Daily bathing with octenidine on an intensive care unit is associated with a lower carriage rate of meticillin-resistant Staphylococcus aureus.

PubMed

Spencer, C; Orr, D; Hallam, S; Tillmanns, E

2013-02-01

Routine daily bathing of intensive care (ICU) patients with topical chlorhexidine reduces meticillin-resistant Staphylococcus aureus (MRSA) acquisition. The aim of this study was to investigate whether repeated five-day cycles of daily topical octenidine could result in a similar effect. This was a two-year retrospective, uncontrolled study in a mixed medical and surgical ICU/high dependency unit, demonstrating a 76% reduction in MRSA acquisition but no significant reduction in all ICU-acquired bacteraemias. Chlorhexidine use is increasing but resistance is being reported. This pilot study found a similar reduction in MRSA acquisition with octenidine as an alternative to chlorhexidine. Further study is required to establish causality. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

A comparison of results from two simulators used for studies of astronaut maneuvering units. [with application to Skylab program

NASA Technical Reports Server (NTRS)

Stewart, E. C.; Cannaday, R. L.

1973-01-01

A comparison of the results from a fixed-base, six-degree-of -freedom simulator and a moving-base, three-degree-of-freedom simulator was made for a close-in, EVA-type maneuvering task in which visual cues of a target spacecraft were used for guidance. The maneuvering unit (the foot-controlled maneuvering unit of Skylab Experiment T020) employed an on-off acceleration command control system operated entirely by the feet. Maneuvers by two test subjects were made for the fixed-base simulator in six and three degrees of freedom and for the moving-base simulator in uncontrolled and controlled, EVA-type visual cue conditions. Comparisons of pilot ratings and 13 different quantitative parameters from the two simulators are made. Different results were obtained from the two simulators, and the effects of limited degrees of freedom and uncontrolled visual cues are discussed.

Cost-effectiveness of Phacoemulsification Versus Combined Phacotrabeculectomy for Treating Primary Angle Closure Glaucoma.

PubMed

Chan, Poemen P; Li, Emmy Y; Tsoi, Kelvin K F; Kwong, Yolanda Y; Tham, Clement C

2017-10-01

The purpose of this study is to compare the cost effectiveness of phacoemulsification and combined phacotrabeculectomy for lowering intraocular pressure (IOP) in primary angle closure glaucoma (PACG) eyes with coexisting cataract. Real-life data of 2 previous randomized control trials that involved 51 medically uncontrolled PACG eyes and 72 medically controlled PACG eyes were utilized to calculate the direct cost of treatment. They were followed-up for 2 years. Cost of preoperative assessments, surgical interventions, additional procedures for managing complications and maintenance of filtration, postoperative follow-up, and cost of medications were considered. Cost data of 3 different regions (The United States, People's Republic of China, and Hong Kong) were used for comparison. The corresponding average costs for treating 1 eye with newly diagnosed PACG by phacoemulsification alone and combined phacotrabeculectomy were US$3479 and US$2439 in the United States, US$1051 and US$861 in China, and US$6856 and US$12087 in Hong Kong. Surgical and medications costs were the 2 key contributors. Combined phacotrabeculectomy was more cost-effective for IOP reduction when calculating with the United States and China cost data, but was less cost-effective when calculating with the Hong Kong cost data. The cost-effectiveness was insensitive to the costs of follow-up visit and investigations, the cost of surgical operations, and the cost of postoperative procedures, but sensitive to the cost fluctuation of medications. Furthermore, for the medically uncontrolled PACG group, phacoemulsification alone became more cost-effective when the cost of medication was reduced by >75%. Combined phacotrabeculectomy is a more cost-effective option for lowering IOP in PACG eyes with coexisting cataract, over a 2-year follow-up period.

The association between depression and eating styles in four European countries: The MooDFOOD prevention study.

PubMed

Paans, Nadine P G; Bot, Mariska; Brouwer, Ingeborg A; Visser, Marjolein; Roca, Miquel; Kohls, Elisabeth; Watkins, Ed; Penninx, Brenda W J H

2018-05-01

Depression, one of the most prevalent and disabling disorders in Europe, is thought to be associated with unhealthy eating styles. As prevalence of depression and eating styles potentially differ across Europe, the current study aimed to investigate in a large, European sample, the associations of history of major depressive disorder and depression severity with unhealthy eating styles. Baseline data of the MooDFOOD prevention study was used. The current analysis included 990 participants of four European countries (The Netherlands, United Kingdom, Germany, Spain). Analyses of Covariance and linear regression analyses were performed with depression history or depression severity as determinants, and emotional, uncontrolled, and cognitive restrained eating (Three Factor Eating Questionnaire Revised, 18 item) as outcomes. Depression history and severity were associated with more emotional and uncontrolled eating and with less cognitive restrained eating. Mood, somatic, and cognitive symptom clusters were also associated with more emotional and uncontrolled eating, and with less cognitive restrained eating. The somatic depressive symptoms "increased appetite" and "increased weight" were more strongly associated to unhealthy eating styles compared to other symptoms. No differences in associations between depression and unhealthy eating were found between European countries. Our results suggest that depression is related to more unhealthy eating styles. Diminishing unhealthy eating styles in subthreshold depressed persons could potentially reduce adverse health consequences like weight gain, unhealthy dietary patterns and weight-related diseases. It is also possible that interventions that decrease depressive symptoms can lead to a decrease in unhealthy eating styles. Copyright © 2018 Elsevier Inc. All rights reserved.

Therapy of hyperthyroidism in pregnancy and breastfeeding.

PubMed

Fumarola, Angela; Di Fiore, Agnese; Dainelli, Michela; Grani, Giorgio; Carbotta, Giovanni; Calvanese, Anna

2011-06-01

Uncontrolled hyperthyroidism in pregnancy is associated with an increased risk of perinatal complications. The state of the art discussed here has been derived through a wide MEDLINE search throughout English-language literature by using a combination of words such as hyperthyroidism, propylthiouracil (PTU), methimazole, rituximab, and pregnancy to identify original related works and review articles. Thioamides are the main first-line therapeutic options, whereas beta-blockers and iodine are second-choice drugs; surgery is resorted to only in exceptional cases. Methimazole and PTU reduce the production of thyroid hormones by selectively inhibiting thyroid peroxidase. PTU was once considered to be the first-choice drug in the treatment of gestational hyperthyroidism; however, the United States Food and Drug Administration now recommends it as a second-line thioamide, which should be used solely by women in their first trimester of pregnancy. Thyroidectomy is to be carried out only in pregnant women affected by life-threatening, uncontrollable hyperthyroidism, or in cases with thioamide intolerance. Obstetricians & Gynecologists, Family Physicians After completion of this article, the physician should be better able to choose appropriate therapies for hyperthyroidism in pregnant women, assess the risk of possible complications due to maternal hyperthyroidism, and evaluate strategies for patient follow-up.

Assessment of asthma control: the SERENA study.

PubMed

Corrado, Antonio; Renda, Teresa; Polese, Guido; Rossi, Andrea

2013-11-01

Several studies suggest that many asthmatic subjects have uncontrolled asthma. The control of asthma is now considered the major goal of therapy. to ascertain the level of asthma control, by Asthma Control Test (ACT), in "real-life" clinical practice and the potential risk factors for uncontrolled disease in patients treated with inhaled corticosteroids (ICS) and long-acting beta-adrenergic agonists (LABA). SERENA is a multi-centre, cross-sectional, 6-month observational, non-interventional study carried out in 16 Pulmonary Units in Italy. Asthmatic outpatients aged over 18, undergoing treatment with ICS at medium-high daily doses associated with LABA, were enrolled. The patients were divided in 3 subgroups according to the level of asthma control by ACT score (25:controlled; 20-24:partly controlled; <20: uncontrolled). Out of a total of 548 patients, 396 met the inclusion criteria. Only 9.1% of patients had asthma controlled, while partly controlled and uncontrolled asthma accounted for 39.6% and 51.3% respectively. The mean age was 54.5 ± 15.8 and the mean duration of asthma was 16.1 ± 14.1 years. There were more females than males (63% vs 37%) and females had highest prevalence of uncontrolled asthma (63.1%). The mean values of FEV1% predicted were lower in the uncontrolled group (p < 0.001). The percentage of patients with at least 1 exacerbation, unscheduled visit and/or admissions was lower in controlled (22.2%, 8.3%, 8.3%) than in partly controlled (50%, 38.6%, 9.2%) and uncontrolled (83.2%, 66.2%, 27.8%) groups (p < 0.0001). The multivariate ordinal logistic regression analysis identified female sex, FEV1 and exacerbations as the strongest independent factors associated with the uncontrolled disease. This study highlights the importance in clinical practice of a periodic assessment by a validated asthma control instrument and exacerbations/health care contacts during previous year. Clinicians should be aware that a significant proportion of patients can have uncontrolled asthma, despite regular pharmacological treatment. Copyright © 2013 Elsevier Ltd. All rights reserved.

Chronic Health Outcomes and Prescription Drug Copayments in Medicaid.

PubMed

Kostova, Deliana; Fox, Jared

2017-05-01

Prescription drug copayments and cost-sharing have been linked to reductions in prescription drug use and expenditures. However, little is known about their effect on specific health outcomes. To evaluate the association between prescription drug copayments and uncontrolled hypertension, uncontrolled hypercholesterolemia, and prescription drug utilization among Medicaid beneficiaries with these conditions. Select adults aged 20-64 from NHANES 1999-2012 in 18 states. Uncontrolled hypertension, uncontrolled hypercholesterolemia, and taking medication for each of these conditions. A differencing regression model was used to evaluate health outcomes among Medicaid beneficiaries in 4 states that introduced copayments during the study period, relative to 2 comparison groups-Medicaid beneficiaries in 14 states unaffected by shifts in copayment policy, and a within-state counterfactual group of low-income adults not on Medicaid, while controlling for individual demographic factors and unobserved state-level characteristics. Although uncontrolled hypertension and hypercholesterolemia declined among all low-income persons during the study period, the trend was less pronounced in Medicaid beneficiaries affected by copayments. After netting out concurrent trends in health outcomes of low-income persons unaffected by Medicaid copayment changes, we estimated that introduction of drug copayments in Medicaid was associated with an average rise in uncontrolled hypertension and uncontrolled hypercholesterolemia of 7.7 and 13.2 percentage points, respectively, and with reduced drug utilization for hypercholesterolemia. As Medicaid programs change in the years following the Affordable Care Act, prescription drug copayments may play a role as a lever for controlling hypertension and hypercholesterolemia at the population level.

Methylene blue, midodrine, and pseudoephedrine: a review of alternative agents for refractory hypotension in the intensive care unit.

PubMed

Van Berkel, Megan A; Fuller, Laura A; Alexandrov, Anne W; Jones, G Morgan

2015-01-01

Hypotensive episodes are common among patients in the intensive care unit and can lead to multiorgan failure if uncontrolled. Fluid administration and continuous infusion of vasoactive agents are frequently used for management of hypotension; however, both therapies may be associated with adverse effects including pulmonary edema and tissue necrosis. In addition, availability of these first-line agents has been impacted by the increasing occurrence of drug shortages. Methylene blue, pseudoephedrine, and midodrine have been considered potential alternatives to standard therapy. These agents may not only be used when first-line agents are unavailable due to shortages, but they may also aid in reducing the cumulative dose of other vasoactive agents used. The purpose of this review was to discuss strategies for the safe and effective use of methylene blue, pseudoephedrine, and midodrine for the treatment of hypotension in the critically ill.

Uncontrolled Hypertension and Its Determinants in Patients with Concomitant Type 2 Diabetes Mellitus (T2DM) in Rural South Africa.

PubMed

Adeniyi, Oladele Vincent; Yogeswaran, Parimalaranie; Longo-Mbenza, Benjamin; Ter Goon, Daniel

2016-01-01

Paucity of data on the prevalence, treatment and control of hypertension in individuals living with type 2 diabetes mellitus (T2DM) in the rural communities of South Africa may undermine efforts to reduce the morbidity and mortality associated with cardiovascular diseases. This study examines the socio-demographic and clinical determinants of uncontrolled hypertension among individuals living with T2DM in the rural communities of Mthatha, South Africa. This cross-sectional study involved a serially selected sample of 265 individuals living with T2DM and hypertension at Mthatha General Hospital, Mthatha. Uncontrolled hypertension was defined as systolic blood pressure greater than or equal to 140 mmHg and diastolic blood pressure greater than or equal to 90mmHg in accordance with the Eight Joint National Committee Report (JNC 8) (2014). We performed univariate and multivariate logistic regression analyses to identify the significant determinants of uncontrolled hypertension. Of the total participants (n = 265), the prevalence of uncontrolled hypertension was 75.5% (n = 200). In univariate analysis of all participants, male gender (p = 0.029), age≥65 years (p = 0.016), unemployed status (p<0.0001), excessive alcohol intake (p = 0.005) and consumption of western-type diet (p<0.0001) were positively associated with uncontrolled hypertension. In multivariate logistic regression (LR method) analysis, unemployed status (p<0.0001), excessive alcohol intake (p = 0.007) and consumption of western-type diet (p<0.0001) were independently and significantly associated with uncontrolled hypertension. There is significant association between increasing number and classes of anti-hypertensive drugs and uncontrolled hypertension (p = 0.05 and 0.02, respectively). Prevalence of uncontrolled hypertension was high in individuals with concomitant hypertension and T2DM in the study population. Male sex, aging, clinic inertia, unemployed status and nutritional transitions are the most important determinants of uncontrolled hypertension in T2DM in Mthatha, South Africa. Treatment to blood pressure targets, though feasible in our setting, would require concerted efforts by addressing these determinants and clinic inertia.

The Developmental Vicissitudes of a Municipal Hospital-Based Child Psychiatry Unit in an Urban Ghetto.

ERIC Educational Resources Information Center

Eagle, Carol J.; And Others

The development of a child psychiatric unit in a municipal, ghetto-located hospital is described. Initial problems and their solutions are discussed. Accepting the fact that the problems of the political scene and gross underfunding were uncontrollable, focus was put on devising a service comparable to those utilized by middle class populations. A…

A simplified approach for slope stability analysis of uncontrolled waste dumps.

PubMed

Turer, Dilek; Turer, Ahmet

2011-02-01

Slope stability analysis of municipal solid waste has always been problematic because of the heterogeneous nature of the waste materials. The requirement for large testing equipment in order to obtain representative samples has identified the need for simplified approaches to obtain the unit weight and shear strength parameters of the waste. In the present study, two of the most recently published approaches for determining the unit weight and shear strength parameters of the waste have been incorporated into a slope stability analysis using the Bishop method to prepare slope stability charts. The slope stability charts were prepared for uncontrolled waste dumps having no liner and leachate collection systems with pore pressure ratios of 0, 0.1, 0.2, 0.3, 0.4 and 0.5, considering the most critical slip surface passing through the toe of the slope. As the proposed slope stability charts were prepared by considering the change in unit weight as a function of height, they reflect field conditions better than accepting a constant unit weight approach in the stability analysis. They also streamline the selection of slope or height as a function of the desired factor of safety.

Quo vadis? Microbial profiling revealed strong effects of cleanroom maintenance and routes of contamination in indoor environments

DOE PAGES

Moissl-Eichinger, Christine; Auerbach, Anna K.; Probst, Alexander J.; ...

2015-03-17

Space agencies maintain highly controlled cleanrooms to ensure the demands of planetary protection. To study potential effects of microbiome control, we analyzed microbial communities in two particulate-controlled cleanrooms (ISO 5 and ISO 8) and two vicinal uncontrolled areas (office, changing room) by cultivation and 16S rRNA gene amplicon analysis (cloning, pyrotagsequencing, and PhyloChip G3 analysis). Maintenance procedures affected the microbiome on total abundance and microbial community structure concerning richness, diversity and relative abundance of certain taxa. Cleanroom areas were found to be mainly predominated by potentially human-associated bacteria; archaeal signatures were detected in every area. Results indicate that microorganisms weremore » mainly spread from the changing room (68%) into the cleanrooms, potentially carried along with human activity. The numbers of colony forming units were reduced by up to ~400 fold from the uncontrolled areas towards the ISO 5 cleanroom, accompanied with a reduction of the living portion of microorganisms from 45% (changing area) to 1% of total 16S rRNA gene signatures as revealed via propidium monoazide treatment of the samples. Our results demonstrate the strong effects of cleanroom maintenance on microbial communities in indoor environments and can be used to improve the design and operation of biologically controlled cleanrooms.« less

Quo vadis? Microbial profiling revealed strong effects of cleanroom maintenance and routes of contamination in indoor environments

PubMed Central

Moissl-Eichinger, Christine; Auerbach, Anna K.; Probst, Alexander J.; Mahnert, Alexander; Tom, Lauren; Piceno, Yvette; Andersen, Gary L.; Venkateswaran, Kasthuri; Rettberg, Petra; Barczyk, Simon; Pukall, Rüdiger; Berg, Gabriele

2015-01-01

Space agencies maintain highly controlled cleanrooms to ensure the demands of planetary protection. To study potential effects of microbiome control, we analyzed microbial communities in two particulate-controlled cleanrooms (ISO 5 and ISO 8) and two vicinal uncontrolled areas (office, changing room) by cultivation and 16S rRNA gene amplicon analysis (cloning, pyrotagsequencing, and PhyloChip G3 analysis). Maintenance procedures affected the microbiome on total abundance and microbial community structure concerning richness, diversity and relative abundance of certain taxa. Cleanroom areas were found to be mainly predominated by potentially human-associated bacteria; archaeal signatures were detected in every area. Results indicate that microorganisms were mainly spread from the changing room (68%) into the cleanrooms, potentially carried along with human activity. The numbers of colony forming units were reduced by up to ~400 fold from the uncontrolled areas towards the ISO 5 cleanroom, accompanied with a reduction of the living portion of microorganisms from 45% (changing area) to 1% of total 16S rRNA gene signatures as revealed via propidium monoazide treatment of the samples. Our results demonstrate the strong effects of cleanroom maintenance on microbial communities in indoor environments and can be used to improve the design and operation of biologically controlled cleanrooms. PMID:25778463

Quo vadis? Microbial profiling revealed strong effects of cleanroom maintenance and routes of contamination in indoor environments

NASA Astrophysics Data System (ADS)

Moissl-Eichinger, Christine; Auerbach, Anna K.; Probst, Alexander J.; Mahnert, Alexander; Tom, Lauren; Piceno, Yvette; Andersen, Gary L.; Venkateswaran, Kasthuri; Rettberg, Petra; Barczyk, Simon; Pukall, Rüdiger; Berg, Gabriele

2015-03-01

Space agencies maintain highly controlled cleanrooms to ensure the demands of planetary protection. To study potential effects of microbiome control, we analyzed microbial communities in two particulate-controlled cleanrooms (ISO 5 and ISO 8) and two vicinal uncontrolled areas (office, changing room) by cultivation and 16S rRNA gene amplicon analysis (cloning, pyrotagsequencing, and PhyloChip G3 analysis). Maintenance procedures affected the microbiome on total abundance and microbial community structure concerning richness, diversity and relative abundance of certain taxa. Cleanroom areas were found to be mainly predominated by potentially human-associated bacteria; archaeal signatures were detected in every area. Results indicate that microorganisms were mainly spread from the changing room (68%) into the cleanrooms, potentially carried along with human activity. The numbers of colony forming units were reduced by up to ~400 fold from the uncontrolled areas towards the ISO 5 cleanroom, accompanied with a reduction of the living portion of microorganisms from 45% (changing area) to 1% of total 16S rRNA gene signatures as revealed via propidium monoazide treatment of the samples. Our results demonstrate the strong effects of cleanroom maintenance on microbial communities in indoor environments and can be used to improve the design and operation of biologically controlled cleanrooms.

Quo vadis? Microbial profiling revealed strong effects of cleanroom maintenance and routes of contamination in indoor environments

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

Moissl-Eichinger, Christine; Auerbach, Anna K.; Probst, Alexander J.

Space agencies maintain highly controlled cleanrooms to ensure the demands of planetary protection. To study potential effects of microbiome control, we analyzed microbial communities in two particulate-controlled cleanrooms (ISO 5 and ISO 8) and two vicinal uncontrolled areas (office, changing room) by cultivation and 16S rRNA gene amplicon analysis (cloning, pyrotagsequencing, and PhyloChip G3 analysis). Maintenance procedures affected the microbiome on total abundance and microbial community structure concerning richness, diversity and relative abundance of certain taxa. Cleanroom areas were found to be mainly predominated by potentially human-associated bacteria; archaeal signatures were detected in every area. Results indicate that microorganisms weremore » mainly spread from the changing room (68%) into the cleanrooms, potentially carried along with human activity. The numbers of colony forming units were reduced by up to ~400 fold from the uncontrolled areas towards the ISO 5 cleanroom, accompanied with a reduction of the living portion of microorganisms from 45% (changing area) to 1% of total 16S rRNA gene signatures as revealed via propidium monoazide treatment of the samples. Our results demonstrate the strong effects of cleanroom maintenance on microbial communities in indoor environments and can be used to improve the design and operation of biologically controlled cleanrooms.« less

Anesthesia Preoperative Clinic Referral for Elevated Hba1c Reduces Complication Rate in Diabetic Patients Undergoing Total Joint Arthroplasty.

PubMed

Kallio, Peter J; Nolan, Jenea; Olsen, Amy C; Breakwell, Susan; Topp, Richard; Pagel, Paul S

2015-06-01

Diabetes mellitus (DM) is risk factor for complications after orthopedic surgery. We tested the hypothesis that anesthesia preoperative clinic (APC) referral for elevated glycosylated hemoglobin (HbA1c) reduces complication rate after total joint arthroplasty (TJA). Patients (n = 203) with and without DM were chosen from 1,237 patients undergoing TJA during 2006 - 12. Patients evaluated in the APC had surgery in 2006 - 8 regardless of HbA1c (uncontrolled). Those evaluated between in subsequent two-year intervals were referred to primary care for HbA1c ≥ 10% and ≥ 8%, respectively, to improve DM control before surgery. Complications and mortality were quantified postoperatively and at three, six, and twelve months. Length of stay (LOS) and patients requiring a prolonged LOS (> 5 days) were recorded. Patients (197 men, 6 women) underwent 71, 131, and 1 total hip, knee, and shoulder replacements, respectively. Patients undergoing TJA with uncontrolled HbA1c and those with HbA1c < 10%, but not those with HbA1c < 8%, had a higher incidence of coronary disease and hypercholesterolemia than patients without DM. An increase in complication rate was observed in DM patients with uncontrolled HbA1c versus patients without DM (P < 0.001); the complication rate progressively decreased with tighter HbA1c control. More DM patients with preoperative HbA1c that was uncontrolled or ≥ 10% required prolonged LOS versus those without DM (P < 0.001 and P = 0.0404, respectively). APC referral for elevated HbA1c reduces complication rate and the incidence of prolonged hospitalization during the first year after surgery in diabetics undergoing TJA.

Demonstration of Mer-Cure Technology for Enhanced Mercury Control

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

John Marion; Dave O'Neill; Kevin Taugher

2008-06-01

Alstom Power Inc. has completed a DOE/NETL-sponsored program (under DOE Cooperative Agreement No. De-FC26-07NT42776) to demonstrate Mer-Cure{trademark}, one of Alstom's mercury control technologies for coal-fired boilers. The Mer-Cure{trademark}system utilizes a small amount of Mer-Clean{trademark} sorbent that is injected into the flue gas stream for oxidation and adsorption of gaseous mercury. Mer-Clean{trademark} sorbents are carbon-based and prepared with chemical additives that promote oxidation and capture of mercury. The Mer-Cure{trademark} system is unique in that the sorbent is injected into an environment where the mercury capture kinetics is accelerated. The full-scale demonstration program originally included test campaigns at two host sites: LCRA's 480-MW{sub e} Fayette Unit No.3 and Reliant Energy's 190-MW{sub e} Shawville Unit No.3. The only demonstration tests actually done were the short-term tests at LCRA due to budget constraints. This report gives a summary of the demonstration testing at Fayette Unit No.3. The goals for this Mercury Round 3 program, established by DOE/NETL under the original solicitation, were to reduce the uncontrolled mercury emissions by 90% at a cost significantly less than 50% of the previous target ofmore » $$60,000/lb mercury removed. The results indicated that Mer-Cure{trademark} technology could achieve mercury removal of 90% based on uncontrolled stack emissions. The estimated costs for 90% mercury control, at a sorbent cost of $$0.75 to $2.00/lb respectively, were $13,400 to $18,700/lb Hg removed. In summary, the results from demonstration testing show that the goals established by DOE/NETL were met during this test program. The goal of 90% mercury reduction was achieved. Estimated mercury removal costs were 69-78% lower than the benchmark of $60,000/lb mercury removed, significantly less than 50% of the baseline removal cost.« less

Health care use and costs for participants in a diabetes disease management program, United States, 2007-2008.

PubMed

Dall, Timothy M; Roary, Mary; Yang, Wenya; Zhang, Shiping; Chen, Yaozhu J; Arday, David R; Gantt, Cynthia J; Zhang, Yiduo

2011-05-01

The Disease Management Association of America identifies diabetes as one of the chronic conditions with the greatest potential for management. TRICARE Management Activity, which administers health care benefits for US military service personnel, retirees, and their dependents, created a disease management program for beneficiaries with diabetes. The objective of this study was to determine whether participation intensity and prior indication of uncontrolled diabetes were associated with health care use and costs for participants enrolled in TRICARE's diabetes management program. This ongoing, opt-out study used a quasi-experimental approach to assess program impact for beneficiaries (n = 37,370) aged 18 to 64 living in the United States. Inclusion criteria were any diabetes-related emergency department visits or hospitalizations, more than 10 diabetes-related ambulatory visits, or more than twenty 30-day prescriptions for diabetes drugs in the previous year. Beginning in June 2007, all participants received educational mailings. Participants who agreed to receive a baseline telephone assessment and telephone counseling once per month in addition to educational mailings were considered active, and those who did not complete at least the baseline telephone assessment were considered passive. We categorized the diabetes status of each participant as "uncontrolled" or "controlled" on the basis of medical claims containing diagnosis codes for uncontrolled diabetes in the year preceding program eligibility. We compared observed outcomes to outcomes predicted in the absence of diabetes management. Prediction equations were based on regression analysis of medical claims for a historical control group (n = 23,818) that in October 2004 met the eligibility criteria for TRICARE's program implemented June 2007. We conducted regression analysis comparing historical control group patient outcomes after October 2004 with these baseline characteristics. Per-person total annual medical savings for program participants, calculated as the difference between observed and predicted outcomes, averaged $783. Active participants had larger reductions in inpatient days and emergency department visits, larger increases in ambulatory visits, and larger increases in receiving retinal examinations, hemoglobin A1c tests, and urine microalbumin tests compared with passive participants. Participants with prior indication of uncontrolled diabetes had higher per-person total annual medical savings, larger reduction in inpatient days, and larger increases in ambulatory visits than did participants with controlled diabetes. Greater intensity of participation in TRICARE's diabetes management program was associated with lower medical costs and improved receipt of recommended testing. That patients who were categorized as having uncontrolled diabetes realized greater program benefits suggests diabetes management programs should consider indication of uncontrolled diabetes in their program candidate identification criteria.

Health economics in the United States: cost implications.

PubMed

Whitelaw, G N

1993-01-01

World health care costs are increasing uncontrollably and will continue to grow even if draconian controls are implemented immediately. In the United States, the health care objectives are to control the escalating costs of health care and increase access to quality care. To achieve these goals, new administrative controls will be put in place to respond to the cost pressures. New policies to accommodate these new controls will be made by the state and federal governments and by various private third parties. The policies will contain incentives and disincentives for private and institutional providers and beneficiaries. As a result, providers are responding with various cost-control techniques and payors are attempting to reduce costs. In addition, new decision makers in hospitals, insurance companies, and government will be evaluating new technologies by new standards. In order to gain or maintain significant market penetration for a product, drug and device manufacturers will have to develop a multifaceted strategy to present their products in the most favorable economic light.

Investigation of tenuous plasma environment using Active Spacecraft Potential Control (ASPOC) on Magnetospheric Multiscale (MMS) Mission

NASA Astrophysics Data System (ADS)

Nakamura, Rumi; Jeszenszky, Harald; Torkar, Klaus; Andriopoulou, Maria; Fremuth, Gerhard; Taijmar, Martin; Scharlemann, Carsten; Svenes, Knut; Escoubet, Philippe; Prattes, Gustav; Laky, Gunter; Giner, Franz; Hoelzl, Bernhard

2015-04-01

The NASA's Magnetospheric Multiscale (MMS) Mission is planned to be launched on March 12, 2015. The scientific objectives of the MMS mission are to explore and understand the fundamental plasma physics processes of magnetic reconnection, particle acceleration and turbulence in the Earth's magnetosphere. The region of scientific interest of MMS is in a tenuous plasma environment where the positive spacecraft potential reaches an equilibrium at several tens of Volts. An Active Spacecraft Potential Control (ASPOC) instrument neutralizes the spacecraft potential by releasing positive charge produced by indium ion emitters. ASPOC thereby reduces the potential in order to improve the electric field and low-energy particle measurement. The method has been successfully applied on other spacecraft such as Cluster and Double Star. Two ASPOC units are present on each of the MMS spacecraft. Each unit contains four ion emitters, whereby one emitter per instrument is operated at a time. ASPOC for MMS includes new developments in the design of the emitters and the electronics enabling lower spacecraft potentials, higher reliability, and a more uniform potential structure in the spacecraft's sheath compared to previous missions. Model calculations confirm the findings from previous applications that the plasma measurements will not be affected by the beam's space charge. A perfectly stable spacecraft potential precludes the utilization of the spacecraft as a plasma probe, which is a conventional technique used to estimate ambient plasma density from the spacecraft potential. The small residual variations of the potential controlled by ASPOC, however, still allow to determine ambient plasma density by comparing two closely separated spacecraft and thereby reconstructing the uncontrolled potential variation from the controlled potential. Regular intercalibration of controlled and uncontrolled potentials is expected to increase the reliability of this new method.

Priority-based methods for reducing the impact of packet loss on HEVC encoded video streams

NASA Astrophysics Data System (ADS)

Nightingale, James; Wang, Qi; Grecos, Christos

2013-02-01

The rapid growth in the use of video streaming over IP networks has outstripped the rate at which new network infrastructure has been deployed. These bandwidth-hungry applications now comprise a significant part of all Internet traffic and present major challenges for network service providers. The situation is more acute in mobile networks where the available bandwidth is often limited. Work towards the standardisation of High Efficiency Video Coding (HEVC), the next generation video coding scheme, is currently on track for completion in 2013. HEVC offers the prospect of a 50% improvement in compression over the current H.264 Advanced Video Coding standard (H.264/AVC) for the same quality. However, there has been very little published research on HEVC streaming or the challenges of delivering HEVC streams in resource-constrained network environments. In this paper we consider the problem of adapting an HEVC encoded video stream to meet the bandwidth limitation in a mobile networks environment. Video sequences were encoded using the Test Model under Consideration (TMuC HM6) for HEVC. Network abstraction layers (NAL) units were packetized, on a one NAL unit per RTP packet basis, and transmitted over a realistic hybrid wired/wireless testbed configured with dynamically changing network path conditions and multiple independent network paths from the streamer to the client. Two different schemes for the prioritisation of RTP packets, based on the NAL units they contain, have been implemented and empirically compared using a range of video sequences, encoder configurations, bandwidths and network topologies. In the first prioritisation method the importance of an RTP packet was determined by the type of picture and the temporal switching point information carried in the NAL unit header. Packets containing parameter set NAL units and video coding layer (VCL) NAL units of the instantaneous decoder refresh (IDR) and the clean random access (CRA) pictures were given the highest priority followed by NAL units containing pictures used as reference pictures from which others can be predicted. The second method assigned a priority to each NAL unit based on the rate-distortion cost of the VCL coding units contained in the NAL unit. The sum of the rate-distortion costs of each coding unit contained in a NAL unit was used as the priority weighting. The preliminary results of extensive experiments have shown that all three schemes offered an improvement in PSNR, when comparing original and decoded received streams, over uncontrolled packet loss. Using the first method consistently delivered a significant average improvement of 0.97dB over the uncontrolled scenario while the second method provided a measurable, but less consistent, improvement across the range of testing conditions and encoder configurations.

Petri Net controller synthesis based on decomposed manufacturing models.

PubMed

Dideban, Abbas; Zeraatkar, Hashem

2018-06-01

Utilizing of supervisory control theory on the real systems in many modeling tools such as Petri Net (PN) becomes challenging in recent years due to the significant states in the automata models or uncontrollable events. The uncontrollable events initiate the forbidden states which might be removed by employing some linear constraints. Although there are many methods which have been proposed to reduce these constraints, enforcing them to a large-scale system is very difficult and complicated. This paper proposes a new method for controller synthesis based on PN modeling. In this approach, the original PN model is broken down into some smaller models in which the computational cost reduces significantly. Using this method, it is easy to reduce and enforce the constraints to a Petri net model. The appropriate results of our proposed method on the PN models denote worthy controller synthesis for the large scale systems. Copyright © 2018 ISA. Published by Elsevier Ltd. All rights reserved.

40 CFR 60.191 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... control system designed to remove gaseous and particulate flourides from exhaust gases which are captured... means a building unit which houses a group of electrolytic cells in which aluminum is produced. Potroom group means an uncontrolled potroom, a potroom which is controlled individually, or a group of potrooms...

40 CFR 60.191 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... control system designed to remove gaseous and particulate flourides from exhaust gases which are captured... means a building unit which houses a group of electrolytic cells in which aluminum is produced. Potroom group means an uncontrolled potroom, a potroom which is controlled individually, or a group of potrooms...

40 CFR 60.191 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... control system designed to remove gaseous and particulate flourides from exhaust gases which are captured... means a building unit which houses a group of electrolytic cells in which aluminum is produced. Potroom group means an uncontrolled potroom, a potroom which is controlled individually, or a group of potrooms...

40 CFR 60.191 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... control system designed to remove gaseous and particulate flourides from exhaust gases which are captured... means a building unit which houses a group of electrolytic cells in which aluminum is produced. Potroom group means an uncontrolled potroom, a potroom which is controlled individually, or a group of potrooms...

40 CFR 60.191 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... control system designed to remove gaseous and particulate flourides from exhaust gases which are captured... means a building unit which houses a group of electrolytic cells in which aluminum is produced. Potroom group means an uncontrolled potroom, a potroom which is controlled individually, or a group of potrooms...

Creating a Transdisciplinary Research Center to Reduce Cardiovascular Health Disparities in Baltimore, Maryland: Lessons Learned

PubMed Central

Boulware, L. Ebony; Miller, Edgar R.; Golden, Sherita Hill; Carson, Kathryn A.; Noronha, Gary; Huizinga, Mary Margaret; Roter, Debra L.; Yeh, Hsin-Chieh; Bone, Lee R.; Levine, David M.; Hill-Briggs, Felicia; Charleston, Jeanne; Kim, Miyong; Wang, Nae-Yuh; Aboumatar, Hanan; Halbert, Jennifer P.; Ephraim, Patti L.; Brancati, Frederick L.

2013-01-01

Cardiovascular disease (CVD) disparities continue to have a negative impact on African Americans in the United States, largely because of uncontrolled hypertension. Despite the availability of evidence-based interventions, their use has not been translated into clinical and public health practice. The Johns Hopkins Center to Eliminate Cardiovascular Health Disparities is a new transdisciplinary research program with a stated goal to lower the impact of CVD disparities on vulnerable populations in Baltimore, Maryland. By targeting multiple levels of influence on the core problem of disparities in Baltimore, the center leverages academic, community, and national partnerships and a novel structure to support 3 research studies and to train the next generation of CVD researchers. We also share the early lessons learned in the center’s design. PMID:24028238

Uncontrolled asthma: assessing quality of life and productivity of children and their caregivers using a cross-sectional Internet-based survey.

PubMed

Dean, Bonnie B; Calimlim, Brian C; Sacco, Patricia; Aguilar, Daniel; Maykut, Robert; Tinkelman, David

2010-09-08

Results of a national survey of asthmatic children that evaluated management goals established in 2004 by the National Asthma Education and Prevention Program (NAEPP) indicated that asthma symptom control fell short on nearly every goal. An Internet-based survey was administered to adult caregivers of children aged 6-12 years with moderate to severe asthma. Asthma was categorized as uncontrolled when the caregiver reported pre-specified criteria for daytime symptoms, nighttime awakening, activity limitation, or rescue medication based on the NAEPP guidelines. Children's health-related quality of life (HRQOL) and caregivers' quality of life (QOL) were assessed using the Child Health Questionnaire Parent Form 28 (CHQ-PF28) and caregiver's work productivity using a modified Work Productivity and Activity Impairment Questionnaire. Children with uncontrolled vs. controlled asthma were compared. 360 caregivers of children with uncontrolled asthma and 113 of children with controlled asthma completed the survey. Children with uncontrolled asthma had significantly lower CHQ-PF28 physical (mean 38.1 vs 49.8, uncontrolled vs controlled, respectively) and psychosocial (48.2 vs 53.8) summary measure scores. They were more likely to miss school (5.5 vs 2.2 days), arrive late or leave early (26.7 vs 7.1%), miss school-related activities (40.6 vs 6.2%), use a rescue inhaler at school (64.2 vs 31.0%), and visit the health office or school nurse (22.5 vs 8.8%). Caregivers of children with uncontrolled asthma reported significantly greater work and activity impairment and lower QOL for emotional, time-related and family activities. Poorly controlled asthma symptoms impair HRQOL of children, QOL of their caregivers, and productivity of both. Proper treatment and management to improve symptom control may reduce humanistic and economic burdens on asthmatic children and their caregivers.

U.S. Immigration Policy and the National Interest.

ERIC Educational Resources Information Center

Fauriol, Georges

1984-01-01

The national security of the United States depends upon its domestic strength and international stability. This strength requires an ability to control national borders, the maintenance of an independent foreign policy, a prosperous economy, and a cohesive domestic political environment. Uncontrolled migration is undermining this strength. (RM)

40 CFR Table 20 to Subpart Uuu of... - Continuous Compliance With Organic HAP Emission Limits for Catalytic Reforming Units

Code of Federal Regulations, 2010 CFR

2010-07-01

... uncontrolled emissions of total organic compounds (TOC) or nonmethane TOC from your process vent by 98 percent... of TOC or nonmethane TOC; or maintaining a TOC or nonmethane TOC concentration of not more than 20...

New combination treatments in the management of asthma: focus on fluticasone/vilanterol

PubMed Central

Tan, Laren D; Chan, Andrew L; Albertson, Timothy E

2014-01-01

Despite the 2007 National Asthma Education and Prevention Program Expert Panel 3 guidelines for the treatment of uncontrolled asthma, many patients with poorly controlled asthma still continue to tax the health care system. Controlling asthma symptoms and preventing acute exacerbations have been the foundation of care. Using long-term controller treatments such as inhaled corticosteroids (ICS) and inhaled long-acting beta2-agonists (LABAs) is a common approach. While patient responses to recommended pharmacotherapy may vary, poor adherence to therapy also contributes to poor asthma control. A once-daily combination inhaler, such as fluticasone furoate, an ICS, in combination with vilanterol, a LABA, offers increased convenience and potential improved adherence, which should result in enhanced clinical outcomes and reduced exacerbations. The ICS/LABA combination inhaler of fluticasone furoate and vilanterol is currently approved in the United States for use in the maintenance of chronic obstructive pulmonary disease and to reduce exacerbations. This paper reviews the expanding literature on the efficacy of fluticasone furoate and vilanterol in treating asthma. PMID:24833910

Dynamics of heart rate variability in patients with type 2 diabetes mellitus during spinal anaesthesia: prospective observational study.

PubMed

Lee, Su Hyun; Lee, Dong Hoon; Ha, Dong Hoon; Oh, Young Jun

2015-10-08

Little is known about the changes in autonomic function during spinal anaesthesia in type 2 diabetic patients. The purpose of the study was to assess the influence of spinal anaesthesia on the heart rate variability in type 2 diabetic patients according to the glycated hemoglobin (HbA1c) level. Sixty-six patients who were scheduled for elective orthostatic lower limb surgery were assigned to three groups (n = 22, each) according to HbA1c; controlled diabetes mellitus (HbA1c < 7 %), uncontrolled diabetes mellitus (HbA1c > 7 %) and the control group. The heart rate variability was measured 10 min before (T0), and at10 min (T1), 20 min (T2) and 30 min (T3) after spinal anaesthesia. Before spinal anaesthesia, total, low-and high-frequency power were significantly lower in the uncontrolled diabetec group than in other group (p < 0.05). During spinal anaesthesia, total, low- and high-frequency powers were did not change in the uncontrolled diabetec group while the low-frequency power in the controlled diabetec group was significantly depressed (p < 0.05). The ratio of low-to high-frequency was comparable among the groups, while it was reduced at T1-2 than at T0 in all the groups. The blood pressures were higher in the uncontrolled diabetec group than in the other groups. Spinal anaesthesia had an influence on the cardiac autonomic modulation in controlled diabetec patients, but not in uncontrolled diabetec patients. There were no differences in all haemodynamic variables during an adequate level of spinal anaesthesia in controlled and uncontrolled type 2 DM. ClinicalTrials.gov NCT02137057.

OVERVIEW OF THE HISTORY, PRESENT STATUS, AND FUTURE DIRECTION OF SOLIDIFICATION/STABILIZATION TECHNOLOGIES FOR HAZARDOUS WASTE TREATMENT

EPA Science Inventory

Solidification/stabilization (S/S) technology processes are currently being utilized in the United States to treat inorganic and organic hazardous waste and radioactive waste. These wastes are generated from operating industry or have resulted from the uncontrolled management of ...

Estimates of Flow Duration, Mean Flow, and Peak-Discharge Frequency Values for Kansas Stream Locations

USGS Publications Warehouse

Perry, Charles A.; Wolock, David M.; Artman, Joshua C.

2004-01-01

Streamflow statistics of flow duration and peak-discharge frequency were estimated for 4,771 individual locations on streams listed on the 1999 Kansas Surface Water Register. These statistics included the flow-duration values of 90, 75, 50, 25, and 10 percent, as well as the mean flow value. Peak-discharge frequency values were estimated for the 2-, 5-, 10-, 25-, 50-, and 100-year floods. Least-squares multiple regression techniques were used, along with Tobit analyses, to develop equations for estimating flow-duration values of 90, 75, 50, 25, and 10 percent and the mean flow for uncontrolled flow stream locations. The contributing-drainage areas of 149 U.S. Geological Survey streamflow-gaging stations in Kansas and parts of surrounding States that had flow uncontrolled by Federal reservoirs and used in the regression analyses ranged from 2.06 to 12,004 square miles. Logarithmic transformations of climatic and basin data were performed to yield the best linear relation for developing equations to compute flow durations and mean flow. In the regression analyses, the significant climatic and basin characteristics, in order of importance, were contributing-drainage area, mean annual precipitation, mean basin permeability, and mean basin slope. The analyses yielded a model standard error of prediction range of 0.43 logarithmic units for the 90-percent duration analysis to 0.15 logarithmic units for the 10-percent duration analysis. The model standard error of prediction was 0.14 logarithmic units for the mean flow. Regression equations used to estimate peak-discharge frequency values were obtained from a previous report, and estimates for the 2-, 5-, 10-, 25-, 50-, and 100-year floods were determined for this report. The regression equations and an interpolation procedure were used to compute flow durations, mean flow, and estimates of peak-discharge frequency for locations along uncontrolled flow streams on the 1999 Kansas Surface Water Register. Flow durations, mean flow, and peak-discharge frequency values determined at available gaging stations were used to interpolate the regression-estimated flows for the stream locations where available. Streamflow statistics for locations that had uncontrolled flow were interpolated using data from gaging stations weighted according to the drainage area and the bias between the regression-estimated and gaged flow information. On controlled reaches of Kansas streams, the streamflow statistics were interpolated between gaging stations using only gaged data weighted by drainage area.

Effect of intensive glycaemic control on endothelial progenitor cells in patients with long-standing uncontrolled type 2 diabetes.

PubMed

Lev, Eli I; Singer, Joel; Leshem-Lev, Dorit; Rigler, Merav; Dadush, Oshrat; Vaduganathan, Muthiah; Battler, Alexander; Kornowski, Ran

2014-09-01

Endothelial progenitor cells (EPCs) have an important role in repair following vascular injury. However, in patients with diabetes, EPC number and function are markedly reduced. It is unclear whether intensive glycaemic control can modify EPC properties in diabetic patients. We aimed to examine whether glycaemic control can improve EPC number and function in patients with long-standing uncontrolled type 2 diabetes. Thirty-five patients with treated type 2 diabetes and HgA1c ≥ 8.5% were included. Patients were tested at baseline and after 3-4 months of an intensive glycaemic control programme, with the aim of achieving HgA1c of 7%. The diabetes group was compared to 20 patients without diabetes (control). Circulating EPC levels were assessed by flow cytometry for expression of VEGFR2, CD133, and CD34. The capacity of the cells to form colony-forming units (CFUs), and their migration and viability were quantified after 1 week of culture. Patients with diabetes (mean age 61.1 ± 7 years, 28.6% women, disease duration of 19.2 ± 8 years) had a baseline HgA1c of 9.4 ± 0.8%. After the glycaemic control period, HgA1c decreased to 8 ± 0.8%. Circulating EPC levels increased significantly after the intensive control period and reached a level similar to the control group. The number of EPC CFUs also increased significantly after glycaemic control but remained lower than the control group. All EPC functional assays improved following the glycaemic control. In patients with uncontrolled long-standing type 2 diabetes, intensive glycaemic control was associated with an increase in the levels of circulating EPCs, and improvement in their functional properties. © The European Society of Cardiology 2013 Reprints and permissions:sagepub.co.uk/journalsPermissions.nav.

Cost-effectiveness of omalizumab add-on to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting.

PubMed

Suzuki, Cibele; Lopes da Silva, Nilceia; Kumar, Praveen; Pathak, Purnima; Ong, Siew Hwa

2017-08-01

Omalizumab add-on to standard-of-care therapy has proven to be efficacious in severe asthma patients for whom exacerbations cannot be controlled otherwise. Moreover, evidence from different healthcare settings suggests reduced healthcare resource utilization with omalizumab. Based on these findings, this study aimed to assess the cost-effectiveness of the addition of omalizumab to standard-of-care therapy in patients with uncontrolled severe allergic asthma in a Brazilian healthcare setting. A previously published Markov model was adapted using Brazil-specific unit costs to compare the costs and outcomes of the addition of omalizumab to standard-of-care therapy vs standard-of-care therapy alone. Model inputs were largely based on the eXpeRience study. Costs and health outcomes were calculated for lifetime-years and were annually discounted at 5%. Both one-way and probabilistic sensitivity analyses were performed. An additional cost of R$280,400 for 5.20 additional quality-adjusted life-years was estimated with the addition of omalizumab to standard-of-care therapy, resulting in an incremental cost-effectiveness ratio of R$53,890. One-way sensitivity analysis indicated that discount rates, standard-of-care therapy exacerbation rates, and exacerbation-related mortality rates had the largest impact on incremental cost-effectiveness ratios. Assumptions of lifetime treatment adherence and rate of future exacerbations, independent of previous events, might affect the findings. The lack of Brazilian patients in the eXpeRience study may affect the findings, although sample size and baseline characteristics suggest that the modeled population closely resembles Brazilian severe allergic asthma patients. Results indicate that omalizumab as an add-on therapy is more cost-effective than standard-of-care therapy alone for Brazilian patients with uncontrolled severe allergic asthma, based on the World Health Organization's cost-effectiveness threshold of up to 3-times the gross domestic product.

40 CFR Table 3 to Subpart Uuuu of... - Initial Compliance With Emission Limits and Work Practice Standards

Code of Federal Regulations, 2010 CFR

2010-07-01

... uncontrolled total sulfide emissions were reduced by at least 25%; (3) you prepare a material balance that... reduced by at least 75%; (3) you prepare a material balance that includes the pertinent data used to... emissions were reduced by at least 35%; (3) you prepare a material balance that includes the pertinent data...

40 CFR Table 3 to Subpart Uuuu of... - Initial Compliance With Emission Limits and Work Practice Standards

Code of Federal Regulations, 2011 CFR

2011-07-01

... uncontrolled total sulfide emissions were reduced by at least 25%; (3) you prepare a material balance that... reduced by at least 75%; (3) you prepare a material balance that includes the pertinent data used to... emissions were reduced by at least 35%; (3) you prepare a material balance that includes the pertinent data...

CANCER MORTALITY AMONG UNITED STATES COUNTIES WITH HAZARDOUS WASTE SITES AND SOLE SOURCE DRINKING WATER CONTAMINATION

EPA Science Inventory

Since the late 1950's more than 750 million tons of toxic wastes have been discarded in an estimated 30,000 to 50,000 hazardous waste sies (HWS). he uncontrolled discarding of chemical wastes creates the potential for risks to human health. tilizing the National Priorities Listin...

40 CFR Table 1 to Subpart Uuuu of... - Emission Limits and Work Practice Standards

Code of Federal Regulations, 2010 CFR

2010-07-01

... cellulosic sponge operation i. reduce total uncontrolled sulfide emissions (reported as carbon disulfide) by... process unit” mean “cellulose food casing, rayon, cellulosic sponge, cellophane, or cellulose ether...

Physician and patient characteristics associated with clinical inertia in blood pressure control.

PubMed

Harle, Christopher A; Harman, Jeffrey S; Yang, Shuo

2013-11-01

Clinical inertia, the failure to adjust antihypertensive medications during patient visits with uncontrolled hypertension, is thought to be a common problem. This retrospective study used 5 years of electronic medical records from a multispecialty group practice to examine the association between physician and patient characteristics and clinical inertia. Hierarchical linear models (HLMs) were used to examine (1) differences in physician and patient characteristics among patients with and without clinical inertia, and (2) the association between clinical inertia and future uncontrolled hypertension. Overall, 66% of patients experienced clinical inertia. Clinical inertia was associated with one physician characteristic, patient volume (odds ratio [OR]=0.998). However, clinical inertia was associated with multiple patient characteristics, including patient age (OR=1.021), commercial insurance (OR=0.804), and obesity (OR=1.805). Finally, patients with clinical inertia had 2.9 times the odds of uncontrolled hypertension at their final visit in the study period. These findings may aid the design of interventions to reduce clinical inertia. ©2013 Wiley Periodicals, Inc.

Job strain, blood pressure and response to uncontrollable stress.

PubMed

Steptoe, A; Cropley, M; Joekes, K

1999-02-01

The association between cardiovascular disease risk and job strain (high-demand, low-control work) may be mediated by heightened physiological stress responsivity. We hypothesized that high levels of job strain lead to increased cardiovascular responses to uncontrollable but not controllable stressors. Associations between job strain and blood pressure reductions after the working day (unwinding) were also assessed. Assessment of cardiovascular responses to standardized behavioral tasks, and ambulatory monitoring of blood pressure and heart rate during a working day and evening. We studied 162 school teachers (60 men, 102 women) selected from a larger survey as experiencing high or low job strain. Blood pressure, heart rate and electrodermal responses to an externally paced (uncontrollable) task and a self-paced (controllable) task were assessed. Blood pressure was monitored using ambulatory apparatus from 0900 to 2230 h on a working day. The groups of subjects with high and low job strain did not differ in demographic factors, body mass or resting cardiovascular activity. Blood pressure reactions to the uncontrollable task were greater in high than low job-strain groups, but responses to the controllable task were not significantly different between groups. Systolic and diastolic blood pressure did not differ between groups over the working day, but decreased to a greater extent in the evening in subjects with low job strain. Job strain is associated with a heightened blood pressure response to uncontrollable but not controllable tasks. The failure of subjects with high job strain to show reduced blood pressure in the evening may be a manifestation of chronic allostatic load.

Active Epilepsy and Seizure Control in Adults - United States, 2013 and 2015.

PubMed

Tian, Niu; Boring, Michael; Kobau, Rosemarie; Zack, Matthew M; Croft, Janet B

2018-04-20

Approximately 3 million American adults reported active epilepsy* in 2015 (1). Active epilepsy, especially when seizures are uncontrolled, poses substantial burdens because of somatic, neurologic, and mental health comorbidity; cognitive and physical dysfunction; side effects of antiseizure medications; higher injury and mortality rates; poorer quality of life; and increased financial cost (2). Thus, prompt diagnosis and seizure control (i.e., seizure-free in the 12 months preceding the survey) confers numerous clinical and social advantages to persons with active epilepsy. To obtain recent and reliable estimates of active epilepsy and seizure control status in the U.S. population, CDC analyzed aggregated data from the 2013 and the 2015 National Health Interview Surveys (NHISs). Overall, an annual estimated 2.6 million (1.1%) U.S. adults self-reported having active epilepsy, 67% of whom had seen a neurologist or an epilepsy specialist in the past year, and 90% of whom reported taking epilepsy medication. Among those taking epilepsy medication, only 44% reported having their seizures controlled. A higher prevalence of active epilepsy and poorer seizure control were associated with low family income, unemployment, and being divorced, separated, or widowed. Use of epilepsy medication was higher among adults who saw an epilepsy specialist in the past year than among those who did not. Health care and public health should ensure that adults with uncontrolled seizures have appropriate care and self-management support in order to promote seizure control, improve health and social outcomes, and reduce health care costs.

40 CFR 61.164 - Test methods and procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... glass type (i) produced during the 12-month period, as follows: ER17OC00.483 Where: Ti = The theoretical uncontrolled arsenic emission factor for each glass type (i), g/kg (lb/ton). Abi = Fraction by weight of elemental arsenic in the fresh batch for each glass type (I). Wbi = Weight of fresh batch melted per unit...

Use of CTX-I and PINP as bone turnover markers: National Bone Health Alliance recommendations to standardize sample handling and patient preparation to reduce pre-analytical variability.

PubMed

Szulc, P; Naylor, K; Hoyle, N R; Eastell, R; Leary, E T

2017-09-01

The National Bone Health Alliance (NBHA) recommends standardized sample handling and patient preparation for C-terminal telopeptide of type I collagen (CTX-I) and N-terminal propeptide of type I procollagen (PINP) measurements to reduce pre-analytical variability. Controllable and uncontrollable patient-related factors are reviewed to facilitate interpretation and minimize pre-analytical variability. The IOF and the International Federation of Clinical Chemistry (IFCC) Bone Marker Standards Working Group have identified PINP and CTX-I in blood to be the reference markers of bone turnover for the fracture risk prediction and monitoring of osteoporosis treatment. Although used in clinical research for many years, bone turnover markers (BTM) have not been widely adopted in clinical practice primarily due to their poor within-subject and between-lab reproducibility. The NBHA Bone Turnover Marker Project team aim to reduce pre-analytical variability of CTX-I and PINP measurements through standardized sample handling and patient preparation. Recommendations for sample handling and patient preparations were made based on review of available publications and pragmatic considerations to reduce pre-analytical variability. Controllable and un-controllable patient-related factors were reviewed to facilitate interpretation and sample collection. Samples for CTX-I must be collected consistently in the morning hours in the fasted state. EDTA plasma is preferred for CTX-I for its greater sample stability. Sample collection conditions for PINP are less critical as PINP has minimal circadian variability and is not affected by food intake. Sample stability limits should be observed. The uncontrollable aspects (age, sex, pregnancy, immobility, recent fracture, co-morbidities, anti-osteoporotic drugs, other medications) should be considered in BTM interpretation. Adopting standardized sample handling and patient preparation procedures will significantly reduce controllable pre-analytical variability. The successful adoption of such recommendations necessitates the close collaboration of various stakeholders at the global stage, including the laboratories, the medical community, the reagent manufacturers and the regulatory agencies.

Obstructive sleep apnea syndrome and arterial hypertension--a complicated relationship? The role of controlling blood pressure values in patients with OSAS.

PubMed

Deleanu, Oana-Claudia; Mălăuţ, Andra Elena; Nebunoiu, Ana Maria; Micheu, Miruna Mihaela; Mihălţan, Florin Dumitru

2014-01-01

Arterial hypertension (HT) and obstructive sleep apnea syndrome (OSAS) are associated through cause-effect relationship. We aimed to study the effect of medication controlled hypertension on OSAS patients. From 483 followed patients with OSAS, 252 associating HT; 142 patients of them (56.34%) received antihypertensive medication, 59 patients (41.54%) had controlled HT, 83 patients (58.46%) had uncontrolled HT. Demographic and anthropometric data, OSAS symptoms, comorbidities, apnea index (IA), apnea-hypopnea index (IAH), desaturation index, CPAP titration, CPAP failure rate were studiated regarding differences between patients with controlled and uncontrolled HT. Fifty nine patients with controlled HT were: 20 women (33.9%), 39 men (66.1%), with mean age of 56.08 years +/- 11.33, with an average AHI of 53.61 +/- 34.42/hour, an average of CPAP pressure prediction of 10.15 +/- 243 cm H2O. Eighty three patients with uncontrolled HT were: 18 women (21.7%), 65 men (78.3%), with mean age 55 +/- 9.06 years, with an average AHl of 61.91 +/- 43.61/hour, an average of CPAP pressure prediction of 10.47 +/- 2cm H2O. Comparing with the controlled HT group, patients with uncontrolled HT reported morning headaches, morning fatigue and impotency in a higher rate (p = 0.020, 0.018, 0.011 respectively); Epworth Sleepiness Scale was under 10 (cut-off for daytime sleepiness) in patients with controlled HT(p = 0.001) and higher in those with uncontrolled HT. Patients with uncontrolled HT were diagnosed with HT for a longer period (p = 0.006), had higher values of systolic and diastolic blood pressure at the time of the presentation. Statistically significant differences were found only for AHI post-CPAP (11.89/h vs. 22.30/h, p = 0.013) and nocturnal desaturation index post-CPAP (6.03/h vs. 16.55/h, p = 0.017), both higher in patients with uncontrolled HT. The hypothesis regarding existing differences related to the cardiovascular comorbidities was not supported. Controlled blood pressure deletes sleepiness, a defining symptom for OSAS and reduces remaining symptoms (headaches, impotency and morning fatigue). Presence of OSAS symptoms is less common in the controlled HT group, making the OSAS more difficult to suspect. These patients may have a grater benefit from CPAP therapy--they have AHI post-CPAP and desaturations post-CPAP significantly lower than patients with uncontrolled HT.

Dispositional mindfulness and reward motivated eating: The role of emotion regulation and mental habit.

PubMed

Fisher, Naomi R; Mead, Bethan R; Lattimore, Paul; Malinowski, Peter

2017-11-01

Evidence regarding the effectiveness of mindfulness based interventions (MBIs) for eating disorders, weight management and food craving is emerging and further studies are required to understand the underlying mechanisms of MBIs in these domains. The current study was designed to establish the role of specific mechanisms underlying the putative relationship between mindfulness and reward motivated eating. We predicted that mindfulness would be negatively related to features of reward motivated eating and that this association would be mediated by emotion regulation and habitual negative self-thinking. A cross-sectional survey measuring uncontrolled and emotional eating, mindfulness, emotion regulation and habitual negative self-thinking was completed by female and male meditators and non-meditators (N = 632). Lower levels of dispositional mindfulness were associated with difficulties in emotion regulation, habitual negative self-thinking and both emotional and uncontrolled eating. Difficulties in emotion regulation significantly mediated the mindfulness-uncontrolled eating relationship. Habitual negative self-thinking significantly mediated the mindfulness-emotional eating relationship. Participants with meditation experience reported greater levels of dispositional mindfulness, fewer difficulties with emotion regulation and habitual negative self-thinking and reduced uncontrolled eating tendencies, compared to non-meditators. The findings suggest that MBIs designed to change reward motivated eating and weight control should focus on emotion regulation and mental habits as underlying mechanisms. Copyright © 2017. Published by Elsevier Ltd.

Out of control mortality matters: the effect of perceived uncontrollable mortality risk on a health-related decision.

PubMed

Pepper, Gillian V; Nettle, Daniel

2014-01-01

Prior evidence from the public health literature suggests that both control beliefs and perceived threats to life are important for health behaviour. Our previously presented theoretical model generated the more specific hypothesis that uncontrollable, but not controllable, personal mortality risk should alter the payoff from investment in health protection behaviours. We carried out three experiments to test whether altering the perceived controllability of mortality risk would affect a health-related decision. Experiment 1 demonstrated that a mortality prime could be used to alter a health-related decision: the choice between a healthier food reward (fruit) and an unhealthy alternative (chocolate). Experiment 2 demonstrated that it is the controllability of the mortality risk being primed that generates the effect, rather than mortality risk per se. Experiment 3 showed that the effect could be seen in a surreptitious experiment that was not explicitly health related. Our results suggest that perceptions about the controllability of mortality risk may be an important factor in people's health-related decisions. Thus, techniques for adjusting perceptions about mortality risk could be important tools for use in health interventions. More importantly, tackling those sources of mortality that people perceive to be uncontrollable could have a dual purpose: making neighbourhoods and workplaces safer would have the primary benefit of reducing uncontrollable mortality risk, which could lead to a secondary benefit from improved health behaviours.

A dimension reduction method for flood compensation operation of multi-reservoir system

NASA Astrophysics Data System (ADS)

Jia, B.; Wu, S.; Fan, Z.

2017-12-01

Multiple reservoirs cooperation compensation operations coping with uncontrolled flood play vital role in real-time flood mitigation. This paper come up with a reservoir flood compensation operation index (ResFCOI), which formed by elements of flood control storage, flood inflow volume, flood transmission time and cooperation operations period, then establish a flood cooperation compensation operations model of multi-reservoir system, according to the ResFCOI to determine a computational order of each reservoir, and lastly the differential evolution algorithm is implemented for computing single reservoir flood compensation optimization in turn, so that a dimension reduction method is formed to reduce computational complexity. Shiguan River Basin with two large reservoirs and an extensive uncontrolled flood area, is used as a case study, results show that (a) reservoirs' flood discharges and the uncontrolled flood are superimposed at Jiangjiaji Station, while the formed flood peak flow is as small as possible; (b) cooperation compensation operations slightly increase in usage of flood storage capacity in reservoirs, when comparing to rule-based operations; (c) it takes 50 seconds in average when computing a cooperation compensation operations scheme. The dimension reduction method to guide flood compensation operations of multi-reservoir system, can make each reservoir adjust its flood discharge strategy dynamically according to the uncontrolled flood magnitude and pattern, so as to mitigate the downstream flood disaster.

A vitamin, mineral, herb dietary supplement effect on blood glucose in uncontrolled type II diabetic subjects.

PubMed

González, Michael J; Ricart, Carlos M; Miranda-Massari, Jorge

2004-06-01

We tested a dietary supplement formulated with a synergistic combination of vitamins, minerals, herbals in a group of 15 patients with uncontrolled diabetes type II. The supplement was given for 30 days. Fasting blood glucose was measured prior to the supplementation and at the end of the 30 days treatment period. Blood glucose was significantly reduced in all patients with no adverse effects. This orthomolecular correction of faulty glucose metabolism with a combination of nontoxic, safe and fairly inexpensive nutraceuticals needs to be further substantiated. Nervertheless the idea of correcting metabolism with micronutrients is a new concept of genetic nutritioneering that seems appealing and cost effective.

Technology: The Culture of Machine Living. Program in American History and Civilization.

ERIC Educational Resources Information Center

Tufts Univ., Medford, MA. Lincoln Filene Center for Citizenship and Public Affairs.

The readings in this narrative unit are concerned with the machine's role today and its future use in shaping man's environment. The general teaching objectives are to enable the student: 1) to adapt to a society directed toward total living, rather than one in which he earns a living; 2) to understand that uncontrolled technological advance may…

Growing-finishing performance and carcass yield of pigs reared in a climate-controlled and uncontrolled environment

NASA Astrophysics Data System (ADS)

Berton, Mariana Piatto; de Cássia Dourado, Rita; de Lima, Flávia Biondi Fernandes; Rodrigues, Ana Beatriz Bertoncello; Ferrari, Fábio Borba; do Carmo Vieira, Leonardo Dimas; de Souza, Pedro Alves; Borba, Hirasilva

2015-08-01

The objective of this study was to evaluate the effect of temperature on the performance and carcass yield of pigs housed in different environments. Twenty castrated male pigs of the Topigs line were assigned to two treatments: T1, controlled environment, and T2, uncontrolled environment containing a shallow pool. A completely randomized design consisting of two treatments and ten repetitions each was used. The data were submitted to analysis of variance, and means were compared by the Tukey test at a level of significance of 5 % using the SAS 9.2 program (SAS Institute, Inc., NC, USA). The results showed that rearing pigs in an uncontrolled environment during the growing and finishing phases reduced daily feed intake (1.722 and 3.164 kg, respectively) and improved feed conversion (2.15 and 2.70 kg, respectively), but did not influence the carcass yield of the animals. In conclusion, rearing pigs under different environmental conditions during the growing and finishing phases influenced animal performance without interfering with carcass yield.

Growing-finishing performance and carcass yield of pigs reared in a climate-controlled and uncontrolled environment.

PubMed

Berton, Mariana Piatto; de Cássia Dourado, Rita; de Lima, Flávia Biondi Fernandes; Rodrigues, Ana Beatriz Bertoncello; Ferrari, Fábio Borba; do Carmo Vieira, Leonardo Dimas; de Souza, Pedro Alves; Borba, Hirasilva

2015-08-01

The objective of this study was to evaluate the effect of temperature on the performance and carcass yield of pigs housed in different environments. Twenty castrated male pigs of the Topigs line were assigned to two treatments: T1, controlled environment, and T2, uncontrolled environment containing a shallow pool. A completely randomized design consisting of two treatments and ten repetitions each was used. The data were submitted to analysis of variance, and means were compared by the Tukey test at a level of significance of 5 % using the SAS 9.2 program (SAS Institute, Inc., NC, USA). The results showed that rearing pigs in an uncontrolled environment during the growing and finishing phases reduced daily feed intake (1.722 and 3.164 kg, respectively) and improved feed conversion (2.15 and 2.70 kg, respectively), but did not influence the carcass yield of the animals. In conclusion, rearing pigs under different environmental conditions during the growing and finishing phases influenced animal performance without interfering with carcass yield.

[Perception of insulin therapy in uncontrolled patients with type 2 diabetes mellitus].

PubMed

Leyva Jiménez, Rafael; Hernández Zambrano, Gustavo; Ibarra Maldonado, Silvia; Ibarra Ramírez, Carlos Tomás

2016-10-01

To determine the perception of insulin therapy by patients with uncontrolled type2 diabetes mellitus, who have been treated with oral hypoglycaemic agents or insulin. Prospective comparative cross-sectional study. Family Medicine Unit No. 53 León, Guanajuato of Mexican Institute of Social Security. Patients between 40 and 80years old with uncontrolled type2 mellitus diabetes, treated with insulin or oral hypoglycaemic agents. Perception was assessed using the insulin treatment appraisal scale (ITAS). The rating of the survey is from 20 to 100 points, as such that when score increases the greater is the negative opinion. A sample of 459 diabetes patients were interviewed and split into 2 groups of patients according to their treatment. The OH group were patients treated with oral hypoglycaemic drugs only (56.9%), and the IN group were patients treated with insulin alone or combined with an oral hypoglycaemic (43.1%). Perception score was significantly higher in OH group (56.95±7.78 versus 49.55±8.89 points) than in the IN group (P<.001). The perception of insulin therapy was worse in patients treated with only oral hypoglycaemic agents than in patients using insulin. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Passive Smoking Impairs Histone Deacetylase-2 in Children With Severe Asthma

PubMed Central

Kobayashi, Yoshiki; Bossley, Cara; Gupta, Atul; Akashi, Kenichi; Tsartsali, Lemonia; Mercado, Nicolas; Barnes, Peter J.; Bush, Andrew

2014-01-01

Background: Parental smoking is known to worsen asthma symptoms in children and to make them refractory to asthma treatment, but the molecular mechanism is unclear. Oxidative stress from tobacco smoke has been reported to impair histone deacetylase-2 (HDAC2) via phosphoinositide-3-kinase (PI3K)/Akt activation and, thus, to reduce corticosteroid sensitivity. The aim of this study was to investigate passive smoking-dependent molecular abnormalities in alveolar macrophages (AMs) by comparing passive smoke-exposed children and non-passive smoke-exposed children with uncontrolled severe asthma. Methods: BAL fluid (BALF) was obtained from 19 children with uncontrolled severe asthma (10 non-passive smoking-exposed subjects and nine passive smoking-exposed subjects), and HDAC2 expression/activity, Akt/HDAC2 phosphorylation levels, and corticosteroid responsiveness in AMs were evaluated. Results: Parental smoking reduced HDAC2 protein expression by 54% and activity by 47%, with concomitant enhancement of phosphorylation of Akt1 and HDAC2. In addition, phosphorylation levels of Akt1 correlated positively with HDAC2 phosphorylation levels and negatively with HDAC2 activity. Furthermore, passive smoke exposure reduced the inhibitory effects of dexamethasone on tumor necrosis factor-α-induced CXCL8 release in AMs. There were relatively higher neutrophil counts and CXCL8 concentrations in BALF and lower Asthma Control Test scores compared with non-passive smoke-exposed children with uncontrolled severe asthma. Conclusions: Passive smoking impairs HDAC2 function via PI3K signaling activation, which could contribute to corticosteroid-insensitive inflammation in children with severe asthma. This novel mechanism will be a treatment target in children with severe asthma and stresses the need for a smoke-free environment for asthmatic children. PMID:24030221

CEM43°C thermal dose thresholds: a potential guide for magnetic resonance radiofrequency exposure levels?

PubMed

van Rhoon, Gerard C; Samaras, Theodoros; Yarmolenko, Pavel S; Dewhirst, Mark W; Neufeld, Esra; Kuster, Niels

2013-08-01

To define thresholds of safe local temperature increases for MR equipment that exposes patients to radiofrequency fields of high intensities for long duration. These MR systems induce heterogeneous energy absorption patterns inside the body and can create localised hotspots with a risk of overheating. The MRI + EUREKA research consortium organised a "Thermal Workshop on RF Hotspots". The available literature on thresholds for thermal damage and the validity of the thermal dose (TD) model were discussed. The following global TD threshold guidelines for safe use of MR are proposed: 1. All persons: maximum local temperature of any tissue limited to 39 °C 2. Persons with compromised thermoregulation AND (a) Uncontrolled conditions: maximum local temperature limited to 39 °C (b) Controlled conditions: TD < 2 CEM43°C 3. Persons with uncompromised thermoregulation AND (a) Uncontrolled conditions: TD < 2 CEM43°C (b) Controlled conditions: TD < 9 CEM43°C The following definitions are applied: Controlled conditions A medical doctor or a dedicated trained person can respond instantly to heat-induced physiological stress Compromised thermoregulation All persons with impaired systemic or reduced local thermoregulation • Standard MRI can cause local heating by radiofrequency absorption. • Monitoring thermal dose (in units of CEM43°C) can control risk during MRI. • 9 CEM43°C seems an acceptable thermal dose threshold for most patients. • For skin, muscle, fat and bone,16 CEM43°C is likely acceptable.

BDNF action in the brain attenuates diabetic hyperglycemia via insulin-independent inhibition of hepatic glucose production.

PubMed

Meek, Thomas H; Wisse, Brent E; Thaler, Joshua P; Guyenet, Stephan J; Matsen, Miles E; Fischer, Jonathan D; Taborsky, Gerald J; Schwartz, Michael W; Morton, Gregory J

2013-05-01

Recent evidence suggests that central leptin administration fully normalizes hyperglycemia in a rodent model of uncontrolled insulin-deficient diabetes by reducing hepatic glucose production (HGP) and by increasing glucose uptake. The current studies were undertaken to determine whether brain-derived neurotrophic factor (BDNF) action in the brain lowers blood glucose in uncontrolled insulin-deficient diabetes and to investigate the mechanisms mediating this effect. Adult male rats implanted with cannulas to either the lateral cerebral ventricle or the ventromedial hypothalamic nucleus (VMN) received either vehicle or streptozotocin to induce uncontrolled insulin-deficient diabetes. Three days later, animals received daily intracerebroventricular or intra-VMN injections of either BDNF or its vehicle. We found that repeated daily intracerebroventricular administration of BDNF attenuated diabetic hyperglycemia independent of changes in food intake. Instead, using tracer dilution techniques during a basal clamp, we found that BDNF lowered blood glucose levels by potently suppressing HGP, without affecting tissue glucose uptake, an effect associated with normalization of both plasma glucagon levels and hepatic expression of gluconeogenic genes. Moreover, BDNF microinjection directly into the VMN also lowered fasting blood glucose levels in uncontrolled insulin-deficient diabetes, but this effect was modest compared with intracerebroventricular administration. We conclude that central nervous system BDNF attenuates diabetic hyperglycemia via an insulin-independent mechanism. This action of BDNF likely involves the VMN and is associated with inhibition of glucagon secretion and a decrease in the rate of HGP.

Treatment outcomes of open pelvic fractures associated with extensive perineal injuries.

PubMed

Hasankhani, Ebrahim Ghayem; Omidi-Kashani, Farzad

2013-12-01

The main causes of death in patients with open pelviperineal injuries are uncontrollable bleeding and pelvic sepsis. The aim of this study was to evaluate the management outcomes of open pelvic fractures associated with extensive perineal injuries. We retrospectively studied 15 cases with open pelvic fractures associated with extensive perineal injuries (urethral and anal canal laceration) admitted between August 2006 and September 2010. Mechanism of injury, Injury Severity Score, associated injuries, hemodynamic status on arrival, resuscitation and transfusion requirements, operative techniques, intra- and postoperative complications, length of intensive care unit and hospital stay, and mortality were recorded in a computerised database for further evaluation and analysis. The male to female ratio was 12:3 with an average age of 38.6 years (ranged, 11 to 65 years). The average packed red blood cell units used were 8 units (ranged, 4 to 21 units). All patients were initially transferred to the operating room for colostomy, radical debridement and fixation of the pelvic fracture by an external fixator. One patient had acute renal failure, which improved with medical treatment and 2 patients (13.3%) died, one with type III anteroposterior compression fracture due to hemorrhagic shock and the other due to septicemia. Open pelvic fractures with extensive perineal injuries are associated with high mortality rates. Early diagnosis and appropriate treatment, including reanimation, colostomy, cystostomy, vigorous and repeated irrigation and debridement, and fixation by an external fixator can improve the outcomes and reduce the mortality rate.

Benefit of an electronic medical record-based alarm in the optimization of stress ulcer prophylaxis.

PubMed

Saad, Emanuel José; Bedini, Marianela; Becerra, Ana Florencia; Martini, Gustavo Daniel; Gonzalez, Jacqueline Griselda; Bolomo, Andrea; Castellani, Luciana; Quiroga, Silvana; Morales, Cristian; Leathers, James; Balderramo, Domingo; Albertini, Ricardo Arturo

2018-06-09

The use of stress ulcer prophylaxis (SUP) has risen in recent years, even in patients without a clear indication for therapy. To evaluate the efficacy of an electronic medical record (EMR)-based alarm to improve appropriate SUP use in hospitalized patients. We conducted an uncontrolled before-after study comparing SUP prescription in intensive care unit (ICU) patients and non-ICU patients, before and after the implementation of an EMR-based alarm that provided the correct indications for SUP. 1627 patients in the pre-intervention and 1513 patients in the post-intervention cohorts were included. The EMR-based alarm improved appropriate (49.6% vs. 66.6%, p<0.001) and reduced inappropriate SUP use (50.4% vs. 33.3%, p<0.001) in ICU patients only. These differences were related to the optimization of SUP in low risk patients. There was no difference in overt gastrointestinal bleeding between the two cohorts. Unjustified costs related to SUP were reduced by a third after EMR-based alarm use. The use of an EMR-based alarm improved appropriate and reduced inappropriate use of SUP in ICU patients. This benefit was limited to optimization in low risk patients and associated with a decrease in SUP costs. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

Analysis of knowledge of the general population and health professionals on organ donation after cardiac death.

PubMed

Bedenko, Ramon Correa; Nisihara, Renato; Yokoi, Douglas Shun; Candido, Vinícius de Mello; Galina, Ismael; Moriguchi, Rafael Massayuki; Ceulemans, Nico; Salvalaggio, Paolo

2016-09-01

To evaluate the knowledge and acceptance of the public and professionals working in intensive care units regarding organ donation after cardiac death. The three hospitals with the most brain death notifications in Curitiba were selected, and two groups of respondents were established for application of the same questionnaire: the general public (i.e., visitors of patients in intensive care units) and health professionals working in the same intensive care unit. The questionnaire contained questions concerning demographics, intention to donate organs and knowledge of current legislation regarding brain death and donation after cardiac death. In total, 543 questionnaires were collected, including 442 from family members and 101 from health professionals. There was a predominance of women and Catholics in both groups. More females intended to donate. Health professionals performed better in the knowledge comparison. The intention to donate organs was significantly higher in the health professionals group (p = 0.01). There was no significant difference in the intention to donate in terms of education level or income. There was a greater acceptance of donation after uncontrolled cardiac death among Catholics than among evangelicals (p < 0.001). Most of the general population intended to donate, with greater intentions expressed by females. Education and income did not affect the decision. The type of transplant that used a donation after uncontrolled cardiac death was not well accepted in the study population, indicating the need for more clarification for its use in our setting.

Presumed consent for organ preservation in uncontrolled donation after cardiac death in the United States: a public policy with serious consequences

PubMed Central

Verheijde, Joseph L; Rady, Mohamed Y; McGregor, Joan

2009-01-01

Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for duration before stopping resuscitation efforts and techniques, and assumption of presumed intent to donate for the purpose of initiating temporary organ-preservation interventions when no expressed consent to donate is present. From a legal point of view, not having scientifically valid criteria of cessation of circulation and respiration for declaring death could lead to a conclusion that organ procurement itself is the proximate cause of death. Although the revised Uniform Anatomical Gift Act of 2006 provides broad immunity to those involved in organ-procurement activities, courts have yet to provide an opinion on whether persons can be held liable for injuries arising from the determination of death itself. Preserving organs in uncontrolled donation after cardiac death requires the administration of life-support systems such as extracorporeal membrane oxygenation. These life-support systems can lead to return of signs of life that, in turn, have to be deliberately suppressed by the administration of pharmacological agents. Finally, allowing temporary organ-preservation interventions without expressed consent is inherently a violation of the principle of respect for a person's autonomy. Proponents of organ donation from uncontrolled donation after cardiac death, on the other hand, claim that these nonconsensual interventions enhance respect for autonomy by allowing people, through surrogate decision making, to execute their right to donate organs. However, the lack of transparency and the absence of protection of individual autonomy, for the sake of maximizing procurement opportunities, have placed the current organ-donation system of opting-in in great jeopardy. Equally as important, current policies enabling and enhancing organ procurement practices, pose challenges to the constitutional rights of individuals in a pluralistic society as these policies are founded on flawed medical standards for declaring death. PMID:19772617

Presumed consent for organ preservation in uncontrolled donation after cardiac death in the United States: a public policy with serious consequences.

PubMed

Verheijde, Joseph L; Rady, Mohamed Y; McGregor, Joan

2009-09-22

Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for duration before stopping resuscitation efforts and techniques, and assumption of presumed intent to donate for the purpose of initiating temporary organ-preservation interventions when no expressed consent to donate is present. From a legal point of view, not having scientifically valid criteria of cessation of circulation and respiration for declaring death could lead to a conclusion that organ procurement itself is the proximate cause of death. Although the revised Uniform Anatomical Gift Act of 2006 provides broad immunity to those involved in organ-procurement activities, courts have yet to provide an opinion on whether persons can be held liable for injuries arising from the determination of death itself. Preserving organs in uncontrolled donation after cardiac death requires the administration of life-support systems such as extracorporeal membrane oxygenation. These life-support systems can lead to return of signs of life that, in turn, have to be deliberately suppressed by the administration of pharmacological agents. Finally, allowing temporary organ-preservation interventions without expressed consent is inherently a violation of the principle of respect for a person's autonomy. Proponents of organ donation from uncontrolled donation after cardiac death, on the other hand, claim that these nonconsensual interventions enhance respect for autonomy by allowing people, through surrogate decision making, to execute their right to donate organs. However, the lack of transparency and the absence of protection of individual autonomy, for the sake of maximizing procurement opportunities, have placed the current organ-donation system of opting-in in great jeopardy. Equally as important, current policies enabling and enhancing organ procurement practices, pose challenges to the constitutional rights of individuals in a pluralistic society as these policies are founded on flawed medical standards for declaring death.

Lesson From the New York City Out-of-Hospital Uncontrolled Donation After Circulatory Determination of Death Program.

PubMed

Wall, Stephen P; Kaufman, Bradley J; Williams, Nicholas; Norman, Elizabeth M; Gilbert, Alexander J; Munjal, Kevin G; Maikhor, Shana; Goldstein, Michael J; Rivera, Julia E; Lerner, Harvey; Meyers, Chad; Machado, Marion; Montella, Susan; Pressman, Marcy; Teperman, Lewis W; Dubler, Nancy N; Goldfrank, Lewis R

2016-04-01

In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%). In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Preparation and response in case of natural disasters: Cuban programs and experience.

PubMed

Mas Bermejo, Pedro

2006-01-01

Inadequate preparation for national disasters is frequently particularly devastating in lower income countries. The Cuba's location has a diversity of potential natural disasters, including hurricanes, non-tropical depressions, tropical storms, tropical cyclones, and severe local storms, all with intense rains and winds, earthquakes and droughts. Cuban preparation, at all levels, is geared to these predominant threats. Planning for natural disasters is integral to the political and economic life of Cuba, nationally and locally. On several occasions, United Nations (UN) officials have pointed to Cuba as a model for developing countries preparing for hurricanes and other natural disasters. A global policy for managing the risks of natural disasters could improve continuity of assistance for development and reduce the necessity of humanitarian aid. Planning in advance of disasters is a feasible way of helping people, by reducing expenses of emergencies, recuperation, and reconstruction. As climate changes accelerate, many researchers fear a period of irreversible and uncontrollable change. While the atmosphere continues to warm, it generates more intense rains, more frequent heat waves, and more ferocious storms. Thus, achieving better protection of developing countries from an increasing onslaught of natural disasters will only grow in importance. Even though Cuba's contribution to know-how has been recognized by United Nations' officials, progress toward more adequate preparation worldwide has been slow. To support other countries beyond conveying the lessons, Cuba now offers specially trained personnel to cooperate immediately with any country suffering a natural disaster.

Uncontrolled hypertension among patients managed in primary healthcare facilities in Kinshasa, Democratic Republic of the Congo.

PubMed

Kika, T M; Lepira, F B; Kayembe, P K; Makulo, J R; Sumaili, E K; Kintoki, E V; M'Buyamba-Kabangu, J R

Uncontrolled hypertension remains an important issue in daily clinical practice worldwide. Although the majority of patients are treated in primary care, most of the data on blood pressure control originate from population-based studies or secondary healthcare. The aim of this study was to evaluate the frequency of uncontrolled hypertension and associated risk factors among hypertensive patients followed at primary care facilities in Kinshasa, the capital city of Democratic Republic of the Congo. A sample of 298 hypertensive patients seen at primary healthcare facilities, 90 men and 208 women, aged ≥ 18 years, were consecutively included in this cross-sectional study. The majority (66%) was receiving monotherapy, and diuretics (43%) were the most used drugs. According to 2007 European Society of Hypertension/European Society of Cardiology hypertension guidelines, uncontrolled hypertension was defined as blood pressure ≥ 140/90 or ≥ 130/80 mmHg (diabetes or chronic kidney disease). Logistic regression analysis was used to identify the determinants of uncontrolled hypertension. Uncontrolled hypertension was observed in 231 patients (77.5%), 72 men and 159 women. Uncontrolled systolic blood pressure (SBP) was more frequent than uncontrolled diastolic blood pressure (DBP) and increased significantly with advancing age (p = 0.002). The proportion of uncontrolled SBP and DBP was significantly higher in patients with renal failure (p = 0.01) and those with high (p = 0.03) to very high (p = 0.02) absolute cardiovascular risk. The metabolic syndrome (OR 2.40; 95% CI 1.01-5.74; p = 0.04) emerged as the main risk factor associated with uncontrolled hypertension. Uncontrolled hypertension was common in this case series and was associated with factors related to lifestyle and diet, which interact with blood pressure control.

Movement - uncontrolled or slow

MedlinePlus

Dystonia; Involuntary slow and twisting movements; Choreoathetosis; Leg and arm movements - uncontrollable; Arm and leg movements - uncontrollable; Slow involuntary movements of large muscle groups; Athetoid movements

Association Between Blood Pressure Lowering and Quality of Life by Treatment of Azilsartan.

PubMed

Fujiwara, Nobuharu; Tanaka, Atsushi; Kawaguchi, Atsushi; Tago, Motoko; Oyama, Jun-Ichi; Uchida, Yasufumi; Matsunaga, Kazuo; Moroe, Kazuo; Toyoda, Shigeru; Inoue, Teruo; Ikeda, Hideo; Node, Koichi

2017-10-21

The authors assessed the effects of switching from a conventional angiotensin II receptor blocker (ARB) to azilsartan on blood pressure (BP) and health-related quality of life (HR-QOL) in patients with uncontrolled hypertension. Key eligibility criteria were uncontrolled hypertension treated for ≥ 1 month with an ARB, excluding azilsartan, that did not reach the target BP. We recruited 147 patients (64 males and 83 females; mean ± standard deviation age 73 ± 15 years). Azilsartan reduced both systolic and diastolic BP significantly, from 151 ± 16/82 ± 12 to 134 ± 17/73 ± 12 mm Hg, 3 months after switching. Although scores on the comprehensive QOL scale, the EuroQoL 5 dimensions (EQ5D), and the simplified menopausal index (SMI) did not change, the Geriatric Depression Scale (GDS) score improved significantly, and there was a significant association between the change in the GDS score and systolic BP lowering (r = 0.2554, P = 0.030). The Pittsburgh sleep quality index (PSQI) improved significantly only in the female subgroup. Besides sufficient BP lowering activity, anti-hypertensive treatment with azilsartan may have a favorable impact on depression in geriatric patients with uncontrolled hypertension.

The Effectiveness of Eye Movement Desensitization and Reprocessing Integrative Group Protocol with Adolescent Survivors of the Central Italy Earthquake.

PubMed

Maslovaric, Giada; Zaccagnino, Maria; Mezzaluna, Clarice; Perilli, Sava; Trivellato, Denis; Longo, Vittorio; Civilotti, Cristina

2017-01-01

Earthquakes, which can cause widespread territorial and socio-economic destruction, are life-threatening, unexpected, unpredictable, and uncontrollable events caused by the shaking of the surface of the earth. The psychological consequences, such as PTSD, anxiety, depression, and suicidal ideation, are well-known to clinicians and researchers. This study was conducted with the aim of evaluating the use of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol on a sample of adolescents, after the earthquake in Central Italy on 24 August 2016. The objective of the EMDR intervention was to reduce PTSD symptoms. Before and after EMDR, specific assessment to find changes in PTSD symptoms was made using the Impact of Event Scale-Revised and through the analyses of the Subjective Units of Disturbance. The EMDR treatment was given in three sessions (T1, T2, and T3), each lasting 90 min, and the results at follow-up phase (T4) were also monitored. The results are very encouraging, showing significantly reduced PTSD symptoms in the majority of the subjects. The clinical implications and limitations will be discussed.

The Effectiveness of Eye Movement Desensitization and Reprocessing Integrative Group Protocol with Adolescent Survivors of the Central Italy Earthquake

PubMed Central

Maslovaric, Giada; Zaccagnino, Maria; Mezzaluna, Clarice; Perilli, Sava; Trivellato, Denis; Longo, Vittorio; Civilotti, Cristina

2017-01-01

Earthquakes, which can cause widespread territorial and socio-economic destruction, are life-threatening, unexpected, unpredictable, and uncontrollable events caused by the shaking of the surface of the earth. The psychological consequences, such as PTSD, anxiety, depression, and suicidal ideation, are well-known to clinicians and researchers. This study was conducted with the aim of evaluating the use of the Eye Movement Desensitization and Reprocessing (EMDR) Integrative Group Treatment Protocol on a sample of adolescents, after the earthquake in Central Italy on 24 August 2016. The objective of the EMDR intervention was to reduce PTSD symptoms. Before and after EMDR, specific assessment to find changes in PTSD symptoms was made using the Impact of Event Scale-Revised and through the analyses of the Subjective Units of Disturbance. The EMDR treatment was given in three sessions (T1, T2, and T3), each lasting 90 min, and the results at follow-up phase (T4) were also monitored. The results are very encouraging, showing significantly reduced PTSD symptoms in the majority of the subjects. The clinical implications and limitations will be discussed. PMID:29109693

Beverage-consumption patterns and associations with metabolic risk factors among low-income Latinos with uncontrolled type 2 diabetes.

PubMed

Wang, Monica L; Lemon, Stephenie C; Olendzki, Barbara; Rosal, Milagros C

2013-12-01

In the United States, Latinos experience disproportionately higher rates of type 2 diabetes and diabetes-related complications than non-Latino whites. Sugar-sweetened beverage (SSB) consumption is strongly associated with increased risk of developing type 2 diabetes. Reducing caloric intake, particularly from energy-dense, low-nutrient foods or beverages, can be an effective and key strategy for metabolic and weight control. However, little is known about the contribution of various types of beverages, including but not limited to SSBs, to total caloric intake among Latinos with type 2 diabetes. Low-income Latinos (87.7% Puerto Rican) participating in a diabetes self-management intervention trial (N=238) provided cross-sectional, descriptive data on beverage-consumption patterns, anthropometric outcomes, and metabolic characteristics. Beverages accounted for one fifth of the total daily caloric intake. SSBs and milk beverages, respectively, contributed 9.6% of calories to overall daily caloric intake. Interventions directed at diabetes risk factors among low-income Latinos with diabetes can benefit from consideration of beverage-consumption behaviors as an important strategy to reduce caloric and sugar intake. Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Emissions and Cost Implications of Controlled Electric Vehicle Charging in the U.S. PJM Interconnection.

PubMed

Weis, Allison; Michalek, Jeremy J; Jaramillo, Paulina; Lueken, Roger

2015-05-05

We develop a unit commitment and economic dispatch model to estimate the operation costs and the air emissions externality costs attributable to new electric vehicle electricity demand under controlled vs uncontrolled charging schemes. We focus our analysis on the PJM Interconnection and use scenarios that characterize (1) the most recent power plant fleet for which sufficient data are available, (2) a hypothetical 2018 power plant fleet that reflects upcoming plant retirements, and (3) the 2018 fleet with increased wind capacity. We find that controlled electric vehicle charging can reduce associated generation costs by 23%-34% in part by shifting loads to lower-cost, higher-emitting coal plants. This shift results in increased externality costs of health and environmental damages from increased air pollution. On balance, we find that controlled charging of electric vehicles produces negative net social benefits in the recent PJM grid but could have positive net social benefits in a future grid with sufficient coal retirements and wind penetration.

Stressful life events, social support, attachment security and alexithymia in vitiligo. A case-control study.

PubMed

Picardi, A; Pasquini, P; Cattaruzza, M S; Gaetano, P; Melchi, C F; Baliva, G; Camaioni, D; Tiago, A; Abeni, D; Biondi, M

2003-01-01

It has often been suggested that stress might trigger vitiligo. However, only one study supported this hypothesis, and no study explored the role of other personality or social factors. Out-patients experiencing a recent onset or exacerbation of vitiligo (n = 31) were compared with out-patients with skin conditions in which psychosomatic factors are commonly were regarded as negligible (n = 116). Stressful events during the last 12 months were assessed with Paykel's Interview for Recent Life Events. Attachment style, alexithymia and social support were assessed with the 'Experiences in Close Relationships' questionnaire, the Toronto Alexithymia Scale (TAS-20), and the Multidimensional Scale of Perceived Social Support, respectively. Cases and controls did not differ regarding the total number of events and the number of undesirable, uncontrollable or major events. Three or more uncontrollable events had occurred more frequently among cases than controls. Perceived social support was lower in cases than in controls. Cases scored higher than controls on anxious attachment, tended towards higher scores on avoidant attachment and were classified more often as insecure. Cases scored higher than controls on the TAS-20 and were classified more often as alexithymic or borderline alexithymic. The occurrence of many uncontrollable events, alexithymia and anxious attachment were associated with vitiligo also in multiple logistic regression analysis. These findings suggest that vulnerability to vitiligo is not increased by stressful events, except for many uncontrollable events. Alexithymia, insecure attachment and poor social support appear to increase susceptibility to vitiligo, possibly through deficits in emotion regulation or reduced ability to cope effectively with stress. Copyright 2003 S. Karger AG, Basel

Patient-led versus physician-led titration of insulin glargine in patients with uncontrolled type 2 diabetes: a randomized multinational ATLAS study.

PubMed

Garg, Satish K; Admane, Karim; Freemantle, Nick; Odawara, Masato; Pan, Chang-Yu; Misra, Anoop; Jarek-Martynowa, Iwona R; Abbas-Raza, Syed; Mirasol, Roberto C; Perfetti, Riccardo

2015-02-01

Self-adjustment of insulin dose is commonly practiced in Western patients with type 2 diabetes but is usually not performed in Asian patients. This multinational, 24-week, randomized study compared patient-led with physician-led titration of once-daily insulin glargine in Asian patients with uncontrolled type 2 diabetes who were on 2 oral glucose-lowering agents. Patient-led (n = 275) or physician-led (n = 277) subjects followed the same dose-titration algorithm guided by self-monitored fasting blood glucose (FBG; target, 110 mg/dL [6.1 mmol/L]). The primary endpoint was change in mean glycated hemoglobin (HbA1c) at week 24 in the patient-led versus physician-led titration groups. Patient-led titration resulted in a significantly higher drop in HbA1c value at 24 weeks when compared with physician-led titration (-1.40% vs. -1.25%; mean difference, -0.15; 95% confidence interval, -0.29 to 0.00; P = .043). Mean decrease in FBG was greatest in the patient-led group (-2.85 mmol/L vs. -2.48 mmol/L; P = .001). The improvements in HbA1c and FBG were consistent across countries, with similar improvements in treatment satisfaction in both groups. Mean daily insulin dose was higher in the patient-led group (28.9 units vs. 22.2 units; P<.001). Target HbA1c of <7.0% without severe hypoglycemia was achieved in 40.0% and 32.9% in the patient-led and physician-led groups, respectively (P = .086). Severe hypoglycemia was not different in the 2 groups (0.7%), with an increase in nocturnal and symptomatic hypoglycemia in the patient-led arm. Patient-led insulin glargine titration achieved near-target blood glucose levels in Asian patients with uncontrolled type 2 diabetes who were on 2 oral glucose-lowering drugs, demonstrating that Asian patients can self-uptitrate insulin dose effectively when guided.

Risk of transmission of bovine spongiform encephalopathy to humans in the United States: report of the Council on Scientific Affairs. American Medical Association.

PubMed

Tan, L; Williams, M A; Khan, M K; Champion, H C; Nielsen, N H

The risk of possible transmission of bovine spongiform encephalopathy (BSE) in the United States is a substantial public health concern. To systematically review the current scientific literature and discuss legislation and regulations that have been implemented to prevent the disease. Literature review using the MEDLINE, EMBASE, and Lexis/Nexis databases for 1975 through 1997 on the terms bovine spongiform encephalopathy, prion diseases, prions, and Creutzfeldt-Jakob syndrome. The Internet was used to identify regulatory actions and health surveillance. MEDLINE, EMBASE, and Lexis/Nexis databases were searched from 1975 through 1997 for English-language articles that provided information on assessment of transmission risk. Unique circumstances in the United Kingdom caused the emergence and propagation of BSE in cattle, including widespread use of meat and bonemeal cattle feed derived from scrapie-infected sheep and the adoption of a new type of processing that did not reduce the amount of infectious prions prior to feeding. Many of these circumstances do not exist in the United States. In the United Kingdom, new variant Creutzfeldt-Jakob disease probably resulted from the ingestion of BSE-contaminated processed beef. The United Kingdom and the European Union now have strong regulations in place to stop the spread of BSE. While BSE has not been observed in the United States, the US government has surveillance and response plans in effect. Current risk of transmission of BSE in the United States is minimal because (1) BSE has not been shown to exist in this country; (2) adequate regulations exist to prevent entry of foreign sources of BSE into the United States; (3) adequate regulations exist to prevent undetected cases of BSE from uncontrolled amplification within the US cattle population; and (4) adequate preventive guidelines exist to prevent high-risk bovine materials from contaminating products intended for human consumption.

77 FR 33021 - Approval, Disapproval and Promulgation of Implementation Plans; State of Wyoming; Regional Haze...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-04

... or refer to air-fuel ratio controls. iii. The initials BART mean or refer to Best Available Retrofit... install BART controls for the purpose of eliminating or reducing visibility impairment. The specific... retrofit controls at certain larger, often uncontrolled, older stationary sources in order to address...

An arc control and protection system for the JET lower hybrid antenna based on an imaging system.

PubMed

Figueiredo, J; Mailloux, J; Kirov, K; Kinna, D; Stamp, M; Devaux, S; Arnoux, G; Edwards, J S; Stephen, A V; McCullen, P; Hogben, C

2014-11-01

Arcs are the potentially most dangerous events related to Lower Hybrid (LH) antenna operation. If left uncontrolled they can produce damage and cause plasma disruption by impurity influx. To address this issue an arc real time control and protection imaging system for the Joint European Torus (JET) LH antenna has been implemented. The LH system is one of the additional heating systems at JET. It comprises 24 microwave generators (klystrons, operating at 3.7 GHz) providing up to 5 MW of heating and current drive to the JET plasma. This is done through an antenna composed of an array of waveguides facing the plasma. The protection system presented here is based primarily on an imaging arc detection and real time control system. It has adapted the ITER like wall hotspot protection system using an identical CCD camera and real time image processing unit. A filter has been installed to avoid saturation and spurious system triggers caused by ionization light. The antenna is divided in 24 Regions Of Interest (ROIs) each one corresponding to one klystron. If an arc precursor is detected in a ROI, power is reduced locally with subsequent potential damage and plasma disruption avoided. The power is subsequently reinstated if, during a defined interval of time, arcing is confirmed not to be present by image analysis. This system was successfully commissioned during the restart phase and beginning of the 2013 scientific campaign. Since its installation and commissioning, arcs and related phenomena have been prevented. In this contribution we briefly describe the camera, image processing, and real time control systems. Most importantly, we demonstrate that an LH antenna arc protection system based on CCD camera imaging systems works. Examples of both controlled and uncontrolled LH arc events and their consequences are shown.

Add on Exenatide Treatment is Beneficial in Poorly Controlled Obese Type 2 Diabetics under Intensive Insulin Regimens.

PubMed

Sönmez, Alper; Dinç, Mustafa; Taşlıpınar, Abdullah; Aydoğdu, Aydogan; Meriç, Coskun; Başaran, Yalcin; Haymana, Cem; Demir, Orhan; Yılmaz, İlker; Azal, Ömer

2017-04-01

Background: Intensive insulin treatment is bothersome in obese patients with type 2 diabetes mellitus. High insulin dosages further increase weight gain and the risk of hypoglycemia. Glucagon like peptide-1 receptor agonists decrease the insulin need, cause weight loss and reduce the risk of hypoglycemia. There is limited data about the effect of exenatide on obese diabetics under intensive insulin regimens. Methods: This retrospective case series report the clinical outcomes of 23 obese (13 morbidly obese) patients with uncontrolled type 2 diabetes mellitus (Age=59±10.44 years, body mass index 41.1±6.8 kg/m 2 , HbA1c 9.9±1.5%), under high dose (94.1±39.6 unit) intensive insulin. Exenatide twice daily was added for a mean follow-up period of 11.22±7.01 (3-30) months. Intensive insulin regimens were continued in 7 patients while the others were switched to basal insulin during the follow-up. Results: During the follow-up, mean HbA1c levels of the patients significantly improved (p=0.019), along with the significant decrease in body mass index and the total insulin need (p<0.001 for both). Baseline insulin dosages were significantly higher in the intensive regimen group (p=0.013) while other demographical and clinical characteristics were similar. No significant difference was present between the groups regarding the alterations of HbA1c, body mass index and the reduction in total insulin dosages. Conclusion: Add on exenatide appears to be a rational treatment modality in uncontrolled obese patients with type 2 diabetes mellitus despite intensive insulin regimens. Further prospective randomized studies with longer follow-up periods are recommended. © Georg Thieme Verlag KG Stuttgart · New York.

The Uncontrolled Economic Engine of the Developing Economies, Speeding up the Climate Shift

NASA Astrophysics Data System (ADS)

Khan, K. M.; Khan, M. A.

2014-12-01

As we progress into the 21st century, the world faces challenges of truly global nature bearing implications on the whole world in one way or another. The global economic engine has shifted from the western world (Developed Economies) to the eastern world (Developing Economies) which has brought about tremendous change in the climate related variables in this part of the world. As uncontrolled carbon emissions grow in the developing economies, the phenomenon of global warming and climate shifts become more and more prevalent. While this economic activity provides income for millions of households, it is contributing generously to the rapid degradation of the environment. Developing economies as it has been seen do not employ or abide by stringent regulations regarding emissions which result in uncontrolled emissions. In this particular scenario, it is a tedious task to convince governments in the developing economies to implement regulations regarding emissions because businesses in these economies deem such regulations to be economically unviable. The other side of the problem is that these uncontrolled emission are causing evident climate shifts which has had adverse impacts on the agricultural societies where shifting climates are leading to reduced agricultural output and productivity. Consequently the lives of millions associated directly or indirectly with agriculture are affected and on a more global level, the agricultural produce is decreasing which increases the chances of famine in parts of the world. The situation could have devastating impacts on the global economy and environmental standards and therefore needs to be addressed on emergency basis. The first step towards betterment could be the introduction of the carbon trading economy in the developing economies which would incentivize emission reduction and become more attractive and in the process sustaining minimum possible damage to the environment. Though carbon trading is a formidable first step in the right direction, it is in no way the only step and many other steps need to be taken. Agricultural economies have to study climate changes in detail and inculcate findings into their agricultural practices in order to keep the productivity from reducing.

Comparative effectiveness of home blood pressure telemonitoring (HBPTM) plus nurse case management versus HBPTM alone among Black and Hispanic stroke survivors: study protocol for a randomized controlled trial.

PubMed

Spruill, Tanya M; Williams, Olajide; Teresi, Jeanne A; Lehrer, Susan; Pezzin, Liliana; Waddy, Salina P; Lazar, Ronald M; Williams, Stephen K; Jean-Louis, Girardin; Ravenell, Joseph; Penesetti, Sunil; Favate, Albert; Flores, Judith; Henry, Katherine A; Kleiman, Anne; Levine, Steven R; Sinert, Richard; Smith, Teresa Y; Stern, Michelle; Valsamis, Helen; Ogedegbe, Gbenga

2015-03-15

Black and Hispanic stroke survivors experience higher rates of recurrent stroke than whites. This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these populations. Home blood pressure telemonitoring (HBPTM) and nurse case management (NCM) have proven efficacy in addressing the multilevel barriers to blood pressure (BP) control and reducing BP. However, the effectiveness of these interventions has not been evaluated in stroke patients. This study is designed to evaluate the comparative effectiveness, cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension. A total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are randomly assigned to one of two 12-month interventions: 1) HBPTM with wireless feedback to primary care providers or 2) HBPTM plus individualized, culturally-tailored, telephone-based NCM. Patients are recruited from stroke centers and primary care practices within the Health and Hospital Corporations (HHC) Network in New York City. Study visits occur at baseline, 6, 12 and 24 months. The primary outcomes are within-patient change in systolic BP at 12 months, and the rate of stroke recurrence at 24 months. The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months; and exploratory outcomes include changes in stroke risk factors, health behaviors and treatment intensification. Recruitment for the stroke telemonitoring hypertension trial is currently ongoing. The combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation. Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension. If effective among Black and Hispanic stroke survivors, these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence. ClinicalTrials.gov NCT02011685 . Registered 10 December 2013.

Healthcare utilization and costs in adults with stable and uncontrolled epilepsy.

PubMed

Cramer, Joyce A; Wang, Zhixiao J; Chang, Eunice; Powers, Annette; Copher, Ronda; Cherepanov, Dasha; Broder, Michael S

2014-02-01

Despite the availability of numerous antiepileptic drugs (AEDs), some epilepsies remain resistant to treatment. We compared utilization and costs in patients with uncontrolled epilepsy to those with stable epilepsy. Claims data (2007-2009) were used to identify adults with epilepsy requiring additional AED therapy (having uncontrolled epilepsy) and those not requiring additional AED therapy (having stable epilepsy). The date in 2008 on which an additional AED was started was the index date for patients with uncontrolled epilepsy, and a randomly selected date was used for patients with stable epilepsy, whose AED use was unchanged in the preceding year. In the postindex year, all pharmacy and medical claims were used to estimate overall utilization and costs; claims with epilepsy in any diagnosis field were used to estimate epilepsy-related outcomes. Outcomes were adjusted using multivariate analyses. We identified 1536 patients with uncontrolled epilepsy and 8571 patients with stable epilepsy (mean age: 42.8years; female: 48%). Patients with uncontrolled epilepsy had higher comorbidity rates (p<.02). A greater proportion of patients with uncontrolled epilepsy had ≥1 hospitalization or emergency department visit (p<.001). Patients with uncontrolled epilepsy had a greater mean length of hospital stay and more physician office visits (p<.034). After adjustment, the odds of hospitalization (OR: 1.8, any diagnosis; 2.2, epilepsy-related) and emergency department visit (OR: 1.6, any diagnosis; 1.9, epilepsy-related) were greater for patients with uncontrolled epilepsy. Annual overall ($23,238 vs. $13,839) and epilepsy-related ($12,399 vs. $5511) costs were higher in patients with uncontrolled epilepsy and remained higher after adjustment (p<.001). Patients with uncontrolled epilepsy use more services and incur higher costs compared with those with stable epilepsy. Epilepsy-related costs accounted for <50% of the total costs, suggesting that comorbid conditions and/or underidentification of utilization may substantially contribute to costs. © 2013.

46 CFR 32.63-5 - Barge hull classifications-B/ALL.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the uncontrolled release of the cargo to the waterways and/or atmosphere. (2) Type II barge hull... measures to preclude uncontrolled release to the atmosphere, but whose uncontrolled release to the...

46 CFR 32.63-5 - Barge hull classifications-B/ALL.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the uncontrolled release of the cargo to the waterways and/or atmosphere. (2) Type II barge hull... measures to preclude uncontrolled release to the atmosphere, but whose uncontrolled release to the...

Direct costs of asthma in Brazil: a comparison between controlled and uncontrolled asthmatic patients.

PubMed

Santos, L A; Oliveira, M A; Faresin, S M; Santoro, I L; Fernandes, A L G

2007-07-01

Asthma is a common chronic illness that imposes a heavy burden on all aspects of the patient's life, including personal and health care cost expenditures. To analyze the direct cost associated to uncontrolled asthma patients, a cross-sectional study was conducted to determine costs related to patients with uncontrolled and controlled asthma. Uncontrolled patient was defined by daytime symptoms more than twice a week or nocturnal symptoms during two consecutive nights or any limitations of activities, or need for relief rescue medication more than twice a week, and an ACQ score less than 2 points. A questionnaire about direct cost stratification in health services, including emergency room visits, hospitalization, ambulatory visits, and asthma medications prescribed, was applied. Ninety asthma patients were enrolled (45 uncontrolled/45 controlled). Uncontrolled asthmatics accounted for higher health care expenditures than controlled patients, US$125.45 and US$15.58, respectively [emergency room visits (US$39.15 vs US$2.70) and hospitalization (US$86.30 vs US$12.88)], per patient over 6 months. The costs with medications in the last month for patients with mild, moderate and severe asthma were US$1.60, 9.60, and 25.00 in the uncontrolled patients, respectively, and US$6.50, 19.00 and 49.00 in the controlled patients. In view of the small proportion of uncontrolled subjects receiving regular maintenance medication (22.2%) and their lack of resources, providing free medication for uncontrolled patients might be a cost-effective strategy for the public health system.

Effects of aerobic dance training on blood pressure in individuals with uncontrolled hypertension on two antihypertensive drugs: a randomized clinical trial.

PubMed

Maruf, Fatai Adesina; Akinpelu, Aderonke Omobonike; Salako, Babatunde Lawal; Akinyemi, Joshua Odunayo

2016-04-01

There is a dearth of reports on possible additive blood pressure (BP)-reducing effect of aerobic exercise on antihypertensive drug in humans. This study investigated the additive BP-reducing effect of aerobic exercise on BP in individuals with uncontrolled hypertension. In this 12-week double-blind study, 120 new-diagnosed individuals with mild-to-moderate hypertension were randomized to receive coamilozide + 5/10 mg of amlodipine + aerobic dance or coamilozide + 5/10 mg of amlodipine alone. Forty-five and 43 participants in exercise and control groups, respectively, completed the 12-week intervention. Addition of aerobic exercise to antihypertensive drug therapy significantly reduced systolic BP (7.1 mm Hg [95% confidence interval: 5.0, 9.3]; P < .001) and diastolic BP (1.7 mm Hg [95% confidence interval: 0.4, 3.0]; P = .009) at 12 weeks. BP control rate differed significantly between exercise (53.9%) and control (35.3%) groups, P < .001. Postintervention, proportion of participants in exercise group who had their number of antihypertensive drug reduced to one (20.3%) differed from that in control group (11.1%); (χ(2) = 11.0; P = .001). Combination of aerobic dance and antihypertensive drugs reduces number of antihypertensive drugs needed to achieve BP control and enhances BP control in individuals with hypertension on two antihypertensive drugs. Copyright © 2016 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Effectiveness of vildagliptin as add-on to metformin monotherapy among uncontrolled type 2 diabetes mellitus patients in a real-world setting.

PubMed

Melzer Cohen, Cheli; Davis, Carla; Shalev, Varda; Chodick, Gabriel

2018-01-01

Vildagliptin is a dipeptidyl peptidase-4 inhibitor commonly used as a dual oral agent with metformin, thiazolidinediones, or sulfonylurea for the treatment of type 2 diabetes mellitus (T2DM). The efficacy of dual therapy with vildagliptin and metformin has been established in randomized controlled trials, but there is little evidence from observational studies. The aims of the present study were to evaluate the effectiveness of vildagliptin as an add-on therapy to metformin in reducing HbA1c and its affects on body weight and blood lipids in a real-life setting. Included in the present retrospective cohort were T2DM patients (n = 345) who were uncontrolled on metformin monotherapy and intensified treatment with vildagliptin. The efficacy of at least 90 days of dual therapy with vildagliptin and metformin in reducing HbA1c levels, as well as changes in blood lipids and body weight, were evaluated. After 180 days (range 90-365 days) from the index date with a mean daily dose of 92 mg vildagliptin, HbA1c was significantly (P < 0.001) reduced by an average of 0.9% (95% confidence interval -1.0%, -0.7%). The absolute reduction in HbA1c was positively associated with baseline HbA1c levels. In addition to HbA1c, a modest but significant (P < 0.05) decrement was also calculated in the patients' body weight and blood lipids. The present analysis of real-world data corroborates the results of previous randomized controlled trials indicating that add-on therapy with vildagliptin in uncontrolled patients on metformin monotherapy is associated with a significant improvement in the control of HbA1c. © 2017 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

Renal denervation reduces office and ambulatory heart rate in patients with uncontrolled hypertension: 12-month outcomes from the global SYMPLICITY registry.

PubMed

Böhm, Michael; Ukena, Christian; Ewen, Sebastian; Linz, Dominik; Zivanovic, Ina; Hoppe, Uta; Narkiewicz, Krzysztof; Ruilope, Luis; Schlaich, Markus; Negoita, Manuela; Schmieder, Roland; Williams, Bryan; Zeymer, Uwe; Zirlik, Andreas; Mancia, Giuseppe; Mahfoud, Felix

2016-12-01

Renal denervation (RDN) can reduce sympathetic activity and blood pressure (BP) in patients with hypertension. The effects on resting and ambulatory heart rate (HR), also regulated by the sympathetic nervous system, are not established. Herein, we report 12-month outcomes from the Global SYMPLICITY Registry on office and ambulatory HR and BP in patients with uncontrolled hypertension (n = 846). HR declined in correlation with the HR at baseline and at 12 months, in particular, in patients in the upper tertile of HR (>74 bpm). BP reduction was similar in the tertiles of HR at baseline. Similar effects were observed when 24-h ambulatory HR and SBP were determined. Office HR was similarly decreased when patients were on a β-blocker or not. Antihypertensive treatment remained unchanged during the 12-month period of the Global SYMPLICITY Registry. RDN reduces BP independent from HR. A HR reduction is dependent on baseline HR and unchanged by β-blocker treatment. The effects of RDN on SBP and HR are durable up to 1 year. HR reduction might be a target for RDN in patients with high HR at baseline, which needs to be scrutinized in prospective trials.

Radiation resistence of microorganisms from radiation sterilization processing environments

NASA Astrophysics Data System (ADS)

Sabovljev, Svetlana A.; Žunić, Zora S.

The radiation resistance of microorganisms was examined on the samples of dust collected from the radiation sterilization processing environments including assembly, storage, and sterilization plant areas. The isolation of radiation resistant strains was performed by irradiation with screening doses ranging from 10 to 35 kGy and test pieces containing 10 6 to 10 8 CFU in dried serum-broth, representing 100 to 5000 colonies of primary cultures of microorganisms from 7 different sites. In an examination of 16900 colonies of aerobic microorganisms from 3 hygienically controlled production sites and 4 uncontrolled ones, 30 strains of bacteria were isolated. Of those 15 were classified as genus Bacillus, 9 as Micrococcus and 6 as Sarcina. All of the 15 strains of Gram positive sporeforming aerobic rods exhibited an exponential decrease in the surviving fraction as a function of dose, indicating that the inactivation of spores of aerobic rods is a consequence of a single energy deposition into the target. All strains were found to be moderately resistant to radiation with D-6 values (dose required to reduce survival to 6 log cycles) between 18 and 26 kGy. All of the isolated Gram positive cocci showed inactivation curves having a shoulder, indicating that different processes are involved in the inactivation of these cells, e.g. accumulation of sublethal lesions, or final repair capacity of potential lethal lesions. Moderate radiation resistance was observed in 13 strains with D-6 values between 16 to 30 kGy. Two slow-growing, red pigmented strains tentatively classified as genus Micrococcus isolated from uncontrolled sites (human dwellings) were exceptionally resistant with D-6 more than 45 kGy. For hygienically controlled sites, Gram positive spereforming rods composed two thirds of the resistant microflora, while Gram positive cocci comprised one third. For hygienically uncontrolled sites this ratio was reversed. An assumption is made that one isolated strain has grown up from one CFU in the original microflora. In the light of the observed proportion of radiation resistant bacteria in microflora from hygienically controlled radiation sterilization processing environments, and assuming an initial contamination of 50 CFU per product unit, there is no more than one chance of a contaminated item remaining within a population of 10 7 items subjected to sterilization by exposure to a radiation dose of 25 kGy.

Estimates of Median Flows for Streams on the 1999 Kansas Surface Water Register

USGS Publications Warehouse

Perry, Charles A.; Wolock, David M.; Artman, Joshua C.

2004-01-01

The Kansas State Legislature, by enacting Kansas Statute KSA 82a?2001 et. seq., mandated the criteria for determining which Kansas stream segments would be subject to classification by the State. One criterion for the selection as a classified stream segment is based on the statistic of median flow being equal to or greater than 1 cubic foot per second. As specified by KSA 82a?2001 et. seq., median flows were determined from U.S. Geological Survey streamflow-gaging-station data by using the most-recent 10 years of gaged data (KSA) for each streamflow-gaging station. Median flows also were determined by using gaged data from the entire period of record (all-available hydrology, AAH). Least-squares multiple regression techniques were used, along with Tobit analyses, to develop equations for estimating median flows for uncontrolled stream segments. The drainage area of the gaging stations on uncontrolled stream segments used in the regression analyses ranged from 2.06 to 12,004 square miles. A logarithmic transformation of the data was needed to develop the best linear relation for computing median flows. In the regression analyses, the significant climatic and basin characteristics, in order of importance, were drainage area, mean annual precipitation, mean basin permeability, and mean basin slope. Tobit analyses of KSA data yielded a model standard error of prediction of 0.285 logarithmic units, and the best equations using Tobit analyses of AAH data had a model standard error of prediction of 0.250 logarithmic units. These regression equations and an interpolation procedure were used to compute median flows for the uncontrolled stream segments on the 1999 Kansas Surface Water Register. Measured median flows from gaging stations were incorporated into the regression-estimated median flows along the stream segments where available. The segments that were uncontrolled were interpolated using gaged data weighted according to the drainage area and the bias between the regression-estimated and gaged flow information. On controlled segments of Kansas streams, the median flow information was interpolated between gaging stations using only gaged data weighted by drainage area. Of the 2,232 total stream segments on the Kansas Surface Water Register, 34.5 percent of the segments had an estimated median streamflow of less than 1 cubic foot per second when the KSA analysis was used. When the AAH analysis was used, 36.2 percent of the segments had an estimated median streamflow of less than 1 cubic foot per second. This report supercedes U.S. Geological Survey Water-Resources Investigations Report 02?4292.

Planning for the closure of uncontrolled landfills in Turkey to reduce environmental impacts.

PubMed

Ergene Şentürk, Didar; Alp, Emre

2016-11-01

Landfilling is the most preferred solid waste disposal method in Turkey owing to both economic and technical reasons. However, beside the sanitary landfills there are also hundreds of uncontrolled waste sites located throughout Turkey, which are often left either abandoned or burning. Because there is a lack of legislative guidelines governing the closure and rehabilitation of these dumpsites, the municipalities that are responsible for waste management do not initiate the proactive strategies required for the closure of these sites. In this study, a method based on a multi-criteria analysis is conducted for different dumpsites in Turkey to evaluate the level of negative impacts on the environment. This method is based on the use of environmental indices for a quantitative assessment of the landfills, such as environmental interaction between the source and the receptors, environmental values of the receptors, and operational conditions. It was possible to assess the robustness of the proposed methodology since the pre- and post-groundwater quality monitoring data was available from the study sites that were closed and rehabilitated in 2014. The results of this study show that the method based on a multi-criteria analysis is an effective tool while in the preliminary planning stages of closure and rehabilitation activities of uncontrolled waste landfills. © The Author(s) 2016.

Efficacy and safety of sacubitril/valsartan in patients with essential hypertension uncontrolled by olmesartan: A randomized, double-blind, 8-week study.

PubMed

Cheung, Deanna G; Aizenberg, Diego; Gorbunov, Vladimir; Hafeez, Kudsia; Chen, Chien-Wei; Zhang, Jack

2018-01-01

A majority of patients with hypertension fail to achieve blood pressure (BP) control despite treatment with commonly prescribed drugs. This randomized, double-blind phase III trial assessed the superiority of sacubitril/valsartan 200 mg (97/103 mg) to continued olmesartan 20 mg in reducing ambulatory systolic BP after 8-week treatment in patients with mild to moderate essential hypertension uncontrolled with olmesartan 20 mg alone. A total of 376 patients were randomized to receive either sacubitril/valsartan (n = 188) or olmesartan (n = 188). Superior reductions in 24-hour mean ambulatory systolic BP were observed in the sacubitril/valsartan group vs the olmesartan group (-4.3 mm Hg vs -1.1 mm Hg, P < .001). Reductions in 24-hour mean ambulatory diastolic BP and pulse pressure and office systolic BP and diastolic BP were significantly greater with sacubitril/valsartan vs olmesartan (P < .014). A greater proportion of patients achieved BP control with sacubitril/valsartan vs olmesartan. The overall incidence of adverse events was comparable between the groups. Compared with continued olmesartan, sacubitril/valsartan was more effective and generally safe in patients with hypertension uncontrolled with olmesartan 20 mg. ©2018 Wiley Periodicals, Inc.

Environmental Security in Botswana

DTIC Science & Technology

2011-10-01

concerns are vital to state survival. Upstream diversions of river water, poaching of wildlife or uncontrolled immigration can destroy ecosystems that would...gratefully accepted. Executing its first mission in October, 1987 the BDF immediately made positive impacts and dramatically reduced poaching ...experience large scale, organized cross-border poaching which overwhelmed the Botswana Department of Wildlife and National Parks. By 1987 the situation

Under- treatment and under diagnosis of hypertension: a serious problem in the United Arab Emirates

PubMed Central

Abdulle, Abdishakur M; Nagelkerke, Nico JD; Abouchacra, Samra; Pathan, Javed Y; Adem, Abdu; Obineche, Enyioma N

2006-01-01

Background Hypertension, notably untreated or uncontrolled, is a major risk factor for cardiovascular diseases (CVD) morbidity and mortality. In countries in transition, little is known about the epidemiology of hypertension, and its biochemical correlates. This study was carried out in Al Ain, United Arab Emirates, to characterize self-reported (SR) normotensives and hypertensives in terms of actual hypertension status, demographic variables, CVD risk factors, treatment, and sequalae. Methods A sample, stratified by SR hypertensive status, of 349 SR hypertensives (Mean age ± SD; 50.8 ± 9.2 yrs; Male: 226) and 640 SR normotensives (42.9 ± 9.3 yrs, Male: 444) among nationals and expatriates was used. Hypertensives and normotensive subjects were recruited from various outpatient clinics and government organizations in Al-Ain city, United Arab Emirates (UAE) respectively. Anthropometric and demographic variables were measured by conventional methods. Results Both under-diagnosis of hypertension (33%) and under-treatment (76%) were common. Characteristics of undiagnosed hypertensives were intermediate between normotensives and SR hypertensives. Under-diagnosis of hypertension was more common among foreigners than among nationals. Risk factors for CVD were more prevalent among SR hypertensives. Obesity, lack of exercise and smoking were found as major risk factors for CVD among hypertensives in this population. Conclusion Hypertension, even severe, is commonly under-diagnosed and under-treated in the UAE. Preventive strategies, better diagnosis and proper treatment compliance should be emphasized to reduce incidence of CVD in this population. PMID:16753071

Modeling posttraumatic growth among cancer patients: The roles of social support, appraisals, and adaptive coping.

PubMed

Cao, Weidan; Qi, Xiaona; Cai, Deborah A; Han, Xuanye

2018-01-01

The purpose of the study was to build a model to explain the relationships between social support, uncontrollability appraisal, adaptive coping, and posttraumatic growth (PTG) among cancer patients in China. The participants who were cancer patients in a cancer hospital in China filled out a survey. The final sample size was 201. Structural equation modeling was used to build a model explaining PTG. Structural equation modeling results indicated that higher levels of social support predicted higher levels of adaptive coping, higher levels of uncontrollability appraisal predicted lower levels of adaptive coping, and higher levels of adaptive coping predicted higher levels of PTG. Moreover, adaptive coping was a mediator between social support and growth, as well as a mediator between uncontrollability and growth. The direct effects of social support and uncontrollability on PTG were insignificant. The model demonstrated the relationships between social support, uncontrollability appraisal, adaptive coping, and PTG. It could be concluded that uncontrollability appraisal was a required but not sufficient condition for PTG. Neither social support nor uncontrollability appraisal had direct influence on PTG. However, social support and uncontrollability might indirectly influence PTG, through adaptive coping. It implies that both internal factors (eg, cognitive appraisal and coping) and external factors (eg, social support) are required in order for growth to happen. Copyright © 2017 John Wiley & Sons, Ltd.

Running Reduces Uncontrollable Stress-Evoked Serotonin and Potentiates Stress-Evoked Dopamine Concentrations in the Rat Dorsal Striatum

PubMed Central

Clark, Peter J.; Amat, Jose; McConnell, Sara O.; Ghasem, Parsa R.; Greenwood, Benjamin N.; Maier, Steven F.; Fleshner, Monika

2015-01-01

Accumulating evidence from both the human and animal literature indicates that exercise reduces the negative consequences of stress. The neurobiological etiology for this stress protection, however, is not completely understood. Our lab reported that voluntary wheel running protects rats from expressing depression-like instrumental learning deficits on the shuttle box escape task after exposure to unpredictable and inescapable tail shocks (uncontrollable stress). Impaired escape behavior is a result of stress-sensitized serotonin (5-HT) neuron activity in the dorsal raphe (DRN) and subsequent excessive release of 5-HT into the dorsal striatum following exposure to a comparatively mild stressor. However, the possible mechanisms by which exercise prevents stress-induced escape deficits are not well characterized. The purpose of this experiment was to test the hypothesis that exercise blunts the stress-evoked release of 5-HT in the dorsal striatum. Changes to dopamine (DA) levels were also examined, since striatal DA signaling is critical for instrumental learning and can be influenced by changes to 5-HT activity. Adult male F344 rats, housed with or without running wheels for 6 weeks, were either exposed to tail shock or remained undisturbed in laboratory cages. Twenty-four hours later, microdialysis was performed in the medial (DMS) and lateral (DLS) dorsal striatum to collect extracellular 5-HT and DA before, during, and following 2 mild foot shocks. We report wheel running prevents foot shock-induced elevation of extracellular 5-HT and potentiates DA concentrations in both the DMS and DLS approximately 24 h following exposure to uncontrollable stress. These data may provide a possible mechanism by which exercise prevents depression-like instrumental learning deficits following exposure to acute stress. PMID:26555633

Baroreflex activation therapy in patients with prior renal denervation.

PubMed

Wallbach, Manuel; Halbach, Marcel; Reuter, Hannes; Passauer, Jens; Lüders, Stephan; Böhning, Enrico; Zenker, Dieter; Müller, Gerhard A; Wachter, Rolf; Koziolek, Michael J

2016-08-01

Both baroreflex activation therapy (BAT) and renal denervation modulate sympathetic activity. The aim of this study was to systematically investigate whether additive modulation of autonomic nervous system by BAT lowers blood pressure (BP) in patients who still suffer from uncontrolled resistant hypertension despite prior renal denervation. From 2012 to January 2015, patients treated with BAT for uncontrolled resistant hypertension, who prior received renal denervation were consecutively analyzed in four German centers for hypertension. Analyses of office BP, 24-h ambulatory BP, central hemodynamics, parameters of renal function were performed. A total of 28 patients, who underwent renal denervation at least 5 months before and still suffer from uncontrolled BP, were subsequently treated with BAT. The office SBP decreased from 182 ± 28 to 163 ± 27 mmHg (P < 0.01) with a responder rate of 68% (office SBP reduction ≥10 mmHg) at month 6, whereas the number of prescribed antihypertensive drug classes remained unchanged (6.2 ± 1.5 vs. 6.0 ± 1.7, P = 0.30). Serum creatinine, estimated glomerular filtration rate and cystatin C remained stable (P = 1.00, P = 0.41 and P = 0.22, respectively), whereas albuminuria was significantly reduced by a median of -29% (P = 0.02). Central SBP (-15 ± 24 mmHg, P = 0.047) and end systolic pressure (-14 ± 20 mmHg, P = 0.03) were significantly reduced. The present data demonstrate that BAT may exert BP-lowering as well as antiproteinuric effects in patients with prior renal denervation. However, precise evaluation of BAT effects in patients with prior renal denervation will need randomized controlled trials using sham procedures.

Eslicarbazepine acetate as adjunctive therapy in patients with uncontrolled partial-onset seizures: Results of a phase III, double-blind, randomized, placebo-controlled trial.

PubMed

Sperling, Michael R; Abou-Khalil, Bassel; Harvey, Jay; Rogin, Joanne B; Biraben, Arnaud; Galimberti, Carlo A; Kowacs, Pedro A; Hong, Seung Bong; Cheng, Hailong; Blum, David; Nunes, Teresa; Soares-da-Silva, Patrício

2015-02-01

To evaluate the efficacy and safety of adjunctive eslicarbazepine acetate (ESL) in patients with refractory partial-onset seizures. This randomized, placebo-controlled, double-blind, parallel-group, phase III study was conducted at 173 centers in 19 countries, including the United States and Canada. Eligible patients were aged ≥16 years and had uncontrolled partial-onset seizures despite treatment with 1-2 antiepileptic drugs (AEDs). After an 8-week baseline period, patients were randomized to once-daily placebo (n = 226), ESL 800 mg (n = 216), or ESL 1,200 mg (n = 211). Following a 2-week titration period, patients received ESL 800 or 1,200 mg once-daily for 12 weeks. Seizure data were captured and documented using event-entry or daily entry diaries. Standardized seizure frequency (SSF) during the maintenance period (primary end point) was reduced with ESL 1,200 mg (p = 0.004), and there was a trend toward improvement with ESL 800 mg (p = 0.06), compared with placebo. When data for titration and maintenance periods were combined, ESL 800 mg (p = 0.001) and 1,200 mg (p < 0.001) both reduced SSF. There were no statistically significant interactions between treatment response and geographical region (p = 0.38) or diary version (p = 0.76). Responder rate (≥50% reduction in SSF) was significantly higher with ESL 1,200 mg (42.6%, p < 0.001) but not ESL 800 mg (30.5%, p = 0.07) than placebo (23.1%). Incidence of treatment-emergent adverse events (TEAEs) and TEAEs leading to discontinuation increased with ESL dose. The most common TEAEs were dizziness, somnolence, nausea, headache, and diplopia. Adjunctive ESL 1,200 mg once-daily was more efficacious than placebo in adult patients with refractory partial-onset seizures. The once-daily 800 mg dose showed a marginal effect on SSF, but did not reach statistical significance. Both doses were well tolerated. Efficacy assessment was not affected by diary format used. © 2014 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

76 FR 16240 - Mandatory Reliability Standards for Interconnection Reliability Operating Limits

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-23

... Standards. The Reliability Standards were designed to prevent instability, uncontrolled separation, or... designed to prevent instability, uncontrolled separation, or cascading outages that adversely impact the... instability, uncontrolled separation, or cascading outages. See NERC Glossary, available at http://www.nerc...

Facial nerve paralysis: A case report of rare complication in uncontrolled diabetic patient with mucormycosis

PubMed Central

Shekar, Vandana; Sikander, Jeelani; Rangdhol, Vishwanath; Naidu, Madhulika

2015-01-01

Mucormycosis is a rare opportunistic aggressive and fatal infection caused by mucor fungus. Seven types of mucormycosis are identified based on the extension and involvement of the lesion, of which the rhino orbital mucormycosis is most common in the head and neck region. Although it is widely spread in nature, clinical cases are rare and observed only in immunocompromised patients and patients with uncontrolled diabetes mellitus. Early symptoms include fever, nasal ulceration or necrosis, periorbital edema or facial swelling, paresthesia and reduced vision. Involvement of cranial nerves although not common, facial nerve palsy is a rare finding. The infection may spread through cribriform plate to the brain resulting in extensive cerebellar infarctions. Timely diagnosis and early recognition of the signs and symptoms, correction of underlying medical disorders, and aggressive medical and surgical intervention are necessary for successful therapeutic outcome. PMID:25810669

Modulating effects in learned helplessness of dyadic dominance-submission relations.

PubMed

Díaz-Berciano, Cristina; de Vicente, Francisco; Fontecha, Elisa

2008-01-01

In this experiment, learned helplessness was studied from an ethological perspective by examining individual differences in social dominance and its influence on the effects of helplessness. Ninety animals were used, 30 randomly selected and 60 selected because of their clear dominance or submission. Each condition (dominant, submissive, and random) was distributed in three subgroups corresponding to the triadic design. The test consisted of an escape/avoidance task. The results showed that the animals in the uncontrollable condition performed worse than those in the controllable and no treatment conditions. Social submission and dominance reduced vulnerability of the subjects against learned helplessness. Submission had a facilitating effect on subsequent learning, independently of whether pretreatment was controllability or uncontrollability. Learned mastery was observed in the submissive condition, because submission benefited the subjects in the controllable condition in comparison with the untreated subjects, and dominance impaired the subjects in the controllable condition. Copyright 2007 Wiley-Liss, Inc.

Environmental interventions to reduce fear of crime: systematic review of effectiveness.

PubMed

Lorenc, Theo; Petticrew, Mark; Whitehead, Margaret; Neary, David; Clayton, Stephen; Wright, Kath; Thomson, Hilary; Cummins, Steven; Sowden, Amanda; Renton, Adrian

2013-05-12

Fear of crime is associated with negative health and wellbeing outcomes, and may mediate some impacts of the built environment on public health. A range of environmental interventions have been hypothesized to reduce the fear of crime. This review aimed to synthesize the literature on the effectiveness of interventions in the built environment to reduce the fear of crime. Systematic review methodology, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, was used. Studies of environmental interventions which reported a fear of crime outcome and used any prospective evaluation design (randomized controlled trial (RCT), trial or uncontrolled before-and-after study) were included. Eighteen databases were searched. The Hamilton tool was used to assess quality. A narrative synthesis of findings was undertaken. A total of 47 studies were included, 22 controlled and 25 uncontrolled, with total sample sizes ranging from n = 52 to approximately n = 23,000. Thirty-six studies were conducted in the UK, ten studies in the USA and one study in the Netherlands. The quality of the evidence overall is low. There are some indications that home security improvements and non-crime-related environmental improvements may be effective for some fear of crime outcomes. There is little evidence that the following reduce fear of crime: street lighting improvements, closed-circuit television (CCTV), multi-component environmental crime prevention programs or regeneration programs. There is some evidence for the effectiveness of specific environmental interventions in reducing some indicators of fear of crime, but more attention to the context and possible confounders is needed in future evaluations of complex social interventions such as these.

The Pentagon’s New Map...to Oblivion: Why the United States Should Declare War on Oil

DTIC Science & Technology

2005-05-17

U.S. Geological Survey reports that the economically recoverable oil from the reserve would account for only 0.3 percent of the global oil inventory .28...policy is the same...we need to fill in the knowledge and the scientific gaps.,,35 Climate change, it seems, is an acceptable risk. Meanwhile, America...for western skiers ), "extended uncontrolled emissions" could lead to major problems, including releasing significant volumes of sea-level impacting

Reducing Conflicts between Motor Vehicles and Pedestrians: The Separate and Combined Effects of Pavement Markings and a Sign Prompt

ERIC Educational Resources Information Center

Huybers, Sherry; Van Houten, Ron; Malenfant, J.E. Louis

2004-01-01

The effects of a symbolic "yield here to pedestrians" sign and advance yield pavement markings on pedestrian/motor vehicle conflicts, motorists' yielding behavior, and the distance motorists' yield in advance of crosswalks were evaluated at multilane crosswalks at uncontrolled T intersections. In Experiment 1, the sign, when used alone, reduced…

78 FR 68345 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-14

... of the outboard actuator load path, could result in uncontrolled retraction of the outboard flap... outboard actuator load path, if not corrected, could result in uncontrolled retraction of the outboard flap..., combined with loss of the outboard actuator load path, could result in uncontrolled retraction of the...

Climatology, hydrology, and simulation of an emergency outlet, Devils Lake basin, North Dakota

USGS Publications Warehouse

Wiche, Gregg J.; Vecchia, A.V.; Osborne, Leon; Wood, Carrie M.; Fay, James T.

2000-01-01

Devils Lake is a natural lake in northeastern North Dakota that is the terminus of a nearly 4,000-square-mile subbasin in the Red River of the North Basin. The lake has not reached its natural spill elevation to the Sheyenne River (a tributary of the Red River of the North) in recorded history. However, geologic evidence indicates a spill occurred sometime within the last 1,800 years. From 1993 to 1999, Devils Lake rose 24.5 feet and, at the present (August 2000), is about 13 feet below the natural spill elevation. The recent lake-level rise has caused flood damages exceeding $300 million and triggered development of future flood-control options to prevent further infrastructure damage and reduce the risk of a potentially catastrophic uncontrolled spill. Construction of an emergency outlet from the west end of Devils Lake to the Sheyenne River is one flood-control option being considered. This report describes the climatologic and hydrologic causes of the recent lake level rise, provides information on the potential for continued lake-level rises during the next 15 years, and describes the potential effectiveness of an emergency outlet in reducing future lake levels and in reducing the risk of an uncontrolled spill. The potential effects of an outlet on downstream water quantity and quality in the upper Sheyenne River also are described.

Overview of entry risk predictions

NASA Astrophysics Data System (ADS)

Mrozinski, R.; Mendeck, G.; Cutri-Kohart, R.

Risk to people on the ground from uncontrolled entries of spacecraft is a primary concern when analyzing end-of-life disposal options for satellites. Countries must balance this risk with the need to mitigate an exponentially growing space debris population. Currently the United States does this via guidelines that call for a satellite to be disposed of in a controlled manner if an uncontrolled entry would be too risky to people on the ground. This risk is measured by a quantity called "casualty expectation", or E , where casualty expectation is defined as the expectedc number of people suffering death or injury due to a spacecraft entry event. If Ec exceeds 1 in 10,000, U. S. guidelines state that the entry should be controlled rather than uncontrolled. Since this guideline can have serious impacts on the cost, lifetime, and even the mission and functionality of a satellite, it is critical that this quantity be estimated well, and decision makers understand all assumptions and limitations inherent in the resulting value. This paper discusses several issues regarding estimates of casualty expectation, beginning with an overview of relevant United States policies and guidelines. The equation the space industry typically uses to estimate casualty expectation is presented, along with a look at the sensitivity of the results to the typical assumptions, models, and initial condition uncertainties. Differences in these modeling issues with respect to launch failure Ec estimates are included in the discussion. An alternate quantity to assess risks due to spacecraft entries is introduced. "Probability of casualty", or Pc , is defined as the probability of one or more instances of people suffering death or injury due to a spacecraft entry event. The equation to estimate Pc is derived, where the same assumptions, modeling, and initial condition issues for Ec apply. Several examples are then given of both Ec and Pc estimate calculations. Due to the difficult issues in estimating both Ec and Pc, it is argued that "true" absolute quantities can never be computed. However, E and Pc are ideal for relativec analyses against a standard tool that eliminates these issues. Such a tool is recommended for assessing compliance with requirements of regulating institutions.

Active control of reheat buzz

NASA Astrophysics Data System (ADS)

Dowling, A. P.; Hooper, N.; Langhorne, P. J.; Bloxsidge, G. J.

1987-01-01

Reheat buzz is a low-frequency combustion instability involving the propagation of longitudinal pressure waves inside a duct in which a flame is anchored. Active control has been successfully applied to this instability. The controller alters the upstream acoustic boundary condition and thereby changes the energy balance in duct. Control is found to reduce the peak in the pressure spectrum due to the combustion instability by 20 dB. The acoustic energy in the whole 0-800-Hz bandwidth is reduced to about 10 percent of its uncontrolled value. A comparison with numerical calculations is presented.

Among adults with epilepsy reporting recent seizures, one of four on antiseizure medication and three of four not on medication had not seen a neurologist/epilepsy specialist within the last year, the 2010 and 2013 US National Health Interview Surveys.

PubMed

Cui, Wanjun; Kobau, Rosemarie; Zack, Matthew M

2016-08-01

We combined 2010 and 2013 National Health Interview Survey (NHIS) data to examine the prevalence of seeing a neurologist/epilepsy specialist and/or a general doctor among US adults with active epilepsy who either took antiseizure medications or had at least one seizure in the past 12months. Among adults with recent seizures, about 76% of adults who did not take antiseizure medication (including 55% of those who saw only a general doctor and 21% of those who saw neither a specialist nor a general doctor) and 26% of those who took medication (including 23% of those who saw only a general doctor and 3% of those who saw neither a specialist nor a general doctor) had not seen a specialist within the past year-indicating gaps in quality care putting patients with uncontrolled seizures at risk of negative outcomes. The US Healthy People 2020 objectives call for increasing the proportion of people with epilepsy and uncontrolled seizures who receive appropriate medical care. Epilepsy stakeholders can work with community services/organizations to improve provider education about epilepsy, eliminate barriers to specialized care, and promote self-management support to reduce the burden of uncontrolled seizures in people with epilepsy. Published by Elsevier Inc.

Efficacy and Safety of Fixed-Dose Perindopril Arginine/Amlodipine in Hypertensive Patients Not Adequately Controlled with Amlodipine 5 mg or Perindopril tert-Butylamine 4 mg Monotherapy.

PubMed

Hu, Dayi; Sun, Yihong; Liao, Yuhua; Huang, Jing; Zhao, Ruiping; Yang, Kan

2016-01-01

To assess the blood pressure-lowering efficacy and tolerability of perindopril/amlodipine fixed-dose combinations in Chinese patients with mild-to-moderate essential hypertension not adequately controlled with monotherapy alone. In 2 separate double-blind studies, patients received a 4-week run-in monotherapy of amlodipine 5 mg or perindopril 4 mg, respectively. Those whose blood pressure was uncontrolled were then randomized to receive the fixed-dose combination of perindopril 5 mg/amlodipine 5 mg (Per/Amlo group) or remain on the monotherapy for 8 weeks. Patients who were uncontrolled at the week 8 (W8) visit were up-titrated for the Per/Amlo combination, or received additional treatment if on monotherapy, for a further 4 weeks. The main efficacy assessment was at 8 weeks. After 8 weeks, systolic blood pressure (SBP; primary criterion) was statistically significantly lower in the Per/Amlo group (vs. Amlo 5 mg, p = 0.0095; vs. Per 4 mg, p < 0.0001). Uncontrolled patients at W8 who received an up-titration of the Per/Amlo combination showed a further SBP reduction. These changes were mirrored by reassuring reductions in diastolic blood pressure. The fixed-dose combinations were well tolerated. Single-pill combinations of perindopril and amlodipine provide hypertensive patients with a convenient and effective method of reducing blood pressure. © 2016 S. Karger AG, Basel.

Using a Ventilation Controller to Optimize Residential Passive Ventilation For Energy and Indoor Air Quality

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

Turner, William; Walker, Iain

One way to reduce the energy impact of providing residential ventilation is to use passive and hybrid systems. However, these passive and hybrid (sometimes called mixed-mode) systems must still meet chronic and acute health standards for ventilation. This study uses a computer simulation approach to examine the energy and indoor air quality (IAQ) implications of passive and hybrid ventilation systems, in 16 California climate zones. Both uncontrolled and flow controlled passive stacks are assessed. A new hybrid ventilation system is outlined that uses an intelligent ventilation controller to minimise energy use, while ensuring chronic and acute IAQ standards are met.more » ASHRAE Standard 62.2-2010 – the United States standard for residential ventilation - is used as the chronic standard, and exposure limits for PM 2.5, formaldehyde and NO 2 are used as the acute standards.The results show that controlled passive ventilation and hybrid ventilation can be used in homes to provide equivalent IAQ to continuous mechanical ventilation, for less use of energy.« less

Impact of Distress Reduction on Behavioral Correlates and A1C in African American Women with Uncontrolled Type 2 Diabetes: Results from EMPOWER.

PubMed

Cummings, Doyle M; Lutes, Lesley D; Littlewood, Kerry; Solar, Chelsey; Hambidge, Bertha; Gatlin, Peggy

2017-01-01

Symptoms of emotional distress related to diabetes have been associated with inadequate self-care behaviors, medication non-adherence, and poor glycemic control that may predispose patients to premature death. African American women, in whom diabetes is more common and social support is often insufficient, may be at particularly high risk. The objective of this study was to examine the impact of lowering diabetes-related emotional distress on glycemic control and associated behavioral correlates in rural African American women with uncontrolled type 2 diabetes (T2D). Post-hoc analysis of prospective, randomized, controlled trial. Rural communities in the southeastern United States. 129 rural middle-aged African American women with uncontrolled type 2 diabetes (T2D)(A1C ≥ 7.0). Diabetes-related distress. Changes from baseline to 12-month follow-up in diabetes-related distress, and associated changes in medication adherence, self-care activities, self-efficacy, and glycemic control (A1C). Patients with a reduction in diabetes-related distress (n=79) had significantly greater improvement in A1C, medication adherence, self-care activities, and self-efficacy compared with those in whom diabetes distress worsened or was unchanged (n=50). Changes in distress were also significantly and inversely correlated with improvements in medication adherence, self-care activities, and self-efficacy. Among rural African American women, reductions in diabetes-related distress may be associated with lower A1C and improvements in self-efficacy, self-care behaviors, and medication adherence.

Glycemic control and the outcomes of Hispanic patients with diabetes admitted to the general ward of a community hospital in Puerto Rico.

PubMed

Torres-Torres, Nancy; Maldonado-Rodríguez, Miguel A; Pérez-López, Shirley; Sierra-Martínez, Kassandra; García, Astrid J

2011-06-01

Uncontrolled glucose, present in 40% of diabetic patients admitted to United States hospitals, has been associated with prolonged length of stay and poorer general outcomes in critically ill and surgical patients. However, past studies of general ward patients have shown there to be no consistent benefits of strict glucose control, and the Hispanic population has been underrepresented in such studies. This work evaluated the association between glycemic control and the outcomes of hospitalized Hispanics with diabetes and to describe physicians' interventions in the treatment of diabetes. This is a retrospective chart review of all patients with diabetes admitted over a period of six months in the general ward of a community hospital in Puerto Rico. We evaluated glucose levels during the first 72 hours, length of stay, and reported complications during admission. Outcomes were evaluated with crude odds ratios and multivariate logistic regression. Uncontrolled blood glucose was observed in 59.1% of the 875 patients whose records were revised; of that 59.1%, treatment modification was not prescribed for 43.2%. Patients with poorly controlled glucose were more likely to develop acute coronary syndrome (corrected OR: 11.46; 95% CI = 1.48-88.50) as a complication and less likely to develop hypoglycemia (corrected OR: 0.57; 95% = CI 0.37-0.88). Our results suggest that hospitalized but non-critically ill Hispanic patients with diabetes are prone to poor outcomes secondary to uncontrolled glucose levels; in addition, those results support the creation of standardized protocols for the management of diabetes in this population.

Outcomes of glycemic control in Hispanic geriatric diabetic patients admitted to a general ward community hospital in Puerto Rico.

PubMed

Maldonado-Rodríguez, Miguel; Pérez-López, Shirley; Torres-Torres, Nancy; Torres-Semprit, Erick; Millán-Aponte, Ismenio

2012-01-01

Diabetes mellitus is one of the most prevalent medical conditions among the Hispanic population. Although studies with patients in intensive care units have shown poor outcomes among those with uncontrolled glucose, more recent data have shown increased mortality associated with a tighter inpatient glucose control. In view of the lack of information regarding geriatric Hispanic patients with diabetes this study evaluated the effect of glucose control in the outcomes of this population in a community hospital in Puerto Rico. Through analysis of data from a previous study we evaluated 502 admissions of Hispanic geriatric patients with diabetes as comorbidity, for glucose control, management of diabetes and outcome. Data was stratified by age groups (65-74 years, 75-84 years and > or = 85 years) and outcomes were compared between the groups using chi-square and odds ratio. The most common admission diagnosis was pneumonia. Hypoglycemia was the most common complication and was associated with tighter glucose control in the age group of 75-84 years. An increased risk of having an acute coronary syndrome/acute myocardial infarction among uncontrolled patients was observed in the 75-84 year old group. Finally, although we found a high prevalence of uncontrolled blood glucose, only 54% of the patients received interventions for their glucose control. Poor glucose control seems to be associated with a tendency for decreased risk of hypoglycemia and higher risk of acute coronary syndrome/acute myocardial infarction as complications among geriatric patients with diabetes admitted to a general ward.

A case report of evaluating a large-scale health systems improvement project in an uncontrolled setting: a quality improvement initiative in KwaZulu-Natal, South Africa.

PubMed

Mate, Kedar S; Ngidi, Wilbroda Hlolisile; Reddy, Jennifer; Mphatswe, Wendy; Rollins, Nigel; Barker, Pierre

2013-11-01

New approaches are needed to evaluate quality improvement (QI) within large-scale public health efforts. This case report details challenges to large-scale QI evaluation, and proposes solutions relying on adaptive study design. We used two sequential evaluative methods to study a QI effort to improve delivery of HIV preventive care in public health facilities in three districts in KwaZulu-Natal, South Africa, over a 3-year period. We initially used a cluster randomised controlled trial (RCT) design. During the RCT study period, tensions arose between intervention implementation and evaluation design due to loss of integrity of the randomisation unit over time, pressure to implement changes across the randomisation unit boundaries, and use of administrative rather than functional structures for the randomisation. In response to this loss of design integrity, we switched to a more flexible intervention design and a mixed-methods quasiexperimental evaluation relying on both a qualitative analysis and an interrupted time series quantitative analysis. Cluster RCT designs may not be optimal for evaluating complex interventions to improve implementation in uncontrolled 'real world' settings. More flexible, context-sensitive evaluation designs offer a better balance of the need to adjust the intervention during the evaluation to meet implementation challenges while providing the data required to evaluate effectiveness. Our case study involved HIV care in a resource-limited setting, but these issues likely apply to complex improvement interventions in other settings.

Uncontrollable Stress, Coping, and Subjective Well-Being in Urban Adolescents

ERIC Educational Resources Information Center

Coyle, Laura D.; Vera, Elizabeth M.

2013-01-01

The purpose of this study was to determine whether uncontrollable stress related to levels of subjective well-being (SWB) in a group of ethnically diverse urban adolescents. Additionally, the researchers examined what types of coping skills were utilized in the face of high levels of uncontrollable stress. Finally, a moderation model was proposed,…

A Combined Training Program for Veterans with Amnestic Mild Cognitive Impairment

DTIC Science & Technology

2014-10-01

portal   hypertension , hepatic encephalopathy).  E05  Current severe cardiac disease (e.g., uncontrolled atrial fibrillation, defined as mean 24 hour  heart... hypertension , obesity, and type II diabetes mellitus [1, 2; 3; 4]. Hence, it may be that by improving cardiovascular health and reducing vascular risk factors

A randomized trial of peer coach and office staff support to reduce coronary heart disease risk in African-Americans with uncontrolled hypertension.

PubMed

Turner, Barbara J; Hollenbeak, Christopher S; Liang, Yuanyuan; Pandit, Kavita; Joseph, Shelly; Weiner, Mark G

2012-10-01

Adopting features of the Chronic Care Model may reduce coronary heart disease risk and blood pressure in vulnerable populations. We evaluated a peer and practice team intervention on reduction in 4-year coronary heart disease risk and systolic blood pressure. A single blind, randomized, controlled trial in two adjacent urban university-affiliated primary care practices. Two hundred eighty African-American subjects aged 40 to 75 with uncontrolled hypertension. Three monthly calls from trained peer patients with well-controlled hypertension and, on alternate months, two practice staff visits to review a personalized 4-year heart disease risk calculator and slide shows about heart disease risks. All subjects received usual physician care and brochures about healthy cooking and heart disease. Change in 4-year coronary heart disease risk (primary) and change in systolic blood pressure, both assessed at 6 months. At baseline, the 136 intervention and 144 control subjects' mean 4-year coronary heart disease risk did not differ (intervention=5.8 % and control=6.4 %, P=0.39), and their mean systolic blood pressure was the same (140.5 mmHg, p=0.83). Endpoint data for coronary heart disease were obtained for 69 % of intervention and 82 % of control subjects. After multiple imputation for missing endpoint data, the reduction in risk among all 280 subjects favored the intervention, but was not statistically significant (difference -0.73 %, 95 % confidence interval: -1.54 % to 0.09 %, p=0.08). Among the 247 subjects with a systolic blood pressure endpoint (85 % of intervention and 91 % of control subjects), more intervention than control subjects achieved a >5 mmHg reduction (61 % versus 45 %, respectively, p=0.01). After multiple imputation, the absolute reduction in systolic blood pressure was also greater for the intervention group (difference -6.47 mmHg, 95 % confidence interval: -10.69 to -2.25, P=0.003). One patient died in each study arm. Peer patient and office-based behavioral support for African-American patients with uncontrolled hypertension did not result in a significantly greater reduction in coronary heart disease risk but did significantly reduce systolic blood pressure.

Landscape change in the southern Piedmont: challenges, solutions, and uncertainty across scales

USGS Publications Warehouse

Conroy, M.J.; Allen, Craig R.; Peterson, J.T.; Pritchard, L.J.; Moore, C.T.

2003-01-01

The southern Piedmont of the southeastern United States epitomizes the complex and seemingly intractable problems and hard decisions that result from uncontrolled urban and suburban sprawl. Here we consider three recurrent themes in complicated problems involving complex systems: (1) scale dependencies and cross-scale, often nonlinear relationships; (2) resilience, in particular the potential for complex systems to move to alternate stable states with decreased ecological and/or economic value; and (3) uncertainty in the ability to understand and predict outcomes, perhaps particularly those that occur as a result of human impacts. We consider these issues in the context of landscape-level decision making, using as an example water resources and lotic systems in the Piedmont region of the southeastern United States.

Patient Perspectives on Quality of Life With Uncontrolled Type 1 Diabetes Mellitus: A Systematic Review and Qualitative Meta-synthesis.

PubMed

Vanstone, Meredith; Rewegan, Alex; Brundisini, Francesca; Dejean, Deirdre; Giacomini, Mita

2015-01-01

Patients with uncontrolled type 1 diabetes mellitus may be candidates for pancreatic islet cell transplantation. This report synthesizes qualitative research on how patients with uncontrolled type 1 diabetes perceive their quality of life. The objective of this analysis was to examine the perceptions of patients with uncontrolled type 1 diabetes on how it affects their lived experience and quality of life. This report synthesizes 31 primary qualitative studies to examine quality of life from the perspectives of adult patients with type 1 diabetes mellitus and their families or partners. We performed a qualitative meta-synthesis to integrate findings across primary research studies. Long- and short-term negative consequences of uncontrolled type 1 diabetes affect all aspects of patients' lives: physical, emotional, practical, and social. The effect on each domain is far-reaching, and effects interact across domains. Uncontrolled blood sugar levels lead to substantial psychological distress, negative moods, cognitive difficulties, irritable or aggressive behaviour, and closely associated problems with relationships, self-image, and confidence. Emotional distress is pervasive and under-addressed by health care providers. Patients live in fear of complications from diabetes over the long term. In the shorter term, they are anxious about the personal, social, and professional consequences of hypoglycemic episodes (e.g., injury, humiliation), and may curtail normal activities such as driving or socializing because they are worried about having an episode. The quality of life for patients' family members is also negatively impacted by uncontrolled type 1 diabetes. Uncontrolled type 1 diabetes has significant negative impacts on the quality of life of both people with the disease and their families.

Reasons for uncontrolled seizures in children: the impact of pseudointractability.

PubMed

Asadi-Pooya, Ali A; Emami, Mehrdad

2012-11-01

We investigated the various possible reasons for uncontrolled seizures in patients under 18 years of age to determine the impact of pseudointractability. We also investigated the various forms of pseudointractability in children with uncontrolled seizures. In this cross-sectional retrospective chart review study, all patients under 18 years of age with their first seizure occurring at least 6 months prior to the referral date, taking at least one antiepileptic drug (AED), and having at least one seizure in the past 3 months were studied. The presumed reason for uncontrolled seizures was arbitrarily considered to be one of these five categories: poor adherence; wrong medication; wrong dose of the correct medication; diagnosis other than epilepsy; and finally, medically refractory epilepsy. Statistical analyses were performed using Chi-square and Fisher's Exact tests to determine potentially significant differences, and a P value less than 0.05 was considered significant. During the study period, 198 patients were referred to us due to uncontrolled seizures. Ninety patients (45%) were taking one AED, 55 (28%) were taking two AEDs, and 53 (27%) patients were taking more than two AEDs at the time of referral. Four percent of these patients did not have epilepsy. Forty-seven percent of the children with uncontrolled seizures had medically refractory epilepsy; 37% were taking the wrong AEDs; 10% were taking suboptimal doses of AEDs; and 2% had poor drug adherence. Uncontrolled seizures in children are a commonly encountered problem, particularly at epilepsy clinics. One should consider all possible reasons for these uncontrolled seizures, including non-epileptic seizures, pseudointractability, and medically refractory epilepsy. The mainstay for making a correct diagnosis is a detailed clinical history. Copyright © 2012 Elsevier Inc. All rights reserved.

Sexual murderers' implicit theories.

PubMed

Beech, Anthony; Fisher, Dawn; Ward, Tony

2005-11-01

Interviews with 28 sexual murderers were subjected to grounded theory analysis. Five implicit theories (ITs) were identified: dangerous world, male sex drive is uncontrollable, entitlement, women as sexual objects, and women as unknowable. These ITs were found to be identical to those identified in the literature as being present in rapists. The presence of dangerous world and male sex drive is uncontrollable were present, or absent, such that three groups could be identified: (a) dangerous world plus male sex drive is uncontrollable; (b) dangerous world, in the absence of male sex drive is uncontrollable; (c) male sex drive is uncontrollable in the absence of dangerous world. These three groups were found to differ in motivation: (a) were motivated by urges to rape and murder; (b) were motivated by grievance, resentment and/or anger toward women; (c) were motivated to sexually offend but were prepared to kill to avoid detection, or secure compliance.

Design and initial validation of a wireless control system based on WSN

NASA Astrophysics Data System (ADS)

Yu, Yan; Li, Luyu; Li, Peng; Wang, Xu; Liu, Hang; Ou, Jinping

2013-04-01

At present, cantilever structure used widely in civil structures will generate continuous vibration by external force due to their low damping characteristic, which leads to a serious impact on the working performance and service time. Therefore, it is very important to control the vibration of these structures. The active vibration control is the primary means of controlling the vibration with high precision and strong adaptive ability. Nowadays, there are many researches using piezoelectric materials in the structural vibration control. Piezoelectric materials are cheap, reliable and they can provide braking and sensing method harmless to the structure, therefore they have broad usage. They are used for structural vibration control in a lot of civil engineering research currently. In traditional sensor applications, information exchanges with the monitoring center or a computer system through wires. If wireless sensor networks(WSN) technology is used, cabling links is not needed, thus the cost of the whole system is greatly reduced. Based on the above advantages, a wireless control system is designed and validated through preliminary tests. The system consists of a cantilever, PVDF as sensor, signal conditioning circuit(SCM), A/D acquisition board, control arithmetic unit, D/A output board, power amplifier, piezoelectric bimorph as actuator. DSP chip is used as the control arithmetic unit and PD control algorithm is embedded in it. PVDF collects the parameters of vibration, sends them to the SCM after A/D conversion. SCM passes the data to the DSP through wireless technology, and DSP calculates and outputs the control values according to the control algorithm. The output signal is amplified by the power amplifier to drive the piezoelectric bimorph for vibration control. The structural vibration duration reduces to 1/4 of the uncontrolled case, which verifies the feasibility of the system.

Environmental interventions to reduce fear of crime: systematic review of effectiveness

PubMed Central

2013-01-01

Background Fear of crime is associated with negative health and wellbeing outcomes, and may mediate some impacts of the built environment on public health. A range of environmental interventions have been hypothesized to reduce the fear of crime. Methods This review aimed to synthesize the literature on the effectiveness of interventions in the built environment to reduce the fear of crime. Systematic review methodology, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, was used. Studies of environmental interventions which reported a fear of crime outcome and used any prospective evaluation design (randomized controlled trial (RCT), trial or uncontrolled before-and-after study) were included. Eighteen databases were searched. The Hamilton tool was used to assess quality. A narrative synthesis of findings was undertaken. Results A total of 47 studies were included, 22 controlled and 25 uncontrolled, with total sample sizes ranging from n = 52 to approximately n = 23,000. Thirty-six studies were conducted in the UK, ten studies in the USA and one study in the Netherlands. The quality of the evidence overall is low. There are some indications that home security improvements and non-crime-related environmental improvements may be effective for some fear of crime outcomes. There is little evidence that the following reduce fear of crime: street lighting improvements, closed-circuit television (CCTV), multi-component environmental crime prevention programs or regeneration programs. Conclusions There is some evidence for the effectiveness of specific environmental interventions in reducing some indicators of fear of crime, but more attention to the context and possible confounders is needed in future evaluations of complex social interventions such as these. PMID:23663285

A two-step crushed lava rock filter unit for grey water treatment at household level in an urban slum.

PubMed

Katukiza, A Y; Ronteltap, M; Niwagaba, C B; Kansiime, F; Lens, P N L

2014-01-15

Decentralised grey water treatment in urban slums using low-cost and robust technologies offers opportunities to minimise public health risks and to reduce environmental pollution caused by the highly polluted grey water i.e. with a COD and N concentration of 3000-6000 mg L(-1) and 30-40 mg L(-1), respectively. However, there has been very limited action research to reduce the pollution load from uncontrolled grey water discharge by households in urban slums. This study was therefore carried out to investigate the potential of a two-step filtration process to reduce the grey water pollution load in an urban slum using a crushed lava rock filter, to determine the main filter design and operation parameters and the effect of intermittent flow on the grey water effluent quality. A two-step crushed lava rock filter unit was designed and implemented for use by a household in the Bwaise III slum in Kampala city (Uganda). It was monitored at a varying hydraulic loading rate (HLR) of 0.5-1.1 m d(-1) as well as at a constant HLR of 0.39 m d(-1). The removal efficiencies of COD, TP and TKN were, respectively, 85.9%, 58% and 65.5% under a varying HLR and 90.5%, 59.5% and 69%, when operating at a constant HLR regime. In addition, the log removal of Escherichia coli, Salmonella spp. and total coliforms was, respectively, 3.8, 3.2 and 3.9 under the varying HLR and 3.9, 3.5 and 3.9 at a constant HLR. The results show that the use of a two-step filtration process as well as a lower constant HLR increased the pollutant removal efficiencies. Further research is needed to investigate the feasibility of adding a tertiary treatment step to increase the nutrients and microorganisms removal from grey water. Copyright © 2013 Elsevier Ltd. All rights reserved.

Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study

PubMed Central

van Welie, Steven; Wijma, Linda; Beerden, Tim; van Doormaal, Jasperien; Taxis, Katja

2016-01-01

Objectives Residents of nursing homes often have difficulty swallowing (dysphagia), which complicates the administration of solid oral dosage formulations. Erroneously crushing medication is common, but few interventions have been tested to improve medication safety. Therefore, we evaluated the effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes. Setting This was a prospective uncontrolled intervention study with a preintervention and postintervention measurement. The study was conducted on 18 wards (total of 200 beds) in 3 nursing homes in the North of the Netherlands. Participants We observed 36 nurses/nursing assistants (92% female; 92% nursing assistants) administering medication to 197 patients (62.9% female; mean age 81.6). Intervention The intervention consisted of a set of warning symbols printed on each patient's unit dose packaging indicating whether or not a medication could be crushed as well as education of ward staff (lectures, newsletter and poster). Primary outcome measure The relative risk (RR) of a crushing error occurring in the postintervention period compared to the preintervention period. A crushing error was defined as the crushing of a medication considered unsuitable to be crushed based on standard reference sources. Data were collected using direct (disguised) observation of nurses during drug administration. Results The crushing error rate decreased from 3.1% (21 wrongly crushed medicines out of 681 administrations) to 0.5% (3/636), RR=0.15 (95% CI 0.05 to 0.51). Likewise, there was a significant reduction using data from patients with swallowing difficulties only, 87.5% (21 errors/24 medications) to 30.0% (3/10) (RR 0.34, 95% CI 0.13 to 0.89). Medications which were erroneously crushed included enteric-coated formulations (eg, omeprazole), medication with regulated release systems (eg, Persantin; dipyridamol) and toxic substances (eg, finasteride). Conclusions Warning symbols combined with education reduced erroneous crushing of medication, a well-known and common problem in nursing homes. PMID:27496242

An arc control and protection system for the JET lower hybrid antenna based on an imaging system

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

Figueiredo, J., E-mail: joao.figueiredo@jet.efda.org; Mailloux, J.; Kirov, K.

Arcs are the potentially most dangerous events related to Lower Hybrid (LH) antenna operation. If left uncontrolled they can produce damage and cause plasma disruption by impurity influx. To address this issue an arc real time control and protection imaging system for the Joint European Torus (JET) LH antenna has been implemented. The LH system is one of the additional heating systems at JET. It comprises 24 microwave generators (klystrons, operating at 3.7 GHz) providing up to 5 MW of heating and current drive to the JET plasma. This is done through an antenna composed of an array of waveguidesmore » facing the plasma. The protection system presented here is based primarily on an imaging arc detection and real time control system. It has adapted the ITER like wall hotspot protection system using an identical CCD camera and real time image processing unit. A filter has been installed to avoid saturation and spurious system triggers caused by ionization light. The antenna is divided in 24 Regions Of Interest (ROIs) each one corresponding to one klystron. If an arc precursor is detected in a ROI, power is reduced locally with subsequent potential damage and plasma disruption avoided. The power is subsequently reinstated if, during a defined interval of time, arcing is confirmed not to be present by image analysis. This system was successfully commissioned during the restart phase and beginning of the 2013 scientific campaign. Since its installation and commissioning, arcs and related phenomena have been prevented. In this contribution we briefly describe the camera, image processing, and real time control systems. Most importantly, we demonstrate that an LH antenna arc protection system based on CCD camera imaging systems works. Examples of both controlled and uncontrolled LH arc events and their consequences are shown.« less

Budget impact analysis of adjunctive therapy with lacosamide for partial-onset epileptic seizures in Belgium.

PubMed

Simoens, Steven

2011-01-01

This study aims to compute the budget impact of lacosamide, a new adjunctive therapy for partial-onset seizures in epilepsy patients from 16 years of age who are uncontrolled and having previously used at least three anti-epileptic drugs from a Belgian healthcare payer perspective. The budget impact analysis compared the 'world with lacosamide' to the 'world without lacosamide' and calculated how a change in the mix of anti-epileptic drugs used to treat uncontrolled epilepsy would impact drug spending from 2008 to 2013. Data on the number of patients and on the market shares of anti-epileptic drugs were taken from Belgian sources and from the literature. Unit costs of anti-epileptic drugs originated from Belgian sources. The budget impact was calculated from two scenarios about the market uptake of lacosamide. The Belgian target population is expected to increase from 5333 patients in 2008 to 5522 patients in 2013. Assuming that the market share of lacosamide increases linearly over time and is taken evenly from all other anti-epileptic drugs (AEDs), the budget impact of adopting adjunctive therapy with lacosamide increases from €5249 (0.1% of reference drug budget) in 2008 to €242,700 (4.7% of reference drug budget) in 2013. Assuming that 10% of patients use standard AED therapy plus lacosamide, the budget impact of adopting adjunctive therapy with lacosamide is around €800,000-900,000 per year (or 16.7% of the reference drug budget). Adjunctive therapy with lacosamide would raise drug spending for this patient population by as much as 16.7% per year. However, this budget impact analysis did not consider the fact that lacosamide reduces costs of seizure management and withdrawal. The literature suggests that, if savings in other healthcare costs are taken into account, adjunctive therapy with lacosamide may be cost saving.

Pseudo-phase-matched four-wave mixing in soliton wavelength-division multiplexing transmission.

PubMed

Mamyshev, P V; Mollenauer, L F

1996-03-15

In a soliton transmission system using lumped amplifiers, pseudo phase matching allows four-wave mixing fields from soliton-soliton collisions to grow uncontrollably and inf lict severe penalties. Through numerical simulation, we show that this growth can be eliminated, or at least greatly reduced, through the use of fiber whose dispersion is tapered, either continuously or in steps, in conformity with the fiber loss curve.

Synergistic GABA-Enhancing Therapy against Seizures in a Mouse Model of Dravet Syndrome

PubMed Central

Oakley, John C.; Cho, Alvin R.; Cheah, Christine S.; Scheuer, Todd

2013-01-01

Seizures remain uncontrolled in 30% of patients with epilepsy, even with concurrent use of multiple drugs, and uncontrolled seizures result in increased morbidity and mortality. An extreme example is Dravet syndrome (DS), an infantile-onset severe epilepsy caused by heterozygous loss of function mutations in SCN1A, the gene encoding the brain type-I voltage-gated sodium channel NaV1.1. Studies in Scn1a heterozygous knockout mice demonstrate reduced excitability of GABAergic interneurons, suggesting that enhancement of GABA signaling may improve seizure control and comorbidities. We studied the efficacy of two GABA-enhancing drugs, clonazepam and tiagabine, alone and in combination, against thermally evoked myoclonic and generalized tonic-clonic seizures. Clonazepam, a positive allosteric modulator of GABA-A receptors, protected against myoclonic and generalized tonic-clonic seizures. Tiagabine, a presynaptic GABA reuptake inhibitor, was protective against generalized tonic-clonic seizures but only minimally protective against myoclonic seizures and enhanced myoclonic seizure susceptibility at high doses. Combined therapy with clonazepam and tiagabine was synergistic against generalized tonic-clonic seizures but was additive against myoclonic seizures. Toxicity determined by rotorod testing was additive for combination therapy. The synergistic actions of clonazepam and tiagabine gave enhanced seizure protection and reduced toxicity, suggesting that combination therapy may be well tolerated and effective for seizures in DS. PMID:23424217

Design and experiment of vehicular charger AC/DC system based on predictive control algorithm

NASA Astrophysics Data System (ADS)

He, Guangbi; Quan, Shuhai; Lu, Yuzhang

2018-06-01

For the car charging stage rectifier uncontrollable system, this paper proposes a predictive control algorithm of DC/DC converter based on the prediction model, established by the state space average method and its prediction model, obtained by the optimal mathematical description of mathematical calculation, to analysis prediction algorithm by Simulink simulation. The design of the structure of the car charging, at the request of the rated output power and output voltage adjustable control circuit, the first stage is the three-phase uncontrolled rectifier DC voltage Ud through the filter capacitor, after by using double-phase interleaved buck-boost circuit with wide range output voltage required value, analyzing its working principle and the the parameters for the design and selection of components. The analysis of current ripple shows that the double staggered parallel connection has the advantages of reducing the output current ripple and reducing the loss. The simulation experiment of the whole charging circuit is carried out by software, and the result is in line with the design requirements of the system. Finally combining the soft with hardware circuit to achieve charging of the system according to the requirements, experimental platform proved the feasibility and effectiveness of the proposed predictive control algorithm based on the car charging of the system, which is consistent with the simulation results.

Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care: A Cost-Benefit Analysis.

PubMed

Basu, Sanjay; Jack, Helen E; Arabadjis, Sophia D; Phillips, Russell S

2017-02-01

Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption. To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer's perspective. Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program's expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources. CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4-5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure-approximately 3%-4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings. Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient's primary diagnosis.

Dynamic Hydrostatic Pressure Promotes Differentiation of Human Dental Pulp Stem Cells

PubMed Central

Yu, V; Damek-Poprawa, M.; Nicoll, S. B.; Akintoye, S.O.

2009-01-01

The masticatory apparatus absorbs high occlusal forces, but uncontrolled parafunctional or orthodontic forces damage periodontal ligament (PDL), cause pulpal calcification, pulp necrosis and tooth loss. Morphology and functional differentiation of connective tissue cells can be controlled by mechanical stimuli but effects of uncontrolled forces on intra-pulpal homeostasis and ability of dental pulp stem cells (DPSCs) to withstand direct external forces are unclear. Using dynamic hydrostatic pressure (HSP), we tested the hypothesis that direct HSP disrupts DPSC survival and odontogenic differentiation. DPSCs from four teenage patients were subjected to HSP followed by assessment of cell adhesion, survival and recovery capacity based on odontogenic differentiation, mineralization and responsiveness to bone morphogenetic protein-2 (BMP-2). HSP down-regulated DPSC adhesion and survival but promoted differentiation by increasing mineralization, in vivo hard tissue regeneration and BMP-2 responsiveness despite reduced cell numbers. HSP-treated DPSCs displayed enhanced odontogenic differentiation, an indication of favorable recovery from HSP-induced cellular stress. PMID:19555657

Urinary incontinence

MedlinePlus

Loss of bladder control; Uncontrollable urination; Urination - uncontrollable; Incontinence - urinary ... have diabetes, keep your blood sugar under good control. For urine leaks, wear absorbent pads or undergarments. ...

Movement - uncontrollable

MedlinePlus

... movements; Body movements - uncontrollable; Dyskinesia; Athetosis; Myoclonus; Ballismus Images Central nervous system and peripheral nervous system References Jankovic J, Lang AE. Diagnosis and assessment of Parkinson disease ...

Uncontrolled eating in adolescents: The role of impulsivity and automatic approach bias for food.

PubMed

Booth, Charlotte; Spronk, Desiree; Grol, Maud; Fox, Elaine

2018-01-01

Obesity is a global problem reaching epidemic proportions and can be explained by unhealthy eating and sedentary lifestyles. Understanding the psychological processes underlying unhealthy eating behaviour is crucial for the development of effective obesity prevention programmes. Dual-process models implicate the interplay between impaired cognitive control and enhanced automatic responsivity to rewarding food cues as key risk factors. The current study assessed the influence of four different components of trait impulsivity (reflecting impaired cognitive control) and automatic approach bias for food (reflecting automatic responsivity to food) on uncontrolled eating in a large sample (N = 504) of young adolescents. Of the four impulsivity factors, negative urgency was found to be the strongest predictor of uncontrolled eating. Interestingly, we found that lack of premeditation was a key risk factor for uncontrolled eating, but only when approach bias for food was high, supporting a dual-process model. Lack of perseverance showed a similar interactive pattern to a lesser degree and sensation-seeking did not predict uncontrolled eating. Together, our results show that distinct components of trait impulsivity are differentially associated with uncontrolled eating behaviour in adolescents, and that automatic processing of food cues may be an important factor in modulating this relationship. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Emotional and uncontrolled eating styles and chocolate chip cookie consumption. A controlled trial of the effects of positive mood enhancement.

PubMed

Turner, Sally Ann; Luszczynska, Aleksandra; Warner, Lisa; Schwarzer, Ralf

2010-02-01

The study tested the effects of positive mood enhancement on chocolate chip cookie consumption in the context of emotional and uncontrolled eating styles. The relationship between emotional eating style and chocolate chip cookie intake was assumed to be mediated by uncontrolled eating style. Further, it was hypothesized that the effectiveness of the positive mood enhancement may be more salient among those who have effective control of their eating. In this experimental study, respondents (N=106, 70% women, aged 16-45 years old) were assigned by means of cluster randomization to the control or positive mood enhancement condition (a comedy movie clip). Compared to the control condition, positive mood enhancement resulted in consuming on average 53.86 kcal less. Relationships between emotional eating style and cookie intake were mediated by uncontrolled eating. Moderated mediation analysis indicated that the effect of a mediator (uncontrolled eating) on cookie intake was moderated by the group assignment. Positive mood enhancement resulted in eating on average 3.3 cookies less among individuals with a more controlled eating style. By contrast, among those who presented uncontrolled eating, positive mood enhancement led to consuming an average of 1.7 cookies more. 2009 Elsevier Ltd. All rights reserved.

Glycemic Control and the Outcomes of Hispanic Patients with Diabetes Admitted to the General Ward of a Community Hospital in Puerto Rico

PubMed Central

Torres-Torres, Nancy; Maldonado-Rodríguez, Miguel A.; Pérez-López, Shirley; Sierra-Martínez, Kassandra; García, Astrid J.

2017-01-01

Objective Uncontrolled glucose, present in 40% of diabetic patients admitted to United States hospitals, has been associated with prolonged length of stay and poorer general outcomes in critically ill and surgical patients. However, past studies of general ward patients have shown there to be no consistent benefits of strict glucose control, and the Hispanic population has been underrepresented in such studies. This work evaluated the association between glycemic control and the outcomes of hospitalized Hispanics with diabetes and to describe physicians’ interventions in the treatment of diabetes. Methods This is a retrospective chart review of all patients with diabetes admitted over a period of six months in the general ward of a community hospital in Puerto Rico. We evaluated glucose levels during the first 72 hours, length of stay, and reported complications during admission. Outcomes were evaluated with crude odds ratios and multivariate logistic regression. Results Uncontrolled blood glucose was observed in 59.1% of the 875 patients whose records were revised; of that 59.1%, treatment modification was not prescribed for 43.2%. Patients with poorly controlled glucose were more likely to develop acute coronary syndrome (corrected OR: 11.46; 95% CI = 1.48 – 88.50) as a complication and less likely to develop hypoglycemia (corrected OR: 0.57; 95% = CI 0.37 – 0.88). Conclusion Our results suggest that hospitalized but non-critically ill Hispanic patients with diabetes are prone to poor outcomes secondary to uncontrolled glucose levels; in addition, those results support the creation of standardized protocols for the management of diabetes in this population. PMID:21682145

Statistical Issues for Uncontrolled Reentry Hazards Empirical Tests of the Predicted Footprint for Uncontrolled Satellite Reentry Hazards

NASA Technical Reports Server (NTRS)

Matney, Mark

2011-01-01

A number of statistical tools have been developed over the years for assessing the risk of reentering objects to human populations. These tools make use of the characteristics (e.g., mass, material, shape, size) of debris that are predicted by aerothermal models to survive reentry. The statistical tools use this information to compute the probability that one or more of the surviving debris might hit a person on the ground and cause one or more casualties. The statistical portion of the analysis relies on a number of assumptions about how the debris footprint and the human population are distributed in latitude and longitude, and how to use that information to arrive at realistic risk numbers. Because this information is used in making policy and engineering decisions, it is important that these assumptions be tested using empirical data. This study uses the latest database of known uncontrolled reentry locations measured by the United States Department of Defense. The predicted ground footprint distributions of these objects are based on the theory that their orbits behave basically like simple Kepler orbits. However, there are a number of factors in the final stages of reentry - including the effects of gravitational harmonics, the effects of the Earth s equatorial bulge on the atmosphere, and the rotation of the Earth and atmosphere - that could cause them to diverge from simple Kepler orbit behavior and possibly change the probability of reentering over a given location. In this paper, the measured latitude and longitude distributions of these objects are directly compared with the predicted distributions, providing a fundamental empirical test of the model assumptions.

Increased metabolic activity in the septum and habenula during stress is linked to subsequent expression of learned helplessness behavior.

PubMed

Mirrione, Martine M; Schulz, Daniela; Lapidus, Kyle A B; Zhang, Samuel; Goodman, Wayne; Henn, Fritz A

2014-01-01

Uncontrollable stress can have a profound effect on an organism's ability to respond effectively to future stressful situations. Behavior subsequent to uncontrollable stress can vary greatly between individuals, falling on a spectrum between healthy resilience and maladaptive learned helplessness. It is unclear whether dysfunctional brain activity during uncontrollable stress is associated with vulnerability to learned helplessness; therefore, we measured metabolic activity during uncontrollable stress that correlated with ensuing inability to escape future stressors. We took advantage of small animal positron emission tomography (PET) and 2-deoxy-2[(18)F]fluoro-D-glucose ((18)FDG) to probe in vivo metabolic activity in wild type Sprague Dawley rats during uncontrollable, inescapable, unpredictable foot-shock stress, and subsequently tested the animals response to controllable, escapable, predictable foot-shock stress. When we correlated metabolic activity during the uncontrollable stress with consequent behavioral outcomes, we found that the degree to which animals failed to escape the foot-shock correlated with increased metabolic activity in the lateral septum and habenula. When used a seed region, metabolic activity in the habenula correlated with activity in the lateral septum, hypothalamus, medial thalamus, mammillary nuclei, ventral tegmental area, central gray, interpeduncular nuclei, periaqueductal gray, dorsal raphe, and rostromedial tegmental nucleus, caudal linear raphe, and subiculum transition area. Furthermore, the lateral septum correlated with metabolic activity in the preoptic area, medial thalamus, habenula, interpeduncular nuclei, periaqueductal gray, dorsal raphe, and caudal linear raphe. Together, our data suggest a group of brain regions involved in sensitivity to uncontrollable stress involving the lateral septum and habenula.

Increased metabolic activity in the septum and habenula during stress is linked to subsequent expression of learned helplessness behavior

PubMed Central

Mirrione, Martine M.; Schulz, Daniela; Lapidus, Kyle A. B.; Zhang, Samuel; Goodman, Wayne; Henn, Fritz A.

2013-01-01

Uncontrollable stress can have a profound effect on an organism's ability to respond effectively to future stressful situations. Behavior subsequent to uncontrollable stress can vary greatly between individuals, falling on a spectrum between healthy resilience and maladaptive learned helplessness. It is unclear whether dysfunctional brain activity during uncontrollable stress is associated with vulnerability to learned helplessness; therefore, we measured metabolic activity during uncontrollable stress that correlated with ensuing inability to escape future stressors. We took advantage of small animal positron emission tomography (PET) and 2-deoxy-2[18F]fluoro-D-glucose (18FDG) to probe in vivo metabolic activity in wild type Sprague Dawley rats during uncontrollable, inescapable, unpredictable foot-shock stress, and subsequently tested the animals response to controllable, escapable, predictable foot-shock stress. When we correlated metabolic activity during the uncontrollable stress with consequent behavioral outcomes, we found that the degree to which animals failed to escape the foot-shock correlated with increased metabolic activity in the lateral septum and habenula. When used a seed region, metabolic activity in the habenula correlated with activity in the lateral septum, hypothalamus, medial thalamus, mammillary nuclei, ventral tegmental area, central gray, interpeduncular nuclei, periaqueductal gray, dorsal raphe, and rostromedial tegmental nucleus, caudal linear raphe, and subiculum transition area. Furthermore, the lateral septum correlated with metabolic activity in the preoptic area, medial thalamus, habenula, interpeduncular nuclei, periaqueductal gray, dorsal raphe, and caudal linear raphe. Together, our data suggest a group of brain regions involved in sensitivity to uncontrollable stress involving the lateral septum and habenula. PMID:24550809

Does Tramadol Have a Role in Pain Control in Palliative Care?

PubMed

Gonçalves, José António Ferraz; Silva, Paula; Araújo, Patrícia

2015-09-01

The effectiveness of the step II of the World Health Organization analgesic ladder including tramadol has been questioned recently. Retrospective study of patients treated with tramadol admitted as inpatients to one palliative care unit between November 1, 2009, and October 30, 2012. In the study period, 730 patients were admitted and 66 (9%) of them met the criteria for inclusion; 45 (68%) continued medication with tramadol until discharge from the unit, while 21 (32%) had to switch to an opioid for moderate to severe pain. The reason for switching was uncontrolled pain in 16 (76%) patients, and for 5 (24%) patients, the switch was made for other reasons. The data suggest that tramadol may have a role to play in the treatment of pain in palliative care. © The Author(s) 2014.

Urban adolescent stress and hopelessness.

PubMed

Landis, Dana; Gaylord-Harden, Noni K; Malinowski, Sara L; Grant, Kathryn E; Carleton, Russell A; Ford, Rebecca E

2007-12-01

This study sought to explore potential mechanisms through which uncontrollable, chronic stressors may lead to hopelessness in low-income, urban adolescents. In particular, the roles of specific coping strategies as moderators and/or mediators of the association between stressors and hopelessness were examined. Results suggest that chronic, uncontrollable stressors were significantly and positively related to hopelessness in this sample. Active coping, distraction coping, and social-support-seeking coping emerged as moderators for males, such that uncontrollable stressors were more highly associated with hopelessness for those boys who reported using more active, distraction, and social-support-seeking coping strategies. An analogous moderating effect was found for ruminative coping for girls. Ruminative coping also emerged as a mediator of the relation between uncontrollable stressors and hopelessness for girls.

Eslicarbazepine acetate as adjunctive therapy in patients with uncontrolled partial-onset seizures: Results of a phase III, double-blind, randomized, placebo-controlled trial

PubMed Central

Sperling, Michael R; Abou-Khalil, Bassel; Harvey, Jay; Rogin, Joanne B; Biraben, Arnaud; Galimberti, Carlo A; Kowacs, Pedro A; Hong, Seung Bong; Cheng, Hailong; Blum, David; Nunes, Teresa; Soares-da-Silva, Patrício

2015-01-01

Objective To evaluate the efficacy and safety of adjunctive eslicarbazepine acetate (ESL) in patients with refractory partial-onset seizures. Methods This randomized, placebo-controlled, double-blind, parallel-group, phase III study was conducted at 173 centers in 19 countries, including the United States and Canada. Eligible patients were aged ≥16 years and had uncontrolled partial-onset seizures despite treatment with 1–2 antiepileptic drugs (AEDs). After an 8-week baseline period, patients were randomized to once-daily placebo (n = 226), ESL 800 mg (n = 216), or ESL 1,200 mg (n = 211). Following a 2-week titration period, patients received ESL 800 or 1,200 mg once-daily for 12 weeks. Seizure data were captured and documented using event-entry or daily entry diaries. Results Standardized seizure frequency (SSF) during the maintenance period (primary end point) was reduced with ESL 1,200 mg (p = 0.004), and there was a trend toward improvement with ESL 800 mg (p = 0.06), compared with placebo. When data for titration and maintenance periods were combined, ESL 800 mg (p = 0.001) and 1,200 mg (p < 0.001) both reduced SSF. There were no statistically significant interactions between treatment response and geographical region (p = 0.38) or diary version (p = 0.76). Responder rate (≥50% reduction in SSF) was significantly higher with ESL 1,200 mg (42.6%, p < 0.001) but not ESL 800 mg (30.5%, p = 0.07) than placebo (23.1%). Incidence of treatment-emergent adverse events (TEAEs) and TEAEs leading to discontinuation increased with ESL dose. The most common TEAEs were dizziness, somnolence, nausea, headache, and diplopia. Significance Adjunctive ESL 1,200 mg once-daily was more efficacious than placebo in adult patients with refractory partial-onset seizures. The once-daily 800 mg dose showed a marginal effect on SSF, but did not reach statistical significance. Both doses were well tolerated. Efficacy assessment was not affected by diary format used. PMID:25528898

Assessment of the Electrification of the Road Transport Sector on Net System Emissions

NASA Astrophysics Data System (ADS)

Miller, James

As worldwide environmental consciousness grows, electric vehicles (EVs) are becoming more common and despite the incredible potential for emissions reduction, the net emissions of the power system supply side plus the transportation system are dependent on the generation matrix. Current EV charging patterns tend to correspond directly with the peak consumption hours and have the potential to increase demand sharply allowing for only a small penetration of Electric Vehicles. Using the National Household Travel Survey (NHTS) data a model is created for vehicle travel patterns using trip chaining. Charging schemes are modeled to include uncontrolled residential, uncontrolled residential/industrial charging, optimized charging and optimized charging with vehicle to grid discharging. A charging profile is then determined based upon the assumption that electric vehicles would directly replace a percentage of standard petroleum-fueled vehicles in a known system. Using the generation profile for the specified region, a unit commitment model is created to establish not only the generation dispatch, but also the net CO2 profile for variable EV penetrations and charging profiles. This model is then used to assess the impact of the electrification of the road transport sector on the system net emissions.

Solar energy system performance evaluation: Seasonal report for Colt Yosemite, Yosemite National Park, California

NASA Technical Reports Server (NTRS)

1980-01-01

The system's operational performance from May 1979 through April 1980 is described. Solar energy satisfied 23 percent of the total performance load, which was significantly below the design value of 56 percent. A fossil savings of 80.89 million Btu's or 578 gallons of fuel oil is estimated. If uncontrolled losses could have been reduced to an inconsequential level, the system's efficiency would have been improved considerably.

Cardiorespiratory response to exercise after renal sympathetic denervation in patients with resistant hypertension.

PubMed

Ukena, Christian; Mahfoud, Felix; Kindermann, Ingrid; Barth, Christine; Lenski, Matthias; Kindermann, Michael; Brandt, Mathias C; Hoppe, Uta C; Krum, Henry; Esler, Murray; Sobotka, Paul A; Böhm, Michael

2011-09-06

This study sought to investigate the effects of interventional renal sympathetic denervation (RD) on cardiorespiratory response to exercise. RD reduces blood pressure at rest in patients with resistant hypertension. We enrolled 46 patients with therapy-resistant hypertension as extended investigation of the Symplicity HTN-2 (Renal Denervation With Uncontrolled Hypertension) trial. Thirty-seven patients underwent bilateral RD and 9 patients were assigned to the control group. Cardiopulmonary exercise tests were performed at baseline and 3-month follow-up. In the RD group, compared with baseline examination, blood pressure at rest and at maximum exercise after 3 months was significantly reduced by 31 ± 13/9 ± 13 mm Hg (p < 0.0001) and by 21 ± 20/5 ± 14 mm Hg (p < 0.0001), respectively. Achieved work rate increased by 5 ± 13 W (p = 0.029) whereas peak oxygen uptake remained unchanged. Blood pressure 2 min after exercise was significantly reduced by 29 ± 17/8 ± 15 mm Hg (p < 0.001 for systolic blood pressure; p = 0.002 for diastolic blood pressure). Heart rate at rest decreased after RD (4 ± 11 beats/min; p = 0.028), whereas maximum heart rate and heart rate increase during exercise were not different. Heart rate recovery improved significantly by 4 ± 7 beats/min after renal denervation (p = 0.009). In the control group, there were no significant changes in blood pressure, heart rate, maximum work rate, or ventilatory parameters after 3 months. RD reduces blood pressure during exercise without compromising chronotropic competence in patients with resistant hypertension. Heart rate at rest decreased and heart rate recovery improved after the procedure. (Renal Denervation With Uncontrolled Hypertension; [Symplicity HTN-2]; NCT00888433). Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Determinants of Uncontrolled Hypertension in Rural Communities in South Asia - Bangladesh, Pakistan, and Sri Lanka.

PubMed

Jafar, Tazeen H; Gandhi, Mihir; Jehan, Imtiaz; Naheed, Aliya; de Silva, H Asita; Shahab, Hunaina; Alam, Dewan; Luke, Nathasha; Lim, Ching Wee

2018-04-26

Uncontrolled blood pressure (BP) is a leading risk factor for death and disability in South Asia. We aimed to determine the cross-country variation, and the factors associated with uncontrolled BP among adults treated for hypertension in rural South Asia. We enrolled 1718 individuals aged ≥40 years treated for hypertension in a cross-sectional study from rural communities in Bangladesh, Pakistan, and Sri Lanka. Multivariable logistic regression model was used to determine the factors associated with uncontrolled BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg). Among hypertensive individuals, 58.0% (95% confidence interval 55.7, 60.4) had uncontrolled BP: 52.8% (49.0, 56.6) in Bangladesh, 70.6% (65.7, 75.1) in Pakistan, and 56.5% (52.7, 60.1) in Sri Lanka. The odds (odds ratio (95% confidence interval)) of uncontrolled BP were significantly higher in individuals with lower wealth index (1.17 (1.02, 1.35)); single vs married (1.46 (1.10, 1.93)); higher log urine albumin-to-creatinine ratio (1.41 (1.24, 1.60)); lower estimated glomerular filtration rate (1.23 (1.01, 1.49)); low vs high adherence to antihypertensive medication (1.50 (1.16, 1.94)); and Pakistan (2.91 (1.60, 5.28)) vs Sri Lanka. However, the odds were lower in those with vs without self-reported kidney disease (0.51 (0.28, 0.91)); and receiving vs not receiving statins (0.62 (0.44, 0.87)). The majority of individuals with treated hypertension have uncontrolled BP in rural Bangladesh, Pakistan, and Sri Lanka with significant disparities among and within countries. Urgent public health efforts are needed to improve access and adherence to antihypertensive medications in disadvantaged populations in rural South Asia.

Reasons for uncontrolled seizures in adults; the impact of pseudointractability.

PubMed

Asadi-Pooya, Ali A; Emami, Mehrdad; Ashjazadeh, Nahid; Nikseresht, Alireza; Shariat, Abdolhamid; Petramfar, Peyman; Yousefipour, Gholamali; Borhani-Haghighi, Afshin; Izadi, Sadegh; Rahimi-Jaberi, Abbas

2013-05-01

We investigated the various possible reasons for uncontrolled seizures in patients 18 years of age and older to determine the impact of pseudointractability. We also tried to investigate the various forms of pseudointractability. In this cross-sectional study, all patients 18 years of age and older with their first seizure occurring at least six months prior to the referral date, taking at least one antiepileptic drug (AED) and having at least one seizure in the past three months were studied. The presumed reason for uncontrolled seizures was arbitrarily considered to be one of these five categories: Poor compliance; Wrong medication (misclassification); Wrong dose of the correct medication; Diagnosis other than epilepsy; and finally, Medically-refractory epilepsy. Statistical analyses were performed using Chi-square and Fisher's exact tests, and a P value less than 0.05 was considered significant. 350 patients were referred to us due to uncontrolled seizures. One hundred ninety-one (55%) were male and 159 (45%) were female. Twelve percent of the patients had diagnoses other than epilepsy, 40% had indeed medically-refractory epilepsy; 29% were taking the wrong AEDs (misclassified epilepsy); 18% were taking suboptimal doses of AEDs; and 1% had poor drug compliance. The most common reason for uncontrolled seizures among patients with idiopathic generalized epilepsy was taking the wrong AED. However, among patients with focal epilepsy, true medically-refractory epilepsy was the most common reason. Uncontrolled seizures are a commonly encountered problem, especially at epilepsy clinics and one should consider all possible reasons for these uncontrolled seizures. The mainstay for making a correct diagnosis is a detailed clinical history. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Glycated hemoglobin correlates with arterial stiffness and endothelial dysfunction in patients with resistant hypertension and uncontrolled diabetes mellitus.

PubMed

Moreno, Beatriz; de Faria, Ana Paula; Ritter, Alessandra Mileni Versuti; Yugar, Lara Buonalumi Tacito; Ferreira-Melo, Silvia Elaine; Amorim, Rivadavio; Modolo, Rodrigo; Fattori, André; Yugar-Toledo, Juan Carlos; Coca, Antonio; Moreno, Heitor

2018-05-01

This study aimed to evaluate the effects of glycated hemoglobin (HbA 1c ) on flow-mediated dilation, intima-media thickness, pulse wave velocity, and left ventricular mass index in patients with resistant hypertension (RHTN) comparing RHTN-controlled diabetes mellitus and RHTN-uncontrolled type 2 diabetes mellitus. Two groups were formed: HbA 1c <7.0% (RHTN-controlled diabetes mellitus: n = 98) and HbA 1c ≥7.0% (RHTN-uncontrolled diabetes mellitus: n = 122). Intima-media thickness and flow-mediated dilation were measured by high-resolution ultrasound, left ventricular mass index by echocardiography, and arterial stiffness by carotid-femoral pulse wave velocity. No differences in blood pressure levels were found between the groups but body mass index was higher in patients with RHTN-uncontrolled diabetes mellitus. Endothelial dysfunction and arterial stiffness were worse in patients with RHTN-uncontrolled diabetes mellitus. Intima-media thickness and left ventricular mass index measurements were similar between the groups. After adjustments, multiple linear regression analyses showed that HbA 1c was an independent predictor of flow-mediated dilation and pulse wave velocity in all patients with RHTN. In conclusion, HbA 1c may predict the grade of arterial stiffness and endothelial dysfunction in patients with RHTN, and superimposed uncontrolled diabetes mellitus implicates further impairment of vascular function. ©2018 Wiley Periodicals, Inc.

Prevalence of pseudoresistant hypertension due to inaccurate blood pressure measurement

PubMed Central

Bhatt, Hemal; Siddiqui, Mohammed; Judd, Eric; Oparil, Suzanne; Calhoun, David

2016-01-01

Background The prevalence of pseudoresistant hypertension (HTN) due to inaccurate BP measurement remains unknown. Methods Triage BP measurements and measurements obtained at the same clinic visit by trained physicians were compared in consecutive adult patients referred for uncontrolled resistant HTN (RHTN). Triage BP measurements were taken by the clinic staff during normal intake procedures. BP measurements were obtained by trained physicians using the BpTRU device. The prevalence of uncontrolled RHTN and differences in BP measurements were compared. Results Of 130 patients with uncontrolled RHTN, 33.1% (n=43) were falsely identified as having uncontrolled RHTN based on triage BP measurements. The median (IQR) of differences in systolic BP between pseudoresistant and true resistant groups were 23 (17 – 33) mm Hg and 13 (6 – 21) mm Hg, respectively (P=0.0001). The median (IQR) of differences in diastolic BP between the two groups were 12 (7 – 18) mm Hg and 8 (4 – 11) mm Hg, respectively (P=0.001). Conclusion Triage BP technique overestimated the prevalence of uncontrolled RHTN in approximately 33% of the patients emphasizing the importance of obtaining accurate BP measurements. PMID:27129931

Adapting a 1% or less milk campaign for a Hispanic/Latino population: the Adelante Con Leche Semi-descremada 1% experience.

PubMed

Hinkle, Arnell J; Mistry, Ritesh; McCarthy, William J; Yancey, Antronette K

2008-01-01

Describe and evaluate a media campaign to encourage 1% or nonfat milk consumption. Uncontrolled pre/post test. One largely rural (Santa Paula) and one urban (East Los Angeles) California community. Community residents and milk vendors in primarily low-income Latino/Hispanic communities. The "1% or Less" milk campaign, which promotes substitution of 2% fat or whole milk with 1% or less fat milk was adapted and implemented. Comparison of post-campaign milk sales with pre-campaign sales. Chi-square tests of independence used to compare precampaign and postcampaign sales. There were decreases in the proportion of whole milk sold and increases in the proportion of reduced-fat, low-fat, and nonfat milk sold in the weeks following each campaign (Santa Paula: p = .0165; East Los Angeles: p < .0001). However, follow-up data from East Los Angeles suggest that these changes were not sustained. The proportions of the different units of milk sold also changed in the weeks following each campaign (p < .0001). Sales of whole milk gallon units decreased from 36.3% to 28.4% in Santa Paula, and from 43.5% to 10.2% in East Los Angeles. Highly focused campaigns to promote substitution of high-fat milk with low-fat or nonfat milk can show dramatic initial changes in sales patterns. However, whether such campaigns can have a sustained impact in largely Latino/Hispanic communities is not evident.

The Role of Neuropeptide Y (NPY) in Uncontrolled Alcohol Drinking and Relapse Behavior Resulting from Exposure to Stressful Events

DTIC Science & Technology

2011-01-01

effects of stressors on excessive and uncontrolled drinking and relapse-like drinking. We proposed to use foot-shock as the stressor to elicit increase...did significantly increase deprivation-induced relapse-like drinking, and that this effect was more robust in mutant mice lacking the NPY Y1R. Thus...ethanol consumption using a models of excessive uncontrolled drinking, and mutant mice lacking NPY or the Y1R were more sensitive to the effects of

Attitude control concepts for precision-pointing nonrigid spacecraft

NASA Technical Reports Server (NTRS)

Likins, P. W.

1974-01-01

Literal criteria are developed for the controllability and observability of general models of flexible spacecraft. Results are interpreted in special cases and in physical terms, permitting in some cases the identification of uncontrollable and unobservable states simply by examination of scalars composed of modal parameters and location matrices for sensors and actuators. A procedure is established for isolation of uncontrollable states, whereby sensor and actuator configurations assure that uncontrollable flexible mode states are also unobservable; in many applications such states can then be removed by coordinate truncation.

Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization.

PubMed

Manjunath, Ranjani; Paradis, Pierre Emmanuel; Parisé, Hélène; Lafeuille, Marie-Hélène; Bowers, Brian; Duh, Mei Sheng; Lefebvre, Patrick; Faught, Edward

2012-10-30

To quantify the clinical and economic burden of uncontrolled epilepsy in patients requiring emergency department (ED) visit or hospitalization. Health insurance claims from a 5-state Medicaid database (1997Q1-2009Q2) and 55 self-insured US companies ("employer," 1999Q1 and 2008Q4) were analyzed. Adult patients with epilepsy receiving antiepileptic drugs (AED) were selected. Using a retrospective matched-cohort design, patients were categorized into cohorts of "uncontrolled" (≥ 2 changes in AED therapy, then ≥ 1 epilepsy-related ED visit/hospitalization within 1 year) and "well-controlled" (no AED change, no epilepsy-related ED visit/hospitalization) epilepsy. Matched cohorts were compared for health care resource utilization and costs using multivariate conditional regression models and nonparametric methods. From 110,312 (Medicaid) and 36,529 (employer) eligible patients, 3,454 and 602 with uncontrolled epilepsy were matched 1:1 to patients with well-controlled epilepsy, respectively. In both populations, uncontrolled epilepsy cohorts presented about 2 times more fractures and head injuries (all p values < 0.0001) and higher health care resource utilization (ranges of adjusted incidence rate ratios [IRRs] [all-cause utilization]: AEDs = 1.8-1.9, non-AEDs = 1.3-1.5, hospitalizations = 5.4-6.7, length of hospital stays = 7.3-7.7, ED visits = 3.7-5.0, outpatient visits = 1.4-1.7, neurologist visits = 2.3-3.1; all p values < 0.0001) than well-controlled groups. Total direct health care costs were higher in patients with uncontrolled epilepsy (adjusted cost difference [95% confidence interval (CI)] Medicaid = $12,258 [$10,482-$14,083]; employer = $14,582 [$12,019-$17,097]) vs well-controlled patients. Privately insured employees with uncontrolled epilepsy lost 2.5 times more work days, with associated indirect costs of $2,857 (95% CI $1,042-$4,581). Uncontrolled epilepsy in patients requiring ED visit or hospitalization was associated with significantly greater health care resource utilization and increased direct and indirect costs compared to well-controlled epilepsy in both publicly and privately insured settings.

Uncontrolled burning of solid waste by households in Mexico is a significant contributor to climate change in the country.

PubMed

Reyna-Bensusan, Natalia; Wilson, David C; Smith, Stephen R

2018-05-01

Uncontrolled burning of municipal solid waste (MSW) is an important source of air pollution and is wide spread in many developing countries, but only limited data quantify the extent of domestic open burning of household waste. Here, we present some of the first field data to be reported on the uncontrolled domestic burning of waste. A representative community of Mexico (Huejutla de Reyes Municipality) was investigated and household surveys, interviews with waste operators and a waste characterisation analysis were completed to assess the extent of, and factors controlling, the open burning of waste. Waste collection provision to rural communities was very limited and, consequently 92% of households in rural areas reported that they disposed of waste by uncontrolled burning in backyards or unofficial dumps. Overall, 24% of the total MSW generated in the Municipality was disposed by uncontrolled burning. Urban and periurban areas received twice-weekly collections and the rate of uncontrolled burning was considerably smaller compared to rural households, corresponding to approximately 2% of total waste generation. Carbon equivalency calculations showed that burning waste in backyards represented approximately 6% of the total and 8.5% of fuel related CO 2 Eq emissions by the municipality. Moreover, the equivalent carbon dioxide (CO 2 Eq) from black carbon (BC) emitted by uncontrolled burning in backyards was over fifteen times larger compared to methane (CH 4 ) potentially released from equivalent amounts of combustible biodegradable waste disposal at the official dumpsite. An assessment of local respiratory health data showed the incidence of disease was higher in rural than in urban areas, when the opposite trend is typically observed in the international literature; given the high rate of burning activity found in rural areas we suggest that open burning of waste could be a major reason for the apparent poorer respiratory health status of the rural population and requires further investigation. The results emphasise the importance of including BC from uncontrolled burning of waste in international emission inventories of greenhouse gases and in the assessment of the health status of local communities in developing countries where this practice is prevalent. Copyright © 2018 Elsevier Inc. All rights reserved.

Liquid radwaste in-leakage reduction at TVA's Browns Ferry nuclear plant

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

Smith, A.C.; Roccasano, J.J.

1987-01-01

Early in 1985, Tennessee Valley Authority's (TVA's) Browns Ferry Nuclear Plant (BFNP) decided to initiate a liquid radwaste in-leakage reduction project as part of their chemistry improvement program. The purpose of this project was to reduce the overall volume of water processed by the radwaste system at BFNP by restricting uncontrolled in-leakage through the floor drain system. Impell Corporation was contracted to perform the project, which consisted of several tasks, each design to provide data for the reduction of in-leakage or to reduce the in-leakage directly. The program was begun in March 1985. Buy July of that same year, liquidmore » input to radwaste through the floor drain system had been reduced by --30%.« less

Drag reduction and thrust generation by tangential surface motion in flow past a cylinder

NASA Astrophysics Data System (ADS)

Mao, Xuerui; Pearson, Emily

2018-03-01

Sensitivity of drag to tangential surface motion is calculated in flow past a circular cylinder in both two- and three-dimensional conditions at Reynolds number Re ≤ 1000 . The magnitude of the sensitivity maximises in the region slightly upstream of the separation points where the contour lines of spanwise vorticity are normal to the cylinder surface. A control to reduce drag can be obtained by (negatively) scaling the sensitivity. The high correlation of sensitivities of controlled and uncontrolled flow indicates that the scaled sensitivity is a good approximation of the nonlinear optimal control. It is validated through direct numerical simulations that the linear range of the steady control is much higher than the unsteady control, which synchronises the vortex shedding and induces lock-in effects. The steady control injects angular momentum into the separating boundary layer, stabilises the flow and increases the base pressure significantly. At Re=100 , when the maximum tangential motion reaches 50% of the free-stream velocity, the vortex shedding, boundary-layer separation and recirculation bubbles are eliminated and 32% of the drag is reduced. When the maximum tangential motion reaches 2.5 times of the free-stream velocity, thrust is generated and the power savings ratio, defined as the ratio of the reduced drag power to the control input power, reaches 19.6. The mechanism of drag reduction is attributed to the change of the radial gradient of spanwise vorticity (partial r \\hat{ζ } ) and the subsequent accelerated pressure recovery from the uncontrolled separation points to the rear stagnation point.

How We Identify and Manage Patients with Inadequately Controlled Polycythemia Vera.

PubMed

Reiter, Andreas; Harrison, Claire

2016-10-01

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm (MPN) characterized by an overactive Janus kinase/signal transducer and activator of transcription (JAK/STAT) pathway through mutations in JAK2 exons 12 or 14 (JAK2 V617F). The dominant clinical characteristics include erythrocytosis (with or without leukocytosis/thrombocytosis), thrombotic events, and symptoms. Increased risk of mortality is mainly caused by thrombotic events and progression to post-polycythemia vera myelofibrosis (PPV-MF) or secondary acute myeloid leukemia (sAML). The most important prognostic factors include age and a history of thrombotic events, although recent evidence has indicated that leukocytosis and additional cytogenetic aberrations may also be of significant prognostic value. First-line therapies include aspirin and phlebotomies, which significantly reduce the incidence of thrombotic events and prolong survival. Cytoreductive treatment with hydroxyurea (approved) and conventional or pegylated interferon-α (effective, but not approved in many countries) is initiated for high-risk or inadequately controlled disease, e.g., uncontrolled hematocrit, leukocytosis, thrombocytosis, thrombotic events, splenomegaly, or symptoms. However, some patients may not receive initial benefit from first-line therapy or may become resistant or intolerant in due course. Although second-line treatment options are limited, clinical trials have shown the efficacy of ruxolitinib toward improving blood counts, enlarged spleen, and symptoms and potentially reducing thrombotic events. Identification of patients with uncontrolled PV is important for clinical care, as such patients have a high risk of complications, and future studies with JAK inhibitors or other agents alone or in combination are needed to test their potential to reduce rates of thrombotic events and transformation to PPV-MF or sAML.

Pilot preference and procedures at uncontrolled airports

NASA Technical Reports Server (NTRS)

Parker, L. C.

1975-01-01

The report presents the results of a pilot questionnaire utilized at the 1974 Reading, Pennsylvania Air Show to obtain data on pilot procedures and preference in the terminal airspace of uncontrolled airports.

Long-term effects of controllability or the lack of it on coping abilities and stress resilience in the rat.

PubMed

Lucas, Morgan; Ilin, Yana; Anunu, Rachel; Kehat, Orli; Xu, Lin; Desmedt, Aline; Richter-Levin, Gal

2014-09-01

Findings suggest that stress-induced impaired learning and coping abilities may be attributed more to the psychological nature of the stressor, rather than its physical properties. It has been proposed that establishing controllability over stressors can ameliorate some of its effects on cognition and behavior. Gaining controllability was suggested to be associated with the development of stress resilience. Based on repeated exposure to the two-way shuttle avoidance task, we previously developed and validated a behavioral task that leads to a strict dissociation between gaining controllability (to the level that the associated fear is significantly reduced) and a fearful state of uncontrollability. Employing this protocol, we investigated here the impact of gaining or failing to gain emotional controllability on indices of anxiety and depression and on subsequent abilities to cope with positively or negatively reinforcing learning experiences. In agreement with previous studies, rats exposed to the uncontrollable protocol demonstrated high concentration of sera corticosterone, increased immobility, reduced duration of struggling in the forced swim test and impaired ability to acquire subsequent learning tasks. Achieving emotional controllability resulted in resilience to stress as was indicated by longer duration of struggling in the forced swim test, and enhanced learning abilities. Our prolonged training protocol, with the demonstrated ability of rats to gain emotional controllability, is proposed as a useful tool to study the neurobiological mechanisms of stress resilience.

Landscape change in the Southern Piedmont: Challenges, solutions and uncertainty across scales

USGS Publications Warehouse

Conroy, M.J.; Allen, Craig R.; Peterson, J.T.; Pritchard, L.; Moore, C.T.

2003-01-01

The southern Piedmont of the southeastern United States epitomizes the complex and seemingly intractable problems and hard decisions that result from uncontrolled urban and suburban sprawl. Here we consider three recurrent themes in complicated problems involving complex systems: (1) scale dependencies and cross-scale, often nonlinear relationships; (2) resilience, in particular the potential for complex systems to move to alternate stable states with decreased ecological and/or economic value; and (3) uncertainty in the ability to understand and predict outcomes, perhaps particularly those that occur as a result of human impacts. We consider these issues in the context of landscape-level decision making, using as an example water resources and lotic systems in the Piedmont region of the southeastern United States. Copyright ?? 2003 by the author(s). Published here under licence by The Resilience Alliance.

Properties influencing fat, oil, and grease deposit formation.

PubMed

Keener, Kevin M; Ducoste, Joel J; Holt, Leon M

2008-12-01

Fat, oil, and grease (FOG) deposits are the reported cause of 50 to 75% of sanitary sewer overflows in the United States, resulting in 1.8 X 10(6) m3 (500 mil. gal) of raw wastewater released into the environment annually. The objective of this research was to characterize the chemical and physical properties of FOG deposits. Twenty-three cities from around the United States contributed FOG samples for the study. The FOG deposits showed a wide range in yield strength (4 to 34 kPa), porosity (10 to 24%), and moisture content (10 to 60%), suggesting uncontrolled formation processes. A majority of these deposits display hard, sandstonelike texture, with distinct layering effects, suggesting a discontinuous formation process. The results found that 84% of FOG deposits contained high concentrations of saturated fatty acids and calcium, suggesting preferential accumulation.

Bedtime administration of cilnidipine controls morning hypertension.

PubMed

Ashizawa, Naoto; Seto, Shinji; Shibata, Yoshisada; Yano, Katsusuke

2007-09-01

Morning blood pressure (BP) level plays an important role in the incidence of cardiovascular disease. Recently, Kario, et al proposed the usefulness of ME difference (morning minus evening systolic BP) and ME average (average of morning and evening systolic BP) for the evaluation of antihypertensive treatment. Cilnidipine is a novel calcium channel blocker (CCB) that exerts inhibitory actions not only on L-type but also on N-type calcium channels. We investigated the effect of bedtime administration of cilnidipine (10 mg) in addition to the antihypertensive treatment for uncontrolled morning hypertension. Twenty-three hypertensive outpatients (13 males and 10 females; mean age, 66.9 years) with stable antihypertensive medication and uncontrolled morning BP were studied using self-measured BP monitoring in the morning and evening. Morning SBP (P < 0.001) and DBP (P < 0.001) decreased significantly from 150.2 +/- 8.7 and 87.8 +/- 9.3 to 132.7 +/- 7.4 and 77.5 +/- 8.5 mmHg, respectively, after the addition of cilnidipine. Morning heart rate did not change (63.3 +/- 7.0 to 64.1 +/- 9.4). The evening SBP, but not DBP, decreased significantly after treatment. Both the ME average (P < 0.001) and ME difference (P < 0.01) significantly decreased from 143.0 +/- 9.2 and 14.3 +/- 12.4 to 131.3 +/- 7.2 and 2.8 +/- 9.2 mmHg after treatment, respectively. The microalbuminuria decreased from 39.6 +/- 13.2 to 27.3 +/- 8.4 mg/g Cr. In conclusion, L-/N-type CCB cilnidipine may be useful for patients with uncontrollable morning hypertension by reducing both ME average and ME difference.

Effects of Vildagliptin Add-on Insulin Therapy on Nocturnal Glycemic Variations in Uncontrolled Type 2 Diabetes.

PubMed

Li, Feng-Fei; Shen, Yun; Sun, Rui; Zhang, Dan-Feng; Jin, Xing; Zhai, Xiao-Fang; Chen, Mao-Yuan; Su, Xiao-Fei; Wu, Jin-Dan; Ye, Lei; Ma, Jian-Hua

2017-10-01

To investigate whether vildagliptin add-on insulin therapy improves glycemic variations in patients with uncontrolled type 2 diabetes (T2D) compared to patients with placebo therapy. This was a 24-week, single-center, double-blind, placebo-controlled trial. Inadequately controlled T2D patients treated with insulin therapy were recruited between June 2012 and April 2013. The trial included a 2-week screening period and a 24-week randomized period. Subjects were randomly assigned to a vildagliptin add-on insulin therapy group (n = 17) or a matched placebo group (n = 16). Scheduled visits occurred at weeks 4, 8, 12, 16, 20, and 24. Continuous glucose monitoring (CGM) was performed before and at the endpoint of the study. A total of 33 subjects were admitted, with 1 patient withdrawing from the placebo group. After 24 weeks of therapy, HbA1c values were significantly reduced at the endpoint in the vildagliptin add-on group. CGM data showed that patients with vildagliptin add-on therapy had a significantly lower 24-h mean glucose concentration and mean amplitude of glycemic excursion (MAGE). At the endpoint of the study, patients in the vildagliptin add-on group had a significantly lower MAGE and standard deviation compared to the control patients during the nocturnal period (0000-0600). A severe hypoglycemic episode was not observed in either group. Vildagliptin add-on therapy to insulin has the ability to improve glycemic variations, especially during the nocturnal time period, in patients with uncontrolled T2D.

Practice Level Costs of Office-Based Hypertension Performance Improvement: The Heart Healthy Lenoir Study.

PubMed

Primary care practice leaders who consider engaging in quality improvement (QI) need to understand the practice level costs incurred when asking staff to take on new tasks. The Heart Healthy Lenoir study is a prospective cohort trial in which QI methods were used to enhance hypertension (HTN) care and reduce racial disparities in blood pressure control in small rural primary care practices in North Carolina. As part of this effort, we performed an activity-based costing analysis to describe the costs incurred to develop, implement, and maintain key tasks.We interviewed 20 practice stakeholders and phone-based health coaches during 2012-2014. We calculated the time invested by individuals to perform each task within each study phase and applied national hourly wages to generate cost estimates. Our descriptive analyses focus on four of the most widely used practices. Activities included time to abstract HTN control data, participate in project meetings, identify patients with uncontrolled HTN, create standardized work, and provide additional health coaching for patients with uncontrolled HTN. Despite practice and staffing differences, the developmental phase costs were similar, ranging from $879 to $1,417. Implementation costs varied more widely as practices took different approaches to identifying patients with uncontrolled HTN. Practice-specific phone health coaching costs ranged from $19,508 to more than $38,000. This study adds to the growing literature regarding practice level costs of engaging in systems change. Understanding these costs and balancing them against practice incentives may be helpful as stakeholders make decisions regarding HTN QI.

Helplessness and perceived pain intensity: relations to cortisol concentrations after electrocutaneous stimulation in healthy young men

PubMed Central

2011-01-01

Background Uncontrollable aversive events are associated with feelings of helplessness and cortisol elevation and are suitable as a model of depression. The high comorbidity of depression and pain symptoms and the importance of controllability in both conditions are clinically well-known but empirical studies are scarce. The study investigated the relationship of pain experience, helplessness, and cortisol secretion after controllable vs. uncontrollable electric skin stimulation in healthy male individuals. Methods Sixty-four male volunteers were randomly assigned to receive 30 controllable (self-administered) or uncontrollable (experimenter-administered) painful electric skin stimuli. Perceived pain intensity (PPI), subjective helplessness ratings, and salivary cortisol concentrations were assessed. PPI was assessed after stress exposure. For salivary cortisol concentrations and subjective helplessness ratings, areas under the response curve (AUC) were calculated. Results After uncontrollable vs. controllable stress exposure significantly higher PPI ratings (P = 0.023), higher subjective helplessness AUC (P < 0.0005) and higher salivary cortisol AUC (P = 0.004, t-tests) were found. Correlation analyses revealed a significant correlation between subjective helplessness AUC and PPI (r = 0.500, P < 0.0005), subjective helplessness AUC and salivary cortisol AUC (r = 0.304, P = 0.015) and between PPI and salivary cortisol AUC (r = 0.298, P = 0.017). Conclusions The results confirm the impact of uncontrollability on stress responses in humans; the relationship of PPI with subjective helplessness and salivary cortisol suggests a cognitive-affective sensitization of pain perception, particularly under uncontrollable conditions. PMID:21718526

[Perioperative and postoperative management of two patients with uncontrolled hyperthyroidism using short acting beta blocker, landiolol].

PubMed

Fujita, Yasuki; Shimizu, Tomoaki; Matsumoto, Atsuhiro; Aoki, Motoaki

2008-09-01

Thyroid storm, sudden onset of life-threatening manifestations of hyperthyroidism, often appears during and after surgery in patients with uncontrolled hyperthyroidism. We report perioperative and postoperative management of two such cases with uncontrolled hyperthyroidism. The first patient is a 41-year-old man with a past history of uncontrolled Graves disease, and was scheduled for emergency video-assisted thoracoscopic surgery for spontaneous pneumothorax. The second patient is a 25-year-old man with a past history of hypertension, and was scheduled for open reduction and internal fixation for mandibular fracture. In both patients, tachycardia and hypertension were observed at admission to the operating room. Therapy included the use of landiolol infusion, a short acting beta blocker, for control of tachycardia. Heart rate was controlled around 90 beats x min(-1) using landiolol during surgery. In each case, landiolol was administered until they can take long acting beta blocker and antithyroid drug orally. In the postoperative period, delirium appeared for a few hours in the first case, but no severe complications were observed in each case. Short acting beta blocker was useful for control of tachycardia in the perioperative and postoperative management of the patient with uncontrolled hyperthyroidism.

Mice subjected to uncontrollable electric shocks show depression-like behaviors irrespective of their state of helplessness.

PubMed

Kim, Jin Yong; Yang, Soo Hyun; Kwon, Jihyun; Lee, Hyun Woo; Kim, Hyun

2017-03-30

The unpredictable and inescapable electric shock-induced "learned helplessness" paradigm has long been used to produce an animal model of depression to identify the molecules associated with depressive symptoms or to assess the efficacy of pharmacological treatments for depression. After exposure to unpredictable and inescapable shocks (uncontrollable stress), most of mice showed defect in escape behavior in active avoidance test (learned helplessness, LH), while others did not (non-learned helplessness, NLH). Here, we investigated whether mice with LH or NLH exhibited depressive symptoms, including anhedonia, anxiety, and despair. We found that compared with control naïve mice, both uncontrollable shocks-induced LH and NLH mice showed increased anhedonia- and anxiety- but not despair-like behaviors. Notably, mice subjected to uncontrollable shocks showed similar behaviors, irrespective of whether they also showed LH or NLH. Furthermore, since both LH and NLH mice showed only anhedonia- and anxiety- but not despair-like behaviors, this model may be generally inadequate for classic depression-like behavior assessment. In conclusion, uncontrollable electric shock induces depression-like behavior, irrespective of the state of helplessness. Copyright © 2017 Elsevier B.V. All rights reserved.

Real-life efficacy and safety of omalizumab in Portuguese patients with persistent uncontrolled asthma.

PubMed

Pereira Barbosa, M; Bugalho de Almeida, A; Pereira, C; Chen, C-W; Georgiou, P; Peachey, G

2015-01-01

The real life effectiveness, safety and the use of omalizumab for Portuguese patients with uncontrolled persistent allergic asthma are not sufficiently well known. The objective of this report was to make an evaluation, in a post-marketing, non-interventional, observational registry, of the Portuguese population included in the eXpeRience study. The methods used in this report are the same as the global eXpeRience ones, applied to a Portuguese sub-population. Patients with uncontrolled allergic asthma who had started omalizumab within the previous 15 weeks were enrolled and received omalizumab add-on therapy for 24 months. The physicians' global evaluation of treatment effectiveness (GETE), asthma symptoms and control (ACT score), quality of life (mini-AQLQ score), exacerbations, and serious adverse events (SAE) were reported. Of the 943 patients recruited in the eXpeRience registry, 62 patients were from Portugal. 62.1% of them were observed to be responders with good/excellent GETE assessment at Week 16. Clinically meaningful improvements in asthma control (ACT score) and quality of life (mini-AQLQ score) were observed with omalizumab therapy at Months 12 (mean change: +7.7 [n=35]; +2.1 [n=20], respectively) and 24 (mean change: +7.0 [n=26]; +2.7 [n=13], respectively). Asthma symptoms and rescue medication usage were reduced to ≤1 day/week at Month 24 from a baseline of ≥3.5 days/week. The proportion of patients with no clinically significant exacerbations increased from 6.5% during pre-treatment (n=62) to 50% at Month 12 (n=54) and 60% at Month 24 (n=45). The findings from the Portugal subpopulation of eXpeRience registry confirm that omalizumab add-on therapy is efficacious and well tolerated in the management of uncontrolled persistent allergic asthma. Another pertinent issue is the fact that the Portuguese subpopulation response is similar to the international population average of the study. Copyright © 2014 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.

Attitude guidance and tracking for spacecraft with two reaction wheels

NASA Astrophysics Data System (ADS)

Biggs, James D.; Bai, Yuliang; Henninger, Helen

2018-04-01

This paper addresses the guidance and tracking problem for a rigid-spacecraft using two reaction wheels (RWs). The guidance problem is formulated as an optimal control problem on the special orthogonal group SO(3). The optimal motion is solved analytically as a function of time and is used to reduce the original guidance problem to one of computing the minimum of a nonlinear function. A tracking control using two RWs is developed that extends previous singular quaternion stabilisation controls to tracking controls on the rotation group. The controller is proved to locally asymptotically track the generated reference motions using Lyapunov's direct method. Simulations of a 3U CubeSat demonstrate that this tracking control is robust to initial rotation errors and angular velocity errors in the controlled axis. For initial angular velocity errors in the uncontrolled axis and under significant disturbances the control fails to track. However, the singular tracking control is combined with a nano-magnetic torquer which simply damps the angular velocity in the uncontrolled axis and is shown to provide a practical control method for tracking in the presence of disturbances and initial condition errors.

Illumination-invariant and deformation-tolerant inner knuckle print recognition using portable devices.

PubMed

Xu, Xuemiao; Jin, Qiang; Zhou, Le; Qin, Jing; Wong, Tien-Tsin; Han, Guoqiang

2015-02-12

We propose a novel biometric recognition method that identifies the inner knuckle print (IKP). It is robust enough to confront uncontrolled lighting conditions, pose variations and low imaging quality. Such robustness is crucial for its application on portable devices equipped with consumer-level cameras. We achieve this robustness by two means. First, we propose a novel feature extraction scheme that highlights the salient structure and suppresses incorrect and/or unwanted features. The extracted IKP features retain simple geometry and morphology and reduce the interference of illumination. Second, to counteract the deformation induced by different hand orientations, we propose a novel structure-context descriptor based on local statistics. To our best knowledge, we are the first to simultaneously consider the illumination invariance and deformation tolerance for appearance-based low-resolution hand biometrics. Settings in previous works are more restrictive. They made strong assumptions either about the illumination condition or the restrictive hand orientation. Extensive experiments demonstrate that our method outperforms the state-of-the-art methods in terms of recognition accuracy, especially under uncontrolled lighting conditions and the flexible hand orientation requirement.

Illumination-Invariant and Deformation-Tolerant Inner Knuckle Print Recognition Using Portable Devices

PubMed Central

Xu, Xuemiao; Jin, Qiang; Zhou, Le; Qin, Jing; Wong, Tien-Tsin; Han, Guoqiang

2015-01-01

We propose a novel biometric recognition method that identifies the inner knuckle print (IKP). It is robust enough to confront uncontrolled lighting conditions, pose variations and low imaging quality. Such robustness is crucial for its application on portable devices equipped with consumer-level cameras. We achieve this robustness by two means. First, we propose a novel feature extraction scheme that highlights the salient structure and suppresses incorrect and/or unwanted features. The extracted IKP features retain simple geometry and morphology and reduce the interference of illumination. Second, to counteract the deformation induced by different hand orientations, we propose a novel structure-context descriptor based on local statistics. To our best knowledge, we are the first to simultaneously consider the illumination invariance and deformation tolerance for appearance-based low-resolution hand biometrics. Settings in previous works are more restrictive. They made strong assumptions either about the illumination condition or the restrictive hand orientation. Extensive experiments demonstrate that our method outperforms the state-of-the-art methods in terms of recognition accuracy, especially under uncontrolled lighting conditions and the flexible hand orientation requirement. PMID:25686317

An hourly variation in zoo visitor interest: measurement and significance for animal welfare research.

PubMed

Davey, Gareth

2006-01-01

A methodological difficulty facing welfare research on nonhuman animals in the zoo is the large number of uncontrolled variables due to variation within and between study sites. Zoo visitors act as uncontrolled variables, with number, density, size, and behavior constantly changing. This is worrisome because previous research linked visitor variables to animal behavioral changes indicative of stress. There are implications for research design: Studies not accounting for visitors' effect on animal welfare risk confounding (visitor) variables distorting their findings. Zoos need methods to measure and minimize effects of visitor behavior and to ensure that there are no hidden variables in research models. This article identifies a previously unreported variable--hourly variation (decrease) in visitor interest--that may impinge on animal welfare and validates a methodology for measuring it. That visitor interest wanes across the course of the day has important implications for animal welfare management; visitor effects on animal welfare are likely to occur, or intensify, during the morning or in earlier visits when visitor interest is greatest. This article discusses this issue and possible solutions to reduce visitor effects on animal well-being.

Flies cope with uncontrollable stress by learned helplessness.

PubMed

Yang, Zhenghong; Bertolucci, Franco; Wolf, Reinhard; Heisenberg, Martin

2013-05-06

In a wide range of animals, uncontrollable stressful events can induce a condition called "learned helplessness." In mammals it is associated with low general activity, poor learning, disorders of sleep and feeding, ulcers, and reduced immune status, as well as with increased serotonin in parts of the brain. It is considered an animal model of depression in humans. Here we investigate learned helplessness in Drosophila, showing that this behavioral state consists of a cognitive and a modulatory, possibly mood-like, component. A fly, getting heated as soon as it stops walking, reliably resumes walking to escape the heat. If, in contrast, the fly is not in control of the heat, it learns that its behavior has no effect and quits responding. In this state, the fly walks slowly and takes longer and more frequent rests, as if it were "depressed." This downregulation of walking behavior is more pronounced in females than in males. Learned helplessness in Drosophila is an example of how, in a certain situation, behavior is organized according to its expected consequences. Copyright © 2013 Elsevier Ltd. All rights reserved.

DAN (NBL1) promotes collective neural crest migration by restraining uncontrolled invasion.

PubMed

McLennan, Rebecca; Bailey, Caleb M; Schumacher, Linus J; Teddy, Jessica M; Morrison, Jason A; Kasemeier-Kulesa, Jennifer C; Wolfe, Lauren A; Gogol, Madeline M; Baker, Ruth E; Maini, Philip K; Kulesa, Paul M

2017-10-02

Neural crest cells are both highly migratory and significant to vertebrate organogenesis. However, the signals that regulate neural crest cell migration remain unclear. In this study, we test the function of differential screening-selected gene aberrant in neuroblastoma (DAN), a bone morphogenetic protein (BMP) antagonist we detected by analysis of the chick cranial mesoderm. Our analysis shows that, before neural crest cell exit from the hindbrain, DAN is expressed in the mesoderm, and then it becomes absent along cell migratory pathways. Cranial neural crest and metastatic melanoma cells avoid DAN protein stripes in vitro. Addition of DAN reduces the speed of migrating cells in vivo and in vitro, respectively. In vivo loss of function of DAN results in enhanced neural crest cell migration by increasing speed and directionality. Computer model simulations support the hypothesis that DAN restrains cell migration by regulating cell speed. Collectively, our results identify DAN as a novel factor that inhibits uncontrolled neural crest and metastatic melanoma invasion and promotes collective migration in a manner consistent with the inhibition of BMP signaling. © 2017 McLennan et al.

DAN (NBL1) promotes collective neural crest migration by restraining uncontrolled invasion

PubMed Central

McLennan, Rebecca; Bailey, Caleb M.; Schumacher, Linus J.; Teddy, Jessica M.; Morrison, Jason A.; Kasemeier-Kulesa, Jennifer C.; Wolfe, Lauren A.; Gogol, Madeline M.; Baker, Ruth E.; Maini, Philip K.

2017-01-01

Neural crest cells are both highly migratory and significant to vertebrate organogenesis. However, the signals that regulate neural crest cell migration remain unclear. In this study, we test the function of differential screening-selected gene aberrant in neuroblastoma (DAN), a bone morphogenetic protein (BMP) antagonist we detected by analysis of the chick cranial mesoderm. Our analysis shows that, before neural crest cell exit from the hindbrain, DAN is expressed in the mesoderm, and then it becomes absent along cell migratory pathways. Cranial neural crest and metastatic melanoma cells avoid DAN protein stripes in vitro. Addition of DAN reduces the speed of migrating cells in vivo and in vitro, respectively. In vivo loss of function of DAN results in enhanced neural crest cell migration by increasing speed and directionality. Computer model simulations support the hypothesis that DAN restrains cell migration by regulating cell speed. Collectively, our results identify DAN as a novel factor that inhibits uncontrolled neural crest and metastatic melanoma invasion and promotes collective migration in a manner consistent with the inhibition of BMP signaling. PMID:28811280

Effect of 24-h continuous rotigotine treatment on stationary and non-stationary locomotion in de novo patients with Parkinson disease in an open-label uncontrolled study.

PubMed

Serrao, Mariano; Ranavolo, Alberto; Conte, Carmela; Davassi, Chiara; Mari, Silvia; Fasano, Alfonso; Chini, Giorgia; Coppola, Gianluca; Draicchio, Francesco; Pierelli, Francesco

2015-11-01

The aim of this study was to investigate the effect of a rotigotine transdermal patch on stationary and non-stationary locomotion in de novo Parkinson disease (PD) patients in an open-label uncontrolled study. A 3-D gait analysis system was used to investigate four different locomotor tasks: steady-state linear walking, gait initiation, gait termination and 180°-turning. A series of gait variables were measured for each locomotor task. PD patients who received rotigotine treatment (4-8 mg) displayed: (1) increased step length, gait speed, cadence and arm oscillations, and reduced double support duration and step asymmetry during steady-state linear gait; (2) increased initial step length during gait initiation; (3) increased final step length and gait speed, and decreased stability index during gait termination; (4) decreased duration of turning and head-pelvis delays during 180°-turning. The main finding that emerges from the present study is that the dopamine agonist rotigotine can improve various aspects of gait in de novo PD patients.

[Antihypertensive Efficacy of Fixed Combination Azilsartan Medoxomil / Chlorthalidone in Patients With Uncontrolled Arterial Hypertension].

PubMed

Kobalava, Z D; Villevalde, S V; Kulakov, V V

2017-11-01

To study effects of a fixed azilsartan medoxomil/chlorthalidone combination (Edarbi Clo) on clinical, ambulatory and central blood pressure (BP) in patients with uncontrolled arterial hypertension (AH)). Patients (n=25) with uncontrolled AH were given fixed azilsartan medoxomil/chlorthalidone combination (40 / 12.5 mg / day) for 4 weeks. After 4 weeks, in patients who did not achieve target BP levels the dose was increased up to 40 / 25 mg / day. Duration of the study was 12 weeks. After 12 weeks of treatment 88 % of patients achieved target clinical BP (.

The Three-Factor Eating Questionnaire, body mass index, and responses to sweet and salty fatty foods: a twin study of genetic and environmental associations.

PubMed

Keskitalo, Kaisu; Tuorila, Hely; Spector, Tim D; Cherkas, Lynn F; Knaapila, Antti; Kaprio, Jaakko; Silventoinen, Karri; Perola, Markus

2008-08-01

The relation between body weight and energy-dense foods remains unclear. We estimated the effects of genetic and environmental factors on cognitive and emotional aspects of dieting behavior, body mass index (BMI), and responses to fatty foods and on their relations. A total of 1326 adult twin persons (aged 17-82 y; 17% M and 83% F) from the United Kingdom and Finland completed the revised version of the Three-Factor Eating Questionnaire (TFEQ-R18) and reported the liking and use-frequency of 4 sweet-and-fatty and salty-and-fatty food items (6 items in the United Kingdom and 5 items in Finland). Genetic modeling was done by using linear structural equations. Heritability estimates were calculated separately for the countries and sexes; they were 26-63% for cognitive restraint, 45-69% for uncontrolled eating, and 9-45% for emotional eating, respectively. Of the variation in liking and use-frequency of fatty foods, 24-54% was attributed to interindividual genetic differences. No significant correlations were observed between BMI and fatty food use or liking. However, BMI was positively (mostly genetically) correlated (genetic r = 0.16-0.51) with all of the dieting behaviors, and they correlated with fatty food use and liking ratings. Uncontrolled eating was both genetically and environmentally associated with liking for salty-and-fatty foods (genetic and environmental r = 0.16), and emotional eating was genetically associated with liking for sweet-and-fatty foods (genetic r = 0.31). The relation between BMI and diet appears to be mediated through dieting behaviors. Dietary counseling should focus on unhealthy dieting behaviors rather than only on direct advice on food use.

Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia

PubMed Central

Tibebu, Abel; Mengistu, Daniel; Negesa, Lemma

2017-01-01

Introduction One of the most prevalent noncommunicable diseases is hypertension (HTN). The availability of effective antihypertensive medications does not result in the expected outcomes in terms of controlling blood pressure. The rationale for these and other findings of uncontrolled HTN points toward poor adherence. The most neglected causes of uncontrolled HTN are unhealthy lifestyles. Few studies have been conducted to show the gap and magnitude of self-management adherence. Objective This study aimed to assess adherence to recommended lifestyle modifications of hypertensive patients undergoing follow-up at chronic follow-up units of public health hospitals in Addis Ababa, Ethiopia, 2016. Methods Institutional-based cross-sectional study was conducted in four public health hospitals which were selected by drawing lots. Systematic random sampling was used to select study subjects. The results of the descriptive statistics were expressed as percentages and frequencies. Associations between lifestyle modification and independent variables were ana-lyzed using bivariate and multivariate logistic regression analysis. The study was conducted from February 15, 2016 to April 15, 2016. Results The study included 404 respondents with a 97% response rate; 210 (52%) were male and the mean age was 54.00±10.77 years. The respondents’ adherence to lifestyle modifications was 23%. The lifestyle adherence was found to be better in females, patients who had comorbidities, and had been knowledgeable about the disease and was poor among young adult respondents. Conclusion The rates of adherence to lifestyle changes were generally found to be low. Educational sessions that especially focus on lifestyle modifications and ongoing support for patients should be designed and studies which assess all the components of self-management should be conducted for comparison among different subgroups. PMID:28280305

Clinical Effectiveness and Impact on Insulin Therapy Cost After Addition of Dapagliflozin to Patients with Uncontrolled Type 2 Diabetes.

PubMed

Sosale, Bhavana; Sosale, Aravind; Bhattacharyya, Arpandev

2016-12-01

Dapagliflozin, a sodium glucose co-transporter 2 (SGLT2) inhibitor, is a promising drug approved for the treatment of type 2 diabetes mellitus (T2DM). However, its cost is an obstacle for use in developing countries like India. Thus, we aimed to analyse the impact on the cost of insulin therapy after adding dapagliflozin for patients using insulin in real-world clinical practice. This retrospective chart review study included patients with uncontrolled T2DM previously on maximum doses of OADs and insulin therapy, initiated on dapagliflozin. Parameters measured were: HbA1c, changes in weight and insulin dosage, frequency and cost, at baseline and after 3 months of adding dapagliflozin 10 mg. Hospital records of patients attending the diabetes outpatient departments at the study centres were scrutinised to identify eligible patients. A treat-to-target approach was used to make changes in the insulin dosages and regimen. The cost of insulin was calculated based on the total daily dose, cost per unit based on the formulation and insulin delivery device. Statistical analysis included descriptive and inferential methods. Overall, 70 patients meeting the inclusion criteria were included in the study. The mean age of patients and duration of T2DM were 52.6 ± 10 and 12 ± 5 years respectively. The mean reduction in HbA1c and weight was 2.1 ± 1% (p < 0.01) and 2.4 ± 1 kg (p < 0.01) respectively. Genital mycotic infections were reported in two (2.8%) patients. The mean reduction in the total daily dose of insulin was 9.5 ± 6 units. A significant reduction in the daily insulin requirement (19.87%, p < 0.01) was observed. The cost of insulin decreased by 22.3% or 17.8 ± 15 INR per day ($0.27 ± 0.22 per day) and the frequency of insulin shots administered per day decreased significantly (p < 0.01). In 12.8% and 2.8% of patients the frequency of administration of insulin decreased by one and two injections per day respectively. Reduction in HbA1c and body weight along with minimal side effects was observed. Addition of dapagliflozin reduced the insulin daily dose requirement and cost of insulin therapy in these patients. Diacon Hospital, Bangalore, India.

AIR EMISSIONS FROM SCRAP TIRE COMBUSTION

EPA Science Inventory

The report discusses air emissions from two types of scrap tire combustion: uncontrolled and controlled. Uncontrolled sources are open tire fires, which produce many unhealthful products of incomplete combustion and release them directly into the atmosphere. Controlled combustion...

EMISSIONS OF PCDD/F FROM UNCONTROLLED, DOMESTIC WASTE BURNING

EPA Science Inventory

Emissions of polychlorinated bibenzodioxin and dibenzofuran (PCDD/F) result from inefficiencies of combustion processes, most typically waste combustion. Uncontrolled combustion, such as occurs during so-called "backyard burning" of domestic waste, may therefore produce optimal ...

Young-age gender differences in mathematics mediated by independent control or uncontrollability.

PubMed

Zirk-Sadowski, Jan; Lamptey, Charlotte; Devine, Amy; Haggard, Mark; Szűcs, Dénes

2014-05-01

We studied whether the origins of math anxiety can be related to a biologically supported framework of stress induction: (un)controllability perception, here indicated by self-reported independent efforts in mathematics. Math anxiety was tested in 182 children (8- to 11-year-olds). Latent factor modeling was used to test hypotheses on plausible causal processes and mediations within competing models in quasi-experimental contrasts. Uncontrollability perception in mathematics, or (in)dependence of efforts, best fit the data as an antecedent of math anxiety. In addition, the relationship of math anxiety with gender was fully mediated by adaptive perception of control (i.e. controllability). That is, young boys differ from girls in terms of their experience of control in mathematics learning. These differences influence math anxiety. Our findings are consistent with recent suggestions in clinical literature according to which uncontrollability makes women more susceptible to fear and anxiety disorders. © 2014 John Wiley & Sons Ltd.

Telemonitoring-based service redesign for the management of uncontrolled hypertension (HITS): cost and cost-effectiveness analysis of a randomised controlled trial

PubMed Central

Stoddart, Andrew; Hanley, Janet; Wild, Sarah; Pagliari, Claudia; Paterson, Mary; Lewis, Steff; Sheikh, Aziz; Krishan, Ashma; Padfield, Paul; McKinstry, Brian

2013-01-01

Objectives To compare the costs and cost-effectiveness of managing patients with uncontrolled blood pressure (BP) using telemonitoring versus usual care from the perspective of the National Health Service (NHS). Design Within trial post hoc economic evaluation of data from a pragmatic randomised controlled trial using an intention-to-treat approach. Setting 20 socioeconomically diverse general practices in Lothian, Scotland. Participants 401 primary care patients aged 29–95 with uncontrolled daytime ambulatory blood pressure (ABP) (≥135/85, but <210/135 mm Hg). Intervention Participants were centrally randomised to 6 months of a telemonitoring service comprising of self-monitoring of BP transmitted to a secure website for review by the attending nurse/doctor and patient, with optional automated patient decision-support by text/email (n=200) or usual care (n-201). Randomisation was undertaken with minimisation for age, sex, family practice, use of three or more hypertension drugs and self-monitoring history. Main outcome measures Mean difference in total NHS costs between trial arms and blinded assessment of mean cost per 1 mm Hg systolic BP point reduced. Results Home telemonitoring of BP costs significantly more than usual care (mean difference per patient £115.32 (95% CI £83.49 to £146.63; p<0.001)). Increased costs were due to telemonitoring service costs, patient training and additional general practitioner and nurse consultations. The mean cost of systolic BP reduction was £25.56/mm Hg (95% CI £16.06 to £46.89) per patient. Conclusions Over the 6-month trial period, supported telemonitoring was more effective at reducing BP than usual care but also more expensive. If clinical gains are maintained, these additional costs would be very likely to be compensated for by reductions in the cost of future cardiovascular events. Longer-term modelling of costs and outcomes is required to fully examine the cost-effectiveness implications. Trial registration International Standard Randomised Controlled Trials, number ISRCTN72614272. PMID:23793650

A mobile phone based alarm system for supervising vital parameters in free moving rats.

PubMed

Kellermann, Kristine; Kreuzer, Matthias; Omerovich, Adem; Hoetzinger, Franziska; Kochs, Eberhard F; Jungwirth, Bettina

2012-02-23

Study protocols involving experimental animals often require the monitoring of different parameters not only in anesthetized, but also in free moving animals. Most animal research involves small rodents, in which continuously monitoring parameters such as temperature and heart rate is very stressful for the awake animals or simply not possible. Aim of the underlying study was to monitor heart rate, temperature and activity and to assess inflammation in the heart, lungs, liver and kidney in the early postoperative phase after experimental cardiopulmonary bypass involving 45 min of deep hypothermic circulatory arrest in rats. Besides continuous monitoring of heart rate, temperature and behavioural activity, the main focus was on avoiding uncontrolled death of an animal in the early postoperative phase in order to harvest relevant organs before autolysis would render them unsuitable for the assessment of inflammation. We therefore set up a telemetry-based system (Data Science International, DSI™) that continuously monitored the rat's temperature, heart rate and activity in their cages. The data collection using telemetry was combined with an analysis software (Microsoft excel™), a webmail application (GMX) and a text message-service. Whenever an animal's heart rate dropped below the pre-defined threshold of 150 beats per minute (bpm), a notification in the form of a text message was automatically sent to the experimenter's mobile phone. With a positive predictive value of 93.1% and a negative predictive value of 90.5%, the designed surveillance and alarm system proved a reliable and inexpensive tool to avoid uncontrolled death in order to minimize suffering and harvest relevant organs before autolysis would set in. This combination of a telemetry-based system and software tools provided us with a reliable notification system of imminent death. The system's high positive predictive value helped to avoid uncontrolled death and facilitated timely organ harvesting. Additionally we were able to markedly reduce the drop out rate of experimental animals, and therefore the total number of animals used in our study. This system can be easily adapted to different study designs and prove a helpful tool to relieve stress and more importantly help to reduce animal numbers.

Initial Resuscitation with Plasma and Other Blood Components Reduced Bleeding Compared to Hetastarch in Anesthetized Swine with Uncontrolled Splenic Hemorrhage

DTIC Science & Technology

2011-04-01

products and Hextend. The fluid with the highest amount of coagulation factors , FFP resulted in the lowest blood loss. The FFP treatment had the highest...compared to humans and have higher concentrations of many of the clotting factors (FV, FVII , FVIII, F IX, and FXII).44 Although we have confirmed the higher...utilizing plasma early in treatment is to prevent dilution of remaining coagulation factors or reverse the coagulopathy that has been observed in

Where does the Occluded Artery Trial leave the late open artery hypothesis?

PubMed Central

Lamas, Gervasio A; Hochman, Judith S

2007-01-01

As of April 2007 the early open artery hypothesis is alive and well, but the late open artery hypothesis is adrift. For the foreseeable future, stable patients with persistent occlusion of the infarct artery late after myocardial infarction, and without severe ischaemia or uncontrollable angina, should be managed initially with optimal medical treatment alone, and not with percutaneous coronary intervention. Efforts should focus on establishing reperfusion earlier, including reducing the time to patient presentation. PMID:17933981

The Effect of a Coronary Artery Risk Evaluation Program on the Serum Lipid Values of a Selected Military Population

DTIC Science & Technology

1991-05-01

interventions reduced low density lipoproteins and serum cholesterol levels. The goals of risk factor reduction are disease prevention , delay of disease... preventing CAD (Lipid Research Clinics Program, 1984). A 1% reduction in cholesterol was associated with a 2 % reduction in risk (NIH, 1984). This includes...heart attack before age 65? Yes No 2 . Do you have Diabetes Mellitus ? Yes No 3. Do you have uncontrolled hypertension? (Blood Pressure consistently

Imperative to consider multiple initiatives to maximize prescribing efficiency from generic availability: case history from Abu Dhabi.

PubMed

Abuelkhair, Mohammed; Abdu, Shajahan; Godman, Brian; Fahmy, Sahar; Malmström, Rickard E; Gustafsson, Lars L

2012-02-01

Pharmaceutical expenditure has risen rapidly in Abu Dhabi, resulting in policies surrounding generics. However, various circumstances will reduce potential savings, including pharmacists still being free to dispense either originator or branded generics and be fully reimbursed. To research the changes in utilization patterns of proton pump inhibitors (PPIs) and lipid-lowering drugs before and after combined reforms on generics; and subsequently, calculate potential savings based on 'best practices' among Western European countries. An uncontrolled before-and-after observational study of utilization and expenditure of PPIs, statins and ezetimibe between 2004 and 2010, as well as up to 12 months before the first generic policy, to 1 year after the second generic policy, was carried out. Utilization was converted to defined daily doses (DDDs; 2011 DDDs) and DDDs/1000 inhabitants per day. Expenditure/DDD was calculated for omeprazole and simvastatin. PPI utilization rose by 6.5-fold from 2004 to 2010, principally driven by increased utilization of patent-protected PPIs, although more recently stabilization in esomperazole utilization has occurred. Similar changes were seen for statins. Introduction of best practices would reduce PPI expenditure in 2010 by 32.8 million United Arab Emirates dirham (AED; €6.26 million) and statins by over 27 million AED (€5.15 million). Limited demand-side measures led to increased utilization of patent-protected products in Abu Dhabi following the generic reforms. Successful measures will release considerable resources.

Eating traits questionnaires as a continuum of a single concept. Uncontrolled eating.

PubMed

Vainik, Uku; Neseliler, Selin; Konstabel, Kenn; Fellows, Lesley K; Dagher, Alain

2015-07-01

Research on eating behaviour has identified several potentially relevant eating-related traits captured by different questionnaires. Often, these questionnaires predict Body Mass Index (BMI), but the relationship between them has not been explicitly studied. We studied the unity and diversity of questionnaires capturing five common eating-related traits: Power of Food, Eating Impulsivity, emotional eating, Disinhibition, and binge eating in women from Estonia (n = 740) and Canada (n = 456). Using bifactor analysis, we showed that a) these questionnaires are largely explained by a single factor, and b) relative to this shared factor, only some questionnaires offered additional variance in predicting BMI. Hence, these questionnaires seemed to characterise a common factor, which we label Uncontrolled Eating. Item Response Theory techniques were then applied to demonstrate that c) within this common factor, the questionnaires could be placed on a continuum of Uncontrolled Eating. That is, Eating Impulsivity focused on the milder degree, Power of Food Scale, emotional eating scales, and Disinhibition on intermediate degrees, and the Binge Eating Scale on the most severe degrees of Uncontrolled Eating. In sum, evidence from two samples showed that questionnaires capturing five common BMI-related traits largely reflected the same underlying latent trait - Uncontrolled Eating. In Estonia, some questionnaires focused on different severities of this common construct, supporting a continuum model of Uncontrolled Eating. These findings provide a starting point for developing better questionnaires of the neurobehavioural correlates of obesity, and provide a unifying perspective from which to view the existing literature. R scripts and data used for the analysis are provided. Copyright © 2015 Elsevier Ltd. All rights reserved.

Deficits in episodic memory are related to uncontrolled eating in a sample of healthy adults.

PubMed

Martin, A A; Davidson, T L; McCrory, M A

2018-05-01

Despite a substantial amount of animal data linking deficits in memory inhibition to the development of overeating and obesity, few studies have investigated the relevance of memory inhibition to uncontrolled eating in humans. Further, although memory for recent eating has been implicated as an important contributor to satiety and energy intake, the possibility that variations in episodic memory relate to individual differences in food intake control has been largely neglected. To examine these relationships, we recruited ninety-three adult subjects to attend a single lab session where we assessed body composition, dietary intake, memory performance, and eating behaviors (Three Factor Eating Questionnaire). Episodic recall and memory inhibition were assessed using a well-established measure of memory interference (Retrieval Practice Paradigm). Hierarchical regression analyses indicated that memory inhibition was largely unrelated to participants' eating behaviors; however, episodic recall was reliably predicted by restrained vs. uncontrolled eating: recall was positively associated with strategic dieting (β = 2.45, p = 0.02), avoidance of fatty foods (β = 3.41, p = 0.004), and cognitive restraint (β = 1.55, p = 0.04). In contrast, recall was negatively associated with uncontrolled eating (β = -1.15, p = 0.03) and emotional eating (β = -2.46, p = 0.04). These findings suggest that episodic memory processing is related to uncontrolled eating in humans. The possibility that deficits in episodic memory may contribute to uncontrolled eating by disrupting memory for recent eating is discussed. Copyright © 2017 Elsevier Ltd. All rights reserved.

Community Health Worker Home Visits for Medicaid-Enrolled Children With Asthma: Effects on Asthma Outcomes and Costs

PubMed Central

Brooks, Marissa; Hosokawa, Patrick; Robinson, June; Song, Lin; Krieger, James

2015-01-01

Objectives. We sought to estimate the return on investment of a streamlined version of an evidence-based community health worker (CHW) asthma home visit program. Methods. We used a randomized parallel group trial of home visits by CHWs to Medicaid-enrolled children with uncontrolled asthma versus usual care. Results. A total of 373 participants enrolled in the study (182 in the intervention group and 191 in the control group, of whom 154 and 179, respectively, completed the study). The intervention group had greater improvements in asthma symptom–free days (2.10 days more over 2 weeks; 95% CI =  1.17, 3.05; P < .001) and caretakers’ quality of life (0.43 units more; 95% CI = 0.20, 0.66; P < .001) and a larger reduction in urgent health care utilization events (1.31 events fewer over 12 months; 95% CI = −2.10, −0.52; P = .001). The intervention arm compared with the control arm saved $1340.92 for the $707.04 additional costs invested for the average participant. The return on investment was 1.90. Conclusions. A streamlined CHW asthma home visit program for children with uncontrolled asthma improved health outcomes and yielded a return on investment of 1.90. PMID:26270287

Uncontrolled Donation After Circulatory Determination of Death Donors (uDCDDs) as a Source of Lungs for Transplant

PubMed Central

Egan, T. M.; Requard, J. J.

2017-01-01

In April 2014, the American Journal of Transplantation published a report on the first lung transplant in the United States recovered from an uncontrolled donation after circulatory determination of death donor (uDCDD), assessed by ex vivo lung perfusion (EVLP). The article identified logistical and ethical issues related to introduction of lung transplant from uDCDDs. In an open clinical trial, we have Food and Drug Administration and Institutional Review Board approval to transplant lungs recovered from uDCDDs judged suitable after EVLP. Through this project and other experiences with lung recovery from uDCDDs, we have identified solutions to many logistical challenges and have addressed ethical issues surrounding lung transplant from uDCDDs that were mentioned in this case report. Here, we discuss those challenges, including issues related to recovery of other solid organs from uDCDDs. Despite logistical challenges, uDCDDs could solve the critical shortage of lungs for transplant. Furthermore, by avoiding the deleterious impact of brain death and days of positive pressure ventilation, and by using opportunities to treat lungs in the decedent or during EVLP, lungs recovered from uDCDDs may ultimately prove to be better than lungs currently being transplanted from conventional brain-dead organ donors. PMID:25873272

Establishing a learned-helplessness effect paradigm in C57BL/6 mice: behavioural evidence for emotional, motivational and cognitive effects of aversive uncontrollability per se.

PubMed

Pryce, Christopher R; Azzinnari, Damiano; Sigrist, Hannes; Gschwind, Tilo; Lesch, Klaus-Peter; Seifritz, Erich

2012-01-01

Uncontrollability of major life events has been proposed to be central to depression onset and maintenance. The learned helplessness (LH) effect describes a deficit in terminating controllable aversive stimuli in individuals that experienced aversive stimuli as uncontrollable relative to individuals that experienced the same stimuli as controllable. The LH effect translates across species and therefore can provide an objective-valid readout in animal models of depression. Paradigms for a robust LH effect are established and currently applied in rat but there are few reports of prior and current study of the LH effect in mouse. This includes the C57BL/6 mouse, typically the strain of choice for application of molecular-genetic tools in pre-clinical depression research. The aims of this study were to develop a robust paradigm for the LH effect in BL/6 mice, provide evidence for underlying psychological processes, and study the effect of a depression-relevant genotype on the LH effect. The apparatus used for in/escapable electro-shock exposure and escape test was a two-way shuttle arena with continuous automated measurement of locomotion, compartment transfers, e-shock escapes, vertical activity and freezing. Brother-pairs of BL/6 mice were allocated to either escapable e-shocks (ES) or inescapable e-shocks (IS), with escape latencies of the ES brother used as e-shock durations for the IS brother. The standard two-way shuttle paradigm was modified: the central gate was replaced by a raised divider and e-shock escape required transfer to the distal part of the safe compartment. These refinements yielded reduced superstitious, pre-adaptive e-shock transfers in IS mice and thereby increased the LH effect. To obtain a robust LH effect in all brother pairs, pre-screening for minor between-brother ES differences was necessary and did not confound the LH effect. IS mice developed reduced motor responses to e-shock, consistent with a motivational deficit, and absence of a learning curve for escapes at escape test, consistent with a cognitive deficit. When a tone CS was used to predict e-shock, IS mice exhibited increased reactivity to the CS, consistent with hyper-emotionality. There was no ES-IS difference in pain sensitivity. Mice heterozygous knockout for the 5-HTT gene exhibited an increased LH effect relative to wildtype mice. This mouse model will allow for the detailed molecular study of the aetiology, psychology, neurobiology and neuropharmacology of uncontrollability of aversive stimuli, a potential major aetiological factor and state marker in depression. This article is part of a Special Issue entitled 'Anxiety and Depression'. Copyright © 2011 Elsevier Ltd. All rights reserved.

Quantifying Uncontrolled Air Emissions from Two Florida Landfills

EPA Science Inventory

Landfill gas emissions, if left uncontrolled, contribute to air toxics, climate change, trospospheric ozone, and urban smog. Measuring emissions from landfills presents unique challenges due to the large and variable source area, spatial and temporal variability of emissions, and...

Establishing procedures and guidelines for pedestrian treatments at uncontrolled locations

DOT National Transportation Integrated Search

2017-08-01

Pedestrians are the most vulnerable road users. The risks to pedestrians crossing at uncontrolled locations are much higher than at signalized intersections. There has been an increasing trend in pedestrian deaths during the past decade. Specifically...

NASA Microgravity Combustion Science Program

NASA Technical Reports Server (NTRS)

King, Merrill K.

1999-01-01

Combustion has been a subject of increasingly vigorous scientific research for over a century, not surprising considering that combustion accounts for approximately 85% of the world's energy production and is a key element of many critical technologies used by contemporary society. Although combustion technology is vital to our standard of living, it also poses great challenges to maintaining a habitable environment. A major goal of combustion research is production of fundamental (foundational) knowledge that can be used in developing accurate simulations of complex combustion processes, replacing current "cut-and-try" approaches and allowing developers to improve the efficiency of combustion devices, to reduce the production of harmful emissions, and to reduce the incidence of accidental uncontrolled combustion. With full understanding of the physics and chemistry involved in a given combustion process, including details of the unit processes and their interactions, physically accurate models which can then be used for parametric exploration of new combustion domains via computer simulation can be developed, with possible resultant definition of radically different approaches to accomplishment of various combustion goals. Effects of gravitational forces on earth impede combustion studies more than they impede most other areas of science. The effects of buoyancy are so ubiquitous that we often do not appreciate the enormous negative impact that they have had on the rational development of combustion science. Microgravity offers potential for major gains in combustion science understanding in that it offers unique capability to establish the flow environment rather than having it dominated by uncontrollable (under normal gravity) buoyancy effects and, through this control, to extend the range of test conditions that can be studied. It cannot be emphasized too strongly that our program is dedicated to taking advantage of microgravity to untangle complications caused by gravity, allowing major strides in our understanding of combustion processes and in subsequent development of improved combustion devices leading to improved quality of life on Earth. Fire and/or explosion events aboard spacecraft could be devastating to international efforts to expand the human presence in space. Testing to date has shown that ignition and flame spread on fuel surfaces (e.g., paper, wire insulation) behave quite differently under partial gravity and microgravity conditions. In addition, fire signatures-i.e., heat release, smoke production, flame visibility, and radiation-are now known to be quite different in reduced gravity environments; this research has provided data to improve the effectiveness of fire prevention practices, smoke and fire detectors, and fire extinguishment systems. The more we can apply our scientific and technological understanding to potential fire behavior in microgravity and partial gravity, the more assurance can be given to those people whose lives depend on the environment aboard spacecraft or eventually on habitats on the Moon or Mars.

Adaptation of red cell enzymes and intermediates in metabolic disorders.

PubMed

Goebel, K M; Goebel, F D; Neitzert, A; Hausmann, L; Schneider, J

1975-01-01

The metabolic activity of the red cell glycolytic pathway hexose monophosphate shunt (HMP) with dependent glutathione system was studied in patients with hyperthyroidism (n = 10), hyperlipoproteinemia (n = 16), hypoglycemia (n = 25) and hyperglycemia (n = 23). In uncontrolled diabetics and patients with hyperthyroidism the mean value of glucose phosphate isomerase (GPI), glucose-6-phosphate dehydrogenase (G-6-PD), glutathione reductase (GR) was increased, whereas these enzyme activities were reduced in patients with hypoglycemia. Apart from a few values of hexokinase (HK) which were lower than normal the results in hyperlipoproteinemia patients remained essentially unchanged, including the intermediates such as 2,3-diphosphoglycerate (2,3-DPG), adenosine triphosphate (ATP) and reduced glutathione (GSH). While increased rates of 2,3-DPG and ATP in hypoglycemia patients were obtained, these substrates were markedly reduced in diabetics.

EMISIONES AL AIRE DE LA COMBUSTION DE LLANTAS USADAS (SPANISH VERSION)

EPA Science Inventory

The report discusses air emissions from two types of scrap tire combustion: uncontrolled and controlled. Uncontrolled sources are open tire fires, which produce many unhealthful products of incomplete combustion and release them directly into the atmosphere. Controlled combustion...

26 CFR 1.482-6 - Profit split method.

Code of Federal Regulations, 2012 CFR

2012-04-01

... consistency between the controlled and uncontrolled taxpayers in accounting practices that materially affect... result. Thus, for example, if differences in inventory and other cost accounting practices would... between the controlled and uncontrolled transactions increases, the relative weight accorded the analysis...

26 CFR 1.482-6 - Profit split method.

Code of Federal Regulations, 2013 CFR

2013-04-01

... consistency between the controlled and uncontrolled taxpayers in accounting practices that materially affect... result. Thus, for example, if differences in inventory and other cost accounting practices would... between the controlled and uncontrolled transactions increases, the relative weight accorded the analysis...

26 CFR 1.482-6 - Profit split method.

Code of Federal Regulations, 2014 CFR

2014-04-01

... consistency between the controlled and uncontrolled taxpayers in accounting practices that materially affect... result. Thus, for example, if differences in inventory and other cost accounting practices would... between the controlled and uncontrolled transactions increases, the relative weight accorded the analysis...

26 CFR 1.482-6 - Profit split method.

Code of Federal Regulations, 2011 CFR

2011-04-01

... consistency between the controlled and uncontrolled taxpayers in accounting practices that materially affect... result. Thus, for example, if differences in inventory and other cost accounting practices would... between the controlled and uncontrolled transactions increases, the relative weight accorded the analysis...

Schockmed Valve: A Novel Surgical Option for Uncontrolled Glaucoma in Eyes with Poor Conjunctiva and Encircling Bands.

PubMed

Fleischman, David; Kim, Bryan

2017-01-01

Surgical management of elevated intraocular pressure (IOP) in an eye with scarred conjunctiva, an encircling band, and silicone oil has limited options. By combining the flow restrictor of the Ahmed Glaucoma Valve (New World Medical, Rancho Cucamonga, California) and the capsule of the encircling band as a conduit for aqueous flow, immediate pressure reduction could theoretically be achieved in eyes with limited conjunctival mobilization. This is a description of a surgical technique in a case of a patient with multiple ocular surgeries with uncontrolled multimechanism glaucoma despite using all available topical and oral glaucoma medications. A combination of the Ahmed valve with a modification of the Schocket shunt technique was used in this case of an encircling band and poor conjunctiva. At 10-month follow-up, the patient maintains controlled pressures on dorzolamide-timolol drops. The combined Ahmed-Schocket (or Schockmed) technique may be another surgical option for management of uncontrolled IOP in cases of scarred conjunctiva and encircling bands needing immediate pressure reduction. A novel surgical option for uncontrolled glaucoma in eyes with poor conjunctiva and encircling bands. How to cite this article: Fleischman D, Kim B. Schockmed Valve: A Novel Surgical Option for Uncontrolled Glaucoma in Eyes with Poor Conjunctiva and Encircling Bands. J Curr Glaucoma Pract 2017;11(3):120-124.

Effect of acute tryptophan depletion on the response to controllable and uncontrollable noise stress.

PubMed

Richell, Rebecca A; Deakin, J F William; Anderson, Ian M

2005-02-01

Previous research provides evidence linking serotonin (5-hydroxytryptamine, 5-HT) with stress and depression. The controllable/uncontrollable (C/UC) stress paradigm aims to generate a state/condition, namely a feeling of lack of control in the context of a stressor, which might be an important factor in precipitating a negative mood state. Acute tryptophan depletion (ATD) is a technique that produces a decrease in central 5-HT levels in vivo. This study investigated the role of 5-HT in the behavioral response to a C/UC stress paradigm with ATD. Healthy adult volunteers were randomly assigned to receive either a TRP-supplemented (n = 15) or TRP-deficient (n = 13) amino acid drink. At 5 hours postdrink, volunteers were subjected to sessions of controllable and uncontrollable noise stress (100-dB white noise). Subjective ratings of mood were obtained before and after the interventions. Participants who received the tryptophan-depleting drink had greater self-report ratings of negative mood on visual analogue scales and the Profile of Mood States after the uncontrollable stress than did participants who received the balanced drink. The results suggest that 5-HT might play a role in providing resilience to uncontrollable stress. Additional studies with specific 5-HT pharmacologic probes will further clarify the results.

Associations of metabolic disorder factors with the risk of uncontrolled hypertension: a follow-up cohort in rural China.

PubMed

Xiao, Jing; Hua, Tianqi; Shen, Huan; Zhang, Min; Wang, Xiao-Jian; Gao, Yue-Xia; Lu, Qinyun; Wu, Chuanli

2017-04-07

We evaluated how metabolic disorders affected antihypertension therapy. 2,912 rural Chinese patients with hypertension who provided blood samples, demographic and clinical data at baseline and after 1 year of antihypertension therapy were evaluated. At baseline, 1,515 patients (52.0%) were already receiving drug therapy and 11.4% of them had controlled blood pressure (BP). After 1 year, all 2,912 patients were receiving antihypertension therapy that was administered by community physicians, and 59.42% of them had controlled BP. Central obesity and abnormal triglyceride, high-density lipoprotein cholesterol, and glucose were associated with 15-70% higher risks of uncontrolled hypertension. Metabolic syndrome using the JIS criteria was associated with poor BP control (odds ratio: 1.71 and 1.54 for the baseline and follow-up datasets, respectively). The risk of uncontrolled hypertension increased with the number of metabolic disorders (p for trend <0.01). The presence of ≥3 metabolic disorder factors was associated with higher risks of poor BP control. The associations of metabolic factors and uncontrolled hypertension were stronger for the standard and modified ATP III criteria, compared to the IDF and JIS criteria. Metabolic factors were associated with less effective antihypertension therapy, and all definitions of metabolic syndrome helped identify patients with elevated risks of uncontrolled hypertension.

Clinical Evaluation of Kshara sutra Therapy in the management of Bhagandara( Fistula- in-Ano)- A prospective study.

PubMed

Panigrahi, Hemanta Kumar; Rani, Rakesh; Padhi, M M; Lavekar, G S

2009-01-01

A prospective study of 50 patients suffering from Bhagandara(Fistula in Ano) (age ranging from 18-54years) treated by Kshara sutra therapy Kshara sutra unit, Central research Unit, Punjabi bagh, New Delhi January 2007 to July 2008. To determine the incidence of low or high anal fistula, recurrence rate following Kshara sutra therapy and effect of Ksharasutra therapy on the Bhagandara. The fifty patients (50) were selected randomly in the Out Patient Department. Uncontrolled open level Study. Patients were followed to see the incidence of recurrence, effect of Kshara Sutra Therapy on incontinence. Overall recurrence rate was only 5.88 %. Minor incontinence was observed only following Kshara sutra Therapy for high variety for which no treatment was given. No such complication occurred in low variety. Bhagandara (Fistula in Ano) can be treated by Kshara Sutra Therapy with minimal loss of sphincter muscle and low reoccurrence rate.

Solar energy system performance evaluation. Seasonal report for Colt Pueblo, Pueblo, Colorado

NASA Technical Reports Server (NTRS)

1980-01-01

The Colt-Pueblo solar energy system, designed to provide space heating and hot water preheating, is described and its operational performance for a 12 month period from February 1979 through January 1980 is evaluated. The space heating subsystem met 31 percent of the measured space heating load which was close to the expected 34 percent solar fraction. Although the hot water solar fraction was 79 percent, the overall energy saving capability was reduced because of the low hot water demand. The measured heating subsystem performance would have improved considerably if the uncontrolled losses primarily from transport piping could have been reduced to an inconsequential level. Fossil energy savings of 70.31 million BTUs are estimated.

Reestablishing Public Health and Land Use Planning to Protect Public Water Supplies

PubMed Central

Greenberg, Michael; Mayer, Henry; Miller, K. Tyler; Hordon, Robert; Knee, Daniel

2003-01-01

Objectives. This study measured the extent to which land use, design, and engineering practices could reduce contamination of major public water supplies. Methods. Key parcels of land were identified in New Jersey, and the potential uncontrolled loading of contaminants was estimated with the US Environmental Protection Agency’s Long-Term Hydrologic Impact Assessment model for a variety of land use, design, and engineering scenarios. Results. High-density per-acre development and engineering controls, along with housing and light commercial activity near main railroads, would substantially reduce runoff. Conclusions. In New Jersey, government and purveyor action is being taken as a result of, and in support of, these findings. PMID:12948974

Study of the Spacecraft Potential Under Active Control and Plasma Density Estimates During the MMS Commissioning Phase

NASA Technical Reports Server (NTRS)

Andriopoulou, M.; Nakamura, R.; Torkar, K.; Baumjohann, W.; Torbert, R. B.; Lindqvist, P.-A.; Khotyaintsev, Y. V.; Dorelli, John Charles; Burch, J. L.; Russell, C. T.

2016-01-01

Each spacecraft of the recently launched magnetospheric multiscale MMS mission is equipped with Active Spacecraft Potential Control (ASPOC) Instruments, which control the spacecraft potential in order to reduce spacecraft charging effects. ASPOC typically reduces the spacecraft potential to a few volts. On several occasions during the commissioning phase of the mission, the ASPOC instruments were operating only on one spacecraft at a time. Taking advantage of such intervals, we derive photoelectron curves and also perform reconstructions of the uncontrolled spacecraft potential for the spacecraft with active control and estimate the electron plasma density during those periods. We also establish the criteria under which our methods can be applied.

SNMG: a social-level norm-based methodology for macro-governing service collaboration processes

NASA Astrophysics Data System (ADS)

Gao, Ji; Lv, Hexin; Jin, Zhiyong; Xu, Ping

2017-08-01

In order to adapt to the accelerative open tendency of collaborations between enterprises, this paper proposes a Social-level Norm-based methodology for Macro-Governing service collaboration processes, called SNMG, to regulate and control the social-level visible macro-behaviors of the social individuals participating in collaborations. SNMG not only can remove effectively the uncontrollability hindrance confronted with by open social activities, but also enables across-management-domain collaborations to be implemented by uniting the centralized controls of social individuals for respective social activities. Therefore, this paper provides a brand-new system construction mode to promote the development and large-scale deployment of service collaborations.

Conducted-Susceptibility Testing as an Alternative Approach to Unit-Level Radiated-Susceptibility Verifications

NASA Astrophysics Data System (ADS)

Badini, L.; Grassi, F.; Pignari, S. A.; Spadacini, G.; Bisognin, P.; Pelissou, P.; Marra, S.

2016-05-01

This work presents a theoretical rationale for the substitution of radiated-susceptibility (RS) verifications defined in current aerospace standards with an equivalent conducted-susceptibility (CS) test procedure based on bulk current injection (BCI) up to 500 MHz. Statistics is used to overcome the lack of knowledge about uncontrolled or uncertain setup parameters, with particular reference to the common-mode impedance of equipment. The BCI test level is properly investigated so to ensure correlation of currents injected in the equipment under test via CS and RS. In particular, an over-testing probability quantifies the severity of the BCI test with respect to the RS test.

Zadoff-Chu sequence-based hitless ranging scheme for OFDMA-PON configured 5G fronthaul uplinks

NASA Astrophysics Data System (ADS)

Reza, Ahmed Galib; Rhee, June-Koo Kevin

2017-05-01

A Zadoff-Chu (ZC) sequence-based low-complexity hitless upstream time synchronization scheme is proposed for an orthogonal frequency division multiple access passive optical network configured cloud radio access network fronthaul. The algorithm is based on gradual loading of the ZC sequences, where the phase discontinuity due to the cyclic prefix is alleviated by a frequency domain phase precoder, eliminating the requirements of guard bands to mitigate intersymbol interference and inter-carrier interference. Simulation results for uncontrolled-wavelength asynchronous transmissions from four concurrent transmitting optical network units are presented to demonstrate the effectiveness of the proposed scheme.

Regulation of Romantic Love Feelings: Preconceptions, Strategies, and Feasibility.

PubMed

Langeslag, Sandra J E; van Strien, Jan W

2016-01-01

Love feelings can be more intense than desired (e.g., after a break-up) or less intense than desired (e.g., in long-term relationships). If only we could control our love feelings! We present the concept of explicit love regulation, which we define as the use of behavioral and cognitive strategies to change the intensity of current feelings of romantic love. We present the first two studies on preconceptions about, strategies for, and the feasibility of love regulation. Questionnaire responses showed that people perceive love feelings as somewhat uncontrollable. Still, in four open questions people reported to use strategies such as cognitive reappraisal, distraction, avoidance, and undertaking (new) activities to cope with break-ups, to maintain long-term relationships, and to regulate love feelings. Instructed up-regulation of love using reappraisal increased subjective feelings of attachment, while love down-regulation decreased subjective feelings of infatuation and attachment. We used the late positive potential (LPP) amplitude as an objective index of regulation success. Instructed love up-regulation enhanced the LPP between 300-400 ms in participants who were involved in a relationship and in participants who had recently experienced a romantic break-up, while love down-regulation reduced the LPP between 700-3000 ms in participants who were involved in a relationship. These findings corroborate the self-reported feasibility of love regulation, although they are complicated by the finding that love up-regulation also reduced the LPP between 700-3000 ms in participants who were involved in a relationship. To conclude, although people have the preconception that love feelings are uncontrollable, we show for the first time that intentional regulation of love feelings using reappraisal, and perhaps other strategies, is feasible. Love regulation will benefit individuals and society because it could enhance positive effects and reduce negative effects of romantic love.

Pulmonary vein isolation combined with spironolactone or renal sympathetic denervation in patients with chronic kidney disease, uncontrolled hypertension, paroxysmal atrial fibrillation, and a pacemaker.

PubMed

Kiuchi, Márcio Galindo; Chen, Shaojie; Hoye, Neil Alexander; Pürerfellner, Helmut

2018-01-01

Atrial fibrillation (AF) commonly occurs in chronic kidney disease (CKD), occasioning adverse outcomes. Merging pulmonary vein isolation (PVI) and renal sympathetic denervation (RSD) may decrease the recurrence of AF in subjects with CKD and uncontrolled hypertension. We considered that RSD could reduce the recurrence of AF in patients with CKD by modulating sympathetic hyperactivity. We aimed to evaluate the impact of RSD or spironolactone 50 mg/day associated with PVI in reducing systolic blood pressure (BP), AF recurrence, and AF burden in patients with a history of paroxysmal AF and mild CKD. This was a single-center, prospective, longitudinal, randomized, double-blind study. The individuals were randomly divided into two groups (PVI + spironolactone, n = 36, and PVI + RSD, n = 33). All of them were followed for exactly 1 year to assess maintenance of sinus rhythm and to monitor the other variables. Ambulatory BP measurements were reduced in both groups and at the 12th month also differed between groups. Significantly more patients in the PVI + RSD (61%) than in the PVI + spironolactone group (36%) were AF-free at the 12th month of follow-up, P = 0.0242. Toward the end of the study, the mean AF burden was lower in the PVI + RSD group as compared to PVI + spironolactone group, at the 9th month: ∆ = - 10% (P < 0.0001), and at the 12th month: ∆ = - 12% (P < 0.0001), respectively. PVI + RSD is safe and appears to be superior to PVI + spironolactone in BP reduction, augmentation of AF event-free rate, reduction of AF burden, and improvement of renal function.

Utilizing a diabetic registry to manage diabetes in a low-income Asian American population.

PubMed

Seto, Winnie; Turner, Barbara S; Champagne, Mary T; Liu, Lynn

2012-08-01

Racial and income disparities persist in diabetes management in America. One third of African and Hispanic Americans with diabetes receive the recommended diabetes services (hemoglobin A1c [A1c] testing, retinal and foot examinations) shown to reduce diabetes complications and mortality, compared to half of whites with diabetes. National data for Asian Americans are limited, but studies suggest that those with language and cultural barriers have difficulty accessing health services. A diabetic registry has been shown to improve process and clinical outcomes in a population with diabetes. This study examined whether a community center that serves primarily low-income Asian American immigrants in Santa Clara County, California, could improve diabetes care and outcomes by implementing a diabetic registry. The registry was built using the Access 2007 software program. A total of 580 patients with diabetes were identified by reviewing charts, the appointment database, and reimbursement records from Medicaid, Medicare, and private insurance companies. Utilizing the registry, medical assistants contacted patients for follow-up appointments, and medical providers checked and tracked the patients' A1c results. Among the 431 patients who returned for treatment, the mean A1c was reduced from 7.27% to 6.97% over 8 months (P<0.001). Although 10.8% of the patients changed from controlled to uncontrolled diabetes post intervention, 32.6% of patients with uncontrolled diabetes converted to controlled diabetes (P<0.001). The diabetes control rate improved from 47% to 59% at the end of the study. This study demonstrated that a diabetic registry is an effective tool to manage an underserved population with diabetes, thereby reducing disparities in diabetes management.

The effect of patient race and blood pressure control on patient-physician communication.

PubMed

Cené, Crystal W; Roter, Debra; Carson, Kathryn A; Miller, Edgar R; Cooper, Lisa A

2009-09-01

Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. Communication behaviors and visit length from coding of audiotapes. After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B = -3.9 min, p < 0.01) with less biomedical (B = -24.0, p = 0.05), psychosocial (B = -19.4, p < 0.01), and rapport-building (B = -19.5, p = 0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP. This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.

Gender differences in hypertension control among older korean adults: Korean social life, health, and aging project.

PubMed

Chu, Sang Hui; Baek, Ji Won; Kim, Eun Sook; Stefani, Katherine M; Lee, Won Joon; Park, Yeong-Ran; Youm, Yoosik; Kim, Hyeon Chang

2015-01-01

Controlling blood pressure is a key step in reducing cardiovascular mortality in older adults. Gender differences in patients' attitudes after disease diagnosis and their management of the disease have been identified. However, it is unclear whether gender differences exist in hypertension management among older adults. We hypothesized that gender differences would exist among factors associated with hypertension diagnosis and control among community-dwelling, older adults. This cross-sectional study analyzed data from 653 Koreans aged ≥60 years who participated in the Korean Social Life, Health, and Aging Project. Multiple logistic regression was used to compare several variables between undiagnosed and diagnosed hypertension, and between uncontrolled and controlled hypertension. Diabetes was more prevalent in men and women who had uncontrolled hypertension than those with controlled hypertension or undiagnosed hypertension. High body mass index was significantly associated with uncontrolled hypertension only in men. Multiple logistic regression analysis indicated that in women, awareness of one's blood pressure level (odds ratio [OR], 2.86; p=0.003) and the number of blood pressure checkups over the previous year (OR, 1.06; p=0.011) might influence the likelihood of being diagnosed with hypertension. More highly educated women were more likely to have controlled hypertension than non-educated women (OR, 5.23; p=0.013). This study suggests that gender differences exist among factors associated with hypertension diagnosis and control in the study population of community-dwelling, older adults. Education-based health promotion strategies for hypertension control might be more effective in elderly women than in elderly men. Gender-specific approaches may be required to effectively control hypertension among older adults.

Explaining the relationship between attachment anxiety, eating behaviour and BMI.

PubMed

Wilkinson, Laura L; Rowe, Angela C; Robinson, Eric; Hardman, Charlotte A

2018-05-05

Previous research indicates that attachment anxiety (fear of abandonment) is predictive of overeating and higher body mass index (BMI). The current study explored the nature of the mechanisms underpinning this relationship. Study 1 assessed the relative contribution of 'emotional eating', 'susceptibility to hunger' and 'uncontrolled eating'. Study 2 assessed whether misperception of emotion and poor emotion management would mediate the relationship between attachment anxiety and stress-induced eating (and then BMI). Two cross-sectional online questionnaire studies were conducted (Study 1 N = 665, & Study 2 N = 548), in UK and US-based samples, which assessed attachment orientation and BMI alongside the potential mediators. The relative contribution of emotional eating, susceptibility to hunger and uncontrolled eating (Study 1) and difficulties in emotion regulation and stress-induced eating (Study 2) as mediators of this relationship were examined. In Study 1, parallel multiple mediation analysis (PROCESS) showed that emotional eating and susceptibility to hunger (but not uncontrolled eating) were significant mediators of the relationship between attachment anxiety and BMI. In Study 2, serial mediation analysis showed that difficulties in 'engaging with goal directed behaviours when upset' and stress-induced eating operated in series to significantly mediate the relationship between attachment anxiety and BMI. These findings suggest that attachment anxious individuals feel less capable in disengaging from negative emotions and go on to try to soothe themselves through eating which has a negative impact on their BMI. There was less support for an explanation of the relationship between attachment anxiety and BMI based around the misperception of emotion. Taken together, the findings highlight attachment anxiety and emotion regulation strategies as key targets for interventions that aim to reduce overeating and excess body weight. Copyright © 2018 Elsevier Ltd. All rights reserved.

Retrospective comparison of voglibose or acarbose as an add-on therapy to sulfonylureas in Western Indian patients with uncontrolled overweight/obese type 2 diabetes.

PubMed

Talaviya, Praful A; Saboo, Banshi D; Dodiya, Hardik G; Rao, Shaival K; Joshi, Shashank R; Modh, Vipul B; Ghadiya, Sneha V

2016-01-01

The study was aimed to investigate the effect of voglibose or acarbose as an add-on treatment in overweight/obese type 2 diabetes (T2DM) patients who are uncontrolled with metformin and sulfonylureas (SUs) in Western part of India. A retrospective study included 77 participants (BMI≥25kg/m(2); HbA1c level>8% and<9.5%) with overweight/obese T2DM. These participants were treated with either voglibose or acarbose. Glycemic parameters (fasting blood glucose and glycated hemoglobin [HbA1c]), bodyweight, BMI and lipid parameters were evaluated at baseline, 3-month, 6-month and 9-month of treatment. Adverse events were also captured at respective time points. Voglibose showed significant reduction in HbA1c and bodyweight with short duration of treatment (6 months; P<0.05 and 9 months; P<0.01) whereas acarbose showed significant reduction with longer duration of treatment (9 months; P<0.05) when compared with baseline. Moreover, both treatment groups were reported with reduction in BMI. Further, significant improvement in lipid parameters except LDL and HDL were observed in both treatment groups when compared with baseline. None of participant was discontinued due to side effects of the treatment. In addition, the frequency of hypoglycemia was decreased in both treatment groups. Voglibose or acarbose as an add-on treatment with metformin and sulfonylureas in uncontrolled obese/overweight T2DM provides desired glycemic control, reduces bodyweight and improves lipid parameters with good tolerability profile. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Sludge management modeling to enhance P-recovery as struvite in wastewater treatment plants.

PubMed

Martí, N; Barat, R; Seco, A; Pastor, L; Bouzas, A

2017-07-01

Interest in phosphorus (P) recovery and reuse has increased in recent years as supplies of P are declining. After use, most of the P remains in wastewater, making Wastewater Treatment Plants (WWTPs) a vital part of P recycling. In this work, a new sludge management operation was studied by modeling in order to recover P in the form of struvite and minimize operating problems due to uncontrolled P precipitation in WWTPs. During the study, intensive analytical campaigns were carried out on the water and sludge lines. The results identified the anaerobic digester as a "hot spot" of uncontrolled P precipitation (9.5 gP/kg sludge) and highlighted possible operating problems due to the accumulation of precipitates. A new sludge line management strategy was simulated therefore using DESASS © software, consisting of the elutriation of the mixed sludge in the mixing chamber, to reduce uncontrolled P precipitation and to obtain a P-rich stream (primary thickener supernatant) to be used in a crystallization process. The key operating parameters were found to be: the elutriation flow from the mixing chamber to the primary thickener, the digestion flow and the sludge blanket height of the primary thickener, with optimized values between 70 and 80 m 3 /d, 90-100 m 3 /d and 1.4-1.5 m, respectively. Under these operating conditions, the preliminary results showed that P concentration in the primary thickener overflow significantly increased (from 38 to 100 mg PO 4 -P/L), which shows that this stream is suitable for use in a subsequent crystallization reactor to recover P in the form of struvite. Copyright © 2017 Elsevier Ltd. All rights reserved.

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya

PubMed Central

Ashur, Sana Taher; Shah, Shamsul Azhar; Bosseri, Soad; Fah, Tong Seng; Shamsuddin, Khadijah

2016-01-01

Background Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. Methods A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8©), while glycaemic control status was based on the HbA1c level. Results Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03–2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05–3.54), patients on insulin (OR=3.14, 95% CI=1.66–6.03), and low-medication adherents (OR=2.25, 95% CI=1.36–3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77–0.94). Conclusion The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control. PMID:27005896

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya.

PubMed

Ashur, Sana Taher; Shah, Shamsul Azhar; Bosseri, Soad; Fah, Tong Seng; Shamsuddin, Khadijah

2016-01-01

Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8(©)), while glycaemic control status was based on the HbA1c level. Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94). The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

Glycaemic control status among type 2 diabetic patients and the role of their diabetes coping behaviours: a clinic-based study in Tripoli, Libya.

PubMed

Ashur, Sana Taher; Shah, Shamsul Azhar; Bosseri, Soad; Fah, Tong Seng; Shamsuddin, Khadijah

2016-01-01

Background Achieving good glycaemic control is important in diabetes management. However, poor glycaemic control is widely reported. This article assessed the prevalence of uncontrolled and poor glycaemic control among Libyans with type 2 diabetes and examined the relative contribution of diabetes coping behaviours to their glycaemic control status. Methods A cross-sectional study was undertaken in 2013 in a large diabetes centre in Tripoli. The study included 523 respondents. Diabetes coping behaviours were measured using the revised version of the Summary of Diabetes Self-Care Activities measure (SDSCA) and the eight-item Morisky Medication Adherence Scale (MMAS-8 © ), while glycaemic control status was based on the HbA1c level. Results Mean HbA1c was 8.9 (±2.1), and of the 523 patients, only 114 (21.8%) attained the glycaemic control target of HbAc1 of less than 7.0%. Females (OR=1.74, 95% CI=1.03-2.91), patients on insulin and oral hypoglycaemic agents (OR=1.92, 95% CI=1.05-3.54), patients on insulin (OR=3.14, 95% CI=1.66-6.03), and low-medication adherents (OR=2.25, 95% CI=1.36-3.73) were more likely to have uncontrolled and poor glycaemic control, while exercise contributed to glycaemic control status as a protective factor (OR=0.85, 95% CI=0.77-0.94). Conclusion The findings from this study showed the considerable burden of uncontrolled and poor glycaemic control in one of the largest diabetes care settings in Libya. Medication adherence as well as exercise promotion programs would help in reducing the magnitude of poor glycaemic control.

Antihypertensive drug use in resistant and nonresistant hypertension and in controlled and uncontrolled resistant hypertension.

PubMed

de la Sierra, Alejandro; Armario, Pedro; Oliveras, Anna; Banegas, José R; Gorostidi, Manuel; Vinyoles, Ernest; de la Cruz, Juan J; Segura, Julián; Ruilope, Luis M

2018-07-01

Treatment-resistant hypertension (TRH) is associated with particular clinical features, nonadherence, and suboptimal treatment. We assessed possible associations of antihypertensive drug classes, specific agents inside each class, and types of combinations, with the presence of non-TRH vs. TRH, and with controlled vs. uncontrolled TRH. Comparisons were done in 14 264 patients treated with three drugs (non-TRH: 2988; TRH: 11 276) and in 6974 treated with at least four drugs (controlled TRH: 1383; uncontrolled TRH: 5591). Associations were adjusted for age, sex, and previous cardiovascular event. In both groups of patients treated with three or with at least four drugs, aldosterone antagonists among drug classes [adjusted odds ratio (OR): 1.82 and 1.41, respectively], and ramipril (OR: 1.28 and 1.30), olmesartan (OR: 1.31 and 1.37), and amlodipine (OR: 1.11 and 1.41) inside each class were significantly associated with blood pressure control (non-TRH or controlled TRH). In patients treated with three drugs, non-TRH was also associated with the use of chlorthalidone (OR: 1.50) and bisoprolol (OR: 1.19), whereas in patients treated with at least four drugs, controlled TRH was significantly associated with the triple combination of a renin-angiotensin system blocker, a calcium channel blocker, and a diuretic (OR: 1.17). The use of aldosterone antagonists is associated with blood pressure control in patients treated with three or more drugs. Similar results are observed with specific agents inside each class, being ramipril, olmesartan, chlorthalidone, amlodipine, and bisoprolol those exhibiting significant results. An increased use of these drugs might probably reduce the burden of TRH.

DIOXIN EMISSIONS FROM OPEN AND UNCONTROLLED BURNING OF BIOMASS AND WASTE

EPA Science Inventory

Emissions of polychlorinated dibenzodioxins and dibenszofurans (PCDD/PCDF) from uncontrolled burring of biomass and waste are responsible for a significant, if not major, portion of the global releases. Limited testing for emissions, coupled with activity factors, shows that som...

Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands.

PubMed

Worm-Smeitink, M; Nikolaus, S; Goldsmith, K; Wiborg, J; Ali, S; Knoop, H; Chalder, T

2016-08-01

Cognitive behaviour therapy (CBT) reduces fatigue and disability in chronic fatigue syndrome (CFS). However, outcomes vary between studies, possibly because of differences in patient characteristics, treatment protocols, diagnostic criteria and outcome measures. The objective was to compare outcomes after CBT in tertiary treatment centres in the Netherlands (NL) and the United Kingdom (UK), using different treatment protocols but identical outcome measures, while controlling for differences in patient characteristics and diagnostic criteria. Consecutively referred CFS patients who received CBT were included (NL: n=293, UK: n=163). Uncontrolled effect sizes for improvement in fatigue (Chalder Fatigue Questionnaire), physical functioning (SF-36 physical functioning subscale) and social functioning (Work and Social Adjustment Scale) were compared. Multiple regression analysis was used to examine whether patient differences explained outcome differences between centres. Effect sizes differed between centres for fatigue (Cohen's D NL=1.74, 95% CI=1.52-1.95; UK=0.99, CI=0.73-1.25), physical functioning (NL=0.99, CI=0.81-1.18; UK=0.33, CI=0.08-0.58) and social functioning (NL=1.47, CI=1.26-1.69; UK=0.61, CI=0.35-0.86). Patients in the UK had worse physical functioning at baseline and there were minor demographic differences. These could not explain differences in centre outcome. Effectiveness of CBT differed between treatment centres. Differences in treatment protocols may explain this and should be investigated to help further improve outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: an uncontrolled before and after study.

PubMed

van Welie, Steven; Wijma, Linda; Beerden, Tim; van Doormaal, Jasperien; Taxis, Katja

2016-08-05

Residents of nursing homes often have difficulty swallowing (dysphagia), which complicates the administration of solid oral dosage formulations. Erroneously crushing medication is common, but few interventions have been tested to improve medication safety. Therefore, we evaluated the effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes. This was a prospective uncontrolled intervention study with a preintervention and postintervention measurement. The study was conducted on 18 wards (total of 200 beds) in 3 nursing homes in the North of the Netherlands. We observed 36 nurses/nursing assistants (92% female; 92% nursing assistants) administering medication to 197 patients (62.9% female; mean age 81.6). The intervention consisted of a set of warning symbols printed on each patient's unit dose packaging indicating whether or not a medication could be crushed as well as education of ward staff (lectures, newsletter and poster). The relative risk (RR) of a crushing error occurring in the postintervention period compared to the preintervention period. A crushing error was defined as the crushing of a medication considered unsuitable to be crushed based on standard reference sources. Data were collected using direct (disguised) observation of nurses during drug administration. The crushing error rate decreased from 3.1% (21 wrongly crushed medicines out of 681 administrations) to 0.5% (3/636), RR=0.15 (95% CI 0.05 to 0.51). Likewise, there was a significant reduction using data from patients with swallowing difficulties only, 87.5% (21 errors/24 medications) to 30.0% (3/10) (RR 0.34, 95% CI 0.13 to 0.89). Medications which were erroneously crushed included enteric-coated formulations (eg, omeprazole), medication with regulated release systems (eg, Persantin; dipyridamol) and toxic substances (eg, finasteride). Warning symbols combined with education reduced erroneous crushing of medication, a well-known and common problem in nursing homes. 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/

Impact of Behavioral Control on the Processing of Nociceptive Stimulation

PubMed Central

Grau, James W.; Huie, J. Russell; Garraway, Sandra M.; Hook, Michelle A.; Crown, Eric D.; Baumbauer, Kyle M.; Lee, Kuan H.; Hoy, Kevin C.; Ferguson, Adam R.

2012-01-01

How nociceptive signals are processed within the spinal cord, and whether these signals lead to behavioral signs of neuropathic pain, depends upon their relation to other events and behavior. Our work shows that these relations can have a lasting effect on spinal plasticity, inducing a form of learning that alters the effect of subsequent nociceptive stimuli. The capacity of lower spinal systems to adapt, in the absence of brain input, is examined in spinally transected rats that receive a nociceptive shock to the tibialis anterior muscle of one hind leg. If shock is delivered whenever the leg is extended (controllable stimulation), it induces an increase in flexion duration that minimizes net shock exposure. This learning is not observed in subjects that receive the same amount of shock independent of leg position (uncontrollable stimulation). These two forms of stimulation have a lasting, and divergent, effect on subsequent learning: controllable stimulation enables learning whereas uncontrollable stimulation disables it (learning deficit). Uncontrollable stimulation also enhances mechanical reactivity. We review evidence that training with controllable stimulation engages a brain-derived neurotrophic factor (BDNF)-dependent process that can both prevent and reverse the consequences of uncontrollable shock. We relate these effects to changes in BDNF protein and TrkB signaling. Controllable stimulation is also shown to counter the effects of peripheral inflammation (from intradermal capsaicin). A model is proposed that assumes nociceptive input is gated at an early sensory stage. This gate is sensitive to current environmental relations (between proprioceptive and nociceptive input), allowing stimulation to be classified as controllable or uncontrollable. We further propose that the status of this gate is affected by past experience and that a history of uncontrollable stimulation will promote the development of neuropathic pain. PMID:22934018

Asthma control in Saudi Arabia: Gender implications.

PubMed

Torchyan, Armen A

2017-05-01

Gender-related factors in asthma control should be considered in clinical consultations to substantially improve asthma control in women. Meanwhile, a limited number of studies have been reported on gender differences in factors related to asthma control, especially in Saudi Arabia. To study the potential gender differences in factors associated with asthma control among adult patients with physician-diagnosed asthma. A cross-sectional study was conducted in adult patients with asthma who attended primary care clinics at three major hospitals in Riyadh, Saudi Arabia. Asthma control was measured by using the Asthma Control Test. Asthma control status was classified as either controlled (Asthma Control Test score of >19) or uncontrolled (Asthma Control Test score of ≤19). Multiple logistic regression analysis was performed. In this study, 58.9% of men and 77.0% of women had uncontrolled asthma (p = 0.002). Factors associated with uncontrolled asthma were different between men and women, except for household income. Reporting higher levels of stress (odds ratio [OR] 4.3 [95% confidence interval {CI}, 1.7-11.1]), daily tobacco smoking (OR 5.8 [95% CI, 1.5-23.5]), and a monthly household income of <15,000 Saudi Arabian Riyals (OR 4.5 [95% CI, 1.9-10.5]) were associated with uncontrolled asthma in men. Being unemployed (OR 3.4 [95% CI, 1.3-9.4]), being obese (OR 3.2 [95% CI, 1.1-9.2]), or having a monthly household income of <15,000 Saudi Arabian Riyals (OR 3.1 [95% CI, 1.2-8.0]) were associated with uncontrolled asthma in women. This study demonstrated that many factors, such as stress, occupation, and obesity, had a differential relationship with uncontrolled asthma among men and women in Saudi Arabia that could provide more insight into methods of improving asthma control, especially in women.

When Pain Hurts: Nociceptive Stimulation Induces a State of Maladaptive Plasticity and Impairs Recovery after Spinal Cord Injury.

PubMed

Grau, James W; Huang, Yung-Jen; Turtle, Joel D; Strain, Misty M; Miranda, Rajesh C; Garraway, Sandra M; Hook, Michelle A

2017-05-15

Spinal cord injury (SCI) is often accompanied by other tissue damage (polytrauma) that provides a source of pain (nociceptive) input. Recent findings are reviewed that show SCI places the caudal tissue in a vulnerable state that exaggerates the effects nociceptive stimuli and promotes the development of nociceptive sensitization. Stimulation that is both unpredictable and uncontrollable induces a form of maladaptive plasticity that enhances nociceptive sensitization and impairs spinally mediated learning. In contrast, relational learning induces a form of adaptive plasticity that counters these adverse effects. SCI sets the stage for nociceptive sensitization by disrupting serotonergic (5HT) fibers that quell overexcitation. The loss of 5HT can enhance neural excitability by reducing membrane-bound K + -Cl - cotransporter 2, a cotransporter that regulates the outward flow of Cl - . This increases the intracellular concentration of Cl - , which reduces the hyperpolarizing (inhibitory) effect of gamma-aminobutyric acid. Uncontrollable noxious stimulation also undermines the recovery of locomotor function, and increases behavioral signs of chronic pain, after a contusion injury. Nociceptive stimulation has a greater effect if experienced soon after SCI. This adverse effect has been linked to a downregulation in brain-derived neurotrophic factor and an upregulation in the cytokine, tumor necrosis factor. Noxious input enhances tissue loss at the site of injury by increasing the extent of hemorrhage and apoptotic/pyroptotic cell death. Intrathecal lidocaine blocks nociception-induced hemorrhage, cellular indices of cell death, and its adverse effect on behavioral recovery. Clinical implications are discussed.

APPROACHES FOR REMEDIATION OF UNCONTROLLED WOOD PRESERVING SITES

EPA Science Inventory

This document provides an overview of remediation of uncontrolled wood preserving sites. It is, in part, a distillation of discussions that took place at a Forum on Wood Preserving Waste that was held in San Francisco, California, in October 1988. Information from this workshop h...

36 CFR 228.108 - Surface use requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... authorized in an approved surface use plan of operations, protect such resources. (e) Fire prevention and control. To the extent practicable, the operator shall take measures to prevent uncontrolled fires on the area of operation and to suppress uncontrolled fires resulting from the operations. (f) Fisheries...

36 CFR 228.108 - Surface use requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... authorized in an approved surface use plan of operations, protect such resources. (e) Fire prevention and control. To the extent practicable, the operator shall take measures to prevent uncontrolled fires on the area of operation and to suppress uncontrolled fires resulting from the operations. (f) Fisheries...

36 CFR 228.108 - Surface use requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... authorized in an approved surface use plan of operations, protect such resources. (e) Fire prevention and control. To the extent practicable, the operator shall take measures to prevent uncontrolled fires on the area of operation and to suppress uncontrolled fires resulting from the operations. (f) Fisheries...

The influence of type 1 and type 2 diabetes on periodontal disease progression: prospective results from the Study of Health in Pomerania (SHIP).

PubMed

Demmer, Ryan T; Holtfreter, Birte; Desvarieux, Moïse; Jacobs, David R; Kerner, Wolfgang; Nauck, Matthias; Völzke, Henry; Kocher, Thomas

2012-10-01

To explore associations between diabetes etiology (type 1 diabetes mellitus [T1DM] vs. T2DM) and glycemic control in the prediction of 5-year periodontal status change. The Study of Health in Pomerania (SHIP) is a population-based stratified sample of German men and women. Healthy participants and those determined to have T2DM arose from the SHIP cohort, and T1DM participants were recruited from diabetes clinics in the catchment area that gave rise to SHIP. Dentate participants (n = 2,626; 53% women; 20-81 years of age) were included. Diabetes was determined via physician diagnosis and/or HbA(1c) ≥6.5% (uncontrolled diabetes >7.0%). Examiners blinded to diabetes status performed random half-mouth periodontal examinations, assessing probing depth (PD) and attachment loss (AL) (four sites/tooth) at baseline and follow-up. Participants were categorized into six groups as follows: 1) diabetes free (n = 2,280), 2) incident T2DM (n = 79), 3) controlled T2DM (n = 80), 4) uncontrolled T2DM (n = 72), 5) controlled T1DM (n = 43), and 6) uncontrolled T1DM (n = 72). In multivariable regressions, mean PD change (ΔMPD), mean AL change (ΔMAL), or incident tooth-loss values were regressed across the aforementioned diabetes categories. Mean (SD) ΔMPD and ΔMAL values among all participants were -0.08 ± 0.5 mm and 0.08 ± 1.03 mm, respectively, and 34% lost one or more teeth. Relative to diabetes-free participants, those with uncontrolled T2DM experienced greater ΔMPD ± SE (P < 0.05), whereas participants with either uncontrolled T1DM or uncontrolled T2DM realized greater ΔMAL (P < 0.05). Uncontrolled T1DM and T2DM were both associated with an increased risk of future tooth loss (P < 0.05). Diabetes control, but not etiology, was associated with future tooth loss and accelerated AL progression.

Reducing the Blood Pressure-Related Burden of Cardiovascular Disease: Impact of Achievable Improvements in Blood Pressure Prevention and Control.

PubMed

Hardy, Shakia T; Loehr, Laura R; Butler, Kenneth R; Chakladar, Sujatro; Chang, Patricia P; Folsom, Aaron R; Heiss, Gerardo; MacLehose, Richard F; Matsushita, Kunihiro; Avery, Christy L

2015-10-27

US blood pressure reduction policies are largely restricted to hypertensive populations and associated benefits are often estimated based on unrealistic interventions. We used multivariable linear regression to estimate incidence rate differences contrasting the impact of 2 pragmatic hypothetical interventions to reduce coronary heart disease, stroke, and heart failure (HF) incidence: (1) a population-wide intervention that reduced systolic blood pressure by 1 mm Hg and (2) targeted interventions that reduced the prevalence of unaware, untreated, or uncontrolled blood pressure above goal (per Eighth Joint National Committee treatment thresholds) by 10%. In the Atherosclerosis Risk in Communities Study (n=15 744; 45 to 64 years at baseline, 1987-1989), incident coronary heart disease and stroke were adjudicated by physician panels. Incident HF was defined as the first hospitalization with discharge diagnosis code of "428." A 10% proportional reduction in unaware, untreated, or uncontrolled blood pressure above goal resulted in ≈4.61, 3.55, and 11.01 fewer HF events per 100,000 person-years in African Americans, and 3.77, 1.63, and 4.44 fewer HF events per 100 000 person-years, respectively, in whites. In contrast, a 1 mm Hg population-wide systolic blood pressure reduction was associated with 20.3 and 13.3 fewer HF events per 100 000 person-years in African Americans and whites, respectively. Estimated event reductions for coronary heart disease and stroke were smaller than for HF, but followed a similar pattern for both population-wide and targeted interventions. Modest population-wide shifts in systolic blood pressure could have a substantial impact on cardiovascular disease incidence and should be developed in parallel with interventions targeting populations with blood pressure above goal. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Exploring why Costa Rica outperforms the United States in life expectancy: A tale of two inequality gradients.

PubMed

Rosero-Bixby, Luis; Dow, William H

2016-02-02

Mortality in the United States is 18% higher than in Costa Rica among adult men and 10% higher among middle-aged women, despite the several times higher income and health expenditures of the United States. This comparison simultaneously shows the potential for substantially lowering mortality in other middle-income countries and highlights the United States' poor health performance. The United States' underperformance is strongly linked to its much steeper socioeconomic (SES) gradients in health. Although the highest SES quartile in the United States has better mortality than the highest quartile in Costa Rica, US mortality in its lowest quartile is markedly worse than in Costa Rica's lowest quartile, providing powerful evidence that the US health inequality patterns are not inevitable. High SES-mortality gradients in the United States are apparent in all broad cause-of-death groups, but Costa Rica's overall mortality advantage can be explained largely by two causes of death: lung cancer and heart disease. Lung cancer mortality in the United States is four times higher among men and six times higher among women compared with Costa Rica. Mortality by heart disease is 54% and 12% higher in the United States than in Costa Rica for men and women, respectively. SES gradients for heart disease and diabetes mortality are also much steeper in the United States. These patterns may be partly explained by much steeper SES gradients in the United States compared with Costa Rica for behavioral and medical risk factors such as smoking, obesity, lack of health insurance, and uncontrolled dysglycemia and hypertension.

Exploring why Costa Rica outperforms the United States in life expectancy: A tale of two inequality gradients

PubMed Central

Rosero-Bixby, Luis; Dow, William H.

2016-01-01

Mortality in the United States is 18% higher than in Costa Rica among adult men and 10% higher among middle-aged women, despite the several times higher income and health expenditures of the United States. This comparison simultaneously shows the potential for substantially lowering mortality in other middle-income countries and highlights the United States’ poor health performance. The United States’ underperformance is strongly linked to its much steeper socioeconomic (SES) gradients in health. Although the highest SES quartile in the United States has better mortality than the highest quartile in Costa Rica, US mortality in its lowest quartile is markedly worse than in Costa Rica’s lowest quartile, providing powerful evidence that the US health inequality patterns are not inevitable. High SES-mortality gradients in the United States are apparent in all broad cause-of-death groups, but Costa Rica’s overall mortality advantage can be explained largely by two causes of death: lung cancer and heart disease. Lung cancer mortality in the United States is four times higher among men and six times higher among women compared with Costa Rica. Mortality by heart disease is 54% and 12% higher in the United States than in Costa Rica for men and women, respectively. SES gradients for heart disease and diabetes mortality are also much steeper in the United States. These patterns may be partly explained by much steeper SES gradients in the United States compared with Costa Rica for behavioral and medical risk factors such as smoking, obesity, lack of health insurance, and uncontrolled dysglycemia and hypertension. PMID:26729886

DECONTAMINATION OF HAZARDOUS WASTE SUBSTANCES FROM SPILLS AND UNCONTROLLED WASTE SITES BY RADIO FREQUENCY IN SITU HEATING

EPA Science Inventory

The radio frequency (RF) heating process can be used to volumetrically heat and thus decontaminate uncontrolled landfills and hazardous substances from spills. After the landfills are heated, decontamination of the hazardous substances occurs due to thermal decomposition, vaporiz...

26 CFR 1.482-5 - Comparable profits method.

Code of Federal Regulations, 2010 CFR

2010-04-01

... operating profit represents a return for the investment of resources and assumption of risks. Therefore... from a sufficient number of years of data to reasonably measure returns that accrue to uncontrolled... party and uncontrolled comparables include the following— (i) Rate of return on capital employed. The...

Effects of Prolonged Deprivation on Learned Helplessness.

ERIC Educational Resources Information Center

Mal, Suraj; And Others

1990-01-01

Investigated influence of prolonged deprivation on responses to uncontrollable outcome among 104 Indian students in the tenth grade. Finds high-deprived and female students displayed greater helplessness than did their low-deprived and male counterparts. Females and high-deprives students attributed uncontrollable outcome more to internal, stable,…

Nitrate-rich beetroot juice selectively lowers ambulatory pressures and LDL cholesterol in uncontrolled but not controlled hypertension: a pilot study.

PubMed

Kerley, C P; Dolan, E; Cormican, L

2017-11-01

Dietary nitrate has been shown to increase nitrate/nitrite levels in multiple populations, with potential blood pressure lowering effects. However, there are few reports among hypertensives. We aimed to assess the effect of daily nitrate in subjects with controlled hypertension vs. uncontrolled hypertension. On day 0, hypertensives wore an ambulatory BP monitor (ABPM) for 24 h and fasting blood was taken. Subjects then consumed concentrated beetroot juice (12.9 mmol nitrate) for 14 consecutive days. On day 14 subjects consumed their last nitrate dose after fasting blood was drawn and again had an ABPM for 24 h. According to baseline ABPM, 11 subjects had controlled BP while 8 had uncontrolled BP. There were similar, significant increases in serum nitrate/nitrite in both groups. We observed little change in BP variables among controlled hypertensives. However, there were reductions in BP variables in uncontrolled hypertensives where decreases in nighttime DBP (-6 ± 4.8 mmHg), arterial stiffness (-0.08 ± 0.03 ambulatory arterial stiffness index) and LDL (-0.36 ± 0.42 mmol/L) reached significance (p = 003, 0.05 and 0.046, respectively). Our results support the existing data suggesting an anti-hypertensive effect of nitrate-containing beetroot juice, but only among those with uncontrolled hypertension.

Factors Associated with Uncontrolled Hypertension among Renal Transplant Recipients Attending Nephrology Clinics in Nairobi, Kenya

PubMed Central

Kubo, Mary N.; Kayima, Joshua K.; Were, Anthony J.; McLigeyo, Seth O.; Ogola, Elijah N.

2015-01-01

Objective. To determine the factors associated with poor blood pressure control among renal transplant recipients in a resource-limited setting. Methods. A cross-sectional study was carried out on renal transplant recipients at the Kenyatta National Hospital. Sociodemographic details, blood pressure, urine albumin : creatinine ratio, and adherence using the MMAS-8 questionnaire were noted. Independent factors associated with uncontrolled hypertension were determined using logistic regression analysis. Results. 85 subjects were evaluated. Mean age was 42.4 (SD ± 12.2) years, with a male : female ratio of 1.9 : 1. Fifty-five patients (64.7%) had uncontrolled hypertension (BP ≥ 130/80 mmHg). On univariate analysis, male sex (OR 3.7, 95% CI 1.4–9.5, p = 0.006), higher levels of proteinuria (p = 0.042), and nonadherence to antihypertensives (OR 18, 95% CI 5.2–65.7, p < 0.001) were associated with uncontrolled hypertension. On logistic regression analysis, male sex (adjusted OR 4.6, 95% CI 1.1–19.0, p = 0.034) and nonadherence (adjusted OR 33.8, 95% CI 8.6–73.0, p < 0.001) were independently associated with uncontrolled hypertension. Conclusion. Factors associated with poor blood pressure control in this cohort were male sex and nonadherence to antihypertensives. Emphasis on adherence to antihypertensive therapy must be pursued within this population. PMID:26257920

Physical and chemical characteristics of the longissimus dorsi from swine reared in climate-controlled and uncontrolled environments

NASA Astrophysics Data System (ADS)

de Mello, Juliana Lolli Malagoli; Berton, Mariana Piatto; de Cassia Dourado, Rita; Giampietro-Ganeco, Aline; de Souza, Rodrigo Alves; Ferrari, Fábio Borba; de Souza, Pedro Alves; Borba, Hirasilva

2017-10-01

The aim of this study was to evaluate the effect of ambient temperature on the physical and chemical characteristics of the longissimus dorsi muscle by comparing the quality of meat from pigs reared in a controlled and in an uncontrolled environment, the latter provided with a shallow pool. Twenty castrated male pigs of the Topigs line were randomly allotted to two treatments: a controlled environment, with constant temperature (22 °C) and relative humidity (70%); and an uncontrolled environment in a conventional shed for rearing pigs equipped with a shallow pool, where pigs were subject to climatic variations. Meat from pigs kept in the controlled environment showed a greater capacity to retain intracellular water, higher tenderness, and lower cholesterol levels than meat from pigs reared in the uncontrolled environment, but displayed higher lipid oxidation and a lower concentration of DHA. Treatments had no effect on color, pH, chemical composition, or fatty acid profile (except DHA concentration). Rearing pigs in sheds equipped with a shallow pool minimizes the effects of environmental heat on meat quality, allowing the production of high-quality meat in warm climate regions without expensive investments. Animals reared in an uncontrolled environment equipped with a shallow pool are able to produce meat with characteristics within the quality standards and with similar quality to that of meat from animals raised in controlled environment.

Lipid peroxidation and antioxidant enzymes activity in controlled and uncontrolled Type 2 diabetic patients.

PubMed

Zarei, Mahnaz; Farahnak, Zahra; Hosseinzadeh-Attar, Mohammad Javad; Javanbakht, Mohammad Hassan; Hosseinzadeh, Payam; Derakhshanian, Hoda; Farahbakhsh-Farsi, Payam; Djalali, Mahmoud

2016-05-01

This study was designed to compare lipid peroxidation and antioxidant enzymes activity in Type 2 diabetes patients with good or weak glycemic control. In this case-control study, 62 Type 2 diabetic patients with glycated hemoglobin (HbA1c) between 6 and 8 were enrolled as the controlled group and 55 patients with HbA1c > 8 were selected as an uncontrolled group. Patients were all referred to Iranian Diabetes Association in Tehran, Iran, from 2010 onward. Groups were chosen by convenience sampling and were matched based on age, sex and duration of disease. Demographic questionnaire, two 24-hour food recall, HbA1c, insulin, malondialdehyde (MDA), superoxide dismutase (SOD), and catalase were measured in blood samples. Data were analyzed by Food Processor II and SPSS software. A mean daily consumption of energy, carbohydrate, protein, and fat was not significantly different between two groups. MDA in the uncontrolled group was significantly higher than controlled group (2.03 ± 0.88 vs. 1.65 ± 1.01 nmol/ml; P = 0.030). A mean SOD was slightly higher in the uncontrolled group comparing to the control group (843.3 ± 101.9 vs. 828.0 ± 127.3 U/g Hb; P = 0.400). These data suggest that MDA as a lipid peroxidation indicator is higher in uncontrolled diabetes probably due to chronic high blood sugar followed by higher oxidative stress.

Physical and chemical characteristics of the longissimus dorsi from swine reared in climate-controlled and uncontrolled environments.

PubMed

de Mello, Juliana Lolli Malagoli; Berton, Mariana Piatto; de Cassia Dourado, Rita; Giampietro-Ganeco, Aline; de Souza, Rodrigo Alves; Ferrari, Fábio Borba; de Souza, Pedro Alves; Borba, Hirasilva

2017-10-01

The aim of this study was to evaluate the effect of ambient temperature on the physical and chemical characteristics of the longissimus dorsi muscle by comparing the quality of meat from pigs reared in a controlled and in an uncontrolled environment, the latter provided with a shallow pool. Twenty castrated male pigs of the Topigs line were randomly allotted to two treatments: a controlled environment, with constant temperature (22 °C) and relative humidity (70%); and an uncontrolled environment in a conventional shed for rearing pigs equipped with a shallow pool, where pigs were subject to climatic variations. Meat from pigs kept in the controlled environment showed a greater capacity to retain intracellular water, higher tenderness, and lower cholesterol levels than meat from pigs reared in the uncontrolled environment, but displayed higher lipid oxidation and a lower concentration of DHA. Treatments had no effect on color, pH, chemical composition, or fatty acid profile (except DHA concentration). Rearing pigs in sheds equipped with a shallow pool minimizes the effects of environmental heat on meat quality, allowing the production of high-quality meat in warm climate regions without expensive investments. Animals reared in an uncontrolled environment equipped with a shallow pool are able to produce meat with characteristics within the quality standards and with similar quality to that of meat from animals raised in controlled environment.

Changing the 30-min Rule in Canada: The Effect of Room Temperature on Bacterial Growth in Red Blood Cells.

PubMed

Ramirez-Arcos, Sandra; Kou, Yuntong; Ducas, Éric; Thibault, Louis

2016-11-01

To maintain product quality and safety, the '30-min rule' requires the discard of red blood cells (RBCs) that are exposed to uncontrolled temperatures for more than 30 min. Recent studies suggest this rule may safely be extended to a 60-min rule. A pool-and-split design study (N = 4) was run in parallel at Canadian Blood Services (SAGM RBCs) and Héma-Québec (AS-3 RBCs). RBCs were spiked with ∼1 colony-forming unit/ml of mesophilic and psychrophilic bacteria. Control units remained in storage at 1-6 °C for 42 days. Test 30 (T30) and T60 units were exposed to room temperature (RT) six times during storage, each time for 30 and 60 min, respectively. Bacterial proliferation was monitored. Mesophilic bacteria do not proliferate in RBCs. The growth of psychrophilic bacteria is not significantly different in RBCs exposed for 30 or 60 min to RT (p < 0.05). The study findings were the final evidence to support extension from a 30-min rule to a 60-min rule in Canada.

V-Go Insulin Delivery System Versus Multiple Daily Insulin Injections for Patients With Uncontrolled Type 2 Diabetes Mellitus.

PubMed

Winter, Abigail; Lintner, Michaela; Knezevich, Emily

2015-04-21

Type 2 diabetes mellitus affects over 29.1 million Americans, diagnosed and undiagnosed. Achieving and maintaining glycemic control for these patients is of extreme importance when working to prevent complications and improve quality of life for patients. The V-Go is a newly developed insulin delivery system. The push of a button inserts a needle into the patient once daily and remains attached for 24 hours. The V-Go is designed to release a set basal rate throughout the day, while allowing patients to provide up to 36 units of on-demand bolus insulin with the manual click of 2 buttons. It is a spring-loaded device filled daily with rapid-acting insulin that runs without the use of batteries or computer software. The main objective of this prospective active comparator study was to observe the A1C lowering effects of multiple daily insulin injections (MDII) versus the use of the V-Go insulin delivery system for patients with uncontrolled type 2 diabetes mellitus over a 3-month period. In addition, the effect on insulin requirement for these patients was assessed with secondary comparisons of weight, blood pressure, prevalence of hypoglycemic events, and quality of life before and after 3 months of intensified insulin therapy with regular monitoring by a clinical pharmacist at an internal medicine clinic. The average A1C lowering experienced by the 3 patients in the V-Go group was 1.5%, while the average A1C change in the 3 patients in the MDII group was an increase of 0.2%. All patients in the V-Go group experienced a decrease in insulin total daily dose (TDD), with an average decrease of 26.3 units. All patients in the MDII group experienced an increase in insulin TDD with an average of 15 units daily to achieve therapeutic goals individualized for each patient. All patients who underwent intensification of insulin therapy experienced an increase in subjective quality of life (QOL) as determined using the Diabetes-39 (D-39) questionnaire, though QOL results lacked statistical significance. © 2015 Diabetes Technology Society.

Effectiveness of interventions to reduce exposure to lead through consumer products and drinking water: A systematic review.

PubMed

Pfadenhauer, Lisa Maria; Burns, Jacob; Rohwer, Anke; Rehfuess, Eva Annette

2016-05-01

The objective of this systematic review is to assess the effectiveness of regulatory, environmental and educational interventions for reducing blood lead levels (BLLs) and associated health outcomes in children, pregnant women and the general population. Searches were run in MEDLINE, EMBASE and the Global Health Library up until August 2015. Studies were eligible for inclusion if they assessed the impact of regulatory, environmental or educational interventions, stand-alone or in combination, on BLLs among children, pregnant women or the general population through randomized controlled trials (RCT), controlled before-after (CBA), interrupted time series (ITS), uncontrolled before-after (UBA) or repeated cross-sectional studies. Studies assessing the impact of interventions to reduce exposure to lead in paint or household dust as well as studies concerned exclusively with environmental concentrations of lead were not included. As documented in a detailed protocol, screening, data extraction and quality appraisal were largely undertaken according to Cochrane standards. Harvest plots were used to graphically summarize evidence of effectiveness. The searches yielded 6466 unique records, of which five met our eligibility criteria; two additional eligible studies were identified by experts. We did not find any studies regarding the effectiveness of regulatory, educational or environmental interventions targeting exposure to lead in consumer products. Evidence regarding the effectiveness of interventions in reducing BLLs from exposures through drinking water is limited in both quantity and quality. Stand-alone targeted educational interventions showed no statistically significant reductions in children's BLL (two RCT) when compared to general educational interventions. Likewise, instructing women to reduce or eliminate lead-contaminated drinking water showed no effect on BLL (one RCT). Stand-alone environmental interventions appeared more promising in reducing BLL (three UBA). Combining educational and environmental interventions and targeting multiple settings may be effective in reducing BLL, as suggested by one uncontrolled before-after study. No studies examining the effectiveness of regulatory interventions were found. The limited quantity and quality of the evidence measuring BLL and associated health outcomes points to an urgent need for more robust research into the effectiveness of interventions to reduce lead exposure from consumer products and drinking water, especially for regulatory interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

Homeostasis 5: nurses as external agents of control in breast cancer.

PubMed

Clancy, John; McVicar, Andrew

Breast cancer is caused by a homeostatic imbalance of cell division. Healthcare practitioners need to understand cellular activities to appreciate the physiological basis of health (homeostasis), the pathophysiological basis of illness and the physiological rationale of healthcare. Cells are the 'basic unit of life' (Clancy and McVicar, 2011a). This article describes normal cell division and the anatomy and physiology of the breast and, using a case study, will show how breast cancer is a homeostatic imbalance of cell division. There are analogies between the components of homeostasis and the components of the nursing (healthcare) process (Clancy and McVicar, 2011b) in the condition of breast cancer. After reading this article, nurses should be able to: understand that breast cancer is a cellular hence chemical imbalance that causes uncontrollable mitotic division of breast cells; understand how the cell cycle of cancer cells differs from that of normal cells; identify nature-nurture interactions involved in the aetiology of breast cancer; understand that when caring for people with breast cancer, health professionals including oncology nurses are acting as external agents of homeostatic control as the patient 'recovers' from breast cancer, and also to some extent when reducing signs and symptoms, hence quality of life, by providing palliative care.

Dangerous noncompliance: a narrative analysis of a CNN special investigation of mental illness.

PubMed

Glick, Douglas; Applbaum, Kalman

2010-08-01

Prevention of illness has become a central theme in debates over strategies to reduce healthcare costs. Severe mental illness poses a special challenge to the paradigm of rational prevention, the principal strategy of which is adherence to pharmacological therapies. With the contraction in the US of in-patient psychiatric care from the 1960s onwards, the mentally ill have become more visible among the homeless and among those caught up in the penal system. Their characteristic visibility contributes to their image as threatening. The perceived dangerousness and the combined societal and economic costs associated with the illness have generated a heightened, and in some venues even a sensationalized rhetoric surrounding the questions of responsibility and control, which we consider in terms of compliance. Using the linguistic method of discourse analysis, we analyze one high profile instance - an episode of CNN's 'Special Investigations Unit', which aired several times in the summer of 2007 - to demonstrate a narrative linking of the high social costs and failures associated with noncompliance and, therefore, the imperative of enforcing it for the safety of society. Through the semiotic reduction of a 'poetic parallelism', the episode reflects and reinforces existing cultural models for mental illness, including its status as straightforward biological disease amenable to pharmacological therapy but which remains uncontrolled due to widespread noncompliance.

Medium chain triglycerides (MCT) in aging and arteriosclerosis.

PubMed

Kaunitz, H

1986-01-01

Some of the nutritional work with triglycerides consisting mainly of C8 and C10 fatty acids (MCT) lends itself to speculations about their influence on arteriosclerosis. Arteriosclerosis is thought to be part of the normal aging process which is due to age associated molecular biological changes. The lipid theory of arteriosclerosis is rejected. Pertinent studies with MCT include these observations. Feeding of MCT to rats resulted in animals of low body weight, small fat deposits and excellent survival rate. This deserves emphasis because of the beneficial influence of low body weight on aging and arteriosclerosis. MCT feeding was associated with low linoleate and low tocopherol requirements in rats. This may lead to reduced formation of those linoleate derived prostaglandins which favor thrombosis formation. Lower linoleate requirements may also lead to the presence of fewer uncontrolled free radicals in the cells. MCT feeding is associated with low levels of serum and liver cholesterol involving speculations that tissue conditions are such that an adaptive increase of cholesterol is unnecessary. The Demographic Yearbook of the United Nations (1978) reported that Sri Lanka has the lowest death rate from ischemic heart disease. Sri Lanka is the only of the countries giving reliable data where coconut oil (containing over 50% medium chain fatty acids) is the main dietary fat.

VARIABLES AFFECTING EMISSIONS OF PCDDS/FS FROM UNCONTROLLED COMBUSTION OF HOUSEHOLD WASTE IN BARRELS

EPA Science Inventory

The uncontrolled burning of household waste in barrels has recently been implicated as a major source of airborne emissions of polychlorinated dibenzo-p-dioxins and polychlorinated dibenzofurans (PCDDs/Fs). Based on the need to generate a more accurate emission factor for burn ba...

40 CFR 63.1386 - Notification, recordkeeping, and reporting requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... temperature above the molten glass in an uncontrolled cold top electric furnace, including any period when the... glass surface, the date and time of the exceedance, when corrective actions were initiated, the cause of... was corrected; (iv) Uncontrolled glass-melting furnace (that is not a cold top electric furnace...

40 CFR 63.1386 - Notification, recordkeeping, and reporting requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... temperature above the molten glass in an uncontrolled cold top electric furnace, including any period when the... glass surface, the date and time of the exceedance, when corrective actions were initiated, the cause of... was corrected; (iv) Uncontrolled glass-melting furnace (that is not a cold top electric furnace...

40 CFR 63.1386 - Notification, recordkeeping, and reporting requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... temperature above the molten glass in an uncontrolled cold top electric furnace, including any period when the... glass surface, the date and time of the exceedance, when corrective actions were initiated, the cause of... was corrected; (iv) Uncontrolled glass-melting furnace (that is not a cold top electric furnace...

40 CFR 63.1386 - Notification, recordkeeping, and reporting requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... temperature above the molten glass in an uncontrolled cold top electric furnace, including any period when the... glass surface, the date and time of the exceedance, when corrective actions were initiated, the cause of... was corrected; (iv) Uncontrolled glass-melting furnace (that is not a cold top electric furnace...

Within Your Control? When Problem Solving May Be Most Helpful.

PubMed

Sarfan, Laurel D; Gooch, Peter; Clerkin, Elise M

2017-08-01

Emotion regulation strategies have been conceptualized as adaptive or maladaptive, but recent evidence suggests emotion regulation outcomes may be context-dependent. The present study tested whether the adaptiveness of a putatively adaptive emotion regulation strategy-problem solving-varied across contexts of high and low controllability. The present study also tested rumination, suggested to be one of the most putatively maladaptive strategies, which was expected to be associated with negative outcomes regardless of context. Participants completed an in vivo speech task, in which they were randomly assigned to a controllable ( n = 65) or an uncontrollable ( n = 63) condition. Using moderation analyses, we tested whether controllability interacted with emotion regulation use to predict negative affect, avoidance, and perception of performance. Partially consistent with hypotheses, problem solving was associated with certain positive outcomes (i.e., reduced behavioral avoidance) in the controllable (vs. uncontrollable) condition. Consistent with predictions, rumination was associated with negative outcomes (i.e., desired avoidance, negative affect, negative perception of performance) in both conditions. Overall, findings partially support contextual models of emotion regulation, insofar as the data suggest that the effects of problem solving may be more adaptive in controllable contexts for certain outcomes, whereas rumination may be maladaptive regardless of context.

Controlled crack growth specimen for brittle systems

NASA Technical Reports Server (NTRS)

Calomino, Anthony M.; Brewer, David N.

1990-01-01

A pure Mode 1 fracture specimen and test procedure has been developed which provides extended, stable, through-thickness crack growth in ceramics and other brittle, nonmetallic materials. Fixed displacement loading, applied at the crack mouth, promotes stable crack extension by reducing the stored elastic strain energy. Extremely fine control of applied displacements is achieved by utilizing the Poisson's expansion of a compressively loaded cylindrical pin. Stable cracks were successfully grown in soda-lime glass and monolithic Al2O3 for lengths in excess of 20 mm without uncontrollable catastrophic failure.

Controlled crack growth specimen for brittle systems

NASA Technical Reports Server (NTRS)

Calomino, Anthony M.; Brewer, David N.

1992-01-01

A pure Mode 1 fracture specimen and test procedure has been developed which provides extended, stable, through-thickness crack growth in ceramics and other brittle, nonmetallic materials. Fixed displacement loading, applied at the crack mouth, promotes stable crack extension by reducing the stored elastic strain energy. Extremely fine control of applied displacements is achieved by utilizing the Poisson's expansion of a compressively loaded cylindrical pin. Stable cracks were successfully grown in soda-lime glass and monolithic Al2O3 for lengths in excess of 2O mm without uncontrollable catastrophic failure.

Pulse combustion engineering research laboratory for indirect heating applications (PERL-IH). Final report, October 1, 1989-June 30, 1992

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

Belles, F.E.

1993-01-01

Uncontrolled NOx emissions from a variety of pulse combustors were measured. The implementation of flue-gas recirculation to reduce NOx was studied. A flexible workstation for parametric testing was built and used to study the phasing between pressure and heat release, and effects of fuel/air mixing on performance. Exhaust-pipe heat transfer was analyzed. An acoustic model of pulse combustion was developed. Technical support was provided to manufacturers on noise, ignition and condensation. A computerized bibliographic database on pulse combustion was created.

When Does Stress Help or Harm? The Effects of Stress Controllability and Subjective Stress Response on Stroop Performance

PubMed Central

Henderson, Roselinde K.; Snyder, Hannah R.; Gupta, Tina; Banich, Marie T.

2012-01-01

The ability to engage in goal-directed behavior despite exposure to stress is critical to resilience. Questions of how stress can impair or improve behavioral functioning are important in diverse settings, from athletic competitions to academic testing. Previous research suggests that controllability is a key factor in the impact of stress on behavior: learning how to control stressors buffers people from the negative effects of stress on subsequent cognitively demanding tasks. In addition, research suggests that the impact of stress on cognitive functioning depends on an individual’s response to stressors: moderate responses to stress can lead to improved performance while extreme (high or low) responses can lead to impaired performance. The present studies tested the hypothesis that (1) learning to behaviorally control stressors leads to improved performance on a test of general executive functioning, the color-word Stroop, and that (2) this improvement emerges specifically for people who report moderate (subjective) responses to stress. Experiment 1: Stroop performance, measured before and after a stress manipulation, was compared across groups of undergraduate participants (n = 109). People who learned to control a noise stressor and received accurate performance feedback demonstrated reduced Stroop interference compared with people exposed to uncontrollable noise stress and feedback indicating an exaggerated rate of failure. In the group who learned behavioral control, those who reported moderate levels of stress showed the greatest reduction in Stroop interference. In contrast, in the group exposed to uncontrollable events, self-reported stress failed to predict performance. Experiment 2: In a second sample (n = 90), we specifically investigated the role of controllability by keeping the rate of failure feedback constant across groups. In the group who learned behavioral control, those who reported moderate levels of stress showed the greatest Stroop improvement. Once again, this pattern was not demonstrated in the group exposed to uncontrollable events. These results suggest that stress controllability and subjective response interact to affect high-level cognitive abilities. Specifically, exposure to moderate, controllable stress benefits performance, but exposure to uncontrollable stress or having a more extreme response to stress tends to harm performance. These findings may provide insights on how to leverage the beneficial effects of stress in a range of settings. PMID:22701442

Modeling ecological traps for the control of feral pigs

PubMed Central

Dexter, Nick; McLeod, Steven R

2015-01-01

Ecological traps are habitat sinks that are preferred by dispersing animals but have higher mortality or reduced fecundity compared to source habitats. Theory suggests that if mortality rates are sufficiently high, then ecological traps can result in extinction. An ecological trap may be created when pest animals are controlled in one area, but not in another area of equal habitat quality, and when there is density-dependent immigration from the high-density uncontrolled area to the low-density controlled area. We used a logistic population model to explore how varying the proportion of habitat controlled, control mortality rate, and strength of density-dependent immigration for feral pigs could affect the long-term population abundance and time to extinction. Increasing control mortality, the proportion of habitat controlled and the strength of density-dependent immigration decreased abundance both within and outside the area controlled. At higher levels of these parameters, extinction was achieved for feral pigs. We extended the analysis with a more complex stochastic, interactive model of feral pig dynamics in the Australian rangelands to examine how the same variables as the logistic model affected long-term abundance in the controlled and uncontrolled area and time to extinction. Compared to the logistic model of feral pig dynamics, the stochastic interactive model predicted lower abundances and extinction at lower control mortalities and proportions of habitat controlled. To improve the realism of the stochastic interactive model, we substituted fixed mortality rates with a density-dependent control mortality function, empirically derived from helicopter shooting exercises in Australia. Compared to the stochastic interactive model with fixed mortality rates, the model with the density-dependent control mortality function did not predict as substantial decline in abundance in controlled or uncontrolled areas or extinction for any combination of variables. These models demonstrate that pest eradication is theoretically possible without the pest being controlled throughout its range because of density-dependent immigration into the area controlled. The stronger the density-dependent immigration, the better the overall control in controlled and uncontrolled habitat combined. However, the stronger the density-dependent immigration, the poorer the control in the area controlled. For feral pigs, incorporating environmental stochasticity improves the prospects for eradication, but adding a realistic density-dependent control function eliminates these prospects. PMID:26045954

Effectiveness of dust control methods for crystalline silica and respirable suspended particulate matter exposure during manual concrete surface grinding.

PubMed

Akbar-Khanzadeh, Farhang; Milz, Sheryl A; Wagner, Cynthia D; Bisesi, Michael S; Ames, April L; Khuder, Sadik; Susi, Pam; Akbar-Khanzadeh, Mahboubeh

2010-12-01

Concrete grinding exposes workers to unacceptable levels of crystalline silica dust, known to cause diseases such as silicosis and possibly lung cancer. This study examined the influence of major factors of exposure and effectiveness of existing dust control methods by simulating field concrete grinding in an enclosed workplace laboratory. Air was monitored during 201 concrete grinding sessions while using a variety of grinders, accessories, and existing dust control methods, including general ventilation (GV), local exhaust ventilation (LEV), and wet grinding. Task-specific geometric mean (GM) of respirable crystalline silica dust concentrations (mg/m³ for LEV:HEPA-, LEV:Shop-vac-, wet-, and uncontrolled-grinding, while GV was off/on, were 0.17/0.09, 0.57/0.13, 1.11/0.44, and 23.1/6.80, respectively. Silica dust concentrations (mg/m³ using 100-125 mm (4-5 inch) and 180 mm (7 inch) grinding cups were 0.53/0.22 and 2.43/0.56, respectively. GM concentrations of silica dust were significantly lower for (1) GV on (66.0%) vs. off, and (2) LEV:HEPA- (99.0%), LEV:Shop-vac- (98.1%) or wet- (94.4%) vs. uncontrolled-grinding. Task-specific GM of respirable suspended particulate matter (RSP) concentrations (mg/m³ for LEV:HEPA-, LEV:Shop-vac-, wet-, and uncontrolled grinding, while GV was off/on, were 1.58/0.63, 7.20/1.15, 9.52/4.13, and 152/47.8, respectively. GM concentrations of RSP using 100-125 mm and 180 mm grinding cups were 4.78/1.62 and 22.2/5.06, respectively. GM concentrations of RSP were significantly lower for (1) GV on (70.2%) vs. off, and (2) LEV:HEPA- (98.9%), LEV:Shop-vac- (96.9%) or wet- (92.6%) vs. uncontrolled grinding. Silica dust and RSP were not significantly affected by (1) orientation of grinding surfaces (vertical vs. inclined); (2) water flow rates for wet grinding; (3) length of task-specific sampling time; or, (4) among cup sizes of 100, 115 or 125 mm. No combination of factors or control methods reduced an 8-hr exposure level to below the recommended criterion of 0.025 mg/m³ for crystalline silica, requiring further refinement in engineering controls, administrative controls, or the use of respirators.

When does stress help or harm? The effects of stress controllability and subjective stress response on stroop performance.

PubMed

Henderson, Roselinde K; Snyder, Hannah R; Gupta, Tina; Banich, Marie T

2012-01-01

The ability to engage in goal-directed behavior despite exposure to stress is critical to resilience. Questions of how stress can impair or improve behavioral functioning are important in diverse settings, from athletic competitions to academic testing. Previous research suggests that controllability is a key factor in the impact of stress on behavior: learning how to control stressors buffers people from the negative effects of stress on subsequent cognitively demanding tasks. In addition, research suggests that the impact of stress on cognitive functioning depends on an individual's response to stressors: moderate responses to stress can lead to improved performance while extreme (high or low) responses can lead to impaired performance. The present studies tested the hypothesis that (1) learning to behaviorally control stressors leads to improved performance on a test of general executive functioning, the color-word Stroop, and that (2) this improvement emerges specifically for people who report moderate (subjective) responses to stress. Experiment 1: Stroop performance, measured before and after a stress manipulation, was compared across groups of undergraduate participants (n = 109). People who learned to control a noise stressor and received accurate performance feedback demonstrated reduced Stroop interference compared with people exposed to uncontrollable noise stress and feedback indicating an exaggerated rate of failure. In the group who learned behavioral control, those who reported moderate levels of stress showed the greatest reduction in Stroop interference. In contrast, in the group exposed to uncontrollable events, self-reported stress failed to predict performance. Experiment 2: In a second sample (n = 90), we specifically investigated the role of controllability by keeping the rate of failure feedback constant across groups. In the group who learned behavioral control, those who reported moderate levels of stress showed the greatest Stroop improvement. Once again, this pattern was not demonstrated in the group exposed to uncontrollable events. These results suggest that stress controllability and subjective response interact to affect high-level cognitive abilities. Specifically, exposure to moderate, controllable stress benefits performance, but exposure to uncontrollable stress or having a more extreme response to stress tends to harm performance. These findings may provide insights on how to leverage the beneficial effects of stress in a range of settings.

Resolvin D3 is dysregulated in arthritis and reduces arthritic inflammation

PubMed Central

Arnardottir, Hildur H.; Dalli, Jesmond; Norling, Lucy V.; Colas, Romain A.; Perretti, Mauro; Serhan, Charles N.

2016-01-01

Uncontrolled inflammation is a unifying component of many chronic inflammatory diseases, such as arthritis. Resolvins (Rv) are a new family from the endogenous specialized pro-resolving lipid mediators (SPM) that actively stimulate resolution of inflammation. Herein, using lipid mediator (LM) metabololipidomics with murine joints we found a temporal regulation of endogenous SPM during self-resolving inflammatory arthritis. The SPMs present in self-resolving arthritic joints include the D-series resolvins, e.g. Resolvin (Rv) D1, RvD2, RvD3 and RvD4. Of note, RvD3 levels were reduced in inflamed joints from mice with delayed-resolving arthritis when compared to self-resolving inflammatory arthritis. RvD3 was also reduced in serum from rheumatoid arthritis (RA) patients compared to healthy controls. RvD3 administration reduced joint leukocytes as well as paw joint eicosanoids, clinical scores and edema. Together, these findings provide evidence for dysregulated endogenous RvD3 levels in inflamed paw joints and its potent actions in reducing murine arthritis. PMID:27534559

Uncontrolled Donation After Circulatory Determination of Death Donors (uDCDDs) as a Source of Lungs for Transplant.

PubMed

Egan, T M; Requard, J J

2015-08-01

In April 2014, the American Journal of Transplantation published a report on the first lung transplant in the United States recovered from an uncontrolled donation after circulatory determination of death donor (uDCDD), assessed by ex vivo lung perfusion (EVLP). The article identified logistical and ethical issues related to introduction of lung transplant from uDCDDs. In an open clinical trial, we have Food and Drug Administration and Institutional Review Board approval to transplant lungs recovered from uDCDDs judged suitable after EVLP. Through this project and other experiences with lung recovery from uDCDDs, we have identified solutions to many logistical challenges and have addressed ethical issues surrounding lung transplant from uDCDDs that were mentioned in this case report. Here, we discuss those challenges, including issues related to recovery of other solid organs from uDCDDs. Despite logistical challenges, uDCDDs could solve the critical shortage of lungs for transplant. Furthermore, by avoiding the deleterious impact of brain death and days of positive pressure ventilation, and by using opportunities to treat lungs in the decedent or during EVLP, lungs recovered from uDCDDs may ultimately prove to be better than lungs currently being transplanted from conventional brain-dead organ donors. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

Surface Cleaning and Disinfection: Efficacy Assessment of Four Chlorine Types Using Escherichia coli and the Ebola Surrogate Phi6.

PubMed

Gallandat, Karin; Wolfe, Marlene K; Lantagne, Daniele

2017-04-18

In the 2014 West African Ebola outbreak, international organizations provided conflicting recommendations for disinfecting surfaces contaminated by uncontrolled patient spills. We compared the efficacy of four chlorine solutions (sodium hypochlorite, sodium dichloroisocyanurate, high-test hypochlorite, and generated hypochlorite) for disinfection of three surface types (stainless steel, heavy-duty tarp, and nitrile) with and without pre-cleaning practices (prewiping, covering, or both) and soil load. The test organisms were Escherichia coli and the Ebola surrogate Phi6. All tests achieved a minimum of 5.9 and 3.1 log removal in E. coli and Phi6, respectively. A 15 min exposure to 0.5% chlorine was sufficient to ensure <8 Phi6 plaque-forming unit (PFU)/cm 2 in all tests. While chlorine types were equally efficacious with and without soil load, variation was seen by surface type. Wiping did not increase disinfection efficacy and is not recommended because it generates infectious waste. Covering spills decreased disinfection efficacy against E. coli on heavy-duty tarp but does prevent splashing, which is critical in Ebola contexts. Our results support the recommendation of a 15 min exposure to 0.5% chlorine, independently of chlorine type, surface, pre-cleaning practices, and organic matter, as an efficacious measure to interrupt disease transmission from uncontrolled spills in Ebola outbreaks.

Thermal investigation of nuclear waste disposal in space

NASA Technical Reports Server (NTRS)

Wilkinson, C. L.

1981-01-01

A thermal analysis has been conducted to determine the allowable size and response of bare and shielded nuclear waste forms in both low earth orbit and at 0.85 astronomical units. Contingency conditions of re-entry with a 45 deg and 60 deg aeroshell are examined as well as re-entry of a spherical shielded waste form. A variety of shielded schemes were examined and the waste form thermal response for each determined. Two optimum configurations were selected. The thermal response of these two shielded waste configurations to indefinite exposure to ground conditions following controlled and uncontrolled re-entry is determined. In all cases the prime criterion is that waste containment must be maintained.

Unpredictable and Uncontrollable Events: A New Perspective on Experimental Neurosis

ERIC Educational Resources Information Center

Kihlstrom, John F.; Mineka, Susan

1978-01-01

Recent work has shown that unpredictable and/or uncontrollable events can produce a variety of cognitive, affective, and somatic disturbances to the organism. These disturbances are compared to and found to be quite similar to the symptoms of the classic cases of experimental neurosis described by Pavlov, Gantt, Liddell, Masserman, and Wolpe.…

Term Based Comparison Metrics for Controlled and Uncontrolled Indexing Languages

ERIC Educational Resources Information Center

Good, B. M.; Tennis, J. T.

2009-01-01

Introduction: We define a collection of metrics for describing and comparing sets of terms in controlled and uncontrolled indexing languages and then show how these metrics can be used to characterize a set of languages spanning folksonomies, ontologies and thesauri. Method: Metrics for term set characterization and comparison were identified and…

Glutathione synthesis is diminished in patients with uncontrolled diabetes and restored by dietary supplementation with cysteine and glycine

USDA-ARS?s Scientific Manuscript database

Sustained hyperglycemia is associated with low cellular levels of the antioxidant glutathione (GSH), which leads to tissue damage attributed to oxidative stress. We tested the hypothesis that diminished GSH in adult patients with uncontrolled type 2 diabetes is attributed to decreased synthesis and ...

Conditions that Influence Drivers' Yielding Behavior for Uncontrolled Crossings

ERIC Educational Resources Information Center

Bourquin, Eugene; Emerson, Robert Wall; Sauerburger, Dona

2011-01-01

Pedestrians with visual impairments need to cross streets where traffic signals and traffic signage are not present. This study examined the influences of several interventions, including a pedestrian's use of a mobility cane, on the behavior of drivers when they were expected to yield to a pedestrian crossing at an uncontrolled crossing.…

Predicted national productivity implications of calorie and sodium reductions in the American diet.

PubMed

Dall, Timothy M; Fulgoni, Victor L; Zhang, Yiduo; Reimers, Kristin J; Packard, Patricia T; Astwood, James D

2009-01-01

To model the potential long-term national productivity benefits from reduced daily intake of calories and sodium. Simulation based on secondary data analysis; quantitative research. Measures include absenteeism, presenteeism, disability, and premature mortality under various hypothetical dietary changes. United States. Two hundred twenty-five million adults. Findings come from a Nutrition Impact Model that combines information from national surveys, peer-reviewed studies, and government reports. We compare current estimates of national productivity loss associated with overweight, obesity, and hypertension to estimates for hypothetical scenarios in which national prevalence of these risk factors is lower. Using the simulation model, we illustrate how modest dietary change can achieve lower national prevalence of excess weight and hypertension. We estimate that permanent 100-kcal reductions in daily intake among the overweight/obese would eliminate approximately 71.2 million cases of overweight/obesity. In the long term, this could increase national productivity by $45.7 billion annually. Long-term sodium reductions of 400 mg in those with uncontrolled hypertension would eliminate about 1.5 million cases, potentially increasing productivity by $2.5 billion annually. More aggressive diet changes of 500 kcal and 1100 mg of sodium reductions yield potential productivity benefits of $133.3 and $5.8 billion, respectively. The potential long-term benefit of reduced calories and sodium, combining medical cost savings with productivity increases, ranges from $108.5 billion for moderate reductions to $255.6 billion for aggressive reductions. These findings help inform public health policy and the business case for improving diet. (AmJ Health Promot 2009;23[6]:423-430.)

A nurse-led education and cognitive behaviour therapy-based intervention among adults with uncontrolled type 2 diabetes: A randomised controlled trial.

PubMed

Whitehead, Lisa C; Crowe, Marie T; Carter, Janet D; Maskill, Virginia R; Carlyle, Dave; Bugge, Carol; Frampton, Chris M A

2017-08-01

Diabetes mellitus is associated with significant morbidity, mortality, and escalating health care costs. Research has consistently demonstrated the importance of glycaemic control in delaying the onset, and decreasing the incidence, of both the short-term and long-term complications of diabetes. Although glycaemic control is difficult to achieve and challenging to maintain, it is key to reducing negative disease outcomes. The aim of this study was to determine whether a nurse-led educational intervention alone or a nurse-led intervention using education and acceptance and commitment therapy (ACT) was effective in reducing hemoglobin A 1c (HbA 1c ) in people living with uncontrolled type 2 diabetes compared to usual care. Adults over the age of 18 years, with a confirmed diagnosis of type 2 diabetes and HbA 1c outside of the recommended range (4%-7%, 20-53 mmol/mol) for 12 months or more, were eligible to participate. Participants were randomised to either a nurse-led education intervention, a nurse-led education plus ACT intervention, or a usual care. One hundred and eighteen participants completed baseline data collection (N = 34 education group, N = 39 education plus ACT, N = 45 control group). An intention to treat analysis was used. A statistically significant reduction in HbA 1c in the education intervention group was found (P = .011 [7.48, 8.14]). At 6 months, HbA 1c was reduced in both intervention groups (education group -0.21 and education and ACT group -0.04) and increased in the control group (+0.32). A positive change in HbA 1c (HbA 1c reduced) was noted in 50 participants overall. Twice as many participants in the intervention groups demonstrated an improvement as compared to the control group (56% of the education group, 51% education plus ACT, and 24% control group. At 6 months post intervention, HbA 1c was reduced in both intervention groups with a greater reduction noted in the nurse-led education intervention. © 2017 John Wiley & Sons, Ltd.

A 12-year prognosis of adult-onset asthma: Seinäjoki Adult Asthma Study.

PubMed

Tuomisto, Leena E; Ilmarinen, Pinja; Niemelä, Onni; Haanpää, Jussi; Kankaanranta, Terhi; Kankaanranta, Hannu

2016-08-01

Long-term prognosis of adult-onset asthma is poorly known. To evaluate 12-year prognosis of adult-onset asthma and the factors associated with disease prognosis. Seinäjoki Adult-onset Asthma Study (SAAS) is a 12-year real-life single-center follow-up study of new-onset asthma diagnosed at adult age and treated in primary and specialized care. Remission was defined by no symptoms and no asthma medication use for 6 months. Asthma control was evaluated according to Global Initiative for Asthma 2010. Factors associated with current asthma control were analyzed by multinomial multivariate logistic regression. A total of 203 patients (79% of the baseline population) were followed for 12 years. Remission occurred in 6 (3%) patients. In 34% asthma was controlled, in 36% it was partially controlled and in 30% uncontrolled. Uncontrolled asthma was predicted by elevated body-mass index at baseline, smoking (pack-years) and current allergic or persistent rhinitis. Elevated blood eosinophils and good lung function (FEV1) at baseline protected from uncontrolled asthma. In contrast, gender, age at the onset or baseline symptoms (Airways Questionnaire 20) were not significant predictors of uncontrolled disease. During a 12-year follow-up, remission of adult-onset asthma was rare occurring in only 3% of patients. The majority of patients (66%) presented either with uncontrolled or partially controlled asthma. This study is registered at ClinicalTrials.gov with identifier number NCT02733016. Copyright © 2016 Elsevier Ltd. All rights reserved.

Interdisciplinary Approach to Fall Prevention in a High-Risk Inpatient Pediatric Population: Quality Improvement Project.

PubMed

Stubbs, Kendra E; Sikes, Lindsay

2017-01-01

Within a tertiary care pediatric medical center, the largest number of inpatient falls (8.84 falls per 1,000 patient days) occurred within a 14-bed rehabilitation/transitional care unit between February and September 2009. An interdisciplinary fall prevention program, called "Red Light, Green Light," was developed to better educate all staff and family members to ensure safety of transfers and ambulation of children with neurological impairments. The purpose of this study was to develop and implement an interdisciplinary pediatric fall prevention program to reduce total falls and falls with family members present in this population. Preintervention 2009 data and longitudinal data from 2010-2014 were obtained from retrospective review of event/incident reports. This quality improvement project was based on inpatient pediatric admissions to a rehabilitation care unit accommodating children with neurological impairments. Data extraction included: total falls, falls with caregiver (alone versus staff versus family), type of falls, and falls by diagnosis. Descriptive statistics were obtained on outcome measures; chi-square statistics were calculated on preintervention and postintervention comparisons. Total falls decreased steadily from 8.84 falls per 1,000 patient days in 2009 to 1.79 falls per 1,000 patient days in 2014 (χ12=3.901, P=.048). Falls with family members present decreased 50% postintervention. (χ12=6.26, P=.012). Limitations included unit size nearly doubled postintervention, event reporting changed to both uncontrolled and controlled therapy falls (safely lowering patient to bed, chair, or floor), and enhanced reporting increased numbers of postintervention falls. The Red Light, Green Light program has resulted in reductions in overall fall rates, falls with family members present, increased staff collaboration, heightened staff and family safety awareness, and a safer environment for patients at high risk for neurological or musculoskeletal impairments. © 2017 American Physical Therapy Association

Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa

PubMed Central

Yogeswaran, Parimalaranie; Longo-Mbenza, Benjamin; Ter Goon, Daniel; Ajayi, Anthony Idowu

2016-01-01

Objectives South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa. Design A cross-sectional analytical study. Setting Primary healthcare setting in OR Tambo district, South Africa. Participants Patients treated for T2DM for 1 or more years (n=327). Primary outcome measure Prevalence of uncontrolled T2DM. Secondary outcome measure Determinants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%). Results Out of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c. Conclusions We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district. PMID:27473948

Poor sleep quality has an adverse effect on childhood asthma control and lung function measures.

PubMed

Sheen, Youn Ho; Choi, Sun Hee; Jang, Sun Jung; Baek, Ji Hyeon; Jee, Hye Mi; Kim, Mi Ae; Chae, Kyu Young; Han, Man Yong

2017-08-01

It is unclear as to whether sleep respiratory breathing disorder (SRBD) is a risk factor for uncontrolled asthma in children. The aim of this study was therefore to investigate whether SRBD may have an adverse effect on childhood asthma control and lung function measures. This was a cross-sectional study of 220 children with well-controlled (n = 108), partly controlled (n = 92), and uncontrolled asthma (n = 20) according to the Global Initiative for Asthma guideline. SRBD was assessed using the Pediatric Sleep Questionnaire (PSQ). The association of SRBD with partly controlled/uncontrolled asthma was investigated on multivariate logistic regression analysis. Of 220 children with asthma, 43 (19.6%) had SRBD: well-controlled, 16.7% (18/108); partly controlled, 21.7% (20/92); and uncontrolled, 25.0% (5/20; P = 0.54). There was a significant difference in forced expiratory volume in 1 s/forced vital capacity (FEV 1 /FVC; P = 0.007) and childhood asthma control test (C-ACT) score (P < 0.001) according to asthma control status, but not in PSQ score (P = 0.18). Children with obstructive sleep apnea (PSQ >0.33) had a lower C-ACT score compared with controls (PSQ ≤0.33; 19.6 ± 5.1 vs 22.0 ± 4.2, P = 0.002). PSQ score was negatively correlated with FEV 1 /FVC (r = -0.16, P = 0.02). On multivariate logistic regression analysis, high PSQ score increased the odds of having partly controlled/uncontrolled asthma by 9.12 (95% CI: 1.04-79.72, P = 0.046) after adjusting for confounding factors. SRBD is an independent risk factor for partly controlled/uncontrolled asthma and has an adverse effect on lung function measures in children. Further research is warranted to determine whether the improvement of sleep quality may also enhance level of asthma control and lung function in children. © 2017 Japan Pediatric Society.

Impact of 5-HT(3) RA selection within triple antiemetic regimens on uncontrolled highly emetogenic chemotherapy-induced nausea/vomiting.

PubMed

Schwartzberg, Lee; Jackson, James; Jain, Gagan; Balu, Sanjeev; Buchner, Deborah

2011-08-01

It is recommended that patients initiate triple antiemetic therapy with one of the 5-hydroxytryptamine receptor antagonists (5-HT(3) RAs), aprepitant (or its intravenous prodrug fosaprepitant) and dexamethasone prior to the start of highly emetogenic chemotherapy (HEC). However, the impact of 5-HT(3) RA selection within triple antiemetic regimens on the risk of uncontrolled chemotherapy-induced nausea and vomiting (CINV) with HEC has not been well studied. To assess the likelihood of an uncontrolled CINV event following antiemetic prophylaxis with the 5-HT(3) RA palonosetron + aprepitant/fosaprepitant + dexamethasone (palonosetron cohort) versus any of the other 5-HT(3) RAs + aprepitant/fosaprepitant + dexamethasone (other 5-HT(3) RA cohort) among single-day HEC cycles. Single-day HEC cycles (a gap of at least 5 days between two administrations) among patients with a cancer diagnosis and receiving antiemetic prophylaxis with the aforementioned regimens between 1/1/2006 and 6/30/2010 were identified from the IMS LifeLink claims database. Uncontrolled CINV events were identified through ICD-9-CM codes (nausea and vomiting), Current Procedural Terminology codes (hydration), rescue medications and/or use of antiemetic therapy from days 2-5 following HEC administration. Risks for an uncontrolled CINV event among all patients, and within breast cancer and multiple cancer subpopulations, were analyzed at cycle level using logistic multivariate regression models. A total of 8018 cycles for the palonosetron cohort and 1926 cycles for the other 5-HT(3) RA cohort (3574 and 978 patients, respectively) were analyzed. Single-day HEC cycles received by the palonosetron cohort had a significantly lower unadjusted risk of an uncontrolled CINV event (17.5 vs 20.7% for the other 5-HT(3) RA cohort; p = 0.0010), with a 17% lower adjusted risk for palonosetron-administered cycles (odds ratio: 0.83; 95% CI: 0.73-0.94; p = 0.0042). Results in the breast cancer and multiple cancer subgroups were consistent with those for the overall population. In this retrospective claims data analysis, single-day HEC cycles administered with palonosetron + aprepitant/fosaprepitant + dexamethasone had a lower risk for an uncontrolled CINV event versus other 5-HT(3) RAs + aprepitant/fosaprepitant + dexamethasone.

Recommendations on the use of prescribed burning practices in grassland conservation - An evidence-based study from Hungary

NASA Astrophysics Data System (ADS)

Tóthmérész, Béla; Valkó, Orsolya; Török, Péter; Végvári, Zsolt; Deák, Balázs

2015-04-01

Fire as a natural disturbance has been present in most European grasslands. In parallel controlled use of burning was an important part of the traditional landscape management for millennia. It was used to reduce litter and suppress woody vegetation as well as to maintain open landscapes suitable for farming. Recently, human activities have a considerable impact on natural fire regimes through habitat fragmentation, cessation of traditional grassland management and climate change. Nowadays the majority of human-ignited fires are uncontrolled burnings and arson, which have serious negative impacts on human life, property and can be detrimental also from the nature conservation point of view. Despite fire was widely applied in the past and the considerable extension and frequency of current grassland fires, the impact of fire on the grassland biodiversity is still scarcely documented in Europe. The aim of our study was to gather practical knowledge and experiences from Hungary concerning the effects of fire on grasslands. To fulfil this aim we sent questionnaires to experts from Hungarian national park directorates to gather unpublished data and field observations concerning the effects of burning on grasslands. Based on the answers for the questionnaires fire regularly occur in almost every grassland types in Hungary. We found that effects of fire are habitat-specific. One hand uncontrolled burning and arson have serious detrimental impacts on many endangered species (ground-dwelling birds, such as Asio flammeus, Tringa totanus and Vanellus vanellus; or lizards, such as Ablepharus kitaibelii). On the other hand in several cases fire has a positive effect on the habitat structure and favours species of high nature conservation interest (plant species, such as Adonis volgensis, Chamaecytisus supinus and Pulsatilla grandis; butterflies, such as Euphydryas aurinia; bird species such as Circus aeruginosus and Larus cachinnans). Our results suggest that even uncontrolled burning can have positive impacts from a nature conservation point of view by supporting several endangered species, reducing accumulated litter and maintaining open landscapes. Given the fact that due to land use changes and global warming the frequency of fire events are expected to increase in the next future, it is crucial to summarize evidence-based knowledge on fire in a European level and to design prescribed burning experiments in which the effects of fire could be studied in a controlled way.

Uncontrolled re-entry of satellite parts after finishing their mission in LEO: Titanium alloy degradation by thermite reaction energy

NASA Astrophysics Data System (ADS)

Monogarov, K. A.; Pivkina, A. N.; Grishin, L. I.; Frolov, Yu. V.; Dilhan, D.

2017-06-01

Analytical and experimental studies conducted at Semenov Institute of Chemical Physics for investigating the use of pyrotechnic compositions, i.e., thermites, to reduce the risk of the fall of thermally stable parts of deorbiting end-of-life LEO satellites on the Earth are described. The main idea was the use of passive heating during uncontrolled re-entry to ignite thermite composition, fixed on the titanium surface, with the subsequent combustion energy release to be sufficient to perforate the titanium cover. It is supposed, that thus destructed satellite parts will lose their streamline shape, and will burn out being aerodynamically heated during further descending in atmosphere (patent FR2975080). On the base of thermodynamic calculations the most promising thermite compositions have been selected for the experimental phase. The unique test facilities have been developed for the testing of the efficiency of thermite charges to perforate the titanium TA6V cover of 0.8 mm thickness under temperature/pressure conditions duplicated the uncontrolled re-entry of titanium tank after its mission on LEO. Experiments with the programmed laser heating inside the vacuum chamber revealed the only efficient thermite composition among preliminary selected ones to be Al/Co3O4. Experimental searching of the optimal aluminum powder between spherical and flaked nano- and micron-sized ones revealed the possibility to adjust the necessary ignition delay time, according to the titanium cover temperature dependency on deorbiting time. For the titanium tank the maximum temperature is 1100 °C at altitude 68 km and pressure 60 Pa. Under these conditions Al/Co3O4 formulations with nano-Al spherical particles provide the ignition time to be 13.3 s, and ignition temperature as low as 592±5 °C, whereas compositions with the micron-sized spherical Al powder reveal these values to be much higher, i.e., 26.3 s and 869±5 °C, respectively. The analytical and experimental studies described in this paper provide a portion of the basic information required for the development of pyrotechnic device to reduce the risk of the fall of thermally stable parts of deorbiting end-of-life LEO satellites on the Earth.

The Sacubitril/Valsartan, a First-in-Class, Angiotensin Receptor Neprilysin Inhibitor (ARNI): Potential Uses in Hypertension, Heart Failure, and Beyond.

PubMed

Kario, Kazuomi

2018-01-27

Sacubitril/valsartan (LCZ696) is a first-in-class, novel-acting, angiotensin receptor neprilysin inhibitor (ARNI) that provides inhibition of neprilysin and the angiotensin (AT 1 ) receptor. A recent clinical trial PRARDIGM-HF demonstrated that this drug is superior to angiotensin-converting enzyme (ACE) inhibitors for improving the prognosis in the patients with heart failure, and this has resulted in the drug being included in clinical practice guidelines for the management of heart failure with reduced ejection fraction (EF). In addition, sacubitril/valsartan has been developed for the management of hypertension, because it has unique anti-aging properties. However, the clinical evidence of mechanism has not been well validated. A recent mechanistic study PARAMETER demonstrated that sacubitril/valsartan (LCZ696) is superior to angiotensin receptor blocker (ARB) monotherapy for reducing central aortic systolic pressure (primary endpoint) as well as for central aortic pulse pressure (secondary endpoint) and nocturnal BP preferentially. Considering these results, sacubitril/valsartan may be an attractive therapeutic agent to treat the elderly with age-related hypertension phenotypes, such as drug-uncontrolled (resistant) hypertension characterized as systolic (central) hypertension (structural hypertension) and/or nocturnal hypertension (salt-sensitive hypertension). These are the high-risk hypertension phenotypes which are prone to develop heart failure with preserved EF and chronic kidney disease. Sacubitril/valsartan may be effective to suppress the age-related continuum from hypertension to heart failure, and it could be clinically useful not only for secondary prevention, but also as primary prevention of heart failure in uncontrolled elderly hypertensive patients.

Neurogenesis and Helplessness are Mediated by Controllability in Males but not in Females

PubMed Central

Shors, Tracey J.; Mathew, Jason; Sisti, Helene M.; Edgecomb, Carol; Beckoff, Steven; Dalla, Christina

2009-01-01

Background Numerous studies have implicated neurogenesis in the hippocampus in animal models of depression, especially those related to controllability and learned helplessness. Here, we tested the hypothesis that uncontrollable, but not controllable stress would reduce cell proliferation in the hippocampus of male and female rats, and would relate to the expression of helplessness behavior. Methods To manipulate controllability, groups of male and female rats were trained in one session (acute stress) or over seven sessions (repeated stress) to escape a footshock, while yoked controls could not escape, but were exposed to the same amount of stress. Cell proliferation was assessed with immunohistochemistry of BrdU and immunofluorescence of BrdU and NeuN. Separate groups were exposed to either controllable or uncontrollable stress and their ability to learn to escape during training on a more difficult task was used as a behavioral measure of helplessness. Results Acute stress reduced cell proliferation in males, but did not affect proliferation in the female hippocampus. When animals were given the opportunity to learn to control the stress over days, males produced more cells than the yoked males without control. Repeated training with controllable stress did not influence proliferation in females. Under all conditions, males were more likely than females to express helplessness behavior, even males that were not previously stressed. Conclusions The modulation of neurogenesis by controllability was evident in males but not in females, as was the expression of helplessness behavior, despite the fact that men are less likely than women to experience depression. PMID:17306770

Neurogenesis and helplessness are mediated by controllability in males but not in females.

PubMed

Shors, Tracey J; Mathew, Jason; Sisti, Helene M; Edgecomb, Carol; Beckoff, Steven; Dalla, Christina

2007-09-01

Numerous studies have implicated neurogenesis in the hippocampus in animal models of depression, especially those related to controllability and learned helplessness. Here, we tested the hypothesis that uncontrollable but not controllable stress would reduce cell proliferation in the hippocampus of male and female rats and would relate to the expression of helplessness behavior. To manipulate controllability, groups of male and female rats were trained in one session (acute stress) or over seven sessions (repeated stress) to escape a footshock, whereas yoked control subjects could not escape but were exposed to the same amount of stress. Cell proliferation was assessed with immunohistochemistry of bromodeoxyuridine (BrdU) and immunofluorescence of BrdU and neuronal nuclei (NeuN). Separate groups were exposed to either controllable or uncontrollable stress, and their ability to learn to escape during training on a more difficult task was used as a behavioral measure of helplessness. Acute stress reduced cell proliferation in males but did not affect proliferation in the female hippocampus. When animals were given the opportunity to learn to control the stress over seven days, males produced more cells than the yoked males without control. Repeated training with controllable stress did not influence proliferation in females. Under all conditions, males were more likely than females to express helplessness behavior, even males that were not previously stressed. The modulation of neurogenesis by controllability was evident in males but not in females, as was the expression of helplessness behavior, despite the fact that men are less likely than women to experience depression.

Controlled and Uncontrolled Subject Descriptions in the CF Database: A Comparison of Optimal Cluster-Based Retrieval Results.

ERIC Educational Resources Information Center

Shaw, W. M., Jr.

1993-01-01

Describes a study conducted on the cystic fibrosis (CF) database, a subset of MEDLINE, that investigated clustering structure and the effectiveness of cluster-based retrieval as a function of the exhaustivity of the uncontrolled subject descriptions. Results are compared to calculations for controlled descriptions based on Medical Subject Headings…

Young-Age Gender Differences in Mathematics Mediated by Independent Control or Uncontrollability

ERIC Educational Resources Information Center

Zirk-Sadowski, Jan; Lamptey, Charlotte; Devine, Amy; Haggard, Mark; Szucs, Dénes

2014-01-01

We studied whether the origins of math anxiety can be related to a biologically supported framework of stress induction: (un)controllability perception, here indicated by self-reported independent efforts in mathematics. Math anxiety was tested in 182 children (8- to 11-year-olds). "Latent factor modeling" was used to test hypotheses on…

Depositing aluminum as sacrificial metal to reduce metal-graphene contact resistance

NASA Astrophysics Data System (ADS)

Da-cheng, Mao; Zhi, Jin; Shao-qing, Wang; Da-yong, Zhang; Jing-yuan, Shi; Song-ang, Peng; Xuan-yun, Wang

2016-07-01

Reducing the contact resistance without degrading the mobility property is crucial to achieve high-performance graphene field effect transistors. Also, the idea of modifying the graphene surface by etching away the deposited metal provides a new angle to achieve this goal. We exploit this idea by providing a new process method which reduces the contact resistance from 597 Ω·μm to sub 200 Ω·μm while no degradation of mobility is observed in the devices. This simple process method avoids the drawbacks of uncontrollability, ineffectiveness, and trade-off with mobility which often exist in the previously proposed methods. Project by the National Science and Technology Major Project, China (Grant No. 2011ZX02707.3), the National Natural Science Foundation of China (Grant No. 61136005), the Chinese Academy of Sciences (Grant No. KGZD-EW-303), and the Project of Beijing Municipal Science and Technology Commission, China (Grant No. Z151100003515003).

Improving the physical health of people with severe mental illness in a low secure forensic unit: An uncontrolled evaluation study of staff training and physical health care plans.

PubMed

Haddad, Mark; Llewellyn-Jones, Sian; Yarnold, Steve; Simpson, Alan

2016-12-01

The life expectancy of people with severe mental illnesses is substantially reduced, and monitoring and screening for physical health problems is a key part of addressing this health inequality. Inpatient admission presents a window of opportunity for this health-care activity. The present study was conducted in a forensic mental health unit in England. A personal physical health plan incorporating clearly-presented and easily-understood values and targets for health status in different domains was developed. Alongside this, a brief physical education session was delivered to health-care staff (n = 63). Printed learning materials and pedometers and paper tape measures were also provided. The impact was evaluated by a single-group pretest post-test design; follow-up measures were 4 months' post-intervention. The feasibility and acceptability of personal health plans and associated resources were examined by free-text questionnaire responses. Fifty-seven staff provided measures of attitudes and knowledge before training and implementation of the physical health plans. Matched-pairs analysis indicated a modest but statistically-significant improvement in staff knowledge scores and attitudes to involvement in physical health care. Qualitative feedback indicated limited uptake of the care plans and perceived need for additional support for better adoption of this initiative. Inpatient admission is a key setting for assessing physical health and promoting improved management of health problems. Staff training and purpose-designed personalized care plans hold potential to improve practice and outcomes in this area, but further support for such innovations appears necessary for their uptake in inpatient mental health settings. © 2016 Australian College of Mental Health Nurses Inc.

Severe Gastrointestinal Haemorrhage: Summary of a National Quality of Care Study with Focus on Radiological Services

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

McPherson, Simon J., E-mail: simon.mcpherson@nhs.net, E-mail: smcpherson@ncepod.org.uk; Sinclair, Martin T.; Smith, Neil C. E.

Purpose of StudyTo identify the remediable factors in the quality of care provided to patients with severe gastrointestinal (GI) bleeding.MethodAll hospital admissions in the first four months of 2013 with ICD10 coding for GI bleeding who received a transfusion of 4 units or more of blood. Up to five cases/hospital randomly selected for structured case note peer review. National availability of GI bleeding services data derived from organisational questionnaire completed by all hospitals.Results4563/29,796 (15.3%) of GI bleeds received 4 or more units of blood with a mortality rate of 20.2% compared to 7.3% without blood transfusion. 30.8% of GI bleedsmore » received a blood transfusion. 32% (60/185) of hospitals admitting acute GI bleeds lacked 24/7 endoscopy. 26% (48/185) had on-site embolisation 24/7 with a further 34% (64/185) accessing embolisation by transfer within a validated formal network. Blood product use was inappropriate in 20% (84/426). Improved management, principally earlier senior gastroenterologist review and/or endoscopy, would have reduced blood product use in 25% (113/457). 14.5% (90/618) had a CT scan which identified the site of bleeding in 32% (29/90). 7.8% (36/459) underwent an Interventional Radiology (IR) procedure but a further 6.3% (21/33) should have had IR. 6% (36/586) underwent surgery with 21/36 for uncontrolled bleeding. In 20/35 IR was not considered despite the majority being suitable for IR. Overall 44% (210/476) received an acceptable standard of care according to peer review.Conclusions26 recommendations were made to improve the quality of care in GI bleeding, with six principle recommendations.« less

Risk factors for early disability pension in patients with epilepsy and vocational difficulties - Data from a specialized rehabilitation unit.

PubMed

Specht, Ulrich; Coban, Ingrid; Bien, Christian G; May, Theodor W

2015-10-01

The purpose of this study was to assess the risk factors for early disability pension (EDP) in adult patients with epilepsy in a specialized epilepsy rehabilitation setting. In a retrospective study, 246 patients with epilepsy and employment difficulties leading to referral to an inpatient rehabilitation unit were evaluated with a questionnaire on admission and after a mean of 2.5years after discharge. Patients already receiving EDP at baseline were excluded. Epilepsy-related, demographic, and employment-related data as well as cognitive functioning and psychiatric comorbidity were assessed as risk factors for EDP at follow-up and analyzed using logistic regression models. Seventy-six percent of the patients had uncontrolled epilepsy, and 66.7% had psychiatric comorbidity. At follow-up, 33.7% received an EDP. According to multivariate logistic regression analysis, age>50years (odds ratio (OR) 5.44, compared to age<30years), application for an EDP prior to admission (OR 3.7), sickness absence>3months in the previous year (OR 3.30, compared to sickness absence<3months), and psychiatric comorbidity (OR 2.79) were significant risk factors for an EDP at follow-up, while epilepsy-related factors and cognitive impairment showed an effect only in the univariate analyses. Potential risk factors for EDP in patients with epilepsy were evaluated using multivariate analysis. Knowledge of such factors may help to develop appropriate criteria for rehabilitation candidacy and interventions to reduce the risk for EDP. This might lead to an amelioration of both psychosocial burden of patients and economic burden on society. Copyright © 2015 Elsevier Inc. All rights reserved.

A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in patients with uncontrolled type 2 diabetes.

PubMed

Safren, Steven A; Gonzalez, Jeffrey S; Wexler, Deborah J; Psaros, Christina; Delahanty, Linda M; Blashill, Aaron J; Margolina, Aleksandra I; Cagliero, Enrico

2014-01-01

To test cognitive behavioral therapy for adherence and depression (CBT-AD) in type 2 diabetes. We hypothesized that CBT-AD would improve adherence; depression; and, secondarily, hemoglobin A1c (A1C). Eighty-seven adults with unipolar depression and uncontrolled type 2 diabetes received enhanced treatment as usual (ETAU), including medication adherence, self-monitoring of blood glucose (SMBG), and lifestyle counseling; a provider letter documented psychiatric diagnoses. Those randomized to the intervention arm also received 9-11 sessions of CBT-AD. Immediately after acute treatment (4 months), adjusting for baseline, CBT-AD had 20.7 percentage points greater oral medication adherence on electronic pill cap (95% CI -31.14 to -10.22, P = 0.000); 30.2 percentage points greater SMBG adherence through glucometer downloads (95% CI -42.95 to -17.37, P = 0.000); 6.44 points lower depression scores on the Montgomery-Asberg Depression Rating Scale (95% CI 2.33-10.56, P = 0.002); 0.74 points lower on the Clinical Global Impression (95% CI 0.16-1.32, P = 0.01); and 0.72 units lower A1C (95% CI 0.29-1.15, P = 0.001) relative to ETAU. Analyses of 4-, 8-, and 12-month follow-up time points indicated that CBT-AD maintained 24.3 percentage points higher medication adherence (95% CI -38.2 to -10.3, P = 0.001); 16.9 percentage points greater SMBG adherence (95% CI -33.3 to -0.5, P = 0.043); and 0.63 units lower A1C (95% CI 0.06-1.2, P = 0.03) after acute treatment ended. For depression, there was some evidence of continued improvement posttreatment, but no between-group differences. CBT-AD is an effective intervention for adherence, depression, and glycemic control, with enduring and clinically meaningful benefits for diabetes self-management and glycemic control in adults with type 2 diabetes and depression.

Clinical Evaluation of Kshara sutra Therapy in the management of Bhagandara( Fistula- in-Ano)- A prospective study

PubMed Central

Panigrahi, Hemanta Kumar; Rani, Rakesh; Padhi, M.M.; Lavekar, G.S.

2009-01-01

Study design: A prospective study of 50 patients suffering from Bhagandara(Fistula in Ano) (age ranging from 18-54years) treated by Kshara sutra therapy Place: Kshara sutra unit, Central research Unit, Punjabi bagh, New Delhi Duration: January 2007 to July 2008. Objectives: To determine the incidence of low or high anal fistula, recurrence rate following Kshara sutra therapy and effect of Ksharasutra therapy on the Bhagandara. Material and methods: The fifty patients (50) were selected randomly in the Out Patient Department. Study Design: Uncontrolled open level Study. Results: Patients were followed to see the incidence of recurrence, effect of Kshara Sutra Therapy on incontinence. Overall recurrence rate was only 5.88 %. Minor incontinence was observed only following Kshara sutra Therapy for high variety for which no treatment was given. No such complication occurred in low variety. Conclusion: Bhagandara (Fistula in Ano) can be treated by Kshara Sutra Therapy with minimal loss of sphincter muscle and low reoccurrence rate. PMID:22557318

Technical Report of the Use of a Novel Eye Tracking System to Measure Impairment Associated with Mild Traumatic Brain Injury

PubMed Central

2017-01-01

This technical report details the results of an uncontrolled study of EyeGuide Focus, a 10-second concussion management tool which relies on eye tracking to determine the potential impairment of visual attention, an indicator often of mild traumatic brain injury (mTBI). Essentially, people who can visually keep steady and accurate attention on a moving object in their environment likely suffer from no impairment. However, if after a potential mTBI event, subjects cannot keep attention on a moving object in a normal way as demonstrated on their previous healthy baseline tests. This may indicate possible neurological impairment. Now deployed at multiple locations across the United States, Focus (EyeGuide, Lubbock, Texas, United States) to date, has recorded more than 4,000 test scores. Our data analysis of these results shows the promise of Focus as a low-cost, ocular-based impairment test for assessing potential neurological impairment caused by mTBI in subjects ages eight and older.  PMID:28630809

Technical Report of the Use of a Novel Eye Tracking System to Measure Impairment Associated with Mild Traumatic Brain Injury.

PubMed

Kelly, Michael

2017-05-15

This technical report details the results of an uncontrolled study of EyeGuide Focus, a 10-second concussion management tool which relies on eye tracking to determine the potential impairment of visual attention, an indicator often of mild traumatic brain injury (mTBI). Essentially, people who can visually keep steady and accurate attention on a moving object in their environment likely suffer from no impairment. However, if after a potential mTBI event, subjects cannot keep attention on a moving object in a normal way as demonstrated on their previous healthy baseline tests. This may indicate possible neurological impairment. Now deployed at multiple locations across the United States, Focus (EyeGuide, Lubbock, Texas, United States) to date, has recorded more than 4,000 test scores. Our data analysis of these results shows the promise of Focus as a low-cost, ocular-based impairment test for assessing potential neurological impairment caused by mTBI in subjects ages eight and older.

An attributional analysis of excuse giving: studies of a naive theory of emotion.

PubMed

Weiner, B; Amirkhan, J; Folkes, V S; Verette, J A

1987-02-01

We conducted four studies that pertained to excuses given for a broken social contract. In an initial field investigation, participants recalled occasions in which they had given true and false reasons for not fulfilling a social obligation. Communicated reasons tended to be external to the person, uncontrollable, and unintentional (e.g., "My car broke down"), whereas withheld reasons tended to be internal, controllable, and either intentional (e.g., "I did not want to go") or unintentional (e.g., "I forgot"). The external uncontrollable excuses were anticipated to lessen the anger of the wronged party. In a subsequent simulation study, excuses based on the categories detected in Experiment 1 were manipulated and related to anger ratings. The same pattern of results was displayed, with intent and negligence provoking the highest anger ratings. The final two studies involved laboratory manipulation of a communicated reason for coming late to an experiment. In Experiment 3, a confederate conveyed either an internal controllable, an external uncontrollable, or no reason for making a subject wait, whereas in Experiment 4, subjects were detained and created their own good, bad, any, or no excuse for being tardy, which was communicated to a second, waiting subject. A consistent pattern of good excuse/external uncontrollable reason and bad excuse/internal controllable reason was displayed; offering no excuse resulted in the same judgments as giving a poor excuse. Relative to the external uncontrollable reasons, internal controllable excuses for being late augmented aversive emotional reactions, increased negative personality ratings, and resulted in a desire for no further social contact.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary care physicians behaviour on hypertensive patients with poor blood pressure control. The PRESCAP 2006 study].

PubMed

Alonso-Moreno, F J; Llisterri Caro, J L; Rodríguez-Roca, G C; Ferreiro Madueño, M; González-Segura Alsina, D; Divisón Garrote, J A; Banegas, J R; Barrios Alonso, V; Lou Arnal, S; Sánchez Ruiz, T; Santos Rodríguez, J A; Durá Belinchón, R

2008-09-01

There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients. Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease. A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients. Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.

Optimization of the structural and control system for LSS with reduced-order model

NASA Technical Reports Server (NTRS)

Khot, N. S.

1989-01-01

The objective is the simultaneous design of the structural and control system for space structures. The minimum weight of the structure is the objective function, and the constraints are placed on the closed loop distribution of the frequencies and the damping parameters. The controls approach used is linear quadratic regulator with constant feedback. A reduced-order control system is used. The effect of uncontrolled modes is taken into consideration by the model error sensitivity suppression (MESS) technique which modified the weighting parameters for the control forces. For illustration, an ACOSS-FOUR structure is designed for a different number of controlled modes with specified values for the closed loop damping parameters and frequencies. The dynamic response of the optimum designs for an initial disturbance is compared.

Automated Pilot Advisory System

NASA Technical Reports Server (NTRS)

Parks, J. L., Jr.; Haidt, J. G.

1981-01-01

An Automated Pilot Advisory System (APAS) was developed and operationally tested to demonstrate the concept that low cost automated systems can provide air traffic and aviation weather advisory information at high density uncontrolled airports. The system was designed to enhance the see and be seen rule of flight, and pilots who used the system preferred it over the self announcement system presently used at uncontrolled airports.

Transvenous Embolization to Treat Uncontrolled Hemobilia and Peritoneal Bleeding After Transjugular Liver Biopsy

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

Koshy, Chiramel George, E-mail: gkchiramel@gmail.co; Eapen, C. E.; Lakshminarayan, Raghuram

2010-06-15

Hemobilia is one of the complications that can occur after a transjugular liver biopsy. Various treatment options have been described for the management of this condition, including transarterial embolization and open surgery. We describe a patient who developed uncontrolled hemobilia after a transjugular liver biopsy that required a transvenous approach for embolization and treatment purposes.

Level of asthma control and its relationship with medication use in asthma patients in Brazil*

PubMed Central

Marchioro, Josiane; Gazzotti, Mariana Rodrigues; Nascimento, Oliver Augusto; Montealegre, Federico; Fish, James; Jardim, José Roberto

2014-01-01

OBJECTIVE: To assess asthma patients in Brazil in terms of the level of asthma control, compliance with maintenance treatment, and the use of rescue medication. METHODS: We used data from a Latin American survey of a total of 400 asthma patients in four Brazilian state capitals, all of whom completed a questionnaire regarding asthma control and treatment. RESULTS: In that sample, the prevalence of asthma was 8.8%. Among the 400 patients studied, asthma was classified, in accordance with the Global Initiative for Asthma criteria, as controlled, partially controlled, and uncontrolled in 37 (9.3%), 226 (56.5%), and 137 (34.3%), respectively. In those three groups, the proportion of patients on maintenance therapy in the past four weeks was 5.4%, 19.9%, and 41.6%, respectively. The use of rescue medication was significantly more common in the uncontrolled asthma group (86.9%; p < 0.001). CONCLUSIONS: Our findings suggest that, in accordance with the established international criteria, asthma is uncontrolled in the vast majority of asthma patients in Brazil. Maintenance medications are still underutilized in Brazil, and patients with partially controlled or uncontrolled asthma are more likely to use rescue medications and oral corticosteroids. PMID:25410836

Long-term effect of pH on short-chain fatty acids accumulation and microbial community in sludge fermentation systems.

PubMed

Yuan, Yue; Wang, Shuying; Liu, Ye; Li, Baikun; Wang, Bo; Peng, Yongzhen

2015-12-01

Long-term effect of pH (4, 10, and uncontrolled) on short-chain fatty acid (SCFA) accumulation, microbial community and sludge reduction were investigated in waste activated sludge (WAS) fermentors for over 90days. The average SCFAs accumulation was 1721.4 (at pH 10), 114.2 (at pH 4), and 58.1 (at uncontrolled pH) mg chemical oxygen demand (COD)/L. About 31.65mgCOD/L was produced at pH 10, accounting for 20% of the influent COD. Illumina MiSeq sequencing revealed that Alcaligenes (hydrolic bacteria) and Erysipelothrix (acidogenic bacteria) were enriched at pH 10, while less acidogenic bacteria existed at pH 4 than pH 10, and no acidogenic bacteria were detected at the uncontrolled pH. The ratios of archaea to bacteria were 1:41, 1:16, and 1:9 at the pH of 10, 4, and uncontrolled. This study elucidated the effects of pH on WAS fermentation, and established the correlation of microbial structure with SCFAs accumulations and sludge reduction. Copyright © 2015 Elsevier Ltd. All rights reserved.

Creatinine plasma at uncontrolled type 2 diabetes mellitus and controlled type 2 diabetes mellitus patients at primary health care in Binjai city, Indonesia

NASA Astrophysics Data System (ADS)

Rusdiana; Savira, M.; Syahputra, M.; Santoso, A.

2018-03-01

The aim of the study knowing the comparison creatinine plasma levels at uncontrolled type 2 diabetes mellitus and controlled type 2 diabetes mellitus patients at Primary Health Care in Binjai city of North Sumatera in Indonesia. This cross-sectional study was conductedon 40 type 2 Diabetes Mellitus patients who attended Primary Health Care in Binjai. Patients with age > 40 years old, (both sexes) were included in the study. We recorded different demographic parameter as age, Body Mass Index, Blood Pressure, and personal history status. And we examined the biochemicalparameters including Hba1c, Fasting Blood Sugar Levels (FBL) and creatinine serum. We separated into two groups base on HbA1c test, controlled type 2 diabetes mellitus and uncontrolled type 2 diabetes mellitus. We measured FBL by using the portable measuring instrument, and Thamrin clinical laboratory measured Hba1c, andwe measured creatinine plasmaby spectrophotometry in Biochemistry laboratory. With statistical analysis using T-test found that there was asignificant differencein creatinine plasma levels between uncontrolled type 2 diabetes mellitus with controlled type 2 diabetes mellitus (p<0.005).

The Comparison of Dietary Behaviors among Rural Controlled and Uncontrolled Hypertensive Patients.

PubMed

Kamran, Aziz; Shekarchi, Ali Akbar; Sharifian, Elham; Heydari, Heshmatolah

2016-01-01

Nutrition is a dominant peripheral factor in increasing blood pressure; however, little information is available about the nutritional status of hypertensive patients in Iran. This study aimed to compare nutritional behaviors of the rural controlled and uncontrolled hypertensive patients and to determine the predictive power of nutritional behaviors from blood pressure. This cross-sectional study was conducted on 671 rural hypertensive patients, using multistage random sampling method in Ardabil city in 2013. Data were collected by a 3-day food record questionnaire. Nutritional data were extracted by Nutritionist 4 software and analyzed by the SPSS 18 software using Pearson correlation, multiple linear regression, ANOVA, and independent t-test. A significant difference was observed in the means of fat intake, cholesterol, saturated fat, sodium, energy, calcium, vitamin C, fiber, and nutritional knowledge between controlled and uncontrolled groups. In the controlled group, sodium, saturated fats, vitamin C, calcium, and energy intake explained 30.6% of the variations in blood pressure and, in the uncontrolled group, sodium, carbohydrate, fiber intake, and nutritional knowledge explained 83% of the variations in blood pressure. There was a significant difference in the nutritional behavior between the two groups and changes in blood pressure could be explained significantly by nutritional behaviors.

Load shift potential of electric vehicles in Europe

NASA Astrophysics Data System (ADS)

Babrowski, Sonja; Heinrichs, Heidi; Jochem, Patrick; Fichtner, Wolf

2014-06-01

Many governments highly encourage electric mobility today, aiming at a high market penetration. This development would bring forth an impact on the energy system, which strongly depends on the driving and charging behavior of the users. While an uncontrolled immediate charging might strain the local grid and/or higher peak loads, there are benefits to be gained by a controlled charging. We examine six European mobility studies in order to display the effects of controlled and uncontrolled unidirectional charging. Taking into account country-specific driving patterns, we generate for each country a charging load curve corresponding to uncontrolled charging and consider the corresponding parking time at charging facilities in order to identify load shift potentials. The main results are that besides the charging power of the vehicles, the possibility to charge at the work place has a significant influence on the uncontrolled charging curve. Neither national nor regional differences are as significant. When charging is only possible at home, the vehicle availability at charging facilities during the day for all countries is at least 24%. With the additional possibility to charge at work, at least 45% are constantly available. Accordingly, we identified a big potential for load shifting through controlled charging.

Assessment of tools for protection of quality of water: Uncontrollable discharges of pollutants.

PubMed

Dehghani Darmian, Mohsen; Hashemi Monfared, Seyed Arman; Azizyan, Gholamreza; Snyder, Shane A; Giesy, John P

2018-06-06

Selecting an appropriate crisis management plans during uncontrollable loading of pollution to water systems is crucial. In this research the quality of water resources against uncontrollable pollution is protected by use of suitable tools. Case study which was chosen in this investigation was a river-reservoir system. Analytical and numerical solutions of pollutant transport equation were considered as the simulation strategy to calculate the efficient tools to protect water quality. These practical instruments are dilution flow and a new tool called detention time which is proposed and simulated for the first time in this study. For uncontrollable pollution discharge which was approximately 130% of the river's assimilation capacity, as long as the duration of contact (T c ) was considered as a constraint, by releasing 30% of the base flow of the river from the upstream dilution reservoir, the unallowable pollution could be treated. Moreover, when the affected distance (X c ) was selected as a constraint, the required detention time that the rubber dam should detained the water to be treated was equal to 187% of the initial duration of contact. Copyright © 2018 Elsevier Inc. All rights reserved.

Association of Controlled and Uncontrolled Hypertension With Workplace Productivity.

PubMed

Unmuessig, Victoria; Fishman, Paul A; Vrijhoef, Hubertus J M; Elissen, Arianne M J; Grossman, David C

2016-03-01

The authors estimated the lost productive time (LPT) due to absenteeism and presenteeism among employees at the Group Health Cooperative with controlled and uncontrolled hypertension compared with normotensive patients. The patients responded to a survey inquiring about health behaviors with links to their medical record to identify diagnoses, blood pressure measurement, and prescription drug dispenses. Individuals with controlled hypertension were more likely to report any LPT relative to individuals with uncontrolled hypertension (40.6% vs 32.6%, P<.05). There were no significant differences in the average hours of LPT due to presenteeism among individuals regardless of their hypertension status but individuals with hypertension were more likely to report hours of LPT due to absenteeism compared with normotensive individuals (1.04 vs 0.59 hours; P=.001). Individuals with uncontrolled hypertension were more likely to report LPT due to absenteeism compared with individuals with controlled hypertension (1.35 vs 0.72 hours; P=.001). There were no significant differences between individuals with hypertension whose blood pressure was controlled and normotensive individuals with respect to the likelihood of reporting any LPT or in the amounts of absenteeism and presenteeism. © 2015 Wiley Periodicals, Inc.

Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi.

PubMed

Almas, Aysha; Ghouse, Ayaz; Iftikhar, Ahmed Raza; Khursheed, Munawwar

2014-01-01

Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup.

Gaining efficiency by centralising the corporate business resiliency process.

PubMed

Martinez, Robert

2017-06-01

Organisations have compiled many business continuity plans over the years in response to uncontrollable events and natural disasters. As the types of threats increase, even more plans are being created. Unfortunately, many corporations do not communicate the existence of these various plans outside of their centre of excellence. Creating a centralised oversight of your business resiliency process brings many benefits, including greater awareness, a bigger pool of expertise, common terminology and reducing the chances of redundant efforts. Having an overarching corporate response plan in place makes it possible to have high-level leadership trained and ready in case an extreme event occurs.

Studies of uncontrolled air traffic patterns, phase 1

NASA Technical Reports Server (NTRS)

Baxa, E. G., Jr.; Scharf, L. L.; Ruedger, W. H.; Modi, J. A.; Wheelock, S. L.; Davis, C. M.

1975-01-01

The general aviation air traffic flow patterns at uncontrolled airports are investigated and analyzed and traffic pattern concepts are developed to minimize the midair collision hazard in uncontrolled airspace. An analytical approach to evaluate midair collision hazard probability as a function of traffic densities is established which is basically independent of path structure. Two methods of generating space-time interrelationships between terminal area aircraft are presented; one is a deterministic model to generate pseudorandom aircraft tracks, the other is a statistical model in preliminary form. Some hazard measures are presented for selected traffic densities. It is concluded that the probability of encountering a hazard should be minimized independently of any other considerations and that the number of encounters involving visible-avoidable aircraft should be maximized at the expense of encounters in other categories.

Clinical and Economic Burden of Elevated Blood Eosinophils in Patients With and Without Uncontrolled Asthma.

PubMed

Casciano, Julian; Krishnan, Jerry; Dotiwala, Zenobia; Li, Chenghui; Sun, Shawn X

2017-01-01

The European Respiratory Society and American Thoracic Society (ERS/ATS) published guidelines in 2014 for the evaluation and treatment of asthma. These guidelines draw attention to management of patients with asthma that remains uncontrolled despite therapy. One phenotypic characteristic of therapy-resistant asthma is eosinophil elevation. It is important to better understand the burden of care gaps in this patient subgroup in order to support improved treatment strategies in the future. To quantify the economic burden of asthma patients with and without peripheral blood eosinophil elevation. A retrospective cohort study was conducted using data from patients aged 12 years or older with a diagnosis of asthma using electronic health records of over 2 million patients between 2004-2010. Patients with a diagnosis of chronic obstructive pulmonary disease, Churg Strauss syndrome/Wegener's granulomatosis, eosinophilia, cystic/pulmonary fibrosis, allergic bronchopulmonary aspergillosis, or lung cancer in the 12-month period before the date of asthma diagnosis were excluded. Patients with asthma were followed for 12 months after their initial asthma diagnosis to identify those with controlled versus uncontrolled asthma based on ERS/ATS criteria. Patients with at least 1 peripheral blood eosinophil test result of ≥ 400 cells/µL were classified as those with elevated eosinophils. Total annual paid-claim cost was compared by eosinophil levels within the controlled and uncontrolled asthma subgroups. Costs were adjusted to 2015 U.S. dollars. Patients were stratified by control level, and generalized linear modeling regressions were used to assess the magnitude of increase in cost of the elevated eosinophil group. A total of 2,701 patients were included in the study, of which 17% had uncontrolled asthma and 21% had elevated eosinophils. The mean total annual cost of patients with uncontrolled asthma was more than 2 times the cost of those with controlled asthma ($18,341 vs. $8,670, P < 0.001). Patients with uncontrolled asthma in the elevated eosinophil group had almost double the total cost ($28,644 vs. $14,188, P = 0.008) compared with those with blood eosinophil levels in a normal range. Similarly, patients classified as those with controlled asthma in the elevated eosinophil group had almost twice the average costs as those without elevated eosinophils ($14,754 vs. $7,203, P < 0.001). Uncontrolled asthma with elevated eosinophils had 4 times greater hospital admissions and over 4 times higher total costs than controlled asthma without elevated eosinophils. Among patients with uncontrolled asthma, patients with elevated eosinophils had a 53% increase in mean cost ($17,723 vs. $11,581, P < 0.001) compared with patients without elevated eosinophils. Among patients with controlled asthma, patients with elevated eosinophils had a 62% increase in mean cost ($8,897 vs. $5,486, P < 0.001) compared with patients without elevated eosinophils. Elevated peripheral blood eosinophil level is associated with higher cost irrespective of disease control status. This study was funded by Teva Pharmaceuticals. Dotiwala and Casciano report consulting and writing fees from Teva Pharmaceuticals for work on this study. Sun is an employee and stockholder of Teva Pharmaceuticals. Li reports consulting fees from eMAX Health. All authors contributed to study design. Dotiwala took the lead in data collection, along with the other authors, and data interpretation was performed primarily by Krishnan, Sun, and Li, along with Casciano and Dotiwala. The manuscript was written by Casciano, Dotiwala, and Li, along with Sun and Krishnan, and revised by Casciano, Dotiwala, Sun, and Li, with assistance from Krishnan.

Renal angioplasty and stenting: is it still indicated after ASTRAL and STAR studies?

PubMed

Henry, M; Benjelloun, A; Henry, I; Polydorou, A; Hugel, M

2010-10-01

A renal artery stenosis (RAS) is common among patients with atherosclerosis, up to a third of patients undergoing cardiac catheterization. Fibromuscular dysplasia is the next cause of RAS, commonly found in young women. Atherosclerosis RAS generally progresses overtime and is often associated with loss of renal mass and worsening renal function (RF). Percutaneous renal artery stent placement is the preferred method of revascularization for hemodynamically significant RAS according to ACC and AHA guidelines. Several randomized trials have shown the superiority of endovascular procedures to medical therapy alone. However, two studies ASTRAL and STAR studies were recently published and did not find any difference between renal stenting and medical therapy. But these studies have a lot of limitations and flaws as we will discuss (poor indications, poor results, numerous complications, failures, poor technique, inexperienced operators, ecc.). Despite these questionable studies, renal stenting keeps indications in patients with: uncontrolled hypertension; ischemic nephropathy; cardiac disturbance syndrome (e.g. "flash" pulmonary edema, uncontrolled heart failure or uncontrolled angina pectoris); solitary kidney. To improve the clinical response rates, a better selection of the patients and lesions is mandatory with: good non-invasive or invasive imaging; physiologic lesion assessment using transluminal pressure gradients; measurements of biomarkers (e.g., BNP); fractional flow reserve study. A problem remains after renal angioplasty stenting, the deterioration of the RF in 20-30% of the patients. Atheroembolism seems to play an important role and is probably the main cause of this R.F deterioration. The use of protection devices alone or in combination with IIb IIa inhibitors has been proposed and seems promising as shown in different recent reports. Renal angioplasty and stenting is still indicated but we need: a better patient and lesion selection; improvements in techniques and maybe the use of protection devices to reduce the risk of RF deterioration after renal stenting.

Full-dose Perindopril/Indapamide in the Treatment of Difficult-to-Control Hypertension: The FORTISSIMO Study.

PubMed

Karpov, Yuri Aleksandrovich

2017-02-01

Blood pressure (BP) control in hypertensive patients remains poor worldwide, particularly in high-risk patients with hypertension and diabetes. Guidelines recommend that such patients receive prompt pharmacological therapy at maximal doses to rapidly control BP. We aimed to evaluate efficacy and safety of single-pill combination (SPC) perindopril/indapamide (PER/IND) at full dose (10/2.5 mg) in hypertensive patients, including diabetics, with BP uncontrolled by previous medication. Twelve-week prospective, observational study in patients with uncontrolled hypertension (≥160-200 mmHg systolic BP [SBP] and <110 mmHg diastolic BP [DBP]) on a previous SPC or free-dose combination of renin-angiotensin system blocker plus thiazide diuretic, substituted with PER/IND 10/2.5 mg. Office BP, quality of life, and blood parameters were evaluated in the whole cohort and patients with type 2 diabetes mellitus. 2120 ambulatory hypertensive patients were enrolled, including 307 with type 2 diabetes. Two weeks after substitution, SBP significantly decreased from 171.0 ± 13.3 to 148.6 ± 13.4 mmHg, and DBP from 98.6 ± 8.3 to 88.8 ± 7.9 mmHg (both p < 0.00001). A similar rapid decrease was noted in the diabetes subgroup. After 12 weeks, BP had reduced by 42/19 mmHg in the whole cohort (diabetes subgroup: 41/18 mmHg). Most (84%; diabetes subgroup: 77%) patients reached BP target (<140/90 mmHg). Laboratory tests and quality of life improved in the whole cohort and the diabetic subgroup. Switching to PER/IND at full dose (10/2.5 mg) was well tolerated, leading to fast BP reduction and control in the majority of patients with uncontrolled hypertension, including difficult-to-treat patients with diabetes.

Normal aging reduces motor synergies in manual pointing.

PubMed

Verrel, Julius; Lövdén, Martin; Lindenberger, Ulman

2012-01-01

Depending upon its organization, movement variability may reflect poor or flexible control of a motor task. We studied adult age-related differences in the structure of postural variability in manual pointing using the uncontrolled manifold (UCM) method. Participants from 2 age groups (younger: 20-30 years; older: 70-80 years; 12 subjects per group) completed a total of 120 pointing trials to 2 different targets presented according to 3 schedules: blocked, alternating, and random. The age groups were similar with respect to basic kinematic variables, end point precision, as well as the accuracy of the biomechanical forward model of the arm. Following the uncontrolled manifold approach, goal-equivalent and nongoal-equivalent components of postural variability (goal-equivalent variability [GEV] and nongoal-equivalent variability [NGEV]) were determined for 5 time points of the movements (start, 10%, 50%, 90%, and end) and used to define a synergy index reflecting the flexibility/stability aspect of motor synergies. Toward the end of the movement, younger adults showed higher synergy indexes than older adults. Effects of target schedule were not reliable. We conclude that normal aging alters the organization of common multidegree-of-freedom movements, with older adults making less flexible use of motor abundance than younger adults. Copyright © 2012 Elsevier Inc. All rights reserved.

Acetyl-L-Carnitine Augmentation of Clozapine in Partial-Responder Schizophrenia: A 12-Week, Open-Label Uncontrolled Preliminary Study.

PubMed

Bruno, Antonio; Pandolfo, Gianluca; Crucitti, Manuela; Lorusso, Simona; Zoccali, Rocco Antonio; Muscatello, Maria Rosaria Anna

This was the first 12-week, open-label, uncontrolled trial aimed at exploring the efficacy of acetyl-L-carnitine (ALC) add-on pharmacotherapy on clinical symptoms and cognitive functioning in 15 schizophrenia patients with suboptimal clinical response despite receiving clozapine (CLZ) monotherapy at the highest tolerated dosage. After clinical (Positive and Negative Symptoms Scale [PANSS]) and neuropsychological (Wisconsin Card Sorting Test, Stroop Color-Word Test, Verbal Fluency Test) assessments, patients received 1 g/d of ALC for 12 weeks. A final sample of 9 subjects completed the study. Acetyl-L-carnitine augmentation of CLZ significantly reduced only PANSS domains "positive" (P = 0.049); at end point, only 2 subjects (22.2% of the completers) reached a minimal improvement (25% reduction in PANSS total score). No significant differences emerged in cognitive performances at the end of the study; effect sizes were small in each explored cognitive dimension. The findings provide preliminary evidence that ALC added to ongoing CLZ treatment appeared to be ineffective to improve symptoms in schizophrenia patients who have failed to respond sufficiently to CLZ. Further trials with adequately powered methodology are needed to identify which augmentation strategies are more effective in schizophrenia patients showing a suboptimal response to CLZ.

Ebselen exhibits glycation-inhibiting properties and protects against osmotic fragility of human erythrocytes in vitro.

PubMed

Soares, Julio C M; Folmer, Vanderlei; Da Rocha, João B T; Nogueira, Cristina W

2014-05-01

Diabetic status is associated with an increase on oxidative stress markers in humans and animal models. We have investigated the in vitro effects of high concentrations of glucose on the profile of oxidative stress and osmotic fragility of blood from control and diabetic patients; we considered whether its antioxidant properties could afford some protection against glucose-induced osmotic fragility, and whether ebselen could act as an inhibitor of hemoglobin glycation. Raising blood glucose to 5-100 mmol/L resulted in a concentration-dependent increase of glycated hemoglobin (HbA1c; P < 0.001) and thiobarbituric acid reactive species (TBA-RS) content (P < 0.004). Non-protein SH groups (NPSH) also increased significantly as the concentration of glucose increased up to 30 mmol/L (P < 0.001). The osmotic fragility was more pronounced in blood of uncontrolled diabetic patients than in these non-diabetic subjects. Ebselen significantly reduced the glucose-induced increase in osmotic fragility and inhibited HbA1c formation (P < 0.0001). These results indicate that blood from patients with uncontrolled diabetes are more sensitive to osmotic shock than from patients with controlled diabetes and control subjects in relation to increased production of free radicals in vivo. © 2014 International Federation for Cell Biology.

Subthreshold IKK activation modulates the effector functions of primary mast cells and allows specific targeting of transformed mast cells

PubMed Central

Drube, Sebastian; Beyer, Mandy; Rothe, Mandy; Rabenhorst, Anja; Göpfert, Christiane; Meininger, Isabel; Diamanti, Michaela A.; Stegner, David; Häfner, Norman; Böttcher, Martin; Reinecke, Kirstin; Herdegen, Thomas; Greten, Florian R.; Nieswandt, Bernhard; Hartmann, Karin; Krämer, Oliver H.; Kamradt, Thomas

2015-01-01

Mast cell differentiation and proliferation depends on IL-3. IL-3 induces the activation of MAP-kinases and STATs and consequently induces proliferation and survival. Dysregulation of IL-3 signaling pathways also contribute to inflammation and tumorigenesis. We show here that IL-3 induces a SFK- and Ca2+-dependent activation of the inhibitor of κB kinases 2 (IKK2) which results in mast cell proliferation and survival but does not induce IκBα-degradation and NFκB activation. Therefore we propose the term “subthreshold IKK activation”. This subthreshold IKK activation also primes mast cells for enhanced responsiveness to IL-33R signaling. Consequently, co-stimulation with IL-3 and IL-33 increases IKK activation and massively enhances cytokine production induced by IL-33. We further reveal that in neoplastic mast cells expressing constitutively active Ras, subthreshold IKK activation is associated with uncontrolled proliferation. Consequently, pharmacological IKK inhibition reduces tumor growth selectively by inducing apoptosis in vivo. Together, subthreshold IKK activation is crucial to mediate the full IL-33-induced effector functions in primary mast cells and to mediate uncontrolled proliferation of neoplastic mast cells. Thus, IKK2 is a new molecularly defined target structure. PMID:25749030

Tobacco Harm Reduction with Vaporised Nicotine (THRiVe): The Study Protocol of an Uncontrolled Feasibility Study of Novel Nicotine Replacement Products among People Living with HIV Who Smoke.

PubMed

Bell, Stephanie; Dean, Judith; Gilks, Charles; Boyd, Mark A; Fitzgerald, Lisa; Mutch, Allyson; Baker, Peter; Neilsen, Graham; Gartner, Coral E

2017-07-18

Smoking is a leading cause of morbidity and premature mortality among people living with HIV (PLHIV), who have high rates of tobacco smoking. Vaporised nicotine products (VNPs) are growing in popularity as a quit aid and harm reduction tool. However, little is known about their acceptability and use among PLHIV. Using a pragmatic, uncontrolled, mixed methods design this exploratory clinical trial aims to examine the feasibility of conducting a powered randomised clinical trial of VNPs as a smoking cessation and harm reduction intervention among vulnerable populations, such as PLHIV who smoke tobacco. Convenience sampling and snowball methods will be used to recruit participants (N = 30) who will receive two VNPs and up to 12 weeks' supply of nicotine e-liquid to use in a quit attempt. Surveys will be completed at weeks 0 (baseline), 4, 8, 12 (end of treatment) and 24 (end of the study) and qualitative interviews at weeks 0 and 12. As far as we are aware, this feasibility study is the first to trial VNPs among PLHIV for smoking cessation. If feasible and effective, this intervention could offer a new approach to reducing the high burden of tobacco-related disease among PLHIV and other vulnerable populations.

Perceived helplessness is associated with individual differences in the central motor output system.

PubMed

Salomons, Tim V; Moayedi, Massieh; Weissman-Fogel, Irit; Goldberg, Michael B; Freeman, Bruce V; Tenenbaum, Howard C; Davis, Karen D

2012-05-01

Learned helplessness is a maladaptive response to uncontrollable stress characterized by impaired motor escape responses, reduced motivation and learning deficits. There are important individual differences in the likelihood of becoming helpless following exposure to uncontrollable stress but little is known about the neural mechanisms underlying these individual differences. Here we used structural MRI to measure gray and white matter in individuals with chronic pain, a population at high risk for helplessness due to prolonged exposure to a poorly controlled stressor (pain). Given that self-reported helplessness is predictive of treatment outcomes in chronic pain, understanding such differences might provide valuable clinical insight. We found that the magnitude of self-reported helplessness correlated with cortical thickness in the supplementary motor area (SMA) and midcingulate cortex, regions implicated in cognitive aspects of motor behavior. We then examined the white matter connectivity of these regions and found that fractional anisotropy of connected white matter tracts along the corticospinal tract was associated with helplessness and mediated the relationship between SMA cortical thickness and helplessness. These data provide novel evidence that links individual differences in the motor output pathway with perceived helplessness over a chronic and poorly controlled stressor. © 2012 The Authors. European Journal of Neuroscience © 2012 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

Regulation of Romantic Love Feelings: Preconceptions, Strategies, and Feasibility

PubMed Central

Langeslag, Sandra J. E.; van Strien, Jan W.

2016-01-01

Love feelings can be more intense than desired (e.g., after a break-up) or less intense than desired (e.g., in long-term relationships). If only we could control our love feelings! We present the concept of explicit love regulation, which we define as the use of behavioral and cognitive strategies to change the intensity of current feelings of romantic love. We present the first two studies on preconceptions about, strategies for, and the feasibility of love regulation. Questionnaire responses showed that people perceive love feelings as somewhat uncontrollable. Still, in four open questions people reported to use strategies such as cognitive reappraisal, distraction, avoidance, and undertaking (new) activities to cope with break-ups, to maintain long-term relationships, and to regulate love feelings. Instructed up-regulation of love using reappraisal increased subjective feelings of attachment, while love down-regulation decreased subjective feelings of infatuation and attachment. We used the late positive potential (LPP) amplitude as an objective index of regulation success. Instructed love up-regulation enhanced the LPP between 300–400 ms in participants who were involved in a relationship and in participants who had recently experienced a romantic break-up, while love down-regulation reduced the LPP between 700–3000 ms in participants who were involved in a relationship. These findings corroborate the self-reported feasibility of love regulation, although they are complicated by the finding that love up-regulation also reduced the LPP between 700–3000 ms in participants who were involved in a relationship. To conclude, although people have the preconception that love feelings are uncontrollable, we show for the first time that intentional regulation of love feelings using reappraisal, and perhaps other strategies, is feasible. Love regulation will benefit individuals and society because it could enhance positive effects and reduce negative effects of romantic love. PMID:27529751

BSA modification to reduce CTAB induced nonspecificity and cytotoxicity of aptamer-conjugated gold nanorods

NASA Astrophysics Data System (ADS)

Yasun, Emir; Li, Chunmei; Barut, Inci; Janvier, Denisse; Qiu, Liping; Cui, Cheng; Tan, Weihong

2015-05-01

Aptamer-conjugated gold nanorods (AuNRs) are excellent candidates for targeted hyperthermia therapy of cancer cells. However, in high concentrations of AuNRs, aptamer conjugation alone fails to result in highly cell-specific AuNRs due to the presence of positively charged cetyltrimethylammonium bromide (CTAB) as a templating surfactant. Besides causing nonspecific electrostatic interactions with the cell surfaces, CTAB can also be cytotoxic, leading to uncontrolled cell death. To avoid the nonspecific interactions and cytotoxicity triggered by CTAB, we report the further biologically inspired modification of aptamer-conjugated AuNRs with bovine serum albumin (BSA) protein. Following this modification, interaction between CTAB and the cell surface was efficiently blocked, thereby dramatically reducing the side effects of CTAB. This approach may provide a general and simple method to avoid one of the most serious issues in biomedical applications of nanomaterials: nonspecific binding of the nanomaterials with biological cells.Aptamer-conjugated gold nanorods (AuNRs) are excellent candidates for targeted hyperthermia therapy of cancer cells. However, in high concentrations of AuNRs, aptamer conjugation alone fails to result in highly cell-specific AuNRs due to the presence of positively charged cetyltrimethylammonium bromide (CTAB) as a templating surfactant. Besides causing nonspecific electrostatic interactions with the cell surfaces, CTAB can also be cytotoxic, leading to uncontrolled cell death. To avoid the nonspecific interactions and cytotoxicity triggered by CTAB, we report the further biologically inspired modification of aptamer-conjugated AuNRs with bovine serum albumin (BSA) protein. Following this modification, interaction between CTAB and the cell surface was efficiently blocked, thereby dramatically reducing the side effects of CTAB. This approach may provide a general and simple method to avoid one of the most serious issues in biomedical applications of nanomaterials: nonspecific binding of the nanomaterials with biological cells. Electronic supplementary information (ESI) available: Fig. S-1 to S-6 are included. See DOI: 10.1039/c5nr01704a

Resuspension of sediment, a new approach for remediation of contaminated sediment.

PubMed

Pourabadehei, Mehdi; Mulligan, Catherine N

2016-06-01

Natural events and anthropogenic activities are the reasons of undesirable resuspension of contaminated sediments in aquatic environment. Uncontrolled resuspension could remobilize weakly bound heavy metals into overlying water and pose a potential risk to aquatic ecosystem. Shallow harbours, with contaminated sediments are subjected to the risk of uncontrolled resuspension. Remediation of sediments in these areas cannot be performed by conventional in situ methods (e.g. capping with or without reactive amendment). Ex situ remediation also requires dredging of sediment, which could increase the risk of spreading contaminants. Alternatively, the resuspension technique was introduced to address these issues. The concept of the resuspension method is that finer sediments have a greater tendency to adsorb the contamination. Therefore, finer sediments, believed carry more concentration of contaminants, were targeted for removal from aquatic environment by a suspension mechanism in a confined water column. The objective of this study was to evaluate the feasibility of the resuspension technique as a new approach for remediation of contaminated sediment and a viable option to reduce the risk of remobilization of contaminants in harbours due to an undesirable resuspension event. Unlike the common in situ techniques, the resuspension method could successfully reduce the total concentration of contaminants in almost all samples below the probable effect level (PEL) with no significant change in the quality of overlying water. The results indicated that removal efficiency could be drastically enhanced for metals in sediment with a higher enrichment factor. Moreover, availability of metals (e.g. Cd and Pb) with a high concentration in labile fractions was higher in finer sediments with a high enrichment factor. Consequently, removal of contaminants from sediment through the resuspension method could reduce the risk of mobility and availability of metals under changing environmental conditions. Potential dredging in harbours could be performed safer and more cost-effective afterward. Copyright © 2016 Elsevier Ltd. All rights reserved.

Symposium review: Modulating adipose tissue lipolysis and remodeling to improve immune function during the transition period and early lactation of dairy cows.

PubMed

Contreras, G Andres; Strieder-Barboza, Clarissa; De Koster, Jenne

2018-03-01

Despite major advances in our understanding of transition and early lactation cow physiology and the use of advanced dietary, medical, and management tools, at least half of early lactation cows are reported to develop disease and over half of cow deaths occur during the first week of lactation. Excessive lipolysis, usually measured as plasma concentrations of free fatty acids (FFA), is a major risk factor for the development of displaced abomasum, ketosis, fatty liver, and metritis, and may also lead to poor lactation performance. Lipolysis triggers adipose tissue (AT) remodeling that is characterized by enhanced humoral and cell-mediated inflammatory responses and changes in its distribution of cellular populations and extracellular matrix composition. Uncontrolled AT inflammation could perpetuate lipolysis, as we have observed in cows with displaced abomasum, especially in those animals with genetic predisposition for excessive lipolysis responses. Efficient transition cow management ensures a moderate rate of lipolysis that is rapidly reduced as lactation progresses. Limiting FFA release from AT benefits immune function as several FFA are known to promote dysregulation of inflammation. Adequate formulation of pre- and postpartum diet reduces the intensity of AT lipolysis. Additionally, supplementation with niacin, monensin, and rumen-protected methyl donors (choline and methionine) during the transition period is reported to minimize FFA release into systemic circulation. Targeted supplementation of energy sources during early lactation improves energy balance and increases insulin concentration, which limits AT lipolytic responses. This review elaborates on the mechanisms by which uncontrolled lipolysis triggers inflammatory disorders. Details on current nutritional and pharmacological interventions that aid the modulation of FFA release from AT and their effect on immune function are provided. Understanding the inherent characteristics of AT biology in transition and early lactation cows will reduce disease incidence and improve lactation performance. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications

PubMed Central

Zimmitti, Giuseppe; Vauthey, Jean-Nicolas; Shindoh, Junichi; Tzeng, Ching-Wei D.; Roses, Robert E.; Ribero, Dario; Capussotti, Lorenzo; Giuliante, Felice; Nuzzo, Gennaro; Aloia, Thomas A.

2013-01-01

Objective After hepatectomy, bile leaks remain a major cause of morbidity, cost, and disability. This study was designed to determine if a novel intraoperative Air Leak Test (ALT) would reduce the incidence of post-hepatectomy biliary complications. Study design Rates of postoperative biliary complications were compared between 103 patients who underwent ALT and 120 matched patients operated on before ALT was utilized. All study patients underwent major hepatectomy without bile duct resection at 3 high-volume hepatobiliary centers between 2008 and 2012. ALT was performed by placement of a trans-cystic cholangiogram catheter to inject air into the biliary tree while the upper abdomen was filled with saline and the distal common bile duct was manually occluded. Uncontrolled bile ducts were identified by localization of air bubbles at the transection surface and were directly repaired. Results The 2 groups were similar in diagnosis, chemotherapy use, tumor number and size, resection extent, surgery duration, and blood loss (all p>0.05). Single or multiple uncontrolled bile ducts were intraoperatively detected and repaired in 62.1% of ALT vs. 8.3% of non-ALT patients (p<0.001). This resulted in a lower rate of postoperative bile leaks in ALT (1.9%) vs. non-ALT patients (10.8%, p=0.008). Independent risk factors for postoperative bile leaks included extended hepatectomy (p=0.031), caudate resection (p=0.02), and not performing ALT (p=0.002) [odds ratio (95% Confidence Interval): 3.8 (1.3–11.8), 4.0 (1.1–14.3), and 11.8 (2.4–58.8), respectively]. Conclusion ALT is an easily reproducible test that is highly effective for intraoperative detection and repair of open bile ducts, reducing the rate of postoperative bile leaks. PMID:24246619

Systematic use of an intraoperative air leak test at the time of major liver resection reduces the rate of postoperative biliary complications.

PubMed

Zimmitti, Giuseppe; Vauthey, Jean-Nicolas; Shindoh, Junichi; Tzeng, Ching-Wei D; Roses, Robert E; Ribero, Dario; Capussotti, Lorenzo; Giuliante, Felice; Nuzzo, Gennaro; Aloia, Thomas A

2013-12-01

After hepatectomy, bile leaks remain a major cause of morbidity, cost, and disability. This study was designed to determine if a novel intraoperative air leak test (ALT) would reduce the incidence of post-hepatectomy biliary complications. Rates of postoperative biliary complications were compared among 103 patients who underwent ALT and 120 matched patients operated on before ALT was used. All study patients underwent major hepatectomy without bile duct resection at 3 high-volume hepatobiliary centers between 2008 and 2012. The ALT was performed by placement of a transcystic cholangiogram catheter to inject air into the biliary tree, the upper abdomen was filled with saline, and the distal common bile duct was manually occluded. Uncontrolled bile ducts were identified by localization of air bubbles at the transection surface and were directly repaired. The 2 groups were similar in diagnosis, chemotherapy use, tumor number and size, resection extent, surgery duration, and blood loss (all, p > 0.05). Single or multiple uncontrolled bile ducts were intraoperatively detected and repaired in 62.1% of ALT vs 8.3% of non-ALT patients (p < 0.001). This resulted in a lower rate of postoperative bile leaks in ALT (1.9%) vs non-ALT patients (10.8%; p = 0.008). Independent risk factors for postoperative bile leaks included extended hepatectomy (p = 0.031), caudate resection (p = 0.02), and not performing ALT (p = 0.002) (odds ratio = 3.8; 95% CI, 1.3-11.8; odds ratio = 4.0; 95% CI, 1.1-14.3; and odds ratio = 11.8; 95% CI, 2.4-58.8, respectively). The ALT is an easily reproducible test that is highly effective for intraoperative detection and repair of open bile ducts, reducing the rate of postoperative bile leaks. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Caring for the infant of a diabetic mother.

PubMed

Hatfield, Linda; Schwoebel, Ann; Lynyak, Corinne

2011-01-01

In the United States, approximately 100,000 infants are born to diabetic mothers each year. If diabetes in pregnancy is uncontrolled, the diversity of resulting health problems can have a profound effect on the embryo, the fetus, and the neonate. These infants are at risk for a multitude of physiologic, metabolic, and congenital complications such as macrosomia, asphyxia, respiratory distress, hypoglycemia, hypocalcemia, hyperbilirubinemia, polycythemia and hyperviscosity, cardiomegaly, and central nervous system disruption. Preconception control of glucose metabolism throughout the trajectory of a woman's pregnancy is a significant factor in decreasing the adverse impact of diabetes on the fetus and newborn. Meticulous attention to neonatal glucose levels, thorough physical examination, and precise diagnosis are prerequisites to appropriate care for the neonate.

Successfully use agglomeration for size enlargement

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

Pietsch, W.

1996-04-01

The processing of fine and ultrafine particles by size enlargement finds an ever increasing application. At the same time, undesirable agglomeration such as buildup, caking, bridging, and uncontrolled aggregation of fine particles can occur during processing and handling of these particulate solids. This article will provide a survey of the phenomena of agglomeration and discuss the unit operation of size enlargement by agglomeration. This article is also an invitation, particularly to young engineers, to become interested in agglomeration. Considering that mechanical process technologies are requiring more energy every year than any other group of consumers and efficiencies are typically inmore » the single digits or teens at best, considerable rewards can be expected from the development of scientifically modified, more energy-efficient methods and equipment.« less

40 CFR Table 2 to Subpart Mmm of... - Standards for New and Existing PAI Sources

Code of Federal Regulations, 2010 CFR

2010-07-01

... TOC. Processes having uncontrolled HCl and chlorine emissions ≥6.8 Mg/yr 94% for HCl and chlorine per... November 10, 1997 98% gaseous organic HAP control per vent or ≤20 ppmv TOC outlet limit. New: Processes having uncontrolled organic HAP emissions ≥0.15 Mg/yr 98% for organic HAP per process or ≤20 ppmv TOC...

Resolvin D3 Is Dysregulated in Arthritis and Reduces Arthritic Inflammation.

PubMed

Arnardottir, Hildur H; Dalli, Jesmond; Norling, Lucy V; Colas, Romain A; Perretti, Mauro; Serhan, Charles N

2016-09-15

Uncontrolled inflammation is a unifying component of many chronic inflammatory diseases, such as arthritis. Resolvins (Rvs) are a new family from the endogenous specialized proresolving mediators (SPMs) that actively stimulate resolution of inflammation. In this study, using lipid mediator metabololipidomics with murine joints we found a temporal regulation of endogenous SPMs during self-resolving inflammatory arthritis. The SPMs present in self-resolving arthritic joints include the D-series Rvs, for example, RvD1, RvD2, RvD3, and RvD4. Of note, RvD3 levels were reduced in inflamed joints from mice with delayed-resolving arthritis when compared with self-resolving inflammatory arthritis. RvD3 was also reduced in serum from rheumatoid arthritis patients compared with healthy controls. RvD3 administration reduced joint leukocytes as well as paw joint eicosanoids, clinical scores, and edema. Taken together, these findings provide evidence for dysregulated endogenous RvD3 levels in inflamed paw joints and its potent actions in reducing murine arthritis. Copyright © 2016 by The American Association of Immunologists, Inc.

Control of nonlinear systems with applications to constrained robots and spacecraft attitude stabilization

NASA Technical Reports Server (NTRS)

Krishnan, Hariharan

1993-01-01

This thesis is organized in two parts. In Part 1, control systems described by a class of nonlinear differential and algebraic equations are introduced. A procedure for local stabilization based on a local state realization is developed. An alternative approach to local stabilization is developed based on a classical linearization of the nonlinear differential-algebraic equations. A theoretical framework is established for solving a tracking problem associated with the differential-algebraic system. First, a simple procedure is developed for the design of a feedback control law which ensures, at least locally, that the tracking error in the closed loop system lies within any given bound if the reference inputs are sufficiently slowly varying. Next, by imposing additional assumptions, a procedure is developed for the design of a feedback control law which ensures that the tracking error in the closed loop system approaches zero exponentially for reference inputs which are not necessarily slowly varying. The control design methodologies are used for simultaneous force and position control in constrained robot systems. The differential-algebraic equations are shown to characterize the slow dynamics of a certain nonlinear control system in nonstandard singularly perturbed form. In Part 2, the attitude stabilization (reorientation) of a rigid spacecraft using only two control torques is considered. First, the case of momentum wheel actuators is considered. The complete spacecraft dynamics are not controllable. However, the spacecraft dynamics are small time locally controllable in a reduced sense. The reduced spacecraft dynamics cannot be asymptotically stabilized using continuous feedback, but a discontinuous feedback control strategy is constructed. Next, the case of gas jet actuators is considered. If the uncontrolled principal axis is not an axis of symmetry, the complete spacecraft dynamics are small time locally controllable. However, the spacecraft attitude cannot be asymptotically stabilized using continuous feedback, but a discontinuous stabilizing feedback control strategy is constructed. If the uncontrolled principal axis is an axis of symmetry, the complete spacecraft dynamics cannot be stabilized. However, the spacecraft dynamics are small time locally controllable in a reduced sense. The reduced spacecraft dynamics cannot be asymptotically stabilized using continuous feedback, but again a discontinuous feedback control strategy is constructed.

Group acceptance and commitment therapy (ACT) for bipolar disorder and co-existing anxiety - an open pilot study.

PubMed

Pankowski, Sara; Adler, Mats; Andersson, Gerhard; Lindefors, Nils; Svanborg, Cecilia

2017-03-01

Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and Action Questionnaire - AAQ-2) before, during and after the treatment. At post-treatment, the participants reported significant improvements in all outcome measures, with large effects (Cohen's d between 0.73 and 1.98). The mean reduction in anxiety symptoms was 45%. At post-treatment, 96% of the patients were classified as responders on at least one of the outcome measures. A limitation is that the trial is uncontrolled. The results suggest that ACT has the potential to be an effective treatment for BD patients with co-existing anxiety. Further randomized studies are warranted.

Hba1c, Blood Pressure, and Lipid Control in People with Diabetes: Japan Epidemiology Collaboration on Occupational Health Study

PubMed Central

Hu, Huanhuan; Hori, Ai; Nishiura, Chihiro; Sasaki, Naoko; Okazaki, Hiroko; Nakagawa, Tohru; Honda, Toru; Yamamoto, Shuichiro; Tomita, Kentaro; Miyamoto, Toshiaki; Nagahama, Satsue; Uehara, Akihiko; Yamamoto, Makoto; Murakami, Taizo; Shimizu, Chii; Shimizu, Makiko; Eguchi, Masafumi; Kochi, Takeshi; Imai, Teppei; Okino, Akiko; Kuwahara, Keisuke; Kashino, Ikuko; Akter, Shamima; Kurotani, Kayo; Nanri, Akiko; Kabe, Isamu; Mizoue, Tetsuya; Kunugita, Naoki; Dohi, Seitaro

2016-01-01

Aims The control of blood glucose levels, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) levels reduces the risk of diabetes complications; however, data are scarce on control status of these factors among workers with diabetes. The present study aimed to estimate the prevalence of participants with diabetes who meet glycated hemoglobin (HbA1c), BP, and LDL-C recommendations, and to investigate correlates of poor glycemic control in a large working population in Japan. Methods The Japan Epidemiology Collaboration on Occupational Health (J-ECOH) Study is an ongoing cohort investigation, consisting mainly of employees in large manufacturing companies. We conducted a cross-sectional analysis of 3,070 employees with diabetes (2,854 men and 216 women) aged 20–69 years who attended periodic health examinations. BP was measured and recorded using different company protocols. Risk factor targets were defined using both American Diabetes Association (ADA) guidelines (HbA1c < 7.0%, BP < 140/90 mmHg, and LDL-C < 100 mg/dL) and Japan Diabetes Society (JDS) guidelines (HbA1c < 7.0%, BP < 130/80 mmHg, and LDL-C < 120 mg/dL). Logistic regression models were used to explore correlates of poor glycemic control (defined as HbA1c ≥ 8.0%). Results The percentages of participants who met ADA (and JDS) targets were 44.9% (44.9%) for HbA1c, 76.6% (36.3%) for BP, 27.1% (56.2%) for LDL-C, and 11.2% (10.8%) for simultaneous control of all three risk factors. Younger age, obesity, smoking, and uncontrolled dyslipidemia were associated with poor glycemic control. The adjusted odds ratio of poor glycemic control was 0.58 (95% confidence interval, 0.46–0.73) for participants with treated but uncontrolled hypertension, and 0.47 (0.33–0.66) for participants with treated and controlled hypertension, as compared with participants without hypertension. There was no significant difference in HbA1c levels between participants with treated but uncontrolled hypertension and those with treated and controlled hypertension. Conclusion Data from a large working population, predominantly composed of men, suggest that achievement of HbA1c, BP, and LDL-C targets was less than optimal, especially in younger participants. Uncontrolled dyslipidemia was associated with poor glycemic control. Participants not receiving antihypertensive treatment had higher HbA1c levels. PMID:27437997

Ideal resuscitation pressure for uncontrolled hemorrhagic shock in different ages and sexes of rats

PubMed Central

2013-01-01

Introduction Our previous studies demonstrated that 50-60 mmHg mean arterial blood pressure was the ideal target hypotension for uncontrolled hemorrhagic shock during the active hemorrhage in sexually mature rats. The ideal target resuscitation pressure for immature and older rats has not been determined. Methods To elucidate this issue, using uncontrolled hemorrhagic-shock rats of different ages and sexes (6 weeks, 14 weeks and 1.5 years representing pre-adult, adult and older rats, respectively), the resuscitation effects of different target pressures (40, 50, 60, 70 and 80 mmHg) on uncontrolled hemorrhagic shock during active hemorrhage and the age and sex differences were observed. Results Different target resuscitation pressures had different resuscitation outcomes for the same age and sex of rats. The optimal target resuscitation pressures for 6-week-old, 14-week-old and 1.5-year-old rats were 40 to 50 mmHg, 50 to 60 mmHg and 70 mmHg respectively. Ideal target resuscitation pressures were significantly superior to other resuscitation pressures in improving the hemodynamics, blood perfusion, organ function and animal survival of uncontrolled hemorrhagic-shock rats (P < 0.01). For same target resuscitation pressures, the beneficial effect on hemorrhagic shock had a significant age difference (P < 0.01) but no sex difference (P > 0.05). Different resuscitation pressures had no effect on coagulation function. Conclusion Hemorrhagic-shock rats at different ages have different target resuscitation pressures during active hemorrhage. The ideal target resuscitation hypotension for 6-week-old, 14-week-old and 1.5-year-old rats was 40 to 50 mmHg, 50 to 60 mmHg and 70 mmHg, respectively. Their resuscitation effects have significant age difference but had no sex difference. PMID:24020401

Recognizing Disordered Eating in Primary Care Patients with Obesity

PubMed Central

Chacko, Sara A.; Chiodi, Sarah N.; Wee, Christina C.

2015-01-01

Objective In clinical practice, behavioral approaches to obesity treatment focus heavily on diet and exercise recommendations. However, these approaches may not be effective for patients with disordered eating behaviors. Little is known about the prevalence of disordered eating behaviors in primary care patients with obesity or whether they affect difficulty making dietary changes. Methods We conducted a telephone interview of 337 primary care patients aged 18–65 years with BMI≥35kg/m2 in Greater-Boston, 2009–2011 (58% response rate, 69% women). We administered the Three-Factor Eating Questionnaire R-18 (Scores 0–100) and the Impact of Weight on Quality of Life-Lite (IWQOL-lite) (Scores 0–100). We measured difficulty making dietary changes using four questions regarding perceived difficulty changing diet (Scores 0–10). Results 50% of patients reported high emotional eating (score>50) and 28% reported high uncontrolled eating (score>50). Women were more likely to report emotional [OR=4.14 (2.90, 5.92)] and uncontrolled eating [OR=2.11 (1.44, 3.08)] than men. African Americans were less likely than Caucasians to report emotional [OR=0.29 (95% CI: 0.19, 0.44)] and uncontrolled eating [OR=0.11 (0.07, 0.19)]. For every 10-point reduction in QOL score (IWQOL-lite), emotional and uncontrolled eating scores rose significantly by 7.82 and 5.48, respectively. Furthermore, participants who reported emotional and uncontrolled eating reported greater difficulty making dietary changes. Conclusions Disordered eating behaviors are prevalent among obese primary care patients and disproportionately affect women, Caucasians, and patients with poor QOL. These eating behaviors may impair patients' ability to make clinically recommended dietary changes. Clinicians should consider screening for disordered eating behaviors and tailoring obesity treatment accordingly. PMID:25572624

White-Coat Effect Is Uncommon in Patients With Refractory Hypertension.

PubMed

Siddiqui, Mohammed; Judd, Eric K; Oparil, Suzanne; Calhoun, David A

2017-09-01

Refractory hypertension is a recently described phenotype of antihypertensive treatment failure defined as uncontrolled blood pressure (BP) despite the use of ≥5 different antihypertensive agents, including chlorthalidone and spironolactone. Recent studies indicate that refractory hypertension is uncommon, with a prevalence of ≈5% to 10% of patients referred to a hypertension specialty clinic for uncontrolled hypertension. The prevalence of white-coat effect, that is, uncontrolled automated office BP ≥135/85 mm Hg and controlled out-of-office BP <135/85 mm Hg, by awake ambulatory BP monitor in hypertensive patients overall is ≈30% to 40%. The prevalence of white-coat effect among patients with refractory hypertension has not been previously reported. In this prospective evaluation, consecutive patients referred to the University of Alabama at Birmingham Hypertension Clinic for uncontrolled hypertension were enrolled. Refractory hypertension was defined as uncontrolled automated office BP ≥135/85 mm Hg with the use of ≥5 antihypertensive agents, including chlorthalidone and spironolactone. Automated office BP measurements were based on 6 serial readings, done automatically with the use of a BpTRU device unobserved in the clinic. Out-of-office BP measurements were done by 24-hour ambulatory BP monitor. Thirty-four patients were diagnosed with refractory hypertension, of whom 31 had adequate ambulatory BP monitor readings. White-coat effect was present in only 2 patients, or 6.5% of the 31 patients with refractory hypertension, suggesting that white-coat effect is largely absent in patients with refractory hypertension. These findings suggest that white-coat effect is not a common cause of apparent lack of BP control in patients failing maximal antihypertensive treatment. © 2017 American Heart Association, Inc.

Freewheel running prevents learned helplessness/behavioral depression: role of dorsal raphe serotonergic neurons.

PubMed

Greenwood, Benjamin N; Foley, Teresa E; Day, Heidi E W; Campisi, Jay; Hammack, Sayamwong H; Campeau, Serge; Maier, Steven F; Fleshner, Monika

2003-04-01

Serotonin (5-HT) neurons in the dorsal raphe nucleus (DRN) are implicated in mediating learned helplessness (LH) behaviors, such as poor escape responding and expression of exaggerated conditioned fear, induced by acute exposure to uncontrollable stress. DRN 5-HT neurons are hyperactive during uncontrollable stress, resulting in desensitization of 5-HT type 1A (5-HT1A) inhibitory autoreceptors in the DRN. 5-HT1A autoreceptor downregulation is thought to induce transient sensitization of DRN 5-HT neurons, resulting in excessive 5-HT activity in brain areas that control the expression of learned helplessness behaviors. Habitual physical activity has antidepressant/anxiolytic properties and results in dramatic alterations in physiological stress responses, but the neurochemical mediators of these effects are unknown. The current study determined the effects of 6 weeks of voluntary freewheel running on LH behaviors, uncontrollable stress-induced activity of DRN 5-HT neurons, and basal expression of DRN 5-HT1A autoreceptor mRNA. Freewheel running prevented the shuttle box escape deficit and the exaggerated conditioned fear that is induced by uncontrollable tail shock in sedentary rats. Furthermore, double c-Fos/5-HT immunohistochemistry revealed that physical activity attenuated tail shock-induced activity of 5-HT neurons in the rostral-mid DRN. Six weeks of freewheel running also resulted in a basal increase in 5-HT1A inhibitory autoreceptor mRNA in the rostral-mid DRN. Results suggest that freewheel running prevents behavioral depression/LH and attenuates DRN 5-HT neural activity during uncontrollable stress. An increase in 5-HT1A inhibitory autoreceptor expression may contribute to the attenuation of DRN 5-HT activity and the prevention of LH in physically active rats.

Risk Indicators for Periodontitis in US Adults: NHANES 2009 to 2012.

PubMed

Eke, Paul I; Wei, Liang; Thornton-Evans, Gina O; Borrell, Luisa N; Borgnakke, Wenche S; Dye, Bruce; Genco, Robert J

2016-10-01

Through the use of optimal surveillance measures and standard case definitions, it is now possible to more accurately determine population-average risk profiles for severe (SP) and non-severe periodontitis (NSP) in adults (aged 30 years and older) in the United States. Data from the 2009 to 2012 National Health and Nutrition Examination Survey were used, which, for the first time, used the "gold standard" full-mouth periodontitis surveillance protocol to classify severity of periodontitis following suggested Centers for Disease Control/American Academy of Periodontology case definitions. Probabilities of periodontitis by: 1) sociodemographics, 2) behavioral factors, and 3) comorbid conditions were assessed using prevalence ratios (PRs) estimated by predicted marginal probability from multivariable generalized logistic regression models. Analyses were further stratified by sex for each classification of periodontitis. Likelihood of total periodontitis (TP) increased with age for overall and NSP relative to non-periodontitis. Compared with non-Hispanic whites, TP was more likely in Hispanics (adjusted [a]PR = 1.38; 95% confidence interval 95% CI: 1.26 to 1.52) and non-Hispanic blacks (aPR = 1.35; 95% CI: 1.22 to 1.50), whereas SP was most likely in non-Hispanic blacks (aPR = 1.82; 95% CI: 1.44 to 2.31). There was at least a 50% greater likelihood of TP in current smokers compared with non-smokers. In males, likelihood of TP in adults aged 65 years and older was greater (aPR = 2.07; 95% CI: 1.76 to 2.43) than adults aged 30 to 44 years. This probability was even greater in women (aPR = 3.15; 95% CI: 2.63 to 3.77). Likelihood of TP was higher in current smokers relative to non-smokers regardless of sex and periodontitis classification. TP was more likely in men with uncontrolled diabetes mellitus (DM) compared with adults without DM. Assessment of risk profiles for periodontitis in adults in the United States based on gold standard periodontal measures show important differences by severity of disease and sex. Cigarette smoking, specifically current smoking, remains an important modifiable risk for all levels of periodontitis severity. Higher likelihood of TP in older adults and in males with uncontrolled DM is noteworthy. These findings could improve identification of target populations for effective public health interventions to improve periodontal health of adults in the United States.

Simultaneous Implantation of an Ahmed and Baerveldt Glaucoma Drainage Device for Uncontrolled Intraocular Pressure in Advanced Glaucoma.

PubMed

Rao, Veena S; Christenbury, Joseph; Lee, Paul; Allingham, Rand; Herndon, Leon; Challa, Pratap

2017-02-01

To evaluate efficacy and safety of a novel technique, simultaneous implantation of Ahmed and Baerveldt shunts, for improved control of intraocular pressure (IOP) in advanced glaucoma with visual field defects threatening central fixation. Retrospective case series; all patients receiving simultaneous Ahmed and Baerveldt implantation at a single institution between October 2004 and October 2009 were included. Records were reviewed preoperatively and at postoperative day 1, week 1, month 1, month 3, month 6, year 1, and yearly until year 5. Outcome measures included IOP, best-corrected visual acuity, visual field mean deviation, cup to disc ratio, number of glaucoma medications, and complications. Fifty-nine eyes were identified; mean (±SD) follow-up was 26±23 months. Primary open-angle glaucoma was most common (n=37, 63%). Forty-six eyes (78%) had prior incisional surgery. Mean preoperative IOP was 25.5±9.8 mm Hg. IOP was reduced 50% day 1 (P<0.001, mean 12.7±7.0 mm Hg), which persisted throughout follow-up. At year 1, cup to disc ratio and mean deviation were stable with decreased best-corrected visual acuity from logMAR 0.72±0.72(20/100) to 1.06±1.13(20/200) (P=0.007). The Kaplan-Meier survival analysis showed median and mean survival of 1205 and 829±91 days, respectively. Complication rate was 47%. IOP is markedly reduced postoperative day 1 following double glaucoma tube implantation with effects persisting over postoperative year 1 and up to year 5. Complications were higher than that seen in reports of single shunt implantation, which may be explained by patient complexity in this cohort. This technique may prove a promising novel approach for management of uncontrolled IOP in advanced glaucoma.

Value of a facilitated quality improvement initiative on cardiovascular disease risk: findings from an evaluation of the Aggressively Treating Global Cardiometabolic Risk Factors to Reduce Cardiovascular Events (AT GOAL).

PubMed

Losby, Jan L; Osuji, Thearis A; House, Marnie J; Davis, Rachel; Boyce, Simone Peart; Greenberg, Michael Canter; Whitehill, John M

2015-10-01

In the United States, cardiovascular disease (CVD) is the leading cause of death. The US Centers for Disease Control and Prevention contracted an evaluation of the Aggressively Treating Global Cardiometabolic Risk Factors to Reduce Cardiovascular Events (AT GOAL) programme as part of its effort to identify strategies to address CVD risk factors. This study analysed patient-level data from 7527 patients in 43 primary care practices. The researchers assessed average change in control rates for CVD-related measures across practices, and then across patients between baseline and a patient's last visit during the practice's tenure in the programme (referred to as 'end line') using repeated measures analysis of variance and random effects generalized least squares, respectively. Among non-diabetic patients, there were significant increases in control rates for overall blood pressure (74.3% to 78.0%, P = 0.0002), systolic blood pressure (70.3% to 80.6%, P = 0.0099), diastolic blood pressure (90.1% to 92.7%, P = 0.0001) and low-density lipoprotein (LDL; 48.6% to 53.1%, P = 0.0001) between baseline and end line. Among diabetic patients, there was a significant increase in diastolic blood pressure control (59.8% to 61.9%, P = 0.0141). While continuous CVD-related outcomes show an overall trend between baseline and end line, patients with uncontrolled measures at baseline showed a decrease between baseline and end line relative to their counterparts who were controlled at baseline. Findings from the AT GOAL evaluation support the value of a facilitated quality improvement (QI) initiative on managing CVD risk. © 2015 John Wiley & Sons, Ltd.

Shock progression and survival after use of a condom uterine balloon tamponade package in women with uncontrolled postpartum hemorrhage.

PubMed

Burke, Thomas F; Danso-Bamfo, Sandra; Guha, Moytrayee; Oguttu, Monica; Tarimo, Vincent; Nelson, Brett D

2017-10-01

To examine the outcomes of women in advanced shock from uncontrolled postpartum hemorrhage (PPH) who underwent placement of an Every Second Matters for Mothers and Babies Uterine Balloon Tamponade (ESM-UBT) device. In a prospective case series, data were collected for women who received an ESM-UBT device at healthcare facilities in Kenya, Senegal, Sierra Leone, and Tanzania between September 1, 2012, and September 30, 2016. Shock class was assigned on the basis of recorded blood pressures and mental status at the time of UBT placement. Data for 306 women with uncontrolled PPH from uterine atony across 117 facilities were analyzed. Normal vital signs or class I/II shock were reported for 166 (54.2%). In this group, one death occurred and was attributed to PPH (survival rate 99.4%). There were no cases of shock progression. One hundred and eleven (36.3%) were in class III shock and 29 (9.5%) in class IV shock; the respective survival rates were 97.3% (n=108) and 86.2% (n=25). The ESM-UBT device arrests hemorrhage, prevents shock progression, and is associated with high survival rates among women with uncontrolled PPH from uterine atony. © 2017 International Federation of Gynecology and Obstetrics.

Learned helplessness: effects of response requirement and interval between treatment and testing.

PubMed

Hunziker, M H L; Dos Santos, C V

2007-11-01

Three experiments investigated learned helplessness in rats manipulating response requirements, shock duration, and intervals between treatment and testing. In Experiment 1, rats previously exposed to uncontrollable or no shocks were tested under one of four different contingencies of negative reinforcement: FR 1 or FR 2 escape contingency for running, and FR1 escape contingency for jumping (differing for the maximum shock duration of 10s or 30s). The results showed that the uncontrollable shocks produced a clear operant learning deficit (learned helplessness effect) only when the animals were tested under the jumping FR 1 escape contingency with 10-s max shock duration. Experiment 2 isolated of the effects of uncontrollability from shock exposure per se and showed that the escape deficit observed using the FR 1 escape jumping response (10-s shock duration) was produced by the uncontrollability of shock. Experiment 3 showed that using the FR 1 jumping escape contingency in the test, the learned helplessness effect was observed one, 14 or 28 days after treatment. These results suggest that running may not be an appropriate test for learned helplessness, and that many diverging results found in the literature might be accounted for by the confounding effects of respondent and operant contingencies present when running is required of rats.

Hypertensive Crisis, Burden, Management, and Outcome at a Tertiary Care Center in Karachi

PubMed Central

Almas, Aysha; Ghouse, Ayaz; Iftikhar, Ahmed Raza; Khursheed, Munawwar

2014-01-01

Objectives. Hypertension, if uncontrolled, can lead to hypertensive crisis. We aim to determine the prevalence of hypertensive crisis, its management, and outcome in patients presenting to a tertiary care center in Karachi. Methods. This was a cross-sectional study conducted at the Aga Khan University, Karachi, Pakistan. Adult inpatients (>18 yrs) presenting to the ER who were known hypertensive and had uncontrolled hypertension were included. Results. Out of 1336 patients, 28.6% (387) had uncontrolled hypertension. The prevalence of hypertensive crisis among uncontrolled hypertensive was 56.3% (218). Per oral calcium channel blocker; 35.4% (137) and intravenous nitrate; 22.7% (88) were the most commonly administered medication in the ER. The mean (SD) drop in SBP in patients with hypertensive crisis on intravenous treatment was 53.1 (29) mm Hg and on per oral treatment was 43 (27) mm Hg. The maximum mean (SD) drop in blood pressure was seen by intravenous sodium nitroprusside; 80 (51) mm Hg in SBP. Acute renal failure was the most common complication with a prevalence of 11.5% (24). Conclusion. The prevalence of hypertensive crisis is high. Per oral calcium channel blocker and intravenous nitrate are the most commonly administered medications in our setup. PMID:26464857

Analysis of electric energy consumption of automatic milking systems in different configurations and operative conditions.

PubMed

Calcante, Aldo; Tangorra, Francesco M; Oberti, Roberto

2016-05-01

Automatic milking systems (AMS) have been a revolutionary innovation in dairy cow farming. Currently, more than 10,000 dairy cow farms worldwide use AMS to milk their cows. Electric consumption is one of the most relevant and uncontrollable operational cost of AMS, ranging between 35 and 40% of their total annual operational costs. The aim of the present study was to measure and analyze the electric energy consumption of 4 AMS with different configurations: single box, central unit featuring a central vacuum system for 1 cow unit and for 2 cow units. The electrical consumption (daily consumption, daily consumption per cow milked, consumption per milking, and consumption per 100L of milk) of each AMS (milking unit + air compressor) was measured using 2 energy analyzers. The measurement period lasted 24h with a sampling frequency of 0.2Hz. The daily total energy consumption (milking unit + air compressor) ranged between 45.4 and 81.3 kWh; the consumption per cow milked ranged between 0.59 and 0.99 kWh; the consumption per milking ranged between 0.21 and 0.33 kWh; and the consumption per 100L of milk ranged between 1.80 to 2.44 kWh according to the different configurations and operational contexts considered. Results showed that AMS electric consumption was mainly conditioned by farm management rather than machine characteristics/architectures. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Field Demonstration of Enhanced Sorbent Injection for Mercury Control

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

Shin Kang; Robert Schrecengost

2009-01-07

Alstom Power Inc. has conducted a DOE/NETL-sponsored program (under DOE Cooperative Agreement No. DE-FC26-04NT42306) to demonstrate Mer-Cure{trademark}, one of Alstom's mercury control technologies for coal-fired boilers. Mer-Cure{trademark} utilizes a small amount of Mer-Clean{trademark} sorbent that is injected into the flue gas stream for oxidation and adsorption of gaseous mercury. Mer-Clean{trademark} sorbents are carbon-based and prepared with chemical additives that promote oxidation and capture of mercury. Mer-Cure{trademark} is unique in that the sorbent is injected into an environment where the mercury capture kinetics is accelerated. This full-scale demonstration program was comprised of three seven-week long test campaigns at three host sites including PacifiCorp's 240-MW{sub e} Dave Johnston Unit No.3 burning a Powder River Basin (PRB) coal, Basin Electric's 220-MW{sub e} Leland Olds Unit No.1 burning a North Dakota lignite, and Reliant Energy's 170-MW{sub e} Portland Unit No.1 burning an Eastern bituminous coal. All three boilers are equipped with electrostatic precipitators. The goals for this Round 2 program, established by DOE/NETL under the original solicitation, were to reduce the uncontrolled mercury emissions by 50 to 70% at a cost 25 to 50% lower than the previous target ofmore » $$60,000/lb mercury removed. The results for all three host sites indicated that Mer-Cure{trademark} technology could achieve mercury removal of 90%. The estimated mercury removal costs were 25-92% lower than the benchmark of $$60,000/lb mercury removed. The estimated costs for control, at sorbent cost of $1.25 to $2.00/lb respectively, are as follows: (1) Dave Johnston Unit No.3--$2,650 to $4,328/lb Hg removed (92.8% less than $60k/lb); (2) Leland Olds Unit No.1--$8,680 to $13,860/lb Hg removed (76.7% less than $60k/lb); and (3) Portland Unit No.1--$28,540 to $45,065/lb Hg removed (24.9% less than $60k/lb). In summary, the results from demonstration testing at all three host sites show that the goals established by DOE/NETL were exceeded during this test program. Mercury removal performance4 of greater than 90% reduction was above the 50-70% reduction goal, and mercury removal cost of 25-92% lower than the benchmark was above the 25 to 50% cost reduction goal.« less

Knowledge regarding noncytotoxic medication extravasation among registered nurses working in western Saudi Arabia.

PubMed

Sisan, Mo'men; Rayan, Ahmad; Elmorsy, Soha; Elyan, Hamza; Salahat, Mosab

2018-03-01

Extravasation and infiltration are among the most common intravenous therapy complications. For noncytotoxic agents, the incidence of extravasation remains unknown. There has been little research into extravasation due to ethical considerations limiting controlled research; most evidences are based on small, uncontrolled trials or case reports. The purpose of this study was to assess the knowledge level regarding noncytotoxic medications extravasation and its associated factors among staff nurses.A descriptive correlational design using self-administered questionnaire was employed. A convenience sample of 387 nurses completed a questionnaire about noncytotoxic medication extravasation. Statistical Package for Social Sciences version 21 was used to analyze data by applying the chi-square test, t test, and the Mann-Whitney test to assess the knowledge difference between open and closed units' nurses.The results indicate that only 19.6% of nurses have a good knowledge about noncytotoxic medications extravasation. There was consistently poor staff knowledge regarding noncytotoxic medications extravasation. Although the closed units' nurses reported relatively higher level of knowledge than open units' nurses, their level of knowledge still inadequate. Health care organizations must consider developing specific policies regarding extravasation. Closed and open units' nurses should be enrolled in special education programs to improve their level of knowledge regarding noncytotoxic medication extravasation. Copyright © 2017 Society for Vascular Nursing, Inc. Published by Elsevier Inc. All rights reserved.

Local uncontrollability for affine control systems with jumps

NASA Astrophysics Data System (ADS)

Treanţă, Savin

2017-09-01

This paper investigates affine control systems with jumps for which the ideal If(g1, …, gm) generated by the drift vector field f in the Lie algebra L(f, g1, …, gm) can be imbedded as a kernel of a linear first-order partial differential equation. It will lead us to uncontrollable affine control systems with jumps for which the corresponding reachable sets are included in explicitly described differentiable manifolds.

Development and implementation of a navigator-facilitated care coordination algorithm to improve clinical outcomes of underserved Latino patients with uncontrolled diabetes.

PubMed

Congdon, Heather Brennan; Eldridge, Barbara Hoffman; Truong, Hoai-An

2013-11-01

Development and implementation of an interprofessional navigator-facilitated care coordination algorithm (NAVCOM) for low-income, uninsured patients with uncontrolled diabetes at a safety-net clinic resulted in improvement of disease control as evidenced by improvement in hemoglobin A1C. This report describes the process and lessons learned from the development and implementation of NAVCOM and patient success stories.

Risk Assessment During the Final Phase of an Uncontrolled Re-Entry

NASA Astrophysics Data System (ADS)

Gaudel, A.; Hourtolle, C.; Goester, J. F.; Fuentes, N.

2013-09-01

As French National Space Agency, CNES is empowered to monitor compliance with technical regulations of the French Space Operation Act, FSOA, and to take all necessary measures to ensure the safety of people, property, public health and environment for all space operations involving French responsibility at international level.Therefore, CNES developed ELECTRA that calculates the risk for ground population involved in three types of events: rocket launching, controlled re-entry and uncontrolled re-entry. For the first two cases, ELECTRA takes into account degraded cases due to a premature stop of propulsion.Major evolutions were implemented recently on ELECTRA to meet new users' requirements, like the risk assessment during the final phase of uncontrolled re-entry, that can be combined with the computed risk for each country involved by impacts.The purpose of this paper is to provide an overview of the ELECTRA method and main functionalities, and then to highlight these recent improvements.

Acute compartment syndrome caused by uncontrolled hypothyroidism.

PubMed

Modi, Anar; Amin, Hari; Salzman, Matthew; Morgan, Farah

2017-06-01

Acute compartment syndrome is increased tissue pressure exceeding perfusion pressure in a closed compartment resulting in nerve and muscle ischemia. Common precipitating causes are crush injuries, burns, substance abuse, osseous or vascular limb trauma. This is a case of 42year old female with history of hypothyroidism who presented to emergency room with acute onset of severe pain and swelling in right lower extremity. Physical examination was concerning for acute compartment syndrome of right leg which was confirmed by demonstration of elevated compartmental pressures. No precipitating causes were readily identified. Further laboratory testing revealed uncontrolled hypothyroidism. Management included emergent fasciotomy and initiating thyroid hormone replacement. This case represents a rare association between acute compartment syndrome and uncontrolled hypothyroidism. We also discuss the pathogenesis of compartment syndrome in hypothyroid patients and emphasize the importance of evaluating for less common causes, particularly in setting of non-traumatic compartment syndrome. Copyright © 2016 Elsevier Inc. All rights reserved.

Counterfactual reasoning for regretted situations involving controllable versus uncontrollable events: the modulating role of contingent self-esteem.

PubMed

Wilkinson, Meredith R; Ball, Linden J; Alford, David

2015-01-01

We report a study that examined the modulating impact of contingent self-esteem on regret intensity for regretted outcomes associated with controllable versus uncontrollable events. The Contingent Self-Esteem Scale (e.g., Kernis & Goldman, 2006) was used to assess the extent to which a person's sense of self-worth is based on self and others' expectations. We found that there was an influence of self-esteem contingency for controllable but not for uncontrollable regret types. For controllable regret types individuals with a high contingent (i.e., unstable) self-esteem reported greater regret intensity than those with a low contingent (i.e., stable) self-esteem. We interpret this finding as reflecting a functional and adaptive role of high contingent self-esteem in terms of mobilizing the application of counterfactual reasoning and planning mechanisms that can enable personal expectations to be achieved in the future.

Ethical, legal, and societal issues and recommendations for controlled and uncontrolled DCD.

PubMed

Haase, Bernadette; Bos, Michael; Boffa, Catherine; Lewis, Penney; Rudge, Chris; Valero, Ricard; Wind, Tineke; Wright, Linda

2016-07-01

This report deals with organ retrieval procedures in both controlled and uncontrolled DCD, looking at the ethical, legal, and psychosocial aspects during the different phases of the process. A recently published report by the UK Donation Ethics Committee (UKDEC) has served as an important reference document to outline the steps in the controlled DCD patient-donor pathway (Academy of Medical Royal Colleges. UK Donation Ethics Committee. An ethical framework for controlled donation after circulatory death. December 2011). For uncontrolled DCD, the UKDEC pathway description was adapted. At the 6th International Conference in Organ Donation held in Paris in 2013, an established expert European Working Group reviewed the UKDEC reports, which were then considered along with the available published literature. Along this pathway, the crucial ethical, legal, and psychosocial aspects have been flagged, and relevant recommendations have been formulated based on a consensus of the working group. © 2015 Steunstichting ESOT.

Counterfactual Reasoning for Regretted Situations Involving Controllable Versus Uncontrollable Events: The Modulating Role of Contingent Self-Esteem

PubMed Central

Wilkinson, Meredith R.; Ball, Linden J.; Alford, David

2015-01-01

We report a study that examined the modulating impact of contingent self-esteem on regret intensity for regretted outcomes associated with controllable versus uncontrollable events. The Contingent Self-Esteem Scale (e.g., Kernis & Goldman, 2006) was used to assess the extent to which a person’s sense of self-worth is based on self and others’ expectations. We found that there was an influence of self-esteem contingency for controllable but not for uncontrollable regret types. For controllable regret types individuals with a high contingent (i.e., unstable) self-esteem reported greater regret intensity than those with a low contingent (i.e., stable) self-esteem. We interpret this finding as reflecting a functional and adaptive role of high contingent self-esteem in terms of mobilizing the application of counterfactual reasoning and planning mechanisms that can enable personal expectations to be achieved in the future. PMID:25883697

Social Network Resources and Management of Hypertension*

PubMed Central

Cornwell, Erin York; Waite, Linda J.

2013-01-01

Hypertension is one of the most prevalent chronic diseases among older adults, but rates of blood pressure control are low. In this paper, we explore the role of social network ties and network-based resources (e.g., information and support) in hypertension diagnosis and management. We use data from the National Social Life, Health, and Aging Project (NSHAP) to identify older adults with undiagnosed or uncontrolled hypertension. We find that network characteristics and emotional support are associated with hypertension diagnosis and control. Importantly, the risks of undiagnosed and uncontrolled hypertension are lower among those with larger social networks -- if they discuss health issues with their network members. When these lines of communication are closed, network size is associated with greater risk of undiagnosed and uncontrolled hypertension. Health care utilization partially mediates associations with diagnosis, but the benefits of network resources for hypertension control do not seem to stem from health-related behaviors. PMID:22660826

Embolic Brain Infarcts: A Rare Fatal Complication of Preoperative Embolization of a Massive Solitary Fibrous Tumor of the Pleura

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

Patel, Shreyas R., E-mail: Shrey000@gmail.com; Vachhani, Prasann; Moeslein, Fred

Solitary fibrous tumor of the pleura (SFTP) is a rare intrathoracic neoplasm, often giant in size and highly vascular, which can make surgical resection very challenging. Preoperative percutaneous embolization before surgical removal can significantly reduce the risk of uncontrollable intraoperative hemorrhage. However, a rare potential life threatening complication could result from embolization of SFTP and must be taken into consideration. This report describes a 69-year-old female with a large right thoracic SFTP, who underwent preoperative angiography and embolization and developed diffuse embolic brain infarcts immediately after the administration of polyvinyl alcohol particles.

Hybrid slab-microchannel gel electrophoresis system

DOEpatents

Balch, Joseph W.; Carrano, Anthony V.; Davidson, James C.; Koo, Jackson C.

1998-01-01

A hybrid slab-microchannel gel electrophoresis system. The hybrid system permits the fabrication of isolated microchannels for biomolecule separations without imposing the constraint of a totally sealed system. The hybrid system is reusable and ultimately much simpler and less costly to manufacture than a closed channel plate system. The hybrid system incorporates a microslab portion of the separation medium above the microchannels, thus at least substantially reducing the possibility of non-uniform field distribution and breakdown due to uncontrollable leakage. A microslab of the sieving matrix is built into the system by using plastic spacer materials and is used to uniformly couple the top plate with the bottom microchannel plate.

Evaluating the benefits of home-based peritoneal dialysis

PubMed Central

François, Karlien; Bargman, Joanne M

2014-01-01

Peritoneal dialysis (PD) is an effective renal replacement strategy for patients suffering from end-stage renal disease. PD offers patient survival comparable to or better than in-center hemodialysis while preserving residual kidney function, empowering patient autonomy, and reducing financial burden to payors. The majority of patients suffering from kidney failure are eligible for PD. In patients with cardiorenal syndrome and uncontrolled fluid status, PD is of particular benefit, decreasing hospitalization rates and duration. This review discusses the benefits of chronic PD, performed by the patient or a caregiver at home. Recognition of the benefits of PD is a cornerstone in stimulating the use of this treatment strategy. PMID:25506238

Pregnancy in a woman with proportionate (primordial) dwarfism: a case report and literature review.

PubMed

Vance, C E; Desmond, M; Robinson, A; Johns, J; Zacharin, M; Savarirayan, R; König, K; Warrillow, S; Walker, S P

2012-09-01

Primordial dwarfism is a rare form of severe proportionate dwarfism which poses significant challenges in pregnancy. A 27-year-old with primordial dwarfism (height 97 cm, weight 22 kg) and coexisting morbidities of familial hypercholesterolaemia and hypertension presented to our unit. Early pregnancy was complicated by difficult blood pressure control, sinus tachycardia, biochemical hyperthyroidism and insulin-requiring gestational diabetes. Delivery was indicated at 24 weeks with uncontrollable hypertension, progressive renal impairment and intrauterine growth restriction. A caesarean section was performed under general anaesthesia, resulting in the delivery of a 486 g male infant. This case highlights the difficulties of managing pregnancy in a woman with primordial dwarfism. Her limited capacity to respond to the physiological demands of pregnancy created a life-threatening situation, culminating in profound preterm birth.

Orbital Debris: A Policy Perspective

NASA Technical Reports Server (NTRS)

Johnson, Nicholas L.

2007-01-01

A viewgraph presentation describing orbital debris from a policy perspective is shown. The contents include: 1) Voyage through near-Earth Space-animation; 2) What is Orbital Debris?; 3) Orbital Debris Detectors and Damage Potential; 4) Hubble Space Telescope; 5) Mir Space Station Solar Array; 6) International Space Station; 7) Space Shuttle; 8) Satellite Explosions; 9) Satellite Collisions; 10) NASA Orbital Debris Mitigation Guidelines; 11) International Space Station Jettison Policy; 12) Controlled/Uncontrolled Satellite Reentries; 13) Return of Space Objects; 14) Orbital Debris and U.S. National Space Policy; 15) U.S Government Policy Strategy; 16) Bankruptcy of the Iridium Satellite System; 17) Inter-Agency Space Debris Coordination Committee (IADC); 18) Orbital Debris at the United Nations; 19) Chinese Anti-satellite System; 20) Future Evolution of Satellite Population; and 21) Challenge of Orbital Debris

Task shifting in the management of hypertension in Kinshasa, Democratic Republic of Congo: a cross-sectional study.

PubMed

Lulebo, Aimée M; Kaba, Didine K; Atake, Silvestre E-H; Mapatano, Mala A; Mafuta, Eric M; Mampunza, Julien M; Coppieters, Yves

2017-12-04

The Democratic Republic of the Congo (DRC) is characterized by a high prevalence of hypertension (HTN) and a high proportion of uncontrolled HTN, which is indicative of poor HTN management. Effective management of HTN in the African region is challenging due to limited resources, particularly human resources for health. To address the shortage of health workers, the World Health Organization (WHO) recommends task shifting for better disease management and treatment. Although task shifting from doctors to nurses is being implemented in the DRC, there are no studies, to the best of our knowledge, that document the association between task shifting and HTN control. The aim of this study was to investigate the association between task shifting and HTN control in Kinshasa, DRC. We conducted a cross-sectional study in Kinshasa from December 2015 to January 2016 in five general referral hospitals (GRHs) and nine health centers (HCs). A total of 260 hypertensive patients participated in the study. Sociodemographic, clinical, health care costs and perceived health care quality assessment data were collected using a structured questionnaire. To examine the association between task shifting and HTN control, we assessed differences between GRH and HC patients using bivariate and multivariate analyses. Almost half the patients were female (53.1%), patients' mean age was 59.5 ± 11.4 years. Over three-fourths of patients had uncontrolled HTN. There was no significant difference in the proportion of GRH and HC patients with uncontrolled HTN (76.2% vs 77.7%, p = 0.771). Uncontrolled HTN was associated with co-morbidity (OR = 10.3; 95% CI: 3.8-28.3) and the type of antihypertensive drug used (OR = 4.6; 95% CI: 1.3-16.1). The mean healthcare costs in the GRHs were significantly higher than costs in the HCs (US$ 34.2 ± US$3.34 versus US$ 7.7 ± US$ 0.6, respectively). Uncontrolled HTN was not associated with the type of health facility. This finding suggests that the management of HTN at primary healthcare level might be just as effective as at secondary level. However, the high proportion of patients with uncontrolled HTN underscores the need for HTN management guidelines at all healthcare levels.

Progression to Uncontrolled Severe Asthma: A Novel Risk Equation.

PubMed

Casciano, Julian; Krishnan, Jerry; Small, Mary Buatti; Li, Chenghui; Dotiwala, Zenobia; Martin, Bradley C

2017-01-01

Recently published asthma guidelines by the European Respiratory Society and the American Thoracic Society (ERS-ATS) define severe disease based on medication use and control level. These guidelines also emphasize that asthma severity involves certain biomarker phenotypes, one of them being eosinophilic phenotype. The quantification of the influence of eosinophil level toward predicting disease severity can help decision makers manage therapy better earlier. To develop a risk-scoring algorithm to identify patients at greater risk of developing uncontrolled severe asthma as defined by ERS-ATS guidelines. Data on asthma patients were extracted from the EMRClaims + database from January 2004 to July 2011. Patients with continuous enrollment 12 months before and after the date of the first encounter with a diagnosis of asthma (index date) with at least 1 blood eosinophil test result in the 12 months after the index date, but before the development of uncontrolled severe asthma or the study end date, were included. Uncontrolled severe asthma was defined as the first date on which all criteria of the ERS-ATS definition were first satisfied in the 12 months after the index date. Age (≥ 50 years vs. < 50 years), race, and sex were measured at index, and the Charlson Comorbidity Index (CCI) score (> 0 vs. 0) was measured in the pre-index period. Elevated eosinophil level was defined as a test result with ≥ 400 cells/µL. The study cohort was randomly split 50-50 into derivation and validation samples. Cox proportional hazards regression was used to develop the risk score for uncontrolled severe asthma using the derivation cohort with independent variables of eosinophil level, age, sex, race, and CCI. A bootstrapping procedure was used to generate 1,000 samples from the derivation cohort. Variables significant in ≥ 50% of the samples were retained in the final regression model. A risk score was then calculated based on the coefficient estimates of the final model. C-statistic was used to test the model's discrimination power. The study included 2,405 patients, 147 (6%) of whom developed uncontrolled severe asthma. Higher eosinophil level and CCI score > 0 were significantly and independently associated with an increased risk of uncontrolled severe asthma in the derivation cohort (HR = 1.90, 95% CI = 1.17-3.08 and HR = 2.00, 95% CI = 1.28-3.13, respectively); findings were similar in the validation cohort. Total risk score was categorized as 0, 2, and 4. All models showed good C-statistics (0.79-0.80), indicating favorable model discrimination. There was a significantly greater number of patients with uncontrolled severe asthma in the risk score segments of 2 and 4 compared with 0 (each P < 0.0001). A risk stratification tool using peripheral eosinophil counts and CCI can be used to predict the development of uncontrolled severe asthma. This study was funded by Teva Pharmaceuticals. eMAX Health Systems was a consultant to Teva Pharmaceuticals for this study and received payment from Teva Pharmaceuticals for work on this study. Casciano and Dotiwala are employed by eMAX Health Systems. Krishnan, Li, and Martin received payment from eMAX Health Systems for work on this study. Small was employed by Teva Pharmaceuticals at the time of this study. Study concept and design were contributed primarily by Casciano, Krishnan, Small, and Martin, along with Li and Dotiwala. Dotiwala, Casciano, Small, and Li collected the data, along with Martin and Li and Krishnan. Data interpretation was provided by Martin, Casciano, and Li, with assistance from the other authors. The manuscript was written by Li, Casciano, Dotiwala, and Small, with assistance from the other authors, and revised by Dotiwala, Small, Li, and Martin, with assistance from Krishnan and Casciano.

Applying Bayesian hierarchical models to examine motorcycle crashes at signalized intersections.

PubMed

Haque, Md Mazharul; Chin, Hoong Chor; Huang, Helai

2010-01-01

Motorcycles are overrepresented in road traffic crashes and particularly vulnerable at signalized intersections. The objective of this study is to identify causal factors affecting the motorcycle crashes at both four-legged and T signalized intersections. Treating the data in time-series cross-section panels, this study explores different Hierarchical Poisson models and found that the model allowing autoregressive lag-1 dependence specification in the error term is the most suitable. Results show that the number of lanes at the four-legged signalized intersections significantly increases motorcycle crashes largely because of the higher exposure resulting from higher motorcycle accumulation at the stop line. Furthermore, the presence of a wide median and an uncontrolled left-turn lane at major roadways of four-legged intersections exacerbate this potential hazard. For T signalized intersections, the presence of exclusive right-turn lane at both major and minor roadways and an uncontrolled left-turn lane at major roadways increases motorcycle crashes. Motorcycle crashes increase on high-speed roadways because they are more vulnerable and less likely to react in time during conflicts. The presence of red light cameras reduces motorcycle crashes significantly for both four-legged and T intersections. With the red light camera, motorcycles are less exposed to conflicts because it is observed that they are more disciplined in queuing at the stop line and less likely to jump start at the start of green.

Evidence That in Uncontrolled Diabetes, Hyperglucagonemia Is Required for Ketosis but Not for Increased Hepatic Glucose Production or Hyperglycemia

PubMed Central

Meek, Thomas H.; Dorfman, Mauricio D.; Matsen, Miles E.; Fischer, Jonathan D.; Cubelo, Alexis; Kumar, Monica R.; Taborsky, Gerald J.

2015-01-01

Several lines of evidence implicate excess glucagon secretion in the elevated rates of hepatic glucose production (HGP), hyperglycemia, and ketosis characteristic of uncontrolled insulin-deficient diabetes (uDM), but whether hyperglucagonemia is required for hyperglycemia in this setting is unknown. To address this question, adult male Wistar rats received either streptozotocin (STZ) to induce uDM (STZ-DM) or vehicle and remained nondiabetic. Four days later, animals received daily subcutaneous injections of either the synthetic GLP-1 receptor agonist liraglutide in a dose-escalating regimen to reverse hyperglucagonemia or its vehicle for 10 days. As expected, plasma glucagon levels were elevated in STZ-DM rats, and although liraglutide treatment lowered glucagon levels to those of nondiabetic controls, it failed to attenuate diabetic hyperglycemia, elevated rates of glucose appearance (Ra), or increased hepatic gluconeogenic gene expression. In contrast, it markedly reduced levels of both plasma ketone bodies and hepatic expression of the rate-limiting enzyme involved in ketone body production. To independently confirm this finding, in a separate study, treatment of STZ-DM rats with a glucagon-neutralizing antibody was sufficient to potently lower plasma ketone bodies but failed to normalize elevated levels of either blood glucose or Ra. These data suggest that in rats with uDM, hyperglucagonemia is required for ketosis but not for increased HGP or hyperglycemia. PMID:25633417

Endo-Perio Lesion and Uncontrolled Diabetes.

PubMed

Dhoum, Sara; Laslami, Kaoutar; Rouggani, Fatimazahraa; El Ouazzani, Amal; Jabri, Mouna

2018-01-01

This work is to discuss the management of an endo-perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth and especially with an altered general condition. A 50-year-old female patient with uncontrolled diabetes type 2 is suffering from a purulent discharge coming from the upper right canine. Endodontic and periodontal treatments were realized with 36 months radiological and clinical follow-up with the collaboration of her internist doctor.

Mucormycosis pulmonary abscess, containment in a patient with uncontrolled diabetes mellitus.

PubMed

Jaffer, Faraz; Beatty, Norman; Ahmad, Kareem

2017-01-18

A 56-year-old Hispanic male with solo risk factor of uncontrolled diabetes mellitus presented with recurrent haemoptysis. Initial concern was for malignancy with postobstructive pneumonia; however, invasive testing and biopsy confirmed infectious mass of fungal aetiology requiring surgical resection followed by a prolonged course of anti-fungal therapy. Discussion centred on approach to, progression of and course of action in the management of pulmonary abscess due to mucormycosis. 2017 BMJ Publishing Group Ltd.

[Application of classic formulae in treatment of hypertension].

PubMed

Xiong, Xing-Jiang; Wang, Jie

2013-06-01

Classic formulae have a wide prospect in the treatment of hypertension with such advantages as symposium relief, improvement of body constitution and uncontrollable blood pressure factors. The paper systematically reviews the application of classic formula in pre-hypertension, different stages of hypertension, special type of hypertension, secondary hypertension, and uncontrollable blood pressure factors. It is believed that classic formulae are effective under the premise of their in-depth understanding of objective indications, modern pathogenesis and evolvement regularity.

Candida species and other yeasts in the oral cavities of type 2 diabetic patients in Cali, Colombia

PubMed Central

Álvarez, María Inés; de Bernal, Matilde; Collazos, Andrés

2013-01-01

Objective: To determine the prevalence of Candida species and to study factors associated to oral cavity colonization in patients with type 2 diabetes mellitus. Methods: A total of 107 diabetics were classified into controlled and uncontrolled according to glycosylated hemoglobin values. Each patient was assessed for stimulated salivary flow rates, pH, and an oral rinse to search for yeast. The study also determined the state of oral health via Klein and Palmer CPO indexes for permanent dentition, dental plaque by O'Leary, and a periodontal chart. Results: We found yeasts in 74.8% of the patients. A total of 36 of the 52 subjects with controlled diabetes presented yeasts and 44 in the uncontrolled; no significant differences (p = 0.2) were noted among the presence of yeasts and the control of blood glucose. The largest number of isolates corresponded to C. albicans, followed by C. parapsilosis. Uncontrolled individuals presented a significantly higher percentage of yeast different from C. albicans (p = 0.049). Conclusions: We found a high percentage of Candida colonization and uncontrolled individuals had greater diversity of species. The wide range of CFU/mL found both in patients with oral candidiasis, as well as in those without it did not permit distinguishing between colonization and disease. We only found association between isolation of yeasts and the low rate of salivary flow. PMID:24892318

Dietary nitrate lowers ambulatory blood pressure in treated, uncontrolled hypertension: a 7-d, double-blind, randomised, placebo-controlled, cross-over trial.

PubMed

Kerley, Conor P; Dolan, Eamon; James, Philip E; Cormican, Liam

2018-03-01

Dietary nitrate has been shown to increase nitrate/nitrite levels and decrease blood pressure (BP) in multiple populations. There are few reports among hypertensives and these reports have provided conflicting evidence. We aimed to assess the effect of daily nitrate compared with placebo in subjects with uncontrolled hypertension (HTN). On day 0, hypertensives wore an ambulatory BP monitor (ABPM) for 24 h and blood was taken. Subjects were then randomised to 7-d nitrate-rich beetroot juice (NO3 -) (12·9 mmol nitrate) followed by 7-d nitrate-depleted beetroot juice (0·5 mmol nitrate) or vice versa. ABPM and blood were assessed before and after both conditions. In all, twenty subjects with treated yet uncontrolled HTN entered and completed the trial (mean age=62·5 years, mean BMI=30·7 kg/m2). Baseline BP was 137/80 (sd 7/7) mmHg. Dietary nitrate was well tolerated and resulted in significantly increased plasma nitrite (P=0·0004) and decreased 24-h systolic BP and diastolic BP compared with placebo (-8 mmHg; P=0·012 and -4 mmHg; P=0·018, respectively). Our results support the existing data suggesting an anti-hypertensive effect of dietary nitrate in treated yet uncontrolled hypertensives. Targeted dietary strategies appear promising contributors to BP control.

Nominal group technique: a brainstorming tool for identifying areas to improve pain management in hospitalized patients.

PubMed

Peña, Adolfo; Estrada, Carlos A; Soniat, Debbie; Taylor, Benjamin; Burton, Michael

2012-01-01

Pain management in hospitalized patients remains a priority area for improvement; effective strategies for consensus development are needed to prioritize interventions. To identify challenges, barriers, and perspectives of healthcare providers in managing pain among hospitalized patients. Qualitative and quantitative group consensus using a brainstorming technique for quality improvement-the nominal group technique (NGT). One medical, 1 medical-surgical, and 1 surgical hospital unit at a large academic medical center. Nurses, resident physicians, patient care technicians, and unit clerks. Responses and ranking to the NGT question: "What causes uncontrolled pain in your unit?" Twenty-seven health workers generated a total of 94 ideas. The ideas perceived contributing to a suboptimal pain control were grouped as system factors (timeliness, n = 18 ideas; communication, n = 11; pain assessment, n = 8), human factors (knowledge and experience, n = 16; provider bias, n = 8; patient factors, n = 19), and interface of system and human factors (standardization, n = 14). Knowledge, timeliness, provider bias, and patient factors were the top ranked themes. Knowledge and timeliness are considered main priorities to improve pain control. NGT is an efficient tool for identifying general and context-specific priority areas for quality improvement; teams of healthcare providers should consider using NGT to address their own challenges and barriers. Copyright © 2011 Society of Hospital Medicine.

Motor control theories and their applications.

PubMed

Latash, Mark L; Levin, Mindy F; Scholz, John P; Schöner, Gregor

2010-01-01

We describe several influential hypotheses in the field of motor control including the equilibrium-point (referent configuration) hypothesis, the uncontrolled manifold hypothesis, and the idea of synergies based on the principle of motor abundance. The equilibrium-point hypothesis is based on the idea of control with thresholds for activation of neuronal pools; it provides a framework for analysis of both voluntary and involuntary movements. In particular, control of a single muscle can be adequately described with changes in the threshold of motor unit recruitment during slow muscle stretch (threshold of the tonic stretch reflex). Unlike the ideas of internal models, the equilibrium-point hypothesis does not assume neural computations of mechanical variables. The uncontrolled manifold hypothesis is based on the dynamic system approach to movements; it offers a toolbox to analyze synergic changes within redundant sets of elements related to stabilization of potentially important performance variables. The referent configuration hypothesis and the principle of abundance can be naturally combined into a single coherent scheme of control of multi-element systems. A body of experimental data on healthy persons and patients with movement disorders are reviewed in support of the mentioned hypotheses. In particular, movement disorders associated with spasticity are considered as consequences of an impaired ability to shift threshold of the tonic stretch reflex within the whole normal range. Technical details and applications of the mentioned hypo-theses to studies of motor learning are described. We view the mentioned hypotheses as the most promising ones in the field of motor control, based on a solid physical and neurophysiological foundation.

Interactive binocular treatment (I-BiT) for amblyopia: results of a pilot study of 3D shutter glasses system.

PubMed

Herbison, N; Cobb, S; Gregson, R; Ash, I; Eastgate, R; Purdy, J; Hepburn, T; MacKeith, D; Foss, A

2013-09-01

A computer-based interactive binocular treatment system (I-BiT) for amblyopia has been developed, which utilises commercially available 3D 'shutter glasses'. The purpose of this pilot study was to report the effect of treatment on visual acuity (VA) in children with amblyopia. Thirty minutes of I-BiT treatment was given once weekly for 6 weeks. Treatment sessions consisted of playing a computer game and watching a DVD through the I-BiT system. VA was assessed at baseline, mid-treatment, at the end of treatment, and at 4 weeks post treatment. Standard summary statistics and an exploratory one-way analysis of variance (ANOVA) were performed. Ten patients were enrolled with strabismic, anisometropic, or mixed amblyopia. The mean age was 5.4 years. Nine patients (90%) completed the full course of I-BiT treatment with a mean improvement of 0.18 (SD=0.143). Six out of nine patients (67%) who completed the treatment showed a clinically significant improvement of 0.125 LogMAR units or more at follow-up. The exploratory one-way ANOVA showed an overall effect over time (F=7.95, P=0.01). No adverse effects were reported. This small, uncontrolled study has shown VA gains with 3 hours of I-BiT treatment. Although it is recognised that this pilot study had significant limitations-it was unblinded, uncontrolled, and too small to permit formal statistical analysis-these results suggest that further investigation of I-BiT treatment is worthwhile.

Analysis of a Panel of 48 Cytokines in BAL Fluids Specifically Identifies IL-8 Levels as the Only Cytokine that Distinguishes Controlled Asthma from Uncontrolled Asthma, and Correlates Inversely with FEV1

PubMed Central

Qi, Huibin; Kurosky, Alexander; Jennings, Kristofer; Sun, Qian; Boldogh, Istvan; Sur, Sanjiv

2015-01-01

We sought to identify cells and cytokines in bronchoalveolar lavage (BAL) fluids that distinguish asthma from healthy control subjects and those that distinguish controlled asthma from uncontrolled asthma. Following informed consent, 36 human subjects were recruited for this study. These included 11 healthy control subjects, 15 subjects with controlled asthma with FEV1≥80% predicted and 10 subjects with uncontrolled asthma with FEV1 <80% predicted. BAL fluid was obtained from all subjects. The numbers of different cell types and the levels of 48 cytokines were measured in these fluids. Compared to healthy control subjects, patients with asthma had significantly more percentages of eosinophils and neutrophils, IL-1RA, IL-1α, IL-1β, IL-2Rα, IL-5, IL-6, IL-7, IL-8, G-CSF, GROα (CXCL1), MIP-1β (CCL4), MIG (CXCL9), RANTES (CCL5) and TRAIL in their BAL fluids. The only inflammatory markers that distinguished controlled asthma from uncontrolled asthma were neutrophil percentage and IL-8 levels, and both were inversely correlated with FEV1. We examined whether grouping asthma subjects on the basis of BAL eosinophil % or neutrophil % could identify specific cytokine profiles. The only differences between neutrophil-normal asthma (neutrophil≤2.4%) and neutrophil-high asthma (neutrophils%>2.4%) were a higher BAL fluid IL-8 levels, and a lower FEV1 in the latter group. By contrast, compared to eosinophil-normal asthma (eosinophils≤0.3%), eosinophil-high asthma (eosinophils>0.3%) had higher levels of IL-5, IL-13, IL-16, and PDGF-bb, but same neutrophil percentage, IL-8, and FEV1. Our results identify neutrophils and IL-8 are the only inflammatory components in BAL fluids that distinguish controlled asthma from uncontrolled asthma, and both correlate inversely with FEV1. PMID:26011707

Risk factors and predictors of uncontrolled hyperglycemia and diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus in Jeddah, western Saudi Arabia.

PubMed

Sayed, Mohamed Hesham; Hegazi, Moustafa Abdelaal; Abdulwahed, Khairyah; Moussa, Khairya; El-Deek, Basem Salama; Gabel, Hala; Ragheb, Rana

2017-02-01

Little is known about levels of glycemic control and risk factors for uncontrolled hyperglycemia in Saudi children with type 1 diabetes mellitus (T1DM). The aim of the present study was to identify levels of glycemic control, risk factors and predictors of uncontrolled hyperglycemia (HG) and diabetic ketoacidosis (DKA) in children with T1DM. A retrospective study was performed on Saudi children and adolescents with confirmed T1DM who were followed at the Pediatric Endocrinology Clinic of the Maternity and Children Hospital, Jeddah, from 2000 to 2014. Data collection included all possible factors that may be associated with uncontrolled T1DM. Patients were classified according to American Diabetes Association guidelines for target HbA1c levels per age group. Comparisons were made between well-controlled (WC) patients, HG patients, and DKA patients. Calculation of odds ratios and logistic regression allowed for estimation of the role of each risk factor in uncontrolled T1DM. Only 31.2 % of children and adolescents with T1DM were well controlled. Better glycemic control was associated with age < 6 years, urban residence, and T1DM duration <5 years. Glycemic control was not affected by gender, insulin therapy, or comorbidities. The most significant independent predictors of hyperglycemia and DKA were poor compliance with a healthy lifestyle (adjusted hazards ratio [AHR] 28.94; 95 % confidence interval [CI] 8.37-100.04) and an excess intake of sweets (AHR 3.31; 95 % CI 1.54-7.11). The most significant independent predictor for poor glycemic control (particularly DKA rather than hyperglycemia) in Saudi children and adolescents was poor compliance with a healthy lifestyle with an excessive intake of sweets. © 2016 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

The relationship between health related quality of life and sensory deficits among patients with diabetes mellitus.

PubMed

Engel-Yeger, Batya; Darawsha Najjar, Sanaa; Darawsha, Mahmud

2017-08-13

(1) To profile sensory deficits examined in the ability to process sensory information from daily environment and discriminate between tactile stimuli among patients with controlled and un-controlled diabetes mellitus. (2) Examine the relationship between the sensory deficits and patients' health-related quality of life. This study included 115 participants aged 33-55 with uncontrolled (n = 22) or controlled (n = 24) glycemic levels together with healthy subjects (n = 69). All participants completed the brief World Health Organization Quality of Life Questionnaire, the Adolescent/Adult Sensory Profile and performed the tactile discrimination test. Sensory deficits were more emphasized among patients with uncontrolled glycemic levels as expressed in difficulties to register sensory input, lower sensation seeking in daily environments and difficulties to discriminate between tactile stimuli. They also reported the lowest physical and social quality of life as compared to the other two groups. Better sensory seeking and registration predicted better quality of life. Disease control and duration contributed to these predictions. Difficulties in processing sensory information from their daily environments are particularly prevalent among patients with uncontrolled glycemic levels, and significantly impacted their quality of life. Clinicians should screen for sensory processing difficulties among patients with diabetes mellitus and understand their impacts on patients' quality of life. Implications for Rehabilitation Patients with diabetes mellitus, and particularly those with uncontrolled glycemic levels, may have difficulties in processing sensory information from daily environment. A multidisciplinary intervention approach is recommended: clinicians should screen for sensory processing deficits among patients with diabetes mellitus and understand their impacts on patients' daily life. By providing the patients with environmental adaptations and coping strategies, clinicians may assist in optimizing sensory experiences in real life context and elevate patients' quality of life. Relating to quality of life and emphasizing a multidisciplinary approach is of major importance in broadening our understanding of health conditions and providing holistic treatment for patients.

[Risks associated with unrestricted consumption of alkaline-reduced water].

PubMed

Henry, Marc; Chambron, Jacques

2014-01-01

Consumption of alkaline reduced water produced by domestic electrolysis devices was approved in Japan in 1965 by the Minister of Health, Work and Wellbeing, for the treatment of gastrointestinal disorders. Today, these devices are also freely available in France. The commercial information provided with the devices recommends the consumption of 1 to 1.5 liters per day, not only for gastrointestinal disorders but also for numerous other illnesses such as diabetes, cancer and inflammation. Academic research on this subject has been undergoing in Japan since 1990, and has established that the active ingredient is dissolved dihydrogen, which eliminates the free radical HO· in vivo. It has also been shown that electrode degradation during use of the devices releases highly reactive platinum nanoparticles, the toxicity of which is unknown. The authors of this report recommend alerting the French health authorities to the uncontrolled availability of these devices that generate drug substances and should therefore be subject to regulatory requirements.

Hyperspectral fluorescence imaging coupled with multivariate image analysis techniques for contaminant screening of leafy greens

NASA Astrophysics Data System (ADS)

Everard, Colm D.; Kim, Moon S.; Lee, Hoyoung

2014-05-01

The production of contaminant free fresh fruit and vegetables is needed to reduce foodborne illnesses and related costs. Leafy greens grown in the field can be susceptible to fecal matter contamination from uncontrolled livestock and wild animals entering the field. Pathogenic bacteria can be transferred via fecal matter and several outbreaks of E.coli O157:H7 have been associated with the consumption of leafy greens. This study examines the use of hyperspectral fluorescence imaging coupled with multivariate image analysis to detect fecal contamination on Spinach leaves (Spinacia oleracea). Hyperspectral fluorescence images from 464 to 800 nm were captured; ultraviolet excitation was supplied by two LED-based line light sources at 370 nm. Key wavelengths and algorithms useful for a contaminant screening optical imaging device were identified and developed, respectively. A non-invasive screening device has the potential to reduce the harmful consequences of foodborne illnesses.

Comparison of the Intensity of Ventilation at Windows Exchange in the Room - Case Study

NASA Astrophysics Data System (ADS)

Kapalo, Peter; Voznyak, Orest

2017-06-01

Doing the replacement of old wooden windows in a new plastic windows, in the old buildings, we get the great reducing of the building heat loss. Simpler maintenance and attendance of window is the next advantage. New windows are characterized by better tightness. The aim of the article is determination due to the performed experimental measurements, how much more are reduce the uncontrolled ventilation that is caused of the infiltration windows. In the article there is presented the experimental measurement of indoor air quality in the room in two phases. In the first phase there is the room installed by 55 year old wood window. In the second phase there is the same room installed by new plastic window. Due to the experimental measurement of indoor air quality it is calculated intensity of ventilation - infiltration. These results of ventilation intensity are reciprocally compared.

Hyperstaticity for ergonomie design of a wrist exoskeleton.

PubMed

Esmaeili, Mohammad; Jarrassé, Nathanaël; Dailey, Wayne; Burdet, Etienne; Campolo, Domenico

2013-06-01

Increasing the level of transparency in rehabilitation devices has been one of the main goals in robot-aided neurorehabilitation for the past two decades. This issue is particularly important to robotic structures that mimic the human counterpart's morphology and attach directly to the limb. Problems arise for complex joints such as the human wrist, which cannot be accurately matched with a traditional mechanical joint. In such cases, mechanical differences between human and robotic joint cause hyperstaticity (i.e. overconstraint) which, coupled with kinematic misalignments, leads to uncontrolled force/torque at the joint. This paper focuses on the prono-supination (PS) degree of freedom of the forearm. The overall force and torque in the wrist PS rotation is quantified by means of a wrist robot. A practical solution to avoid hyperstaticity and reduce the level of undesired force/torque in the wrist is presented, which is shown to reduce 75% of the force and 68% of the torque.

A global study of the unmet need for glycemic control and predictor factors among patients with type 2 diabetes mellitus who have achieved optimal fasting plasma glucose control on basal insulin.

PubMed

Raccah, Denis; Chou, Engels; Colagiuri, Stephen; Gaàl, Zsolt; Lavalle, Fernando; Mkrtumyan, Ashot; Nikonova, Elena; Tentolouris, Nikolaos; Vidal, Josep; Davies, Melanie

2017-03-01

This study used data from different sources to identify the extent of the unmet need for postprandial glycemic control in patients with type 2 diabetes mellitus (T2DM) after the initiation of basal insulin therapy in Europe, Asia Pacific, the United States, and Latin America. Different levels of evidence were used as available for each country/region, with data extracted from seven randomized controlled trials (RCTs), three clinical trial registries (CTRs), and three electronic medical record (EMR) databases. Glycemic status was categorized as "well controlled" (glycated hemoglobin [HbA 1c ] at target [<7%]), "residual hyperglycemia" (fasting plasma glucose [FPG] but not HbA 1c at target [FPG <7.2/7.8 mmol/L, <130/140 mg/dL, depending on country-specific recommendations]), or "uncontrolled" (both FPG and HbA 1c above target). Predictor factors were identified from the RCT data set using logistic regression analysis. RCT data showed that 16.9% to 28.0%, 42.7% to 54.4%, and 16.9% to 38.1% of patients with T2DM had well-controlled glycemia, residual hyperglycemia, and uncontrolled hyperglycemia, respectively. In CTRs, respective ranges were 21.8% to 33.6%, 31.5% to 35.6%, and 30.7% to 46.8%, and in EMR databases were 4.4% to 21.0%, 23.9% to 31.8%, and 53.6% to 63.8%. Significant predictor factors of residual hyperglycemia identified from RCT data included high baseline HbA 1c (all countries/regions except Brazil), high baseline FPG (United Kingdom/Japan), longer duration of diabetes (Brazil), and female sex (Europe/Latin America). Irrespective of intrinsic differences between data sources, 24% to 54% of patients with T2DM globally had residual hyperglycemia with HbA 1c not at target, despite achieving FPG control, indicating a significant unmet need for postprandial glycemic control. © 2016 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.

An Investigation of the Causes of the Coronary-Prone (Type A) Behavior Pattern and Coronary Heart Disease.

DTIC Science & Technology

1983-09-01

experiences. Uncontrollable Stress Uncontrollable stress arises when an individual’s outcome is not determined by his/her response to a situation. Seligman ... Linda Hervig, and Ray H. Rosenman. "Heritability of Type A Behavior," Psychosomatic Medicine, 40, No. 6 (1978), pp. 478-486. , Robert T. Rubin, and...Performance, 25 (1980), pp. 184-215. Seligman , M. E. P. Helplessness: On Depression, Develop- ment, and Death. San Francisco: Freeman, 1975. Tamir, I., G

Uncontrolled Hemorrhage Differs From Volume- or Pressure-Matched Controlled Hemorrhage in Swine

DTIC Science & Technology

2007-10-01

differences between these models, we evaluated the relationship between blood volume loss and blood pressure in controlled versus uncontrolled hemorrhage...aortotomy; (2) group P, controlled hemorrhage matched to the blood pressure profile of group U; or (3) group V, controlled hemorrhage matched to the...hemorrhage and received no fluid resuscitation. Group U resulted in a blood loss of 17.6 T 0.7 mL kgj1 and a reduction in blood pressure to 28 T 3 mmHg at

Endo-Perio Lesion and Uncontrolled Diabetes

PubMed Central

Laslami, Kaoutar; Rouggani, Fatimazahraa; El Ouazzani, Amal; Jabri, Mouna

2018-01-01

This work is to discuss the management of an endo-perio lesion, which represents a challenge to clinicians when it comes to diagnosis and prognosis of the involved teeth and especially with an altered general condition. A 50-year-old female patient with uncontrolled diabetes type 2 is suffering from a purulent discharge coming from the upper right canine. Endodontic and periodontal treatments were realized with 36 months radiological and clinical follow-up with the collaboration of her internist doctor. PMID:29888011

General aviation air traffic pattern safety analysis

NASA Technical Reports Server (NTRS)

Parker, L. C.

1973-01-01

A concept is described for evaluating the general aviation mid-air collision hazard in uncontrolled terminal airspace. Three-dimensional traffic pattern measurements were conducted at uncontrolled and controlled airports. Computer programs for data reduction, storage retrieval and statistical analysis have been developed. Initial general aviation air traffic pattern characteristics are presented. These preliminary results indicate that patterns are highly divergent from the expected standard pattern, and that pattern procedures observed can affect the ability of pilots to see and avoid each other.

A Hemoglobin Based Oxygen Carrier, Bovine Polymerized Hemoglobin (HBOC-201) versus Hetastarch (HEX) in an Uncontrolled Liver Injury Hemorrhagic Shock Swine Model with Delayed Evacuation

DTIC Science & Technology

2004-10-01

A Hemoglobin Based Oxygen Carrier, Bovine Polymerized Hemoglobin (HBOC-201) versus Hetastarch (HEX) in an Uncontrolled Liver Injury Hemorrhagic Shock...Transcutaneous tis- sue oxygenation was restored more rap- idly in HBOC-201 pigs, there was a trend to lower lactic acid, and base deficit was less...lactic acidosis and base deficit (BD) abnormalities, indicating on-going hypoperfusion.2–4 As these abnormalities measured upon hospital arrival

Novel Heat Controller for Thermogenerators Working on Uncontrolled Stoves

NASA Astrophysics Data System (ADS)

Juanicó, Luis E.; Rinalde, Fabián; Taglialavore, Eduardo; Molina, Marcelo

2013-07-01

This paper describes the development of a thermogenerator designed for uncontrolled firewood household stoves. It was built on BiTe thermoelectric (TE) modules, and it uses a water pot as a cooling device that also serves as a hot water source. An original heat controller was developed; it has low thermal resistance ( R) during low-power operation, but its R can be continuously increased according to the stove temperature so that the TE never overheats while its power generation is optimized.

The Study of Productivity Measurement and Incentive Methodology (Phase III - Paper Test). Volume 1

DTIC Science & Technology

1986-03-14

possible to measure explicitly, in terms of dollars the profit impacts of these uncontrollable as well as controllable factors and to de - termine and...the rate of engineering changes increases. • Production processes arc be- coming less reliant on direct la - bor as the primary factor in pro...MFPMM makes it •: —.sibie to measure explicitly, in terms of dollars the profit impacts of these uncontrollable as well as controllable factors and to de

Metaplasticity within the spinal cord: Evidence brain-derived neurotrophic factor (BDNF), tumor necrosis factor (TNF), and alterations in GABA function (ionic plasticity) modulate pain and the capacity to learn.

PubMed

Grau, James W; Huang, Yung-Jen

2018-04-07

Evidence is reviewed that behavioral training and neural injury can engage metaplastic processes that regulate adaptive potential. This issue is explored within a model system that examines how training affects the capacity to learn within the lower (lumbosacral) spinal cord. Response-contingent (controllable) stimulation applied caudal to a spinal transection induces a behavioral modification indicative of learning. This behavioral change is not observed in animals that receive stimulation in an uncontrollable manner. Exposure to uncontrollable stimulation also engages a process that disables spinal learning for 24-48 h. Controllable stimulation has the opposite effect; it engages a process that enables learning and prevents/reverses the learning deficit induced by uncontrollable stimulation. These observations suggest that a learning episode can impact the capacity to learn in future situations, providing an example of behavioral metaplasticity. The protective/restorative effect of controllable stimulation has been linked to an up-regulation of brain-derived neurotrophic factor (BDNF). The disruption of learning has been linked to the sensitization of pain (nociceptive) circuits, which is enabled by a reduction in GABA-dependent inhibition. After spinal cord injury (SCI), the co-transporter (KCC2) that regulates the outward flow of Cl - is down-regulated. This causes the intracellular concentration of Cl - to increase, reducing (and potentially reversing) the inward flow of Cl - through the GABA-A receptor. The shift in GABA function (ionic plasticity) increases neural excitability caudal to injury and sets the stage for nociceptive sensitization. The injury-induced shift in KCC2 is related to the loss of descending serotonergic (5HT) fibers that regulate plasticity within the spinal cord dorsal horn through the 5HT-1A receptor. Evidence is presented that these alterations in spinal plasticity impact pain in a brain-dependent task (place conditioning). The findings suggest that ionic plasticity can affect learning potential, shifting a neural circuit from dampened/hard-wired to excitable/plastic. Copyright © 2018 Elsevier Inc. All rights reserved.

Efficacy and Tolerability of Nilvadipine in Combination with an Angiotensin II Receptor Antagonist in Patients with Essential Hypertension: A Multicenter, Open-Label, Uncontrolled Study

PubMed Central

Noda, Keita; Ideishi, Munehito; Tashiro, Eiichiro; Nakashima, Yoshiyuki; Imamura, Mitsuhide; Seki, Masahiko; Fujino, Masanori; Sou, Toshimitsu; Kohara, Masaki; Kanaya, Hisashi; Saku, Nishiki; Kamei, Ritsu; Yamasaki, Misao; Sakai, Hiroshi; Gondo, Naoki; Saku, Keijiro

2003-01-01

Background: Combination therapy with different classes of antihypertensive drugs often is needed to achieve controlled blood pressure (BP). The combination of an angiotensin II receptor antagonist (AIIA) and a calcium antagonist is a preferred option for reducing uncontrolled BP. Objective: The aim of this study was to assess the clinical efficacy and tolerability of nilvadipine, a dihydropyridine calcium antagonist, in combination with an AIIA. Methods: Patients with essential hypertension whose BP was not controlled by an AIIA alone were eligible for this multicenter, open-label, uncontrolled study. One of 3 AIIAs (candesartan cilexetil, losartan potassium, or valsartan) was given for at least 10 weeks before the addition of nilvadipine (daily dose, 4 or 8 mg orally). This combination therapy was given for 8 weeks. BP and heart rate were measured between 2 and 4 weeks before and 0, 4, and 8 weeks after the start of combination therapy. Adverse events were monitored at each visit. Results: Thirty-one patients (18 women [58.1%], 13 men [41.9%]; mean [SD] age, 58.5 [10.5] years) were enrolled. At weeks 4 and 8 of combination therapy, mean systolic BP (SBP) and diastolic BP (DBP) were significantly decreased (P<0.01) (at week 8, by 22.0 mm Hg and 12.5 mm Hg, respectively). The mean BP-lowering effect did not differ significantly between the 3 AIIAs tested. Pulse pressure also decreased significantly at week 8, by 9.6 mm Hg (P<0.01). The responder rate (ie, the percentage of patients with DBP <90 mm Hg or a decrease in DBP ≥10 mm Hg) was 72.0% at week 8. Three patients experienced a total of 4 adverse events: mild or severe flushing, mild headache, and mild palpitation. All of these symptoms resolved after nilvadipine treatment was discontinued. Conclusions: Nilvadipine in combination with an AIIA showed good antihypertensive efficacy and was well tolerated in the hypertensive patients in this study. This combination also significantly decreased pulse pressure, suggesting that this combination therapy also may have a beneficial effect in elderly patients with isolated systolic hypertension. PMID:25053855

What Is the Future of Generics in Transplantation?

PubMed

van Gelder, Teun

2015-11-01

Generic immunosuppressive drugs are available in Europe, Canada, and the United States. Between countries, there are large differences in the market penetration of generic drugs in general, and for immunosuppressive drugs in particular. The registration criteria for generic immunosuppressive drugs are often criticized. However, it is unlikely that the criteria for registration of narrow therapeutic index drugs are going to change, and bioequivalence studies, performed in healthy volunteers, will remain the backbone of the registration process. It would be good if the registration authorities would demand that all generic variants of an innovator drug have the same pill appearance to reduce errors and promote drug adherence.To allow for safe substitution, a number of criteria need to be fulfilled. Generic substitution should not be taken out of the hands of the treating physicians. Generic substitution can only be done safely if initiated by the prescriber, and in well-informed and prepared patients. Payers should refrain from forcing pharmacists to dispense generic drugs in patients on maintenance treatment with innovator drug. Instead, together with transplant societies, they should design guidelines on how to implement generic immunosuppressive drugs into clinical practice. Substitutions must be followed by control visits to check if the patient is taking the medication correctly and if drug exposure remains stable. Inadvertent, uncontrolled substitutions from 1 generic to another, initiated outside the scope of the prescriber, must be avoided as they are unsafe. Repetitive subsequent generic substitutions result in minimal additional cost savings and have an inherent risk of medication errors.

Retinal complications of gout: a case report and review of the literature.

PubMed

Jiang, Ying; Brenner, Jason E; Foster, William J

2018-01-19

There have been few reported findings of posterior segment complications of gout. While exudative lesions, an increased risk of macular degeneration, and vascular occlusions have been previously reported, to our knowledge, refractile macular lesions have not been reported in a patient with chronic uncontrolled gout. Highly refractile, crystal-like lesions were found in the macula of a 62 year old male patient with chronically uncontrolled gout. The lesions appeared at the termination of retinal arterioles and were located at the level of the retinal pigment epithelium. The lesions did not stain with fluorescein and were associated with larger areas geographic atrophy. Review of the patient's blood tests revealed well-controlled vasculopathic risk factors. Fundus appearance and best-corrected visual acuity remained stable over 12 months of follow-up during which the uric acid levels were well controlled. Retinopathy may be associated with chronically uncontrolled gout and patients with visual complaints should undergo a dilated examination in addition to the typical anterior segment slit-lamp exam.

The medical antigravity suit for management of surgically uncontrollable bleeding associated with abdominal pregnancy.

PubMed

Sandberg, E C; Pelligra, R

1983-07-01

Three patients with abdominal pregnancy have been treated at Stanford University Hospital in recent years. Common to each was surgically uncontrolled hemorrhage for which circumferential pneumatic compression (supplied by a medical antigravity suit) was used to stop the bleeding. In each patient, the hemostatic effect of treatment was dramatic. In published accounts of the use of the garment in other severely hemorrhaging patients, the effects have been similarly dramatic and equally successful. These observations lead to a compelling consideration in regard to optimum management of patients with abdominal pregnancy. If our experience is confirmed by others, optimum management in abdominal pregnancy hereafter should regularly and routinely include removal of the placenta at the primary operation. This approach would anticipate use of the medical antigravity suit to provide hemostasis if surgically uncontrollable bleeding is encountered. Theoretically, the complications and long-term morbidity associated with retention of the placenta would be eliminated by this means while the previous disadvantage of placental removal, the potential for exsanguinating hemorrhage, would be circumvented.

Predictability of uncontrollable multifocal seizures - towards new treatment options

NASA Astrophysics Data System (ADS)

Lehnertz, Klaus; Dickten, Henning; Porz, Stephan; Helmstaedter, Christoph; Elger, Christian E.

2016-04-01

Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.

[Learned helplessness, generalized self-efficacy, and immune function].

PubMed

Kuno, Mayumi; Yazawa, Hisashi; Ohira, Hideki

2003-02-01

Generalized self-efficacy is considered one of important personality traits that determine psychological and physiological stress responses. The present study examined the interaction effects of generalized self-efficacy and controllability of acute stress on salivary secretory immunoglobulin A (s-IgA), task performance, and psychological stress responses in a typical learned helplessness paradigm. Twenty low and 19 high self-efficacy undergraduate women performed two response selection tasks one after another. In the first task, they were exposed to controllable or uncontrollable aversive noise. The second task was identical for all, but perceived controllability was higher for the high self-efficacy group than the low. Performance under uncontrollable condition was lower than controllable condition. The interaction of self-efficacy and controllability was observed only on the s-IgA variable; increase of secretion of s-IgA secretion under stressor uncontrollability was more prominent in the low self-efficacy group than the high. These results suggested that generalized self-efficacy was a moderator of the stressor controllability effect on secretory immunity.

Coordinated management of combined sewer overflows by means of environmental decision support systems.

PubMed

Murla, Damian; Gutierrez, Oriol; Martinez, Montse; Suñer, David; Malgrat, Pere; Poch, Manel

2016-04-15

During heavy rainfall, the capacity of sewer systems and wastewater treatment plants may be surcharged producing uncontrolled wastewater discharges and a depletion of the environmental quality. Therefore there is a need of advanced management tools to tackle with these complex problems. In this paper an environmental decision support system (EDSS), based on the integration of mathematical modeling and knowledge-based systems, has been developed for the coordinated management of urban wastewater systems (UWS) to control and minimize uncontrolled wastewater spills. Effectiveness of the EDSS has been tested in a specially designed virtual UWS, including two sewers systems, two WWTP and one river subjected to typical Mediterranean rain conditions. Results show that sewer systems, retention tanks and wastewater treatment plants improve their performance under wet weather conditions and that EDSS can be very effective tools to improve the management and prevent the system from possible uncontrolled wastewater discharges. Copyright © 2016 Elsevier B.V. All rights reserved.

The Zika Virus Outbreak in Brazil: Knowledge Gaps and Challenges for Risk Reduction.

PubMed

Garcia Serpa Osorio-de-Castro, Claudia; Silva Miranda, Elaine; Machado de Freitas, Carlos; Rochel de Camargo, Kenneth; Cranmer, Hilarie Hartel

2017-06-01

We analyzed uncertainties and complexities of the Zika virus outbreak in Brazil, and we discuss risk reduction for future emergencies. We present the public health situation in Brazil and concurrent determinants of the epidemic and the knowledge gaps that persist despite building evidence from research, making public health decisions difficult. Brazil has adopted active measures, but producing desired outcomes may be uncertain because of partial or unavailable information. Reducing population group vulnerabilities and acting on environmental issues are medium- to long-term measures. Simultaneously dealing with information gaps, uncontrolled disease spread, and vulnerabilities is a new risk scenario and must be approached decisively to face emerging biothreats.

Safe and rapid resolution of severe hypertriglyceridaemia in two patients with intravenous insulin.

PubMed

Triay, J M; Day, A; Singhal, P

2010-09-01

To rapidly reduce serum triglyceride to a safe serum level. Severe hypertriglyceridaemia is associated with uncontrolled diabetes, obesity and poor physical activity. Even moderate increases in triglyceride levels (> 5mmol/L) confer an increased risk of pancreatitis and coronary artery disease. We present two patients with diabetes and serum triglyceride levels of greater than 85mmol/L despite polypharmacy intervention. 72-hour intravenous insulin infusion was administered. Serum triglyceride levels fell to 9.4 and 4.6 mmol/L respectively, without adverse events and sustained effect over several months. We suggest the use of intravenous insulin infusion where lifestyle and oral drug therapies have failed can impact on severe hypertriglyceridaemia.

Design of an electrostatic phase shifting device for biological transmission electron microscopy.

PubMed

Koeck, Philip J B

2018-04-01

I suggest an electrostatic phase plate designed to broaden the contrast transfer function of a transmission electron microscope operated close to Scherzer defocus primarily in the low resolution direction. At higher defocus the low frequency behavior is equal to that close to Scherzer defocus, but CTF-correction becomes necessary to extend image interpretation to higher resolution. One simple realization of the phase plate consists of two ring shaped electrodes symmetrically surrounding the central beam. Since no physical components come into contact with the central beam and charge on the electrodes is controlled by an external voltage supply, problems with uncontrolled charging are expected to be reduced. Copyright © 2018 Elsevier B.V. All rights reserved.

Hybrid slab-microchannel gel electrophoresis system

DOEpatents

Balch, J.W.; Carrano, A.V.; Davidson, J.C.; Koo, J.C.

1998-05-05

A hybrid slab-microchannel gel electrophoresis system is described. The hybrid system permits the fabrication of isolated microchannels for biomolecule separations without imposing the constraint of a totally sealed system. The hybrid system is reusable and ultimately much simpler and less costly to manufacture than a closed channel plate system. The hybrid system incorporates a microslab portion of the separation medium above the microchannels, thus at least substantially reducing the possibility of non-uniform field distribution and breakdown due to uncontrollable leakage. A microslab of the sieving matrix is built into the system by using plastic spacer materials and is used to uniformly couple the top plate with the bottom microchannel plate. 4 figs.

[Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control].

PubMed

Benítez Camps, M; Egocheaga Cabello, M Isabel; Dalfó Baqué, A; Bajo García, J; Vara González, L; Sanchis Doménech, C; Martín Rioboo, E; Ureña Fernández, T; Domínguez Sardiña, M; Bonet Pla, A

2015-01-01

To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

Ratiometric analysis of optical coherence tomography-measured in vivo retinal layer thicknesses for the detection of early diabetic retinopathy.

PubMed

Bhaduri, Basanta; Shelton, Ryan L; Nolan, Ryan M; Hendren, Lucas; Almasov, Alexandra; Labriola, Leanne T; Boppart, Stephen A

2017-11-01

Influence of diabetes mellitus (DM) and diabetic retinopathy (DR) on parafoveal retinal thicknesses and their ratios was evaluated. Six retinal layer boundaries were segmented from spectral-domain optical coherence tomography images using open-source software. Five study groups: (1) healthy control (HC) subjects, and subjects with (2) controlled DM, (3) uncontrolled DM, (4) controlled DR and (5) uncontrolled DR, were identified. The one-way analyses of variance (ANOVA) between adjacent study groups (i. e. 1 with 2, 2 with 3, etc) indicated differences in retinal thicknesses and ratios. Overall retinal thickness, ganglion cell layer (GCL) thickness, inner plexiform layer (IPL) thickness, and their combination (GCL+ IPL), appeared to be significantly less in the uncontrolled DM group when compared to controlled DM and controlled DR groups. Although the combination of nerve fiber layer (NFL) and GCL, and IPL thicknesses were not different, their ratio, (NFL+GCL)/IPL, was found to be significantly higher in the controlled DM group compared to the HC group. Comparisons of the controlled DR group with the controlled DM group, and with the uncontrolled DR group, do not show any differences in the layer thicknesses, though several significant ratios were obtained. Ratiometric analysis may provide more sensitive parameters for detecting changes in DR. Picture: A representative segmented OCT image of the human retina is shown. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

The burden of conscientiousness? Examining brain activation and cortisol response during social evaluative stress.

PubMed

Dahm, Anne-Sophie; Schmierer, Phöbe; Veer, Ilya M; Streit, Fabian; Görgen, Anna; Kruschwitz, Johann; Wüst, Stefan; Kirsch, Peter; Walter, Henrik; Erk, Susanne

2017-04-01

Although conscientiousness has for a long time been considered generally adaptive, there are findings challenging this view, suggesting that conscientiousness might be less advantageous during uncontrollable stress. We here examined the impact of conscientiousness on brain activation during and the cortisol response following an uncontrollable social evaluative stress task in order to test this hypothesis. Brain activation and cortisol levels were measured during an fMRI stress task, where subjects (n=86) performed cognitive tasks containing preprogrammed failure under time pressure, while being monitored by a panel of experts inducing social-evaluative threat. The degree of conscientiousness was measured using the NEO-FFI. We observed a positive correlation between conscientiousness and salivary cortisol levels in response to the stressful task in male subjects only. In male subjects conscientiousness correlated positively with activation in right amygdala and left insula, and, moreover, mediated the influence of amygdala and insula activation on cortisol output. This pattern of brain activation can be interpreted as a disadvantageous response to uncontrollable stress to which highly conscientious individuals might be predisposed. This is the first study showing the effect of conscientiousness on physiology and brain activation to an uncontrollable psychosocial stressor. Our results provide neurobiological evidence for the hypothesis that conscientiousness should not just be seen as beneficial, but rather as a trait associated with either costs or benefits depending on the extent to which one is in control of the situation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Subgingival biodiversity in subjects with uncontrolled type-2 diabetes and chronic periodontitis.

PubMed

Casarin, R C V; Barbagallo, A; Meulman, T; Santos, V R; Sallum, E A; Nociti, F H; Duarte, P M; Casati, M Z; Gonçalves, R B

2013-02-01

There is a bidirectional relationship between periodontal disease and type-2 diabetes mellitus (DM). Inflammatory mediators may negatively affect glycemic control, and increased glucose levels and resultant glycation end-products may alter the host response against bacterial infection. However, no agreement has been reached regarding the effect of DM on periodontal subgingival microbiota. Therefore, the purpose of the present study was to compare the subgingival biodiversity in deep periodontal pockets of subjects with chronic periodontitis and either uncontrolled type-2 diabetes or no diabetes using 16S rRNA gene cloning and sequencing. Twelve subjects with uncontrolled type-2 diabetes (glycated hemoglobin > 8%) and eleven nondiabetic subjects presenting severe and generalized chronic periodontitis were selected. Subgingival biofilm from periodontal pockets > 5 mm were assessed using the 16S rRNA gene cloning and sequencing technique. Significant differences were observed in subgingival microbiota between diabetic and nondiabetic subjects. Diabetic subjects presented higher percentages of total clones of TM7, Aggregatibacter, Neisseria, Gemella, Eikenella, Selenomonas, Actinomyces, Capnocytophaga, Fusobacterium, Veillonella and Streptococcus genera, and lower percentages of Porphyromonas, Filifactor, Eubacterium, Synergistetes, Tannerella and Treponema genera than nondiabetic individuals (p < 0.05). Moreover, some phylotypes, such as Fusobacterium nucleatum, Veillonella parvula, V. dispar and Eikenella corrodens were detected significantly more often in diabetic subjects than in nondiabetic subjects (p < 0.05). Subjects with uncontrolled type-2 diabetes and chronic periodontitis presented significant dissimilarities in subgingival biodiversity compared with nondiabetic subjects. © 2012 John Wiley & Sons A/S.

The role of adding metformin in insulin-resistant diabetic pregnant women: a randomized controlled trial.

PubMed

Ibrahim, Moustafa Ibrahim; Hamdy, Ahmed; Shafik, Adel; Taha, Salah; Anwar, Mohammed; Faris, Mohammed

2014-05-01

The aim of the present study is to assess the impact of adding oral metformin to insulin therapy in pregnant women with insulin-resistant diabetes mellitus. The current non-inferiority randomized controlled trial was conducted at Ain Shams University Maternity Hospital. The study included pregnant women with gestational or pre-existing diabetes mellitus at gestations between 20 and 34 weeks, who showed insulin resistance (defined as poor glycemic control at a daily dose of ≥1.12 units/kg). Recruited women were randomized into one of two groups: group I, including women who received oral metformin without increasing the insulin dose; and group II, including women who had their insulin dose increased. The primary outcome was maternal glycemic control. Secondary outcomes included maternal bouts of hypoglycemia, need for another hospital admission for uncontrolled diabetes during pregnancy, gestational age at delivery, mode of delivery, birth weight, birth trauma, congenital anomalies, 1- and 5-min Apgar score, neonatal hypoglycemia, need for neonatal intensive care unit (NICU) admission and adverse neonatal outcomes. A total number of 154 women with diabetes mellitus with pregnancy were approached; of them 90 women were eligible and were randomly allocated and included in the final analysis. The recruited 90 women were randomized into one of two groups: group I (metformin group) (n = 46), including women who received oral metformin in addition to the same initial insulin dose; and group II (control group) (n = 44), including women who had their insulin dose increased according to the standard protocol. The mean age of included women was 29.84 ± 5.37 years (range 20-42 years). The mean gestational age at recruitment was 28.7 ± 3.71 weeks (range 21-34 weeks). Among the 46 women of group I, 17 (36.9 %) women reached proper glycemic control at a daily metformin dose of 1,500 mg, 18 (39.2 %) at a daily dose of 2,000 mg, while 11 (23.9 %) received metformin at a daily dose of 2,000 mg without reaching proper glycemic control and needed raising the dose of insulin dose. Adding metformin to insulin therapy in women with insulin-resistant diabetes mellitus with pregnancy seems to be effective in proper glycemic control in a considerable proportion of women, along with benefits of reduced hospital stay, reduced frequency of maternal hypoglycemia as well as reduced frequency of neonatal hypoglycemia, NICU admission and neonatal respiratory distress syndrome.

Integrating Out-Of-Office Blood Pressure in the Diagnosis and Management of Hypertension

PubMed Central

Cohen, Jordana B.; Cohen, Debbie L.

2016-01-01

Guidelines for the diagnosis and monitoring of hypertension were historically based on in-office blood pressure measurements. However, the United States Preventive Services Task Force recently expanded their recommendations on screening for hypertension to include out-of-office blood pressure measurements to confirm the diagnosis of hypertension. Out-of-office blood pressure monitoring, including ambulatory blood pressure monitoring and home blood pressure monitoring, are important tools in distinguishing between normotension, masked hypertension, white-coat hypertension, and sustained (including uncontrolled or drug-resistant) hypertension. Compared to in-office readings, out-of-office blood pressures are a greater predictor of renal and cardiac morbidity and mortality. There are multiple barriers to the implementation of out-of-office blood pressure monitoring which need to be overcome in order to promote more widespread use of these modalities. PMID:27677895

Pregnancy in a woman with proportionate (primordial) dwarfism: a case report and literature review

PubMed Central

Vance, C E; Desmond, M; Robinson, A; Johns, J; Zacharin, M; Savarirayan, R; König, K; Warrillow, S; Walker, S P

2012-01-01

Primordial dwarfism is a rare form of severe proportionate dwarfism which poses significant challenges in pregnancy. A 27-year-old with primordial dwarfism (height 97 cm, weight 22 kg) and coexisting morbidities of familial hypercholesterolaemia and hypertension presented to our unit. Early pregnancy was complicated by difficult blood pressure control, sinus tachycardia, biochemical hyperthyroidism and insulin-requiring gestational diabetes. Delivery was indicated at 24 weeks with uncontrollable hypertension, progressive renal impairment and intrauterine growth restriction. A caesarean section was performed under general anaesthesia, resulting in the delivery of a 486 g male infant. This case highlights the difficulties of managing pregnancy in a woman with primordial dwarfism. Her limited capacity to respond to the physiological demands of pregnancy created a life-threatening situation, culminating in profound preterm birth. PMID:27582869

A social-level macro-governance mode for collaborative manufacturing processes

NASA Astrophysics Data System (ADS)

Gao, Ji; Lv, Hexin; Jin, Zhiyong; Xu, Ping

2017-08-01

This paper proposes the social-level macro-governance mode for innovating the popular centralized control for CoM (Collaborative Manufacturing) processes, and makes this mode depend on the support from three aspects of technologies standalone and complementary: social-level CoM process norms, CoM process supervision system, and rational agents as the brokers of enterprises. It is the close coupling of those technologies that redounds to removing effectively the uncontrollability obstacle confronted with by cross-management-domain CoM processes. As a result, this mode enables CoM applications to be implemented by uniting the centralized control of CoM partners for respective CoM activities, and therefore provides a new distributed CoM process control mode to push forward the convenient development and large-scale deployment of SME-oriented CoM applications.

Hearing Tests on Mobile Devices: Evaluation of the Reference Sound Level by Means of Biological Calibration.

PubMed

Masalski, Marcin; Kipiński, Lech; Grysiński, Tomasz; Kręcicki, Tomasz

2016-05-30

Hearing tests carried out in home setting by means of mobile devices require previous calibration of the reference sound level. Mobile devices with bundled headphones create a possibility of applying the predefined level for a particular model as an alternative to calibrating each device separately. The objective of this study was to determine the reference sound level for sets composed of a mobile device and bundled headphones. Reference sound levels for Android-based mobile devices were determined using an open access mobile phone app by means of biological calibration, that is, in relation to the normal-hearing threshold. The examinations were conducted in 2 groups: an uncontrolled and a controlled one. In the uncontrolled group, the fully automated self-measurements were carried out in home conditions by 18- to 35-year-old subjects, without prior hearing problems, recruited online. Calibration was conducted as a preliminary step in preparation for further examination. In the controlled group, audiologist-assisted examinations were performed in a sound booth, on normal-hearing subjects verified through pure-tone audiometry, recruited offline from among the workers and patients of the clinic. In both the groups, the reference sound levels were determined on a subject's mobile device using the Bekesy audiometry. The reference sound levels were compared between the groups. Intramodel and intermodel analyses were carried out as well. In the uncontrolled group, 8988 calibrations were conducted on 8620 different devices representing 2040 models. In the controlled group, 158 calibrations (test and retest) were conducted on 79 devices representing 50 models. Result analysis was performed for 10 most frequently used models in both the groups. The difference in reference sound levels between uncontrolled and controlled groups was 1.50 dB (SD 4.42). The mean SD of the reference sound level determined for devices within the same model was 4.03 dB (95% CI 3.93-4.11). Statistically significant differences were found across models. Reference sound levels determined in the uncontrolled group are comparable to the values obtained in the controlled group. This validates the use of biological calibration in the uncontrolled group for determining the predefined reference sound level for new devices. Moreover, due to a relatively small deviation of the reference sound level for devices of the same model, it is feasible to conduct hearing screening on devices calibrated with the predefined reference sound level.

Self regulating formulations for safe hydrogen gettering

DOEpatents

Shepodd, Timothy Jon

2002-01-01

A method and composition are disclosed for preventing uncontrolled exothermic reaction in the presence of a catalyst. A catalyst deployed as a finely divided powder which is attached to the surface of a low melting point wax or wax-like material which is utilized as a carrier for the catalyst. During operation should the catalyst overheat due to uncontrolled conditions brought about by a run-away reaction the heat of reaction melts the low melting point wax which would itself wet the surface of the catalyst and prevent further catalysis.

Aircraft Accident Report; Uncontrolled Impact with Terrain, Fine Airlines Flight 101, Douglas DC-8-61, N27UA, Miami, Florida, August 7, 1997

DTIC Science & Technology

1998-06-16

Transcolombiana de Carga ATI Air Transport International ATOS Air Transportation Oversight System ATP airline transport pilot CAM cockpit area microphone...495,000 fine against Aero Transcolombiana de Carga (ATC) for operating a DC-8-51 "over the weight limits set forth in its FAA-approved flight manual...PB98-910402 NTSB/AAR-98/02 DCA97MA059 NATIONAL TRANSPORTATION SAFETY BOARD WASHINGTON, D.C. 20594 AIRCRAFT ACCIDENT REPORT c>C== UNCONTROLLED IMPACT

Pediatric intensive care treatment of uncontrolled status epilepticus.

PubMed

Wilkes, Ryan; Tasker, Robert C

2013-04-01

The critically ill mechanically ventilated child with ongoing seizures that are refractory to any treatment presents a distinct challenge in pediatric neurocritical care. The evidence base from randomized controlled trials on which anti-epileptic drug (AED) strategy should be used is inadequate. This review of refractory and super-refractory status epilepticus summarizes recent pediatric case series regarding definitions, the second-tier AED therapies once initial anticonvulsants have failed, and the experience of high-dose midazolam, barbiturate anesthesia, and volatile anesthetics for uncontrolled status epilepticus. Copyright © 2013 Elsevier Inc. All rights reserved.

Satellite recovery - Attitude dynamics of the targets

NASA Technical Reports Server (NTRS)

Cochran, J. E., Jr.; Lahr, B. S.

1986-01-01

The problems of categorizing and modeling the attitude dynamics of uncontrolled artificial earth satellites which may be targets in recovery attempts are addressed. Methods of classification presented are based on satellite rotational kinetic energy, rotational angular momentum and orbit and on the type of control present prior to the benign failure of the control system. The use of approximate analytical solutions and 'exact' numerical solutions to the equations governing satellite attitude motions to predict uncontrolled attitude motion is considered. Analytical and numerical results are presented for the evolution of satellite attitude motions after active control termination.

Exposure to Unsolvable Anagrams Impairs Performance on the Iowa Gambling Task

PubMed Central

Starcke, Katrin; Agorku, Janet D.; Brand, Matthias

2017-01-01

Recent research indicates that external manipulations, such as stress or mood induction, can affect decision-making abilities. In the current study, we investigated whether the exposure to an unsolvable task affected subsequent performance on the Iowa Gambling Task. Participants were randomly assigned to a condition in which they were exposed to unsolvable anagrams (n = 20), or a condition in which they worked on solvable anagrams (n = 22). Afterwards, all participants played the Iowa Gambling Task, a prominent task that measures decision making under uncertain conditions with no explicit rules for gains and losses. In this task, it is essential to process feedback from previous decisions. The results demonstrated that participants who worked on unsolvable anagrams made more disadvantageous decisions on the Iowa Gambling Task than the other participants. In addition, a significant gender effect was observed: Males who worked on unsolvable anagrams made a more disadvantageous decisions than the other male participants. Females who worked on unsolvable anagrams also made more disadvantageous decision than the other female participants, but differences were small and not significant. We conclude that the exposure to unsolvable anagrams induced the experience of uncontrollability which can elicit stress and learned helplessness. Stress and learned helplessness might have reduced the ability to learn from the given feedback, particularly in male participants. We assume that in real life, uncontrollable challenges that last longer than a single experimental manipulation can affect decision making severely, at least in males. PMID:28642693

OPERA- A CNES Tool to Monitor Short and Middle Term Uncontrolled Re-Entries Using Mean Theories

NASA Astrophysics Data System (ADS)

Dolado, J. C.; Agueda, A.; Aivar, L.; Tirado, J.

2013-09-01

Objects in Low-Earth Orbits (LEO) and Highly Elliptical Orbits (HEO) are subjected to decay and re- entry into the atmosphere due mainly to the drag force. While being this process the best solution to avoid the proliferation of debris in space and ensure the sustainability of future space activities, it implies a threat to the population on ground. Thus, the prediction of the in-orbit lifetime of an object and the evaluation of the risk on population and ground assets constitutes a crucial task. This paper will concentrate on the first of these tasks.Unfortunately the lifetime of an object in space is remarkably difficult to predict. This is mainly due to the dependence of the atmospheric drag on a number of uncertain elements such as the density profile and its dependence on the solar activity, the atmospheric conditions, the mass and surface area of the object (very difficult to evaluate), its uncontrolled attitude, etc.In this paper we will present a method for the prediction of this lifetime based on publicly available Two-Line Elements (TLEs) from the American USSTRATCOM's Joint Space Operations Center (JSpOC). TLEs constitute an excellent source to access routinely orbital information for thousands of objects even though of their reduced and unpredictable accuracy.Additionally, the implementation of the method on a CNES's Java-based tool will be presented. This tool (OPERA) is executed routinely at CNES to predict the orbital lifetime of a whole catalogue of objects.

Efficacy of an amlodipine/olmesartan treatment algorithm in patients with or without type 2 diabetes and hypertension (a secondary analysis of the BP-CRUSH study).

PubMed

Nesbitt, S D; Shojaee, A; Maa, J-F; Weir, M R

2013-07-01

A prespecified subgroup analysis of an open-label, multicenter, single-arm, dose-titration study is presented. The efficacy and safety of 20-week treatment with an amlodipine (AML)/olmesartan medoxomil (OM)±hydrochlorothiazide (HCTZ) algorithm were assessed in patients with hypertension and type 2 diabetes mellitus (T2DM) who were uncontrolled by antihypertensive monotherapy. Eligible patients received AML/OM 5/20 mg for 4 weeks, followed by stepwise uptitration to AML/OM 5/40 mg, AML/OM 10/40 mg, AML/OM 10/40 mg+HCTZ 12.5 mg and AML/OM 10/40 mg+HCTZ 25 mg at 4-week intervals if blood pressure (BP) remained uncontrolled. The primary end point was the achievement of the seated cuff systolic BP (SeSBP) goal (<140 mm Hg, or <130 mm Hg for patients with T2DM) at week 12. Seated cuff BP was significantly reduced from baseline at all titration dose periods. At week 12, the cumulative SeSBP goal was achieved by 57.9% and 80.1% of patients in the T2DM and non-T2DM subgroups, respectively. Treatment was well tolerated, with low rates of peripheral edema. In summary, switching to a treatment algorithm based on AML/OM±HCTZ after failed monotherapy was safe and improved BP control in patients with hypertension and T2DM.

(Z)-5-(2,4-Dihydroxybenzylidene)thiazolidine-2,4-dione Prevents UVB-Induced Melanogenesis and Wrinkle Formation through Suppressing Oxidative Stress in HRM-2 Hairless Mice

PubMed Central

Lee, Bonggi; Moon, Kyoung Mi; Kim, Seong Jin; Kim, So Hee; Kim, Dae Hyun; An, Hye Jin; Jeong, Ji Won; Kim, Ye Ra; Son, Sujin; Kim, Min Jo; Chung, Ki Wung; Lee, Eun Kyeong; Chun, Pusoon; Ha, Young Mi; Kim, Min-Sun; Mo, Sang Hyun; Moon, Hyung Ryong; Chung, Hae Young

2016-01-01

Background. Uncontrolled melanogenesis and wrinkle formation are an indication of photoaging. Our previous studies demonstrated that (Z)-5-(2,4-dihydroxybenzylidene)thiazolidine-2,4-dione (MHY498) inhibited tyrosinase activity and melanogenesis in vitro. Objective. To examine in vivo effects of MHY498 as an antiaging compound on UVB-induced melanogenesis and wrinkle formation, we topically applied MHY498 on dorsal skin of HRM-2 hairless mice. Methods. Using histological analysis, we evaluated effects of MHY498 on melanogenesis and wrinkle formation after UVB exposure. In addition, related molecular signaling pathways were examined using western blotting, fluorometric assay, and enzyme-linked immunosorbent assay. Results. MHY498 suppressed UVB-induced melanogenesis by inhibiting phosphorylation of CREB and translocation of MITF protein into the nucleus, which are key factors for tyrosinase expression. Consistently, tyrosinase protein levels were notably reduced in the dorsal skin of the hairless mice by MHY498 treatment. Furthermore, MHY498 inhibited UVB-induced wrinkle formation and collagen fiber destruction by increasing type 1 procollagen concentration and decreasing protein expression levels of MMPs, which play an essential role in collagen fiber degradation. As a mechanism, MHY498 notably ameliorated UVB-induced oxidative stress and NF-κB activation in the dermal skin of the hairless mice. Conclusion. Our study suggests that MHY498 can be used as a therapeutic or cosmetic agent for preventing uncontrolled melanogenesis and wrinkle formation. PMID:27242917

Electroconvulsive therapy can benefit from controlled hyperventilation using a laryngeal mask.

PubMed

Haeck, Martina; Gillmann, Benjamin; Janouschek, Hildegard; Grözinger, Michael

2011-11-01

Hypocapnia through hyperventilation is a well-known procedure in electroconvulsive therapy (ECT) to enhance seizure activity. However, it has mostly been applied in an uncontrolled manner. Originally intended for a better management of the supraglottic airway, laryngeal masks are more suited to monitor levels of CO(2) during hyperventilation than face masks and thereby provide for the possibility of controlled hyperventilation (CHV). The impact of CHV was retrospectively studied in 114 consecutive patients; 65 of them had received ECT with CHV and 49 had received ECT with uncontrolled hyperventilation (UHV) directly prior to the time period when the laryneal mask was introduced to the ECT treatment procedure. The CO(2) level in the CHV group was aimed at 30 mmHg or below. CHV considerably enhanced the seizure activity leading to changes in clinically determined parameters of the treatment course: the necessity for increasing the electric charge, for re-stimulations (trend) and for bilateral stimulations was lower in the CHV group as compared to the UHV group. The improvement in the Global Assessment of Functioning Scores was not different in both groups. CHV was associated with a higher amount of prolonged seizures, with a reduced number of delirious symptoms after treatments and an attenuating effect on heart rate. Concluding, CHV can help to maintain the applied electric charge low without worsening the clinical outcome. Therefore, it is a helpful technical improvement. However, it should be used carefully with regard to prolonged seizures.

Fusaric acid is a crucial factor in the disturbance of leaf water imbalance in Fusarium-infected banana plants.

PubMed

Dong, Xian; Ling, Ning; Wang, Min; Shen, Qirong; Guo, Shiwei

2012-11-01

Fusarium wilt of banana is caused by Fusarium oxysporum f. sp. cubense infection. The initial chlorosis symptoms occur progressively from lower to upper leaves, with wilt symptoms subsequently occurring in the whole plant. To determine the effect of the pathogen infection on the gas exchange characteristics and water content in banana leaves, hydroponic experiments with pathogen inoculation were conducted in a greenhouse. Compared with control plants, infected banana seedlings showed a higher leaf temperature as determined by thermal imaging. Reduced stomatal conductance (g(s)) and transpiration rate (E) in infected plants resulted in lower levels of water loss than in control plants. Water potential in heavily diseased plants (II) was significantly reduced and the E/g(s) ratio was higher than in noninfected plants, indicating the occurrence of uncontrolled water loss not regulated by stomata in diseased plants. As no pathogen colonies were detected from the infected plant leaves, the crude toxin was extracted from the pathogen culture and evaluated about the effect on banana plant to further investigate the probable reason of these physiological changes in Fusarium-infected banana leaf. The phytotoxin fusaric acid (FA) was found in the crude toxin, and both crude toxin and pure FA had similar effects as the pathogen infection on the physiological changes in banana leaf. Additionally, FA was present at all positions in diseased plants and its concentration was positively correlated with the incidence of disease symptoms. Taken together, these observations indicated that FA secreted by the pathogen is an important factor involved in the disturbance of leaf temperature, resulting in uncontrolled leaf water loss and electrolyte leakage due to damaging the cell membrane. In conclusion, FA plays a critical role in accelerating the development of Fusarium wilt in banana plants by acting as a phytotoxin. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Effects of cholera toxin on the potential difference and motor responses induced by distension in the rat proximal small intestine in vivo.

PubMed

Kordasti, Shirin; Sapnara, Maria; Thomas, Evan A; Lindstrom, Erik; Forsman, Mikael; Bornstein, Joel C; Sjövall, Henrik

2006-05-01

Cholera toxin (CT) may induce uncontrolled firing in recurrent networks of secretomotor neurons in the submucous plexus. This hypothesis was tested in chloralose-anesthetized rats in vivo. The secretory reflex response to graded intestinal distension was measured with or without prior exposure to luminal CT. The transmural potential difference (PD) was used as a marker for electrogenic chloride secretion. In controls, distension increased PD, and this response was reduced by the neural blocker tetrodotoxin given serosally and the vasoactive intestinal peptide (VIP) receptor antagonist [4Cl-d-Phe(6),Leu(17)]VIP (2 mug.min(-1).kg(-1) iv) but unaffected by the serotonin 5-HT(3) receptor antagonist granisetron, by the nicotinic receptor antagonist hexamethonium, by the muscarinic receptor antagonist atropine, or by the cyclooxygenase inhibitor indomethacin. Basal PD increased significantly with time in CT-exposed segments, an effect blocked by granisetron, by indomethacin, and by [4Cl-d-Phe(6),Leu(17)]VIP but not by hexamethonium or atropine. In contrast, once the increased basal PD produced by CT was established, [4Cl-d-Phe(6),Leu(17)]VIP and indomethacin had no significant effect, whereas granisetron and hexamethonium markedly depressed basal PD. CT significantly reduced the increase in PD produced by distension, an effect reversed by granisetron, indomethacin, and atropine. CT also activated a specific motility response to distension, repeated cluster contractions, but only in animals pretreated with granisetron, indomethacin, or atropine. These data are compatible with the hypothesis that CT induces uncontrolled activity in submucous secretory networks. Development of this state depends on 5-HT(3) receptors, VIP receptors, and prostaglandin synthesis, whereas its maintenance depends on 5-HT(3) and nicotinic receptors but not VIP receptors. The motility effects of CT (probably reflecting myenteric activity) are partially suppressed via a mechanism involving 5-HT(3) and muscarinic receptors and prostaglandin synthesis.

Mouse Sensitization and Exposure Are Associated with Asthma Severity in Urban Children.

PubMed

Grant, Torie; Aloe, Charles; Perzanowski, Matthew; Phipatanakul, Wanda; Bollinger, Mary E; Miller, Rachel; Matsui, Elizabeth C

Mouse sensitization and exposure are associated with uncontrolled asthma, but whether they are associated with asthma severity, an intrinsic disease characteristic and long-term outcome predictor, is unclear. To examine relationships between mouse sensitization and/or exposure and asthma severity in urban children. A total of 645 children (5-17 years) with uncontrolled asthma underwent mouse sensitization evaluation. Sensitized children had mouse allergen measured in bedroom dust. Relationships between mouse sensitization, allergen levels, and asthma severity measures (treatment step and Composite Asthma Severity Index [CASI]) were examined using regression models adjusted for age, sex, atopy, study site, race, ethnicity, and insurance. The study population was predominantly minority (69.6% black, 20.8% Hispanic), low income (61.8%), and mouse sensitized (54.4%). Mean ± SD treatment step was 3.2 ± 1.6, equivalent to medium-dose inhaled corticosteroid. Mean ± SD CASI was 6.5 ± 3.4, reflecting moderate persistent asthma. Mouse sensitization was associated with higher treatment step (3.5 vs 2.9, mouse-sensitized vs nonsensitized, P < .001), independent of potential confounders (β [95% CI], 0.36 [0.07-0.64]; P = .01). Mouse sensitization was associated independently with CASI (β [95% CI], 0.82 [0.16-1.47]; P = .02). Among mouse-sensitized participants, higher bedroom floor and bed Mus m 1 were independently associated with treatment step (β [95% CI], 0.26 [0.09-0.43]; P = .002 and β [95% CI], 0.22 [0.01-0.43]; P = .04), respectively. Higher bedroom floor Mus m 1 was independently associated with CASI (β [95% CI], 0.43 [0.05-0.81]; P = .03). Mouse sensitization and exposure are associated with asthma severity, among low-income, minority children. Further studies are needed to determine whether reducing allergen exposure among mouse-sensitized patients with asthma can reduce severity, ultimately altering childhood asthma natural history. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Prevalence of Inadequate Blood Pressure Control Among Veterans After Acute Ischemic Stroke Hospitalization: A Retrospective Cohort

PubMed Central

Roumie, Christianne L.; Ofner, Susan; Ross, Joseph S.; Arling, Greg; Williams, Linda S.; Ordin, Diana L.; Bravata, Dawn M.

2011-01-01

Background Reducing blood pressure (BP) after stroke reduces risk for recurrent events. Our aim was to describe hypertension care among veterans with ischemic stroke including BP control by discharge and over the 6 months post stroke event. Methods and Results The Office of Quality and Performance Stroke Special Study included a systematic sample of veterans hospitalized for ischemic stroke in 2007. We examined BP control (<140/90 mmHg) at discharge excluding those who died, enrolled in hospice, or had unknown discharge disposition (N=3640, 3382 adjusted analysis). The second outcome was BP control (<140/90 mmHg) within 6-months post-stroke, excluding patients who died /readmitted within 30 days, lost to follow-up or did not have a BP recorded (N=2054, 1915 adjusted analysis). The population was white (62.7 %) and male (97.7%); 46.9% were <65 years of age; 29% and 37% had a history of cerebrovascular or cardiovascular disease, respectively. Among the 3640 stroke patients 1573(43%) had their last documented BP prior to discharge >140/90 mmHg. Black race (adjusted OR 0.77 [95% CI 0.65, 0.91]), diabetes (OR 0.73 [95% CI 0.62, 0.86]) and hypertension history (OR 0.51 [95% CI 0.42, 0.63]) were associated with lower odds for controlled BP at discharge. Of the 2054 stroke patients seen within 6 months from their index event, 673 (32.8%) remained uncontrolled. By 6 months post event, neither race nor diabetes was associated with BP control; whereas history of hypertension continued to have lower odds of BP control. For each 10 point increase in systolic BP > 140 mmHg at discharge, odds of BP control within 6 months post discharge decreased by 12% (95% CI (8%, 18%)). Conclusions BP values in excess of national guidelines are common after stroke. Forty three percent of patients were discharged with an elevated BP and 33% remained uncontrolled by 6 months. PMID:21693725

Leptin deficiency causes insulin resistance induced by uncontrolled diabetes.

PubMed

German, Jonathan P; Wisse, Brent E; Thaler, Joshua P; Oh-I, Shinsuke; Sarruf, David A; Ogimoto, Kayoko; Kaiyala, Karl J; Fischer, Jonathan D; Matsen, Miles E; Taborsky, Gerald J; Schwartz, Michael W; Morton, Gregory J

2010-07-01

Depletion of body fat stores during uncontrolled, insulin-deficient diabetes (uDM) results in markedly reduced plasma leptin levels. This study investigated the role of leptin deficiency in the genesis of severe insulin resistance and related metabolic and neuroendocrine derangements induced by uDM. Adult male Wistar rats remained nondiabetic or were injected with the beta-cell toxin, streptozotocin (STZ) to induce uDM and subsequently underwent subcutaneous implantation of an osmotic minipump containing either vehicle or leptin at a dose (150 microg/kg/day) designed to replace leptin at nondiabetic plasma levels. To control for leptin effects on food intake, another group of STZ-injected animals were pair fed to the intake of those receiving leptin. Food intake, body weight, and blood glucose levels were measured daily, with body composition and indirect calorimetry performed on day 11, and an insulin tolerance test to measure insulin sensitivity performed on day 16. Plasma hormone and substrate levels, hepatic gluconeogenic gene expression, and measures of tissue insulin signal transduction were also measured. Physiologic leptin replacement prevented insulin resistance in uDM via a mechanism unrelated to changes in food intake or body weight. This effect was associated with reduced total body fat and hepatic triglyceride content, preservation of lean mass, and improved insulin signal transduction via the insulin receptor substrate-phosphatidylinositol-3-hydroxy kinase pathway in the liver, but not in skeletal muscle or adipose tissue. Although physiologic leptin replacement lowered blood glucose levels only slightly, it fully normalized elevated plasma glucagon and corticosterone levels and reversed the increased hepatic expression of gluconeogenic enzymes characteristic of rats with uDM. We conclude that leptin deficiency plays a key role in the pathogenesis of severe insulin resistance and related endocrine disorders in uDM. Treatment of diabetes in humans may benefit from correction of leptin deficiency as well as insulin deficiency.

Changes in Quadriceps Muscle Activity During Sustained Recreational Alpine Skiing

PubMed Central

Kröll, Josef; Müller, Erich; Seifert, John G.; Wakeling, James M.

2011-01-01

During a day of skiing thousands of repeated contractions take place. Previous research on prolonged recreational alpine skiing show that physiological changes occur and hence some level of fatigue is inevitable. In the present paper the effect of prolonged skiing on the recruitment and coordination of the muscle activity was investigated. Six subjects performed 24 standardized runs. Muscle activity during the first two (PREskiing) and the last two (POSTskiing) runs was measured from the vastus lateralis (VL) and rectus femoris (RF) using EMG and quantified using wavelet and principal component analysis. The frequency content of the EMG signal shifted in seven out of eight cases significantly towards lower frequencies with highest effects observed for RF on outside leg. A significant pronounced outside leg loading occurred during POSTskiing and the timing of muscle activity peaks occurred more towards turn completion. Specific EMG frequency changes were observed at certain time points throughout the time windows and not over the whole double turn. It is suggested that general muscular fatigue, where additional specific muscle fibers have to be recruited due to the reduced power output of other fibers did not occur. The EMG frequency decrease and intensity changes for RF and VL are caused by altered timing (coordination) within the turn towards a most likely more uncontrolled skiing technique. Hence, these data provide evidence to suggest recreational skiers alter their skiing technique before a potential change in muscle fiber recruitment occurs. Key points The frequency content of the EMG signal shifted in seven out of eight cases significantly towards lower frequencies with highest effects observed for RF. General muscular fatigue, where additional specific fibers have to be recruited due to the reduced power output of other fibers, did not occur. A modified skiing style towards a less functional and hence more uncontrolled skiing technique seems to be a key issue with respect to the influence on muscle recruitment for applied prolonged skiing session. PMID:24149299

Nine months in space: effects on human autonomic cardiovascular regulation.

PubMed

Cooke, W H; Ames JE, I V; Crossman, A A; Cox, J F; Kuusela, T A; Tahvanainen, K U; Moon, L B; Drescher, J; Baisch, F J; Mano, T; Levine, B D; Blomqvist, C G; Eckberg, D L

2000-09-01

We studied three Russian cosmonauts to better understand how long-term exposure to microgravity affects autonomic cardiovascular control. We recorded the electrocardiogram, finger photoplethysmographic pressure, and respiratory flow before, during, and after two 9-mo missions to the Russian space station Mir. Measurements were made during four modes of breathing: 1) uncontrolled spontaneous breathing; 2) stepwise breathing at six different frequencies; 3) fixed-frequency breathing; and 4) random-frequency breathing. R wave-to-R wave (R-R) interval standard deviations decreased in all and respiratory frequency R-R interval spectral power decreased in two cosmonauts in space. Two weeks after the cosmonauts returned to Earth, R-R interval spectral power was decreased, and systolic pressure spectral power was increased in all. The transfer function between systolic pressures and R-R intervals was reduced in-flight, was reduced further the day after landing, and had not returned to preflight levels by 14 days after landing. Our results suggest that long-duration spaceflight reduces vagal-cardiac nerve traffic and decreases vagal baroreflex gain and that these changes may persist as long as 2 wk after return to Earth.

Long-term Follow-up of a Case of Gold Shunt Surgery for Refractory Silicone Oil–induced Glaucoma

PubMed Central

Le, Ryan; Berger, Alan R.

2016-01-01

Purpose: To report the first case of gold shunt surgery for treatment of silicone oil–induced refractory glaucoma in a tertiary care academic center, with 5-year follow-up. Design: The study design is a case report. Participants: The participant was a patient who underwent gold shunt surgery. Methods: Institutional Research Ethics Board approval for the study was obtained. A diabetic patient was referred for refractory glaucoma with a history of proliferative diabetic retinal detachment, and surgery with silicone oil. She was uncontrolled on maximal medical therapy and following informed consent, gold shunt surgery was performed. Ocular outcomes and number of medications were reviewed over a 5-year period. Results: Following uncomplicated surgery, intraocular pressure was reduced from 41 to 14 mm Hg, and the number of medications was reduced from 4 to 1. Glaucomatous optic neuropathy remained stable. Conclusions: Gold shunt surgery in this challenging case of silicone oil refractory glaucoma provided long-term intraocular pressure control and reduced need for medication over a 5-year period. PMID:27253968

Design of a pragmatic trial in minority children presenting to the emergency department with uncontrolled asthma: The CHICAGO Plan.

PubMed

Krishnan, Jerry A; Martin, Molly A; Lohff, Cortland; Mosnaim, Giselle S; Margellos-Anast, Helen; DeLisa, Julie A; McMahon, Kate; Erwin, Kim; Zun, Leslie S; Berbaum, Michael L; McDermott, Michael; Bracken, Nina E; Kumar, Rajesh; Margaret Paik, S; Nyenhuis, Sharmilee M; Ignoffo, Stacy; Press, Valerie G; Pittsenbarger, Zachary E; Thompson, Trevonne M

2017-06-01

Among children with asthma, black children are two to four times as likely to have an emergency department (ED) visit and die from asthma, respectively, compared to white children in the United States. Despite the availability of evidence-based asthma management guidelines, minority children are less likely than white children to receive or use effective options for asthma care. The CHICAGO Plan is a three-arm multi-center randomized pragmatic trial of children 5 to 11years old presenting to the ED with uncontrolled asthma that compares: [1] an ED-focused intervention to improve the quality of care on discharge to home, [2] the same ED-focused intervention together with a home-based community health worker (CHW)-led intervention, and [3] enhanced usual care. All children receive spacers for the metered dose inhaler and teaching about its use. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale and Satisfaction with Participation in Social Roles at 6months are the primary outcomes in children and in caregivers, respectively. Other patient-reported outcomes and indicators of healthcare utilization are assessed as secondary outcomes. Innovative features of the CHICAGO Plan include early and continuous engagement of children, caregivers, the Chicago Department of Public Health, and other stakeholders to inform the design and implementation of the study and a shared research infrastructure to coordinate study activities. The objective of this report is to describe the development of the CHICAGO Plan, including the methods and rationale for engaging stakeholders, the shared research infrastructure, and other features of the pragmatic clinical trial design. Published by Elsevier Inc.

Growth Hormone Research Society Workshop Summary: Consensus Guidelines for Recombinant Human Growth Hormone Therapy in Prader-Willi Syndrome

PubMed Central

Tony, Michèle; Höybye, Charlotte; Allen, David B.; Tauber, Maïthé; Christiansen, Jens Sandahl; Ambler, Geoffrey R.; Battista, Renaldo; Beauloye, Véronique; Berall, Glenn; Biller, Beverly M. K.; Butler, Merlin G.; Cassidy, Suzanne B.; Chihara, Kazuo; Cohen, Pinchas; Craig, Maria; Farholt, Stense; Goetghebeur, Mireille; Goldstone, Anthony P.; Greggi, Tiziana; Grugni, Graziano; Hokken-Koelega, Anita C.; Johannsson, Gudmundur; Johnson, Keegan; Kemper, Alex; Kopchick, John J.; Malozowski, Saul; Miller, Jennifer; Mogul, Harriette R.; Muscatelli, Françoise; Nergårdh, Ricard; Nicholls, Robert D.; Radovick, Sally; Rosenthal, M. Sara; Sipilä, Ilkka; Tarride, Jean-Eric; Vogels, Annick; Waters, Michael J.

2013-01-01

Context: Recombinant human GH (rhGH) therapy in Prader-Willi syndrome (PWS) has been used by the medical community and advocated by parental support groups since its approval in the United States in 2000 and in Europe in 2001. Its use in PWS represents a unique therapeutic challenge that includes treating individuals with cognitive disability, varied therapeutic goals that are not focused exclusively on increased height, and concerns about potential life-threatening adverse events. Objective: The aim of the study was to formulate recommendations for the use of rhGH in children and adult patients with PWS. Evidence: We performed a systematic review of the clinical evidence in the pediatric population, including randomized controlled trials, comparative observational studies, and long-term studies (>3.5 y). Adult studies included randomized controlled trials of rhGH treatment for ≥ 6 months and uncontrolled trials. Safety data were obtained from case reports, clinical trials, and pharmaceutical registries. Methodology: Forty-three international experts and stakeholders followed clinical practice guideline development recommendations outlined by the AGREE Collaboration (www.agreetrust.org). Evidence was synthesized and graded using a comprehensive multicriteria methodology (EVIDEM) (http://bit.ly.PWGHIN). Conclusions: Following a multidisciplinary evaluation, preferably by experts, rhGH treatment should be considered for patients with genetically confirmed PWS in conjunction with dietary, environmental, and lifestyle interventions. Cognitive impairment should not be a barrier to treatment, and informed consent/assent should include benefit/risk information. Exclusion criteria should include severe obesity, uncontrolled diabetes mellitus, untreated severe obstructive sleep apnea, active cancer, or psychosis. Clinical outcome priorities should vary depending upon age and the presence of physical, mental, and social disability, and treatment should be continued for as long as demonstrated benefits outweigh the risks. PMID:23543664

Design of a pragmatic trial in minority children presenting to the emergency department with uncontrolled asthma: The CHICAGO Plan

PubMed Central

Krishnan, Jerry A.; Martin, Molly A.; Lohff, Cortland; Mosnaim, Giselle S.; Margellos-Anast, Helen; DeLisa, Julie A.; McMahon, Kate; Erwin, Kim; Zun, Leslie S.; Berbaum, Michael L.; McDermott, Michael; Bracken, Nina E.; Kumar, Rajesh; Paik, S. Margaret; Nyenhuis, Sharmilee M.; Ignoffo, Stacy; Press, Valerie G.; Pittsenbarger, Zachary E.; Thompson, Trevonne M.

2017-01-01

Among children with asthma, black children are two to four times as likely to have an emergency department (ED) visit and die from asthma, respectively, compared to white children in the United States. Despite the availability of evidence-based asthma management guidelines, minority children are less likely than white children to receive or use effective options for asthma care. The CHICAGO Plan is a three-arm multi-center randomized pragmatic trial of children 5 to 11 years old presenting to the ED with uncontrolled asthma that compares: (1) an ED-focused intervention to improve the quality of care on discharge to home, (2) the same ED-focused intervention together with a home-based community health worker (CHW)-led intervention, and (3) enhanced usual care. All children receive spacers for the metered dose inhaler and teaching about its use. The Patient-Reported Outcomes Measurement Information System (PROMIS) Asthma Impact Scale and Satisfaction with Participation in Social Roles at 6 months are the primary outcomes in children and in caregivers, respectively. Other patient-reported outcomes and indicators of healthcare utilization are assessed as secondary outcomes. Innovative features of the CHICAGO Plan include early and continuous engagement of children, caregivers, the Chicago Department of Public Health, and other stakeholders to inform the design and implementation of the study and a shared research infrastructure to coordinate study activities. The objective of this report is to describe the development of the CHICAGO Plan, including the methods and rationale for engaging stakeholders, the shared research infrastructure, and other features of the pragmatic clinical trial design. PMID:28366780

Telephone-based low intensity therapy after crisis presentations to the emergency department is associated with improved outcomes.

PubMed

Bidargaddi, Niranjan; Bastiampillai, Tarun; Allison, Stephen; Jones, Gabrielle M; Furber, Gareth; Battersby, Malcolm; Richards, David

2015-10-01

In Australia there is an overwhelming need to provide effective treatment to patients presenting to the Emergency Department (ED) in mental health crisis. We adapted Improving Access to Psychological Therapies service model (IAPT) from the National Health Service (NHS) method for the large scale delivery of psychological therapies throughout the United Kingdom to an Australian ED setting. This telephone-based low intensity therapy was provided to people presenting in crisis to the EDs with combinations of anxiety, depression, substance use, and suicidal thinking. This uncontrolled study utilised session-by-session, before-and-after measures of anxiety and depression via Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7). Of 347 eligible post-crisis ED referred patients, 291 (83.9%) engaged with the IAPT team. Most patients (65%) had attended the ED previously on an average of 3.9 (SD = 6.0) occasions. Two hundred and forty one patients received an average of 4.1 (SD = 2.3) contacts of low-intensity psychological therapies including 1.2 (SD = 1.7) community outreach visits between 20th Oct 2011 and 31st Dec 2012. Treated patients reported clinically significant improvements in anxiety, depression and suicidal ideation. Uncontrolled effect sizes were moderate for anxiety (0.6) and depression (0.6). The Australian ED IAPT program demonstrated that the UK IAPT program could be adapted for emergency mental health patients and be associated with similar clinical benefits as the original program. The Flinders Medical Centre IAPT program received Emergency Department project funding from the Australian Commonwealth Government through the Council of Australian Governments (COAG) and the South Australian Government initiative, Every Patient Every Service (EPES). © The Author(s) 2015.

GrowthHormone Research Society workshop summary: consensus guidelines for recombinant human growth hormone therapy in Prader-Willi syndrome.

PubMed

Deal, Cheri L; Tony, Michèle; Höybye, Charlotte; Allen, David B; Tauber, Maïthé; Christiansen, Jens Sandahl

2013-06-01

Recombinant human GH (rhGH) therapy in Prader-Willi syndrome (PWS) has been used by the medical community and advocated by parental support groups since its approval in the United States in 2000 and in Europe in 2001. Its use in PWS represents a unique therapeutic challenge that includes treating individuals with cognitive disability, varied therapeutic goals that are not focused exclusively on increased height, and concerns about potential life-threatening adverse events. The aim of the study was to formulate recommendations for the use of rhGH in children and adult patients with PWS. We performed a systematic review of the clinical evidence in the pediatric population, including randomized controlled trials, comparative observational studies, and long-term studies (>3.5 y). Adult studies included randomized controlled trials of rhGH treatment for ≥ 6 months and uncontrolled trials. Safety data were obtained from case reports, clinical trials, and pharmaceutical registries. Forty-three international experts and stakeholders followed clinical practice guideline development recommendations outlined by the AGREE Collaboration (www.agreetrust.org). Evidence was synthesized and graded using a comprehensive multicriteria methodology (EVIDEM) (http://bit.ly.PWGHIN). Following a multidisciplinary evaluation, preferably by experts, rhGH treatment should be considered for patients with genetically confirmed PWS in conjunction with dietary, environmental, and lifestyle interventions. Cognitive impairment should not be a barrier to treatment, and informed consent/assent should include benefit/risk information. Exclusion criteria should include severe obesity, uncontrolled diabetes mellitus, untreated severe obstructive sleep apnea, active cancer, or psychosis. Clinical outcome priorities should vary depending upon age and the presence of physical, mental, and social disability, and treatment should be continued for as long as demonstrated benefits outweigh the risks.

Effects of stressor controllability on psychophysiological, cognitive and behavioural responses in patients with major depression and dysthymia

PubMed Central

Diener, C.; Kuehner, C.; Brusniak, W.; Struve, M.; Flor, H.

2009-01-01

Background The experience of uncontrollability and helplessness in the face of stressful life events is regarded as an important determinant in the development and maintenance of depression. The inability to successfully deal with stressors might be linked to dysfunctional prefrontal functioning. We assessed cognitive, behavioural and physiological effects of stressor uncontrollability in depressed and healthy individuals. In addition, relationships between altered cortical processing and cognitive vulnerability traits of depression were analysed. Method A total of 26 unmedicated depressed patients and 24 matched healthy controls were tested in an expanded forewarned reaction (S1–S2) paradigm. In a factorial design, stressor controllability varied across three consecutive conditions: (a) control, (b) loss of control and (c) restitution of control. Throughout the experiment, error rates, ratings of controllability, arousal, emotional valence and helplessness were assessed together with the post-imperative negative variation (PINV) of the electroencephalogram. Results Depressed participants showed an enhanced frontal PINV as an electrophysiological index of altered information processing during both loss of control and restitution of control. They also felt more helpless than controls. Furthermore, frontal PINV magnitudes were associated with habitual rumination in the depressed subsample. Conclusions These findings indicate that depressed patients are more susceptible to stressor uncontrollability than healthy subjects. Moreover, the experience of uncontrollability seems to bias subsequent information processing in a situation where control is objectively re-established. Alterations in prefrontal functioning appear to contribute to this vulnerability and are also linked to trait markers of depression. PMID:18466665

A case report of dexmedetomidine used to treat intractable pain and delirium in a tertiary palliative care unit.

PubMed

Hilliard, Neil; Brown, Stuart; Mitchinson, Steve

2015-03-01

This case report describes an end-stage cancer patient with intractable neuropathic pain and delirium who was successfully managed during the last 3 weeks of her life with a continuous subcutaneous infusion of dexmedetomidine. A 55-year-old woman with locally advanced cervical cancer and uncontrolled pelvic pain was admitted to a tertiary palliative care unit for pain management. As her disease progressed, the patient's pelvic pain intensified despite treatment with methadone, gabapentin, ketamine, and hydromorphone administered by continuous subcutaneous infusion plus frequent breakthrough doses of hydromorphone and sufentanil. A continuous subcutaneous infusion of dexmedetomidine was started and titrated to achieve pain relief. The patient's pain and delirium cleared. The treatment was successful in fulfilling the patient's goal of care: not to be deeply and continuously sedated, but to be rousable and of clear mind while still having good pain control. Dexmedetomidine is a potentially useful medication for the targeted treatment of intractable pain and delirium in the tertiary palliative care environment. Future research is required to compare dexmedetomidine infusion to standard treatment with midazolam infusion for treatment of intractable symptoms in the palliative care environment. © The Author(s) 2014.

Interplay between Cartilage and Subchondral Bone Contributing to Pathogenesis of Osteoarthritis

PubMed Central

Sharma, Ashish R.; Jagga, Supriya; Lee, Sang-Soo; Nam, Ju-Suk

2013-01-01

Osteoarthritis (OA) is a common debilitating joint disorder, affecting large sections of the population with significant disability and impaired quality of life. During OA, functional units of joints comprising cartilage and subchondral bone undergo uncontrolled catabolic and anabolic remodeling processes to adapt to local biochemical and biological signals. Changes in cartilage and subchondral bone are not merely secondary manifestations of OA but are active components of the disease, contributing to its severity. Increased vascularization and formation of microcracks in joints during OA have suggested the facilitation of molecules from cartilage to bone and vice versa. Observations from recent studies support the view that both cartilage and subchondral bone can communicate with each other through regulation of signaling pathways for joint homeostasis under pathological conditions. In this review we have tried to summarize the current knowledge on the major signaling pathways that could control the cartilage-bone biochemical unit in joints and participate in intercellular communication between cartilage and subchondral bone during the process of OA. An understanding of molecular communication that regulates the functional behavior of chondrocytes and osteoblasts in both physiological and pathological conditions may lead to development of more effective strategies for treating OA patients. PMID:24084727

A half century of scalloping in the work habits of the United States Congress.

PubMed Central

Critchfield, Thomas S; Haley, Rebecca; Sabo, Benjamin; Colbert, Jorie; Macropoulis, Georgette

2003-01-01

It has been suggested that the work environment of the United States Congress bears similarity to a fixed-interval reinforcement schedule. Consistent with this notion, Weisberg and Waldrop (1972) described a positively accelerating pattern in annual congressional bill production (selected years from 1947 to 1968) that is reminiscent of the scalloped response pattern often attributed to fixed-interval schedules, but their analysis is now dated and does not bear on the functional relations that might yield scalloping. The present study described annual congressional bill production over a period of 52 years and empirically evaluated predictions derived from four hypotheses about the mechanisms that underlie scalloping. Scalloping occurred reliably in every year. The data supported several predictions about congressional productivity based on fixed-interval schedule performance, but did not consistently support any of three alternative accounts. These findings argue for the external validity of schedule-controlled operant behavior as measured in the laboratory. The present analysis also illustrates a largely overlooked role for applied behavior analysis: that of shedding light on the functional properties of behavior in uncontrolled settings of considerable interest to the public. PMID:14768667

Immunomodulatory Effects of Soybeans and Processed Soy Food Compounds.

PubMed

Tezuka, Hiroyuki; Imai, Shinjiro

2015-01-01

Inflammation is an immune response against both internal and external antigens in organisms, particularly in mammals, and includes both uncontrolled chronic and low-grade inflammations. Uncontrolled chronic inflammation often leads to severe diseases such as vascular disease, arthritis, cancer, diabete, allergy, and autoimmunity. On the other hand, low-grade inflammation is recognized as a relationship between obesity and risk of metabolic syndrome. Elevated production of pro-inflammatory cytokines and mediators is commonly observed in patients with uncontrolled or low-grade inflammation-associated diseases. Plants have been generated phytochemicals to overcome inflammations and infections through evolution. Phytochemicals belong to alkaloids, polyphenols, flavonoids, coumarins, and terpenoids. The consumption of soybeans plays a role in immune modulation through their components such as isoflavones, saponins, and anthocyanins. Recently, it was reported that the application of phytochemicals into patients with inflammatory diseases improves their symptoms. Therefore, it is important to identify novel phytochemicals with immunomodulatory activities. This review introduces and discusses recent advances and patents regarding soybean or processed soy food compounds which exhibit immunomodulatory activity in immune diseases, particularly allergy, by mediating the suppression of inflammatory pathways.

Comparison of ambulatory blood pressure-lowering effects of higher doses of different calcium antagonists in uncontrolled hypertension: the Calcium Antagonist Controlled-Release High-Dose Therapy in Uncontrolled Refractory Hypertensive Patients (CARILLON) Study.

PubMed

Mizuno, Hiroyuki; Hoshide, Satoshi; Tomitani, Naoko; Kario, Kazuomi

2017-10-01

Data are sparse regarding ambulatory blood pressure (BP) reduction of up-titration from a standard dose to a high dose in both nifedipine controlled-release (CR) and amlodipine. This was a prospective, randomized, multicenter, open-label trial. Fifty-one uncontrolled hypertensives medicated by two or more antihypertensive drugs including a renin-angiotensin system inhibitor and a calcium antagonist were randomly assigned to either the nifedipine CR (80 mg)/candesartan (8 mg) group or the amlodipine (10 mg)/candesartan (8 mg) group. The changes in 24-hr BP were comparable between the groups. The nifedipine group demonstrated a significant decrease in their urinary albumin creatinine ratio, whereas the amlodipine group demonstrated a significant decrease in their NTproBNP level. However, there was no significant difference in any biomarkers between the two groups. Nifedipine showed an almost equal effect on ambulatory blood pressure as amlodipine. Their potentially differential effects on renal protection and NTproBNP should be tested in larger samples.

Robust crop and weed segmentation under uncontrolled outdoor illumination.

PubMed

Jeon, Hong Y; Tian, Lei F; Zhu, Heping

2011-01-01

An image processing algorithm for detecting individual weeds was developed and evaluated. Weed detection processes included were normalized excessive green conversion, statistical threshold value estimation, adaptive image segmentation, median filter, morphological feature calculation and Artificial Neural Network (ANN). The developed algorithm was validated for its ability to identify and detect weeds and crop plants under uncontrolled outdoor illuminations. A machine vision implementing field robot captured field images under outdoor illuminations and the image processing algorithm automatically processed them without manual adjustment. The errors of the algorithm, when processing 666 field images, ranged from 2.1 to 2.9%. The ANN correctly detected 72.6% of crop plants from the identified plants, and considered the rest as weeds. However, the ANN identification rates for crop plants were improved up to 95.1% by addressing the error sources in the algorithm. The developed weed detection and image processing algorithm provides a novel method to identify plants against soil background under the uncontrolled outdoor illuminations, and to differentiate weeds from crop plants. Thus, the proposed new machine vision and processing algorithm may be useful for outdoor applications including plant specific direct applications (PSDA).

Learned helplessness and learned prevalence: exploring the causal relations among perceived controllability, reward prevalence, and exploration.

PubMed

Teodorescu, Kinneret; Erev, Ido

2014-10-01

Exposure to uncontrollable outcomes has been found to trigger learned helplessness, a state in which the agent, because of lack of exploration, fails to take advantage of regained control. Although the implications of this phenomenon have been widely studied, its underlying cause remains undetermined. One can learn not to explore because the environment is uncontrollable, because the average reinforcement for exploring is low, or because rewards for exploring are rare. In the current research, we tested a simple experimental paradigm that contrasts the predictions of these three contributors and offers a unified psychological mechanism that underlies the observed phenomena. Our results demonstrate that learned helplessness is not correlated with either the perceived controllability of one's environment or the average reward, which suggests that reward prevalence is a better predictor of exploratory behavior than the other two factors. A simple computational model in which exploration decisions were based on small samples of past experiences captured the empirical phenomena while also providing a cognitive basis for feelings of uncontrollability. © The Author(s) 2014.

Evaluating the 4-hour and 30-minute rules: effects of room temperature exposure on red blood cell quality and bacterial growth.

PubMed

Ramirez-Arcos, Sandra; Mastronardi, Cherie; Perkins, Heather; Kou, Yuntong; Turner, Tracey; Mastronardi, Emily; Hansen, Adele; Yi, Qi-Long; McLaughlin, Natasha; Kahwash, Eiad; Lin, Yulia; Acker, Jason

2013-04-01

A 30-minute rule was established to limit red blood cell (RBC) exposure to uncontrolled temperatures during storage and transportation. Also, RBC units issued for transfusion should not remain at room temperature (RT) for more than 4 hours (4-hour rule). This study was aimed at determining if single or multiple RT exposures affect RBC quality and/or promote bacterial growth. Growth and RT exposure experiments were performed in RBCs inoculated with Serratia liquefaciens and Serratia marcescens. RBCs were exposed once to RT for 5 hours (S. liquefaciens) or five times to RT for 30 minutes (S. marcescens) with periodic sampling for bacterial counts. Noncontaminated units were exposed to RT once (5 hr) or five times (30 min each) and sampled to measure in vitro quality variables. RBC core temperature was monitored using mock units with temperature loggers. Growth and RT exposure experiments were repeated three and at least six times, respectively. Statistical analysis was done using mixed-model analysis. RBC core temperature ranged from 7.3 to 11.6°C during 30-minute RT exposures and the time to reach 10°C varied from 22 to 55 minutes during 5-hour RT exposures. RBC quality was preserved after single or multiple RT exposures. Increased growth of S. liquefaciens was only observed after 2 hours of continuous RT exposure. S. marcescens concentration increased significantly in multiple-exposed units compared to the controls but did not reach clinically important levels. Single or multiple RT exposures did not affect RBC quality but slightly promoted bacterial growth in contaminated units. The clinical significance of these results remains unclear and needs further investigation. © 2012 American Association of Blood Banks.

TITRATION: A Randomized Study to Assess 2 Treatment Algorithms with New Insulin Glargine 300 units/mL.

PubMed

Yale, Jean-François; Berard, Lori; Groleau, Mélanie; Javadi, Pasha; Stewart, John; Harris, Stewart B

2017-10-01

It was uncertain whether an algorithm that involves increasing insulin dosages by 1 unit/day may cause more hypoglycemia with the longer-acting insulin glargine 300 units/mL (GLA-300). The objective of this study was to compare safety and efficacy of 2 titration algorithms, INSIGHT and EDITION, for GLA-300 in people with uncontrolled type 2 diabetes mellitus, mainly in a primary care setting. This was a 12-week, open-label, randomized, multicentre pilot study. Participants were randomly assigned to 1 of 2 algorithms: they either increased their dosage by 1 unit/day (INSIGHT, n=108) or the dose was adjusted by the investigator at least once weekly, but no more often than every 3 days (EDITION, n=104). The target fasting self-monitored blood glucose was in the range of 4.4 to 5.6 mmol/L. The percentages of participants reaching the primary endpoint of fasting self-monitored blood glucose ≤5.6 mmol/L without nocturnal hypoglycemia were 19.4% (INSIGHT) and 18.3% (EDITION). At week 12, 26.9% (INSIGHT) and 28.8% (EDITION) of participants achieved a glycated hemoglobin value of ≤7%. No differences in the incidence of hypoglycemia of any category were noted between algorithms. Participants in both arms of the study were much more satisfied with their new treatment as assessed by the Diabetes Treatment Satisfaction Questionnaire. Most health-care professionals (86%) preferred the INSIGHT over the EDITION algorithm. The frequency of adverse events was similar between algorithms. A patient-driven titration algorithm of 1 unit/day with GLA-300 is effective and comparable to the previously tested EDITION algorithm and is preferred by health-care professionals. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

Renal Denervation for Chronic Heart Failure: Background and Pathophysiological Rationale.

PubMed

Böhm, Michael; Ewen, Sebastian; Mahfoud, Felix

2017-01-01

The activation of the sympathetic nervous system is associated with cardiovascular hospitalizations and death in heart failure. Renal denervation has been shown to effectively reduce sympathetic overdrive in certain patients with uncontrolled hypertension. Pilot trials investigating renal denervation as a potential treatment approach for heart failure were initiated. Heart failure comorbidities like obstructive sleep apnea, metabolic syndrome and arrhythmias could also be targets for renal denervation, because these occurrences are also mediated by the activation of the sympathetic nervous system. Therefore, renal denervation in heart failure is worthy of further investigation, although its effectiveness still has to be proven. Herein, we describe the pathophysiological rationale and the effect of renal denervation on surrogates of the heart failure syndrome.

Renal Denervation for Chronic Heart Failure: Background and Pathophysiological Rationale

PubMed Central

Ewen, Sebastian; Mahfoud, Felix

2017-01-01

The activation of the sympathetic nervous system is associated with cardiovascular hospitalizations and death in heart failure. Renal denervation has been shown to effectively reduce sympathetic overdrive in certain patients with uncontrolled hypertension. Pilot trials investigating renal denervation as a potential treatment approach for heart failure were initiated. Heart failure comorbidities like obstructive sleep apnea, metabolic syndrome and arrhythmias could also be targets for renal denervation, because these occurrences are also mediated by the activation of the sympathetic nervous system. Therefore, renal denervation in heart failure is worthy of further investigation, although its effectiveness still has to be proven. Herein, we describe the pathophysiological rationale and the effect of renal denervation on surrogates of the heart failure syndrome. PMID:28154583

Beyond the bulk: disclosing the life of single microbial cells

PubMed Central

Rosenthal, Katrin; Oehling, Verena

2017-01-01

Abstract Microbial single cell analysis has led to discoveries that are beyond what can be resolved with population-based studies. It provides a pristine view of the mechanisms that organize cellular physiology, unbiased by population heterogeneity or uncontrollable environmental impacts. A holistic description of cellular functions at the single cell level requires analytical concepts beyond the miniaturization of existing technologies, defined but uncontrolled by the biological system itself. This review provides an overview of the latest advances in single cell technologies and demonstrates their potential. Opportunities and limitations of single cell microbiology are discussed using selected application-related examples. PMID:29029257

Simulation of spread and control of lesions in brain.

PubMed

Thamattoor Raman, Krishna Mohan

2012-01-01

A simulation model for the spread and control of lesions in the brain is constructed using a planar network (graph) representation for the central nervous system (CNS). The model is inspired by the lesion structures observed in the case of multiple sclerosis (MS), a chronic disease of the CNS. The initial lesion site is at the center of a unit square and spreads outwards based on the success rate in damaging edges (axons) of the network. The damaged edges send out alarm signals which, at appropriate intensity levels, generate programmed cell death. Depending on the extent and timing of the programmed cell death, the lesion may get controlled or aggravated akin to the control of wild fires by burning of peripheral vegetation. The parameter phase space of the model shows smooth transition from uncontrolled situation to controlled situation. The simulations show that the model is capable of generating a wide variety of lesion growth and arrest scenarios.

Direct runoff assessment using modified SME method in catchments in the Upper Vistula River Basin

NASA Astrophysics Data System (ADS)

Wałęga, A.; Rutkowska, A.; Grzebinoga, M.

2017-04-01

Correct determination of direct runoff is crucial for proper and safe dimensioning of hydroengineering structures. It is commonly assessed using SCS-CN method developed in the United States. However, due to deficiencies of this method, many improvements and modifications have been proposed. In this paper, a modified Sahu-Mishra-Eldo (SME) method was introduced and tested for three catchments located in the upper Vistula basin. Modification of SME method involved a determination of maximum potential retention S based on CN parameter derived from SCS-CN method. The modified SME method yielded direct runoff values very similar to those observed in the investigated catchments. Moreover, it generated significantly smaller errors in the direct runoff estimation as compared with SCS-CN and SME methods in the analyzed catchments. This approach may be used for estimating the runoff in uncontrolled catchments.

Development of high integrity, maximum durability concrete structures for LLW disposal facilities

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

Taylor, W.P.

1992-05-01

A number of disposal facilities for Low-Level Radioactive Wastes have been planned for the Savannah River Site. Design has been completed for disposal vaults for several waste classifications and construction is nearly complete or well underway on some facilities. Specific design criteria varies somewhat for each waste classification. All disposal units have been designed as below-grade concrete vaults, although the majority will be above ground for many years before being encapsulated with earth at final closure. Some classes of vaults have a minimum required service life of 100 years. All vaults utilize a unique blend of cement, blast furnace slagmore » and pozzolan. The design synthesizes the properties of the concrete mix with carefully planned design details and construction methodologies to (1) eliminate uncontrolled cracking; (2) minimize leakage potential; and (3) maximize durability. The first of these vaults will become operational in 1992. 9 refs.« less

Development of high integrity, maximum durability concrete structures for LLW disposal facilities

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

Taylor, W.P.

1992-01-01

A number of disposal facilities for Low-Level Radioactive Wastes have been planned for the Savannah River Site. Design has been completed for disposal vaults for several waste classifications and construction is nearly complete or well underway on some facilities. Specific design criteria varies somewhat for each waste classification. All disposal units have been designed as below-grade concrete vaults, although the majority will be above ground for many years before being encapsulated with earth at final closure. Some classes of vaults have a minimum required service life of 100 years. All vaults utilize a unique blend of cement, blast furnace slagmore » and pozzolan. The design synthesizes the properties of the concrete mix with carefully planned design details and construction methodologies to (1) eliminate uncontrolled cracking; (2) minimize leakage potential; and (3) maximize durability. The first of these vaults will become operational in 1992. 9 refs.« less

A Mobile Outdoor Augmented Reality Method Combining Deep Learning Object Detection and Spatial Relationships for Geovisualization

PubMed Central

Rao, Jinmeng; Qiao, Yanjun; Ren, Fu; Wang, Junxing; Du, Qingyun

2017-01-01

The purpose of this study was to develop a robust, fast and markerless mobile augmented reality method for registration, geovisualization and interaction in uncontrolled outdoor environments. We propose a lightweight deep-learning-based object detection approach for mobile or embedded devices; the vision-based detection results of this approach are combined with spatial relationships by means of the host device’s built-in Global Positioning System receiver, Inertial Measurement Unit and magnetometer. Virtual objects generated based on geospatial information are precisely registered in the real world, and an interaction method based on touch gestures is implemented. The entire method is independent of the network to ensure robustness to poor signal conditions. A prototype system was developed and tested on the Wuhan University campus to evaluate the method and validate its results. The findings demonstrate that our method achieves a high detection accuracy, stable geovisualization results and interaction. PMID:28837096

A Mobile Outdoor Augmented Reality Method Combining Deep Learning Object Detection and Spatial Relationships for Geovisualization.

PubMed

Rao, Jinmeng; Qiao, Yanjun; Ren, Fu; Wang, Junxing; Du, Qingyun

2017-08-24

The purpose of this study was to develop a robust, fast and markerless mobile augmented reality method for registration, geovisualization and interaction in uncontrolled outdoor environments. We propose a lightweight deep-learning-based object detection approach for mobile or embedded devices; the vision-based detection results of this approach are combined with spatial relationships by means of the host device's built-in Global Positioning System receiver, Inertial Measurement Unit and magnetometer. Virtual objects generated based on geospatial information are precisely registered in the real world, and an interaction method based on touch gestures is implemented. The entire method is independent of the network to ensure robustness to poor signal conditions. A prototype system was developed and tested on the Wuhan University campus to evaluate the method and validate its results. The findings demonstrate that our method achieves a high detection accuracy, stable geovisualization results and interaction.

UK technical activities associated with the return to Earth of the MIR space station

NASA Astrophysics Data System (ADS)

Crowther, Richard; Tremayne-Smith, Richard

2002-11-01

The British National Space Centre (BNSC) acts as the focus in the United Kingdom (UK) for space-related activities. With the anticipated return to Earth of the MIR space station, BNSC established a group of technical experts to consider the associated implications for the UK, and to address both national and international activities relating to the planned de-orbit. In particular, the risk to the UK of an uncontrolled re-entry was considered in contingency planning and the means for the provision of accurate information to the public and media were established to ensure balanced view of the potential hazards that MIR posed to persons and property on the ground. The MIR de-orbit was exemplary, both in terms of the technical activities of the Rosaviakosmos and the safe disposal of MIR in the Pacific, and in relation to the open and effective communication between agencies and the positive reporting by the media.

Male hypogonadism.

PubMed

Basaria, Shehzad

2014-04-05

Male hypogonadism is a clinical syndrome that results from failure to produce physiological concentrations of testosterone, normal amounts of sperm, or both. Hypogonadism may arise from testicular disease (primary hypogonadism) or dysfunction of the hypothalamic-pituitary unit (secondary hypogonadism). Clinical presentations vary dependent on the time of onset of androgen deficiency, whether the defect is in testosterone production or spermatogenesis, associated genetic factors, or history of androgen therapy. The clinical diagnosis of hypogonadism is made on the basis of signs and symptoms consistent with androgen deficiency and low morning testosterone concentrations in serum on multiple occasions. Several testosterone-replacement therapies are approved for treatment and should be selected according to the patient's preference, cost, availability, and formulation-specific properties. Contraindications to testosterone-replacement therapy include prostate and breast cancers, uncontrolled congestive heart failure, severe lower-urinary-tract symptoms, and erythrocytosis. Treatment should be monitored for benefits and adverse effects. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Control of asthma symptoms and cellular markers of inflammation in induced sputum in children and adolescents with chronic asthma].

PubMed

Ciółkowski, Janusz; Stasiowska, Barbara; Mazurek, Henryk

2009-03-01

After the GINA 2006 publication, asthma therapy is based on control of symptoms. However there are suggestions of monitoring of airway inflammation. Aim of the study was to compare clinical criteria of asthma control with cellular markers of lower airway inflammation in induced sputum in a group of young asthmatics. To assess relationship between sputum eosinophilia, asthma severity and spirometry. A group of 154 young patients with chronic asthma (8-21 years) underwent sputum induction by inhalation of 4,5% saline solution. Sputum induction was effective in 121 patients (78%), and in this group control of clinical symptoms was assessed according to GINA 2006 criteria. Asthma was controlled in 82 subjects (67.8%) and uncontrolled in 39 (32.2%). Patients with controlled asthma had higher FEV1/FVC (79.8 +/- 7.1% vs 74.2 +/- 9.9%; p = 0.004) and MMEF (80.7 +/- 23.0% vs 65.3 +/- 21.8%; p < 0.001) than those with uncontrolled disease, but the average FEV1 (as percent predicted) did not differ between the two groups. Patients with controlled asthma had lower sputum eosinophil count than those with uncontrolled asthma (3.5 +/- 6.3% vs 7.2 +/- 8.7%; p = 0.01), but difference in neutrophil count was borderline (27.3 +/- 15.5% vs 34.5 +/- 21.0%; p = 0.05). High sputum eosinophil count (> 3%) was observed in 24.4% of patients with controlled asthma and in 61.5% with uncontrolled asthma (p < 0.001). Increased sputum neutrophil count was more frequent in a group of uncontrolled asthma (2.4 vs 15.4%; p = 0.022). Mean sputum eosinophil count was lower in patients with mild astma than in patients with moderate-severe disease (3.1 +/- 5.7% vs 7.1% +/- 8.8; p = 0.006). Patients with high sputum eosinophil count had lower FEV1 (89.4 +/- 14.9% vs 94.9 +/- 13.9%; p = 0.047), FEV1/FVC (74.5 +/- 10.1% vs 79.2 +/- 9.3%; p = 0.01) and MMEF (68.7 +/- 23.3% vs 81.7 +/- 23.1%; p = 0.004). In this study of young asthmatics, control of asthma symptoms was observed in 67.8% of patients. However, cellular markers of lower airway inflammation were present in 1/4 of patients with controlled asthma and in 3/4 with uncontrolled disease. Sputum eosinophilia was related to asthma severity. FEV1/FVC and MMEF were more important that FEV1 for estimating control of asthma. Improvement of asthma control scoring is needed as well as availability of simple methods of inflammation monitoring.

Abdominal and General Adiposity and Level of Asthma Control in Adults with Uncontrolled Asthma

PubMed Central

Lv, Nan; Xiao, Lan; Camargo, Carlos A.; Wilson, Sandra R.; Buist, A. Sonia; Strub, Peg; Nadeau, Kari C.

2014-01-01

Rationale: Abdominal adiposity may be an important risk factor for uncontrolled asthma in adults, controlling for general obesity. Whether the relationship, if present, is explained by other factors (e.g., asthma onset age, sex, and/or coexisting conditions) is unclear. Objectives: To examine whether clinically applicable anthropometric measures of abdominal adiposity—waist circumference and waist-to-height ratio (WHtR)—are related to poorer asthma control in adults with uncontrolled asthma controlling for body mass index (BMI), and whether the relationship (if present) is explained by gastroesophageal reflux disorder (GERD), sleep quality, or obstructive sleep apnea (OSA) or differs by age of asthma onset or sex. Methods: Patients aged 18 to 70 years with uncontrolled asthma (n = 90) participated in a 6-month randomized clinical trial. Measurements and Main Results: Baseline measures included sociodemographics, standardized anthropometrics, Asthma Control Test (ACT), GERD Symptom Assessment Scale, Pittsburgh Sleep Quality Index, and Berlin Questionnaire for Sleep Apnea. Participants (mean [SD] age, 52 [12] yr) were racially and ethnically diverse, 67% women, and 69% overweight or obese, and 71% reported their age of asthma onset was 12 years or older. Participants had uncontrolled asthma (mean [SD] ACT score, 14.9 [3.7]) and low GERD symptoms score (0.6 [0.4]); 67% reported poor sleep quality, and 42% had a high OSA risk. General linear regression results showed that worse ACT scores were significantly associated with every SD increase in waist circumference (β= −1.03; 95% confidence interval [CI], −1.96 to −0.16; P = 0.02) and waist-to-height ratio (β= −1.16; 95% CI, −2.00 to −0.33; P = 0.008), controlling for sociodemographics. Waist-to-height ratio remained correlated with ACT (β= −2.30; 95% CI, −4.16 to −0.45; P = 0.02) after further adjusting for BMI. The BMI-controlled relationship between WHtR and ACT did not differ by age of asthma onset or sex (P > 0.05 for interactions) and persisted after additional adjustment for GERD, sleep quality, or OSA scores. Poor sleep quality was associated with worse ACT scores (β= −0.87; 95% CI, −1.71 to −0.03; P = 0.045) controlling for waist-to-height ratio, BMI, and sociodemographics. Conclusions: Abdominal adiposity by waist-to-height ratio and poor sleep quality correlated with poorer asthma control in adults with uncontrolled asthma, after controlling for BMI and sociodemographics. These results warrant replication in larger studies of diverse populations. Clinical trial registered with www.clinicaltrials.gov (NCT 01725945). PMID:25343191

Using Campylobacter spp. and Escherichia coli data and Bayesian microbial risk assessment to examine public health risks in agricultural watersheds under tile drainage management.

PubMed

Schmidt, P J; Pintar, K D M; Fazil, A M; Flemming, C A; Lanthier, M; Laprade, N; Sunohara, M D; Simhon, A; Thomas, J L; Topp, E; Wilkes, G; Lapen, D R

2013-06-15

Human campylobacteriosis is the leading bacterial gastrointestinal illness in Canada; environmental transmission has been implicated in addition to transmission via consumption of contaminated food. Information about Campylobacter spp. occurrence at the watershed scale will enhance our understanding of the associated public health risks and the efficacy of source water protection strategies. The overriding purpose of this study is to provide a quantitative framework to assess and compare the relative public health significance of watershed microbial water quality associated with agricultural BMPs. A microbial monitoring program was expanded from fecal indicator analyses and Campylobacter spp. presence/absence tests to the development of a novel, 11-tube most probable number (MPN) method that targeted Campylobacter jejuni, Campylobacter coli, and Campylobacter lari. These three types of data were used to make inferences about theoretical risks in a watershed in which controlled tile drainage is widely practiced, an adjacent watershed with conventional (uncontrolled) tile drainage, and reference sites elsewhere in the same river basin. E. coli concentrations (MPN and plate count) in the controlled tile drainage watershed were statistically higher (2008-11), relative to the uncontrolled tile drainage watershed, but yearly variation was high as well. Escherichia coli loading for years 2008-11 combined were statistically higher in the controlled watershed, relative to the uncontrolled tile drainage watershed, but Campylobacter spp. loads for 2010-11 were generally higher for the uncontrolled tile drainage watershed (but not statistically significant). Using MPN data and a Bayesian modelling approach, higher mean Campylobacter spp. concentrations were found in the controlled tile drainage watershed relative to the uncontrolled tile drainage watershed (2010, 2011). A second-order quantitative microbial risk assessment (QMRA) was used, in a relative way, to identify differences in mean Campylobacter spp. infection risks among monitoring sites for a hypothetical exposure scenario. Greater relative mean risks were obtained for sites in the controlled tile drainage watershed than in the uncontrolled tile drainage watershed in each year of monitoring with pair-wise posterior probabilities exceeding 0.699, and the lowest relative mean risks were found at a downstream drinking water intake reference site. The second-order modelling approach was used to partition sources of uncertainty, which revealed that an adequate representation of the temporal variation in Campylobacter spp. concentrations for risk assessment was achieved with as few as 10 MPN data per site. This study demonstrates for the first time how QMRA can be implemented to evaluate, in a relative sense, the public health implications of controlled tile drainage on watershed-scale water quality. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

β-d-Glucosidase as "key enzyme" for sorghum cyanogenic glucoside (dhurrin) removal and beer bioflavouring.

PubMed

Tokpohozin, Sedjro Emile; Fischer, Susann; Sacher, Bertram; Becker, Thomas

2016-11-01

Sorghum malt used during African beer processing contains a high level of cyanogenic glucoside (dhurrin), up to 1375 ppm. In traditional sorghum malting and mashing, dhurrin is not sufficiently hydrolyzed due to uncontrolled germination and a high gelatinization temperature. The cyanide content of traditional African beers (11 ppm) is higher than the minimum dose (1 ppm) required to form carcinogenic ethyl carbamate during alcoholic fermentation. In the detoxification process, aryl-β-d-glucosidase (dhurrinase) is the "key component". For significant dhurrin hydrolysis during mashing, optimizing dhurrinase synthesis during malting is a good solution to reduce dhurrin completely to below the harmful dose in the sorghum wort. Lactic acid bacteria which exhibit aryl-β-d-glucosidase prior to alcoholic fermentation may help to reduce ethyl carbamate content in alcoholic beverages. Moreover, some specific β-d-glucosidases have a dual property, being able to cleave and synthesize glucosides bonds and thereby generating good precursors for beer bioflavouring. Copyright © 2016 Elsevier Ltd. All rights reserved.

Denervation leads to volume regression in breast cancer.

PubMed

Kappos, Elisabeth A; Engels, Patricia E; Tremp, Mathias; Sieber, Patricia K; von Felten, Stefanie; Madduri, Srinivas; Meyer Zu Schwabedissen, Moritz; Fischmann, Arne; Schaefer, Dirk J; Kalbermatten, Daniel F

2018-06-01

The nervous system plays a key role in controlling the dynamic functions of multicellular complex organisms. Although peripheral nerves are supposed to play a pivotal role in tumor growth and dissemination, little experimental evidence exists to date. We assessed the effect of denervation on breast cancer growth by magnetic resonance imaging (MRI) in rats. Human breast cancer cells were implanted into adipofascial flaps with intact or surgically excised supplying nerve. Tumor volumes were measured 2 and 8 weeks after implantation by in vivo MRI. Results were validated by histology. Postoperative tumor volumes at 2 and 8 weeks were reduced by 76% (95% CI: 22-93%) in the denervated groups. Tumor area as determined histologically was reduced by 70% (95% CI: 60-78%). Thus, peripheral denervation may be an effective surgical approach for the palliative treatment of locally progressing or uncontrollable breast cancer. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Risk Factors of Cancer in the United Arab Emirates.

PubMed

Razzak, Hira Abdul; Harbi, Alya; Shelpai, Wael; Qawas, xAhmadxx

2018-01-01

Cancer is recognized to be a major healthcare problem globally. Cancer is a disease that mainly occurs when alterations in a normal cell group within the body leads to uncontrolled growth, mainly causing a lump referred to as a tumor. The aim of this study is to systematically review and extract studies reporting the risk factors of cancer in UAE between 2007 and 2016. A systematic literature search was performed by using "PubMed, Scopus databases, Science direct, and local journals" and appropriate key terms to retrieve studies carried out in United Arab Emirates with regards to risk factors of the cancer. 75 articles were extracted in the beginning. After screening for exclusion criteria and retrieval of full texts, overall 16 articles were used in this study. Search limits were restricted to studies in English language, between 2007 and 2016, and on UAE population (both citizens and expatriates). This review yielded 16 studies about the cancer risk factors in United Arab Emirates, including cross sectional studies (n = 9), population-based crosssectional retrospective survey (n = 1), retrospective cohort studies (n = 4) and qualitative studies (n = 2). Tobacco use, unhealthy diet, family history, infection with HPV, physical activity, and radiation exposure were among the factors investigated. There was insufficient evidence available on some potentially essential risk factors such as use of alcohol, aging, and being overweight. This systematic review signifies an increasing cancer prevalence in the United Arab Emirates and suggests that extra effort is needed with a multi-sectorial approach in future at both the national and international level to effectively tackle the burden of cancer.

Impact of a history of maternal depression and anxiety on asthma control during pregnancy.

PubMed

Grzeskowiak, Luke E; Smith, Brian; Roy, Anil; Schubert, K Oliver; Baune, Bernhard T; Dekker, Gustaaf A; Clifton, Vicki L

2017-09-01

To determine the impact of self-reported maternal depression/anxiety on asthma control during pregnancy. Pregnant women with a doctor diagnosis of asthma (n = 189) were prospectively recruited at their antenatal booking visit, and the presence of maternal depression and anxiety was identified using self-report and routine questionnaire assessments. Data on exacerbations and asthma control were collected during gestation. Asthma control was assessed using the Juniper Asthma Control Questionnaire (ACQ) and women were classified as having recurrent uncontrolled asthma if their ACQ score was >1.5 during two or more consecutive study visits. Exacerbations were defined as events that led to increased treatment requirements, and doctor or hospital visits. There were 85 women with self-reported depression/anxiety and 104 women without self-reported depression/anxiety. The presence of depression/anxiety was associated with an increased likelihood (adjusted hazard ratio (HR) 1.67: 95% confidence interval (CI) 1.03-2.72) and incidence (adjusted incidence rate ratio (IRR) 1.71: 95% CI 1.13-2.58) of uncontrolled asthma during pregnancy, as well as an increased risk of recurrent uncontrolled asthma during 2 or more study visits (adjusted relative risk (RR) 1.98: 95% CI 1.00-3.91). No impact of depression/anxiety was observed with respect to the likelihood (adjusted HR 0.70: 95% CI 0.35-1.41) or incidence of exacerbations during pregnancy (adjusted IRR 0.66: 95% CI 0.35-1.26). This study provides evidence that the presence of maternal depression/anxiety is associated with an increased likelihood and incidence of uncontrolled asthma during pregnancy. Given the high prevalence of co-morbid depression/anxiety among asthmatics, further research investigating such associations is urgently required.

Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study.

PubMed

Borghi, Claudio; Tubach, Florence; De Backer, Guy; Dallongeville, Jean; Guallar, Eliseo; Medina, Jesús; Perk, Joep; Roy, Carine; Banegas, José R; Rodriguez-Artalejo, Fernando; Halcox, Julian P

2016-09-01

The prevalence of and factors associated with uncontrolled hypertension and apparent resistant hypertension were assessed in the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; NCT00882336). EURIKA was a cross-sectional observational study including patients being treated for the primary prevention of cardiovascular disease in 12 European countries. Patients were assessed if they were being treated for hypertension (N=5220). Blood pressure control was defined according to European guidelines, with sensitivity analysis taking account of patients' age and diabetes status. Associated factors were assessed using multivariate analysis. In the primary analysis, a total of 2691 patients (51.6%) had uncontrolled hypertension. Factors significantly associated with an increased risk of having uncontrolled hypertension included female sex (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.93-2.73), body mass index (BMI; OR per kg/m(2): 1.03; 95% CI: 1.01-1.04), and geographic location. A total of 749 patients (14.3%) had apparent resistant hypertension. Factors significantly associated with an increased risk of having apparent resistant hypertension included BMI (OR per kg/m(2): 1.06; 95% CI: 1.04-1.08), diabetes (OR: 1.28; 95% CI: 1.06-1.53), use of statins (OR: 1.36; 95% CI: 1.15-1.62), serum uric acid levels (OR: 1.16; 95% CI: 1.09-1.23), and geographic location. Similar results were seen in sensitivity analyses. Over 50% of patients treated for hypertension continued to have uncontrolled blood pressure and 14.3% had apparent resistant hypertension. Positive associations were seen with other cardiovascular risk factors. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Role of pressure in angiotensin II-induced renal injury: chronic servo-control of renal perfusion pressure in rats.

PubMed

Mori, Takefumi; Cowley, Allen W

2004-04-01

Renal perfusion pressure was servo-controlled chronically in rats to quantify the relative contribution of elevated arterial pressure versus angiotensin II (Ang II) on the induction of renal injury in Ang II-induced hypertension. Sprague-Dawley rats fed a 4% salt diet were administered Ang II for 14 days (25 ng/kg per minute IV; saline only for sham rats), and the renal perfusion pressure to the left kidney was continuously servo-controlled to maintain a normal pressure in that kidney throughout the period of hypertension. An aortic occluder was implanted around the aorta between the two renal arteries and carotid and femoral arterial pressure were measured continuously throughout the experiment to determine uncontrolled and controlled renal perfusion pressure, respectively. Renal perfusion pressure of uncontrolled, controlled, and sham kidneys over the period of Ang II or saline infusion averaged 152.6+/-7.0, 117.4+/-3.5, and 110.7+/-2.2 mm Hg, respectively. The high-pressure uncontrolled kidneys exhibited tubular necrosis and interstitial fibrosis, especially prominent in the outer medullary region. Regional glomerular sclerosis and interlobular artery injury were also pronounced. Controlled kidneys were significantly protected from interlobular artery injury, juxtamedullary glomeruli injury, tubular necrosis, and interstitial fibrosis as determined by comparing the level of injury. Glomerular injury was not prevented in the outer cortex. Transforming growth factor (TGF)-beta and active NF-kappaB proteins determined by immunohistochemistry were colocalized in the uncontrolled kidney in regions of interstitial fibrosis. We conclude that the preferential juxtamedullary injury found in Ang II hypertension is largely induced by pressure and is probably mediated through the TGF-beta and NF-kappaB pathway.

Resuscitation with lactated ringer's does not increase inflammatory response in a Swine model of uncontrolled hemorrhagic shock.

PubMed

Watters, Jennifer M; Brundage, Susan I; Todd, S Rob; Zautke, Nathan A; Stefater, J A; Lam, J C; Muller, Patrick J; Malinoski, Darren; Schreiber, Martin A

2004-09-01

Lactated Ringer's (LR) and normal saline (NS) are widely and interchangeably used for resuscitation of trauma victims. Studies show LR to be superior to NS in the physiologic response to resuscitation. Recent in vitro studies demonstrate equivalent effects of LR and NS on leukocytes. We aimed to determine whether LR resuscitation would produce an equivalent inflammatory response compared with normal saline (NS) resuscitation in a clinically relevant swine model of uncontrolled hemorrhagic shock. Thirty-two swine were randomized. Control animals (n = 6) were sacrificed following induction of anesthesia for baseline data. Sham animals (n = 6) underwent laparotomy and 2 h of anesthesia. Uncontrolled hemorrhagic shock animals (n = 10/group) underwent laparotomy, grade V liver injury, and blinded resuscitation with LR or NS to maintain baseline blood pressure for 1.5 h before sacrifice. Lung was harvested, and tissue mRNA levels of interleukin-6 (IL-6), granulocyte colony-stimulating factor (G-CSF), and tumor necrosis factor-alpha (TNF-alpha) were determined using quantitative reverse transcriptase polymerase chain reaction (Q-RT-PCR). Sections of lung were processed and examined for neutrophils sequestered within the alveolar walls. Cytokine analysis showed no difference in IL-6 gene transcription in any group (P = 0.99). Resuscitated swine had elevated G-CSF and TNF-alpha gene transcription, but LR and NS groups were not different from each other (P= 0.96 and 0.10, respectively). Both resuscitation groups had significantly more alveolar neutrophils present than controls (P < 0.01) and shams (P < 0.05) but were not different from one another (P= 0.83). LR and NS resuscitation have equivalent effects on indices of inflammation in the lungs in our model of uncontrolled hemorrhagic shock.

MyAirCoach: the use of home-monitoring and mHealth systems to predict deterioration in asthma control and the occurrence of asthma exacerbations; study protocol of an observational study

PubMed Central

Honkoop, Persijn J; Simpson, Andrew; Bonini, Matteo; Snoeck-Stroband, Jiska B; Meah, Sally; Fan Chung, Kian; Usmani, Omar S; Fowler, Stephen; Sont, Jacob K

2017-01-01

Introduction Asthma is a variable lung condition whereby patients experience periods of controlled and uncontrolled asthma symptoms. Patients who experience prolonged periods of uncontrolled asthma have a higher incidence of exacerbations and increased morbidity and mortality rates. The ability to determine and to predict levels of asthma control and the occurrence of exacerbations is crucial in asthma management. Therefore, we aimed to determine to what extent physiological, behavioural and environmental data, obtained by mobile healthcare (mHealth) and home-monitoring sensors, as well as patient characteristics, can be used to predict episodes of uncontrolled asthma and the onset of asthma exacerbations. Methods and analysis In an 1-year observational study, patients will be provided with mHealth and home-monitoring systems to record daily measurements for the first-month (phase I) and weekly measurements during a follow-up period of 11 months (phase II). Our study population consists of 150 patients, aged ≥18 years, with a clinician's diagnosis of asthma, currently on controller medication, with uncontrolled asthma and/or minimally one exacerbation in the past 12 months. They will be enrolled over three participating centres, including Leiden, London and Manchester. Our main outcomes are the association between physiological, behavioural and environmental data and (1) the loss of asthma control and (2) the occurrence of asthma exacerbations. Ethics This study was approved by the Medical Ethics Committee of the Leiden University Medical Center in the Netherlands and by the NHS ethics service in the UK. Trial registration number NCT02774772. PMID:28119390

A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients.

PubMed

Pamungkas, Rian Adi; Chamroonsawasdi, Kanittha; Vatanasomboon, Paranee

2017-09-15

The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide. Continuing diabetes mellitus (DM) care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose monitoring, diet and exercise changes, health outcomes including psychological well-being and self-efficacy, and physiological markers including body mass index, level of blood pressure, cholesterol level and glycemic control. Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles. The search terms were "type 2 diabetes," "self-management," "diabetes self-management education (DSME)," "family support," "social support," and "uncontrolled glycaemia." Joanna Briggs Institute (JBI) guidelines were used to determine which studies to include in the review. Details of the family support components of DSME intervention and the impacts of these interventions had on improving the health outcomes patients with uncontrolled glycaemia patients. A total of 22 intervention studies were identified. These studies involved different DSME strategies, different components of family support provided, and different health outcomes to be measured among T2D patients. Overall, family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological well-being and better glycemic control. This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients. The findings suggest DSME models that include family engagement can be a useful direction for improving diabetes care.

Surgical Outcomes of Ahmed or Baerveldt Tube Shunt Implantation for medically Uncontrolled Traumatic Glaucoma.

PubMed

Yadgarov, Arkadiy; Liu, Dan; Crane, Elliot S; Khouri, Albert S

2017-01-01

To describe postoperative surgical success of either Ahmed or Baerveldt tube shunt implantation for eyes with medically uncontrolled traumatic glaucoma. A review was carried out to identify patients with traumatic glaucoma that required tube shunt implantation between 2009 and 2015 at Rutgers University in Newark, New Jersey, USA. Seventeen eyes from 17 patients met inclusion criteria, including at least 3-month postoperative follow-up. The main outcome measure was surgical success at 1-year follow-up after tube implantation. Mean preoperative intraocular pressure (IOP) was 34.1 ± 8.2 mm Hg on 3.1 ± 1.6 ocular hypotensive medications. Nine eyes (53%) sustained closed globe injury. Ten eyes (59%) received an Ahmed valve shunt and seven eyes (41%) received a Baerveldt tube shunt. Surgical success rate at 1 year postoperatively was 83%. Compared to preoperative, the mean postoperative IOP was significantly lower (16.1 ± 3.5 mm Hg, p < 0.001) on significantly fewer ocular hypertensive medications (1.3 ± 1.6, p = 0.001) at a mean follow-up of 10 months. Mean IOP reduction at last follow-up was 49%. There were three cases of surgical failures: One case of hypotony, one case of tube extrusion with subsequent explan-tation, and one case requiring second tube insertion for IOP control. Implantation of an Ahmed or Baerveldt tube shunt provided successful control of IOP in patients with medically uncontrollable traumatic glaucoma. Yadgarov A, Liu D, Crane ES, Khouri AS. Surgical Outcomes of Ahmed or Baerveldt Tube Shunt Implantation for medically Uncontrolled Traumatic Glaucoma. J Curr Glaucoma Pract 2017;11(1):16-21.

Consequences of uncontrolled cooling during sterlet (Acipenser ruthenus) sperm cryopreservation on post-thaw motility and fertilizing ability.

PubMed

Horokhovatskyi, Yevhen; Rodina, Marek; Asyabar, Hadiseh Dadras; Boryshpolets, Sergii; Dzyuba, Borys

2017-06-01

The significant influence of the number and position of fish sperm sample straws in uncontrolled cooling devices on post-thaw spermatozoa parameters, such as motility and fertilizing ability, is presented in this study. The two most popular uncontrolled cooling devices were used in this study: a Styrofoam box setup with a polystyrene floating raft on liquid nitrogen and the dry shipper setup with a straw holder. We tested the effect of different quantities of straws (6 or 60) placed on the polystyrene floating raft and the position of the straws in the holder (on the periphery or in the centre). Using these cooling methods, sperm of 10 male sterlets diluted with methanol containing cryoprotective medium was frozen. All temperature changes were recorded by a thermocouple inside the straw, and the thermogram intervals were analysed. Spermatozoa motility was evaluated by video microscopy with integrated computer-assisted sperm analysis software. Fertilization trials were conducted at a 10 5 spermatozoa/egg ratio. Post-thaw spermatozoa parameters, including the percent of motile spermatozoa, curvilinear velocity, velocity according to the smoothed path, linearity of track, beat-cross frequency and fertilization rate, were significantly decreased in the 60-straw floating raft setup in comparison to all of the other cooling methods. The freezing rate between -10 °C and -30 °C was significantly decreased by up to 18.6 ± 0.61 °C/min for the 60-straw floating raft setup in comparison to the other freezing conditions. Considering the above results, efforts to standardize cryopreservation protocols using uncontrolled cooling devices should take into account the amount of straws subjected to freezing. Copyright © 2017. Published by Elsevier Inc.

Clinical lung transplantation from uncontrolled non-heart-beating donors revisited.

PubMed

Gomez-de-Antonio, David; Campo-Cañaveral, Jose Luis; Crowley, Silvana; Valdivia, Daniel; Cordoba, Mar; Moradiellos, Javier; Naranjo, Jose Manual; Ussetti, Piedad; Varela, Andrés

2012-04-01

The aim of our study is to review and update the long-term results from our previously published series of lung transplantation in uncontrolled non-heart-beating donors (NHBDs). A prospective collection of data was undertaken from all lung transplants performed among uncontrolled NHBDs between 2002 and December 2009. The statistical analysis was performed using SPSS software and survival was estimated using the Kaplan-Meier method. Twenty-nine lung transplants were performed. Mean total ischemic times for the first and second lung were 575 minutes (SD 115.6) and 701 minutes (SD 111.3), respectively. Primary graft dysfunction (PGD) G1, G2 and G3 occurred in 5 cases (17%), 5 cases (17%) and 11 cases (38%), respectively. Overall hospital mortality rate was 17% (5 patients). Statistical analysis revealed a statistically significant association of mortality with ischemic times and with PGD. In terms of overall survival, 3-month, 1-year, 2-year and 5-year survival rates were 78%, 68%, 57% and 51%, respectively, and the conditional survival rates in those who survived the first 3 months were 86%, 72% and 65%, respectively. The cumulative incidence of bronchiolitis obliterans syndrome (BOS) was 11%, 35% and 45% at 1, 3 and 5 years, respectively. Lung transplantation from uncontrolled non-heart-beating donors shows acceptable results for both mid- and long-term survival and BOS; however, the higher rates of PGD and its impact on early mortality must make us more demanding with respect to the acceptance criteria and methods of evaluation used with these donors. Copyright © 2012 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Association between control to target blood pressures and healthy lifestyle factors among Japanese hypertensive patients: longitudinal data analysis from Fukushima Research of Hypertension (FRESH).

PubMed

Yokokawa, Hirohide; Goto, Aya; Sanada, Hironobu; Watanabe, Tsuyoshi; Felder, Robin A; Jose, Pedro A; Yasumura, Seiji

2014-01-01

To determine success rates in controlling target blood pressures longitudinally by measuring several factors, including lifestyle characteristics associated with uncontrolled blood pressures for target treatment goals. This prospective observational cohort study (September 2008-September 2010) collected information on blood pressure control status and healthy lifestyle factors listed in Breslow's seven health practices through medical records and self-administered questionnaires from 884 of the 1264 Japanese hypertensive patients initially registered in the FRESH study. Multivariate analysis adjusted for associated factors was performed to estimate the association between lifestyle change and "uncontrolled blood pressures" at the final follow-up survey. Median age and proportion of men were 73 years and 39.1%, respectively. All survey failure rates were 37.6% among non-elderly patients (<65 years of age) without diabetes mellitus or chronic kidney disease, and 35.0% among patients with these diseases or myocardial infarction. Maintaining a healthy lifestyle was a protective factor against uncontrolled blood pressures in multivariate analysis. Obesity and smoking status were associated with uncontrolled blood pressures, and exercise frequency was borderline significance. The number of participants with healthy responses for these factors remained relatively low during follow up. Our study revealed low rates of controlled blood pressures, especially in non-elderly patients without diabetes mellitus or chronic kidney disease, and patients with these diseases or myocardial infarction. Our data indicate the need to maintain a healthy lifestyle, in particular, ideal body weight and adequate exercise frequency, for better hypertension management according to treatment guidelines. Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Glycemic control, cognitive function, and family support among middle-aged and older Hispanics with diabetes: The Hispanic Community Health Study/Study of Latinos.

PubMed

Strizich, Garrett; Kaplan, Robert C; González, Hector M; Daviglus, Martha L; Giachello, Aida L; Teng, Yanping; Lipton, Richard B; Grober, Ellen

2016-07-01

To examine among Hispanics in the U.S., a population with increased reliance on informal healthcare support structures, (1) the association between cognitive function and control of diabetes; and (2) whether this association is modified by family support. The Digit Symbol Substitution Test (DSST), word fluency, and learning and delayed recall components of the Spanish English Verbal Learning Test were administered to 1794 Hispanic adults aged 45-76years with diagnosed diabetes. An executive function index and global cognitive function index (GCFI) were derived. Uncontrolled diabetes (HbA1c⩾7% [53mmol/mol]) was compared across quartiles of cognitive function using multivariable logit models with interaction terms for cognitive function and family support. After adjustment, lower DSST scores were associated with uncontrolled diabetes (P=0.03). Family support modified the relationship between other measures of cognition and diabetes control (Pinteraction: 0.002, 0.09). Among individuals with low family support, as cognitive function declined, the odds of uncontrolled diabetes increased (P-trend across quartiles of the GCFI, 0.015). Among those with low family support, persons in the lowest quartile of global cognitive function were more than twice as likely to have uncontrolled diabetes as those in the highest performing quartile (OR=2.31; 95% CI: 1.17, 4.55). There was no similar effect among those with high family support. Family support may buffer the negative association between low cognitive functioning and diabetes control in US Hispanics/Latinos. Educational programs targeted at family members of middle-age and older persons with diabetes regardless of neurocognitive status may help improve population-level glycemic control. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Prevalence of Recommendations Made Within Dental Research Articles Using Uncontrolled Intervention or Observational Study Designs.

PubMed

Wilson, M K; Chestnutt, I G

2016-03-01

Evidence to inform clinical practice is reliant on research carried out using appropriate study design. The objectives of this work were to (i) identify the prevalence of articles reporting on human studies using uncontrolled intervention or observational research designs published in peer-reviewed dental journals and (ii) determine the nature of recommendations made by these articles. Six peer-reviewed dental journals were selected. Issues published in January to June 2013 were examined and the types of articles published categorized. Following pre-defined inclusion/exclusion criteria, human studies classified as using uncontrolled intervention or observational research designs were subject to detailed review by two independent investigators, to examine if they presented clinical, policy or research recommendations and if these recommendations were supported by the data presented. 52.9% (n = 156) of studies published during the time period met the inclusion criteria. Studies with uncontrolled intervention or observational research designs comprised a larger proportion of the primary research studies published in the journals with lower impact factors (73.3%; n = 107) compared to the high impact journals (38.9%; n = 49). Analysis showed that 60.9% (n = 95) of the included studies made recommendations for clinical practice/dental policy. In 28.2% (n = 44) of studies, the clinical/policy recommendations made were judged to not be fully supported by the data presented. Many studies published in the current dental literature, which are not considered to produce strong evidence, make recommendations for clinical practice or policy. There were some cases when the recommendations were not fully supported by the data presented. Copyright © 2016 Elsevier Inc. All rights reserved.

A Systematic Review: Family Support Integrated with Diabetes Self-Management among Uncontrolled Type II Diabetes Mellitus Patients

PubMed Central

Pamungkas, Rian Adi; Chamroonsawasdi, Kanittha; Vatanasomboon, Paranee

2017-01-01

The rate of type-2 diabetes mellitus (T2D) is dramatically increasing worldwide. Continuing diabetes mellitus (DM) care needs effective self-management education and support for both patients and family members. This study aimed to review and describe the impacts of diabetes mellitus self-management education (DSME) that involve family members on patient outcomes related to patient health behaviors and perceived self-efficacy on self-management such as medication adherence, blood glucose monitoring, diet and exercise changes, health outcomes including psychological well-being and self-efficacy, and physiological markers including body mass index, level of blood pressure, cholesterol level and glycemic control. Three databases, PubMed, CINAHL, and Scopus were reviewed for relevant articles. The search terms were “type 2 diabetes,” “self-management,” “diabetes self-management education (DSME),” “family support,” “social support,” and “uncontrolled glycaemia.” Joanna Briggs Institute (JBI) guidelines were used to determine which studies to include in the review. Details of the family support components of DSME intervention and the impacts of these interventions had on improving the health outcomes patients with uncontrolled glycaemia patients. A total of 22 intervention studies were identified. These studies involved different DSME strategies, different components of family support provided, and different health outcomes to be measured among T2D patients. Overall, family support had a positive impact on healthy diet, increased perceived support, higher self-efficacy, improved psychological well-being and better glycemic control. This systematic review found evidence that DSME with family support improved self-management behaviors and health outcomes among uncontrolled glycaemia T2D patients. The findings suggest DSME models that include family engagement can be a useful direction for improving diabetes care. PMID:28914815

Influence of pH control in the formation of inclusion bodies during production of recombinant sphingomyelinase-D in Escherichia coli.

PubMed

Castellanos-Mendoza, Andrea; Castro-Acosta, Ricardo M; Olvera, Alejandro; Zavala, Guadalupe; Mendoza-Vera, Miguel; García-Hernández, Enrique; Alagón, Alejandro; Trujillo-Roldán, Mauricio A; Valdez-Cruz, Norma A

2014-09-12

Inclusion bodies (IBs) are aggregated proteins that form clusters when protein is overexpressed in heterologous expression systems. IBs have been considered as non-usable proteins, but recently they are being used as functional materials, catalytic particles, drug delivery agents, immunogenic structures, and as a raw material in recombinant therapeutic protein purification. However, few studies have been made to understand how culture conditions affect the protein aggregation and the physicochemical characteristics that lead them to cluster. The objective of our research was to understand how pH affects the physicochemical properties of IBs formed by the recombinant sphingomyelinase-D of tick expressed in E. coli BL21-Gold (DE3) by evaluating two pH culture strategies. Uncontrolled pH culture conditions favored recombinant sphingomyelinase-D aggregation and IB formation. The IBs of sphingomyelinase-D produced under controlled pH at 7.5 and after 24 h were smaller (<500 nm) than those produced under uncontrolled pH conditions (>500 nm). Furthermore, the composition, conformation and β-structure formation of the aggregates were different. Under controlled pH conditions in comparison to uncontrolled conditions, the produced IBs presented higher resistance to denaturants and proteinase-K degradation, presented β-structure, but apparently as time passes the IBs become compacted and less sensitive to amyloid dye binding. The manipulation of the pH has an impact on IB formation and their physicochemical characteristics. Particularly, uncontrolled pH conditions favored the protein aggregation and sphingomyelinase-D IB formation. The evidence may lead to find methodologies for bioprocesses to obtain biomaterials with particular characteristics, extending the application possibilities of the inclusion bodies.

Inhaled corticosteroids and asthma control in adult-onset asthma: 12-year follow-up study.

PubMed

Vähätalo, Iida; Ilmarinen, Pinja; Tuomisto, Leena E; Niemelä, Onni; Kankaanranta, Hannu

2018-04-01

Prescribed inhaled corticosteroid (ICS) doses in asthma have been studied in cross-sectional settings whereas long-term follow-up studies have not been carried out. To evaluate prescribed medication longitudinally by calculating cumulative ICS doses and dose changes in a cohort of new-onset adult asthma during 12 years and in different groups of asthma control. A total of 203 patients were followed for 12 years as part of Seinäjoki Adult Asthma Study (SAAS). All asthma-related visits and prescribed medication over the study period were collected from medical records. Total cumulative ICS dose for the 12-year follow-up period was 3.4g (±SEM 0.1) per patient. Both respiratory specialists and GPs prescribed step-ups and step-downs in ICS treatment and in total 649 dose changes were noted during the follow-up (median 3(1-5) per patient). Patients with uncontrolled asthma received higher ICS doses throughout the follow-up period, and therefore, cumulative 12-year ICS dose (3.8g ± SEM 0.2) in this group was higher than that in those with partially controlled (3.4g ± SEM 0.2) or controlled disease (2.9g ± SEM 0.2) (p = 0.0001). Patients with uncontrolled asthma were also prescribed a higher number of ICS dose changes than patients with controlled disease. Despite frequent dose changes and high ICS doses during the 12-year follow-up, the level of asthma control remained poor in patients with uncontrolled asthma. This suggests that high ICS doses may not be effective enough for management of disease in patients with uncontrolled adult-onset asthma and novel targeted treatments are required. Copyright © 2018 Elsevier Ltd. All rights reserved.

Is There a Clinically Meaningful Change in the Blood Pressure of Osteoarthritis Patients with Comorbid Hypertension During the Course of Balneotherapy?

PubMed Central

Hayta, Emrullah; Yılmaz, Mehmet Birhan; Yayıkçı, İlker; Özer, Zafer; Şahin, Özlem

2015-01-01

Background: Balneotherapy (BT) is a treatment modality that uses the physical and chemical effects of water, including thermomineral, acratothermal, and acratopegal waters. It has many effects on cardiovascular system. Aim: The aim of the study is to investigate the effects of 3-week BT on blood pressure of osteoarthritis (OA) patients with no hypertension (HT), and controlled or uncontrolled HT. Materials and Methods: The OA patients (n = 270) were divided into three groups: No HT, controlled HT, and uncontrolled HT. All the groups received BT in the facilities of our university hospital at the same time every day (10:00-11:30 AM) for 10 min per day, 5 days per week, for a total duration of 15 days in a 3-week period. Systolic and diastolic blood pressures and pulse rates were measured before and after BT on daily basis. Results: Overall, (1) the pulse rates of study groups measured after BT were significantly increased compared to before BT; (2) the systolic blood pressures of study groups measured before and after BT were found as comparable; and (3) the diastolic blood pressures of no HT and controlled HT groups measured before and after BT were not statistically significant (P > 0.05); however, in the uncontrolled HT group, the diastolic blood pressure showed a decreasing trend after BT (P < 0.05). Conclusions: In patients with OA, BT can be safely used without resulting in any meaningful changes in systolic and diastolic blood pressures in patients with normal and controlled HT but a decrease in diastolic blood pressure of patients with uncontrolled HT. This may be an advantage in OA patients having HT as comorbid disease. PMID:26713300

Differences in Paracingulate Connectivity Associated with Epileptiform Discharges and Uncontrolled Seizures in Genetic Generalized Epilepsy

PubMed Central

Kay, Benjamin P; Holland, Scott K; Privitera, Michael D; Szaflarski, Jerzy P

2014-01-01

Summary Objective Patients with genetic generalized epilepsy (GGE) frequently continue to suffer from seizures despite appropriate clinical management. GGE is associated with changes in the resting-state networks modulated by clinical factors such as duration of disease and response to treatment. However, the effect of GSWDs and/or seizures on resting-state functional connectivity (RSFC) is not well understood. Methods We investigated the effects of GSWD frequency (in GGE patients), GGE (patients vs. healthy controls), and seizures (uncontrolled vs. controlled) on RSFC using seed-based voxel correlation in simultaneous EEG and resting-state fMRI (EEG/fMRI) data from 72 GGE patients (23 w/uncontrolled seizures) and 38 healthy controls. We used seeds in paracingulate cortex, thalamus, cerebellum, and posterior cingulate cortex to examine changes in cortical-subcortical resting-state networks and the default mode network (DMN). We excluded from analyses time points surrounding GSWDs to avoid possible contamination of the resting state. Results (1) Higher frequency of GSWDs was associated with an increase in seed-based voxel correlation with cortical and subcortical brain regions associated with executive function, attention, and the DMN, (2) RSFC in patients with GGE, when compared to healthy controls, was increased between paracingulate cortex and anterior, but not posterior, thalamus, and (3) GGE patients with uncontrolled seizures exhibited decreased cereballar RSFC. Significance Our findings in this large sample of patients with GGE (1) demonstrate an effect of interictal GSWDs on resting-state networks, (2) provide evidence that different thalamic nuclei may be affected differently by GGE, and (3) suggest that cerebellum is a modulator of ictogenic circuits. PMID:24447031

MyAirCoach: the use of home-monitoring and mHealth systems to predict deterioration in asthma control and the occurrence of asthma exacerbations; study protocol of an observational study.

PubMed

Honkoop, Persijn J; Simpson, Andrew; Bonini, Matteo; Snoeck-Stroband, Jiska B; Meah, Sally; Fan Chung, Kian; Usmani, Omar S; Fowler, Stephen; Sont, Jacob K

2017-01-24

Asthma is a variable lung condition whereby patients experience periods of controlled and uncontrolled asthma symptoms. Patients who experience prolonged periods of uncontrolled asthma have a higher incidence of exacerbations and increased morbidity and mortality rates. The ability to determine and to predict levels of asthma control and the occurrence of exacerbations is crucial in asthma management. Therefore, we aimed to determine to what extent physiological, behavioural and environmental data, obtained by mobile healthcare (mHealth) and home-monitoring sensors, as well as patient characteristics, can be used to predict episodes of uncontrolled asthma and the onset of asthma exacerbations. In an 1-year observational study, patients will be provided with mHealth and home-monitoring systems to record daily measurements for the first-month (phase I) and weekly measurements during a follow-up period of 11 months (phase II). Our study population consists of 150 patients, aged ≥18 years, with a clinician's diagnosis of asthma, currently on controller medication, with uncontrolled asthma and/or minimally one exacerbation in the past 12 months. They will be enrolled over three participating centres, including Leiden, London and Manchester. Our main outcomes are the association between physiological, behavioural and environmental data and (1) the loss of asthma control and (2) the occurrence of asthma exacerbations. This study was approved by the Medical Ethics Committee of the Leiden University Medical Center in the Netherlands and by the NHS ethics service in the UK. NCT02774772. 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/.

[Effect of metabolic uncontrolled diabetes mellitus (DM) on the resistance index of renal (IR) Interlobar arteries assessed with pulsed Doppler].

PubMed

Muraira-Cárdenas, Luis Cesar; Barrios-Pérez, Martín

2016-01-01

Diabetes mellitus is a chronic degenerative disease characterized by elevated hyperglycemia, triggering a series of processes and culminating in chronic, uncontrolled, cellular and vascular damage in different organs. To assess whether the elevated glycosylated hemoglobin, microalbuminuria, and the time evolution of more than 10 years of diabetes mellitus are associated with elevated resistance index of the interlobar renal arteries assessed with pulsed Doppler in patients with metabolic uncontrolled diabetes mellitus. Transversal-analytical, observational, prospective study that included diabetic patients attending UMAE abdominal ultrasound in 25 of IMSS, from October 15, 2014 to November 15, 2014, which was performed for pulsed Doppler index resistance of vascular interlobar renal arteries and was collected from electronic medical records: age, sex, glycated hemoglobin, and microalbuminuria. The association between metabolic uncontrolled diabetes mellitus was analyzed with the elevation of resistance index by χ(2) test or Fisher, being significant with a value of p < 0.05, and to assess the magnitude of the association that was measured with a response magnitude of 95%. 63 patients with type 2 diabetes were examined, with an average age of 52.3 ± 14.2 years, 41 were older than 50 years (65.0%), 26 with hypertension (41.2%), 32 with higher levels of glycated hemoglobin 7 (50.8%), 35 with normoalbuminuria (55.6%), 28 with microalbuminuria (44.4%), and 39 with a time evolution of diabetes of more than 10 years (61.9%). We observed a statistically significant difference between microalbuminuria and increased duration of diabetes mellitus with high resistance index. The alterations in renal microvasculature conditioned by the occurrence of microalbuminuria in diabetic nephropathy and the duration of diabetes are strongly associated with higher resistance index.

Impact of pH and butyric acid on butanol production during batch fermentation using a new local isolate of Clostridium acetobutylicum YM1.

PubMed

Al-Shorgani, Najeeb Kaid Nasser; Kalil, Mohd Sahaid; Yusoff, Wan Mohtar Wan; Hamid, Aidil Abdul

2018-02-01

The effect of pH and butyric acid supplementation on the production of butanol by a new local isolate of Clostridium acetobutylicum YM1 during batch culture fermentation was investigated. The results showed that pH had a significant effect on bacterial growth and butanol yield and productivity. The optimal initial pH that maximized butanol production was pH 6.0 ± 0.2. Controlled pH was found to be unsuitable for butanol production in strain YM1, while the uncontrolled pH condition with an initial pH of 6.0 ± 0.2 was suitable for bacterial growth, butanol yield and productivity. The maximum butanol concentration of 13.5 ± 1.42 g/L was obtained from cultures grown under the uncontrolled pH condition, resulting in a butanol yield ( Y P / S ) and productivity of 0.27 g/g and 0.188 g/L h, respectively. Supplementation of the pH-controlled cultures with 4.0 g/L butyric acid did not improve butanol production; however, supplementation of the uncontrolled pH cultures resulted in high butanol concentrations, yield and productivity (16.50 ± 0.8 g/L, 0.345 g/g and 0.163 g/L h, respectively). pH influenced the activity of NADH-dependent butanol dehydrogenase, with the highest activity obtained under the uncontrolled pH condition. This study revealed that pH is a very important factor in butanol fermentation by C. acetobutylicum YM1.

Extracapsular local infiltration analgesia in hip arthroscopy: a retrospective study

PubMed Central

Kahn, Timothy L; Adeyemi, Temitope F; Maak, Travis G

2018-01-01

ABSTRACT Many hip arthroscopy patients experience significant pain in the immediate postoperative period. Although peripheral nerve blocks have demonstrated efficacy in alleviating some of this pain, they come with significant costs. Local infiltration analgesia (LIA) may be a significantly cheaper and efficacious treatment modality. Although LIA has been well studied in hip and knee arthroplasty, its efficacy in hip arthroscopy is unclear. The purpose of this retrospective study is to determine the efficacy of a single extracapsular injection of bupivacaine–epinephrine during hip arthroscopy in reducing the rate of elective postoperative femoral nerve blocks. A retrospective review of 100 consecutive patients who underwent primary hip arthroscopy at a single medical center was performed. The control group consisted of 50 patients before the implementation of the current LIA protocol, whereas another 50 patients received a 20-ml extracapsular injection of 0.25% bupivacaine–epinephrine under direct arthroscopic visualization after capsular closure. In the post-anesthesia care unit (PACU), patients were offered a femoral nerve block for uncontrolled pain. The rate of femoral nerve block, and total opioid consumption, was compared between groups. The proportion of patients receiving elective femoral nerve blocks was significantly less in the LIA group (34%) as compared with the control group (56%; P = 0.027). There was no significant difference in total PACU opioid consumption between groups (P = 0.740). The decreased utilization of postoperative nerve blocks observed in the LIA group suggests that LIA may improve postoperative pain management and should be considered as a potentially cost-effective tool in pain management in hip arthroscopy patients. Level of Evidence: III PMID:29423252

Microbiological Characterization and Concerns of the International Space Station Internal Active Thermal Control System

NASA Technical Reports Server (NTRS)

Roman, Monsi C.; Wieland, Paul O.

2005-01-01

Since January 1999, the chemical the International Space Station Thermal Control System (IATCS) and microbial state of (ISS) Internal Active fluid has been monitored by analysis of samples returned to Earth. Key chemical parameters have changed over time, including a drop in pH from the specified 9.5 +/- 0.5 ta = 58.4, an increase in the level of total inorganic carbon (TIC), total organic carbon (TOC) and dissolved nickel (Ni) in the fluid, and a decrease in the phosphate (PO,) level. In addition, silver (AS) ion levels in the fluid decreased rapidly as Ag deposited on internal metallic surfaces of the system. The lack of available Ag ions coupled with changes in the fluid chemistry has resulted in a favorable environment for microbial growth. Counts of heterotrophic bacteria have increased from less than 10 colony-forming units (CFUs)/l00 mL to l0(exp 6) to l0(exp 7) CFUs/100 mL. The increase of the microbial population is of concern because uncontrolled microbiological growth in the IATCS can contribute to deterioration in the performance of critical components within the system and potentially impact human health if opportunistic pathogens become established and escape into the cabin atmosphere. Micro-organisms can potentially degrade the coolant chemistry; attach to surfaces and form biofilms; lead to biofouling of filters, tubing, and pumps; decrease flow rates; reduce heat transfer; initiate and accelerate corrosion; and enhance mineral scale formation. The micro- biological data from the ISS IATCS fluid, and approaches to addressing the concerns, are summarized in this paper.

PRELIMINARY ENVIRONMENTAL, HEALTH AND SAFETY RISK ASSESSMENT ON THE INTEGRATION OF A PROCESS UTILIZING LOW-ENERGY SOLVENTS FOR CARBON DIOXIDE CAPTURE ENABLED BY A COMBINATION OF ENZYMES AND VACUUM REGENERATION WITH A SUBCRITICAL PC POWER PLANT

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

Fitzgerald, David; Vidal, Rafael; Russell, Tania

2014-12-31

The results of the preliminary environmental, health and safety (EH&S) risk assessment for an enzyme-activated potassium carbonate (K2CO3) solution post-combustion CO2 capture (PCC) plant, integrated with a subcritical pulverized coal (PC) power plant, are presented. The expected emissions during normal steady-state operation have been estimated utilizing models of the PCC plant developed in AspenTech’s AspenPlus® software, bench scale test results from the University of Kentucky, and industrial experience of emission results from a slipstream PCC plant utilizing amine based solvents. A review of all potential emission species and their sources was undertaken that identified two credible emission sources, the absorbermore » off-gas that is vented to atmosphere via a stack and the waste removed from the PCC plant in the centrifuge used to reclaim enzyme and solvent. The conditions and compositions of the emissions were calculated and the potential EH&S effects were considered as well as legislative compliance requirements. Potential mitigation methods for emissions during normal operation have been proposed and solutions to mitigate uncontrolled releases of species have been considered. The potential emissions were found to pose no significant EH&S concerns and were compliant with the Federal legislation reviewed. The limitations in predicting full scale plant performance from bench scale tests have been noted and further work on a larger scale test unit is recommended to reduce the level of uncertainty.« less