping strategies on stress in parents of children with ASD. Children's autism symptoms and parental coping strategies (task-oriented, emotion-oriented, social diversion, and distraction) were evaluated as predictors of four types of parental stress (parent and family problems, pessimism,…

  2. Restoration of shortleaf pine (Pinus echinata) - hardwood ecosystems severely impacted by the southern pine beetle (Dendroctonus frontalis)

    Treesearch

    Katherine J. Elliott; James M. Vose; Jennifer D. Knoepp; Barton D. Clinton

    2012-01-01

    In the Southern Appalachian Mountains of eastern USA, pine-hardwood ecosystems have been severely impacted by the interactions of past land use, fire exclusion, drought, and southern pine beetle (SPB, Dendroctonus frontalis). We examined the effects of restoration treatments: burn only (BURN); cut + burn on dry sites (DC + B); cut + burn on sub-mesic sites (MC + B);...

  3. The Impact of Group-as-a-Whole Work on Anxiety and Depression in a Severely Mentally Ill Population

    ERIC Educational Resources Information Center

    Semmelhack, Diana J.; Hazell, Clive; Hoffman, William

    2008-01-01

    This study explored the impact of a group-as-a-whole processing group on 11 severely mentally ill adult clients residing in a long term care facility over 30 weeks. Participants were evaluated for the effect of the group on anxiety and depression, using the Beck Depression Index (BDI-II) and the Beck Anxiety Index (BAI). This longitudinal study…

  4. Does severity of physical neglect moderate the impact of an efficacious preventive intervention for maltreated children in foster care?

    PubMed

    Taussig, Heather N; Culhane, Sara E; Garrido, Edward; Knudtson, Michael D; Petrenko, Christie L M

    2013-02-01

    Physically neglected youth are at increased risk of mental health problems, but there are few interventions that have demonstrated efficacy in reducing mental health symptoms for this vulnerable population. The Fostering Healthy Futures (FHF) program, which consists of mentoring and skills groups, was developed for preadolescent youth in foster care. In a published randomized controlled trial with 156 youth, FHF demonstrated positive impacts on mental health functioning. The current study sought to determine whether FHF might be particularly effective in ameliorating the impact of neglectful family environments. Because it was not possible to isolate a neglected-only subgroup, as most children with physical neglect histories had experienced other types of maltreatment, we tested the hypothesis that intervention effects would be stronger among children with more severe physical neglect. Findings did not support this hypothesis, however, as severity of physical neglect did not significantly moderate the impact of the intervention on psychosocial outcomes.

  5. Risk factors associated with impact severity of cyberbullying victimization: a qualitative study of adolescent online social networking.

    PubMed

    Dredge, Rebecca; Gleeson, John F M; de la Piedad Garcia, Xochitl

    2014-05-01

    Cyberbullying victimization is associated with a range of emotional and behavioral outcomes for adolescents. However, previous research has shown that this type of victimization does not affect all individuals negatively. The factors that account for individual differences in reactions to the same online experiences are not well understood. Using a qualitative inductive approach, a set of strong themes relating to factors that either increased the severity of impact of cyberbullying victimization or buffered victims against the impact emerged from interviews with 25 adolescents aged 15-24 years. Themes related to publicity, anonymity of perpetrators, features of the medium, presence of bystanders, and individual level factors were identified as potential influences upon impact severity. The implications of these results for further research and for school/university cyberbullying prevention programs for victims, perpetrators, and bystanders are discussed.

  6. Effect of helmet liner systems and impact directions on severity of head injuries sustained in ballistic impacts: a finite element (FE) study.

    PubMed

    Tse, Kwong Ming; Tan, Long Bin; Yang, Bin; Tan, Vincent Beng Chye; Lee, Heow Pueh

    2017-04-01

    The current study aims to investigate the effectiveness of two different designs of helmet interior cushion, (Helmet 1: strap-netting; Helmet 2: Oregon Aero foam-padding), and the effect of the impact directions on the helmeted head during ballistic impact. Series of ballistic impact simulations (frontal, lateral, rear, and top) of a full-metal-jacketed bullet were performed on a validated finite element head model equipped with the two helmets, to assess the severity of head injuries sustained in ballistic impacts using both head kinematics and biomechanical metrics. Benchmarking with experimental ventricular and intracranial pressures showed that there is good agreement between the simulations and experiments. In terms of extracranial injuries, top impact had the highest skull stress, still without fracturing the skull. In regard to intracranial injuries, both the lateral and rear impacts generally gave the highest principal strains as well as highest shear strains, which exceed the injury thresholds. Off-cushion impacts were found to be at higher risk of intracranial injuries. The study also showed that the Oregon Aero foam pads helped to reduce impact forces. It also suggested that more padding inserts of smaller size may offer better protection. This provides some insights on future's helmet design against ballistic threats.

  7. The impact of child restraint legislation on the incidence of severe paediatric injury in Chile.

    PubMed

    Nazif-Muñoz, J Ignacio; Gariépy, Geneviève; Falconer, James; Gong, Annie; Macpherson, Alison

    2017-10-01

    The objective of this study is to determine the association between Chile's 2005 child restraint legislation (CRL) and the incidence of severe paediatric motor vehicle-related injury. We analysed motor vehicle injury data from Chile's Road Safety Commission from 2000 to 2012 to determine the association between Chile's 2005 CRL and severe paediatric injury. Using Poisson time-series models we assessed the effect of the law on two outcome variables: (1) severely injured children per vehicle fleet; and (2) severely injured children per population. Chile's 2005 CRL is significantly associated with a 24% reduction in severely injured children per vehicle, and 19% reduction in severely injured children per population in the 1st year of its enactment. In 2007 this law is also significantly associated with a 17% decrease in severely injured children per vehicle, and with an 11% decrease in severely injured children per population. However, this legislation had a short-term effect since no reductions in severely injured children per vehicle were observed after 2009 and no reductions for severely injured children per population were registered after 2008. This is the first study to examine the association between CRL and severe paediatric injury in a Latin-American country. This study suggests that Chile's CRL was only effective in the short term. To support this type of reforms in the long term, other measures such as police enforcement, public information campaigns and involvement of public health professionals in educating parents about the benefits of using child restraints should be considered. 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/.

  8. Development of the simulation system {open_quotes}IMPACT{close_quotes} for analysis of nuclear power plant severe accidents

    SciTech Connect

    Naitoh, Masanori; Ujita, Hiroshi; Nagumo, Hiroichi

    1997-07-01

    The Nuclear Power Engineering Corporation (NUPEC) has initiated a long-term program to develop the simulation system {open_quotes}IMPACT{close_quotes} for analysis of hypothetical severe accidents in nuclear power plants. IMPACT employs advanced methods of physical modeling and numerical computation, and can simulate a wide spectrum of senarios ranging from normal operation to hypothetical, beyond-design-basis-accident events. Designed as a large-scale system of interconnected, hierarchical modules, IMPACT`s distinguishing features include mechanistic models based on first principles and high speed simulation on parallel processing computers. The present plan is a ten-year program starting from 1993, consisting of the initial one-year of preparatory work followed by three technical phases: Phase-1 for development of a prototype system; Phase-2 for completion of the simulation system, incorporating new achievements from basic studies; and Phase-3 for refinement through extensive verification and validation against test results and available real plant data.

  9. The impact of obstructive sleep apnea on nonalcoholic fatty liver disease in patients with severe obesity.

    PubMed

    Benotti, Peter; Wood, G Craig; Argyropoulos, George; Pack, Allan; Keenan, Brendan T; Gao, Xiang; Gerhard, Glenn; Still, Christopher

    2016-04-01

    Obstructive sleep apnea (OSA) is common among candidates for bariatric surgery. OSA and its associated intermittent hypoxia have been implicated in the pathogenesis of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis. A large cohort of bariatric surgery patients was studied in an effort to explore the relationship between OSA severity, hypoxia, metabolic syndrome, and the severity of NAFLD. Bariatric surgery candidates who underwent both polysomnography and liver biopsy were studied. The severity of OSA as determined by the apnea-hypopnea index (AHI) and parameters of hypoxia was studied in relation to extent of abnormalities of liver histology as measured by the presence of hepatic steatosis, inflammation, and fibrosis. The study cohort included 362 patients with a mean age of 46.2 years and BMI of 49.9 kg/m(2) . On the basis of AHI, 26% of the cohort had no OSA, 32% mild OSA, 22% moderate OSA, and 20% severe OSA. For the study subjects without metabolic syndrome, positive correlations were found between OSA severity, as measured by AHI, and parameters of hypoxia, with the severity of NAFLD. OSA severity and its accompanying hypoxia are associated with the severity of NAFLD. © 2016 The Obesity Society.

  10. Severe perineal laceration during operative vaginal delivery: the impact of occiput posterior position.

    PubMed

    Hirsch, E; Elue, R; Wagner, A; Nelson, K; Silver, R K; Zhou, Y; Adams, M G

    2014-12-01

    To identify risk factors for severe (third/fourth degree) perineal laceration with operative vaginal delivery (OVD, forceps or vacuum). Case-control study comparing singleton OVDs with or without severe laceration (n=138). In multivariable analyses, severe perineal laceration was associated with occiput posterior (OP) position at delivery, vaginal nulliparity, use of forceps, longer period pushing in the second stage and lower gestational age, but not birth weight, labor induction or episiotomy. Among 29 OP patients at full dilation, 9/13 (69%) attempted rotations to occiput anterior (OA) were successful, and 14/16 (88%) patients in whom rotation was not attempted remained OP at delivery. Successful rotation from OP to OA was associated with fewer severe lacerations than no attempt or unsuccessful rotation (22 vs 75%, P=0.01). Severe perineal laceration during OVD is associated with OP position at delivery and is reduced threefold in patients successfully rotated from OP to OA.

  11. Empirical assessment of the impact of highway design exceptions on the frequency and severity of vehicle accidents.

    PubMed

    Malyshkina, Nataliya V; Mannering, Fred L

    2010-01-01

    Compliance to standardized highway design criteria is considered essential to ensure roadway safety. However, for a variety of reasons, situations arise where exceptions to standard-design criteria are requested and accepted after review. This research explores the impact that such design exceptions have on the frequency and severity of highway accidents in Indiana. Data on accidents at carefully selected roadway sites with and without design exceptions are used to estimate appropriate statistical models of the frequency and severity of accidents at these sites using recent statistical advances with mixing distributions. The results of the modeling process show that presence of approved design exceptions has not had a statistically significant effect on the average frequency or severity of accidents - suggesting that current procedures for granting design exceptions have been sufficiently rigorous to avoid adverse safety impacts. However, the findings do suggest that the process that determines the frequency of accidents does vary between roadway sites with design exceptions and those without.

  12. Compressive strength after blast of sandwich composite materials

    PubMed Central

    Arora, H.; Kelly, M.; Worley, A.; Del Linz, P.; Fergusson, A.; Hooper, P. A.; Dear, J. P.

    2014-01-01

    Composite sandwich materials have yet to be widely adopted in the construction of naval vessels despite their excellent strength-to-weight ratio and low radar return. One barrier to their wider use is our limited understanding of their performance when subjected to air blast. This paper focuses on this problem and specifically the strength remaining after damage caused during an explosion. Carbon-fibre-reinforced polymer (CFRP) composite skins on a styrene–acrylonitrile (SAN) polymer closed-cell foam core are the primary composite system evaluated. Glass-fibre-reinforced polymer (GFRP) composite skins were also included for comparison in a comparable sandwich configuration. Full-scale blast experiments were conducted, where 1.6×1.3 m sized panels were subjected to blast of a Hopkinson–Cranz scaled distance of 3.02 m kg−1/3, 100 kg TNT equivalent at a stand-off distance of 14 m. This explosive blast represents a surface blast threat, where the shockwave propagates in air towards the naval vessel. Hopkinson was the first to investigate the characteristics of this explosive air-blast pulse (Hopkinson 1948 Proc. R. Soc. Lond. A 89, 411–413 (doi:10.1098/rspa.1914.0008)). Further analysis is provided on the performance of the CFRP sandwich panel relative to the GFRP sandwich panel when subjected to blast loading through use of high-speed speckle strain mapping. After the blast events, the residual compressive load-bearing capacity is investigated experimentally, using appropriate loading conditions that an in-service vessel may have to sustain. Residual strength testing is well established for post-impact ballistic assessment, but there has been less research performed on the residual strength of sandwich composites after blast. PMID:24711494

  13. Compressive strength after blast of sandwich composite materials.

    PubMed

    Arora, H; Kelly, M; Worley, A; Del Linz, P; Fergusson, A; Hooper, P A; Dear, J P

    2014-05-13

    Composite sandwich materials have yet to be widely adopted in the construction of naval vessels despite their excellent strength-to-weight ratio and low radar return. One barrier to their wider use is our limited understanding of their performance when subjected to air blast. This paper focuses on this problem and specifically the strength remaining after damage caused during an explosion. Carbon-fibre-reinforced polymer (CFRP) composite skins on a styrene-acrylonitrile (SAN) polymer closed-cell foam core are the primary composite system evaluated. Glass-fibre-reinforced polymer (GFRP) composite skins were also included for comparison in a comparable sandwich configuration. Full-scale blast experiments were conducted, where 1.6×1.3 m sized panels were subjected to blast of a Hopkinson-Cranz scaled distance of 3.02 m kg(-1/3), 100 kg TNT equivalent at a stand-off distance of 14 m. This explosive blast represents a surface blast threat, where the shockwave propagates in air towards the naval vessel. Hopkinson was the first to investigate the characteristics of this explosive air-blast pulse (Hopkinson 1948 Proc. R. Soc. Lond. A 89, 411-413 (doi:10.1098/rspa.1914.0008)). Further analysis is provided on the performance of the CFRP sandwich panel relative to the GFRP sandwich panel when subjected to blast loading through use of high-speed speckle strain mapping. After the blast events, the residual compressive load-bearing capacity is investigated experimentally, using appropriate loading conditions that an in-service vessel may have to sustain. Residual strength testing is well established for post-impact ballistic assessment, but there has been less research performed on the residual strength of sandwich composites after blast.

  14. Simulations of Porcine Eye Exposure to Primary Blast Insult

    PubMed Central

    Watson, Richard; Gray, Walt; Sponsel, William E.; Lund, Brian J.; Glickman, Randolph D.; Groth, Sylvia L.; Reilly, Matthew A.

    2015-01-01

    Purpose A computational model of the porcine eye was developed to simulate primary blast exposure. This model facilitates understanding of blast-induced injury mechanisms. Methods A computational model of the porcine eye was used to simulate the effects of primary blast loading for comparison with experimental findings from shock tube experiments. The eye model was exposed to overpressure-time histories measured during physical experiments. Deformations and mechanical stresses within various ocular tissues were then examined for correlation with pathological findings in the experiments. Results Stresses and strains experienced in the eye during a primary blast event increase as the severity of the blast exposure increases. Peak stresses in the model occurred in locations in which damage was most often observed in the physical experiments. Conclusions Blast injuries to the anterior chamber may be due to inertial displacement of the lens and ciliary body while posterior damage may arise due to contrecoup interactions of the vitreous and retina. Correlation of modeling predictions with physical experiments lends confidence that the model accurately represents the conditions found in the physical experiments. Translational Relevance This computational model offers insights into the mechanisms of ocular injuries arising due to primary blast and may be used to simulate the effects of new protective eyewear designs. PMID:26336633

  15. Computer cast blast modelling

    SciTech Connect

    Chung, S.; McGill, M.; Preece, D.S.

    1994-07-01

    Cast blasting can be designed to utilize explosive energy effectively and economically for coal mining operations to remove overburden material. The more overburden removed by explosives, the less blasted material there is left to be transported with mechanical equipment, such as draglines and trucks. In order to optimize the percentage of rock that is cast, a higher powder factor than normal is required plus an initiation technique designed to produce a much greater degree of horizontal muck movement. This paper compares two blast models known as DMC (Distinct Motion Code) and SABREX (Scientific Approach to Breaking Rock with Explosives). DMC, applies discrete spherical elements interacted with the flow of explosive gases and the explicit time integration to track particle motion resulting from a blast. The input to this model includes multi-layer rock properties, and both loading geometry and explosives equation-of-state parameters. It enables the user to have a wide range of control over drill pattern and explosive loading design parameters. SABREX assumes that heave process is controlled by the explosive gases which determines the velocity and time of initial movement of blocks within the burden, and then tracks the motion of the blocks until they come to a rest. In order to reduce computing time, the in-flight collisions of blocks are not considered and the motion of the first row is made to limit the motion of subsequent rows. Although modelling a blast is a complex task, the DMC can perform a blast simulation in 0.5 hours on the SUN SPARCstation 10--41 while the new SABREX 3.5 produces results of a cast blast in ten seconds on a 486-PC computer. Predicted percentage of cast and face velocities from both computer codes compare well with the measured results from a full scale cast blast.

  16. Changes in forest structure associated with oak decline in severely impacted areas of northern Arkansas

    Treesearch

    Eric Heitzman; Adrian Grell; Martin Spetich; Dale Starkey

    2007-01-01

    Four mature northern red oak (Quercus rubra L.)–white oak (Quercus alba L.) stands in the Boston Mountains of northern Arkansas were studied to describe the vegetation dynamics of forests heavily impacted by oak decline. Northern red oak was the species most susceptible to decline. Across the four stands, 51–75% of red oak density...

  17. Severe gastric impaction secondary to a gastric polyp in a horse

    PubMed Central

    Furness, Mary Catherine; Snyman, Heindrich Nicolaas; Abrahams, Miranda; Moore, Alison; Vince, Andrew; Anderson, Maureen E.C.

    2013-01-01

    A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse. PMID:24155420

  18. Severe gastric impaction secondary to a gastric polyp in a horse.

    PubMed

    Furness, Mary Catherine; Snyman, Heindrich Nicolaas; Abrahams, Miranda; Moore, Alison; Vince, Andrew; Anderson, Maureen E C

    2013-10-01

    A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse.

  19. Citation Analysis May Severely Underestimate the Impact of Clinical Research as Compared to Basic Research

    PubMed Central

    van Eck, Nees Jan; Waltman, Ludo; van Raan, Anthony F. J.; Klautz, Robert J. M.; Peul, Wilco C.

    2013-01-01

    Background Citation analysis has become an important tool for research performance assessment in the medical sciences. However, different areas of medical research may have considerably different citation practices, even within the same medical field. Because of this, it is unclear to what extent citation-based bibliometric indicators allow for valid comparisons between research units active in different areas of medical research. Methodology A visualization methodology is introduced that reveals differences in citation practices between medical research areas. The methodology extracts terms from the titles and abstracts of a large collection of publications and uses these terms to visualize the structure of a medical field and to indicate how research areas within this field differ from each other in their average citation impact. Results Visualizations are provided for 32 medical fields, defined based on journal subject categories in the Web of Science database. The analysis focuses on three fields: Cardiac & cardiovascular systems, Clinical neurology, and Surgery. In each of these fields, there turn out to be large differences in citation practices between research areas. Low-impact research areas tend to focus on clinical intervention research, while high-impact research areas are often more oriented on basic and diagnostic research. Conclusions Popular bibliometric indicators, such as the h-index and the impact factor, do not correct for differences in citation practices between medical fields. These indicators therefore cannot be used to make accurate between-field comparisons. More sophisticated bibliometric indicators do correct for field differences but still fail to take into account within-field heterogeneity in citation practices. As a consequence, the citation impact of clinical intervention research may be substantially underestimated in comparison with basic and diagnostic research. PMID:23638064

  20. Citation analysis may severely underestimate the impact of clinical research as compared to basic research.

    PubMed

    van Eck, Nees Jan; Waltman, Ludo; van Raan, Anthony F J; Klautz, Robert J M; Peul, Wilco C

    2013-01-01

    Citation analysis has become an important tool for research performance assessment in the medical sciences. However, different areas of medical research may have considerably different citation practices, even within the same medical field. Because of this, it is unclear to what extent citation-based bibliometric indicators allow for valid comparisons between research units active in different areas of medical research. A visualization methodology is introduced that reveals differences in citation practices between medical research areas. The methodology extracts terms from the titles and abstracts of a large collection of publications and uses these terms to visualize the structure of a medical field and to indicate how research areas within this field differ from each other in their average citation impact. Visualizations are provided for 32 medical fields, defined based on journal subject categories in the Web of Science database. The analysis focuses on three fields: Cardiac & cardiovascular systems, Clinical neurology, and Surgery. In each of these fields, there turn out to be large differences in citation practices between research areas. Low-impact research areas tend to focus on clinical intervention research, while high-impact research areas are often more oriented on basic and diagnostic research. Popular bibliometric indicators, such as the h-index and the impact factor, do not correct for differences in citation practices between medical fields. These indicators therefore cannot be used to make accurate between-field comparisons. More sophisticated bibliometric indicators do correct for field differences but still fail to take into account within-field heterogeneity in citation practices. As a consequence, the citation impact of clinical intervention research may be substantially underestimated in comparison with basic and diagnostic research.

  1. Blast-induced neurotrauma in whales.

    PubMed

    Knudsen, Siri K; Øen, Egil O

    2003-07-01

    A majority of investigations on primary blast injuries have focused on gas-containing organs, while the likelihood of blast-induced neurotrauma remains underrated. In Norway minke whales (Balaenoptera acutorostrata) are hunted using small fishing boats rigged with harpoon guns, which fire harpoons tipped with a grenade containing a charge of 30-g penthrite. The grenade detonates 60-70 cm inside the animal. The present study was undertaken to characterize the neuropathological changes caused by the penthrite blast and evaluate its role in the loss of consciousness and death in hunted whales. The study included 37 minke whales that were examined shipboard. The brains were later subjected to gross and light microscopy examination. The results showed that intra-body detonation of the grenade in near vicinity of the brain resulted in trauma similar to severe traumatic brain injury associated with a direct blow to the head. Detonation in more distant areas of the body resulted in injuries resembling acceleration-induced diffuse traumatic brain injury. The authors conclude that even if several vital organs were fatally injured in most whales, the neurotrauma induced by the blast-generated pressure waves were the primary cause for the immediate or very rapid loss of consciousness and death.

  2. Impact of facial burns: relationship between depressive symptoms, self-esteem and scar severity.

    PubMed

    Hoogewerf, Cornelis Johannes; van Baar, Margriet Elisabeth; Middelkoop, Esther; van Loey, Nancy Elisa

    2014-01-01

    This study assessed the role of self-reported facial scar severity as a possible influencing factor on self-esteem and depressive symptoms in patients with facial burns. A prospective multicentre cohort study with a 6 months follow-up was conducted including 132 patients with facial burns. Patients completed the Patient and Observer Scar Assessment Scale, the Rosenberg Self-esteem Scale and the Hospital Anxiety and Depression Scale. Structural Equation Modeling was used to assess the relations between depressive symptoms, self-esteem and scar severity. The model showed that patient-rated facial scar severity was not predictive for self-esteem and depressive symptoms six months post-burn. There was, however, a significant relationship between early depressive symptoms and both patient-rated facial scar severity and subsequent self-esteem. The variables in the model accounted for 37% of the variance in depressive symptoms six months post-burn and the model provided a moderately well-fitting representation of the data. The study suggests that self-esteem and depressive symptoms were not affected by self-reported facial scar severity but that earlier depressive symptoms were indicative for a more severe self-reported facial scar rating. Therefore, routine psychological screening during hospitalisation is recommended in order to identify patients at risk and to optimise their treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Incidence, severity, and impact of hyperhidrosis in people with lower-limb amputation.

    PubMed

    Hansen, Colby; Godfrey, Bradeigh; Wixom, Jody; McFadden, Molly

    2015-01-01

    To assess the incidence and severity of self-reported hyperhidrosis in patients with amputation and understand its effects on prosthetic fit or function, a cross-sectional survey of patients at two amputee clinics was performed. Responses from 121 subjects with lower-limb amputation were analyzed. Of these subjects, 66% reported sweating to a degree that it interfered with daily activities, as measured by the Hyperhidrosis Disease Severity Scale. There was a significant association between sweating and interference with prosthetic fit and function. Sweating was more severe in cases of transtibial amputations, patients under the age of 60, warm weather, and vigorous activity. There was no relationship between severity of sweating and time since amputation, etiology of amputation, duration of daily prosthetic use, or reported ability to perform functional tasks. Subjects reported trying multiple interventions, but the self-reported effectiveness of these treatments was low. Hyperhidrosis, a common problem associated with prosthetic usage, varies in severity and often interferes with daily activities. Sweating severity is associated with poor prosthetic fit and function. Risk factors include younger age and transtibial amputation status. Treatment strategies generally lack efficacy. The results of this study may provide guidance for future interventions and treatment options.

  4. Heterogeneous impacts of gender-interpreted contributing factors on driver injury severities in single-vehicle rollover crashes.

    PubMed

    Wu, Qiong; Zhang, Guohui; Chen, Cong; Tarefder, Rafiqul; Wang, Haizhong; Wei, Heng

    2016-09-01

    In this study, a mixed logit model is developed to identify the heterogeneous impacts of gender-interpreted contributing factors on driver injury severities in single-vehicle rollover crashes. The random parameter of the variables in the mixed logit model, the heterogeneous mean, is elaborated by driver gender-based linear regression models. The model is estimated using crash data in New Mexico from 2010 to 2012. The percentage changes of factors' predicted probabilities are calculated in order to better understand the model specifications. Female drivers are found more likely to experience severe or fatal injuries in rollover crashes than male drivers. However, the probability of male drivers being severely injured is higher than female drivers when the road surface is unpaved. Two other factors with fixed parameters are also found to significantly increase driver injury severities, including Wet and Alcohol Influenced. This study provides a better understanding of contributing factors influencing driver injury severities in rollover crashes as well as their heterogeneous impacts in terms of driver gender. Those results are also helpful to develop appropriate countermeasures and policies to reduce driver injury severities in single-vehicle rollover crashes.

  5. Impact of the severity of vasomotor symptoms on health status, resource use, and productivity.

    PubMed

    Whiteley, Jennifer; Wagner, Jan-Samuel; Bushmakin, Andrew; Kopenhafer, Lewis; Dibonaventura, Marco; Racketa, Jill

    2013-05-01

    The current study characterizes health-related quality of life, work productivity, and resource use among postmenopausal women by severity of vasomotor symptoms (VMS). Participants were selected from the 2010 US National Health and Wellness Survey. Women aged 40 to 75 years who did not report a history of menstrual bleeding or spotting for 1 year were eligible for analysis (N = 3,267). Cohorts of women with no VMS (n = 1,740), mild VMS (n = 931), moderate VMS (n = 462), and severe VMS (n = 134) were compared after controlling for demographic and health characteristics. Outcome measures were assessed using linear models and included health status, work productivity within the past 7 days, and healthcare resource use within the past 6 months. The mean age of women experiencing severe VMS was 57.92 years. After demographic and health characteristics had been controlled for, women experiencing severe and moderate VMS reported significantly lower mean health status scores compared with women with no symptoms (P < 0.0001). The mean number of menopause symptom-related physician visits was significantly greater among women with severe, moderate, or mild symptoms than among women with no symptoms (P < 0.0001). Among employed women experiencing VMS, women with severe and moderate symptoms had adjusted presenteeism of 24.28% and 14.3%, versus 4.33% in women with mild symptoms (P < 0.001), and activities of daily living impairment of 31.66% and 17.06%, versus 6.16% in women with mild symptoms (P < 0.0001). In postmenopausal women, a greater severity of VMS is significantly associated with lower levels of health status and work productivity, and greater healthcare resource use.

  6. Human factors in maintenance: impact on aircraft mishap frequency and severity.

    PubMed

    Krulak, David C

    2004-05-01

    Aviation mishaps caused by maintenance factors vary in severity, but can cost untold sums in lives and equipment lost. This study proposes to demonstrate that certain specific maintenance-related human factors are significantly correlated with both mishap frequency and severity. Using information from the Maintenance Error Information Management System (MEIMS), 1,016 aircraft mishaps caused by human factors in maintenance were examined. These mishaps were previously categorized using the Human Factors Analysis and Classification System-Maintenance Extension (HFACS-ME). Frequency analysis was used to determine the most common HFACS-ME factors seen in aircraft mishaps. Logistic regression techniques were used to describe the relationship between the dichotomized outcome of mishap severity and the human factors found in the HFACS-ME. Inadequate supervision, attention/memory errors, and judgment/decision errors were the factors found most often in aircraft mishaps. The factors of inadequate design, inadequate adaptability/flexibility, inadequate lighting/light, confining workspace, and attention/memory error increased odds of being associated with a higher severity mishap. Emphasis in training and education placed in the first three factors mentioned may reduce overall number of mishaps. Concentrating resources on the final five factors may decrease the number of severe mishaps.

  7. Differential impact of severity of drug use on frontal behavioral symptoms.

    PubMed

    Verdejo-García, Antonio; Rivas-Pérez, Cristina; López-Torrecillas, Francisca; Pérez-García, Miguel

    2006-08-01

    Increasing evidence indicates that substance abusers are impaired in cognitive-executive control tasks relying on different functional systems converging in the prefrontal cortex (PFC). Different PFC functional systems relevant to addiction have been described: the dorsolateral (DLC), orbitofrontal (OFC), and anterior cingulate (ACC) circuits. Each system is associated with different behavioral, cognitive, and emotional deficits, including apathy, disinhibition, and executive dysfunction. In this study, we examined the effects of severity of use of different drugs on apathy, disinhibition and executive dysfunction behavioral deficits as measured by the Frontal Systems Behavior Scale (FrSBe). The FrSBe, and a severity of substance use interview were administered to 32 poly-substance abusers. Multiple regression analyses showed that severity of cannabis use significantly predicted greater apathy and executive dysfunction behavior; and that severity of cocaine use significantly predicted greater disinhibition behavior. These results are consistent with previous studies using cognitive measures and support the notion that severity of substance use significantly affects behavioral symptoms associated with PFC systems functioning. These clinical symptoms should be specifically addressed during rehabilitation.

  8. Cerebrovascular Injury in Blast Loading

    DTIC Science & Technology

    2010-01-01

    TITLE: Cerebrovascular injury in blast loading PRINCIPAL INVESTIGATOR: Kenneth L. Monson, PhD...SUBTITLE Cerebrovascular injury in blast loading 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-08-1-0295 5c. PROGRAM ELEMENT NUMBER 6...and pH control. 15. SUBJECT TERMS Blast brain injury; cerebrovascular injury and dysfunction; shock tube 16. SECURITY CLASSIFICATION OF: 17

  9. An analysis of high-impact, low-predictive skill severe weather events in the northeast U.S

    NASA Astrophysics Data System (ADS)

    Vaughan, Matthew T.

    An objective evaluation of Storm Prediction Center slight risk convective outlooks, as well as a method to identify high-impact severe weather events with poor-predictive skill are presented in this study. The objectives are to assess severe weather forecast skill over the northeast U.S. relative to the continental U.S., build a climatology of high-impact, low-predictive skill events between 1980--2013, and investigate the dynamic and thermodynamic differences between severe weather events with low-predictive skill and high-predictive skill over the northeast U.S. Severe storm reports of hail, wind, and tornadoes are used to calculate skill scores including probability of detection (POD), false alarm ratio (FAR) and threat scores (TS) for each convective outlook. Low predictive skill events are binned into low POD (type 1) and high FAR (type 2) categories to assess temporal variability of low-predictive skill events. Type 1 events were found to occur in every year of the dataset with an average of 6 events per year. Type 2 events occur less frequently and are more common in the earlier half of the study period. An event-centered composite analysis is performed on the low-predictive skill database using the National Centers for Environmental Prediction Climate Forecast System Reanalysis 0.5° gridded dataset to analyze the dynamic and thermodynamic conditions prior to high-impact severe weather events with varying predictive skill. Deep-layer vertical shear between 1000--500 hPa is found to be a significant discriminator in slight risk forecast skill where high-impact events with less than 31-kt shear have lower threat scores than high-impact events with higher shear values. Case study analysis of type 1 events suggests the environment over which severe weather occurs is characterized by high downdraft convective available potential energy, steep low-level lapse rates, and high lifting condensation level heights that contribute to an elevated risk of severe wind.

  10. Does Parenting Influence the Enduring Impact of Severe Childhood Sexual Abuse on Psychiatric Resilience in Adulthood?

    PubMed

    Lind, Mackenzie J; Brown, Ruth C; Sheerin, Christina M; York, Timothy P; Myers, John M; Kendler, Kenneth S; Amstadter, Ananda B

    2017-05-09

    This study examined the effect of parenting on the association between childhood sexual abuse (CSA) and psychiatric resilience in adulthood in a large female twin sample (n = 1423) assessed for severe CSA (i.e., attempted or completed intercourse before age 16). Severe CSA was associated with lower resilience to recent stressors in adulthood (defined as the difference between their internalizing symptoms and their predicted level of symptoms based on cumulative exposure to stressful life events). Subscales of the Parental Bonding Instrument were significantly associated with resilience. Specifically, parental warmth was associated with increased resilience while parental protectiveness was associated with decreased resilience. The interaction between severe CSA and parental authoritarianism was significant, such that individuals with CSA history and higher authoritarianism scores had lower resilience. Results suggest that CSA assessment remains important for therapeutic work in adulthood and that addressing parenting may be useful for interventions in children with a CSA history.

  11. Impact of Injury Severity on Dynamic Inflammation Networks Following Blunt Trauma.

    PubMed

    Almahmoud, Khalid; Namas, Rami A; Abdul-Malak, Othman; Zaaqoq, Akram M; Zamora, Ruben; Zuckerbraun, Brian S; Sperry, Jason; Peitzman, Andrew B; Billiar, Timothy R; Vodovotz, Yoram

    2015-08-01

    Clinical outcomes following trauma depend on the extent of injury and the host's response to injury, along with medical care. We hypothesized that dynamic networks of systemic inflammation manifest differently as a function of injury severity in human blunt trauma. From a cohort of 472 blunt trauma survivors studied following institutional review board approval, three Injury Severity Score (ISS) subcohorts were derived after matching for age and sex: mild ISS (49 patients [33 males and 16 females, aged 42 ± 1.9 years; ISS 9.5 ± 0.4]); moderate ISS (49 patients [33 males and 16 females, aged 42 ± 1.9; ISS 19.9 ± 0.4]), and severe ISS (49 patients [33 males and 16 females, aged 42 ± 2.5 years; ISS 33 ± 1.1]). Multiple inflammatory mediators were assessed in serial blood samples. Dynamic Bayesian Network inference was utilized to infer causal relationships based on probabilistic measures. Intensive care unit length of stay, total length of stay, days on mechanical ventilation, Marshall Multiple Organ Dysfunction score, prevalence of prehospital hypotension and nosocomial infection, and admission lactate and base deficit were elevated as a function of ISS. Multiple circulating inflammatory mediators were significantly elevated in severe ISS versus moderate or mild ISS over both the first 24 h and out to 7 days after injury. Dynamic Bayesian Network suggested that interleukin 6 production in severe ISS was affected by monocyte chemotactic protein 1/CCL2, monokine inducible by interferon γ (MIG)/CXCL9, and IP-10/CXCL10; by monocyte chemotactic protein 1/CCL2 and MIG/CXCL9 in moderate ISS; and by MIG/CXCL9 alone in mild ISS over 7 days after injury. Injury Severity Score correlates linearly with morbidity, prevalence of infection, and early systemic inflammatory connectivity of chemokines to interleukin 6.

  12. Impact of malocclusion and dentofacial anomalies on the prevalence and severity of dental caries among adolescents.

    PubMed

    Feldens, Carlos Alberto; Dos Santos Dullius, Angela Isabel; Kramer, Paulo Floriani; Scapini, Annarosa; Busato, Adair Luiz Stefanello; Vargas-Ferreira, Fabiana

    2015-11-01

    To investigate the association between malocclusion/dentofacial anomalies and dental caries among adolescents. A cross-sectional study was conducted with 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório in southern Brazil. Parents/caregivers answered a structured questionnaire on demographic and socioeconomic variables. A trained examiner recorded the presence of malocclusion (Dental Aesthetic Index [DAI]), traumatic dental injury, and dental caries. Data analysis involved the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Poisson regression with robust variance was used for the multivariable analysis. A total of 44.8% of the adolescents had dental caries (mean DFMT  =  1.33 ± 1.84). The DAI index ranged from 15 to 77 (mean  =  29.0 ± 7.9); 43.6% of the sample had severe malocclusion and 11.6% had traumatic dental injury. The prevalence and severity of dental caries were significantly greater among adolescents with severe malocclusion. The multivariate analysis demonstrated that adolescents with severe or handicapping malocclusion had a 31% greater probability of having dental caries (prevalence ratio: 1.31; 95% CI: 1.02-1.67), independently of demographic, socioeconomic, or clinical aspects. The orthodontic characteristics associated with the occurrence and severity of caries were maxillary irregularity ≥3 mm (P  =  .021) and abnormal molar relationship (P  =  .021). Handicapping malocclusion, maxillary irregularity, and abnormal molar relationship were associated with the occurrence and severity of dental caries. The findings suggest that the prevention and treatment of these conditions can contribute to a reduction in dental caries among adolescents.

  13. Evaluating the Impact of Breastfeeding on Rotavirus Antigenemia and Disease Severity in Indian Children

    PubMed Central

    Das, Sushmita; Sahoo, Ganesh Chandra; Das, Pradeep; Singh, Utpal Kant; Jaiswal, Anil Kumar; Singh, Prachi; Kumar, Ranjeet; Kumar, Rishikesh

    2016-01-01

    Objectives To evaluate the contribution of breastfeeding to Rotavirus (RV)-induced antigenemia and/or RNAemia and disease severity in Indian children (<2 yrs age). Methods Paired stool and serum samples were collected from (a) hospitalized infants with diarrhea (n = 145) and (b) healthy control infants without diarrhea (n = 28). Stool RV-antigen was screened in both groups by commercial rapid-test and enzyme immunoassay. The disease severity was scored and real-time-PCR was used for viral-load estimation. Serum was evaluated for RV-antigenemia by EIA and RV-RNAemia by RT-PCR. Data was stratified by age-group and breastfeeding status and compared. Results Presence of RV-antigenemia and RV-RNAemia was positively related with presence of RV in stool. Disease severity and stool viral-load was significantly associated with RV-antigenemia[(r = 0.74; CI:0.66 to 0.84; P<0.0001,R2 = 0.59) and (r = -0.55; CI:-0.68 to -0.39; P<0.0001,R2 = 0.31) respectively], but not with RV-RNAemia. There was significant reduction in RV-antigenemiarate in the breast-fed group compared to non-breastfed infants, especially in 0–6 month age group (P<0.001). Non-breastfed infants were at risk for RV-antigenemia with severe disease manifestations in form of high Vesikari scores correlating with high fever, more vomiting episodes and dehydration. Conclusion RV-antigenemia was common in nonbreastfed children with severe RV-diarrhea and correlated with stool RV-load and disease severity. PMID:26828823

  14. Blasting-induced damage in coal

    SciTech Connect

    Kabongo, K.K.

    1995-12-31

    The paper is drawn from a project intended to explore a technique of prediction, control and optimization of fracture in coal induced by blasting. It evaluates the fines generated in coal submitted to dynamic loading stresses in an impact stamp mortar. The aim is to analyze a complex phenomenon of coal response to blast-generated stresses from a series of discrete simulations of shock and gas actions in controllable processes. It is learned that despite the nucleation of primary crushing and fractures to originate from the point of impact energy in coal, a secondary crushing appears to depart from within the burden progressing towards the free boundaries. The extension of the secondary crushing zone appears to be influenced by the magnitude of the breaking stresses generated and the coal burden distance. A strong dependence of fines on the coal`s innate discontinuities (strength) and the energy input is highlighted.

  15. Impacts of coexisting bronchial asthma on severe exacerbations in mild-to-moderate COPD: results from a national database

    PubMed Central

    Lee, Hyun; Rhee, Chin Kook; Lee, Byung-Jae; Choi, Dong-Chull; Kim, Jee-Ae; Kim, Sang Hyun; Jeong, Yoolwon; Kim, Tae-Hyung; Chon, Gyu Rak; Jung, Ki-Suck; Lee, Sang Haak; Price, David; Yoo, Kwang Ha; Park, Hye Yun

    2016-01-01

    Background Acute exacerbations are major drivers of COPD deterioration. However, limited data are available for the prevalence of severe exacerbations and impact of asthma on severe exacerbations, especially in patients with mild-to-moderate COPD. Methods Patients with mild-to-moderate COPD (≥40 years) were extracted from Korean National Health and Nutrition Examination Survey data (2007–2012) and were linked to the national health insurance reimbursement database to obtain medical service utilization records. Results Of the 2,397 patients with mild-to-moderate COPD, 111 (4.6%) had severe exacerbations over the 6 years (0.012/person-year). Severe exacerbations were more frequent in the COPD patients with concomitant self-reported physician-diagnosed asthma compared with only COPD patients (P<0.001). A multiple logistic regression presented that asthma was an independent risk factor of severe exacerbations in patients with mild-to-moderate COPD regardless of adjustment for all possible confounding factors (adjusted odds ratio, 1.67; 95% confidence interval, 1.002–2.77, P=0.049). In addition, age, female, poor lung function, use of inhalers, and low EuroQoL five dimensions questionnaire index values were independently associated with severe exacerbation in patients with mild-to-moderate COPD. Conclusion In this population-based study, the prevalence of severe exacerbations in patients with mild-to-moderate COPD was relatively low, compared with previous clinical interventional studies. Coexisting asthma significantly impacted the frequency of severe exacerbations in patients with mild-to-moderate COPD, suggesting application of an exacerbation preventive strategy in these patients. PMID:27143869

  16. Psychiatric comorbidity and severity of dependence on substance users: how it impacts on their health-related quality of life?

    PubMed

    Lozano, Óscar M; Rojas, Antonio J; Fernández Calderón, Fermín

    2017-04-01

    The aim of this study was to analyze the impact of psychiatric comorbidity and severity of dependence on health-related quality of life (HRQoL). One hundred and ninety-eight substance use disorder (SUD) patients were recruited from an outpatient center that provides treatment for SUD. The International Personality Disorder Examination Screening Questionnaire (IPDE-SQ), Mini International Neuropsychiatric Interview (MINI), Substance Dependence Severity Scale (SDSS) and Health-Related Quality of Life for Drug Abusers test (HRQoLDA test) were administered. Patients with psychiatric comorbidity evaluated their HRQoL more negatively than patients without psychiatric comorbidity. An analysis of the relationship between severity of dependence and HRQoL scores indicated significant correlations among alcohol-, cocaine-, heroin- and cannabis-dependent patients. According to multivariate analyses, anxiety disorders, mood disorders, severity of dependence on alcohol, cannabis, cocaine, paranoid, borderline and avoidant personality disorders (PDs) were observed to have a major impact on HRQoL. SUD (severity of dependence on alcohol, cannabis and cocaine) and other mental disorders (anxiety disorders; mood disorders; paranoid, borderline and avoidant PDs) are involved in the deterioration of the SUD patients' HRQoL. This study demonstrates the need for integrated treatment for SUD patients. Treating only a part of the problem (whether SUD or other mental disorders are present) is insufficient for improving quality of life.

  17. Impact of Short Interval SMS Digital Data on Wind Vector Determination for a Severe Local Storms Area

    NASA Technical Reports Server (NTRS)

    Peslen, C. A.

    1979-01-01

    The impact of 5 minute interval SMS-2 visible digital image data in analyzing severe local storms is examined using wind vectors derived from cloud tracking on time lapsed sequence of geosynchronous satellite images. The cloud tracking areas are located in the Central Plains, where on 6 May 1975, hail-producing thunderstorms occurred ahead of a well defined dry line. The results demonstrate that satellite-derived wind vectors and their associated divergence fields complement conventional meteorological analyses in describing the conditions preceding severe local storm development.

  18. Impact of Parental Severe Mental Illness: Ethical and Clinical Issues for Counselors

    ERIC Educational Resources Information Center

    Spiegelhoff, Sarah F.; Ahia, C. Emmanuel

    2011-01-01

    This article draws attention to the issue of parental severe mental illness and the ethical and clinical implications for counselors who work with this population. Parents with mental illness face a multitude of life challenges including, but not limited to, parenting difficulties, medication and hospitalization, custody and placement of their…

  19. Impact of Parental Severe Mental Illness: Ethical and Clinical Issues for Counselors

    ERIC Educational Resources Information Center

    Spiegelhoff, Sarah F.; Ahia, C. Emmanuel

    2011-01-01

    This article draws attention to the issue of parental severe mental illness and the ethical and clinical implications for counselors who work with this population. Parents with mental illness face a multitude of life challenges including, but not limited to, parenting difficulties, medication and hospitalization, custody and placement of their…

  20. Hydrologic impacts of high severity wildfire: Learning from the past and preparing for the future

    Treesearch

    Daniel G. Neary; Karen A. Koestner; Ann Youberg

    2011-01-01

    Wildfire is a natural disturbance with epic potential to drastically alter watershed hydrologic condition. Basins with high-burn severity, especially those with steep previously forested terrain, have flashier hydrographs and can produce peak-flows orders of magnitude greater than pre-fire conditions. This is due to fundamental changes in the hydrology of burnt...

  1. Impact of a Cash Subsidy Program for Families of Children with Severe Developmental Disabilities.

    ERIC Educational Resources Information Center

    Meyers, Judith C.; Marcenko, Maureen O.

    1989-01-01

    Eighty-one Michigan families raising children with severe handicaps were interviewed prior to receiving a $225 monthly cash subsidy and one year later. Mothers reported significantly less family stress (particularly related to financial stress) and enhanced life satisfaction, regardless of marital status, employment status or education, child's…

  2. Ego defense mechanisms in COPD: impact on health-related quality of life and dyspnoea severity.

    PubMed

    Albuquerque, Saulo C; Carvalho, Eduardo R; Lopes, Rebeka S; Marques, Higor S; Macêdo, Danielle S; Pereira, Eanes D; Hyphantis, Thomas N; Carvalho, Andre F

    2011-11-01

    To assess chronic obstructive pulmonary disorder (COPD) patients' defensive profile compared with healthy participants and to test whether specific ego defense mechanisms are associated with health-related quality of life (HRQoL) and self-reported dyspnoea severity. In a cross-sectional study, we assessed, in 80 patients with COPD and 80 age- and gender-matched healthy participants, psychological distress (Hospital Anxiety and Depression Scale) and defense mechanisms/styles (Defense Style Questionnaire). Patients had their HRQoL evaluated with the St. George's Respiratory Questionnaire and underwent a comprehensive clinical evaluation with determination of functional parameters and dyspnoea severity. COPD patients presented higher scores in undoing, acting out, autistic fantasy, denial, and splitting defenses compared with healthy controls. Overall, patients showed a more immature (P = 0.001) and/or neurotic (P = 0.006) defensive profile. Higher scores of denial (P = 0.044), somatization (P = 0.009), and undoing (P = 0.032) defenses were associated with poorer HRQoL, independently of the anticipated significant associations of clinical and psychological distress variables with impaired HRQoL. Somatization was strongly independently associated with more severe self-reported dyspnoea. COPD patients exhibit a relatively immature and neurotic defensive profile. Clinicians and consultation-liaison psychiatrists should consider the patients' underlying personality structure, especially somatization tendencies, since it is independently associated with HRQoL and dyspnoea severity.

  3. Modeling impacts of fire severity on successional trajectories and future fire behavior in Alaskan boreal forests

    Treesearch

    Jill F. Johnstone; T. Scott Rupp; Mark Olson; David. Verbyla

    2011-01-01

    Much of the boreal forest in western North America and Alaska experiences frequent, stand-replacing wildfires. Secondary succession after fire initiates most forest stands and variations in fire characteristics can have strong effects on pathways of succession. Variations in surface fire severity that influence whether regenerating forests are dominated by coniferous...

  4. The Impact of Muscle Disuse on Muscle Atrophy in Severely Burned Rats

    DTIC Science & Technology

    2010-12-01

    Herrick RE, Baldwin KM. Effect of anabolic steroids on skeletal muscle mass during hindlimb suspension. J Appl Physiol 1987;63(5):2122–2127. [PubMed...physical activity also shows advantages in enhancing and improving recovery from muscle catabolism after severe burn [49]. Similarly, both anabolic

  5. Low Level Impacts on Fire Evolution in the Mack Lake and Other Severe Wildfires

    Treesearch

    Joseph J. Charney; Xindi Bian; Brian E. Potter; Warren E. Heilman

    2003-01-01

    The 2000 fire season brought to the forefront the issue of severe wildland fires in the United States. To address the need for new research and for the development of predictive tools for managing wildland fires, Congress allocated funding under the National Fire Plan (NFP) to better equip government agencies to fight and study forest fires. As part of the NFP research...

  6. The Impact of Alleged Abuse on Behaviour in Adults with Severe Intellectual Disabilities

    ERIC Educational Resources Information Center

    Murphy, G. H.; O'Callaghan, A. C.; Clare, I. C. H.

    2007-01-01

    Background: People with intellectual disabilities (ID) are particularly vulnerable to abuse, and most incidents come to light through victim disclosure. Those people with severe or profound ID are not able to describe what has happened to them. This project aimed to describe the consequences of abuse and changes in behaviour following alleged…

  7. Priority Queuing Models for Hospital Intensive Care Units and Impacts to Severe Case Patients

    PubMed Central

    Hagen, Matthew S.; Jopling, Jeffrey K; Buchman, Timothy G; Lee, Eva K.

    2013-01-01

    This paper examines several different queuing models for intensive care units (ICU) and the effects on wait times, utilization, return rates, mortalities, and number of patients served. Five separate intensive care units at an urban hospital are analyzed and distributions are fitted for arrivals and service durations. A system-based simulation model is built to capture all possible cases of patient flow after ICU admission. These include mortalities and returns before and after hospital exits. Patients are grouped into 9 different classes that are categorized by severity and length of stay (LOS). Each queuing model varies by the policies that are permitted and by the order the patients are admitted. The first set of models does not prioritize patients, but examines the advantages of smoothing the operating schedule for elective surgeries. The second set analyzes the differences between prioritizing admissions by expected LOS or patient severity. The last set permits early ICU discharges and conservative and aggressive bumping policies are contrasted. It was found that prioritizing patients by severity considerably reduced delays for critical cases, but also increased the average waiting time for all patients. Aggressive bumping significantly raised the return and mortality rates, but more conservative methods balance quality and efficiency with lowered wait times without serious consequences. PMID:24551379

  8. Effect of driver's age and side of impact on crash severity along urban freeways: a mixed logit approach.

    PubMed

    Haleem, Kirolos; Gan, Albert

    2013-09-01

    This study identifies geometric, traffic, environmental, vehicle-related, and driver-related predictors of crash injury severity on urban freeways. The study takes advantage of the mixed logit model's ability to account for unobserved effects that are difficult to quantify and may affect the model estimation, such as the driver's reaction at the time of crash. Crashes of 5 years occurring on 89 urban freeway segments throughout the state of Florida in the United States were used. Examples of severity predictors explored include traffic volume, distance of the crash to the nearest ramp, and detailed driver's age, vehicle types, and sides of impact. To show how the parameter estimates could vary, a binary logit model was compared with the mixed logit model. It was found that the at-fault driver's age, traffic volume, distance of the crash to the nearest ramp, vehicle type, side of impact, and percentage of trucks significantly influence severity on urban freeways. Additionally, young at-fault drivers were associated with a significant severity risk increase relative to other age groups. It was also observed that some variables in the binary logit model yielded illogic estimates due to ignoring the random variation of the estimation. Since the at-fault driver's age and side of impact were significant random parameters in the mixed logit model, an in-depth investigation was performed. It was noticed that back, left, and right impacts had the highest risk among middle-aged drivers, followed by young drivers, very young drivers, and finally, old and very old drivers. To reduce side impacts due to lane changing, two primary strategies can be recommended. The first strategy is to conduct campaigns to convey the hazardous effect of changing lanes at higher speeds. The second is to devise in-vehicle side crash avoidance systems to alert drivers of a potential crash risk. The study provided a promising approach to screening the predictors before fitting the mixed logit model

  9. Peripheral lesions identified by mydriatic ultrawide field imaging: distribution and potential impact on diabetic retinopathy severity.

    PubMed

    Silva, Paolo S; Cavallerano, Jerry D; Sun, Jennifer K; Soliman, Ahmed Z; Aiello, Lloyd M; Aiello, Lloyd Paul

    2013-12-01

    To assess diabetic retinopathy (DR) as determined by lesions identified using mydriatic ultrawide field imaging (DiSLO200; Optos plc, Scotland, UK) compared with Early Treatment Diabetic Retinopathy Study (ETDRS) 7-standard field film photography. Prospective comparative study of DiSLO200, ETDRS 7-standard field film photographs, and dilated fundus examination (DFE). A total of 206 eyes of 103 diabetic patients selected to represent all levels of DR. Subjects had DiSLO200, ETDRS 7-standard field film photographs, and DFE. Images were graded for severity and distribution of DR lesions. Discrepancies were adjudicated, and images were compared side by side. Distribution of hemorrhage and/or microaneurysm (H/Ma), venous beading (VB), intraretinal microvascular abnormality (IRMA), and new vessels elsewhere (NVE). Kappa (κ) and weighted κ statistics for agreement. The distribution of DR severity by ETDRS 7-standard field film photographs was no DR 12.5%; nonproliferative DR mild 22.5%, moderate 30%, and severe/very severe 8%; and proliferative DR 27%. Diabetic retinopathy severity between DiSLO200 and ETDRS film photographs matched in 80% of eyes (weighted κ = 0.74,κ = 0.84) and was within 1 level in 94.5% of eyes. DiSLO200 and DFE matched in 58.8% of eyes (weighted κ = 0.69,κ = 0.47) and were within 1 level in 91.2% of eyes. Forty eyes (20%) had DR severity discrepancies between DiSLO200 and ETDRS film photographs. The retinal lesions causing discrepancies were H/Ma 52%, IRMA 26%, NVE 17%, and VB 4%. Approximately one-third of H/Ma, IRMA, and NVE were predominantly outside ETDRS fields. Lesions identified on DiSLO200 but not ETDRS film photographs suggested a more severe DR level in 10% of eyes. Distribution in the temporal, superotemporal, inferotemporal, superonasal, and inferonasal fields was 77%, 72%, 61%, 65%, and 59% for H/Ma, respectively (P<0.0001); 22%, 24%, 21%, 28%, and 22% for VB, respectively (P = 0.009); 52%, 40%, 29%, 47%, and 36% for IRMA

  10. Severe hypoglycaemia in adults with insulin-treated diabetes: impact on healthcare resources.

    PubMed

    Heller, S R; Frier, B M; Hersløv, M L; Gundgaard, J; Gough, S C L

    2016-04-01

    To assess resource utilization associated with severe hypoglycaemia across three insulin regimens in a large phase 3a clinical programme involving people with Type 1 diabetes treated with basal-bolus insulin, people with Type 2 diabetes treated with multiple daily injections and people with Type 2 diabetes treated with basal-oral therapy. Data relating to severe hypoglycaemia events (defined as episodes requiring external assistance) from the insulin degludec and insulin degludec/insulin aspart programme (15 trials) were analysed using descriptive statistics. Comparators included insulin glargine, biphasic insulin aspart, insulin detemir and sitagliptin. Mealtime insulin aspart was used in some regimens. This analysis used the serious adverse events records, which documented the use of ambulance/emergency teams, a hospital/emergency room visit ≤ 24 h, or a hospital visit > 24 h. In total, 536 severe hypoglycaemia events were analysed, of which 157 (29.3%) involved an ambulance/emergency team, 64 (11.9%) led to hospital/emergency room attendance of ≤ 24 h and 36 (6.7%) required hospital admission (> 24 h). Although there were fewer events in people with Type 2 diabetes compared with Type 1 diabetes, once a severe episode occurred, the tendency to utilize healthcare resources was higher in Type 2 diabetes vs. Type 1 diabetes. A higher proportion (47.6%) in the basal-oral therapy group required hospital treatment for > 24 h versus the Type 1 diabetes (5.0%) and Type 2 diabetes multiple daily injections (5.3%) groups. This analysis suggests that severe hypoglycaemia events often result in emergency/ambulance calls and hospital treatment, incurring a substantial health economic burden, and were associated with all insulin regimens. © 2015 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

  11. The impact of DSM-5 on the diagnosis and severity indicator of eating disorders in a treatment-seeking sample.

    PubMed

    Nakai, Yoshikatsu; Nin, Kazuko; Noma, Shun'ichi; Teramukai, Satoshi; Fujikawa, Kei; Wonderlich, Stephen A

    2017-08-31

    To examine the impact of the DSM-5 on the diagnoses and severity indicators of eating disorders, we conducted a comparative study on the classification of eating disorders including subtypes of anorexia nervosa (AN) between the DSM-IV and DSM-5 criteria. In addition, we studied the association of the DSM-5 severity criteria and clinical variables. Participants were 304 outpatients, aged 16-45 years, with eating disorders, diagnosed using semi-structured clinical interviews and the eating disorder examination questionnaire (EDE-Q). The severity of AN, bulimia nervosa (BN), and binge-eating disorder (BED) was rated from mild to extreme using the DSM-5 severity criteria. The DSM-5 remarkably reduced the number of diagnoses in the residual category from 37.5% to 9.2% and effectively differentiated the diagnostic groups in eating disorder psychopathology. Unexpectedly, however, the scores of all the EDE-Q subscales significantly decreased as severity ratings increased in the DSM-5 AN. Furthermore, while the AN binge-eating/purging group reported significantly lower severity ratings than the AN restricting group, the former displayed more severe eating disorder psychopathology than the latter. In the BN and BED groups, the level of eating concern increased as severity ratings increased, but the severity groups did not differ on other eating pathology variables. The DSM-5 effectively reduced the reliance on residual categories and differentiated the diagnostic groups in eating disorder psychopathology. However, our findings show limited support for the DSM-5 severity specifiers for eating disorders. It is necessary to test additional clinical or functional variables for severity specifiers across eating disorders. © 2017 Wiley Periodicals, Inc.

  12. Military Traumatic Brain Injury and Blast

    DTIC Science & Technology

    2010-01-01

    cations compared to other mechanisms of injury such as acceleration -deceleration impact has become an im- portant question in the care of our service...injury. The above concepts lead to a frame of reference debate in relation to blast induced concussion or mTBI sug- gesting that lethal injury would...results in a 3D complex flow field that is altered by ambient conditions and envi- ronmental boundaries. This may result in multiple wave reflections and

  13. Blast injury with particular reference to recent terrorist bombing incidents.

    PubMed Central

    Hill, J. F.

    1979-01-01

    The aetiology of primary blast lung is discussed with reference to the biodynamics of blast injury, and the clinical and pathological features of the condition are described. An analysis of casualties from bomb blast incidents occurring in Northern Ireland leads to the following conclusions concerning the injuries found in persons exposed to explosions: (1) there is a predominance of head and neck trauma, including fractures, lacerations, burns, and eye and ear injuries; (2) fractures and traumatic amputations are common and often multiple; (3) penetrating trunk wounds carry a grave prognosis; and (4) primary blast lung is rare. A comparison of four bombing incidents in England in 1973 and 1974 shows how the type and severity of injury are related to the place in which the explosion occurs. The administrative and clinical aspects of the management of casualties resulting from terrorist bombing activities are discussed. PMID:369445

  14. Characterising the acceleration phase of blast wave formation

    SciTech Connect

    Fox, T. E. Pasley, J.; Robinson, A. P. L.; Schmitz, H.

    2014-10-15

    Intensely heated, localised regions in uniform fluids will rapidly expand and generate an outwardly propagating blast wave. The Sedov-Taylor self-similar solution for such blast waves has long been studied and applied to a variety of scenarios. A characteristic time for their formation has also long been identified using dimensional analysis, which by its very nature, can offer several interpretations. We propose that, rather than simply being a characteristic time, it may be interpreted as the definitive time taken for a blast wave resulting from an intense explosion in a uniform media to contain its maximum kinetic energy. A scaling relation for this measure of the acceleration phase, preceding the establishment of the blast wave, is presented and confirmed using a 1D planar hydrodynamic model.

  15. Severe Storms and California's Fragile Delta--Historical Impacts and New Monitoring Approaches

    NASA Astrophysics Data System (ADS)

    Dettinger, M. D.; Ralph, F.; White, A. B.; Anderson, M.; Florsheim, J.; Cayan, D. R.; Hinojosa, A.

    2013-12-01

    California's Sacramento-San Joaquin Delta is a broad inland delta, 100 km east of San Francisco, that has experienced severe ecosystem losses and transformations over the past 100+ years, as it has been engineered to be an ever more important center for the State's water, utilities and transportation, and agriculture systems. As important and engineered as the Delta is, it is also an increasingly fragile system with aging levees, subsiding land surfaces, and a multitude of invading species. Severe storms and the floods that they engender pose great risks to the levees and other infrastructures in the Delta, while also playing necessary roles in key biogeomorphological processes that will need to be maintained (or expanded) if Delta ecosystems are to be restored. Of particular concern are the severe storms associated with landfalling atmospheric rivers (ARs) that, since 1950, have caused 80% of major floods, 76% of inundations of the ecologically important floodplains like the broad Yolo Bypass immediately above the Delta, and 81% of levee breaks in the Central Valley and Delta. Because of the critical role of severe storms and especially ARs in many of the environmental and infrastructural problems facing the Delta (and California, more generally), a new severe-storm monitoring network using several new remote atmospheric-observing technologies is being implemented across the broad catchment of the Delta and much of California by the California Department of Water Resources, NOAA, and Scripps Institution of Oceanography with increasing participation from local agencies. The network is intended to provide much more precise now-casting of critical but previously under-monitored storm characteristics, like rapidly evolving snowlines, barrier jets, and patterns of AR vapor transport into the State, characteristics that will enable a new era of storm-forecast improvements. The network relies on new radar, sounder, and GPS technologies installed strategically and for the

  16. The impact of changing climate conditions on the hydrological behavior of several Mediterranean sub-catchments in Crete

    NASA Astrophysics Data System (ADS)

    Eirini Vozinaki, Anthi; Tapoglou, Evdokia; Tsanis, Ioannis

    2017-04-01

    Climate change, although is already happening, consists of a big threat capable of causing lots of inconveniences in future societies and their economies. In this work, the climate change impact on the hydrological behavior of several Mediterranean sub-catchments, in Crete, is presented. The sensitivity of these hydrological systems to several climate change scenarios is also provided. The HBV hydrological model has been used, calibrated and validated for the study sub-catchments against measured weather and streamflow data and inputs. The impact of climate change on several hydro-meteorological parameters (i.e. precipitation, streamflow etc.) and hydrological signatures (i.e. spring flood peak, length and volume, base flow, flow duration curves, seasonality etc.) have been statistically elaborated and analyzed, defining areas of increased probability risk associated additionally to flooding or drought. The potential impacts of climate change on current and future water resources have been quantified by driving HBV model with current and future scenarios, respectively, for specific climate periods. This work aims to present an integrated methodology for the definition of future climate and hydrological risks and the prediction of future water resources behavior. Future water resources management could be rationally effectuated, in Mediterranean sub-catchments prone to drought or flooding, using the proposed methodology. The research reported in this paper was fully supported by the Project "Innovative solutions to climate change adaptation and governance in the water management of the Region of Crete - AQUAMAN" funded within the framework of the EEA Financial Mechanism 2009-2014.

  17. SAPHO syndrome in an adolescent: a clinical case with unusual severe systemic impact.

    PubMed

    Freira, Sílvia; Fonseca, Helena; Ferreira, Pedro Dias; Vasconcelos, Pedro; Fonseca, João Eurico

    2014-08-01

    SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome includes both dermatological and rheumatologic symptoms. Being a rare condition, the diagnosis is frequently late. The authors report a case of a 13-year-old boy diagnosed with synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome with unusual severe systemic repercussions. The patient presented with acne conglobata, inability to walk due to pain and weakness and weight loss. Bone scintigraphy was suggestive of sacroiliitis, and lumbar spine x-ray showed signs of hyperostosis. His clinical state improved after treatment with nonsteroidal anti-inflammatory drugs, methotrexate, clindamycin, and isotretinoin. A review of the clinical aspects of this syndrome is presented, emphasizing how this underdiagnosed syndrome can lead to severe weight loss and significant functional and psychological impairment at an early age.

  18. Military blast exposure, ageing and white matter integrity.

    PubMed

    Trotter, Benjamin B; Robinson, Meghan E; Milberg, William P; McGlinchey, Regina E; Salat, David H

    2015-08-01

    Mild traumatic brain injury, or concussion, is associated with a range of neural changes including altered white matter structure. There is emerging evidence that blast exposure-one of the most pervasive causes of casualties in the recent overseas conflicts in Iraq and Afghanistan-is accompanied by a range of neurobiological events that may result in pathological changes to brain structure and function that occur independently of overt concussion symptoms. The potential effects of brain injury due to blast exposure are of great concern as a history of mild traumatic brain injury has been identified as a risk factor for age-associated neurodegenerative disease. The present study used diffusion tensor imaging to investigate whether military-associated blast exposure influences the association between age and white matter tissue structure integrity in a large sample of veterans of the recent conflicts (n = 190 blast-exposed; 59 without exposure) between the ages of 19 and 62 years. Tract-based spatial statistics revealed a significant blast exposure × age interaction on diffusion parameters with blast-exposed individuals exhibiting a more rapid cross-sectional age trajectory towards reduced tissue integrity. Both distinct and overlapping voxel clusters demonstrating the interaction were observed among the examined diffusion contrast measures (e.g. fractional anisotropy and radial diffusivity). The regions showing the effect on fractional anisotropy included voxels both within and beyond the boundaries of the regions exhibiting a significant negative association between fractional anisotropy and age in the entire cohort. The regional effect was sensitive to the degree of blast exposure, suggesting a 'dose-response' relationship between the number of blast exposures and white matter integrity. Additionally, there was an age-independent negative association between fractional anisotropy and years since most severe blast exposure in a subset of the blast-exposed group

  19. Military blast exposure, ageing and white matter integrity

    PubMed Central

    Trotter, Benjamin B.; Robinson, Meghan E.; Milberg, William P.; McGlinchey, Regina E.

    2015-01-01

    Mild traumatic brain injury, or concussion, is associated with a range of neural changes including altered white matter structure. There is emerging evidence that blast exposure—one of the most pervasive causes of casualties in the recent overseas conflicts in Iraq and Afghanistan—is accompanied by a range of neurobiological events that may result in pathological changes to brain structure and function that occur independently of overt concussion symptoms. The potential effects of brain injury due to blast exposure are of great concern as a history of mild traumatic brain injury has been identified as a risk factor for age-associated neurodegenerative disease. The present study used diffusion tensor imaging to investigate whether military-associated blast exposure influences the association between age and white matter tissue structure integrity in a large sample of veterans of the recent conflicts (n = 190 blast-exposed; 59 without exposure) between the ages of 19 and 62 years. Tract-based spatial statistics revealed a significant blast exposure × age interaction on diffusion parameters with blast-exposed individuals exhibiting a more rapid cross-sectional age trajectory towards reduced tissue integrity. Both distinct and overlapping voxel clusters demonstrating the interaction were observed among the examined diffusion contrast measures (e.g. fractional anisotropy and radial diffusivity). The regions showing the effect on fractional anisotropy included voxels both within and beyond the boundaries of the regions exhibiting a significant negative association between fractional anisotropy and age in the entire cohort. The regional effect was sensitive to the degree of blast exposure, suggesting a ‘dose-response’ relationship between the number of blast exposures and white matter integrity. Additionally, there was an age-independent negative association between fractional anisotropy and years since most severe blast exposure in a subset of the blast

  20. The impact of disease severity, illness beliefs and coping strategies on outcomes in psoriatic arthritis.

    PubMed

    Howells, Laura; Chisholm, Anna; Cotterill, Sarah; Chinoy, Hector; Warren, Richard B; Bundy, Christine

    2017-08-03

    Little is known about how people with psoriatic arthritis (PsA) cope and manage their condition, but data show psychological problems are under-recognised and under-treated. The Common Sense - Self-Regulatory Model (CS-SRM) suggests illness beliefs, mediated by coping, may influence health outcomes. The study aimed to investigate the roles of disease severity, illness beliefs and coping strategies in predicting depression, anxiety and QoL in people with PsA. Additionally, we aimed to assess the role of depression and anxiety in predicting QoL. A cross-sectional observational study where adults with PsA (N = 179) completed validated measures of predictor (illness beliefs, coping strategies, disease severity) and outcome variables (depression, anxiety, QoL) using an online survey distributed via social media. The participants were a community sample of 179 adults with PsA aged 20 to 72 (77.1% female). After controlling for disease severity, hierarchical multiple regression models indicated that more negative beliefs about consequences and behavioural disengagement as a coping method predicted levels of depression and self-blame predicted anxiety. Beliefs about consequences and the presence of depression predicted quality of life scores after controlling for disease severity. This study offers support for the use of the CS-SRM in explaining variation on psychological outcomes in individuals with PsA. The illness beliefs and coping strategies identified as predictors in this paper are potential targets for interventions addressing PsA-related distress and QoL. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  1. Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis.

    PubMed

    Finfer, Simon; McEvoy, Suzanne; Bellomo, Rinaldo; McArthur, Colin; Myburgh, John; Norton, Robyn

    2011-01-01

    To determine the effect of random assignment to fluid resuscitation with albumin or saline on organ function and mortality in patients with severe sepsis. Pre-defined subgroup analysis of a randomized controlled trial conducted in the intensive care units of 16 hospitals in Australia and New Zealand. Of 1,218 patients with severe sepsis at baseline, 603 and 615 were assigned to receive albumin and saline, respectively. The two groups had similar baseline characteristics. During the first 7 days mean arterial pressure was similar in the two groups, but patients assigned albumin had a lower heart rate on days 1 and 3 (p = 0.002 and p = 0.03, respectively) and a higher central venous pressure on days 1-3 (p < 0.005 each day). There was no difference in the renal or total Sequential Organ Failure Assessment score of the two groups; 113/603 (18.7%) of patients assigned albumin were treated with renal replacement therapy compared to 112/615 (18.2%) assigned saline (p = 0.98). The unadjusted relative risk of death for albumin versus saline was 0.87 [95% confidence interval (CI) 0.74-1.02] for patients with severe sepsis and 1.05 (0.94-1.17) for patients without severe sepsis (p = 0.06 for heterogeneity). From multivariate logistic regression analysis adjusting for baseline factors in patients with complete baseline data (919/1,218, 75.5%), the adjusted odds ratio for death for albumin versus saline was 0.71 (95% CI: 0.52-0.97; p = 0.03). Administration of albumin compared to saline did not impair renal or other organ function and may have decreased the risk of death.

  2. Impact of Implantable Transvenous Device Lead Location on Severity of Tricuspid Regurgitation

    PubMed Central

    Addetia, Karima; Maffessanti, Francesco; Mediratta, Anuj; Yamat, Megan; Weinert, Lynn; Moss, Joshua D.; Nayak, Hemal M.; Burke, Martin C.; Patel, Amit R.; Kruse, Eric; Jeevanandam, Valluvan; Mor-Avi, Victor; Lang, Roberto M.

    2015-01-01

    Background Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR. Methods A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ≥ 0.5 cm) or severe (VC width ≥ 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis. Results Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively. Conclusion Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for

  3. Impact of Advanced Propeller Technology on Aircraft/Mission Characteristics of Several General Aviation Aircraft

    NASA Technical Reports Server (NTRS)

    Keiter, I. D.

    1982-01-01

    Studies of several General Aviation aircraft indicated that the application of advanced technologies to General Aviation propellers can reduce fuel consumption in future aircraft by a significant amount. Propeller blade weight reductions achieved through the use of composites, propeller efficiency and noise improvements achieved through the use of advanced concepts and improved propeller analytical design methods result in aircraft with lower operating cost, acquisition cost and gross weight.

  4. Mapping burn severity in a disease-impacted forest landscape using Landsat and MASTER imagery

    NASA Astrophysics Data System (ADS)

    Chen, Gang; Metz, Margaret R.; Rizzo, David M.; Meentemeyer, Ross K.

    2015-08-01

    Global environmental change has increased forest vulnerability to the occurrence of interacting disturbances, including wildfires and invasive diseases. Mapping post-fire burn severity in a disease-affected forest often faces challenges because burned and infested trees may exhibit a high similarity in spectral reflectance. In this study, we combined (pre- and post-fire) Landsat imagery and (post-fire) high-spectral resolution airborne MASTER data [MODIS (moderate resolution imaging spectroradiometer)/ASTER (advanced spaceborne thermal emission and reflection radiometer)] to map burn severity in a California coastal forest environment, where a non-native forest disease sudden oak death (SOD) was causing substantial tree mortality. Results showed that the use of Landsat plus MASTER bundle performed better than using the individual sensors in most of the evaluated forest strata from ground to canopy layers (i.e., substrate, shrubs, intermediate-sized trees, dominant trees and average), with the best model performance achieved at the dominant tree layer. The mid to thermal infrared spectral bands (3.0-12.5 μm) from MASTER were found to augment Landsat's visible to shortwave infrared bands in burn severity assessment. We also found that infested and uninfested forests similarly experienced moderate to high degrees of burns where CBI (composite burn index) values were higher than 1. However, differences occurred in the regions with low burn severity (CBI values lower than 1), where uninfested stands revealed a much lower burn effect than that in infested stands, possibly due to their higher resilience to small fire disturbances as a result of higher leaf water content.

  5. Misfolding of vWF to Pathologically Disordered Conformations Impacts the Severity of von Willebrand Disease

    PubMed Central

    Tischer, Alexander; Madde, Pranathi; Moon-Tasson, Laurie; Auton, Matthew

    2014-01-01

    The primary hemostatic von Willebrand factor (vWF) functions to sequester platelets from rheological blood flow and mediates their adhesion to damaged subendothelium at sites of vascular injury. We have surveyed the effect of 16 disease-causing mutations identified in patients diagnosed with the bleeding diathesis disorder, von Willebrand disease (vWD), on the structure and rheology of vWF A1 domain adhesiveness to the platelet GPIbα receptor. These mutations have a dynamic phenotypical range of bleeding from lack of platelet adhesion to severe thrombocytopenia. Using new rheological tools in combination with classical thermodynamic, biophysical, and spectroscopic metrics, we establish a high propensity of the A1 domain to misfold to pathological molten globule conformations that differentially alter the strength of platelet adhesion under shear flow. Rheodynamic analysis establishes a quantitative rank order between shear-rate-dependent platelet-translocation pause times that linearly correlate with clinically reported measures of patient platelet counts and the severity of thrombocytopenia. These results suggest that specific secondary structure elements remaining in these pathological conformations of the A1 domain regulate GPIbα binding and the strength of vWF-platelet interactions, which affects the vWD functional phenotype and the severity of thrombocytopenia. PMID:25185554

  6. The emotional impact of loss narratives: event severity and narrative perspectives.

    PubMed

    Habermas, Tilmann; Diel, Verena

    2010-06-01

    Out of the complex influences of event, narrative and listener characteristics on narrative emotions, this paper focuses on event severity, narrative perspectives, mood, and dispositions for emotion regulation and empathy. Event severity and perspective representation were systematically varied in sad autobiographical narratives to study their influence on quantity and quality of readers' emotional response. Each of three stories were manipulated to contain elaborated perspectives, only the past protagonists' perspective (dramatic narration), and very little perspectives at all (impersonal narration). We predicted that event severity influences the quantity of emotional response, while degree of perspective representation influences plausibility and whether emotional responses are sympathetic or interactional, that is, directed against the narrator. Hypotheses were confirmed except for plausibility, and perspective representation had an effect only on anger against and dislike of the narrator. In a second study, impersonal narration evoked anger at and negative evaluations of the narrator which were related to blaming the narrator for showing too little emotional involvement. The generalizability of findings across emotions and implications for sharing of emotions in everyday and clinical settings are discussed.

  7. Recurrent Mudflows at Popocatepetl Volcano: Impact on the Population over several Thousand Years and possible Precursors.

    NASA Astrophysics Data System (ADS)

    Martin, A. L.; Nieto, A.; Portocarrero, J.; Jaimes-Viera, M. D. C.; Fonseca, R.

    2014-12-01

    Popocatepetl Volcano in central Mexico has been erupting since 1994 with relatively small Strombolian and Vulcanian eruptions, expect for the 2 larger eruptions in 1997 and 2001 that produced more widespread pumice and ash fall, mud flows and in 2001, pumice flows. As part of the recent studies that have focused on monitoring eruptive behavior for risk reduction in this heavily populated area, we are updating the Hazard Map (1995). Here we present the results of the new data for the northwestern sector of the volcano where large mudflows reached 40km from the volcano toward Mexico City (14Ka). The 5Ka mudflows are overlain by several flows that covered pre-Columbian pre-classic settlements at around 2Ka BP. Buildings with ceramics from the classic and postclassic periods (around 1.5Ka and 0.9Ka BP) also indicate that settlements were abandoned and resettled several hundred years later. So far, it seems that inhabitants fled at the beginning of these larger eruptions, since no bodies have been found in the excavations. Since the XVI century, several smaller mudflows have reached the towns, but many are related with secondary deposits (for example, the Nexapa 2010 mudflow reached 15 km from the crater). Although this area has been inhabited for thousands of years, increased population shows that risk is considerable.

  8. The impact of thrombin generation and rotation thromboelastometry on assessment of severity of factor XI deficiency.

    PubMed

    Livnat, Tami; Shenkman, Boris; Martinowitz, Uri; Zivelin, Ariella; Dardik, Rima; Tamarin, Ilia; Mansharov, Rachel; Budnik, Ivan; Salomon, Ophira

    2015-08-01

    The phenotype of bleeding in patients with severe FXI deficiency is unpredictable and unlike other bleeding disorders, it is not directly correlated with levels of FXI. In this study we analyzed whether the global coagulation assays can serve as a clinical tool in predicting bleeding tendency in patients with severe FXI deficiency undergoing surgery, taking into account the large inter-individual variability of FXI levels and genotypes. Thrombin generation (TG) was measured in 39 platelet-poor plasma with or without tissue factor (TF) and in the presence or absence of corn trypsin inhibitor (CTI). Rotation thromboelastometry (ROTEM) was performed with fresh whole blood of 26 patients applying NATEM and INTEM tests. TG induced by recalcification can distinguish between bleeding and non-bleeding patients with severe FXI deficiency particularly among those with FXI activity of 2-20IU/dl. The addition of TF or TF and CTI to the TG assay masked the ability to differentiate between XI activity, genotype as well as bleeding and non-bleeding patients. ROTEM assays failed to distinguish bleeding from non-bleeding patients but could do so between different FXI activity levels and genotypes. In conclusion, in the current study we found a sensitive tool to distinguish between bleeding and non-bleeding patients. In order to recommend TG as a predictive tool for treatment tailoring, a larger patient group is required.

  9. The radiological management of bomb blast injury.

    PubMed

    Hare, S S; Goddard, I; Ward, P; Naraghi, A; Dick, E A

    2007-01-01

    A need to understand the nature and patterns of bomb blast injury, particularly in confined spaces, has come to the fore with the current worldwide threat from terrorism. The purpose of this review article is to familiarize the radiologist with the imaging they might expect to see in a mass casualty terrorist event, illustrated by examples from two of the main institutions receiving patients from the London Underground tube blasts of 7 July 2005. We present examples of injuries that are typical in blast victims, as well as highlighting some blast sequelae that might also be found in other causes of multiple trauma. This should enable the radiologist to seek out typical injuries, including those that may not be initially clinically apparent. Terror-related injuries are often more severe than those seen in other trauma cases, and multi-system trauma at distant anatomical sites should be anticipated. We highlight the value of using a standardized imaging protocol to find clinically undetected traumatic effects and include a discussion on management of multiple human and non-human flying fragments. This review also discusses the role of radiology in the management and planning for a mass casualty terrorist incident and the optimal deployment of radiographic services during such an event.

  10. Characteristics and Impacts of the severe Hailstorm on 28 July 2013

    NASA Astrophysics Data System (ADS)

    Kunz, Michael; Jürgen Punge, Heinz; Fluck, Elody; Schmidberger, Manuel; Blahak, Ulrich; Handwerker, Jan; Mohr, Susanna; Mühr, Bernhard

    2015-04-01

    On 27/28 July, two severe supercell thunderstorms in Germany caused unexpected extreme losses of 3.1 bn EUR(insured) and 4.0 bn EUR(economic), respectively. According to the recently published damage statistics of Munich Re for the year 2013, these hail events were the costliest natural catastrophe in worldwide for that year ranked by insured losses. This example exemplifies the large damage potential related to hail events, which is still underestimated both by the public and the insurance industry. On 27 July, the first supercell moved over the federal states of North Rhine-Westphalia and Lower Saxony. Large hail with diameters of up to 7.5 cm according to observations archived in the European Severe Weather Database (ESWD) caused severe damage especially over the Volkswagen factory in Wolfsburg. One day later, on 28 July, another supercell formed upstream of the Black Forest Mountains and moved almost parallel over the Swabian Jura and Bavaria. Hail with diameters of up to 8 cm fell over a heavily populated region between the cities of Reutlingen and Tübingen. In this area, exposed assets are extremely high, which partly explain the high total loss. Approximately 100,000 buildings and 50,000 automobiles (not considered are the damaged automobiles at the parking lot in Wolfsburg) were severely damaged by these two events. Considering the single event definition over a 72-hr period, which is usually applied in the insurance industry, these hailstorms were one of the most expensive loss events in Germany. In this paper, we investigate the severe hailstorm on 28 July from different views. By using and combining available observational data sets, the objective is to reconstruct the whole events at a very high resolution and to examine the conditions that are most relevant for convective initiation and the further development of the organized convective cell. Using a series of photos of damaged objects the aim is to relate different object classes and hail stone

  11. Acoustic monitoring to document the spatial distribution and hotspots of blast fishing in Tanzania.

    PubMed

    Braulik, Gill; Wittich, Anja; Macaulay, Jamie; Kasuga, Magreth; Gordon, Jonathan; Davenport, Tim R B; Gillespie, Douglas

    2017-09-25

    Destructive fishing using explosives occurs in a number of countries worldwide, negatively impacting coral reefs and fisheries on which millions of people rely. Documenting, quantifying and combating the problem has proved problematic. In March-April 2015 231h of acoustic data were collected over 2692km of systematically laid transects along the entire coast of Tanzania. A total of 318 blasts were confirmed using a combination of manual and supervised semi-autonomous detection. Blasts were detected along the entire coastline, but almost 62% were within 80km of Dar es Salaam, where blast frequency reached almost 10blasts/h. This study is one of the first to use acoustic monitoring to provide a spatial assessment of the intensity of blast fishing. This can be a useful tool that can provide reliable data to define hotspots where the activity is concentrated and determine where enforcement should be focused for maximum impact. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Investigation on occupant ejection in high severity rear impact based on post mortem human subject sled tests.

    PubMed

    Petit, Philippe; Luet, Carole; Potier, Pascal; Vallancien, Guy

    2011-11-01

    Occupant protection in rear impact involves two competing challenges. On one hand, allowing a deformation of the seat would act as an energy absorber in low severity impacts and would consequently decrease the risk of neck injuries. However, on the other hand, large deformations of the seat may increase the likelihood of occupant ejection in high severity cases. Green et al. 1987 analyzed a total of 919 accidents in Great Britain. They found that occupant ejection resulted in a risk of severe injuries and fatalities between 3.6 and 4.5 times higher than those cases where no ejection was observed. The sample included single front, side and rear impacts as well as multiple impacts and rollover. The rate of belt use in the sample was 50%. While this analysis included all forms of impact scenarios, nevertheless, it highlights the relative injury severity of occupant ejection. Extensive literature search has found no full-scale rear impact tests involving Post Mortem Human Subjects (PMHS) conducted in a laboratory environment and resulting in ejection. This paper describes a total of 10 sled tests conducted on 3 belted PMHS using a simplified seat design composed of rigid plates assembled such that the angular and linear stiffness of the seatback (including the foam) was modeled. The initial angular position and the range of motion of the seatback, the size of the PMHS, the slack length of the seatbelt, the angular stiffness of the seatback, and the use of headrest were varied in the test matrix while the pulse was kept constant (triangular acceleration with a peak of 17 G at 30 ms and a duration of 95 ms). In the test series, the tests were not run randomly but the likelihood of occupant ejection was increased systematically until ejection occurred. PMHS seat ejection was observed only for the 95th percentile, initially positioned with a seatback angle relative to the vertical equal to 22°, a range of seatback angular motion equal to 44° and no headrest. Repeating

  13. A thoracic mechanism of mild traumatic brain injury due to blast pressure waves.

    PubMed

    Courtney, A C; Courtney, M W

    2009-01-01

    The mechanisms by which blast pressure waves cause mild-to-moderate traumatic brain injury (mTBI) are an open question. Possibilities include acceleration of the head, direct passage of the blast wave via the cranium, and propagation of the blast wave to the brain via a thoracic mechanism. The hypothesis that the blast pressure wave reaches the brain via a thoracic mechanism is considered in light of ballistic and blast pressure wave research. Ballistic pressure waves, caused by penetrating ballistic projectiles or ballistic impacts to body armor, can only reach the brain via an internal mechanism and have been shown to cause cerebral effects. Similar effects have been documented when a blast pressure wave has been applied to the whole body or focused on the thorax in animal models. While vagotomy reduces apnea and bradycardia due to ballistic or blast pressure waves, it does not eliminate neural damage in the brain, suggesting that the pressure wave directly affects the brain cells via a thoracic mechanism. An experiment is proposed which isolates the thoracic mechanism from cranial mechanisms of mTBI due to blast wave exposure. Results have implications for evaluating risk of mTBI due to blast exposure and for developing effective protection.

  14. GPU-BLAST: using graphics processors to accelerate protein sequence alignment

    PubMed Central

    Vouzis, Panagiotis D.; Sahinidis, Nikolaos V.

    2011-01-01

    Motivation: The Basic Local Alignment Search Tool (BLAST) is one of the most widely used bioinformatics tools. The widespread impact of BLAST is reflected in over 53 000 citations that this software has received in the past two decades, and the use of the word ‘blast’ as a verb referring to biological sequence comparison. Any improvement in the execution speed of BLAST would be of great importance in the practice of bioinformatics, and facilitate coping with ever increasing sizes of biomolecular databases. Results: Using a general-purpose graphics processing unit (GPU), we have developed GPU-BLAST, an accelerated version of the popular NCBI-BLAST. The implementation is based on the source code of NCBI-BLAST, thus maintaining the same input and output interface while producing identical results. In comparison to the sequential NCBI-BLAST, the speedups achieved by GPU-BLAST range mostly between 3 and 4. Availability: The source code of GPU-BLAST is freely available at http://archimedes.cheme.cmu.edu/biosoftware.html. Contact: sahinidis@cmu.edu Supplementary information: Supplementary data are available at Bioinformatics online. PMID:21088027

  15. The impact of documentation of severe acute kidney injury on mortality

    PubMed Central

    Wilson, Francis Perry; Bansal, Amar D.; Jasti, Sravan K.; Lin, Jennie J.; Shashaty, Michael G.S.; Berns, Jeffrey S.; Feldman, Harold I; Fuchs, Barry D.

    2013-01-01

    Aims: Modification of the mortality risk associated with acute kidney injury (AKI) necessitates recognition of AKI when it occurs. We sought to determine whether formal documentation of AKI in the medical record, assessed by billing codes for AKI, would be associated with improved clinical outcomes. Methods: Retrospective cohort study conducted at three hospitals within a single university health system. Adults without severe underlying kidney disease who suffered in-hospital AKI as defined by a doubling of baseline creatinine (n = 5,438) were included. Those whose AKI was formally documented according to discharge billing codes were compared to those without such documentation in terms of 30-day mortality. Results: Formal documentation of AKI occurred in 2,325 patients (43%). Higher baseline creatinine, higher peak creatinine, medical admission status, and higher Sequential Organ Failure Assessment (SOFA) score were strongly associated with documentation of AKI. After adjustment for severity of disease, formal AKI documentation was associated with reduced 30-day mortality – OR 0.81 (0.68 – 0.96, p = 0.02). Patients with formal documentation were more likely to receive a nephrology consultation (31% vs. 6%, p < 0.001) and fluid boluses (64% vs. 45%, p < 0.001), and had a more rapid discontinuation of angiotensin-converting enzyme inhibitor and angiotensin-receptor blocker medications (HR 2.04, CI 1.69 – 2.46, p < 0.001). Conclusions: Formal documentation of AKI is associated with improved survival after adjustment for illness severity among patients with creatinine-defined AKI. PMID:24075024

  16. Impact of severity of drug use on discrete emotions recognition in polysubstance abusers.

    PubMed

    Fernández-Serrano, María José; Lozano, Oscar; Pérez-García, Miguel; Verdejo-García, Antonio

    2010-06-01

    Neuropsychological studies support the association between severity of drug intake and alterations in specific cognitive domains and neural systems, but there is disproportionately less research on the neuropsychology of emotional alterations associated with addiction. One of the key aspects of adaptive emotional functioning potentially relevant to addiction progression and treatment is the ability to recognize basic emotions in the faces of others. Therefore, the aims of this study were: (i) to examine facial emotion recognition in abstinent polysubstance abusers, and (ii) to explore the association between patterns of quantity and duration of use of several drugs co-abused (including alcohol, cannabis, cocaine, heroin and MDMA) and the ability to identify discrete facial emotional expressions portraying basic emotions. We compared accuracy of emotion recognition of facial expressions portraying six basic emotions (measured with the Ekman Faces Test) between polysubstance abusers (PSA, n=65) and non-drug using comparison individuals (NDCI, n=30), and used regression models to explore the association between quantity and duration of use of the different drugs co-abused and indices of recognition of each of the six emotions, while controlling for relevant socio-demographic and affect-related confounders. Results showed: (i) that PSA had significantly poorer recognition than NDCI for facial expressions of anger, disgust, fear and sadness; (ii) that measures of quantity and duration of drugs used significantly predicted poorer discrete emotions recognition: quantity of cocaine use predicted poorer anger recognition, and duration of cocaine use predicted both poorer anger and fear recognition. Severity of cocaine use also significantly predicted overall recognition accuracy.

  17. Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children.

    PubMed

    Chi, Donald L; Momany, Elizabeth T; Neff, John; Jones, Michael P; Warren, John J; Slayton, Rebecca L; Weber-Gasparoni, Karin; Damiano, Peter C

    2011-02-01

    Although Medicaid-enrolled children with a chronic condition (CC) may be less likely to use dental care because of factors related to their CC, dental utilization for this population is poorly understood. To assess the relationship between CC status and CC severity, respectively, on dental utilization for Iowa Medicaid-enrolled children. Retrospective cohort study of Iowa Medicaid data (January 1, 2003 to December 31, 2006). Medicaid-enrolled children aged 3 to 14 (N = 71,115) years. The 3M Corporation Clinical Risk Grouping methods were used to assess CC status (no/yes) and CC severity (episodic/life-long/malignancy/complex). The outcome variable was any dental utilization in 2006. Secondary outcomes included use of diagnostic, preventive, routine restorative, or complex restorative dental care. After adjusting for model covariates, Iowa Medicaid-enrolled children with a CC were significantly more likely to use each type of dental care except routine restorative care (P = 0.86) than those without a CC, although the differences in the odds were small (4%-6%). Compared with Medicaid-enrolled children with an episodic CC, children with a life-long CC were less likely to use routine restorative care (P < 0.0001), children with a malignancy were more likely to use complex restorative care (P < 0.03), and children with a complex CC were less likely to use each type of dental care except complex restorative care (P = 0.97). There were differences in dental utilization for Iowa Medicaid-enrolled children by CC status and CC severity. Children with complex CCs were the least likely to use dental care. Future research efforts should seek to understand why subgroups of Medicaid-enrolled children with a CC exhibit lower dental utilization.

  18. Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study

    PubMed Central

    2012-01-01

    Background Sulfur mustard (SM) has been used as a chemical warfare agent since the early twentieth century. Despite the large number of studies that have investigated SM induced ocular injuries, few of those studies have also focused on the psychological health status of victims. This study has evaluated the most prominent influences on the psychological health status of patients with severe SM induced ocular injuries. Methods This descriptive study was conducted on 149 Iranian war veterans with severe SM induced eye injuries. The psychological health status of all patients was assessed using the Iranian standardized Symptom Check List 90-Revised (SCL90-R) questionnaire. The results of patients' Global Severity Index (GSI) were compared with the optimal cut-off point of 0.4 that has previously been calculated for GSI in Iranian community. The Mann-Whitney U test, T tests and effect sizes (using Cohen's d) were employed as statistical methods. Data were analyzed using SPSS software. Results The mean age of patients was 44.86 (SD = 8.7) and mean duration of disease was 21.58 (SD = 1.20) years. Rate of exposure was once in 99 (66.4%) cases. The mean GSI (1.46) of the study group was higher compared to standardized cut off point (0.4) of the Iranian community. The results of this study showed that the mean of total GSI score was higher in participants with lower educational levels (effect size = 0.507), unemployment (effect size = 0.464) and having more than 3 children (effect size = 0.62). Among the participants, 87 (58.4%) cases had a positive psychological history for hospitalization or receiving outpatient cares previously and 62 (41.6%) cases had a negative psychological history. In addition, the mean of GSI in participants with negative psychological history was lower than those with positive psychological history (Mean Change Difference = -0.621 with SD = 0.120). There was a significant difference between positive and negative psychological history with respect

  19. Impact of psychological problems in chemical warfare survivors with severe ophthalmologic complication, a cross sectional study.

    PubMed

    Ghaedi, Gholamhosein; Ghasemi, Hassan; Mousavi, Batool; Soroush, Mohammad Reza; Rahnama, Parvin; Jafari, Farhad; Afshin-Majd, Siamak; Sadeghi Naeeni, Maryam; Naghizadeh, Mohammad Mehdi

    2012-04-12

    Sulfur mustard (SM) has been used as a chemical warfare agent since the early twentieth century. Despite the large number of studies that have investigated SM induced ocular injuries, few of those studies have also focused on the psychological health status of victims. This study has evaluated the most prominent influences on the psychological health status of patients with severe SM induced ocular injuries. This descriptive study was conducted on 149 Iranian war veterans with severe SM induced eye injuries. The psychological health status of all patients was assessed using the Iranian standardized Symptom Check List 90-Revised (SCL90-R) questionnaire. The results of patients' Global Severity Index (GSI) were compared with the optimal cut-off point of 0.4 that has previously been calculated for GSI in Iranian community. The Mann-Whitney U test, T tests and effect sizes (using Cohen's d) were employed as statistical methods. Data were analyzed using SPSS software. The mean age of patients was 44.86 (SD=8.7) and mean duration of disease was 21.58 (SD=1.20) years. Rate of exposure was once in 99 (66.4%) cases. The mean GSI (1.46) of the study group was higher compared to standardized cut off point (0.4) of the Iranian community. The results of this study showed that the mean of total GSI score was higher in participants with lower educational levels (effect size=0.507), unemployment (effect size=0.464) and having more than 3 children (effect size=0.62). Among the participants, 87 (58.4%) cases had a positive psychological history for hospitalization or receiving outpatient cares previously and 62 (41.6%) cases had a negative psychological history. In addition, the mean of GSI in participants with negative psychological history was lower than those with positive psychological history (Mean Change Difference=-0.621 with SD=0.120). There was a significant difference between positive and negative psychological history with respect to GSI (P<0.001). The study showed that

  20. Characterization of Viscoelastic Materials for Low-Magnitude Blast Mitigation

    NASA Astrophysics Data System (ADS)

    Bartyczak, Susan; Mock, Willis

    2013-06-01

    Recent preliminary research indicates that exposure to low amplitude blast waves, such as from IED detonation or multiple firings of a weapon, causes damage to brain tissue resulting in Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD). Current combat helmets are not sufficiently protecting warfighters from this danger and the effects are debilitating, costly, and long-lasting. The objective of this research is to evaluate the blast mitigating behavior of current helmet materials and new materials designed for blast mitigation using a test fixture recently developed at the Naval Surface Warfare Center Dahlgren Division for use with an existing gas gun. A 40-mm-bore gas gun is used as a shock tube to generate blast waves (ranging from 5 to 30 psi) in a test fixture mounted at the gun muzzle. A fast opening valve is used to release helium gas from a breech which forms into a blast wave and impacts instrumented targets in the test fixture. Blast attenuation of selected materials is determined through the measurement of pressure and accelerometer data in front of and behind the target. Materials evaluated in this research include 6061-T6 aluminum, polyurea 1000, Styrofoam, and Sorbothane (durometer 50, shore 00). The experimental technique, calibration and checkout procedures, and results will be presented.

  1. Characterization of viscoelastic materials for low-magnitude blast mitigation

    NASA Astrophysics Data System (ADS)

    Bartyczak, S.; Mock, W.

    2014-05-01

    Recent research indicates that exposure to low amplitude blast waves, such as IED detonation or multiple firings of a weapon, causes damage to brain tissue resulting in Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD). Current combat helmets are not sufficiently protecting warfighters from this danger and the effects are debilitating, costly, and long-lasting. The objective of the present work is to evaluate the blast mitigating behavior of current helmet materials and new materials designed for blast mitigation using a test fixture recently developed at the Naval Surface Warfare Center Dahlgren Division for use with an existing gas gun. The 40-mm-bore gas gun was used as a shock tube to generate blast waves (ranging from 0.5 to 2 bar) in the test fixture mounted on the gun muzzle. A fast opening valve was used to release helium gas from the breech which formed into a blast wave and impacted instrumented targets in the test fixture. Blast attenuation of selected materials was determined through the measurement of stress data in front of and behind the target. Materials evaluated in this research include polyurethane foam from currently fielded US Army and Marine Corps helmets, polyurea 1000, and three hardnesses of Sorbothane (48, 58, and 70 durometer, Shore 00). Polyurea 1000 and 6061-T6 aluminum were used to calibrate the stress gauges.

  2. A study of the impact of physical (cloud) initialization on severe convection numerical prediction.

    NASA Astrophysics Data System (ADS)

    Chen, Baode; Li, Jia; Huang, Wei; Zhang, Xu

    2017-04-01

    By using the second generation of SMS-WARR Shanghai Meteorological Service-WRF ADAS Rapid Refresh System, a severe convective case in East China was analyzed with an emphasis of the influence of the cloud initialization and the related physical processes. The comparison between results of with/without cloud initialization shows that the forecast using cloud initialization can greatly increase the 00-06 hour precipitation T score, and position of the forecasted precipitation is closer to the observation as well. Further analysis indicates that the cloud initialization can significantly improve the initial fields of hydrometeors, provide more accurate related information of the convection system, obtain the better forecasts of hydrometeors, vertical velocity, etc. over severe convection area, and largely avoid delay of precipitation occurrence during early stage. In the system, cloud analysis constructs the initial state of cloud hydrometeors and adjusts the temperature and humidity field according to corresponding physical constraints, which mitigate the inconsistency between the microphysics and dynamics at initial time, then shorten the "spin-up" time due to the lack of the initial microphysical information. However, results with/without cloud initialization from integrations of more than 6 hours are quite similar to each other. In comparison with ECMWF analysis and radiosonde, cloud initialization can substantially improve the initial humidity analysis over the cloud areas, and result in a better position of the mesoscale vortex and low-level jet

  3. Severity of controlled cortical impact traumatic brain injury in rats and mice dictates degree of behavioral deficits.

    PubMed

    Yu, Seongjin; Kaneko, Yuji; Bae, Eunkyung; Stahl, Christine E; Wang, Yun; van Loveren, Harry; Sanberg, Paul R; Borlongan, Cesar V

    2009-09-01

    The clinical presentation of traumatic brain injury (TBI) involves either mild, moderate, or severe injury to the head resulting in long-term and even permanent disability. The recapitulation of this clinical scenario in animal models should allow examination of the pathophysiology of the trauma and its treatment. To date, only a few studies have demonstrated TBI animal models encompassing the three levels of trauma severity. Thus, in the present study we characterized in mice and rats both brain histopathologic and behavioral alterations across a range of injury magnitudes arising from mild, moderate, and severe TBI produced by controlled cortical impact injury technique. Here, we replicated the previously observed TBI severity-dependent brain damage as revealed by 2,3,5-triphenyltetrazolium chloride staining (severe > moderate > mild) in rats, but also extended this pattern of histopathologic changes in mice. Moreover, we showed severity-dependent abnormalities in locomotor and cognitive behaviors in TBI-exposed rats and mice. Taken together, these results support the use of rodent models of TBI as a sensitive platform for investigations of the injury-induced neurostructural and behavioral deficits, which should serve as key outcome parameters for testing experimental therapeutics.

  4. Impact of uterine balloon tamponade on the use of invasive procedures in severe postpartum hemorrhage.

    PubMed

    Gauchotte, Emilie; De La Torre, Manuela; Perdriolle-Galet, Estelle; Lamy, Catherine; Gauchotte, Guillaume; Morel, Olivier

    2017-07-01

    The aim of this study was to assess the impact of tamponade when uterotonic agents fail, on the need for surgery or interventional radiology. All women who received sulprostone for postpartum hemorrhage were retrospectively compared over two periods [December 2008 to December 2010 without use of tamponade (period 1) and June 2011 to June 2013 with use of tamponade (period 2)] in the case of sulprostone failure (STROBE compliant retrospective cohort study). During period 2, interventional radiology or surgery was used only in the case of tamponade failure. 165 women were included (74 for period 1, 91 for period 2). The rate of interventional radiology or surgery significantly decreased from period 1 (21 of 74 women, 28.4%) to period 2 (six of 91 women, 6.6%, p = 0.0003). The rate of assumed failure of uterotonic agents was higher for period 2: 22 of 74 women (29.7%) during period 1, and 41 of 91 (45.1%, p = 0.0439) during period 2. The success rate of tamponade was 92.1% (35 of 38 women). Although the efficacy of tamponade should be viewed in the light of its widespread use, our findings confirm that tamponade significantly reduces the need for interventional radiology or surgery for postpartum hemorrhage treatment. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Impact of Febuxostat on Renal Function in Gout Patients With Moderate-to-Severe Renal Impairment.

    PubMed

    Saag, Kenneth G; Whelton, Andrew; Becker, Michael A; MacDonald, Patricia; Hunt, Barbara; Gunawardhana, Lhanoo

    2016-08-01

    Renal impairment is a risk factor for gout and a barrier to optimal gout management. We undertook this exploratory study to obtain data that have been heretofore limited regarding the safety and efficacy of febuxostat in patients with moderate-to-severe renal impairment (estimated glomerular filtration rate [GFR] 15-50 ml/minute/1.73 m(2) ). Ninety-six gout patients with moderate-to-severe renal impairment were enrolled in a 12-month multicenter, randomized, double-blind, placebo-controlled study. Patients were randomly assigned at a 1:1:1 ratio to receive 30 mg febuxostat twice daily, 40/80 mg febuxostat once daily, or placebo. The primary efficacy end point was the change in serum creatinine (Cr) level from baseline to month 12. Secondary end points included the change in estimated GFR from baseline to month 12 and the proportion of patients with a serum uric acid (UA) level of <6.0 mg/dl at month 12. At month 12, there were no significant differences in the change in serum Cr level from baseline, or in the change in estimated GFR from baseline, in either febuxostat group compared to the placebo group. The proportion of patients with a serum UA level of <6.0 mg/dl at month 12 was significantly greater in both febuxostat groups compared to the placebo group (both P < 0.001). At least 1 treatment-emergent adverse event (TEAE) occurred in 78.1% of patients receiving 30 mg febuxostat twice daily, 87.5% of patients receiving 40/80 mg febuxostat once daily, and 78.1% of patients receiving placebo. TEAEs most frequently involved the categories of renal failure and impairment and renal function analyses. Febuxostat proved to be efficacious in serum UA reduction and was well tolerated in gout patients with moderate-to-severe renal impairment. Patients randomly assigned to receive febuxostat demonstrated significantly lower serum UA levels and no significant deterioration in renal function. © 2016, American College of Rheumatology.

  6. Different vaccination strategies in Spain and its impact on severe varicella and zoster.

    PubMed

    Gil-Prieto, Ruth; Walter, Stefan; Gonzalez-Escalada, Alba; Garcia-Garcia, Laura; Marín-García, Patricia; Gil-de-Miguel, Angel

    2014-01-03

    Varicella vaccines available in Spain were marketed in 1998 and 2003 for non-routine use. Since 2006 some regions decided to include varicella vaccination in their regional routine vaccination programmes at 15-18 months of age. Other regions chose the strategy of vaccinating susceptible adolescents. This study shows the trends in severe varicella zoster virus infections through the analysis of the hospital discharges related to varicella and herpes zoster in the general population from 2005 to 2010 in Spain. A total of 11,125 hospital discharges related to varicella and 27,736 related to herpes zoster were reported during the study period. The overall annual rate of hospitalization was 4.14 cases per 100,000 for varicella and 10.33 cases per 100,000 for herpes zoster. In children younger than 5 years old varicella hospitalization rate significantly decreased from 46.77 in 2005 to 26.55 per 100,000 in 2010. The hospitalization rate related to herpes zoster slightly increased from 9.71 in 2005 to 10.90 per 100,000 in 2010. This increase was mainly due to the significant increase occurring in the >84 age group, from 69.55 to 97.68 per 100,000. When gathering for regions taking into account varicella vaccine strategy, varicella related hospitalizations decreased significantly more in those regions which included the vaccine at 15-18 months of age as a routine vaccine comparing with those vaccinating at 10-14 years old. No significant differences were found in herpes zoster hospitalization rates regarding the varicella vaccination strategy among regions. Severe varicella infections decreased after implementation of varicella vaccination in Spain. This decrease was significantly higher in regions including the vaccine at 15-18 months of age compared with those vaccinating susceptible adolescents.

  7. Severe burn and disuse in the rat independently adversely impact body composition and adipokines

    PubMed Central

    2013-01-01

    Introduction Severe trauma is accompanied by a period of hypermetabolism and disuse. In this study, a rat model was used to determine the effects of burn and disuse independently and in combination on body composition, food intake and adipokines. Methods Male rats were assigned to four groups 1) sham ambulatory (SA), 2) sham hindlimb unloaded (SH), 3) 40% total body surface area full thickness scald burn ambulatory (BA) and 4) burn and hindlimb unloaded (BH). Animals designated to the SH and BH groups were placed in a tail traction system and their hindlimbs unloaded. Animals were followed for 14 days. Plasma, urine, fecal and tissue samples were analyzed. Results SA had a progressive increase in body mass (BM), SH and BA no change and BH a reduction. Compared to SA, BM was reduced by 10% in both SH and BA and by 17% when combined in BH. Compared to SA, all groups had reductions in lean and fat body mass with BH being greater. The decrease in lean mass was associated with the rate of urinary corticosterone excretion. The loss in fat mass was associated with decreases in plasma leptin and adiponectin and an increase in ghrelin. Following the acute response to injury, BH had a greater food intake per 100 g BM. Food intake was associated with the levels of leptin, adiponectin and ghrelin. Conclusions The effects of the combination of burn and disuse in this animal model were additive, therefore in assessing metabolic changes with severe trauma both injury and disuse should be considered. Furthermore, the observed changes in adipokines, corticosterone and ghrelin provide insights for interventions to attenuate the hypermetabolic state following injury, possibly reducing catabolism and muscle loss and subsequent adverse effects on recovery and function. PMID:24099533

  8. Injury severity assessment for car occupants in frontal impacts, using disability scaling.

    PubMed

    Norin, H; Krafft, M; Korner, J; Nygren, A; Tingvall, C

    1997-01-01

    Injury classification and assessment is one of the most important fields of injury prevention. At present, injury assessment focuses primarily on the risk of fatalities, in spite of the fact that most people who are injured survive the trauma. The net result of a fatality-based approach is that safety and vehicle engineers must make decisions with an incomplete, and sometimes misleading, picture of the traffic safety problem. By applying disability scaling reflecting long-term consequences to injury data, the most significant disabling injuries can be identified. The priorities change with the level of disability used in the scaling. In this study, the risk of permanent medical disability due to different injuries was derived and linked to abbreviated injury scale (AIS) values for 24,087 different injured body regions. This material is based on insurance data. To study how the importance of different bodily injuries changes with different severity assessments in a realistic real-world injury distribution, Swedish insurance industry disability scaling was applied to 3066 cases of belted Volvo drivers involved in frontal collisions. Crash severity was included in the study by using equivalent barrier speed (EBS). When lower levels of disability are included, injuries to the neck and the extremities become the most important, while brain and skull injuries become the most prominent at higher levels of disability. The results presented in this article should be regarded as a contribution to the development of a suitable disability scaling method. The results can also be utilized to further injury research and vehicle design aimed at reducing injuries which have the most important long-term disability consequences.

  9. The impact of inflammatory rheumatic diseases on the presentation, severity, and outcome of acute coronary syndrome.

    PubMed

    Ben-Zvi, Ilan; Goldenberg, Ilan; Matetzky, Shlomi; Grossman, Chagai; Elis, Avishay; Gavrielov-Yusim, Natalie; Livneh, Avi

    2016-01-01

    Patients with inflammatory rheumatic diseases (IRD) have a high burden of cardiovascular disease (CVD), leading to increased mortality and morbidity. However, it is not clear whether increased CVD mortality in IRD is due to a higher incidence or worse outcome of cardiovascular events (higher case fatality). In this observational case-control study, we assessed the outcome of acute coronary syndrome (ACS) in patients with IRDs compared to matched controls without IRD, using data from the Acute Coronary Syndrome Israeli Survey (ACSIS), a large, national, real-life registry detailing the extent, severity, and outcome of ACS. Of 2,193 subjects enrolled to the ACSIS, 20 (nine men) were identified with IRD, including 11 patients with rheumatoid arthritis, five patients with systemic lupus erythematosus (SLE), three patients with ankylosing spondylitis (AS), and one patient with psoriatic arthritis (PsA). The study patients were compared to 120 matched control patients (adjusted for age and risk factors for CVD) without IRD. Compared to controls, IRD patients had similar clinical presentation and similar type of ACS and received identical initial treatment at the ER. The two groups had comparable rates of complications including major adverse cardiovascular events (death, recurrent myocardial infarction, stroke, major bleeding, and definite stent thrombosis) (10 vs. 11.7% in the study and control group, respectively, p > 0.05), re-hospitalization (20 vs. 21.1%, respectively, p > 0.05), and severe congestive heart failure (7.7 vs. 6.9%, respectively, p > 0.05) within 30 days. The outcome and prognosis of ACS in patients with IRD is not worse than that of control, supporting the higher prevalence of CVD in this population as the cause for their excess mortality.

  10. The IMPACT prognosis calculator used in patients with severe traumatic brain injury treated with an ICP-targeted therapy.

    PubMed

    Olivecrona, Magnus; Koskinen, Lars-Owe D

    2012-09-01

    The prognosis of severe traumatic brain injury (sTBI) is important. The International Mission on Prognosis in Traumatic Brain Injury (IMPACT) study group has developed a prediction calculator for the outcome of patients with sTBI, and this has been made available on the World Wide Web. We have studied the use of the IMPACT calculator on sTBI patients treated with an ICP-targeted therapy based on the Lund concept. The individual clinical data of patients in a prospective sTBI protocol-driven trial of the treatment of sTBI using the Lund concept were entered into the prognosis calculator, and the individual prognosis for each patient was calculated and compared with the actual outcome at 6 months. The use of the IMPACT calculator led to an overestimation of mortality and of an unfavourable outcome. Compared with the IMPACT database, the absolute risk reduction (ARR) for mortality was 13.6 %. There is a statistically significant probability for the prediction of mortality and unfavourable outcome. A ROC curve analysis shows an area under the curve (AUC) in the Core model for mortality of 0.744 and of unfavourable outcome of 0.731, in the Extended model of 0.751 and 0.721 respectively, and in the Lab model of 0.779 and 0.810 respectively. The IMPACT prognosis calculator should be used with caution for the prediction of outcome for an individual patient with sTBI treated with an ICP-targeted therapy based on the Lund concept. We conclude that we have to initiate treatment in all patients with blunt sTBI and an initial cerebral perfusion pressure (CPP)≥10 mmHg [corrected]. It seems that the outcome in sTBI patients treated in this fashion is better than would have been expected from the IMPACT prognosis.

  11. Family impact in intellectual disability, severe mental health disorders and mental health disorders in ID. A comparison.

    PubMed

    Martorell, Almudena; Gutiérrez-Recacha, Pedro; Irazábal, Marcia; Marsà, Ferrán; García, Mercedes

    2011-01-01

    Family impact (or family burden) is a concept born in the field of mental health that has successfully been exported to the ambit of intellectual disability (ID). However, differences in family impact associated with severe mental health disorders (schizophrenia), to ID or to mental health problems in ID should be expected. Seventy-two adults with intellectual disability clients of the Carmen Pardo-Valcarce Foundation's sheltered workshops and vocational employment programmes in Madrid (Spain), 203 adults diagnosed with schizophrenia from four Spanish Community Mental Health Services (Barcelona, Madrid, Granada and Navarra) and 90 adults with mental health problems in ID (MH-ID) from the Parc Sanitari Sant Joan de Déu Health Care Site in Sant Boi de Llobregat, Barcelona (Spain) were asked to participate in the present study along with their main caregivers. Family impact experienced by caregivers was assessed with the ECFOS-II/SOFBI-II scale (Entrevista de Carga Familiar Objetiva y Subjetiva/Objective and Subjective Family Burden Interview). In global terms, results showed that the higher family impact was found between caregivers to people with MH-ID. The interaction of both conditions (ID and mental health problems) results in a higher degree of burden on families than when both conditions are presented separately. There was also an impact in caregivers to people with schizophrenia, this impact being higher than the one detected in caregivers to people with intellectual disability. Needs of caregivers to people with disability should be addressed specifically in order to effectively support families. Copyright © 2011 Elsevier Ltd. All rights reserved.

  12. Impact of cognitive function and dysarthria on spoken language and perceived speech severity in multiple sclerosis

    NASA Astrophysics Data System (ADS)

    Feenaughty, Lynda

    judged each speech sample using the perceptual construct of Speech Severity using a visual analog scale. Additional measures obtained to describe participants included the Sentence Intelligibility Test (SIT), the 10-item Communication Participation Item Bank (CPIB), and standard biopsychosocial measures of depression (Beck Depression Inventory-Fast Screen; BDI-FS), fatigue (Fatigue Severity Scale; FSS), and overall disease severity (Expanded Disability Status Scale; EDSS). Healthy controls completed all measures, with the exception of the CPIB and EDSS. All data were analyzed using standard, descriptive and parametric statistics. For the MSCI group, the relationship between neuropsychological test scores and speech-language variables were explored for each speech task using Pearson correlations. The relationship between neuropsychological test scores and Speech Severity also was explored. Results and Discussion: Topic familiarity for descriptive discourse did not strongly influence speech production or perceptual variables; however, results indicated predicted task-related differences for some spoken language measures. With the exception of the MSCI group, all speaker groups produced the same or slower global speech timing (i.e., speech and articulatory rates), more silent and filled pauses, more grammatical and longer silent pause durations in spontaneous discourse compared to reading aloud. Results revealed no appreciable task differences for linguistic complexity measures. Results indicated group differences for speech rate. The MSCI group produced significantly faster speech rates compared to the MSDYS group. Both the MSDYS and the MSCI groups were judged to have significantly poorer perceived Speech Severity compared to typically aging adults. The Task x Group interaction was only significant for the number of silent pauses. The MSDYS group produced fewer silent pauses in spontaneous speech and more silent pauses in the reading task compared to other groups. Finally

  13. The Impact of Severe Obesity on Healthcare Resource Utilisation in Spain.

    PubMed

    Espallardo, Olga; Busutil, Rafael; Torres, Antonio; Zozaya, Néboa; Villoro, Renata; Hidalgo-Vega, Álvaro

    2017-08-01

    Obesity is not only a health problem but also a source of increased monetary expenditures. The objectives of this study were to analyse the use of healthcare resources in the Spanish adult population with class II obesity and above (BMI ≥35 kg/m(2)) and to compare it with other BMI groups. We used the Spanish National Health Survey, a longitudinal population-based survey (n = 18,682), to analyse healthcare resource utilisation by BMI groups. Adjusted and unadjusted logistic regression models were used to calculate odds ratios (OR) for healthcare use among class II and over obese subjects versus normal BMI. Persons with BMI ≥35 are more likely to attend general practitioner (GP)'s consultations (17%), to visit the emergency department (26%), to consume medications (36%), to be hospitalised (49%), to require nursing consultations (61%) and to require psychology consultations (83%). The proportion of obese people receiving home visits is 2.6 times higher than among normal BMI. After controlling for sex and age groups, people with severe obesity (BMI ≥35 kg/m(2)) were more prone to requiring home care visits (OR 2.3; CI [1.3; 4.2]), GP visits (OR 2.1; CI [1.5; 3.0]), psychologist visits (OR 1.96; CI [1.3; 2.99]), emergency service visits (OR 1.5; CI [1.2; 1.8]), nurse visits (OR 1.46; CI [1.2; 1.9]) and hospitalisations (OR 1.43; CI [1.1; 1.9]) and after also adjusting for relevant comorbidities like hypertension, diabetes and cardiovascular diseases: GP visits (OR 1.85; CI [1.3; 2.7]), psychologist visits (OR 1.8; CI [1.2; 2.7]), specialised care visits (OR 0.92; CI [0.7; 1.2]) and physiotherapist visits (OR 0.7; CI [0.5; 1.0]). Severe obesity significantly increases healthcare resource utilisation in Spain. The results shed light on the real magnitude of the burden of obesity in Spain.

  14. Impacts of Regional Scale Climate Variability on the Occurrence and Severity of Drought Events

    NASA Astrophysics Data System (ADS)

    Mishra, V.; Cherkauer, K. A.

    2009-05-01

    Drought is an extreme event which is related to soil moisture patterns, precipitation and runoff. The severity and frequency of drought occurrence is related to regional climate variability. One common indicator used to express climate variability it the El Niño/Southern Oscillation (ENSO), which is related to anomalies in surface temperature and precipitation. In the present work, the effect of ENSO on drought occurrence and its severity in the Midwestern United States is examined using a reconstruction of long term soil moisture, precipitation and daily temperature extremes. The following objectives are addressed: (i) reconstruct soil moisture data using gridded daily climatological forcings for the period of 1916-2007 using the Variable Infiltration Capacity (VIC) model, (ii) estimate changes and trends associated with climate and water balance variables, (iii) identify regional scale historic (1916-2007) extreme drought events and their correlation with ENSO events and (iv) to characterize and classify extreme drought events on the basis of their correlation with ENSO and variations of water balance components. The VIC model was calibrated for monthly stream flow at five streamflow gauging stations and was then evaluated for soil moisture and its persistence, soil temperature and soil heat fluxes. After calibration and evaluation the VIC model was implemented for the full historic (1916-2007) period across the study domain. The non parametric Mann-Kendall method was used to estimate trends using the gridded climatology of precipitation and air temperature variables. Trends were also estimated for annual anomalies of soil moisture variables, snow water equivalent and total runoff. Historic agricultural drought, meteorological drought and hydrological drought events were identified using soil moisture percentiles; the Standard Precipitation Index (SPI) and the Standard Runoff Index (SRI), respectively. ENSO phase (warm event, cold event and base event) was

  15. Primary Blast Exposure Increases Hippocampal Vulnerability to Subsequent Exposure: Reducing Long-Term Potentiation.

    PubMed

    Effgen, Gwen B; Ong, Tiffany; Nammalwar, Shruthi; Ortuño, Andrea I; Meaney, David F; 'Dale' Bass, Cameron R; Morrison, Barclay

    2016-10-15

    Up to 80% of injuries sustained by U.S. soldiers in Operation Enduring Freedom and Operation Iraqi Freedom were the result of blast exposure from improvised explosive devices. Some soldiers experience multiple blasts while on duty, and it has been suggested that symptoms of repetitive blast are similar to those that follow multiple non-blast concussions, such as sport-related concussion. Despite the interest in the effects of repetitive blast exposure, it remains unknown whether an initial blast renders the brain more vulnerable to subsequent exposure, resulting in a synergistic injury response. To investigate the effect of multiple primary blasts on the brain, organotypic hippocampal slice cultures were exposed to single or repetitive (two or three total) primary blasts of varying intensities. Long-term potentiation was significantly reduced following two Level 2 (92.7 kPa, 1.4 msec, 38.5 kPa·msec) blasts delivered 24 h apart without altering basal evoked response. This deficit persisted when the interval between injuries was increased to 72 h but not when the interval was extended to 144 h. The repeated blast exposure with a 24 h interval increased microglia staining and activation significantly but did not significantly increase cell death or damage axons, dendrites, or principal cell layers. Lack of overt structural damage and change in basal stimulated neuron response suggest that injury from repetitive primary blast exposure may specifically affect long-term potentiation. Our studies suggest repetitive primary blasts can exacerbate injury dependent on the injury severity and interval between exposures.

  16. Evaluation of Severity Score in Patients with Lower Limb and Pelvic Fractures Injured in Motor Vehicle Front-Impact Collisions

    PubMed Central

    Gokalp, Mehmet Ata; Hekimoglu, Yavuz; Gozen, Abdurrahim; Guner, Savas; Asirdizer, Mahmut

    2016-01-01

    Background Lower limb and pelvic injuries and fractures occur at a very high incidence in motor vehicle accidents. In this study, the characteristics (e.g., body side, bone location, and fracture severity) of lower limb and pelvic fractures that occurred during front-impact collisions were correlated with the injured patients’ sex, age, and position in the vehicle. Material/Methods We retrospectively evaluated 191 patients (136 males, 55 females) who were injured in motor vehicle accidents, specifically in frontal collisions. Results This study revealed that most of lower limb and pelvic fractures occurred in males (71.2%; p=.000), 19–36 years old (55.5%; p=.000), small vehicles (86.4%; p=.000), and rear seat passengers (49.2%; p=.000). Fractures most commonly occurred in the left side of the body (46.6%; p=.000) and upper legs (37.7%; p=.000). Severity scores were higher (2.76) in males than females (2.07). No statistically significant was found in severity scores of patients and other personal characteristics and fracture features of patients with lower limb and pelvic fractures who were injured in a vehicle during front-impact collisions (p>0.05). Conclusions The results of this study will be useful for the automobile industry, forensics and criminal scientists, and for trauma research studies. PMID:27905350

  17. Evaluation of Severity Score in Patients with Lower Limb and Pelvic Fractures Injured in Motor Vehicle Front-Impact Collisions.

    PubMed

    Gokalp, Mehmet Ata; Hekimoglu, Yavuz; Gozen, Abdurrahim; Guner, Savas; Asirdizer, Mahmut

    2016-12-01

    BACKGROUND Lower limb and pelvic injuries and fractures occur at a very high incidence in motor vehicle accidents. In this study, the characteristics (e.g., body side, bone location, and fracture severity) of lower limb and pelvic fractures that occurred during front-impact collisions were correlated with the injured patients' sex, age, and position in the vehicle. MATERIAL AND METHODS We retrospectively evaluated 191 patients (136 males, 55 females) who were injured in motor vehicle accidents, specifically in frontal collisions. RESULTS This study revealed that most of lower limb and pelvic fractures occurred in males (71.2%; p=.000), 19-36 years old (55.5%; p=.000), small vehicles (86.4%; p=.000), and rear seat passengers (49.2%; p=.000). Fractures most commonly occurred in the left side of the body (46.6%; p=.000) and upper legs (37.7%; p=.000). Severity scores were higher (2.76) in males than females (2.07). No statistically significant was found in severity scores of patients and other personal characteristics and fracture features of patients with lower limb and pelvic fractures who were injured in a vehicle during front-impact collisions (p>0.05). CONCLUSIONS The results of this study will be useful for the automobile industry, forensics and criminal scientists, and for trauma research studies.

  18. Impact of bacterial colonization on the severity, and accompanying airway inflammation, of virus-induced wheezing in children.

    PubMed

    Yu, D; Wei, L; Zhengxiu, L; Jian, L; Lijia, W; Wei, L; Xiqiang, Y; Xiaodong, Z; Zhou, F; Enmei, L

    2010-09-01

    It is reported that bacterial colonization of the airway in neonates affects the likelihood and severity of subsequent wheezing in childhood. This study aimed to explore the impact of bacterial colonization on the severity of virus-induced wheezing, and accompanying airway inflammation. Nasopharyngeal aspirates (NPAs) from 68 hospitalized children with bronchiolitis and 85 children with recurrent wheezing were obtained. Eleven common respiratory viruses were sought by PCR and/or direct fluorescence assay. Bacteria were isolated from NPAs by routine culture methods. Cell numbers and concentrations of cytokines/chemokines in the NPAs were measured, and nucleated cells were characterized. The frequency of bacterial colonization in children with recurrent wheezing was significantly higher than in children with an initial attack of bronchiolitis. Bacterial colonization accompanying virus infection had no effect on clinical manifestations, duration of hospitalization, concentrations of cytokines/chemokines (except interleukin-10 (IL-10)) or cellularity in the children with bronchiolitis; however, among the children with recurrent wheezing, those who had coexistent non-invasive bacterial colonization and virus infection presented more frequent cyanosis, longer duration of hospitalization, a higher concentration of IL-10 and a higher percentage of neutrophils in NPAs than those with virus infection but without bacterial colonization. Bacterial colonization was common in children with virus-induced wheezing, particularly in the situation of recurrent wheezing. To some extent, bacterial colonization accompanying virus infection may contribute to the severity of the wheezing because of its impact on airway inflammation.

  19. Impact of injection drug use on distribution and severity of chronic venous disorders

    PubMed Central

    Pieper, Barbara; Templin, Thomas N.; Kirsner, Robert S.; Birk, Thomas J.

    2009-01-01

    We examined chronic venous disorders (CVD) in persons who injected illicit drugs. The study design was cross-sectional, comparative stratified by age, gender, ethnicity, as well as by three types of drug use (noninjection; arm or upper body injection only; and legs with or without upper body injection). Subjects completed demographic, health, and substances abuse questionnaires and were evaluated using the clinical component of the Clinical-Etiology-Anatomy-Pathophysiology Classification. Seven hundred and thirteen participants were evaluated. Those who injected in the legs ± arms had significantly worse CVD. Thirty-nine percent of leg ± arm injectors vs. 4.2% or noninjectors or arm only injectors had moderate to severe CVD. Persons who injected in the legs ± arms were 9.14 times more likely to develop venous ulcers than those that injected in the arms and upper body only and 34.64 times more likely as those who never injected. CVD was associated with injecting in the groin, legs and feet as compared with other sites. The pattern of disorders associated with leg injection is consistent with the underlying pathology of chronic venous insufficiency. PMID:19614913

  20. Impact of several reactor features on TF coil design for TPSS

    SciTech Connect

    Miller, J.R.; Bulmer, R.H.

    1986-03-26

    A significant driver of machine size in previous designs was the amount of nuclear shielding placed between the blanket and the toroidal field (TF) coils to minimize the radiation heating and damage in these critical components. Of course the total amount of shielding is not arbitrary; it certainly must adequately suppress radiation outside the plant. However, if all of this shielding were contained inside the TF coils, several parameters (coil size and weight, maximum field at the windings, stored energy, etc.) would become inordinately large. Reducing the amount of shielding inside the TF coils and allowing the radiation load to climb to less ''conventional'' levels could pay big benefits in reducing the machine size, so long as the damage and heat load remain tolerable. Recent studies indicate that superconducting windings in TF coils can accept much higher heat loads than have been previously considered and simultaneously can be designed with higher than conventional current densities. The purpose of the present exercise is to probe the limits of acceptable radiation levels in relation to winding pack current densities in the TF coils for reactor relevant designs.

  1. Thermochemistry of Ruthenium Oxyhydroxide Species and Their Impact on Volatile Speciations in Severe Nuclear Accident Conditions.

    PubMed

    Miradji, Faoulat; Virot, François; Souvi, Sidi; Cantrel, Laurent; Louis, Florent; Vallet, Valérie

    2016-02-04

    Literature thermodynamic data of ruthenium oxyhydroxides reveal large uncertainties in some of the standard enthalpies of formation, motivating the use of high-level relativistic correlated quantum chemical methods to reduce the level of discrepancies. Reaction energies leading to the formation of all possible oxyhydroxide species RuOx(OH)y(H2O)z have been calculated for a series of reactions combining DFT (TPSSh-5%HF) geometries and partition functions, CCSD(T) energies extrapolated to the complete basis set limits. The highly accurate ab initio thermodynamic data were used as input data of thermodynamic equilibrium computations to derive the speciation of gaseous ruthenium species in the temperature, pressure and concentration conditions of severe nuclear accidents occurring in pressurized water reactors. At temperatures lower than 1000 K, gaseous ruthenium tetraoxide is the dominating species, between 1000 and 2000 K ruthenium trioxide becomes preponderant, whereas at higher temperatures gaseous ruthenium oxide, dioxide and even Ru in gaseous phase are formed. Although earlier studies predicted the formation of oxyhydroxides in significant quantities, the use of highly accurate ab initio thermodynamic data for ruthenium gaseous species leads to a more reliable inventory of gaseous ruthenium species in which gaseous oxyhydroxide ruthenium molecules are formed only in negligible amounts.

  2. Impact of several water-miscible organic solvents on sorption of benzoic acid by soil

    SciTech Connect

    Lee, L.S.; Rao, P.S.C.

    1996-05-01

    Sorption of benzoic acid by a surface soil was measured from several binary mixtures of water and various organic cosolvents spanning a wide range in solvent properties. For all solvents investigated, the addition to an aqueous solution resulted in an increase in solubility and an alkaline shift in the conditional ionization constant (pK{sub a}{sup c}) of benzoic acid. Sorption data were assessed using a cosolvency model that incorporated speciation of the organic acid as determined by the pK{sub a}{sup c} and soil-solution pH. The model provided reasonable predictions of the sorption trends observed from acetone/water, acetonitrile/ water, and 1,4-dioxane/water solutions. However, enhanced sorption observed from DMSO/water solutions was not well described by the cosolvency model similar to what was previously observed for the sorption of carboxylic acids from methanol/water solutions. The relative importance of cosolvent properties and various solvent-specific mechanisms is discussed. Hydrogen bonding along with preferential solvation are hypothesized as the primary mechanisms responsible for the observed deviations from the model. 36 refs., 5 figs., 1 tab.

  3. Impact of ultrasonic time on hot water elution of severely biodegraded heavy oil from weathered soils.

    PubMed

    Ji, Guodong; Sui, Xin

    2010-07-15

    An ultrasound-enhanced elution system employing water at a temperature of 70 degrees C was used to remedy weathered soils contaminated with severely biodegraded heavy oil (SBHO). The effect of varying the ultrasonic irradiation time from 0 to 1800 s on the elution of SBHO and three characteristic biomarkers (C(26-34) 17alpha 25-norhopanes, C(26-28) TAS, and C(27-29) MTAS) was analyzed using GC/MS, scanning electron microscopy (SEM), and X-ray diffraction (XRD). Elution of the three biomarkers was closely related to the carbon number of the marker. C(26-34) 17alpha 25-norhopanes and C(26-28) TAS species with higher carbon numbers and C(27-29) MTAS species with lower carbon numbers were more readily eluted using sonication times of 1080-1800 s, while smaller TAS homologs were more readily eluted after sonication times of 0-360 s. SEM images of samples treated for longer periods revealed larger "bare patches" on the soil surface. The results of XRD and energy spectroscopy experiments indicated that ultrasound irradiation for 1080 s negatively affected the deposition of CaCO(3), but overall improved the mineral and chemical compositions of treated soils and removal of SBHO.

  4. Mercury exposure and neurochemical impacts in bald eagles across several Great Lakes states.

    PubMed

    Rutkiewicz, Jennifer; Nam, Dong-Ha; Cooley, Thomas; Neumann, Kay; Padilla, Irene Bueno; Route, William; Strom, Sean; Basu, Niladri

    2011-10-01

    In this study, we assessed mercury (Hg) exposure in several tissues (brain, liver, and breast and primary feathers) in bald eagles (Haliaeetus leucocephalus) collected from across five Great Lakes states (Iowa, Michigan, Minnesota, Ohio, and Wisconsin) between 2002-2010, and assessed relationships between brain Hg and neurochemical receptors (NMDA and GABA(A)) and enzymes (glutamine synthetase (GS) and glutamic acid decarboxylase (GAD)). Brain total Hg (THg) levels (dry weight basis) averaged 2.80 μg/g (range: 0.2-34.01), and levels were highest in Michigan birds. THg levels in liver (r(p) = 0.805) and breast feathers (r(p) = 0.611) significantly correlated with those in brain. Brain Hg was not associated with binding to the GABA(A) receptor. Brain THg and inorganic Hg (IHg) were significantly positively correlated with GS activity (THg r(p) = 0.190; IHg r(p) = 0.188) and negatively correlated with NMDA receptor levels (THg r(p) = -0245; IHg r(p) = -0.282), and IHg was negatively correlated with GAD activity (r(s) = -0.196). We also report upon Hg demethylation and relationships between Hg and Se in brain and liver. These results suggest that bald eagles in the Great Lakes region are exposed to Hg at levels capable of causing subclinical neurological damage, and that when tissue burdens are related to proposed avian thresholds approximately 14-27% of eagles studied here may be at risk.

  5. 'Biohyets': a method for displaying the extent and severity of environmental impacts.

    PubMed

    Read, John L; Kovac, Kelli-Jo; Fatchen, Tim J

    2005-10-01

    Bioindicators are often more sensitive indicators of both biodiversity and environmental change than abiotic pollution parameters. The responses of selected plants and animals to anthropogenic insults can be used to assess environmental responses at a variety of spatial and temporal scales. This study maps the response of key reptile, mammal, bird and plant species to airborne contaminants around a large mine and mineral processing operation at Olympic Dam in arid Australia. The responses of different bioindicators should ideally be integrated in order to comprehend overall trends in biological integrity adjacent to pollution sources. Assimilation of different bioindicator responses allows greater precision and geographic coverage of the monitored region and reduces potential distortion from unrelated biological or monitoring responses of individual indicator groups. A single, integrated measure of ecosystem health that overlays the responses of otherwise incompatible datasets, is also of more value to industrial operators and environmental regulators than several disparate responses. Biohyets, which are the contours of bioindicator index values derived from multiple biotic measurements, are here used to map variability in ecosystem health and to identify regions, response variables and disturbance parameters for more rigorous analysis.

  6. Impact of bacteria in nasal aspirates on disease severity of bronchiolitis.

    PubMed

    Jiang, Wujun; Wang, Ting; Li, Li; Ji, Wei; Wang, Yuqing; Yan, Yongdong

    2016-01-01

    The effect of potentially pathogenic bacteria (PPB) on disease severity in patients with bronchiolitis is understudied. This prospective study was carried out in the Children's Hospital of Soochow University during the 2012-2013 autumn and winter seasons. We enrolled consecutive children < 2 years of age hospitalized with an attending physician's diagnosis of bronchiolitis. Nasopharyngeal aspirate samples were tested for multiple respiratory viruses and cultured for Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus. In all, 30% (188 patients) were positive for Strep. pneumoniae, H. influenzae, M. catarrhalis, and Staph. aureus. Length of stay (LOS) for patients with PPB was 4.0 days (interquartile range, IQR, 25th-75th percentile: 3.0-6.0 days) versus 3.0 days (IQR, 3.0-5.0 days) for patients without PPB (p < 0.001). However, requirement and duration of supplemental oxygen were not significantly different between the two groups. H. influenzae was an independent risk factor for hospital LOS ≥ 5.0 days (adjusted odds ratio, 1.75; 95% confidence interval, 1.06-2.91). The presence of PPB was not associated with increased risk of supplemental oxygen requirement. Our study demonstrated that pediatricians should evaluate for PPB in patients with bronchiolitis, especially when they present with RSV infection, fever or percentage of neutrophils > 40%. The presence of H. influenzae in nasal aspirates is associated with longer LOS in patients with bronchiolitis.

  7. Impact of a modern firefighting protective uniform on the incidence and severity of burn injuries in New York City firefighters.

    PubMed

    Prezant, D J; Kelly, K J; Malley, K S; Karwa, M L; McLaughlin, M T; Hirschorn, R; Brown, A

    1999-06-01

    The New York City Fire Department (FDNY) is the largest fire department in the United States, with over 11,000 firefighters. In 1994, FDNY changed to a modern firefighting protective uniform. The major difference between traditional and modern uniforms is that modern uniforms include both protective over-coat and over-pant, whereas traditional uniforms include only the over-coat. Furthermore, modern uniforms are manufactured using improved thermal protective textiles that meet or exceed current National Fire Protection Association standards for structural firefighting. The purpose of this study was to determine the impact of the modern uniform on the incidence and severity of FDNY burn injuries. We also evaluated the incidence and severity of other non-burn injuries to determine whether there was serious adverse impact. The number of lower-extremity burns decreased by 85% when 2 years' experience while wearing the modern uniform was compared with 2 years while wearing the traditional uniform. Upper-extremity burns and head burns decreased by 65% and 40%, respectively. Severity indicators (days lost to medical leave, hospital admissions, and skin grafts) for lower- and upper-extremity burn injuries were all substantially reduced. This occurred without significant change in the incidence or severity of trunk burns, heat exhaustion, inhalation injuries (actually decreased), or cardiac events. The reduction in the incidence and severity of burn injuries, the major occupational injury affecting this workforce, has been so dramatic and without untoward effects that the introduction of the modern uniform must be characterized as a sentinel event in the history of firefighter health and safety.

  8. Blast overpressure induced axonal injury changes in rat brainstem and spinal cord.

    PubMed

    Kallakuri, Srinivasu; Purkait, Heena S; Dalavayi, Satya; VandeVord, Pamela; Cavanaugh, John M

    2015-01-01

    Blast induced neurotrauma has been the signature wound in returning soldiers from the ongoing wars in Iraq and Afghanistan. Of importance is understanding the pathomechansim(s) of blast overpressure (OP) induced axonal injury. Although several recent animal models of blast injury indicate the neuronal and axonal injury in various brain regions, animal studies related to axonal injury in the white matter (WM) tracts of cervical spinal cord are limited. The purpose of this study was to assess the extent of axonal injury in WM tracts of cervical spinal cord in male Sprague Dawley rats subjected to a single insult of blast OP. Sagittal brainstem sections and horizontal cervical spinal cord sections from blast and sham animals were stained by neurofilament light (NF-L) chain and beta amyloid precursor protein immunocytochemistry and observed for axonal injury changes. Observations from this preliminary study demonstrate axonal injury changes in the form of prominent swellings, retraction bulbs, and putative signs of membrane disruptions in the brainstem and cervical spinal cord WM tracts of rats subjected to blast OP. Prominent axonal injury changes following the blast OP exposure in brainstem and cervical spinal WM tracts underscores the need for careful evaluation of blast induced injury changes and associated symptoms. NF-L immunocytochemistry can be considered as an additional tool to assess the blast OP induced axonal injury.

  9. Blast overpressure induced axonal injury changes in rat brainstem and spinal cord

    PubMed Central

    Kallakuri, Srinivasu; Purkait, Heena S.; Dalavayi, Satya; VandeVord, Pamela; Cavanaugh, John M.

    2015-01-01

    Introduction: Blast induced neurotrauma has been the signature wound in returning soldiers from the ongoing wars in Iraq and Afghanistan. Of importance is understanding the pathomechansim(s) of blast overpressure (OP) induced axonal injury. Although several recent animal models of blast injury indicate the neuronal and axonal injury in various brain regions, animal studies related to axonal injury in the white matter (WM) tracts of cervical spinal cord are limited. Objective: The purpose of this study was to assess the extent of axonal injury in WM tracts of cervical spinal cord in male Sprague Dawley rats subjected to a single insult of blast OP. Materials and Methods: Sagittal brainstem sections and horizontal cervical spinal cord sections from blast and sham animals were stained by neurofilament light (NF-L) chain and beta amyloid precursor protein immunocytochemistry and observed for axonal injury changes. Results: Observations from this preliminary study demonstrate axonal injury changes in the form of prominent swellings, retraction bulbs, and putative signs of membrane disruptions in the brainstem and cervical spinal cord WM tracts of rats subjected to blast OP. Conclusions: Prominent axonal injury changes following the blast OP exposure in brainstem and cervical spinal WM tracts underscores the need for careful evaluation of blast induced injury changes and associated symptoms. NF-L immunocytochemistry can be considered as an additional tool to assess the blast OP induced axonal injury. PMID:26752889

  10. Impact of ixekizumab on psoriasis itch severity and other psoriasis symptoms: Results from 3 phase III psoriasis clinical trials.

    PubMed

    Kimball, Alexandra B; Luger, Thomas; Gottlieb, Alice; Puig, Luis; Kaufmann, Roland; Nikaï, Enkeleida; Zhu, Baojin; Edson-Heredia, Emily; Carlier, Hilde; Lin, Chen-Yen; Goldblum, Orin; Yosipovitch, Gil

    2016-12-01

    Itch is a prevalent symptom of psoriasis that impacts quality of life. We sought to describe improvements in itch severity, skin pain, and bothersomeness of skin appearance caused by psoriasis among patients who received ixekizumab, etanercept, or placebo in three 12-week, phase III clinical trials (UNCOVER-1, -2, and -3). The itch numeric rating scale evaluated psoriasis itch severity in all 3 trials. Skin pain was assessed by skin pain visual analog scale. Bothersomeness because of redness/discoloration, thickness, and scaling/flaking was assessed with the Psoriasis Skin Appearance Bothersomeness instrument. Psoriasis skin appearance bothersomeness and skin pain were assessed at baseline and week 12; itch numeric rating scale score was assessed at baseline and weeks 1, 2, 4, 8, and 12. Patients who received ixekizumab demonstrated statistically significant improvements (P < .001) in itch severity, reduction in skin pain, and degree of bothersomeness compared with those who received etanercept or placebo. Clinically meaningful improvements in itch severity were achieved as early as week 1. Longer-term evaluations of psoriasis symptom improvement with ixekizumab treatment are needed. After treatment with ixekizumab, patients reported fast, significant, and clinically meaningful improvements in itch severity and other psoriasis-related symptoms such as skin pain and skin appearance bothersomeness. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Severity of Acute Respiratory Distress Syndrome in haematology patients: long-term impact and early predictive factors.

    PubMed

    Lagier, D; Platon, L; Chow-Chine, L; Sannini, A; Bisbal, M; Brun, J-P; Blache, J-L; Faucher, M; Mokart, D

    2016-09-01

    Severe forms of acute respiratory distress syndrome in patients with haematological diseases expose clinicians to specific medical and ethical considerations. We prospectively followed 143 patients with haematological malignancies, and whose lungs were mechanically ventilated for more than 24 h, over a 5-y period. We sought to identify prognostic factors of long-term outcome, and in particular to evaluate the impact of the severity of acute respiratory distress syndrome in these patients. A secondary objective was to identify the early (first 48 h from ICU admission) predictive factors for acute respiratory distress syndrome severity. An evolutive haematological disease (HR 1.71; 95% CI 1.13-2.58), moderate to severe acute respiratory distress syndrome (HR 1.81; 95% CI 1.13-2.69) and need for renal replacement therapy (HR 2.24; 95% CI 1.52-3.31) were associated with long-term mortality. Resolution of neutropaenia during ICU stay (HR 0.63; 95% CI 0.42-0.94) and early microbiological documentation (HR 0.62; 95% CI 0.42-0.91) were associated with survival. The extent of pulmonary infiltration observed on the first chest X-ray and the diagnosis of invasive fungal infection were the most relevant early predictive factors of the severity of acute respiratory distress syndrome. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

  12. The impact of non-severe burn injury on cardiac function and long-term cardiovascular pathology.

    PubMed

    O'Halloran, Emily; Shah, Amit; Dembo, Lawrence; Hool, Livia; Viola, Helena; Grey, Christine; Boyd, James; O'Neill, Tomas; Wood, Fiona; Duke, Janine; Fear, Mark

    2016-10-03

    Severe burn injury significantly affects cardiovascular function for up to 3 years. However, whether this leads to long-term pathology is unknown. The impact of non-severe burn injury, which accounts for over 80% of admissions in developed countries, has not been investigated. Using a rodent model of non-severe burn injury with subsequent echocardiography we showed significantly increased left ventricular end systolic diameter (LVESD) and ventricular wall thickness at up to 3 months post-injury. Use of propranolol abrogated the changes in cardiac measures observed. Subsequently we investigated changes in a patient cohort with non-severe injury. Echocardiography measured at baseline and at 3 months post-injury showed increased LVESD at 3 months and significantly decreased posterior wall diameter. Finally, 32 years of Western Australian hospital records were used to investigate the incidence of cardiovascular disease admissions after burn injury. People who had experienced a burn had increased hospital admissions and length of stay for cardiovascular diseases when compared to a matched uninjured cohort. This study presents animal, patient and population data that strongly suggest non-severe burn injury has significant effects on cardiovascular function and long-term morbidity in some burn patients. Identification of patients at risk will promote better intervention and outcomes for burn patients.

  13. The impact of non-severe burn injury on cardiac function and long-term cardiovascular pathology

    PubMed Central

    O’Halloran, Emily; Shah, Amit; Dembo, Lawrence; Hool, Livia; Viola, Helena; Grey, Christine; Boyd, James; O’Neill, Tomas; Wood, Fiona; Duke, Janine; Fear, Mark

    2016-01-01

    Severe burn injury significantly affects cardiovascular function for up to 3 years. However, whether this leads to long-term pathology is unknown. The impact of non-severe burn injury, which accounts for over 80% of admissions in developed countries, has not been investigated. Using a rodent model of non-severe burn injury with subsequent echocardiography we showed significantly increased left ventricular end systolic diameter (LVESD) and ventricular wall thickness at up to 3 months post-injury. Use of propranolol abrogated the changes in cardiac measures observed. Subsequently we investigated changes in a patient cohort with non-severe injury. Echocardiography measured at baseline and at 3 months post-injury showed increased LVESD at 3 months and significantly decreased posterior wall diameter. Finally, 32 years of Western Australian hospital records were used to investigate the incidence of cardiovascular disease admissions after burn injury. People who had experienced a burn had increased hospital admissions and length of stay for cardiovascular diseases when compared to a matched uninjured cohort. This study presents animal, patient and population data that strongly suggest non-severe burn injury has significant effects on cardiovascular function and long-term morbidity in some burn patients. Identification of patients at risk will promote better intervention and outcomes for burn patients. PMID:27694999

  14. Disaster Metrics: A Proposed Quantitative Assessment Tool in Complex Humanitarian Emergencies - The Public Health Impact Severity Scale (PHISS)

    PubMed Central

    Bayram, Jamil D.; Kysia, Rashid; Kirsch, Thomas D.

    2012-01-01

    Background: Complex Humanitarian Emergencies (CHE) result in rapid degradation of population health and quickly overwhelm indigenous health resources. Numerous governmental, non-governmental, national and international organizations and agencies are involved in the assessment of post-CHE affected populations. To date, there is no entirely quantitative assessment tool conceptualized to measure the public health impact of CHE. Methods: Essential public health parameters in CHE were identified based on the Sphere Project "Minimum Standards", and scoring rubrics were proposed based on the prevailing evidence when applicable. Results: 12 quantitative parameters were identified, representing the four categories of “Minimum Standards for Disaster Response” according to the Sphere Project; health, shelter, food and nutrition, in addition to water and sanitation. The cumulative tool constitutes a quantitative scale, referred to as the Public Health Impact Severity Scale (PHISS), and the score on this scale ranges from a minimum of 0 to a maximum of 100. Conclusion: Quantitative measurement of the public health impact of CHE is germane to accurate assessment, in order to identify the scale and scope of the critical response required for the relief efforts of the affected populations. PHISS is a new conceptual metric tool, proposed to add an objective quantitative dimension to the post-CHE assessment arsenal. PHISS has not yet been validated, and studies are needed with prospective data collection to test its validity, feasibility and reliability. Citation: Bayram JD, Kysia R, Kirsch TD. Disaster Metrics: A Proposed Quantitative Assessment Tool in Complex Humanitarian Emergencies – The Public Health Impact Severity Scale (PHISS). PLOS Currents Disasters. 2012 Aug 21. doi: 10.1371/4f7b4bab0d1a3. PMID:22984643

  15. Disaster Metrics: A Proposed Quantitative Assessment Tool in Complex Humanitarian Emergencies - The Public Health Impact Severity Scale (PHISS).

    PubMed

    Bayram, Jamil D; Kysia, Rashid; Kirsch, Thomas D

    2012-08-21

    Complex Humanitarian Emergencies (CHE) result in rapid degradation of population health and quickly overwhelm indigenous health resources. Numerous governmental, non-governmental, national and international organizations and agencies are involved in the assessment of post-CHE affected populations. To date, there is no entirely quantitative assessment tool conceptualized to measure the public health impact of CHE. Essential public health parameters in CHE were identified based on the Sphere Project "Minimum Standards", and scoring rubrics were proposed based on the prevailing evidence when applicable. 12 quantitative parameters were identified, representing the four categories of "Minimum Standards for Disaster Response" according to the Sphere Project; health, shelter, food and nutrition, in addition to water and sanitation. The cumulative tool constitutes a quantitative scale, referred to as the Public Health Impact Severity Scale (PHISS), and the score on this scale ranges from a minimum of 0 to a maximum of 100. Quantitative measurement of the public health impact of CHE is germane to accurate assessment, in order to identify the scale and scope of the critical response required for the relief efforts of the affected populations. PHISS is a new conceptual metric tool, proposed to add an objective quantitative dimension to the post-CHE assessment arsenal. PHISS has not yet been validated, and studies are needed with prospective data collection to test its validity, feasibility and reliability. Bayram JD, Kysia R, Kirsch TD. Disaster Metrics: A Proposed Quantitative Assessment Tool in Complex Humanitarian Emergencies - The Public Health Impact Severity Scale (PHISS). PLOS Currents Disasters. 2012 Aug 21. doi: 10.1371/4f7b4bab0d1a3.

  16. Analyzing the impact of severe tropical cyclone Yasi on public health infrastructure and the management of noncommunicable diseases.

    PubMed

    Ryan, Benjamin J; Franklin, Richard C; Burkle, Frederick M; Watt, Kerrianne; Aitken, Peter; Smith, Erin C; Leggat, Peter

    2015-02-01

    Traditionally, post disaster response activities have focused on immediate trauma and communicable diseases. In developed countries such as Australia, the post disaster risk for communicable disease is low. However, a "disease transition" is now recognized at the population level where noncommunicable diseases (NCDs) are increasingly documented as a post disaster issue. This potentially places an extra burden on health care resources and may have implications for disaster-management systems. With increasing likelihood of major disasters for all sectors of global society, there is a need to ensure that health systems, including public health infrastructure (PHI), can respond properly. Problem There is limited peer-reviewed literature on the impact of disasters on NCDs. Research is required to better determine both the impact of NCDs post disaster and their impact on PHI and disaster-management systems. A literature review was used to collect and analyze data on the impact of the index case event, Australia's Severe Tropical Cyclone Yasi (STC Yasi), on PHI and the management of NCDs. The findings were compared with data from other world cyclone events. The databases searched were MEDLINE, CINAHL, Google Scholar, and Google. The date range for the STC Yasi search was January 26, 2011 through May 2, 2013. No time limits were applied to the search from other cyclone events. The variables compared were tropical cyclones and their impacts on PHI and NCDs. The outcome of interest was to identify if there were trends across similar world events and to determine if this could be extrapolated for future crises. This research showed a tropical cyclone (including a hurricane and typhoon) can impact PHI, for instance, equipment (oxygen, syringes, and medications), services (treatment and care), and clean water availability/access that would impact both the treatment and management of NCDs. The comparison between STC Yasi and worldwide tropical cyclones found the challenges faced

  17. Factors associated with quality of life in patients with severe asthma: the impact of pharmacotherapy

    PubMed Central

    Souza, Daiane Silva; Noblat, Lúcia de Araújo Costa Beisl; Santos, Pablo de Moura

    2015-01-01

    ABSTRACT OBJECTIVE: To identify, characterize, and quantify associations of various factors with quality of life (QoL) in patients with asthma, according to the pharmacotherapy employed. METHODS: This was a cross-sectional study involving 49 patients (≥ 18 years of age) with severe uncontrolled or refractory asthma treated at a specialized outpatient clinic of the Brazilian Unified Health Care System, regularly using high doses of inhaled corticosteroids (ICs) or other medications, and presenting comorbidities. At a single time point, QoL was assessed with the Asthma Quality of Life Questionnaire (AQLQ). The overall AQLQ score and those of its domains were correlated with demographic variables (gender and age); Asthma Control Questionnaire score; pharmacotherapy (initial IC dose, inhaler devices, and polytherapy); and comorbidities. RESULTS: Better AQLQ scores were associated with asthma control-overall (OR = 0.38; 95% CI: 0.004-0.341; p < 0.001), "symptoms" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001), and "emotional function" domain (OR = 0.086; 95% CI: 0.016-0.476; p = 0.001)-and with IC dose ≤ 800 µg-"activity limitation" domain (OR = 0.249; 95% CI: 0.070-0.885; p = 0.029). Worse AQLQ scores were associated with polytherapy-"activity limitation" domain (OR = 3.651; 95% CI: 1.061-12.561; p = 0.036)-and number of comorbidities ≤ 5-"environmental stimuli" domain (OR = 5.042; 95% CI: 1.316-19.317; p = 0.015). CONCLUSIONS: Our results, the importance of this issue, and the lack of studies taking pharmacotherapy into consideration warrant longitudinal studies to establish a causal relationship between the identified factors and QoL in asthma patients. PMID:26785957

  18. Copper Oxide Nanoparticles Impact Several Toxicological Endpoints and Cause Neurodegeneration in Caenorhabditis elegans.

    PubMed

    Mashock, Michael J; Zanon, Tyler; Kappell, Anthony D; Petrella, Lisa N; Andersen, Erik C; Hristova, Krassimira R

    2016-01-01

    Engineered nanoparticles are becoming increasingly incorporated into technology and consumer products. In 2014, over 300 tons of copper oxide nanoparticles were manufactured in the United States. The increased production of nanoparticles raises concerns regarding the potential introduction into the environment or human exposure. Copper oxide nanoparticles commonly release copper ions into solutions, which contribute to their toxicity. We quantified the inhibitory effects of both copper oxide nanoparticles and copper sulfate on C. elegans toxicological endpoints to elucidate their biological effects. Several toxicological endpoints were analyzed in C. elegans, including nematode reproduction, feeding behavior, and average body length. We examined three wild C. elegans isolates together with the Bristol N2 laboratory strain to explore the influence of different genotypic backgrounds on the physiological response to copper challenge. All strains exhibited greater sensitivity to copper oxide nanoparticles compared to copper sulfate, as indicated by reduction of average body length and feeding behavior. Reproduction was significantly reduced only at the highest copper dose, though still more pronounced with copper oxide nanoparticles compared to copper sulfate treatment. Furthermore, we investigated the effects of copper oxide nanoparticles and copper sulfate on neurons, cells with known vulnerability to heavy metal toxicity. Degeneration of dopaminergic neurons was observed in up to 10% of the population after copper oxide nanoparticle exposure. Additionally, mutants in the divalent-metal transporters, smf-1 or smf-2, showed increased tolerance to copper exposure, implicating both transporters in copper-induced neurodegeneration. These results highlight the complex nature of CuO nanoparticle toxicity, in which a nanoparticle-specific effect was observed in some traits (average body length, feeding behavior) and a copper ion specific effect was observed for other traits

  19. Impact of HIV severity on cognitive and adaptive functioning during childhood and adolescence.

    PubMed

    Smith, Renee; Chernoff, Miriam; Williams, Paige L; Malee, Kathleen M; Sirois, Patricia A; Kammerer, Betsy; Wilkins, Megan; Nichols, Sharon; Mellins, Claude; Usitalo, Ann; Garvie, Patricia; Rutstein, Richard

    2012-06-01

    The influence of disease severity on cognitive and adaptive functioning in perinatally HIV-infected youth with (PHIV+/C) and without (PHIV+/NoC) a previous AIDS-defining illness (Centers for Disease Control and Prevention Class C event), compared with perinatally HIV-exposed but uninfected youth (PHEU) is not well understood. This was a cross-sectional analysis of cognitive and adaptive functioning in PHIV+/C (n = 88), PHIV+/NoC (n = 270) and PHEU (n = 200) youth aged 7-16 years, from a multisite prospective cohort study. Youth and caregivers completed the Wechsler Intelligence Scale for Children, Fourth Edition and the Adaptive Behavior Assessment System, Second Edition, respectively. We compared means and rates of impairment between groups, and examined associations with other psychosocial factors. Overall mean scores on measures of cognitive and adaptive functioning were in the low average range for all 3 groups. After adjustment for covariates, mean full-scale intelligence quotient scores were significantly lower for the PHIV+/C group than the PHIV+/NoC and PHEU groups (mean = 77.8 versus 83.4 and 83.3, respectively), whereas no significant differences were observed between the PHEU and PHIV+/NoC groups in any domain. Lower cognitive performance for the PHIV+/C group was primarily attributable to a prior diagnosis of encephalopathy. No significant differences between groups were observed in adaptive functioning. For long-term survivors, youth with HIV infection and a prior Centers for Disease Control and Prevention Class C event have higher risk for cognitive but not adaptive impairment regardless of current health status; this finding appears attributable to a previous diagnosis of encephalopathy. Early preventive therapy may be critical in reducing risk of later neurodevelopmental impairments.

  20. Impact of climate change on mean groundwater residence time in several Mediterranean Spanish aquifers

    NASA Astrophysics Data System (ADS)

    Pulido-Velazquez, David; Marín-Lechado, Carlos; Martos-Rosillo, Sergio; Collados-Lara, Antonio-Juan; Ruíz-Constan, Ana

    2017-04-01

    The mean residence time in an aquifer, also known as natural turnover time or renewable period, can be obtained as the relation (R / St) between its storage capacity (St) and its recharge (R). It is an excellent indicator of the aquifer response capacity to its exploitation. Aquifers in which R is close to St values are extremely vulnerable to exploitation, even when it is less than the average recharge. This is especially relevant in Mediterranean climate areas, where long and intensive drought periods appear and will be exacerbated in future scenarios of global change. The natural turnover time depends on the recharge and the Global Change can produce important changes on it in the future. In this research we propose a method for a detailed estimation of natural turnover time by combining detailed 3D geological modelling of the case studies, estimated fields of specific yield for the aquifers (based on the analysis of multiple field sample), and rainfall-recharge models in several aquifer with different ratios of natural turnover time. These detailed 3D geological models have been defined by integrating information coming from seismic profiles, boreholes, magnetotelluric, electromagnetic and electrical sounding, digital elevation models, previous geological maps and new structural dates. They also allow us to deduce the reserve curve as a function of the elevation. On the other hand, different ensemble and downscaling techniques will be used to define potential future global climate change scenarios for the test-regions based on the data coming from simulations with different Regional Circulation Models (RCMs). These precipitation and temperature scenarios will be employed to feed the previously calibrated rainfall-recharge models in order to estimated future recharge and turnover time values. The methodology applied in this work could be a tool of special interest to identify at regional level which aquifers are most vulnerable to exploitation considering

  1. Copper Oxide Nanoparticles Impact Several Toxicological Endpoints and Cause Neurodegeneration in Caenorhabditis elegans

    PubMed Central

    Zanon, Tyler; Kappell, Anthony D.; Petrella, Lisa N.; Andersen, Erik C.; Hristova, Krassimira R.

    2016-01-01

    Engineered nanoparticles are becoming increasingly incorporated into technology and consumer products. In 2014, over 300 tons of copper oxide nanoparticles were manufactured in the United States. The increased production of nanoparticles raises concerns regarding the potential introduction into the environment or human exposure. Copper oxide nanoparticles commonly release copper ions into solutions, which contribute to their toxicity. We quantified the inhibitory effects of both copper oxide nanoparticles and copper sulfate on C. elegans toxicological endpoints to elucidate their biological effects. Several toxicological endpoints were analyzed in C. elegans, including nematode reproduction, feeding behavior, and average body length. We examined three wild C. elegans isolates together with the Bristol N2 laboratory strain to explore the influence of different genotypic backgrounds on the physiological response to copper challenge. All strains exhibited greater sensitivity to copper oxide nanoparticles compared to copper sulfate, as indicated by reduction of average body length and feeding behavior. Reproduction was significantly reduced only at the highest copper dose, though still more pronounced with copper oxide nanoparticles compared to copper sulfate treatment. Furthermore, we investigated the effects of copper oxide nanoparticles and copper sulfate on neurons, cells with known vulnerability to heavy metal toxicity. Degeneration of dopaminergic neurons was observed in up to 10% of the population after copper oxide nanoparticle exposure. Additionally, mutants in the divalent-metal transporters, smf-1 or smf-2, showed increased tolerance to copper exposure, implicating both transporters in copper-induced neurodegeneration. These results highlight the complex nature of CuO nanoparticle toxicity, in which a nanoparticle-specific effect was observed in some traits (average body length, feeding behavior) and a copper ion specific effect was observed for other traits

  2. Blast-induced Mild Traumatic Brain Injury

    DTIC Science & Technology

    2010-01-01

    hemorrhagic lesions including intraparenchymal, subdural, and subarachnoid bleeding. Blast injury also induces a variety of histological effects...and microscopic intracerebral, subarachnoid and subdural hemorrhage , severity related to proximity of explosion to head Decreased rotarod and grip...tensor imaging study. J Neurosurg 2005;103:298-303. 66. Wilde EA, McCauley SR, Hunter JV, et al. Diffusion tensor imaging of acute mild traumatic brain

  3. Facial skin-mucosal biodynamic blast injuries and management.

    PubMed

    Shuker, Sabri T

    2010-08-01

    The blast biodynamic presents maxillofacial injuries of a different type. The analysis of facial skin lacerations and intense flash burns will add new clinical findings that will assist in the early diagnosis of life-threatening airway compromise due to the inhalation of hot gases and toxic fumes. Improvised explosive devices most likely result in blast injuries and severe incendiary situations. Consequently, we require a better understanding of blast pathophysiologic effects, as well as the diagnosis and emergency management of facial soft tissue injuries, which create and provoke new challenges in lifesaving techniques and procedures. This article reviews the physics and biophysics of blast facial skin shredding, extensive contusions, lacerations, multiple puncture wounds, partial scalping, flash and thermal burns, thermal inhalation, and toxic fume injuries, as well as detailing the management of blast and thermal wound injuries. In addition, the initial and immediate care of related airway compromise resulting in life-threatening conditions is reviewed. A new type of conflict-related blast injury is described and evaluated. These explosion wounds result in facial soft tissue injuries, edema of the mucosa of the upper respiratory region, and lung trauma. The understanding of the blast biodynamic injuries associated with thermal burns and inhalation of hot toxic fumes that cause serious respiratory injuries requiring special management should be shared globally with our colleagues. Recently, many victims of improvised explosive devices have shown varying degrees of facial injuries in different patterns with or without flash burns. In addition, patients have had intense thermal inhalation that leads to oral-nasal-pharyngeal edema and toxic fume inhalation that may require the management of life-threatening airway compromise. This report will contribute to the lexicon of maxillofacial surgery diagnosis and procedures, including lifesaving airway management, by the

  4. The Long Term Economic Impact of Severe Obstetric Complications for Women and Their Children in Burkina Faso

    PubMed Central

    Ilboudo, Patrick G. C.; Russell, Steve; D’Exelle, Ben

    2013-01-01

    This study investigates the long term economic impact of severe obstetric complications for women and their children in Burkina Faso, focusing on measures of food security, expenditures and related quality of life measures. It uses a hospital based cohort, first visited in 2004/2005 and followed up four years later. This cohort of 1014 women consisted of two main groups of comparison: 677 women who had an uncomplicated delivery and 337 women who experienced a severe obstetric complication which would have almost certainly caused death had they not received hospital care (labelled a “near miss” event). To analyze the impact of such near miss events as well as the possible interaction with the pregnancy outcome, we compared household and individual level indicators between women without a near miss event and women with a near miss event who either had a live birth, a perinatal death or an early pregnancy loss. We used propensity score matching to remove initial selection bias. Although we found limited effects for the whole group of near miss women, the results indicated negative impacts: a) for near miss women with a live birth, on child development and education, on relatively expensive food consumption and on women’s quality of life; b) for near miss women with perinatal death, on relatively expensive foods consumption and children’s education and c) for near miss women who had an early pregnancy loss, on overall food security. Our results showed that severe obstetric complications have long lasting consequences for different groups of women and their children and highlighted the need for carefully targeted interventions. PMID:24224028

  5. Impact of moderate and severe hypodontia and amelogenesis imperfecta on quality of life and self-esteem of adult patients.

    PubMed

    Hashem, Atef; Kelly, Alan; O'Connell, Brian; O'Sullivan, Michael

    2013-08-01

    The objective of this study was to investigate the impact of moderate and severe hypodontia and amelogenesis imperfecta on the quality of life and self-esteem of affected adult patients. Forty one adult patients (aged 18-45 years) with clinical and radiological diagnoses of moderate to severe hypodontia and twenty seven patients diagnosed with amelogenesis imperfecta were age and gender matched with a control group of patients attending for routine dental care. Subjects completed the Oral Health Impact Profile [OHIP-49] and Rosenberg Self Esteem Scale. A paired t-test was used to analyse data; the test alpha level was set at P ≤ 0.05. The results for hypodontia patients were significantly different from controls in six out of the seven OHIP-49 domains, the exception being the Handicap domain. Total scores were also significantly different between the two groups (P=0.003). Self-esteem was not significantly different between the two groups (P=0.98). For amelogenesis imperfecta patients the results were significantly different from control patients in four out of the seven domains of the OHIP-49 and also in the total scores (P=0.01). When self-esteem was investigated there was no significant differences between the two groups (P=0.92). Moderate to severe hypodontia and amelogenesis imperfecta have marked negative impacts on the Oral Health Related quality of life of this patient population relative to controls. However, self-esteem was not significantly affected. Copyright © 2013 Elsevier Ltd. All rights reserved.

  6. Prevalence of Influenza Vaccination in Chronic Obstructive Pulmonary Disease Patients and Impact on the Risk of Severe Exacerbations.

    PubMed

    Garrastazu, Roberto; García-Rivero, Juan Luis; Ruiz, Mario; Helguera, Jose Manuel; Arenal, Sandra; Bonnardeux, Cristina; León, Carlos; Llorca, Javier; Santibañez, Miguel

    2016-02-01

    To determine the prevalence of influenza vaccination in chronic obstructive pulmonary disease (COPD) patients, and the effectiveness of the procedure. Retrospective population-based cohort study. On 31 December 2011, influenza vaccination history was retrieved from 899 patients with confirmed COPD selected by simple random sampling from all COPD patients in Cantabria (northern Spain). Severe exacerbations (hospitalization due to COPD exacerbation) and overall mortality during 2012 were treated as dependent variables. Odds ratios (OR) were estimated by logistic regression, adjusting for age, sex, smoking status, severity of COPD, and frequency of exacerbations during the previous year. Prevented fraction among the exposed (PFe-adjusted) was determined as a measure of impact. Overall prevalence of influenza vaccination was 62.7%, but this rate fell in patients classified as more severe according to FEV1 (52.0%). Influenza vaccination showed a statistically significant protective effect against severe exacerbations in the following year: Ora: 0.54 (95%CI: 0.35-0.84); FPe-adjusted: 0.46 (95%CI: 0.16-0.65). A non-significant protective effect for overall mortality was observed: Ora: 0.76 (95%CI: 0.41-1.40). When stratified according to COPD severity (FEV1), the protective effect against risk of hospitalization was higher in more severe COPD patients: Ora: 0.23 (95%CI: 0.11-0.48); FPe-adjusted: 0.77 (95%CI: 0.52-0.89). We found that influenza vaccination has a protective effect and reduces the risk of hospitalization due to exacerbations in the following year. Despite the evidence for protection, prevalence of vaccination was not optimal, especially in more severe COPD patients. Copyright © 2015 SEPAR. Published by Elsevier Espana. All rights reserved.

  7. Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD

    PubMed Central

    Morton, Rachael L.; Schlackow, Iryna; Staplin, Natalie; Gray, Alastair; Cass, Alan; Haynes, Richard; Emberson, Jonathan; Herrington, William; Landray, Martin J.; Baigent, Colin; Mihaylova, Borislava

    2016-01-01

    Background The inverse association between educational attainment and mortality is well established, but its relevance to vascular events and renal progression in a population with chronic kidney disease (CKD) is less clear. This study aims to determine the association between highest educational attainment and risk of vascular events, cause-specific mortality, and CKD progression. Study Design Prospective epidemiologic analysis among participants in the Study of Heart and Renal Protection (SHARP), a randomized controlled trial. Setting & Participants 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization recruited in Europe, North America, Asia, Australia, and New Zealand. Predictor Highest educational attainment measured at study entry using 6 levels that ranged from “no formal education” to “tertiary education.” Outcomes Any vascular event (any fatal or nonfatal cardiac, cerebrovascular, or peripheral vascular event), cause-specific mortality, and CKD progression during 4.9 years’ median follow-up. Results There was a significant trend (P < 0.001) toward increased vascular risk with decreasing levels of education. Participants with no formal education were at a 46% higher risk of vascular events (relative risk [RR], 1.46; 95% CI, 1.14-1.86) compared with participants with tertiary education. The trend for mortality across education levels was also significant (P < 0.001): all-cause mortality was twice as high among those with no formal education compared with tertiary-educated individuals (RR, 2.05; 95% CI, 1.62-2.58), and significant increases were seen for both vascular (RR, 1.84; 95% CI, 1.21-2.81) and nonvascular (RR, 2.15; 95% CI, 1.60-2.89) deaths. Lifestyle factors and prior disease explain most of the excess mortality risk. Among 6,245 participants not receiving dialysis at baseline, education level was not significantly associated with

  8. Impact of Educational Attainment on Health Outcomes in Moderate to Severe CKD.

    PubMed

    Morton, Rachael L; Schlackow, Iryna; Staplin, Natalie; Gray, Alastair; Cass, Alan; Haynes, Richard; Emberson, Jonathan; Herrington, William; Landray, Martin J; Baigent, Colin; Mihaylova, Borislava

    2016-01-01

    The inverse association between educational attainment and mortality is well established, but its relevance to vascular events and renal progression in a population with chronic kidney disease (CKD) is less clear. This study aims to determine the association between highest educational attainment and risk of vascular events, cause-specific mortality, and CKD progression. Prospective epidemiologic analysis among participants in the Study of Heart and Renal Protection (SHARP), a randomized controlled trial. 9,270 adults with moderate to severe CKD (6,245 not receiving dialysis at baseline) and no history of myocardial infarction or coronary revascularization recruited in Europe, North America, Asia, Australia, and New Zealand. Highest educational attainment measured at study entry using 6 levels that ranged from "no formal education" to "tertiary education." Any vascular event (any fatal or nonfatal cardiac, cerebrovascular, or peripheral vascular event), cause-specific mortality, and CKD progression during 4.9 years' median follow-up. There was a significant trend (P<0.001) toward increased vascular risk with decreasing levels of education. Participants with no formal education were at a 46% higher risk of vascular events (relative risk [RR], 1.46; 95% CI, 1.14-1.86) compared with participants with tertiary education. The trend for mortality across education levels was also significant (P<0.001): all-cause mortality was twice as high among those with no formal education compared with tertiary-educated individuals (RR, 2.05; 95% CI, 1.62-2.58), and significant increases were seen for both vascular (RR, 1.84; 95% CI, 1.21-2.81) and nonvascular (RR, 2.15; 95% CI, 1.60-2.89) deaths. Lifestyle factors and prior disease explain most of the excess mortality risk. Among 6,245 participants not receiving dialysis at baseline, education level was not significantly associated with progression to end-stage renal disease or doubling of creatinine level (P for trend = 0.4). No

  9. Disability evaluation in acoustic blast trauma

    PubMed Central

    Raju, Ganesan

    2015-01-01

    Introduction: Acoustic blast trauma is different from Noise induced hearing loss. Blast trauma can damage the tympanic membrane, ossicles and cochlea singly or in combination. It produces immediate severe hearing loss and may be associated with tinnitus and vestibular symptoms. Hearing loss recovers spontaneously in many cases but may be permanent in 30-55% cases. Thirteen patients working in an explosive manufacturing unit in Andhra Pradesh were exposed to blast trauma at work place. All these workers complained of immediate hearing loss and were subjected to audiological investigations. Methods: Initial evaluation showed a severe sensorineural type of hearing loss 10 of the 13 cases (77%). They were referred to our Medical board for disability evaluation after 2-3 years of initial injury. Pure tone audiometry indicated severe hearing loss in 12 of 13 cases (92%) that was not correlating clinically. Re-evaluation with Acoustic reflex and ABR (BERA) tests were done and permanent disability was evaluated with the results of these investigations. Observations: No significant hearing loss was found in most patients and these patients had minimal disability. Conclusion: Objective hearing tests should be carried out after one year or more before evaluation of permanent disability. PMID:26957811

  10. Impact of stuttering severity on adolescents' domain-specific and general self-esteem through cognitive and emotional mediating processes.

    PubMed

    Adriaensens, Stefanie; Beyers, Wim; Struyf, Elke

    2015-01-01

    The theory that self-esteem is substantially constructed based on social interactions implies that having a stutter could have a negative impact on self-esteem. Specifically, self-esteem during adolescence, a period of life characterized by increased self-consciousness, could be at risk. In addition to studying mean differences between stuttering and non-stuttering adolescents, this article concentrates on the influence of stuttering severity on domain-specific and general self-esteem. Subsequently, we investigate if covert processes on negative communication attitudes, experienced stigma, non-disclosure of stuttering, and (mal)adaptive perfectionism mediate the relationship between stuttering severity and self-esteem. Our sample comprised 55 stuttering and 76 non-stuttering adolescents. They were asked to fill in a battery of questionnaires, consisting of: Subjective Screening of Stuttering, Self-Perception Profile for Adolescents, Erickson S-24, Multidimensional Perfectionism Scale, and the Stigmatization and Disclosure in Adolescents Who Stutter Scale. SEM (structural equation modeling) analyses showed that stuttering severity negatively influences adolescents' evaluations of social acceptance, school competence, the competence to experience a close friendship, and global self-esteem. Maladaptive perfectionism and especially negative communication attitudes fully mediate the negative influence of stuttering severity on self-esteem. Group comparison showed that the mediation model applies to both stuttering and non-stuttering adolescents. We acknowledge the impact of having a stutter on those domains of the self in which social interactions and communication matter most. We then accentuate that negative attitudes about communication situations and excessive worries about saying things in ways they perceive as wrong are important processes to consider with regard to the self-esteem of adolescents who stutter. Moreover, we provide evidence that these covert

  11. Severe Obesity and Comorbid Condition Impact on the Weight-Related Quality of Life of the Adolescent Patient

    PubMed Central

    Zeller, Meg H.; Inge, Thomas H.; Modi, Avani C.; Jenkins, Todd M.; Michalsky, Marc P.; Helmrath, Michael; Courcoulas, Anita; Harmon, Carroll M.; Rofey, Dana; Baughcum, Amy; Austin, Heather; Price, Karin; Xanthakos, Stavra A.; Brandt, Mary L.; Horlick, Mary; Buncher, Ralph

    2014-01-01

    Objectives To assess links between comorbid health status, severe excess weight, and weight-related quality of life (WRQOL) in adolescents with severe obesity and undergoing weight loss surgery (WLS) to inform clinical care. Study design Baseline (pre-operative) data from Teen-LABS, a prospective multicenter observational study of 242 adolescents with severe obesity (MdnBMI = 50.5 kg/m2; Mage=17.1; 75.6% female; 71.9% White) undergoing WLS, were utilized to examine the impact of demographics, body mass index (BMI), presence/absence of 16 comorbid conditions, and a cumulative comorbidity load (CLoad) index on WRQOL scores (Impact of Weight on Quality of Life-Kids; IWQOL-Kids). Results WRQOL was significantly lower than reference samples of healthy weight, overweight, and obese samples. Of 16 comorbid conditions, the most prevalent were dyslipidemia (74.4%), chronic pain (58.3%), and obstructive sleep apnea (56.6%). Males had a higher CLoad (p=.01) and BMI (p=.01), yet less impairment in total WRQOL (p<.01) than females. CLoad was a significant predictor of male WRQOL. For females, psychosocial (versus physical) comorbidities, BMI, and White race were significant predictors of WRQOL impairment. Less prevalent conditions (e.g., stress urinary incontinence) also emerged as contributors to lower WRQOL. Conclusions WRQOL impairment is substantial for adolescents with severe obesity undergoing WLS, with predictors varying by sex. These patient-data highlight targets for education, support, and adjunctive care referrals prior to WLS. Further, they provide a comprehensive empirical base for understanding heterogeneity in adolescent WRQOL outcomes following WLS, as weight and comorbidity profiles change over time. PMID:25556022

  12. The impact of alcohol use severity on anxiety treatment outcomes in a large effectiveness trial in primary care

    PubMed Central

    Wolitzky-Taylor, Kate; Brown, Lily A.; Roy-Byrne, Peter; Sherbourne, Cathy; Stein, Murray B.; Sullivan, Greer; Bystritsky, Alexander; Craske, Michelle G.

    2014-01-01

    Objective The presence of anxiety disorders is associated with poorer alcohol use disorder treatment outcomes, but little is known about the impact of alcohol use problems on anxiety disorder treatment outcomes despite their high comorbidity. The current study examined the impact of alcohol use symptom severity on anxiety disorder treatment outcomes in a multi-site primary care effectiveness study of anxiety disorder treatment. Method Data came from the Coordinated Anxiety Learning and Management (CALM) effectiveness trial. Participants (N = 1004) were randomized to an evidence-based anxiety intervention (including cognitive behavioral therapy and medications) or usual care in primary care. Participants completed measures of alcohol use, anxiety, and depression a baseline, 6-mo, 12-mo, and 18-mo follow-up periods. Patients with alcohol dependence were excluded. Results There were no significant moderating (Treatment Group x Alcohol Use Severity) interactions. The majority of analyses revealed no predictive effects of alcohol use severity on outcome; however, alcohol problems at baseline were associated with somewhat higher anxiety and depression symptoms at the 18-mo follow-up. Conclusions These data indicate that patients with alcohol problems in primary care can be effectively treated for anxiety disorders. Baseline alcohol problems were associated with some poorer long-term outcomes, but this was evident across CALM and usual care. These findings provide preliminary evidence that there may be no need to postpone treatment of anxiety disorders until alcohol problems are addressed, at least among those who have mild to moderate alcohol problems. Replication with more severe alcohol use disorders is needed. PMID:25615523

  13. Symptom severity of depressive symptoms impacts on social cognition performance in current but not remitted major depressive disorder

    PubMed Central

    Air, Tracy; Weightman, Michael J.; Baune, Bernhard T.

    2015-01-01

    The aim of the present study was to investigate the social cognitive functioning of participants with depression when compared with healthy controls, and to assess the impact of symptom severity. One hundred and eight patients with depression (66 remitted and 42 current) and 52 healthy controls were assessed using the Wechsler Advanced Clinical Solutions: Social Perception Subtest, measuring facial affect recognition in isolation and in combination with prosody and body language interpretation. When healthy controls, remitted depression and currently depressed groups were compared, no associations were found on any of the social cognition subscales. Severity of depressive and anxious symptoms predicted performance on all social cognition subscales in currently depressed participants, controlling for age, gender, education and psychotropic medication. Affective depressive symptoms were inversely related to ACS Pairs and Prosody subscales, while somatic symptoms were inversely related to the ACS Affect Recognition and Total scores. There was no association between severity and the WAIS ACS in remitted depression participants. People with MDD exhibiting more severe depressive and anxious symptoms and a cluster of affective symptoms have greater difficulty undertaking complex social cognitive tasks. Given the state like nature to these deficits, these impairments may cause problems with day to day functioning and have implications in targeted therapeutic interventions. PMID:26300814

  14. Symptom severity of depressive symptoms impacts on social cognition performance in current but not remitted major depressive disorder.

    PubMed

    Air, Tracy; Weightman, Michael J; Baune, Bernhard T

    2015-01-01

    The aim of the present study was to investigate the social cognitive functioning of participants with depression when compared with healthy controls, and to assess the impact of symptom severity. One hundred and eight patients with depression (66 remitted and 42 current) and 52 healthy controls were assessed using the Wechsler Advanced Clinical Solutions: Social Perception Subtest, measuring facial affect recognition in isolation and in combination with prosody and body language interpretation. When healthy controls, remitted depression and currently depressed groups were compared, no associations were found on any of the social cognition subscales. Severity of depressive and anxious symptoms predicted performance on all social cognition subscales in currently depressed participants, controlling for age, gender, education and psychotropic medication. Affective depressive symptoms were inversely related to ACS Pairs and Prosody subscales, while somatic symptoms were inversely related to the ACS Affect Recognition and Total scores. There was no association between severity and the WAIS ACS in remitted depression participants. People with MDD exhibiting more severe depressive and anxious symptoms and a cluster of affective symptoms have greater difficulty undertaking complex social cognitive tasks. Given the state like nature to these deficits, these impairments may cause problems with day to day functioning and have implications in targeted therapeutic interventions.

  15. 2016 SUMMER BLAST PICNIC

    NASA Image and Video Library

    2016-06-09

    MARSHALL SPACE FLIGHT CENTER DIRECTOR TODD MAY CASTS HIS BALLOT IN THE HOMEMADE ICE CREAM CONTEST DURING THE GREAT EXCHANGE SUMMER BLAST SOCIAL, PRESENTED JUNE 9 BY THE MARSHALL EXCHANGE. THE EXCHANGE IS A NON-APPROPRIATED-FUND ACTIVITY THAT AIMS TO CONTRIBUTE TO THE WELFARE, EFFICIENCY AND MORALE OF MARSHALL TEAM MEMBERS, OTHER GOVERNMENT PERSONNEL, RETIRED NASA EMPLOYEES AND THEIR FAMILIES.

  16. Muzzle Blast Amplification

    DTIC Science & Technology

    1976-11-01

    Report) 1». SUPPLEMENTARY NOTES 19. KEY WORDS (Contlnua on reverse » Ida if nacaaeary and Identity by block number) Muzzle Blast...Range NM 88002 Commander US Army Research Office ATTN: CRD -AA-EH P. 0. Box 12211 Research Triangle Park NC 27709 Director US Army BMD Advanced

  17. Comparative Research to Surface Aeration and Blasting Aeration System Based on LCC Theory

    NASA Astrophysics Data System (ADS)

    Liai, CHEN; Hongxun, HOU; Weibiao, FEI; Eryan, ZHAO

    2017-05-01

    It is difficult to select the suitable aeration system for the designers of wastewater treatment plant (WWTP). In this paper, taking two WWTPs with surface aeration systems and blasting aeration respectively for an example, LCC theory was adapted to analysis the cost of consumption and the environmental impact, which caused by the different aeration system. Research results showed that: (1) In the 20-year life cycle, the LCC mainly depended on the cost of energy consumption whatever blasting aeration system or surface aeration, while the LCC of blasting aeration system affected by the equipment maintenance cost, maintenance cost, economic losses caused by wastewater loss and environmental load in maintenance period. (2) The LCC of blasting aeration system was lower than the surface aeration in general, on the premise of the standard discharge; (3) the blasting aeration system estimated a saving of 60,0000RMB annually in costs compared with the surface aeration.

  18. Impact of early operative pelvic fixation on long-term self-reported outcome following severe pelvic fracture.

    PubMed

    Sharpe, John P; Magnotti, Louis J; Gobbell, Wade C; Huang, Xin; Perez, Edward A; Fabian, Timothy C; Croce, Martin A

    2017-03-01

    Traumatic disruption of the pelvic ring is a significant cause of life-threatening hemorrhage. For those patients who survive the initial injury, these fractures are associated with long periods of immobilization and intense rehabilitation. There is little published information available regarding long-term functional outcomes in these patients. This study evaluated the impact of severe pelvic fractures on those long-term outcomes. All patients with severe pelvic fractures over an 18-year period were identified. Severe pelvic fractures were defined as those with vascular disruption, open-book component with symphysis diastasis, or sacroiliac disruption with vertical shear. Functional outcome was measured using the Boston University Activity Measure for Post-Acute Care to assess mobility (normal, >84) and daily activity (normal, >84). Multiple linear regression analysis was used to identify predictors of functional outcome after severe pelvic fracture. From January 1996 to September 2014, 401 patients were identified: 240 (60%) men and 161 (40%) women. Overall mortality was 29%. Of the 285 survivors, follow-up was obtained in 145 patients (51%). Mean follow-up was 8.3 years, with a maximum of 20 years. Mean age and Injury Severity Score were 53 years and 27, respectively. Mean Activity Measure for Post-Acute Care scores for mobility and daily activity were 55 and 63, respectively; both signifying significant impairment when compared with normal. Multiple linear regression analysis using age, traumatic brain injury, transfusions, Injury Severity Score, ventilator days, presence of associated lower-extremity fractures, and time to operative pelvic fixation identified time to pelvic fixation as the only predictor of decreased mobility (β = -0.74, p = 0.04) and activity (β = -0.21, p = 0.03) following severe pelvic fracture. Prolonged time to operative pelvic fixation led to worse long-term functional outcomes in patients with severe pelvic ring disruption. Early

  19. The impact of PASI 75 and PASI 90 on quality of life in moderate to severe psoriasis patients.

    PubMed

    Abrouk, Michael; Nakamura, M; Zhu, T H; Farahnik, B; Koo, J; Bhutani, T

    2017-09-01

    It is well known that psoriasis significantly impacts patients' quality of life (QoL). With the introduction of improved treatment modalities with biologic agents, more patients with moderate to severe psoriasis are able to achieve better results as measured by the Psoriasis Area and Severity Index (PASI). PASI 75 indicates a 75% or greater reduction in PASI scores from baseline and is indicative of excellent disease improvement. With newer biologic agents such as secukinumab, ixekizumab and brodalumab, patients are now capable of achieving PASI 90, introducing additional clinical decisions for physicians when considering treatment options. However, little is known regarding how the difference between achieving PASI-75 versus PASI-90 impacts patients' QoL. The purpose of this study was to compare how achieving PASI 75 versus PASI 90 impacts QoL for patients with moderate to severe plaque psoriasis by using validated psychometric instruments that have been widely used in both dermatologic and non-dermatologic settings. Two separate open-label clinical trials were conducted to specifically assess QoL in patients with moderate to severe psoriasis on adalimumab or ustekinumab over 24 weeks. In addition to clinical assessments of psoriasis, patients completed two surveys: The Psychological General Well-Being (PGWB) Index and the Dermatology Life Quality Index (DLQI). Changes in total PGWB score and DLQI score at weeks 12 and 24 compared to baseline were compared between groups achieving PASI 75 and PASI 90. There was no statistically significant difference in PGWB scores between patients achieving PASI 75 and patients achieving PASI 90 in the adalimumab treatment group (week 12 p = .21, but there was at week 24 p = .05). There was a statistically significant difference in DLQI between the patients achieving PASI 75 and the patients achieving PASI 90 in the adalimumab treatment group at week 24 (p = .01), but not week 12 (p = .11). There was no

  20. BLAST: THE REDSHIFT SURVEY

    SciTech Connect

    Eales, Stephen; Dye, Simon; Mauskopf, Philip; Moncelsi, Lorenzo; Pascale, Enzo; Raymond, Gwenifer; Chapin, Edward L.; Halpern, Mark; Marsden, Gaelen; Scott, Douglas; Devlin, Mark J.; Rex, Marie; Semisch, Christopher; Truch, Matthew D. P.; Hughes, David H.; Netterfield, Calvin B.; Viero, Marco P.; Patanchon, Guillaume; Siana, Brian

    2009-12-20

    The Balloon-borne Large Aperture Submillimeter Telescope (BLAST) has recently surveyed approx =8.7 deg{sup 2} centered on Great Observatories Origins Deep Survey-South at 250, 350, and 500 mum. In Dye et al., we presented the catalog of sources detected at 5sigma in at least one band in this field and the probable counterparts to these sources in other wavebands. In this paper, we present the results of a redshift survey in which we succeeded in measuring redshifts for 82 of these counterparts. The spectra show that the BLAST counterparts are mostly star-forming galaxies but not extreme ones when compared to those found in the Sloan Digital Sky Survey. Roughly one quarter of the BLAST counterparts contain an active nucleus. We have used the spectroscopic redshifts to carry out a test of the ability of photometric redshift methods to estimate the redshifts of dusty galaxies, showing that the standard methods work well even when a galaxy contains a large amount of dust. We have also investigated the cases where there are two possible counterparts to the BLAST source, finding that in at least half of these there is evidence that the two galaxies are physically associated, either because they are interacting or because they are in the same large-scale structure. Finally, we have made the first direct measurements of the luminosity function in the three BLAST bands. We find strong evolution out to z = 1, in the sense that there is a large increase in the space density of the most luminous galaxies. We have also investigated the evolution of the dust-mass function, finding similar strong evolution in the space density of the galaxies with the largest dust masses, showing that the luminosity evolution seen in many wavebands is associated with an increase in the reservoir of interstellar matter in galaxies.

  1. Prediction of Outcome after Moderate and Severe Traumatic Brain Injury: External Validation of the IMPACT and CRASH Prognostic Models

    PubMed Central

    Roozenbeek, Bob; Lingsma, Hester F.; Lecky, Fiona E.; Lu, Juan; Weir, James; Butcher, Isabella; McHugh, Gillian S.; Murray, Gordon D.; Perel, Pablo; Maas, Andrew I.R.; Steyerberg, Ewout W.

    2012-01-01

    Objective The International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models predict outcome after traumatic brain injury (TBI) but have not been compared in large datasets. The objective of this is study is to validate externally and compare the IMPACT and CRASH prognostic models for prediction of outcome after moderate or severe TBI. Design External validation study. Patients We considered 5 new datasets with a total of 9036 patients, comprising three randomized trials and two observational series, containing prospectively collected individual TBI patient data. Measurements Outcomes were mortality and unfavourable outcome, based on the Glasgow Outcome Score (GOS) at six months after injury. To assess performance, we studied the discrimination of the models (by AUCs), and calibration (by comparison of the mean observed to predicted outcomes and calibration slopes). Main Results The highest discrimination was found in the TARN trauma registry (AUCs between 0.83 and 0.87), and the lowest discrimination in the Pharmos trial (AUCs between 0.65 and 0.71). Although differences in predictor effects between development and validation populations were found (calibration slopes varying between 0.58 and 1.53), the differences in discrimination were largely explained by differences in case-mix in the validation studies. Calibration was good, the fraction of observed outcomes generally agreed well with the mean predicted outcome. No meaningful differences were noted in performance between the IMPACT and CRASH models. More complex models discriminated slightly better than simpler variants. Conclusions Since both the IMPACT and the CRASH prognostic models show good generalizability to more recent data, they are valid instruments to quantify prognosis in TBI. PMID:22511138

  2. Impact of Human Immunodeficiency Virus on the Severity of Buruli Ulcer Disease: Results of a Retrospective Study in Cameroon

    PubMed Central

    Christinet, Vanessa; Comte, Eric; Ciaffi, Laura; Odermatt, Peter; Serafini, Micaela; Antierens, Annick; Rossel, Ludovic; Nomo, Alain-Bertrand; Nkemenang, Patrick; Tsoungui, Akoa; Delhumeau, Cecile; Calmy, Alexandra

    2014-01-01

    Background.  Buruli ulcer is the third most common mycobacterial disease after tuberculosis and leprosy and is particularly frequent in rural West and Central Africa. However, the impact of HIV infection on BU severity and prevalence remains unclear. Methods.  This was a retrospective study of data collected at the Akonolinga District Hospital, Cameroon, from January 1, 2002 to March 27, 2013. Human immunodeficiency virus prevalence among BU patients was compared with regional HIV prevalence. Baseline characteristics of BU patients were compared between HIV-negative and HIV-positive patients and according to CD4 cell count strata in the latter group. Buruli ulcer time-to-healing was assessed in different CD4 count strata, and factors associated with BU main lesion size at baseline were identified. Results.  Human immunodeficiency virus prevalence among BU patients was significantly higher than the regional estimated prevalence in each group (children, 4.00% vs 0.68% [P < .001]; men, 17.0% vs 4.7% [P < .001]; women, 36.0% vs 8.0% [P < .001]). Individuals who were HIV positive had a more severe form of BU, with an increased severity in those with a higher level of immunosuppression. Low CD4 cell count was significantly associated with a larger main lesion size (β-coefficient, −0.50; P = .015; 95% confidence interval [CI], −0.91–0.10). Buruli ulcer time-to-healing was more than double in patients with a CD4 cell count below 500 cell/mm3 (hazard ratio, 2.39; P = .001; 95% CI, 1.44–3.98). Conclusion.  Patients who are HIV positive are at higher risk for BU. Human immunodeficiency virus-induced immunosuppression seems to have an impact on BU clinical presentation and disease evolution. PMID:25734094

  3. A cost-utility and budget impact analysis of allogeneic hematopoietic stem cell transplantation for severe thalassemic patients in Thailand

    PubMed Central

    2010-01-01

    Background Hematopoietic stem cell transplantation (HSCT) is the only curative treatment available to severe thalassemic patients. The treatment, however, is very costly, particularly in the context of low and middle income countries, and no studies have been carried out to explore its economic justifiability. This study aimed to estimate the cost-utility of HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for severe thalassemia in Thailand, and to investigate the affordability of HSCT using a budget impact analysis. Methods A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes taking a societal perspective as recommended by Thailand's health technology assessment guidelines. All future costs and outcomes were discounted at a rate of 3% per annum. Primary outcomes of interest were lifetime costs, quality adjusted life years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in Thai baht (THB) per QALY gained. Results Compared to BT-ICT, the incremental cost-effectiveness ratio increased with patient age from 80,700 to 183,000 THB per QALY gained for related HSCT and 209,000 to 953,000 THB per QALY gained for unrelated HSCT among patients aged 1 to 15 years (US$1= 34 THB). The governmental budget impact analysis showed that providing 200 related HSCT to patients aged 1 to 10 years, in accordance with the current infrastructure limitations, would initially require approximately 90 million additional THB per year. Conclusions At a societal willingness to pay of 100,000 THB per QALY gained, related HSCT was likely to be a cost-effective and affordable treatment for young children with severe thalassemia in Thailand. PMID:20633303

  4. Impact of KITcube data on the prediction of maritime convective severe weather. Test for HYMEX IOP13 event.

    NASA Astrophysics Data System (ADS)

    Carrio Carrio, Diego Saul; Homar Santaner, Víctor; Corsmeier, Ulrich

    2015-04-01

    The Special Observation Period 1 (SOP1) was a great milestone reached by the HyMeX scientific community. Observations sampling on 20 cases of severe weather were taken under an unprecedented international collaboration. The nderlying objective of this campaign was to improve the knowledge of the mechanisms leading to heavy precipitation and flash flooding in the Mediterranean. One of the most active platforms during the campaign was the KITcube-observatory of Karlsruhe Institute of Technology, a mobile platform that includes ground-based remote sensors (radar and lidar) and instruments for in-situ measurements. During SOP1, the KITcube operated on the island of Corsica, providing direct observational data on severe weather occurring in the north-eastern region of the Western Mediterranean. IOP 13 occurred between 15-16 October 2012 and it was characterized by heavy rains over northern and central Italy. Storms formed over the French coastlands and over the sea, progressing eastwards across the Gulf of Genoa. The most affected areas were north-eastern Italy (160mm/24h), LiguriaTuscany (120mm/24h) and central Italy (600mm/24h). The prediction of these maritime convection driven cases is highly demanding for both operational offices and high resolution numerical models. Ensemble data assimilation methods provide the tools to combine observational and modeling information to formalize the problem of optimal use and transference of information in the initialization and integration of a forecasting system. We test the benefits offered by an Ensemble Kalman Filter (EnKF) system for the prediction of the IOP13 event. We assess the impacts of various in-situ special observations taken by the KITcube team during this event on the forecasts of socially sensible parameters such as probability of severe and accumulated precipitation. We discuss these impacts not only on the forecasts products but also in terms of the relevant physical mechanisms involved in the event.

  5. Impact of appropriate antimicrobial therapy for patients with severe sepsis and septic shock--a quality improvement study.

    PubMed

    Yokota, Paula K O; Marra, Alexandre R; Martino, Marines D V; Victor, Elivane S; Durão, Marcelino S; Edmond, Michael B; dos Santos, Oscar F P

    2014-01-01

    There is ample literature available on the association between both time to antibiotics and appropriateness of antibiotics and clinical outcomes from sepsis. In fact, the current state of debate surrounds the balance to be struck between prompt empirical therapy and care in the choice of appropriate antibiotics (both in terms of the susceptibility of infecting organism and minimizing resistance arising from use of broad-spectrum agents). The objective of this study is to determine sepsis bundle compliance and the appropriateness of antimicrobial therapy in patients with severe sepsis and septic shock and its impact on outcomes. This study was conducted in the ICU of a tertiary care, private hospital in São Paulo, Brazil. A retrospective cohort study was conducted from July 2005 to December 2012 in patients with severe sepsis and septic shock. A total of 1,279 patients were identified with severe sepsis and septic shock, of which 358 (32.1%) had bloodstream infection (BSI). The inpatient mortality rate was 29%. In evaluation of the sepsis bundle, over time there was a progressive increase in serum arterial lactate collection, obtaining blood cultures prior to antibiotic administration, administration of broad-spectrum antibiotics within 1 hour, and administration of appropriate antimicrobials, with statistically significant differences in the later years of the study. We also observed a significant decrease in mortality. In patients with bloodstream infection, after adjustment for other covariates the administration of appropriate antimicrobial therapy was associated with a decrease in mortality in patients with severe sepsis and septic shock (p = 0.023). The administration of appropriate antimicrobial therapy was independently associated with a decline in mortality in patients with severe sepsis and septic shock due to bloodstream infection. As protocol adherence increased over time, the crude mortality rate decreased, which reinforces the need to implement

  6. Severity of chronic pain in an elderly population in Sweden--impact on costs and quality of life.

    PubMed

    Bernfort, Lars; Gerdle, Björn; Rahmqvist, Mikael; Husberg, Magnus; Levin, Lars-Åke

    2015-03-01

    Chronic pain is associated with large societal costs, but few studies have investigated the total costs of chronic pain with respect to elderly subjects. The elderly usually require informal care, care performed by municipalities, and care for chronic diseases, all factors that can result in extensive financial burdens on elderly patients, their families, and the social services provided by the state. This study aims to quantify the societal cost of chronic pain in people of age 65 years and older and to assess the impact of chronic pain on quality of life. This study collected data from 3 registers concerning health care, drugs, and municipal services and from 2 surveys. A postal questionnaire was used to collect data from a stratified sample of the population 65 years and older in southeastern Sweden. The questionnaire addressed pain intensity and quality of life variables (EQ-5D). A second postal questionnaire was used to collect data from relatives of the elderly patients suffering from chronic pain. A total of 66.5% valid responses of the 10,000 subjects was achieved; 76.9% were categorized as having no or mild chronic pain, 18.9% as having moderate chronic pain, and 4.2% as having severe chronic pain. Consumed resources increased with the severity of chronic pain. Clear differences in EQ-5D were found with respect to the severity of pain. This study found an association between resource use and severity of chronic pain in elderly subjects: the more severe the chronic pain, the more extensive (and expensive) the use of resources.

  7. Poor outcomes in hospitalized patients with gastrointestinal bleeding: impact of baseline risk, bleeding severity, and process of care.

    PubMed

    Jairath, Vipul; Thompson, J; Kahan, B C; Daniel, R; Hearnshaw, S A; Travis, S P L; Murphy, M F; Palmer, K R; Logan, R F A

    2014-10-01

    Previous studies have found higher mortality rates among inpatients (IPs) compared with new admissions (outpatients, OPs) with acute upper gastrointestinal bleeding (AUGIB), but no studies have investigated the cause for this. The objective of this study was to determine whether the difference in outcomes between IPs and OPs with AUGIB can be explained by differences in baseline characteristics, bleeding severity, or processes of care. Data were collected from 6,657 presentations with all-cause AUGIB from 212 UK hospitals as part of a nationwide audit. IPs were older (77 vs. 65 years, P<0.001), had greater comorbidity, and presented with more severe bleeding. There was no difference in median time to endoscopy (24 vs. 24 h, P=0.67) or receipt of endotherapy (19% vs. 17%, P=0.29). IPs had an odds of mortality 4.8 times that of OPs (26% vs. 7%; odds ratio (OR) 4.8, 95% confidence interval (CI) 3.9-5.8); after adjusting for baseline characteristics, this fell by 24% to 3.3 (95% CI 3.2-4.9) and after adjusting for bleeding severity alone to 4.0 (95% CI 3.2-4.9); adjusting for care processes had minimal effect. IPs had more than a twofold increased odds of rebleeding (20% vs. 12%; OR 2.1, 95% CI 1.7-2.5); adjusting for both baseline characteristics and severity of bleeding reduced this by 50% (OR 1.4, 95% CI 1.3-2.4), but process of care had no additional impact. IPs present with both higher baseline risks and more severe bleeding. These differences in baseline characteristics explain some but not all of the greater mortality of IPs with AUGIB.

  8. Coke oven gas injection to blast furnaces

    SciTech Connect

    Maddalena, F.L.; Terza, R.R.; Sobek, T.F.; Myklebust, K.L.

    1995-12-01

    U.S. Steel has three major facilities remaining in Pennsylvania`s Mon Valley near Pittsburgh. The Clairton Coke Works operates 12 batteries which produce 4.7 million tons of coke annually. The Edgar Thomson Works in Braddock is a 2.7 million ton per year steel plant. Irvin Works in Dravosburg has a hot strip mill and a range of finishing facilities. The coke works produces 120 mmscfd of coke oven gas in excess of the battery heating requirements. This surplus gas is used primarily in steel re-heating furnaces and for boiler fuel to produce steam for plant use. In conjunction with blast furnace gas, it is also used for power generation of up to 90 MW. However, matching the consumption with the production of gas has proved to be difficult. Consequently, surplus gas has been flared at rates of up to 50 mmscfd, totaling 400 mmscf in several months. By 1993, several changes in key conditions provided the impetus to install equipment to inject coke oven gas into the blast furnaces. This paper describes the planning and implementation of a project to replace natural gas in the furnaces with coke oven gas. It involved replacement of 7 miles of pipeline between the coking plants and the blast furnaces, equipment capable of compressing coke oven gas from 10 to 50 psig, and installation of electrical and control systems to deliver gas as demanded.

  9. BeoBLAST: distributed BLAST and PSI-BLAST on a Beowulf cluster.

    PubMed

    Grant, J D; Dunbrack, R L; Manion, F J; Ochs, M F

    2002-05-01

    BeoBLAST is an integrated software package that handles user requests and distributes BLAST and PSI-BLAST searches to nodes of a Beowulf cluster, thus providing a simple way to implement a scalable BLAST system on top of relatively inexpensive computer clusters. Additionally, BeoBLAST offers a number of novel search features through its web interface, including the ability to perform simultaneous searches of multiple databases with multiple queries, and the ability to start a search using the PSSM generated from a previous PSI-BLAST search on a different database. The underlying system can also handle automated querying for high throughput work. Source code is available under the GNU public license at http://bioinformatics.fccc.edu/

  10. mBLAST: Keeping up with the sequencing explosion for (meta)genome analysis.

    PubMed

    Davis, Curtis; Kota, Karthik; Baldhandapani, Venkat; Gong, Wei; Abubucker, Sahar; Becker, Eric; Martin, John; Wylie, Kristine M; Khetani, Radhika; Hudson, Matthew E; Weinstock, George M; Mitreva, Makedonka

    2015-08-01

    Recent advances in next-generation sequencing technologies require alignment algorithms and software that can keep pace with the heightened data production. Standard algorithms, especially protein similarity searches, represent significant bottlenecks in analysis pipelines. For metagenomic approaches in particular, it is now often necessary to search hundreds of millions of sequence reads against large databases. Here we describe mBLAST, an accelerated search algorithm for translated and/or protein alignments to large datasets based on the Basic Local Alignment Search Tool (BLAST) and retaining the high sensitivity of BLAST. The mBLAST algorithms achieve substantial speed up over the National Center for Biotechnology Information (NCBI) programs BLASTX, TBLASTX and BLASTP for large datasets, allowing analysis within reasonable timeframes on standard computer architectures. In this article, the impact of mBLAST is demonstrated with sequences originating from the microbiota of healthy humans from the Human Microbiome Project. mBLAST is designed as a plug-in replacement for BLAST for any study that involves short-read sequences and includes high-throughput analysis. The mBLAST software is freely available to academic users at www.multicorewareinc.com.

  11. Chronic post-traumatic stress disorder-related traits in a rat model of low-level blast exposure.

    PubMed

    Perez-Garcia, Georgina; Gama Sosa, Miguel A; De Gasperi, Rita; Lashof-Sullivan, Margaret; Maudlin-Jeronimo, Eric; Stone, James R; Haghighi, Fatemeh; Ahlers, Stephen T; Elder, Gregory A

    2016-09-28

    The postconcussion syndrome following mild traumatic brain injuries (mTBI) has been regarded as a mostly benign syndrome that typically resolves in the immediate months following injury. However, in some individuals, symptoms become chronic and persistent. This has been a striking feature of the mostly blast-related mTBIs that have been seen in veterans returning from the recent conflicts in Iraq and Afghanistan. In these veterans a chronic syndrome with features of both the postconcussion syndrome and post-traumatic stress disorder has been prominent. Animal modeling of blast-related TBI has developed rapidly over the last decade leading to advances in the understanding of blast pathophysiology. However, most studies have focused on acute to subacute effects of blast on the nervous system and have typically studied higher intensity blast exposures with energies more comparable to that involved in human moderate to severe TBI. Fewer animal studies have addressed the chronic effects of lower level blast exposures that are more comparable to those involved in human mTBI or subclinical blast. Here we describe a rat model of repetitive low-level blast exposure that induces a variety of anxiety and PTSD-related behavioral traits including exaggerated fear responses that were present when animals were tested between 28 and 35 weeks after the last blast exposure. These animals provide a model to study the chronic and persistent behavioral effects of blast including the relationship of PTSD to mTBI in dual diagnosis veterans.

  12. The effect of different intensities of treadmill exercise on cognitive function deficit following a severe controlled cortical impact in rats.

    PubMed

    Shen, Xiafeng; Li, Aiping; Zhang, Yuling; Dong, Xiaomin; Shan, Tian; Wu, Yi; Jia, Jie; Hu, Yongshan

    2013-10-31

    Exercise has been proposed for the treatment of traumatic brain injury (TBI). However, the proper intensity of exercise in the early phase following a severe TBI is largely unknown. To compare two different treadmill exercise intensities on the cognitive function following a severe TBI in its early phase, rats experienced a controlled cortical impact (CCI) and were forced to treadmill exercise for 14 days. The results revealed that the rats in the low intensity exercise group had a shorter latency to locate a platform and a significantly better improvement in spatial memory in the Morris water maze (MWM) compared to the control group (p < 0.05). The high intensity exercise group showed a longer latency and a mild improvement in spatial memory compared to the control group rats in the MWM; however, this difference was not statistically significant (p > 0.05). The brain-derived neurotrophic factor (BDNF) and p-CREB protein levels in the contralateral hippocampus were increased significantly in the low intensity exercise group. Our results suggest that 2 weeks of low intensity of treadmill exercise is beneficial for improving cognitive function and increasing hippocampal BDNF expression after a severe TBI in its early phase.

  13. Quantifying the impact of adaptive traffic control systems on crash frequency and severity: Evidence from Oakland County, Michigan.

    PubMed

    Fink, Joshua; Kwigizile, Valerian; Oh, Jun-Seok

    2016-06-01

    Despite seeing widespread usage worldwide, adaptive traffic control systems have experienced relatively little use in the United States. Of the systems used, the Sydney Coordinated Adaptive Traffic System (SCATS) is the most popular in America. Safety benefits of these systems are not as well understood nor as commonly documented. This study investigates the safety benefits of adaptive traffic control systems by using the large SCATS-based system in Oakland County, MI known as FAST-TRAC. This study uses data from FAST-TRAC-controlled intersections in Oakland County and compares a wide variety of geometric, traffic, and crash characteristics to similar intersections in metropolitan areas elsewhere in Michigan. Data from 498 signalized intersections are used to conduct a cross-sectional analysis. Negative binomial models are used to estimate models for three dependent crash variables. Multinomial logit models are used to estimate an injury severity model. A variable tracking the presence of FAST-TRAC controllers at intersections is used in all models to determine if a SCATS-based system has an impact on crash occurrences or crash severity. Estimates show that the presence of SCATS-based controllers at intersections is likely to reduce angle crashes by up to 19.3%. Severity results show a statistically significant increase in non-serious injuries, but not a significant reduction in incapacitating injuries or fatal accidents. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.

  14. Which of the abbreviated burn severity index variables are having impact on the hospital length of stay?

    PubMed

    Andel, Dorothea; Kamolz, Lars-Peter; Niedermayr, Monika; Hoerauf, Klaus; Schramm, Wolfgang; Andel, Harald

    2007-01-01

    Quality control is an important tool ensuring continuous medical efficacy. Outcome scores, however, are unfavorable from a statistical point of view, are not meaningful for less severely injured patients, and may put the treating physicians under pressure to limit therapeutic efforts. In this study the variables of the abbreviated burn severity index (ABSI), primarily an outcome score, were used to predict length of hospital stay (HLS), a continuous quantitative variable reflecting treatment costs and incidence of complications even in less severely injured patients. For 365 patients a multiple linear regression analysis was used to evaluate the influence of the ABSI variables on HLS. Among survivors, age and total body surface area burned (TBSA) contributed significantly to HLS, whereas for nonsurvivors only TBSA significantly influenced HLS. Neither gender nor presence of full-thickness burn or inhalation injury showed a significant influence on HLS. The impact of age and TBSA on HLS might be used as a benchmarking system to evaluate quality of care. However, although HLS is probably widely dependent on regional health care systems, TBSA and age proved to be the only variables of the ABSI to correlate with HLS.

  15. Blast resistance in rice: a review of conventional breeding to molecular approaches.

    PubMed

    Miah, G; Rafii, M Y; Ismail, M R; Puteh, A B; Rahim, H A; Asfaliza, R; Latif, M A

    2013-03-01

    Blast disease caused by the fungal pathogen Magnaporthe oryzae is the most severe diseases of rice. Using classical plant breeding techniques, breeders have developed a number of blast resistant cultivars adapted to different rice growing regions worldwide. However, the rice industry remains threatened by blast disease due to the instability of blast fungus. Recent advances in rice genomics provide additional tools for plant breeders to improve rice production systems that would be environmentally friendly. This article outlines the application of conventional breeding, tissue culture and DNA-based markers that are used for accelerating the development of blast resistant rice cultivars. The best way for controlling the disease is to incorporate both qualitative and quantitative genes in resistant variety. Through conventional and molecular breeding many blast-resistant varieties have been developed. Conventional breeding for disease resistance is tedious, time consuming and mostly dependent on environment as compare to molecular breeding particularly marker assisted selection, which is easier, highly efficient and precise. For effective management of blast disease, breeding work should be focused on utilizing the broad spectrum of resistance genes and pyramiding genes and quantitative trait loci. Marker assisted selection provides potential solution to some of the problems that conventional breeding cannot resolve. In recent years, blast resistant genes have introgressed into Luhui 17, G46B, Zhenshan 97B, Jin 23B, CO39, IR50, Pusa1602 and Pusa1603 lines through marker assisted selection. Introduction of exotic genes for resistance induced the occurrence of new races of blast fungus, therefore breeding work should be concentrated in local resistance genes. This review focuses on the conventional breeding to the latest molecular progress in blast disease resistance in rice. This update information will be helpful guidance for rice breeders to develop durable blast

  16. Blast Exposure, White Matter Integrity, and Cognitive Function in Iraq and Afghanistan Combat Veterans

    PubMed Central

    Ivanov, Iliyan; Fernandez, Corey; Mitsis, Effie M.; Dickstein, Dara L.; Wong, Edmund; Tang, Cheuk Y.; Simantov, Jessie; Bang, Charlene; Moshier, Erin; Sano, Mary; Elder, Gregory A.; Hazlett, Erin A.

    2017-01-01

    The long-term effects of blast exposure are a major health concern for combat veterans returning from the recent conflicts in Iraq and Afghanistan. We used an optimized diffusion tensor imaging tractography algorithm to assess white matter (WM) fractional anisotropy (FA) in blast-exposed Iraq and Afghanistan veterans (n = 40) scanned on average 3.7 years after deployment/trauma exposure. Veterans diagnosed with a blast-related mild traumatic brain injury (mTBI) were compared to combat veterans with blast exposure but no TBI diagnosis. Blast exposure was associated with decreased FA in several WM tracts. However, total blast exposure did not correlate well with neuropsychological testing performance and there were no differences in FA based on mTBI diagnosis. Yet, veterans with mTBI performed worse on every neurocognitive test administered. Multiple linear regression across all blast-exposed veterans using a six-factor prediction model indicated that the amount of blast exposure accounted for 11–15% of the variability in composite FA scores such that as blast exposure increased, FA decreased. Education accounted for 10% of the variability in composite FA scores and 25–32% of FA variability in the right cingulum, such that as level of education increased, FA increased. Total blast exposure, age, and education were significant predictors of FA in the left cingulum. We did not find any effect of post-traumatic stress disorder on cognition or composite FA. In summary, our findings suggest that greater total blast exposure is a contributing factor to poor WM integrity. While FA was not associated with neurocognitive performance, we hypothesize that FA changes in the cingulum in veterans with multiple combat exposures and no head trauma prior to deployment may represent a marker of vulnerability for future deficits. Future work needs to examine this longitudinally. PMID:28484418

  17. Assessing neuro-systemic & behavioral components in the pathophysiology of blast-related brain injury.

    PubMed

    Kobeissy, Firas; Mondello, Stefania; Tümer, Nihal; Toklu, Hale Z; Whidden, Melissa A; Kirichenko, Nataliya; Zhang, Zhiqun; Prima, Victor; Yassin, Walid; Anagli, John; Chandra, Namas; Svetlov, Stan; Wang, Kevin K W

    2013-11-21

    Among the U.S. military personnel, blast injury is among the leading causes of brain injury. During the past decade, it has become apparent that even blast injury as a form of mild traumatic brain injury (mTBI) may lead to multiple different adverse outcomes, such as neuropsychiatric symptoms and long-term cognitive disability. Blast injury is characterized by blast overpressure, blast duration, and blast impulse. While the blast injuries of a victim close to the explosion will be severe, majority of victims are usually at a distance leading to milder form described as mild blast TBI (mbTBI). A major feature of mbTBI is its complex manifestation occurring in concert at different organ levels involving systemic, cerebral, neuronal, and neuropsychiatric responses; some of which are shared with other forms of brain trauma such as acute brain injury and other neuropsychiatric disorders such as post-traumatic stress disorder. The pathophysiology of blast injury exposure involves complex cascades of chronic psychological stress, autonomic dysfunction, and neuro/systemic inflammation. These factors render blast injury as an arduous challenge in terms of diagnosis and treatment as well as identification of sensitive and specific biomarkers distinguishing mTBI from other non-TBI pathologies and from neuropsychiatric disorders with similar symptoms. This is due to the "distinct" but shared and partially identified biochemical pathways and neuro-histopathological changes that might be linked to behavioral deficits observed. Taken together, this article aims to provide an overview of the current status of the cellular and pathological mechanisms involved in blast overpressure injury and argues for the urgent need to identify potential biomarkers that can hint at the different mechanisms involved.

  18. Assessing Neuro-Systemic & Behavioral Components in the Pathophysiology of Blast-Related Brain Injury

    PubMed Central

    Kobeissy, Firas; Mondello, Stefania; Tümer, Nihal; Toklu, Hale Z.; Whidden, Melissa A.; Kirichenko, Nataliya; Zhang, Zhiqun; Prima, Victor; Yassin, Walid; Anagli, John; Chandra, Namas; Svetlov, Stan; Wang, Kevin K. W.

    2013-01-01

    Among the U.S. military personnel, blast injury is among the leading causes of brain injury. During the past decade, it has become apparent that even blast injury as a form of mild traumatic brain injury (mTBI) may lead to multiple different adverse outcomes, such as neuropsychiatric symptoms and long-term cognitive disability. Blast injury is characterized by blast overpressure, blast duration, and blast impulse. While the blast injuries of a victim close to the explosion will be severe, majority of victims are usually at a distance leading to milder form described as mild blast TBI (mbTBI). A major feature of mbTBI is its complex manifestation occurring in concert at different organ levels involving systemic, cerebral, neuronal, and neuropsychiatric responses; some of which are shared with other forms of brain trauma such as acute brain injury and other neuropsychiatric disorders such as post-traumatic stress disorder. The pathophysiology of blast injury exposure involves complex cascades of chronic psychological stress, autonomic dysfunction, and neuro/systemic inflammation. These factors render blast injury as an arduous challenge in terms of diagnosis and treatment as well as identification of sensitive and specific biomarkers distinguishing mTBI from other non-TBI pathologies and from neuropsychiatric disorders with similar symptoms. This is due to the “distinct” but shared and partially identified biochemical pathways and neuro-histopathological changes that might be linked to behavioral deficits observed. Taken together, this article aims to provide an overview of the current status of the cellular and pathological mechanisms involved in blast overpressure injury and argues for the urgent need to identify potential biomarkers that can hint at the different mechanisms involved. PMID:24312074

  19. Blasting Damage Predictions by Numerical Modeling in Siahbishe Pumped Storage Powerhouse

    NASA Astrophysics Data System (ADS)

    Eslami, Majid; Goshtasbi, Kamran

    2017-04-01

    One of the popular methods of underground and surface excavations is the use of blasting. Throughout this method of excavation, the loading resulted from blasting can be affected by different geo-mechanical and structural parameters of rock mass. Several factors affect turbulence in underground structures some of which are explosion, vibration, and stress impulses caused by the neighbouring blasting products. In investigating the blasting mechanism one should address the processes which expand with time and cause seismic events. To protect the adjoining structures against any probable deconstruction or damage, it is very important to model the blasting process prior to any actual operation. Efforts have been taken in the present study to demonstrate the potentiality of numerical methods in predicting the specified parameters in order to prevent any probable destruction. For this purpose the blasting process was modeled, according to its natural implementation, in one of the tunnels of Siahbishe dam by the 3DEC and AUTODYN 3D codes. 3DEC was used for modeling the blasting environment as well as the blast holes and AUTODYN 3D for modeling the explosion process in the blast hole. In this process the output of AUTODYN 3D, which is a result of modeling the blast hole and is in the form of stress waves, is entered into 3DEC. For analyzing the amount of destruction made by the blasting operation, the key parameter of Peak Particle Velocity was used. In the end, the numerical modeling results have been compared with the data recorded by the seismographs planted through the tunnel. As the results indicated 3DEC and AUTODYN 3D proved appropriate for analyzing such an issue. Therefore, by means of these two softwares one can analyze explosion processes prior to their implementation and make close estimation of the damage resulting from these processes.

  20. Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus.

    PubMed

    Rúa-Figueroa, Íñigo; López-Longo, Javier; Galindo-Izquierdo, María; Calvo-Alén, Jaime; Del Campo, Víctor; Olivé-Marqués, Alejandro; Pérez-Vicente, Sabina; Fernández-Nebro, Antonio; Andrés, Mariano; Erausquin, Celia; Tomero, Eva; Horcada, Loreto; Uriarte, Esther; Freire, Mercedes; Montilla, Carlos; Sánchez-Atrio, Ana; Santos, Gregorio; Boteanu, Alina; Díez-Álvarez, Elvira; Narváez, Javier; Martínez-Taboada, Víctor; Silva-Fernández, Lucía; Ruiz-Lucea, Esther; Andreu, José Luis; Hernández-Beriain, José Ángel; Gantes, Marian; Hernández-Cruz, Blanca; Pérez-Venegas, José; Pecondón-Español, Ángela; Marras, Carlos; Ibáñez-Barceló, Mónica; Bonilla, Gema; Torrente, Vicente; Castellví, Iván; Alegre, Juan José; Calvet, Joan; Marenco, Jose Luis; Raya, Enrique; Vázquez, Tomás; Quevedo, Victor; Muñoz-Fernández, Santiago; Rodríguez-Gómez, Manuel; Ibáñez, Jesús; Pego-Reigosa, José M

    2017-08-01

    To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort. All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection. A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ≥1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (≥10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999). Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection

  1. 30 CFR 75.1323 - Blasting circuits.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Blasting circuits. 75.1323 Section 75.1323... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1323 Blasting circuits. (a) Blasting circuits shall be protected from sources of stray electric current. (b) Detonators made by...

  2. 30 CFR 75.1323 - Blasting circuits.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Blasting circuits. 75.1323 Section 75.1323... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1323 Blasting circuits. (a) Blasting circuits shall be protected from sources of stray electric current. (b) Detonators made by...

  3. 30 CFR 75.1323 - Blasting circuits.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Blasting circuits. 75.1323 Section 75.1323... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1323 Blasting circuits. (a) Blasting circuits shall be protected from sources of stray electric current. (b) Detonators made by...

  4. 30 CFR 75.1323 - Blasting circuits.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Blasting circuits. 75.1323 Section 75.1323... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1323 Blasting circuits. (a) Blasting circuits shall be protected from sources of stray electric current. (b) Detonators made by...

  5. 30 CFR 75.1323 - Blasting circuits.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Blasting circuits. 75.1323 Section 75.1323... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Explosives and Blasting § 75.1323 Blasting circuits. (a) Blasting circuits shall be protected from sources of stray electric current. (b) Detonators made by...

  6. 29 CFR 1926.912 - Underwater blasting.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 29 Labor 8 2011-07-01 2011-07-01 false Underwater blasting. 1926.912 Section 1926.912 Labor... Underwater blasting. (a) A blaster shall conduct all blasting operations, and no shot shall be fired without... swimming or diving operations are in progress in the vicinity of the blasting area. If such operations are...

  7. 29 CFR 1926.912 - Underwater blasting.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 29 Labor 8 2010-07-01 2010-07-01 false Underwater blasting. 1926.912 Section 1926.912 Labor... Underwater blasting. (a) A blaster shall conduct all blasting operations, and no shot shall be fired without... swimming or diving operations are in progress in the vicinity of the blasting area. If such operations are...

  8. 29 CFR 1926.912 - Underwater blasting.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... nonsparking metal loading tube when tube is necessary. (d) No blast shall be fired while any vessel under way... within 1,500 feet shall be notified before a blast is fired. (e) No blast shall be fired while any... in progress, signals and arrangements shall be agreed upon to assure that no blast shall be...

  9. 29 CFR 1926.912 - Underwater blasting.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... nonsparking metal loading tube when tube is necessary. (d) No blast shall be fired while any vessel under way... within 1,500 feet shall be notified before a blast is fired. (e) No blast shall be fired while any... in progress, signals and arrangements shall be agreed upon to assure that no blast shall be...

  10. 29 CFR 1926.912 - Underwater blasting.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... nonsparking metal loading tube when tube is necessary. (d) No blast shall be fired while any vessel under way... within 1,500 feet shall be notified before a blast is fired. (e) No blast shall be fired while any... in progress, signals and arrangements shall be agreed upon to assure that no blast shall be...