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Sample records for arrester failure rate

  1. Assessment of surge arrester failure rate and application studies in Hellenic high voltage transmission lines

    Energy Technology Data Exchange (ETDEWEB)

    Christodoulou, C.A.; Fotis, G.P.; Gonos, I.F.; Stathopulos, I.A. [National Technical University of Athens, School of Electrical and Computer Engineering, High Voltage Laboratory, 9 Iroon Politechniou St., Zografou Campus, 157 80 Athens (Greece); Ekonomou, L. [A.S.PE.T.E. - School of Pedagogical and Technological Education, Department of Electrical Engineering Educators, N. Heraklion, 141 21 Athens (Greece)

    2010-02-15

    The use of transmission line surge arresters to improve the lightning performance of transmission lines is becoming more common. Especially in areas with high soil resistivity and ground flash density, surge arresters constitute the most effective protection mean. In this paper a methodology for assessing the surge arrester failure rate based on the electrogeometrical model is presented. Critical currents that exceed arresters rated energy stress were estimated by the use of a simulation tool. The methodology is applied on operating Hellenic transmission lines of 150 kV. Several case studies are analyzed by installing surge arresters on different intervals, in relation to the region's tower footing resistance and the ground flash density. The obtained results are compared with real records of outage rate showing the effectiveness of the surge arresters in the reduction of the recorded failure rate. The presented methodology can be proved valuable to the studies of electric power systems designers intending in a more effective lightning protection, reducing the operational costs and providing continuity of service. (author)

  2. Failure Rates in Introductory Programming

    DEFF Research Database (Denmark)

    Bennedsen, Jens; Caspersen, Michael Edelgaard

    2007-01-01

    It is a common conception that CS1 is a very difficult course and that failure rates are high. However, until now there has only been anecdotal evidence for this claim. This article reports on a survey among institutions around the world regarding failure rates in introductory programming courses...

  3. Failure rate analysis using GLIMMIX

    Energy Technology Data Exchange (ETDEWEB)

    Moore, L.M.; Hemphill, G.M.; Martz, H.F.

    1998-12-01

    This paper illustrates use of a recently developed SAS macro, GLIMMIX, for implementing an analysis suggested by Wolfinger and O`Connell (1993) in modeling failure count data with random as well as fixed factor effects. Interest in this software tool arose from consideration of modernizing the Failure Rate Analysis Code (FRAC), developed at Los Alamos National Laboratory in the early 1980`s by Martz, Beckman and McInteer (1982). FRAC is a FORTRAN program developed to analyze Poisson distributed failure count data as a log-linear model, possibly with random as well as fixed effects. These statistical modeling assumptions are a special case of generalized linear mixed models, identified as GLMM in the current statistics literature. In the nearly 15 years since FRAC was developed, there have been considerable advances in computing capability, statistical methodology and available statistical software tools allowing worthwhile consideration of the tasks of modernizing FRAC. In this paper, the approaches to GLMM estimation implemented in GLIMMIX and in FRAC are described and a comparison of results for the two approaches is made with data on catastrophic time-dependent pump failures from a report by Martz and Whiteman (1984). Additionally, statistical and graphical model diagnostics are suggested and illustrated with the GLIMMIX analysis results.

  4. Successful treatment of thyroid storm presenting as recurrent cardiac arrest and subsequent multiorgan failure by continuous renal replacement therapy

    Directory of Open Access Journals (Sweden)

    Han Soo Park

    2017-03-01

    Full Text Available Thyroid storm is a rare and potentially life-threatening medical emergency. We experienced a case of thyroid storm associated with sepsis caused by pneumonia, which had a catastrophic course including recurrent cardiac arrest and subsequent multiple organ failure (MOF. A 22-year-old female patient with a 10-year history of Graves’ disease was transferred to our emergency department (ED. She had a cardiac arrest at her home and a second cardiac arrest at the ED. Her heart recovered after 20 min of cardiac resuscitation. She was diagnosed with thyroid storm associated with hyperthyroidism complicated by pneumonia and sepsis. Although full conventional medical treatment was given, she had progressive MOF and hemodynamic instability consisting of hyperthermia, tachycardia and hypotension. Because of hepatic and renal failure with refractory hypotension, we reduced the patient’s dose of beta-blocker and antithyroid drug, and she was started on continuous veno-venous renal replacement therapy (CRRT with intravenous albumin and plasma supplementation. Subsequently, her body temperature and pulse rate began to stabilize within 1 h, and her blood pressure reached 120/60 mmHg after 6 h. We discontinued antithyroid drug 3 days after admission because of aggravated hyperbilirubinemia. The patient exhibited progressive improvement in thyroid function even after cessation of antithyroid drug, and she successfully recovered from thyroid storm and MOF. This is the first case of thyroid storm successfully treated by CRRT in a patient considered unfit for antithyroid drug treatment.

  5. [Multiple organ failure after spontaneous return of circulation in cardiac arrest in children].

    Science.gov (United States)

    Carbayo, Tania; de la Mata, Alba; Sánchez, Marina; López-Herce, Jesús; Del Castillo, Jimena; Carrillo, Angel

    2017-07-01

    To assess the frequency of the multiple organ failure and the prognostic value of multiple organ failure scores in children who have recovered from an in-hospital cardiac arrest. A single centre, observational, and retrospective study was conducted on children between 1 month and 16 years old who suffered an in-hospital cardiac arrest and achieved return of spontaneous circulation (ROSC). In the first 24-48hours and between the fifth and the seventh day after ROSC, a record was made of the scores on paediatric severity (PRISM and PIM II) and multiple organ failure scales (PELOD and P-MODS), along with the clinical and analytical data, and including monitoring and treatment, mortality and cause of death. Of the total of 41 children studied, 70.7% male were male, and the median age was 38 months. The overall mortality during admission was 41.5%, with 14.6% dying in the first 48hours, and 7.6% in the following 3 to 5 days. In the first 48hours, clinical severity and multiple organ failure scores were higher in the patients that died than in survivors (PRISM 29 vs. 21) P=.125, PIM II (26.8% vs. 9.2%) P=.02, PELOD (21 vs. 12) P=.005, and P-MODS (9 vs. 6) P=.001. Between the fifth and seventh day, the scores on the four scales were also higher in patients who died, but only those of the PELOD (20.5 vs. 11) p=.002 and P-MODS (6.5 vs. 3) P=.003 reached statistical significance. Mortality in children after return of spontaneous circulation after cardiac arrest is high. The multiple organ failure after return of spontaneous circulation after cardiac arrest in children is associated with increased mortality. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Too close for comfort? Registered sex offender spatial clustering and recidivistic sex crime arrest rates.

    Science.gov (United States)

    Socia, Kelly M

    2013-12-01

    This study examined whether three measures of the spatial distribution of registered sex offenders (RSOs) in September 2010 were associated with differences in county-level rates of recidivistic sex crime arrests over the following year in 52 upstate New York counties. Results indicate that RSO clustering was positively associated with modest increases of recidivistic sex crime arrest rates, but results were significant only for adult victim sex crimes and only for certain types of RSO clustering. Under no circumstances, however, was increased RSO clustering associated with decreased rates of recidivistic sex crime arrests. The results of this study, combined with the limited prior research, suggest that RSO clustering has only a limited association with recidivistic sex crime arrest rates. This implies that housing policies such as residence restrictions may be useful in mitigating risk from some types of recidivistic sex crimes only to the extent that they result in more equitable distributions of RSOs within a county.

  7. Ubiquitous protective effects of cyclosporine A in preventing cardiac arrest-induced multiple organ failure.

    Science.gov (United States)

    Cour, Martin; Abrial, Maryline; Jahandiez, Vincent; Loufouat, Joseph; Belaïdi, Elise; Gharib, Abdallah; Varennes, Annie; Monneret, Guillaume; Thibault, Hélène; Ovize, Michel; Argaud, Laurent

    2014-10-15

    Opening of the mitochondrial permeability transition pore (mPTP) appears to be a pivotal event in myocardial ischemia-reperfusion (I/R) injury. Resuscitated cardiac arrest (CA) leads to the post-CA syndrome that encompasses, not only myocardial dysfunction, but also brain injury, failure of other organs (kidney, liver, or lung), and systemic response to I/R. We aimed to determine whether cyclosporine A (CsA) might prevent multiple organ failure following CA through a ubiquitous mPTP inhibition in each distant vital organ. Anesthetized New Zealand White rabbits were subjected to 15 min of CA and 120 min of reperfusion. At the onset of resuscitation, the rabbits received CsA, its non-immunosuppressive derivative NIM811, or vehicle (controls). Survival, hemodynamics, brain damage, organ injuries, and systemic I/R response were analyzed. Fresh mitochondria were isolated from the brain, heart, kidney, liver, and lung to assess both oxidative phosphorylation and permeability transition. CsA analogs significantly improved short-term survival and prevented multiple organ failure, including brain damage and myocardial dysfunction (P ubiquitous mitochondrial protective effect at the level of each major distant organ.

  8. Rates of organ donation in a UK tertiary cardiac arrest centre following out-of-hospital cardiac arrest.

    Science.gov (United States)

    Cheetham, Olivia V; Thomas, Matthew J C; Hadfield, John; O'Higgins, Fran; Mitchell, Claire; Rooney, Kieron D

    2016-04-01

    To ascertain the rate of successful organ donation (OD) within patients who sustained an out of hospital cardiac arrest (OHCA) with initial return of spontaneous circulation (ROSC) and survival to hospital admission, but whom subsequently do not survive to hospital discharge. A retrospective audit of ambulance service and hospital databases from January 2010 to January 2015 was undertaken in a United Kingdom tertiary-referral regional cardiac arrest centre. Crude denominator data for cardiac arrests was obtained from the regional ambulance service; the ICU database was interrogated for OHCA patient admissions and outcomes. Patients who died were cross-referenced against the local Organ Donation service database. Five hundred and fourteen {514} patients were admitted to ICU following OHCA over this five year period. Two hundred and forty-one {241} patients (47%) survived to hospital discharge and 273 (53%) died of whom 106 (39%) were referred to a Specialist Nurse for Organ Donation (SNOD). The conversion rate after the family was approached was 64%. Twenty-eight {28} patients proceeded to donation and 25 patients (24%) successfully donated at least one organ. On average, a patient proceeding to donation provided 1.9 organs. A proactive, systematic approach to OD in OHCA patients can provide a good conversion rate and substantial number of donors. Most donations occur after death from circulatory criteria. There is a positive socio-economic benefit with nearly £4m in savings to the health service within the next 5 years potentially being realised during this period by liberating patients from dialysis. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. Rate of Failure of Czech Family Firms

    Directory of Open Access Journals (Sweden)

    Ondřej Machek

    2016-06-01

    Full Text Available Family business is becoming a promising area of research in post-socialist countries, including the Czech Republic. Stability belongs to frequently cited properties of family firms. The goal of this article is to test the hypothesis whether family firms tend to have a lower rate of failure than their non-family counterparts. Using a sample of 1148 family and 5972 non-family firms in the Czech Republic, we find that there is no significant relationship between family involvement and rate of failure. A possible greater stability of family businesses is not necessarily linked with a lower rate of bankruptcy. We also discuss possible reasons and policy implications.

  10. Petri nets extension to model state-varying failure rates

    DEFF Research Database (Denmark)

    Lazarova-Molnar, Sanja

    2013-01-01

    One of the most common assumptions in reliability modeling is the constant failure rate. This has been increasingly changing lately, yielding significant research towards abandoning simulation results based on this assumption; thus, deeming constant failure rates as inadequate to model failures......-varying failure rates and extend the formalism of Petri nets to model them. To illustrate our approach we provide an example model that features state-varying failure rates....

  11. Continuous mixtures with bathtub-shaped failure rates

    OpenAIRE

    Block, Henry W.; LI, YULIN; Savits, Thomas H.; Wang, Jie

    2008-01-01

    The failure rate of a mixture of even the most standard distributions used in reliability can have a complicated shape. However, failure rates of mixtures of two carefully selected distributions will have the well-known bathtub shape. Here we show that mixtures of whole families of distribtions can have a bathtub-shaped failure rate.

  12. Discrete-event simulation of the shielding failure of the arrester protected overhead-lines to evaluate risk of flashover

    Energy Technology Data Exchange (ETDEWEB)

    Bank Tavakoli, M.R.; Vahidi, B.; Hosseinian, S.H. [Department of Electrical Engineering, Amirkabir University of Technology, Hafez Avenue, No. 424, P.O. Box 15875-4413, Tehran (Iran)

    2008-12-15

    Damages caused by lightning stroke in power system networks are severe for insulations and result in less reliable energy supply. Knowledge of protection schemes and better selection of these devices in power systems is a goal of designers to reduce the risk of flashover in any risky point. In this paper, a statistical procedure is presented to evaluate risk of failure in an overhead-line which is protected by arresters in most risky towers. Main aim of the work is to present the modeling aspects for considering random nature of stroke and its simulation procedure. The random nature of a lightning stroke composed of proper discrete-event simulation of a stroke via its peak current, front time and tail time and accurate mathematical representation of such lightning stroke in a transient analyzer. In addition, the maximum lightning current which causes shielding failure for a specified tower design and probabilistic specification of lightning for discrete-event simulation is taken into account. As a study case, random nature modeled lightning strokes are applied to a 230 kV overhead-line which is located in a hilly area and the risk of failure is calculated when arresters are located beside the stroke point. (author)

  13. Failures Of CMOS Devices At Low Radiation-Dose Rates

    Science.gov (United States)

    Goben, Charles A.; Price, William E.

    1990-01-01

    Method for obtaining approximate failure-versus-dose-rate curves derived from experiments on failures of SGS 4007 complementary metal oxide/semiconductor (CMOS) integrated circuits irradiated by Co60 and Cs137 radioactive sources.

  14. Nonoperating Failure Rates for Avionics Study.

    Science.gov (United States)

    1980-04-01

    ENVIRONMENTAL MITDK-1B RA7324 LC.76.1 OPERATING NONOPERATING DUIAION DUTY CYCLE METHOD METHOD FAILURES SAILURES ANALYSIS IMO)I OP NERO NOP NOP AOP AAOP A...Reliability and Maintainability Sym- posium, Wash., DC, January 1975. 21. Balaban, H.S. , Guidelines for Application of Warranties to Air Force

  15. Long range correlations in the heart rate variability following the injury of cardiac arrest

    Science.gov (United States)

    Tong, Shanbao; Jiang, Dineng; Wang, Ziming; Zhu, Yisheng; Geocadin, Romeryko G.; Thakor, Nitish V.

    2007-07-01

    Cardiovascular and neurological recovery following cardiac arrest (CA) largely influence the morbidity and mortality of the patients. Monitoring the cardiovascular system has been an important clinical issue in intensive care unit (ICU). On the other hand, the rhythms of the heart rate variability following CA are still not fully understood, and there are limited number of literatures reporting the cardiovascular function recovery following CA. In this paper, we studied the scaling properties of heart rate variability (HRV) after CA by centered-moving-average-based detrended fluctuation analysis (DFA). Our results showed that the scaling factor of the baseline HRV is close to that of Brownian motion, and after a CA event it shifts to a 1/f noise-like rhythm. DFA could be a promising tool in evaluating the cardiovascular long term recovery following CA injury.

  16. Failure Rates for Fiber Optic Assemblies

    Science.gov (United States)

    1980-10-01

    semiconductors presently dominate the market . As would be expected, the LED is vulnerable to all commcn diode failure modes and mechanisms, as well...of the form: Y b 0 + b 1X1 + b2 X2 + ... b iXi / where Y is the resultant dependent variable; X1, X2 ... Xi are the / independent variables which are...sufficient to support a complex model, rapidly changing markets and technology would make the model obsolete in a matter of months. The development of full

  17. Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Lippert, Freddy K; Folke, Fredrik

    2013-01-01

    resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n...

  18. Spacecraft Parachute Recovery System Testing from a Failure Rate Perspective

    Science.gov (United States)

    Stewart, Christine E.

    2013-01-01

    Spacecraft parachute recovery systems, especially those with a parachute cluster, require testing to identify and reduce failures. This is especially important when the spacecraft in question is human-rated. Due to the recent effort to make spaceflight affordable, the importance of determining a minimum requirement for testing has increased. The number of tests required to achieve a mature design, with a relatively constant failure rate, can be estimated from a review of previous complex spacecraft recovery systems. Examination of the Apollo parachute testing and the Shuttle Solid Rocket Booster recovery chute system operation will clarify at which point in those programs the system reached maturity. This examination will also clarify the risks inherent in not performing a sufficient number of tests prior to operation with humans on-board. When looking at complex parachute systems used in spaceflight landing systems, a pattern begins to emerge regarding the need for a minimum amount of testing required to wring out the failure modes and reduce the failure rate of the parachute system to an acceptable level for human spaceflight. Not only a sufficient number of system level testing, but also the ability to update the design as failure modes are found is required to drive the failure rate of the system down to an acceptable level. In addition, sufficient data and images are necessary to identify incipient failure modes or to identify failure causes when a system failure occurs. In order to demonstrate the need for sufficient system level testing prior to an acceptable failure rate, the Apollo Earth Landing System (ELS) test program and the Shuttle Solid Rocket Booster Recovery System failure history will be examined, as well as some experiences in the Orion Capsule Parachute Assembly System will be noted.

  19. Markov and semi-Markov processes as a failure rate

    Science.gov (United States)

    Grabski, Franciszek

    2016-06-01

    In this paper the reliability function is defined by the stochastic failure rate process with a non negative and right continuous trajectories. Equations for the conditional reliability functions of an object, under assumption that the failure rate is a semi-Markov process with an at most countable state space are derived. A proper theorem is presented. The linear systems of equations for the appropriate Laplace transforms allow to find the reliability functions for the alternating, the Poisson and the Furry-Yule failure rate processes.

  20. McDonald Generalized Linear Failure Rate Distribution

    Directory of Open Access Journals (Sweden)

    Ibrahim Elbatal

    2014-10-01

    Full Text Available We introduce in this paper a new six-parameters generalized version of the generalized linear failure rate (GLFR distribution which is called McDonald Generalized Linear failure rate (McGLFR distribution. The new distribution is quite flexible and can be used effectively in modeling survival data and reliability problems. It can have a constant, decreasing, increasing, and upside down bathtub-and bathtub shaped failure rate function depending on its parameters. It includes some well-known lifetime distributions as special sub-models. Some structural properties of the new distribution are studied. Moreover we discuss maximum likelihood estimation of the unknown parameters of the new model.

  1. U.S. Heart Failure Rates on the Rise

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_163266.html U.S. Heart Failure Rates on the Rise And heart ... Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services. More Health ...

  2. Development of Nonelectronic Part Cyclic Failure Rates

    Science.gov (United States)

    1977-12-01

    Figure 26), QM, and QL (Figure 27). The QH and QL are rugged connectors and utilize a course double lead-thread coupling. Other large connectors...group of relays is cacegorized either by MIL- SPOC classification or part type, as applicable. Operating fail- ure rates for each set of data were

  3. "Stayin' alive": a novel mental metronome to maintain compression rates in simulated cardiac arrests.

    Science.gov (United States)

    Hafner, John W; Sturgell, Jeremy L; Matlock, David L; Bockewitz, Elizabeth G; Barker, Lisa T

    2012-11-01

    A novel and yet untested memory aid has anecdotally been proposed for aiding practitioners in complying with American Heart Association (AHA) cardiopulmonary resuscitation (CPR) compression rate guidelines (at least 100 compressions per minute). This study investigates how subjects using this memory aid adhered to current CPR guidelines in the short and long term. A prospective observational study was conducted with medical providers certified in 2005 AHA guideline CPR. Subjects were randomly paired and alternated administering CPR compressions on a mannequin during a standardized cardiac arrest scenario. While performing compressions, subjects listened to a digital recording of the Bee Gees song "Stayin' Alive," and were asked to time compressions to the musical beat. After at least 5 weeks, the participants were retested without directly listening to the recorded music. Attitudinal views were gathered using a post-session questionnaire. Fifteen subjects (mean age 29.3 years, 66.7% resident physicians and 80% male) were enrolled. The mean compression rate during the primary assessment (with music) was 109.1, and during the secondary assessment (without music) the rate was 113.2. Mean CPR compression rates did not vary by training level, CPR experience, or time to secondary assessment. Subjects felt that utilizing the music improved their ability to provide CPR and they felt more confident in performing CPR. Medical providers trained to use a novel musical memory aid effectively maintained AHA guideline CPR compression rates initially and in long-term follow-up. Subjects felt that the aid improved their technical abilities and confidence in providing CPR. Copyright © 2012. Published by Elsevier Inc.

  4. Ventricular rate control of atrial fibrillation in heart failure

    NARCIS (Netherlands)

    Rienstra, Michiel; Van Gelder, Isabelle C

    2013-01-01

    In the last few years, there has been a major shift in the treatment of atrial fibrillation (AF) in the setting of hear failure (HF), from rhythm to ventricular rate control in most patients with both conditions. In this article, the authors focus on ventricular rate control and discuss the indicati

  5. Ventricular rate control of atrial fibrillation in heart failure

    NARCIS (Netherlands)

    Rienstra, Michiel; Van Gelder, Isabelle C

    2013-01-01

    In the last few years, there has been a major shift in the treatment of atrial fibrillation (AF) in the setting of hear failure (HF), from rhythm to ventricular rate control in most patients with both conditions. In this article, the authors focus on ventricular rate control and discuss the

  6. Ventricular rate control of atrial fibrillation in heart failure.

    Science.gov (United States)

    Rienstra, Michiel; Van Gelder, Isabelle C

    2013-10-01

    In the last few years, there has been a major shift in the treatment of atrial fibrillation (AF) in the setting of hear failure (HF), from rhythm to ventricular rate control in most patients with both conditions. In this article, the authors focus on ventricular rate control and discuss the indications; the optimal ventricular rate-control target, including detailed results of the Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison Between Lenient versus Strict Rate Control II (RACE II) study; and the pharmacologic and nonpharmacologic options to control the ventricular rate during AF in the setting of HF.

  7. Location of In-Hospital Cardiac Arrest in the United States-Variability in Event Rate and Outcomes.

    Science.gov (United States)

    Perman, Sarah M; Stanton, Emily; Soar, Jasmeet; Berg, Robert A; Donnino, Michael W; Mikkelsen, Mark E; Edelson, Dana P; Churpek, Matthew M; Yang, Lin; Merchant, Raina M

    2016-09-29

    In-hospital cardiac arrest (IHCA) is a major public health problem with significant mortality. A better understanding of where IHCA occurs in hospitals (intensive care unit [ICU] versus monitored ward [telemetry] versus unmonitored ward) could inform strategies for reducing preventable deaths. This is a retrospective study of adult IHCA events in the Get with the Guidelines-Resuscitation database from January 2003 to September 2010. Unadjusted analyses were used to characterize patient, arrest, and hospital-level characteristics by hospital location of arrest (ICU versus inpatient ward). IHCA event rates and outcomes were plotted over time by arrest location. Among 85 201 IHCA events at 445 hospitals, 59% (50 514) occurred in the ICU compared to 41% (34 687) on the inpatient wards. Compared to ward patients, ICU patients were younger (64±16 years versus 69±14; Plocations. Survival rates vary based on location of IHCA. Optimizing patient assignment to unmonitored wards versus telemetry wards may contribute to improved survival after IHCA. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  8. Asymptotic failure rate of a continuously monitored system

    Energy Technology Data Exchange (ETDEWEB)

    Grall, A. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: antoine.grall@utt.fr; Dieulle, L. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: laurence.dieulle@utt.fr; Berenguer, C. [Institut des Sciences et Technologies de l' Information de Troyes (CNRS-FRE 2732), Equipe de Modelisation et de Surete des Systemes, Universite de Technologie de Troyes, 12 rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: christophe.berenguer@utt.fr; Roussignol, M. [Laboratoire d' Analyse et de Mathematiques Appliquees, Universite de Marne la Vallee, 5 bd Descartes, Champs sur Marne, 77454 Marne la Vallee, Cedex 2 (France)]. E-mail: michel.roussignol@univ-mlv.fr

    2006-02-01

    This paper deals with a perfectly continuously monitored system which gradually and stochastically deteriorates. The system is renewed by a delayed maintenance operation, which is triggered when the measured deterioration level exceeds an alarm threshold. A mathematical model is developed to study the asymptotic behavior of the reliability function. A procedure is proposed which allows us to identify the asymptotic failure rate of the maintained system. Numerical experiments illustrate the efficiency of the proposed procedure and emphasize the relevance of the asymptotic failure rate as an interesting indicator for the evaluation of the control-limit preventive replacement policy.

  9. Teenagers' High Arrest Rates: Features of Young Age or Youth Poverty?

    Science.gov (United States)

    Males, Mike A.; Brown, Elizabeth A.

    2014-01-01

    The association of more crime with youthful age is widely accepted in social science. However, a literature search revealed no studies of the age-crime relationship that controlled for young ages' economic disadvantage. This research gap is addressed using the California Criminal Justice Statistics Center's arrest detail and Census poverty…

  10. Teenagers' High Arrest Rates: Features of Young Age or Youth Poverty?

    Science.gov (United States)

    Males, Mike A.; Brown, Elizabeth A.

    2014-01-01

    The association of more crime with youthful age is widely accepted in social science. However, a literature search revealed no studies of the age-crime relationship that controlled for young ages' economic disadvantage. This research gap is addressed using the California Criminal Justice Statistics Center's arrest detail and Census poverty…

  11. Teenagers' High Arrest Rates: Features of Young Age or Youth Poverty?

    Science.gov (United States)

    Males, Mike A.; Brown, Elizabeth A.

    2014-01-01

    The association of more crime with youthful age is widely accepted in social science. However, a literature search revealed no studies of the age-crime relationship that controlled for young ages' economic disadvantage. This research gap is addressed using the California Criminal Justice Statistics Center's arrest detail and Census…

  12. Youth Arrested for Trading Sex Have the Highest Rates of Childhood Adversity: A Statewide Study of Juvenile Offenders.

    Science.gov (United States)

    Naramore, Rachel; Bright, Melissa A; Epps, Nathan; Hardt, Nancy S

    2017-06-01

    A history of childhood adversity is associated with high-risk behaviors and criminal activity in both adolescents and adults. Furthermore, individuals with histories of child maltreatment are at higher risk for engaging in risky sexual behavior, experiencing re-victimization, and in some cases, becoming sexual offenders. The purpose of the current study was to examine the prevalence of individual and cumulative adverse childhood experiences (ACEs) reported by 102 offending youth who were arrested for trading sex and 64,227 offending youth who were arrested for various other crimes, using Florida's Positive Achievement Change Tool. Youth with violations related to sex trafficking had higher rates for each ACE as well as number of ACEs, particularly sexual abuse and physical neglect. These findings have implications for identifying adverse experiences in both maltreated and offending youth as well as tailoring services to prevent re-victimization.

  13. Heart rate reduction in coronary artery disease and heart failure.

    Science.gov (United States)

    Ferrari, Roberto; Fox, Kim

    2016-08-01

    Elevated heart rate is known to induce myocardial ischaemia in patients with coronary artery disease (CAD), and heart rate reduction is a recognized strategy to prevent ischaemic episodes. In addition, clinical evidence shows that slowing the heart rate reduces the symptoms of angina by improving microcirculation and coronary flow. Elevated heart rate is an established risk factor for cardiovascular events in patients with CAD and in those with chronic heart failure (HF). Accordingly, reducing heart rate improves prognosis in patients with HF, as demonstrated in SHIFT. By contrast, data from SIGNIFY indicate that heart rate is not a modifiable risk factor in patients with CAD who do not also have HF. Heart rate is also an important determinant of cardiac arrhythmias; low heart rate can be associated with atrial fibrillation, and high heart rate after exercise can be associated with sudden cardiac death. In this Review, we critically assess these clinical findings, and propose hypotheses for the variable effect of heart rate reduction in cardiovascular disease.

  14. Chromosomal Aneuploidies and Early Embryonic Developmental Arrest

    Directory of Open Access Journals (Sweden)

    Maria Maurer

    2015-07-01

    Full Text Available Background: Selecting the best embryo for transfer, with the highest chance of achieving a vital pregnancy, is a major goal in current in vitro fertilization (IVF technology. The high rate of embryonic developmental arrest during IVF treatment is one of the limitations in achieving this goal. Chromosomal abnormalities are possibly linked with chromosomal arrest and selection against abnormal fertilization products. The objective of this study was to evaluate the frequency and type of chromosomal abnormalities in preimplantation embryos with developmental arrest. Materials and Methods: This cohort study included blastomeres of embryos with early developmental arrest that were biopsied and analyzed by fluorescence in-situ hybridization (FISH with probes for chromosomes 13, 16, 18, 21 and 22. Forty-five couples undergoing IVF treatment were included, and 119 arrested embryos were biopsied. All probes were obtained from the Kinderwunsch Zentrum, Linz, Austria, between August 2009 and August 2011. Results: Of these embryos, 31.6% were normal for all chromosomes tested, and 68.4% were abnormal. Eleven embryos were uniformly aneuploid, 20 were polyploid, 3 were haploid, 11 displayed mosaicism and 22 embryos exhibited chaotic chromosomal complement. Conclusion: Nearly 70% of arrested embryos exhibit chromosomal errors, making chromosomal abnormalities a major cause of embryonic arrest and may be a further explanation for the high developmental failure rates during culture of the embryos in the IVF setting.

  15. Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia

    Science.gov (United States)

    Straney, Lahn D.; Bray, Janet E.; Beck, Ben; Finn, Judith; Bernard, Stephen; Dyson, Kylie; Lijovic, Marijana; Smith, Karen

    2015-01-01

    Background Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia Methods We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates. Results Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008–2010 to 68.6% in 2010–2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs. Conclusion Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates. PMID:26447844

  16. Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia.

    Directory of Open Access Journals (Sweden)

    Lahn D Straney

    Full Text Available Out-of-hospital cardiac arrest (OHCA remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia.We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0, we linked the location of the arrest using the dispatch coordinates (longitude and latitude to Victorian Local Government Areas (LGAs. We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates.Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1% cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008-2010 to 68.6% in 2010-2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs.Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates.

  17. Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia.

    Science.gov (United States)

    Straney, Lahn D; Bray, Janet E; Beck, Ben; Finn, Judith; Bernard, Stephen; Dyson, Kylie; Lijovic, Marijana; Smith, Karen

    2015-01-01

    Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia. We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates. Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008-2010 to 68.6% in 2010-2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs. Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates.

  18. Metaiodobenzylguanidine and heart rate variability in heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Kurata, Chinori; Shouda, Sakae; Mikami, Tadashi; Uehara, Akihiko; Ishikawa, Keiko [Hamamatsu Univ., Shizuoka (Japan). School of Medicine; Tawarahara, Kei; Nakano, Tomoyasu; Matoh, Fumitaka; Takeuchi, Kazuhiko

    1998-10-01

    It is assumed that the low-frequency power (LF) of heart rate variability (HRV) increases with progress of congestive heart failure (CHF), therefore positively correlating with cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) washout. It is demonstrated here that HRV, including normalized LF, correlated inversely with MIBG washout and positively with the ratio of heart-to-mediastinum MIBG activity in controls and CHF patients, whereas these correlations were not observed within CHF patients. Thus MIBG washout may increase and HRV including normalized LF may decrease with CHF, although the HRV and MIBG measures may not similarly change in proportion to the severity of the cardiac autonomic dysfunction in CHF. (author)

  19. RELIABILITY ANALYSIS FOR A REPAIRABLE PARALLEL SYSTEM WITH TIME-VARYING FAILURE RATES

    Institute of Scientific and Technical Information of China (English)

    TangShengdao; WangFengquan

    2005-01-01

    To solve a real problem :how to calculate the reliability of a system with time-varying failure rates in industry systems,this paper studies a model for the load-sharing parallel system with time-varying failure rates,and obtains calculating formulas of reliability and availability of the system by solving differential equations. In this paper, the failure rates are expressed in polynomial configuration. The constant,linear and Weibull failure rate are in their special form. The polynomial failure rates provide flexibility in modeling the practical time-varying failure rates.

  20. Selected Component Failure Rate Values from Fusion Safety Assessment Tasks

    Energy Technology Data Exchange (ETDEWEB)

    Cadwallader, Lee Charles

    1998-09-01

    This report is a compilation of component failure rate and repair rate values that can be used in magnetic fusion safety assessment tasks. Several safety systems are examined, such as gas cleanup systems and plasma shutdown systems. Vacuum system component reliability values, including large vacuum chambers, have been reviewed. Values for water cooling system components have also been reported here. The report concludes with the examination of some equipment important to personnel safety, atmospheres, combustible gases, and airborne releases of radioactivity. These data should be useful to system designers to calculate scoping values for the availability and repair intervals for their systems, and for probabilistic safety or risk analysts to assess fusion systems for safety of the public and the workers.

  1. Selected component failure rate values from fusion safety assessment tasks

    Energy Technology Data Exchange (ETDEWEB)

    Cadwallader, L.C.

    1998-09-01

    This report is a compilation of component failure rate and repair rate values that can be used in magnetic fusion safety assessment tasks. Several safety systems are examined, such as gas cleanup systems and plasma shutdown systems. Vacuum system component reliability values, including large vacuum chambers, have been reviewed. Values for water cooling system components have also been reported here. The report concludes with the examination of some equipment important to personnel safety, atmospheres, combustible gases, and airborne releases of radioactivity. These data should be useful to system designers to calculate scoping values for the availability and repair intervals for their systems, and for probabilistic safety or risk analysts to assess fusion systems for safety of the public and the workers.

  2. Continuous mixtures of exponentials and IFR gammas having bathtub-shaped failure rates

    OpenAIRE

    Block, Henry W.; Langberg, Naftali A.; Savits, Thomas H.; Wang, Jie

    2010-01-01

    It can be seen that a mixture of an exponential distribution and a gamma distribution with increasing failure rate for the right choice of parameters can yield a distribution with a bathtub-shaped failure rate. In this paper we consider a continuous mixture of exponentials and a continuous mixture of gammas with increasing failure rates and show that the resulting mixture has a bathtub-shaped failure rate.

  3. Voltage stress effects on microcircuit accelerated life test failure rates

    Science.gov (United States)

    Johnson, G. M.

    1976-01-01

    The applicability of Arrhenius and Eyring reaction rate models for describing microcircuit aging characteristics as a function of junction temperature and applied voltage was evaluated. The results of a matrix of accelerated life tests with a single metal oxide semiconductor microcircuit operated at six different combinations of temperature and voltage were used to evaluate the models. A total of 450 devices from two different lots were tested at ambient temperatures between 200 C and 250 C and applied voltages between 5 Vdc and 15 Vdc. A statistical analysis of the surface related failure data resulted in bimodal failure distributions comprising two lognormal distributions; a 'freak' distribution observed early in time, and a 'main' distribution observed later in time. The Arrhenius model was shown to provide a good description of device aging as a function of temperature at a fixed voltage. The Eyring model also appeared to provide a reasonable description of main distribution device aging as a function of temperature and voltage. Circuit diagrams are shown.

  4. In-vessel ITER tubing failure rates for selected materials and coolants

    Energy Technology Data Exchange (ETDEWEB)

    Marshall, T.D. [Rensselaer Polytechnic Institute, Troy, NY (United States); Cadwallader, L.C. [EG& G Idaho Inc., Idaho Falls, ID (United States)

    1994-03-01

    Several materials have been suggested for fabrication of ITER in-vessel coolant tubing: beryllium, copper, Inconel, niobium, stainless steel, titanium, and vanadium. This report generates failure rates for the materials to identify the best performer from an operational safety and availability perspective. Coolant types considered in this report are helium gas, liquid lithium, liquid sodium, and water. Failure rates for the materials are generated by including the influence of ITER`s operating environment and anticipated tubing failure mechanisms with industrial operating experience failure rates. The analyses define tubing failure mechanisms for ITER as: intergranular attack, flow erosion, helium induced swelling, hydrogen damage, neutron irradiation embrittlement, cyclic fatigue, and thermal cycling. K-factors, multipliers, are developed to model each failure mechanism and are applied to industrial operating experience failure rates to generate tubing failure rates for ITER. The generated failure rates identify the best performer by its expected reliability. With an average leakage failure rate of 3.1e-10(m-hr){sup {minus}1}and an average rupture failure rate of 3.1e-11(m-hr){sup {minus}1}, titanium proved to be the best performer of the tubing materials. The failure rates generated in this report are intended to serve as comparison references for design safety and optimization studies. Actual material testing and analyses are required to validate the failure rates.

  5. Failure rate of cemented and uncemented total hip replacements

    DEFF Research Database (Denmark)

    Makela, K. T.; Matilainen, M.; Pulkkinen, P.

    2014-01-01

    Objective To assess the failure rate of cemented, uncemented, hybrid, and reverse hybrid total hip replacements in patients aged 55 years or older. Design Register study. Setting Nordic Arthroplasty Register Association database (combined data from Sweden, Norway, Denmark, and Finland......). Participants 347 899 total hip replacements performed during 1995-2011. Main outcome measures Probability of implant survival (Kaplan-Meier analysis) along with implant survival with revision for any reason as endpoint (Cox multiple regression) adjusted for age, sex, and diagnosis in age groups 55-64, 65......-74, and 75 years or older. Results The proportion of total hip replacements using uncemented implants increased rapidly towards the end of the study period. The 10 year survival of cemented implants in patients aged 65 to 74 and 75 or older (93.8%, 95% confidence interval 93.6% to 94.0% and 95.9%, 95...

  6. Cardiac arrest

    Science.gov (United States)

    ... Article.jsp. Accessed June 16, 2014. Myerburg RJ, Castellanos A. Approach to cardiac arrest and life-threatening ... PA: Elsevier Saunders; 2011:chap 63. Myerburg RJ, Castellanos A. Cardiac arrest and audden aardiac death. In: ...

  7. An interval-valued reliability model with bounded failure rates

    DEFF Research Database (Denmark)

    Kozine, Igor; Krymsky, Victor

    2012-01-01

    The approach to deriving interval-valued reliability measures described in this paper is distinctive from other imprecise reliability models in that it overcomes the issue of having to impose an upper bound on time to failure. It rests on the presupposition that a constant interval-valued failure...... function if only partial failure information is available. An example is provided. © 2012 Copyright Taylor and Francis Group, LLC....

  8. Calculation of the Actual Failure Rate of a DSP Board Using the FMEDA

    Energy Technology Data Exchange (ETDEWEB)

    Keum, Jong Yong; Suh, Yong Suk; Jang, Gwi Sook; Park, Je Yun [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2008-10-15

    Most components have multiple failure modes and these failure modes are more or less important depending on how they are used within a particular design. Though a component is part of a safety function, there is a particular failure mode that has no effect on a safety function. This failure mode is called 'No effect'. This paper presents a method to calculate a DSP (Digital Signal Processor) board failure rate and failure mode data using an FMEDA (Failure Modes Effects and Diagnostic Analysis)

  9. Losartan improves heart rate variability and heart rate turbulence in heart failure due to ischemic cardiomyopathy.

    Science.gov (United States)

    Ozdemir, Murat; Arslan, Uğur; Türkoğlu, Sedat; Balcioğlu, Serhat; Cengel, Atiye

    2007-12-01

    Heart rate variability (HRV) and heart rate turbulence are known to be disturbed and associated with excess mortality in heart failure. The aim of this study was to investigate whether losartan, when added on top of beta-blocker and angiotensin-converting enzyme inhibitor (ACEI) therapy, could improve these indices in patients with systolic heart failure. Seventy-seven patients (mean age 60.4 +/- 8.0, 80.5% male) with ischemic cardiomyopathy (mean ejection fraction 34.5 +/- 4.4%) and New York Heart Association Class II-III heart failure symptoms, already receiving a beta-blocker and an ACEI, were randomly assigned to either open-label losartan (losartan group) or no additional drug (control group) in a 2:1 ratio and the patients were followed for 12 weeks. The HRV and heart rate turbulence indices were calculated from 24-hour Holter recordings both at the beginning and at the end of follow-up. The baseline clinical characteristics, HRV, and heart rate turbulence indices were similar in the 2 groups. At 12 weeks of follow-up, all HRV parameters except pNN50 increased (SDNN: 113.2 +/- 34.2 versus 127.8 +/- 24.1, P = .001; SDANN: 101.5 +/- 31.7 versus 115.2 +/- 22.0, P = .001; triangular index: 29.9 +/- 11.1 versus 34.2 +/- 7.9, P = .008; RMSSD: 29.1 +/- 20.2 versus 34.3 +/- 23.0, P = .009; NN50: 5015.3 +/- 5554.9 versus 6446.7 +/- 6101.1, P = .024; NN50: 5.65 +/- 6.41 versus 7.24 +/- 6.99, P = .089; SDNNi: 45.1 +/- 13.3 versus 50.3 +/- 14.5, P = .004), turbulence onset decreased (-0. 61 +/- 1.70 versus -1.24 +/- 1.31, P = .003) and turbulence slope increased (4.107 +/- 3.881 versus 5.940 +/- 4.281, P = .004) significantly in the losartan group as compared with controls. A 12-week-long losartan therapy significantly improved HRV and heart rate turbulence in patients with Class II-III heart failure and ischemic cardiomyopathy already on beta-blockers and ACEI.

  10. Failure rates in Barsebaeck-1 reactor coolant pressure boundary piping. An application of a piping failure database

    Energy Technology Data Exchange (ETDEWEB)

    Lydell, B. [RSA Technologies, Vista, CA (United States)

    1999-05-01

    This report documents an application of a piping failure database to estimate the frequency of leak and rupture in reactor coolant pressure boundary piping. The study used Barsebaeck-1 as reference plant. The study tried two different approaches to piping failure rate estimation: 1) PSA-style, simple estimation using Bayesian statistics, and 2) fitting of statistical distribution to failure data. A large, validated database on piping failures (like the SKI-PIPE database) supports both approaches. In addition to documenting leak and rupture frequencies, the SKI report describes the use of piping failure data to estimate frequency of medium and large loss of coolant accidents (LOCAs). This application study was co sponsored by Barsebaeck Kraft AB and SKI Research 41 refs, figs, tabs

  11. Reduced in-hospital survival rates of out-of-hospital cardiac arrest victims with obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Blom, M T; Warnier, M J; Bardai, A;

    2013-01-01

    AIM: Out-of-hospital cardiac arrest (OHCA) due to sustained ventricular tachycardia/fibrillation (VT/VF) is common and often lethal. Patient's co-morbidities may determine survival after OHCA, and be instrumental in post-resuscitation care, but are poorly studied. We aimed to study whether patients......, to hospital discharge, and at 30 days after OHCA, of OPD-patients and non-OPD patients, using logistic regression analysis. We also compared 30-day survival of patients who were admitted to hospital, using multivariate logistic regression analysis. RESULTS: OPD patients (n=178) and non-OPD patients (n=994...... admitted to hospital (OPD: n=100, no OPD: n=561) revealed that OPD was an independent determinant of reduced 30-day survival rate (39% vs. 59%, adjusted OR 0.6 [0.4-1.0, p=0.035]). CONCLUSION: OPD-patients had lower survival rates after OHCA than non-OPD patients. Survival to ER and to hospital admission...

  12. Using Arrested Solid-Solid Multiphase Reactions in Geological Materials to Deduce the Rate of Crustal Uplift

    Energy Technology Data Exchange (ETDEWEB)

    Glassley, W.E.; Meike, A.

    2000-03-13

    The history geological terrains experience can be traced as a series of temperature and pressure changes. Each change drives the system toward a new state of thermodynamic equilibrium. The resultant overprinted rock fabrics, textures and chemical heterogeneities can be difficult to interpret. However, if carefully chosen, features from the scale of kilometers to nanometers can be used to reconstruct the history of mountain systems. Uplift of the Sri Lankan Central Highlands was rapid enough to preserve well-developed symplectite textures, some of which represent arrested solid-state diffusion-controlled reactions of garnet + O{sub 2} to form orthopyroxene + plagioclase + magnetite, as the rocks were exhumed from over 30 km in the earth's crust. Our objective has been to determine the reaction mechanisms responsible for symplectite development, and to establish the time interval over which these reactions occurred, to constrain the rate of mountain uplift. Considering that the most rapid mechanism is solid state grain-boundary diffusion of oxygen, the reaction time can be constrained by bounding the rate of oxygen supply to the reaction site. The solid state grain boundary diffusion rate of oxygen has been inferred to be ca. 10{sup -14}m{sup 2}-sec (Farver and Yund, 1991), but is sensitive to inferred grain boundary width. The range of rates thus determined allows the distinction between rapid uplift similar to that of the Himalayan Mountains, and the slow and progressive erosion of a less dramatic terrain. Further constraints on diffusion control and energetic relationships are determined from crystallographic relationships between the reactant and product phases, and submicron scale microstructure.

  13. Oxygen analyzers: failure rates and life spans of galvanic cells.

    Science.gov (United States)

    Meyer, R M

    1990-07-01

    Competing technologies exist for measuring oxygen concentrations in breathing circuits. Over a 4-year period, two types of oxygen analyzers were studied prospectively in routine clinical use to determine the incidence and nature of malfunctions. Newer AC-powered galvanic analyzers (North American Dräger O2med) were compared with older, battery-powered polarographic analyzers (Ohmeda 201) by recording all failures and necessary repairs. The AC-powered galvanic analyzer had a significantly lower incidence of failures (0.12 +/- 0.04 failures per machine-month) than the battery-powered polarographic analyzer (4.0 +/- 0.3 failures per machine-month). Disposable capsules containing the active galvanic cells lasted 12 +/- 7 months. Although the galvanic analyzers tended to remain out of service longer, awaiting the arrival of costly parts, the polarographic analyzers were more expensive to keep operating when calculations included the cost of time spent on repairs. Stocking galvanic capsules would have decreased the amount of time the galvanic analyzers were out of service, while increasing costs. In conclusion, galvanic oxygen analyzers appear capable of delivering more reliable service at a lower overall cost. By keeping the galvanic capsules exposed to room air during periods of storage, it should be possible to prolong their life span, further decreasing the cost of using them. In addition, recognizing the aberrations in their performance that warn of the exhaustion of the galvanic cells should permit timely recording and minimize downtime.

  14. Medium-distance GPS ambiguity resolution with controlled failure rate

    NARCIS (Netherlands)

    Odijk, D.; Verhagen, S.; Teunissen, P.J.G.

    2009-01-01

    The goal of Network RTK is to provide users with precise ionospheric corrections in order to conduct fast GPS ambiguity resolution and to get cm-level positioning results over medium-distance baselines. In this paper it is shown that a Network RTK user should apply the ratio test with fixed failure

  15. The operating mode of the two-cascade thermoelectric cooling device providing the minimum failure rate

    Directory of Open Access Journals (Sweden)

    Socheslav D. P.

    2011-04-01

    Full Text Available The model of interrelation of reliability indicators and the basic significant parameters of the two-cascade thermoelectric cooling device (TED with consecutive electric connection of cascades is considered. The relations are received allowing to estimate reliability indicators, namely failure rate at construction two-cascade ТED working in current mode, providing the minimum failure rate in a wide range of temperature drops taking into account thermal loading.Possibility of use of this mode when the prevailing requirement is maintenance of the minimum failure rate and the maximum probability of non-failure operation cascade TED is shown.

  16. Higher abnormal fertilization, higher cleavage rate, and higher arrested embryos rate were found in conventional IVF than in intracytoplasmic sperm injection.

    Science.gov (United States)

    Ming, Li; Yuan, Chen; Ping, Liu; Jie, Qiao

    2015-01-01

    The aim of this study was to investigate whether performing different fertilization technologies (intracytoplasmic sperm injection [ICSI] and in vitro fertilization [IVF]) may affect the result of fertilization in the normal fertilization cycles. The authors performed a retrospective analysis of 164 cycles using sibling oocytes in combined IVF/ICSI with achieved a normal fertilization ( ≥ 25%) both conventional IVF and ICSI in this infertility centre. It was found that there were no differences in 2PN rate (70.25% vs 70.60%), but higher cleavage rate in ICSI than IVF insemination (98.99% vs 96.81%), higher arrested embryos rate in IVF than ICSI in 2PN group (20.00% vs 13.95%), and higher abnormal fertilization IPN (3.87% vs 1.92%) and 3PN (3.63 vs 0.854%) in IVF than ICSI. There were some differences fertilization outcomes between ICSI and IVF, which may be related to different procedures between two techniques.

  17. High Strain-Rate and Quasi-Static Ductile Failure Mechanisms in Porous Materials

    Science.gov (United States)

    2007-11-02

    detailed understanding of the interrelated physical mechanisms that can result in ductile material failure in rate-dependent porous crystalline materials subjected...strains and slip-rates, and hydrostatic stresses on failure paths and ligament damage in face centered cubic (f.c.c.) crystalline materials have been

  18. Failure Rate of Single Dose Methotrexate in Managment of Ectopic Pregnancy

    OpenAIRE

    Feras Sendy; Eman AlShehri; Amani AlAjmi; Elham Bamanie; Surekha Appani; Taghreed Shams

    2015-01-01

    Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in th...

  19. Small Business Failure Rates: Choice of Definition and the Size Effect

    OpenAIRE

    1996-01-01

    Results of many previous studies on the rate of small business failure suggest an inverse relationship between size of business and propensity to fail. However, it has been suggested that this inverse relationship, between firm size and the rate of discontinuance, may more accurately be characterized as an inverse relationship between age of business and the rate of discontinuance. While some studies have confirmed the positive association between failure and age, they have generally found th...

  20. Effect of Yoga Therapy on Heart Rate, Blood Pressure and Cardiac Autonomic Function in Heart Failure

    OpenAIRE

    Krishna, Bandi Hari; Pal, Pravati; G.K., Pal; J, Balachander; E., Jayasettiaseelon; Y, Sreekanth; M.G., Sridhar; G.S., Gaur

    2014-01-01

    Background and Objective: It is well known that a hall mark of heart failure is adverse changes in autonomic function. Elevated blood pressure is a powerful predictor of congestive heart failure and other Cardiovascular Disease (CVD) outcomes. In this study, we planned to examine the effects of a 12 week yoga therapy on blood pressure, heart rate, heart rate variability, and rate pressure product (RPP).

  1. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies

    NARCIS (Netherlands)

    J. Berdowski; R.A. Berg; J.G.P. Tijssen; R.W. Koster

    2010-01-01

    Aim: The aim of this investigation was to estimate and contrast the global incidence and outcome of out-of-hospital cardiac arrest (OHCA) to provide a better understanding of the variability in risk and survival of OHCA. Methods: We conducted a review of published English-language articles about inc

  2. Daily Arrests

    Data.gov (United States)

    Montgomery County of Maryland — This dataset provides the public with arrest information from the Montgomery County Central Processing Unit (CPU) systems. The data presented is derived from every...

  3. A hybrid approach to calculate the Shielding Failure-Caused Trip-out Rate

    Directory of Open Access Journals (Sweden)

    Zhou Liang

    2016-01-01

    Full Text Available Lightning has become a big threat to the safe operation of the main transmission line. Reasonable and accurate calculation of shielding failure rate plays important role in transmission line and tower design. This paper proposes a hybrid approach to calculate the shielding failure-caused trip-out rate, based on the typical electro-geometric model and the regulation method. The case study prove the validity and correctness of this approach, by comparing with the actual operation shielding failure rate.

  4. The research on aging failure rate and optimization estimation of protective relay under haze conditions

    Science.gov (United States)

    Wang, Ying-kang; Zhou, Meng-ran; Yang, Jie; Zhou, Pei-qiang; Xie, Ying

    2017-01-01

    In the fog and haze, the air contains large amounts of H2S, SO2, SO3 and other acids, air conductivity is greatly improved, the relative humidity is also greatly increased, Power transmission lines and electrical equipment in such an environment will increase in the long-running failure ratedecrease the sensitivity of the detection equipment, impact protection device reliability. Weibull distribution is widely used in component failure distribution fitting. It proposes a protection device aging failure rate estimation method based on the least squares method and the iterative method,.Combined with a regional power grid statistics, computing protective equipment failure rate function. Binding characteristics of electrical equipment operation status under haze conditions, optimization methods, get more in line with aging protection equipment failure under conditions of haze characteristics.

  5. Cardiac arrest - cardiopulmonary resuscitation

    Institute of Scientific and Technical Information of China (English)

    Basri Lenjani; Besnik Elshani; Nehat Baftiu; Kelmend Pallaska; Kadir Hyseni; Njazi Gashi; Nexhbedin Karemani; Ilaz Bunjaku; Taxhidin Zaimi; Arianit Jakupi

    2014-01-01

    Objective:To investigate application of cardiopulmonary resuscitation(CPR) measures within the golden minutes inEurope.Methods:The material was taken from theUniversityClinical Center ofKosovo -EmergencyCentre inPristina, during the two(2) year period(2010-2011).The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.Results:During the2010 to2011 in the emergency center of theCUCK inPristina have been treated a total of269 patients with cardiac arrest, of whom159 or59.1% have been treated in2010, and110 patients or40.9% in2011.Of the269 patients treated in the emergency centre,93 or34.6% have exited lethally in the emergency centre, and176 or 65.4% have been transferred to other clinics.In the total number of patients with cardiac arrest, males have dominated with186 cases, or69.1%.The average age of patients included in the survey was56.7 year oldSD±16.0 years.Of the269 patients with cardiac arrest, defibrillation has been applied for93 or34.6% of patients.In the outpatient settings defibrillation has been applied for3 or3.2% of patients.Patients were defibrillated with application of one to four shocks. Of27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home,3 or11.1% of them have suffered cardiac arrest on the street, and24 or88.9% of them have suffered cardiac arrest in the hospital.5 out of27 patients survived have ended with neurological impairment.Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been onMonday with32.0% of cases, and onFriday with24.5% of cases. Conclusions:All survivors from cardiac arrest have received appropriate medical assistance within10 min from attack, which implies that if cardiac arrest occurs near an institution health care(with an opportunity to provide the emergent health care) the rate of survival is higher.

  6. Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study.

    LENUS (Irish Health Repository)

    Moran, D

    2014-08-23

    We assessed adherence to European Society of Cardiology heart rate guidelines (i.e. heart rates less than 70bpm) in patients with chronic stable heart failure. We also investigated the percent of patients on target doses of rate controlling drugs.

  7. Reducing the failure rate in introductory physics classes

    Science.gov (United States)

    Saul, Jeff; Coulombe, Patrick; Lindell, Rebecca

    2017-01-01

    Calculus-based introductory physics courses are often among the most difficult at many colleges and universities. With the national movement to increase STEM majors, the introductory calculus-based courses need to be less of a weed-out course and more of a course that propels students forward into successful majors. This talk discusses two approaches to reduce DFW rates and improve student retention: studio courses and parachute courses. Studio courses integrate lecture/laboratory into one course where the primary mode of instruction is small group activities. Typically, any students enrolled in the college or university can enroll in a studio version of the course. Parachute courses on the other hand, focus on the poor performing students. Designed so that students not doing well in an introductory physics course can switch into the parachute class mid-semester without harm to their GPA. In addition, the parachute course focuses on helping students build the knowledge and skills necessary for success when retaking the calculus-based Physics course. The studio course format has been found to reduce DFW rates at several universities by 40-60% compared with separate lecture and laboratory format versions of the same courses, while parachutes courses were less successful. At one university, the parachute course succeeded in helping 80% of students maintain their GPA, but only helped 20% successfully pass the calculus-based physics course.

  8. Heart rate modulation by sympathetic nerves in dogs with heart failure.

    Science.gov (United States)

    Uechi, Masami; Shimizu, Akira; Mizuno, Masashi

    2002-11-01

    To clarify heart rate modulation by the sympathetic nervous system, dogs with naturally acquired and experimentally induced heart failure were examined. Heart rate and plasma catecholamine concentrations were measured in clinically healthy dogs (control dogs) and dogs with mitral regurgitation (MR) during a resting period, a standing period, a period of standing in a medical examination room (to which the dogs were unaccustomed), a running period, and a period of recovery after running. The heart rate and plasma catecholamine concentration increased in control dogs during the standing period and the medical examination room period, relative to the resting period. However, dogs with MR did not exhibit any clear increase in heart rate or catecholamine concentration under these light stress conditions. Running stress increased plasma catecholamine levels in control dogs; however, dogs with MR did not exhibit any significant changes. Thirty-two dogs with naturally acquired heart disease were classified as grades I to III on the ISACHC scale. The degree of increase in heart rate and plasma catecholamine levels in dogs with naturally acquired heart failure depended on their degree of heart failure. In conclusion, an increased heart rate and an activated sympathetic nervous system were observed, even in mild heart failure. This chronically activated sympathetic activity is expected to increase myocardial oxygen consumption, myocardial hypertrophy, and fibrosis, and to portend a poorer prognosis in heart failure.

  9. Crop failure rates in a geoengineered climate: impact of climate change and marine cloud brightening

    Science.gov (United States)

    Parkes, B.; Challinor, A.; Nicklin, K.

    2015-08-01

    The impact of geoengineering on crops has to date been studied by examining mean yields. We present the first work focusing on the rate of crop failures under a geoengineered climate. We investigate the impact of a future climate and a potential geoengineering scheme on the number of crop failures in two regions, Northeastern China and West Africa. Climate change associated with a doubling of atmospheric carbon dioxide increases the number of crop failures in Northeastern China while reducing the number of crop failures in West Africa. In both regions marine cloud brightening is likely to reduce the number crop failures, although it is more effective at reducing mild crop failure than severe crop failure. We find that water stress, rather than heat stress, is the main cause of crop failure in current, future and geoengineered climates. This demonstrates the importance of irrigation and breeding for tolerance to water stress as adaptation methods in all futures. Analysis of global rainfall under marine cloud brightening has the potential to significantly reduce the impact of climate change on global wheat and groundnut production.

  10. Automated Production Flow Line Failure Rate Mathematical Analysis with Probability Theory

    Directory of Open Access Journals (Sweden)

    Tan Chan Sin

    2014-12-01

    Full Text Available Automated lines have been widely used in the industries especially for mass production and to customize product. Productivity of automated line is a crucial indicator to show the output and performance of the production. Failure or breakdown of station or mechanisms is commonly occurs in the automated line in real condition due to the technological and technical problem which is highly affect the productivity. The failure rates of automated line are not express or analyse in terms of mathematic form. This paper presents the mathematic analysis by using probability theory towards the failure condition in automated line. The mathematic express for failure rates can produce and forecast the output of productivity accurately

  11. Cardiac arrest – cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Basri Lenjani

    2014-01-01

    Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

  12. Associates of Cardiopulmonary Arrest in the Perihemodialytic Period

    Directory of Open Access Journals (Sweden)

    Jennifer E. Flythe

    2014-01-01

    Full Text Available Cardiopulmonary arrest during and proximate to hemodialysis is rare but highly fatal. Studies have examined peridialytic sudden cardiac event risk factors, but no study has considered associates of cardiopulmonary arrests (fatal and nonfatal events including cardiac and respiratory causes. This study was designed to elucidate patient and procedural factors associated with peridialytic cardiopulmonary arrest. Data for this case-control study were taken from the hemodialysis population at Fresenius Medical Care, North America. 924 in-center cardiopulmonary events (cases and 75,538 controls were identified. Cases and controls were 1 : 5 matched on age, sex, race, and diabetes. Predictors of cardiopulmonary arrest were considered for logistic model inclusion. Missed treatments due to hospitalization, lower body mass, coronary artery disease, heart failure, lower albumin and hemoglobin, lower dialysate potassium, higher serum calcium, greater erythropoietin stimulating agent dose, and normalized protein catabolic rate (J-shaped were associated with peridialytic cardiopulmonary arrest. Of these, lower albumin, hemoglobin, and body mass index; higher erythropoietin stimulating agent dose; and greater missed sessions had the strongest associations with outcome. Patient health markers and procedural factors are associated with peridialytic cardiopulmonary arrest. In addition to optimizing nutritional status, it may be prudent to limit exposure to low dialysate potassium (<2 K bath and to use the lowest effective erythropoietin stimulating agent dose.

  13. An Efficient Implementation of Fixed Failure-Rate Ratio Test for GNSS Ambiguity Resolution

    Science.gov (United States)

    Hou, Yanqing; Verhagen, Sandra; Wu, Jie

    2016-01-01

    Ambiguity Resolution (AR) plays a vital role in precise GNSS positioning. Correctly-fixed integer ambiguities can significantly improve the positioning solution, while incorrectly-fixed integer ambiguities can bring large positioning errors and, therefore, should be avoided. The ratio test is an extensively used test to validate the fixed integer ambiguities. To choose proper critical values of the ratio test, the Fixed Failure-rate Ratio Test (FFRT) has been proposed, which generates critical values according to user-defined tolerable failure rates. This contribution provides easy-to-implement fitting functions to calculate the critical values. With a massive Monte Carlo simulation, the functions for many different tolerable failure rates are provided, which enriches the choices of critical values for users. Moreover, the fitting functions for the fix rate are also provided, which for the first time allows users to evaluate the conditional success rate, i.e., the success rate once the integer candidates are accepted by FFRT. The superiority of FFRT over the traditional ratio test regarding controlling the failure rate and preventing unnecessary false alarms is shown by a simulation and a real data experiment. In the real data experiment with a baseline of 182.7 km, FFRT achieved much higher fix rates (up to 30% higher) and the same level of positioning accuracy from fixed solutions as compared to the traditional critical value. PMID:27347949

  14. An Efficient Implementation of Fixed Failure-Rate Ratio Test for GNSS Ambiguity Resolution

    Directory of Open Access Journals (Sweden)

    Yanqing Hou

    2016-06-01

    Full Text Available Ambiguity Resolution (AR plays a vital role in precise GNSS positioning. Correctly-fixed integer ambiguities can significantly improve the positioning solution, while incorrectly-fixed integer ambiguities can bring large positioning errors and, therefore, should be avoided. The ratio test is an extensively used test to validate the fixed integer ambiguities. To choose proper critical values of the ratio test, the Fixed Failure-rate Ratio Test (FFRT has been proposed, which generates critical values according to user-defined tolerable failure rates. This contribution provides easy-to-implement fitting functions to calculate the critical values. With a massive Monte Carlo simulation, the functions for many different tolerable failure rates are provided, which enriches the choices of critical values for users. Moreover, the fitting functions for the fix rate are also provided, which for the first time allows users to evaluate the conditional success rate, i.e., the success rate once the integer candidates are accepted by FFRT. The superiority of FFRT over the traditional ratio test regarding controlling the failure rate and preventing unnecessary false alarms is shown by a simulation and a real data experiment. In the real data experiment with a baseline of 182.7 km, FFRT achieved much higher fix rates (up to 30% higher and the same level of positioning accuracy from fixed solutions as compared to the traditional critical value.

  15. An Efficient Implementation of Fixed Failure-Rate Ratio Test for GNSS Ambiguity Resolution.

    Science.gov (United States)

    Hou, Yanqing; Verhagen, Sandra; Wu, Jie

    2016-06-23

    Ambiguity Resolution (AR) plays a vital role in precise GNSS positioning. Correctly-fixed integer ambiguities can significantly improve the positioning solution, while incorrectly-fixed integer ambiguities can bring large positioning errors and, therefore, should be avoided. The ratio test is an extensively used test to validate the fixed integer ambiguities. To choose proper critical values of the ratio test, the Fixed Failure-rate Ratio Test (FFRT) has been proposed, which generates critical values according to user-defined tolerable failure rates. This contribution provides easy-to-implement fitting functions to calculate the critical values. With a massive Monte Carlo simulation, the functions for many different tolerable failure rates are provided, which enriches the choices of critical values for users. Moreover, the fitting functions for the fix rate are also provided, which for the first time allows users to evaluate the conditional success rate, i.e., the success rate once the integer candidates are accepted by FFRT. The superiority of FFRT over the traditional ratio test regarding controlling the failure rate and preventing unnecessary false alarms is shown by a simulation and a real data experiment. In the real data experiment with a baseline of 182.7 km, FFRT achieved much higher fix rates (up to 30% higher) and the same level of positioning accuracy from fixed solutions as compared to the traditional critical value.

  16. HEART RATE VARIABILITY IN ASSESSMENT OF CLINICAL STATUS, FUNCTIONAL CONDITIONS AND PROGNOSIS IN HEART FAILURE

    Directory of Open Access Journals (Sweden)

    Y. A. Vasyuk

    2006-01-01

    Full Text Available Data about heart rate variability analysis in healthy people and patients with chronic heart failure are reviewed. Prognostic value of time-domain and spectral measures is mentioned. Influence of standard therapy on heart rate variability is described.

  17. Modeling of failure mode in knee ligaments depending on the strain rate

    Directory of Open Access Journals (Sweden)

    Hyman William

    2002-01-01

    Full Text Available Abstract Background The failure mechanism of the knee ligament (bone-ligament-bone complex at different strain rates is an important subject in the biomechanics of the knee. This study reviews and summarizes the literature describing ligament injury as a function of stain rate, which has been published during the last 30 years. Methods Three modes of injury are presented as a function of strain rate, and they are used to analyze the published cases. The number of avulsions is larger than that of ligament tearing in mode I. There is no significant difference between the number of avulsions and ligament tearing in mode II. Ligament tearing happens more frequently than avulsion in mode III. Results When the strain rate increases, the order of mode is mode I, II, III, I, and II. Analytical models of ligament behavior as a function of strain rate are also presented and used to provide an integrated framework for describing all of the failure regimes. In addition, this study showed the failure mechanisms with different specimens, ages, and strain rates. Conclusion There have been several a numbers of studies of ligament failure under various conditions including widely varying strain rates. One issue in these studies is whether ligament failure occurs mid-ligament or at the bone attachment point, with assertions that this is a function of the strain rate. However, over the range of strain rates and other conditions reported, there has appeared to be discrepancies in the conclusions on the effect of strain rate. The analysis and model presented here provides a unifying assessment of the previous disparities, emphasizing the differential effect of strain rate on the relative strengths of the ligament and the attachment.

  18. Noninvasive ventilation for acute hypercapnic respiratory failure: intubation rate in an experienced unit.

    Science.gov (United States)

    Contou, Damien; Fragnoli, Chiara; Córdoba-Izquierdo, Ana; Boissier, Florence; Brun-Buisson, Christian; Thille, Arnaud W

    2013-12-01

    Failure of noninvasive ventilation (NIV) is common in patients with COPD admitted to the ICU for acute hypercapnic respiratory failure (AHRF). We aimed to assess the rate of NIV failure and to identify early predictors of intubation under NIV in patients admitted for AHRF of all origins in an experienced unit. This was an observational cohort study using data prospectively collected over a 3-year period after the implementation of a nurse-driven NIV protocol in a 24-bed medical ICU of a French university hospital. Among 242 subjects receiving NIV for AHRF (P(aCO2) > 45 mm Hg), 67 had cardiogenic pulmonary edema (CPE), 146 had acute-on-chronic respiratory failure (AOCRF) (including 99 subjects with COPD and 47 with other chronic respiratory diseases), and 29 had non-AOCRF (mostly pneumonia). Overall, the rates of intubation and ICU mortality were respectively 15% and 5%. The intubation rates were 4% in CPE, 15% in AOCRF, and 38% in non-AOCRF (P intubation rate was reduced to 15% in patients receiving NIV for AHRF, with a mortality rate of only 5%. Whereas the risk of NIV failure is associated with hypoxemia and acidosis after initiation of NIV, it is also markedly influenced by the presence or absence of an underlying chronic respiratory disease.

  19. Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates

    Directory of Open Access Journals (Sweden)

    Sund Björn

    2013-02-01

    Full Text Available Abstract Background Out-of-hospital cardiac arrest (OHCA is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study. Methods and results This was done by combining a geographic information systems (GIS simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data. Conclusion We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1 static changes such as trimming the emergency call handling time or (2 dynamic changes such as location of emergency resources or which resources should carry a defibrillator.

  20. [Failure rate and revision surgery in ossiculoplasty with Kurz titanium prosthesis].

    Science.gov (United States)

    Nguyen, D Q; Lavieille, J P; Schmerber, S

    2004-01-01

    Despite its excellent biocompatibility, failures and in particular extrusion of the prosthesis have been described in ossiculoplasty with titanium prosthesis. Report our experience with revision ossicular recontruction in ossiculoplasty with Kurz prosthesis. Identify causes of failure in ossiculoplasty using the titanium prosthesis. Retrospective chart reviews were performed for 110 patients who had undergone titanium ossicular implants between November 1998 and 2002. All patients had undergone ossiculoplasty using titanium middle ear implants. Patients were divided into 2 groups: in group 1 patients underwent revision ossiculoplasty; in group 2 patients had a successful surgery at first stage. Anatomic and functional results have been studied in these two groups. Causes of failures were analysed. The overall failure rate was 20% (22/110). Twenty patients underwent revision ossiculoplasty. Nine primary failures were attributable to a short implant. Two extrusions were observed. At long term billow-up, the functional gain between the primary and revision ossiculoplasty was comparable. Revision ossiculoplasty is worthwhile for those patients who have failure of the titanium prosthesis in ossiculoplasty. A large cartilage graft interposition is necessary to prevent extrusion. The overall luxation rate observed in our series was mainly due to a too short prosthesis and we recommend now a reconstruction with longer prosthesis.

  1. Effect of yoga therapy on heart rate, blood pressure and cardiac autonomic function in heart failure.

    Science.gov (United States)

    Krishna, Bandi Hari; Pal, Pravati; G K, Pal; J, Balachander; E, Jayasettiaseelon; Y, Sreekanth; M G, Sridhar; G S, Gaur

    2014-01-01

    It is well known that a hall mark of heart failure is adverse changes in autonomic function. Elevated blood pressure is a powerful predictor of congestive heart failure and other Cardiovascular Disease (CVD) outcomes. In this study, we planned to examine the effects of a 12 week yoga therapy on blood pressure, heart rate, heart rate variability, and rate pressure product (RPP). Out of 130 heart failure patients recruited for the study, 65 patients were randomly selected to receive 12 week yoga therapy along with standard medical therapy (yoga group). Other patients (n=65) received only standard medical therapy (control group). Heart rate, blood pressure, cardiac autonomic function (by short-term heart-rate variability analysis) and myocardial oxygen consumption (by RPP) were assessed before and after 12 weeks. In the yoga group, 44 patients and in the control group, 48 patients completed the study. There was a significant decrease in heart rate, blood pressure and RPP in yoga group compared to control group. Also, LFnu and LF-HF ratio decreased significantly and HFnu increased significantly in yoga group compared to control group. Twelve-week yoga therapy significantly improved the parasympathetic activity and decreased the sympathetic activity in heart failure patients (NYHA I&II).

  2. System Availability in the Presence of Estimating Common-cause Time-varying Failure Rates

    Directory of Open Access Journals (Sweden)

    M. A. El-Damcese

    2005-01-01

    Full Text Available This study presents a method for calculating the availability of a system depicted by availability block diagram, with identically distributed components, in the presence of estimating common cause hazard, we use the Marshall and Olkin formulation of the multivariate exponential distribution. That is, the components are subject to failure by Poisson failure processes that govern simultaneous failure of a specific subset of the components. A model is proposed for the analysis of systems subject to common-cause failures that are not considered to have a constant rate but that are assumed to obey a uniqueness of maximum likelihood estimators of the 2-parameter Weibull distribution. The method for calculating the system availability requires that a procedure exists for determining the system availability from component availabilities, under the statistically independent component assumption. The study includes an example to illustrate the method.

  3. A New Finite Interval Lifetime Distribution Model for Fitting Bathtub-Shaped Failure Rate Curve

    Directory of Open Access Journals (Sweden)

    Xiaohong Wang

    2015-01-01

    Full Text Available This paper raised a new four-parameter fitting model to describe bathtub curve, which is widely used in research on components’ life analysis, then gave explanation of model parameters, and provided parameter estimation method as well as application examples utilizing some well-known lifetime data. By comparative analysis between the new model and some existing bathtub curve fitting model, we can find that the new fitting model is very convenient and its parameters are clear; moreover, this model is of universal applicability which is not only suitable for bathtub-shaped failure rate curves but also applicable for the constant, increasing, and decreasing failure rate curves.

  4. Relationship between diameter of split Hopkinson pressure bar and minimum loading rate under rock failure

    Institute of Scientific and Technical Information of China (English)

    LI Xi-bing; HONG Liang; YIN Tu-bing; ZHOU Zi-long; YE Zhou-yuan

    2008-01-01

    In order to investigate the relationship between bar diameter and loading rate of the split Hopkinson pressure bar(SHPB) setup under the failure of rock specimen and realize the medium strain rate loading of specimen, new SHPB setups with different elastic bar's diameters of 22, 36, 50 and 75 mm were constructed. The tests were carried out on these setups at different loading rates, and the specimens had the same diameter of elastic bars and same ratio of length to diameter. The test results show that the larger the elastic bar's diameter is, the less the loading rate is needed to cause specimen failure, they show good power relationship, and that under the same strain rate loading, specimens are broken more seriously with larger diameter SHPB setup than with smaller one.

  5. DETECTING CONGESTIVE HEART FAILURE USING HEART RATE SEQUENTIAL TREND ANALYSIS PLOT

    Directory of Open Access Journals (Sweden)

    SRINIVAS KUNTAMALLA,

    2010-12-01

    Full Text Available Heart rate variability analysis is gaining acceptance as a potential non-invasive means of autonomic nervous system assessment in research as well as clinical domains. In this study, a nonlinear analysis method is developed to detect congestive heart failure. The data obtained from an online and widely used public database (i.e., MIT/BIH physionet database, is used for testing the performance of the method. The method developed is based on the sequential trend analysis plot of heart rate variability and correlates well with the characteristic autonomic nervous system regulations in congestive heart failure. The proposed method can be used for screening as well as diagnosing the heart failure patients. The algorithm is computationally simple and can be implemented in a real time processing hardware. This method classifies 31 out of 32 subjects and has the highest discrimination power in terms of sensitivity, specificity and accuracy.

  6. STATISTICAL INFERENCE OF WEIBULL DISTRIBUTION FOR TAMPERED FAILURE RATE MODEL IN PROGRESSIVE STRESS ACCELERATED LIFE TESTING

    Institute of Scientific and Technical Information of China (English)

    WANG Ronghua; FEI Heliang

    2004-01-01

    In this note, the tampered failure rate model is generalized from the step-stress accelerated life testing setting to the progressive stress accelerated life testing for the first time. For the parametric setting where the scale parameter satisfying the equation of the inverse power law is Weibull, maximum likelihood estimation is investigated.

  7. A Comparison of Success and Failure Rates between Computer-Assisted and Traditional College Algebra Sections

    Science.gov (United States)

    Herron, Sherry; Gandy, Rex; Ye, Ningjun; Syed, Nasser

    2012-01-01

    A unique aspect of the implementation of a computer algebra system (CAS) at a comprehensive university in the U.S. allowed us to compare the student success and failure rates to the traditional method of teaching college algebra. Due to space limitations, the university offered sections of both CAS and traditional simultaneously and, upon…

  8. HEART RATE-LOWERING THERAPY IN THE TREATMENT OF CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    S. V. Shalaev

    2015-01-01

    Full Text Available Aspects of heart rate-lowering therapy in patients with chronic heart failure using If-channel blocker ivabradine are discussed. The evidence-based data on ivabradine use reveal its advantages, disadvantages and place in the treatment of cardiac patients.

  9. HEART RATE-LOWERING THERAPY IN THE TREATMENT OF CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    S. V. Shalaev

    2015-09-01

    Full Text Available Aspects of heart rate-lowering therapy in patients with chronic heart failure using If-channel blocker ivabradine are discussed. The evidence-based data on ivabradine use reveal its advantages, disadvantages and place in the treatment of cardiac patients.

  10. Failure rate and cosmesis of immediate tissue expander/implant breast reconstruction after postmastectomy irradiation.

    Science.gov (United States)

    Baschnagel, Andrew M; Shah, Chirag; Wilkinson, J Ben; Dekhne, Nayana; Arthur, Douglas W; Vicini, Frank A

    2012-12-01

    This study reports the rate of breast reconstruction failure and cosmetic outcomes after postmastectomy radiation therapy (PMRT) with temporary tissue expanders (TEs) or implants in place. Ninety-four patients underwent mastectomy (93 unilateral, 1 bilateral; 95 cases total) and immediate TE reconstruction followed by PMRT. Ninety TEs and 5 permanent implants were irradiated. All patients received a dose of 5400 cGy given in 180-cGy fractions to the reconstructed breast. Twenty-one patients (22%) received tangents alone and 74 patients (78%) were treated with tangents and a supraclavicular field using a monoisocentric technique. Bolus was used in 91 patients (96%). Eighty-eight patients (93%) received chemotherapy and 78 patients (82%) received endocrine therapy. With a median follow-up of 24.1 months, 19 patients (20%) experienced failure of reconstruction. The 1-, 2-, and 3-year actuarial rate of reconstruction failure was 9.7%, 19.3%, and 25.5%, respectively. Infection was the most common cause of failure. Of the 19 failures, 8 patients underwent salvage procedures with flap reconstruction. Univariate analysis was performed examining age, chemotherapy use, hormone therapy use, use of a supraclavicular field, smoking status, diabetes, hypertension, and menopausal status. No risk factors were found to be associated with reconstruction failure. In patients who did not experience reconstruction failure, good/excellent cosmesis was observed in 75% of patients. In the current series of women with a high risk of locoregional recurrence, PMRT with a TE/implant in place provides good cosmesis in the majority of women, with an acceptable risk of expander or implant loss. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Failure Rate of Single Dose Methotrexate in Managment of Ectopic Pregnancy

    Directory of Open Access Journals (Sweden)

    Feras Sendy

    2015-01-01

    Full Text Available Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67% received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225 of the patients. 28% (63/225 were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63 of failure received a second dose of methotrexate, and 37% (23/63 underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate.

  12. Rate-weakening friction characterizes both slow sliding and catastrophic failure of landslides

    Science.gov (United States)

    Handwerger, Alexander L.; Rempel, Alan W.; Skarbek, Rob M.; Roering, Joshua J.; Hilley, George E.

    2016-09-01

    Catastrophic landslides cause billions of dollars in damages and claim thousands of lives annually, whereas slow-moving landslides with negligible inertia dominate sediment transport on many weathered hillslopes. Surprisingly, both failure modes are displayed by nearby landslides (and individual landslides in different years) subjected to almost identical environmental conditions. Such observations have motivated the search for mechanisms that can cause slow-moving landslides to transition via runaway acceleration to catastrophic failure. A similarly diverse range of sliding behavior, including earthquakes and slow-slip events, occurs along tectonic faults. Our understanding of these phenomena has benefitted from mechanical treatments that rely upon key ingredients that are notably absent from previous landslide descriptions. Here, we describe landslide motion using a rate- and state-dependent frictional model that incorporates a nonlocal stress balance to account for the elastic response to gradients in slip. Our idealized, one-dimensional model reproduces both the displacement patterns observed in slow-moving landslides and the acceleration toward failure exhibited by catastrophic events. Catastrophic failure occurs only when the slip surface is characterized by rate-weakening friction and its lateral dimensions exceed a critical nucleation length h*h* that is shorter for higher effective stresses. However, landslides that are extensive enough to fall within this regime can nevertheless slide slowly for months or years before catastrophic failure. Our results suggest that the diversity of slip behavior observed during landslides can be described with a single model adapted from standard fault mechanics treatments.

  13. Failure rate of single dose methotrexate in managment of ectopic pregnancy.

    Science.gov (United States)

    Sendy, Feras; AlShehri, Eman; AlAjmi, Amani; Bamanie, Elham; Appani, Surekha; Shams, Taghreed

    2015-01-01

    Background. One of the treatment modalities for ectopic pregnancy is methotrexate. The purpose of this study is to identify the failure rate of methotrexate in treating patients with ectopic pregnancy as well as the risk factors leading to treatment failure. Methods. A retrospective chart review of 225 patients who received methotrexate as a primary management option for ectopic pregnancy. Failure of single dose of methotrexate was defined as drop of BHCG level less than or equal to 14% in the seventh day after administration of methotrexate. Results. 225 patients had methotrexate. Most of the patients (151 (67%)) received methotrexate based on the following formula: f 50 mg X body surface area. Single dose of methotrexate was successful in 72% (162/225) of the patients. 28% (63/225) were labeled as failure of single dose of methotrexate because of suboptimal drop in BhCG. 63% (40/63) of failure received a second dose of methotrexate, and 37% (23/63) underwent surgical treatment. Among patient who received initial dose of methotrexate, 71% had moderate or severe pain, and 58% had ectopic mass size of more than 4 cm on ultrasound. Conclusion. Liberal use of medical treatment of ectopic pregnancy results in 71% success rate.

  14. Rate-weakening friction characterizes both slow sliding and catastrophic failure of landslides.

    Science.gov (United States)

    Handwerger, Alexander L; Rempel, Alan W; Skarbek, Rob M; Roering, Joshua J; Hilley, George E

    2016-09-13

    Catastrophic landslides cause billions of dollars in damages and claim thousands of lives annually, whereas slow-moving landslides with negligible inertia dominate sediment transport on many weathered hillslopes. Surprisingly, both failure modes are displayed by nearby landslides (and individual landslides in different years) subjected to almost identical environmental conditions. Such observations have motivated the search for mechanisms that can cause slow-moving landslides to transition via runaway acceleration to catastrophic failure. A similarly diverse range of sliding behavior, including earthquakes and slow-slip events, occurs along tectonic faults. Our understanding of these phenomena has benefitted from mechanical treatments that rely upon key ingredients that are notably absent from previous landslide descriptions. Here, we describe landslide motion using a rate- and state-dependent frictional model that incorporates a nonlocal stress balance to account for the elastic response to gradients in slip. Our idealized, one-dimensional model reproduces both the displacement patterns observed in slow-moving landslides and the acceleration toward failure exhibited by catastrophic events. Catastrophic failure occurs only when the slip surface is characterized by rate-weakening friction and its lateral dimensions exceed a critical nucleation length [Formula: see text] that is shorter for higher effective stresses. However, landslides that are extensive enough to fall within this regime can nevertheless slide slowly for months or years before catastrophic failure. Our results suggest that the diversity of slip behavior observed during landslides can be described with a single model adapted from standard fault mechanics treatments.

  15. Prediction of cardiac arrest recurrence using ensemble classifiers

    Indian Academy of Sciences (India)

    NACHIKET TAPAS; TUSHAR LONE; DAMODAR REDDY; VENKATANARESH KUPPILI

    2017-07-01

    Inability of a heart to contract effectually or its failure to contract prevents blood from circulating efficiently, causing circulatory arrest or cardiac arrest or cardiopulmonary arrest. The unexpected cardiac arrest is medically referred to as sudden cardiac arrest (SCA). Poor survival rate of patients with SCA is one of themost ubiquitous health care problems today. Recent studies show that heart-rate-derived features can act as early predictors of SCA. Addition of angiographic and electrophysiological features can increase the robustness of the prediction system. Early warning has the capability of saving many lives. Risk of recurrent terminal cardiac arrest is high for out-of-hospital survivors. Foregoing studies indicate that recurrent cardiac events are time dependent and, while in clinical follow-up, are highly probable, predominantly in early phase. In this paper, we observe the changing risk of and changing influence of various clinical, angiographic and electrophysiological parameters on subsequent cardiac arrest recurrence with time. Various medical and synthetic datasets such as ECG dataset from PhysioNet, Pima Indian Diabetes dataset from UCI Machine Learning Repository and gene expression dataset from GEO are used, which are unique as compared with related works. Various classifiers such as LogitBoost with simple regression function, random forest and multilayer perceptron are used for recurrence risk prediction. Collection of these classifiers together forms the ensemble classifiers. Classifiers are compared based on various measures like accuracy and precision. Based on the classification, risk scores are calculated using logistic regression with backward elimination. The proposed method is used for final risk estimation. The same datasets are used for risk score calculation model development. Experimental results are found to be encouraging.

  16. Heart-rate variability depression in porcine peritonitis-induced sepsis without organ failure.

    Science.gov (United States)

    Jarkovska, Dagmar; Valesova, Lenka; Chvojka, Jiri; Benes, Jan; Danihel, Vojtech; Sviglerova, Jitka; Nalos, Lukas; Matejovic, Martin; Stengl, Milan

    2017-05-01

    Depression of heart-rate variability (HRV) in conditions of systemic inflammation has been shown in both patients and experimental animal models and HRV has been suggested as an early indicator of sepsis. The sensitivity of HRV-derived parameters to the severity of sepsis, however, remains unclear. In this study we modified the clinically relevant porcine model of peritonitis-induced sepsis in order to avoid the development of organ failure and to test the sensitivity of HRV to such non-severe conditions. In 11 anesthetized, mechanically ventilated and instrumented domestic pigs of both sexes, sepsis was induced by fecal peritonitis. The dose of feces was adjusted and antibiotic therapy was administered to avoid multiorgan failure. Experimental subjects were screened for 40 h from the induction of sepsis. In all septic animals, sepsis with hyperdynamic circulation and increased plasma levels of inflammatory mediators developed within 12 h from the induction of peritonitis. The sepsis did not progress to multiorgan failure and there was no spontaneous death during the experiment despite a modest requirement for vasopressor therapy in most animals (9/11). A pronounced reduction of HRV and elevation of heart rate developed quickly (within 5 h, time constant of 1.97 ± 0.80 h for HRV parameter TINN) upon the induction of sepsis and were maintained throughout the experiment. The frequency domain analysis revealed a decrease in the high-frequency component. The reduction of HRV parameters and elevation of heart rate preceded sepsis-associated hemodynamic changes by several hours (time constant of 11.28 ± 2.07 h for systemic vascular resistance decline). A pronounced and fast reduction of HRV occurred in the setting of a moderate experimental porcine sepsis without organ failure. Inhibition of parasympathetic cardiac signaling probably represents the main mechanism of HRV reduction in sepsis. The sensitivity of HRV to systemic inflammation may allow

  17. Flow and failure of an aluminium alloy from low to high temperature and strain rate

    Directory of Open Access Journals (Sweden)

    Sancho Rafael

    2015-01-01

    Full Text Available The mechanical behaviour of an aluminium alloy is presented in this paper. The study has been carried out to analyse the flow and failure of the aluminium alloy 7075-T73. An experimental study has been planned performing tests of un-notched and notched tensile specimens at low strain rates using a servo-hydraulic machine. High strain rate tests have been carried out using the same geometry in a Hopkinson Split Tensile Bar. The dynamic experiments at low temperature were performed using a cryogenic chamber, and the high temperature ones with a furnace, both incorporated to the Hopkinson bar. Testing temperatures ranged from − 50 ∘C to 100 ∘C and the strain rates from 10−4 s−1 to 600 s−1. The material behaviour was modelled using the Modified Johnson-Cook model and simulated using LS-DYNA. The results show that the Voce type of strain hardening is the most accurate for this material, while the traditional Johnson-Cook is not enough accurate to reproduce the necking of un-notched specimens. The failure criterion was obtained by means of the numerical simulations using the analysis of the stress triaxiality versus the strain to failure. The diameters at the failure time were measured using the images taken with an image camera, and the strain to failure was computed for un-notched and notched specimens. The numerical simulations show that the analysis of the evolution of the stress triaxiality is crucial to achieve accurate results. A material model using the Modified Johnson-Cook for flow and failure is proposed.

  18. Effectivness Of The Failure Rate On Maintenance Costs Of The City Buses

    Directory of Open Access Journals (Sweden)

    Ignaciuk Piotr

    2015-11-01

    Full Text Available The purpose of this paper was to present a failure rate and maintenance cost comparison for two types of city transport buses. The paper presents in detail a case study of well known bus brands used at Municipal Transport Company in Lublin. A failure index of all functional and constructional systems of the vehicles and their technical availability with regards to calendar time was determined. The paper also presents analysis of the factors related to maintenance costs of buses, including costs of fluids, repair costs and maintenance service. It has been demonstrated, that both analyzed buses generate similar maintenance costs, while their failures and technical availability differ significantly in operational practice. These differences are particularly evident in relation to the cumulative costs of repairs.

  19. Poor self-rated health predicts mortality in patients with stable chronic heart failure.

    Science.gov (United States)

    Inkrot, Simone; Lainscak, Mitja; Edelmann, Frank; Loncar, Goran; Stankovic, Ivan; Celic, Vera; Apostolovic, Svetlana; Tahirovic, Elvis; Trippel, Tobias; Herrmann-Lingen, Christoph; Gelbrich, Götz; Düngen, Hans-Dirk

    2016-12-01

    In heart failure, a holistic approach incorporating the patient's perspective is vital for prognosis and treatment. Self-rated health has strong associations with adverse events and short-term mortality risk, but long-term data are limited. We investigated the predictive value of two consecutive self-rated health assessments with regard to long-term mortality in a large, well characterised sample of elderly patients with stable chronic heart failure. We measured self-rated health by asking 'In general, would you say your health is: 1, excellent; 2, very good; 3, good; 4, fair; 5, poor?' twice: at baseline and the end of a 12-week beta-blocker up-titration period in the CIBIS-ELD trial. Mortality was assessed in an observational follow-up after 2-4 years. A total of 720 patients (mean left ventricular ejection fraction 45±12%, mean age 73±5 years, 36% women) rated their health at both time points. During long-term follow-up, 144 patients died (all-cause mortality 20%). Fair/poor self-rated health in at least one of the two reports was associated with increased mortality (hazard ratio 1.42 per level; 95% confidence interval 1.16-1.75; Ppro B-type natriuretic peptide (NTproBNP), heart rate and other risk prediction covariates. Self-rated health by one level worse was as predictive for mortality as a 1.9-fold increase in NTproBNP. Poor self-rated health predicts mortality in our long-term follow-up of patients with stable chronic heart failure, even after adjustment for established risk predictors. We encourage clinicians to capture patient-reported self-rated health routinely as an easy to assess, clinically meaningful measure and pay extra attention when self-rated health is poor. © The European Society of Cardiology 2015.

  20. Decreasing Congestive Heart Failure Readmission Rates Within 30 Days at the Tampa VA.

    Science.gov (United States)

    Messina, William

    2016-01-01

    High hospital readmission rates contribute to the problem of escalating costs and fragmented quality in the US health care system. This article describes the implementation of a home telehealth (HT) performance improvement project with subsequent cost-avoidance savings. The HT project was designed to potentiate communication between and among patients, clinicians, and administrative staff, in addition to reducing readmissions for patients with congestive heart failure at the James A. Haley Veterans Hospital in Tampa, Florida. Pre- and post-HT implementation comparisons were made of readmission rates, costs, and veteran satisfaction from the same 4-month periods in 2012 and 2013. The application of telehealth and phone care initiatives reduced the congestive heart failure hospital readmission rate by 5%, decreased costs, and improved veteran satisfaction with overall care experience.

  1. Limited value of cystatin-C over estimated glomerular filtration rate for heart failure risk stratification.

    Directory of Open Access Journals (Sweden)

    Elisabet Zamora

    Full Text Available BACKGROUND: To compare the prognostic value of estimated glomerular filtration rate, cystatin-C, an alternative renal biomarker, and their combination, in an outpatient population with heart failure. Estimated glomerular filtration rate is routinely used to assess renal function in heart failure patients. We recently demonstrated that the Cockroft-Gault formula is the best among the most commonly used estimated glomerular filtration rate formulas for predicting heart failure prognosis. METHODOLOGY/PRINCIPAL FINDINGS: A total of 879 consecutive patients (72% men, age 70.4 years [P(25-75 60.5-77.2] were studied. The etiology of heart failure was mainly ischemic heart disease (52.7%. The left ventricular ejection fraction was 34% (P(25-75 26-43%. Most patients were New York Heart Association class II (65.8% or III (25.9%. During a median follow-up of 3.46 years (P(25-75 1.85-5.05, 312 deaths were recorded. In an adjusted model, estimated glomerular filtration rate and cystatin-C showed similar prognostic value according to the area under the curve (0.763 and 0.765, respectively. In Cox regression, the multivariable analysis hazard ratios were 0.99 (95% CI: 0.98-1, P = 0.006 and 1.14 (95% CI: 1.02-1.28, P = 0.02 for estimated glomerular filtration rate and cystatin-C, respectively. Reclassification, assessed by the integration discrimination improvement and the net reclassification improvement indices, was poorer with cystatin-C (-0.5 [-1.0;-0.1], P = 0.024 and -4.9 [-8.8;-1.0], P = 0.013, respectively. The value of cystatin-C over estimated glomerular filtration rate for risk-stratification only emerged in patients with moderate renal dysfunction (eGFR 30-60 ml/min/1.73 m(2, chi-square 12.9, P<0.001. CONCLUSIONS/SIGNIFICANCE: Taken together, the results indicate that estimated glomerular filtration rate and cystatin-C have similar long-term predictive values in a real-life ambulatory heart failure population. Cystatin-C seems to

  2. Analysis and Countermeasures of High Arrest Rate of Alien Crime%外国人犯罪高逮捕率的原因及对策

    Institute of Scientific and Technical Information of China (English)

    杨冰

    2016-01-01

    随着全球经济一体化的加速和国际交往的进一步扩大,内地城市对外开放程度日益加深。外国人在内地犯罪案件呈上升态势,对现行司法制度及法治运行构成一定挑战。当前,外国人犯罪案件逮捕率居高不下,已高于对本国人的逮捕率。如何保障人权,给予外国籍犯罪嫌疑人国民待遇,是值得探讨的法学课题。本文试以合肥市某区人民检察院侦查监督科办理的外国人犯罪审查逮捕案件为例,分析外国人犯罪高逮捕率的原因,并试提出对策、建议。%With the acceleration of the global economic integration and the further expansion of international exchanges, the opening-up of the mainland cities is deepening gradually. Alien crime in the mainland is rising, which creates certain challenges to the current judicial system and the rule of law. At present, the rate of arrest of alien crime cases remains high and has been higher than that of the native. How to protect human rights and to give foreign suspects the national treatment is worthy of judicial discussion. Taking the alien crimes cases conducted by Luyang District of Hefei City People's Procuratorate investigation and supervision department for example, this paper tries to analyze the reasons for the high rate of arrest of alien crimes, and tries to put forward countermeasures and suggestions.

  3. Female sterilization: a review of methods, morbidity, failure rates and medicolegal aspects.

    Science.gov (United States)

    Newton, J; Mccormack, J

    1990-09-01

    Introduced in England in 1967, laparoscopic sterilization has effected a radical change in female sterilization which 1st consisted of electrocoagulation of the Fallopian tubes. Mechanical methods have since basically replaced electrocoagulation, such as tubal rings and clips. In the mid 1970s, the Filshie clip emerged and has since become the most common form of laparoscopic technique. Research demonstrates that it has a low incidence of surgical difficulty, low morbidity, and low failure rates. Other means of accessing the tubes include minilaparotomy and culdotomy (common in India). Generally women undergo general anesthesia for sterilization. Overall morbidity and mortality (10/10,000) following female sterilization is low. Early morbidity may include surgical complications (bleeding during surgery or torn tubes), technical failure (.6-1% for various laparoscopic techniques), and hemorrhage. Few long term follow up studies have taken place, but possible long term adverse effects are abdominal pain, pain during sexual intercourse, changes in menstruation, and a need for gynecologic surgery. Failure rates vary depending on the method, surgical approach, surgeon skill, and type of patient. The highest failure rate of a laparoscopic or minilaparotomy approach lies with culdotomy (7-15/1000) and the lowest with thermal coagulation (1/1000). The laparotomy approach may be as high as 14/1000. Between 1970-1980, the number of litigations have increased because of sterilization failure. These cases have showed a consistent pattern: insufficient patient information, poor notes with no indications of any counseling, little written information for patients to support verbal counseling, and illegible and meager operation notes.

  4. Relationship between sponsorship and failure rate of dental implants: a systematic approach.

    Directory of Open Access Journals (Sweden)

    Antoine Popelut

    Full Text Available BACKGROUND: The number of dental implant treatments increases annually. Dental implants are manufactured by competing companies. Systematic reviews and meta-analysis have shown a clear association between pharmaceutical industry funding of clinical trials and pro-industry results. So far, the impact of industry sponsorship on the outcomes and conclusions of dental implant clinical trials has never been explored. The aim of the present study was to examine financial sponsorship of dental implant trials, and to evaluate whether research funding sources may affect the annual failure rate. METHODS AND FINDINGS: A systematic approach was used to identify systematic reviews published between January 1993 and December 2008 that specifically deal with the length of survival of dental implants. Primary articles were extracted from these reviews. The failure rate of the dental implants included in the trials was calculated. Data on publication year, Impact Factor, prosthetic design, periodontal status reporting, number of dental implants included in the trials, methodological quality of the studies, presence of a statistical advisor, and financial sponsorship were extracted by two independent reviewers (kappa = 0.90; CI(95% [0.77-1.00]. Univariate quasi-Poisson regression models and multivariate analysis were used to identify variables that were significantly associated with failure rates. Five systematic reviews were identified from which 41 analyzable trials were extracted. The mean annual failure rate estimate was 1.09%.(CI(95% [0.84-1.42]. The funding source was not reported in 63% of the trials (26/41. Sixty-six percent of the trials were considered as having a risk of bias (27/41. Given study age, both industry associated (OR = 0.21; CI(95% [0.12-0.38] and unknown funding source trials (OR = 0.33; (CI(95% [0.21-0.51] had a lower annual failure rates compared with non-industry associated trials. A conflict of interest statement was disclosed in 2

  5. Deformation and failure of OFHC copper under high strain rate shear compression

    Science.gov (United States)

    Ruggiero, Andrew; Testa, Gabriel; Bonora, Nicola; Iannitti, Gianluca; Persechino, Italo; Colliander, Magnus Hörnqvist

    2017-01-01

    Hat-shaped specimen geometries were developed to generate high strain, high-strain-rates deformation under prescribed conditions. These geometries offer also the possibility to investigate the occurrence of ductile rupture under low or negative stress triaxiality, where most failure models fail. In this work, three tophat geometries were designed, by means of extensive numerical simulation, to obtain desired stress triaxiality values within the shear region that develops across the ligament. Material failure was simulated using the Continuum Damage Model (CDM) formulation with a unilateral condition for damage accumulation and validated by comparing with quasi-static and high strain rate compression tests results on OFHC copper. Preliminary results seem to indicate that ductile tearing initiates at the specimen corner location where positive stress triaxiality occurs because of local rotation and eventually propagates along the ligament.

  6. Rate dependent response and failure of a ductile epoxy and carbon fiber reinforced epoxy composite

    Energy Technology Data Exchange (ETDEWEB)

    Brown, Eric N [Los Alamos National Laboratory; Rae, Philip J [Los Alamos National Laboratory; Dattelbaum, Dana M [Los Alamos National Laboratory; Stahl, David B [Los Alamos National Laboratory

    2010-01-01

    An extensive characterization suite has been performed on the response and failure of a ductile epoxy 55A and uniaxial carbon fiber reinforced epoxy composite of IM7 fibers in 55A resin from the quasistatic to shock regime. The quasistatic and intermediate strain rate response, including elastic modulus, yield and failure have are characterized by quasistatic, SHPB, and DMA measurements as a function of fiber orientation and temperature. The high strain rate shock effect of fiber orientation in the composite and response of the pure resin are presented for plate impact experiments. It has previously been shown that at lower impact velocities the shock velocity is strongly dependent on fiber orientation but at higher impact velocity the in-plane and through thickness Hugoniots converge. The current results are compared with previous studies of the shock response of carbon fiber composites with more conventional brittle epoxy matrices. The spall response of the composite is measured and compared with quasistatic fracture toughness measurements.

  7. Cancer detection rates of different prostate biopsy regimens in patients with renal failure.

    Science.gov (United States)

    Hoşcan, Mustafa Burak; Özorak, Alper; Oksay, Taylan; Perk, Hakkı; Armağan, Abdullah; Soyupek, Sedat; Serel, Tekin Ahmet; Koşar, Alim

    2014-07-01

    We aimed to evaluate the cancer detection rates of 6-, 10-, 12-core biopsy regimens and the optimal biopsy protocol for prostate cancer diagnosis in patients with renal failure. A total of 122 consecutive patients with renal failure underwent biopsy with age-specific prostate-specific antigen (PSA) levels up to 20 ng/mL. The 12-core biopsy technique (sextant biopsy + lateral base, lateral mid-zone, lateral apex, bilaterally) performed to all patients. Pathology results were examined separately for each sextant, 10-core that exclude parasagittal mid-zones from 12-cores (10a), 10-core that exclude apex zones from 12-cores (10b) and 12-core biopsy regimens. Of 122 patients, 37 (30.3%) were positive for prostate cancer. The cancer detection rates for sextant, 10a, 10b and 12 cores were 17.2%, 29%, 23.7% and 30.7%, respectively. Biopsy techniques of 10a, 10b and 12 cores increased the cancer detection rates by 40%, 27.5% and 43.2% among the sextant technique, respectively. Biopsy techniques of 10a and 12 cores increased the cancer detection rates by 17.1% and 21.6% among 10b biopsy technique, respectively. There were no statistical differences between 12 core and 10a core about cancer detection rate. Adding lateral cores to sextant biopsy improves the cancer detection rates. In our study, 12-core biopsy technique increases the cancer detection rate by 5.4% among 10a core but that was not statistically different. On the other hand, 12-core biopsy technique includes all biopsy regimens. We therefore suggest 12-core biopsy or minimum 10-core strategy incorporating six peripheral biopsies with elevated age- specific PSA levels up to 20 ng/mL in patients with renal failure.

  8. Heart Rate at Hospital Discharge in Patients With Heart Failure Is Associated With Mortality and Rehospitalization

    Science.gov (United States)

    Laskey, Warren K.; Alomari, Ihab; Cox, Margueritte; Schulte, Phillip J.; Zhao, Xin; Hernandez, Adrian F.; Heidenreich, Paul A.; Eapen, Zubin J.; Yancy, Clyde; Bhatt, Deepak L.; Fonarow, Gregg C.

    2015-01-01

    Background Whether heart rate upon discharge following hospitalization for heart failure is associated with long‐term adverse outcomes and whether this association differs between patients with sinus rhythm (SR) and atrial fibrillation (AF) have not been well studied. Methods and Results We conducted a retrospective cohort study from clinical registry data linked to Medicare claims for 46 217 patients participating in Get With The Guidelines®–Heart Failure. Cox proportional‐hazards models were used to estimate the association between discharge heart rate and all‐cause mortality, all‐cause readmission, and the composite outcome of mortality/readmission through 1 year. For SR and AF patients with heart rate ≥75, the association between heart rate and mortality (expressed as hazard ratio [HR] per 10 beats‐per‐minute increment) was significant at 0 to 30 days (SR: HR 1.30, 95% CI 1.22 to 1.39; AF: HR 1.23, 95% CI 1.16 to 1.29) and 31 to 365 days (SR: HR 1.15, 95% CI 1.12 to 1.20; AF: HR 1.05, 95% CI 1.01 to 1.08). Similar associations between heart rate and all‐cause readmission and the composite outcome were obtained for SR and AF patients from 0 to 30 days but only in the composite outcome for SR patients over the longer term. The HR from 0 to 30 days exceeded that from 31 to 365 days for both SR and AF patients. At heart rates heart failure, higher discharge heart rate was associated with increased risks of death and rehospitalization, with higher risk in the first 30 days and for SR compared with AF. PMID:25904590

  9. Statistical Analysis of a Weibull Extension with Bathtub-Shaped Failure Rate Function

    Directory of Open Access Journals (Sweden)

    Ronghua Wang

    2014-01-01

    Full Text Available We consider the parameter inference for a two-parameter life distribution with bathtub-shaped or increasing failure rate function. We present the point and interval estimations for the parameter of interest based on type-II censored samples. Through intensive Monte-Carlo simulations, we assess the performance of the proposed estimation methods by a comparison of precision. Example applications are demonstrated for the efficiency of the methods.

  10. Analysis of field usage failure rate data for plastic encapsulated solid state devices

    Science.gov (United States)

    1981-01-01

    Survey and questionnaire techniques were used to gather data from users and manufacturers on the failure rates in the field of plastic encapsulated semiconductors. It was found that such solid state devices are being successfully used by commercial companies which impose certain screening and qualification procedures. The reliability of these semiconductors is now adequate to support their consideration in NASA systems, particularly in low cost systems. The cost of performing necessary screening for NASA applications was assessed.

  11. Cardiac resynchronization therapy: implant rates, temporal trends and relationships with heart failure epidemiology.

    Science.gov (United States)

    Boriani, Giuseppe; Berti, Elena; Belotti, Laura Maria Beatrice; Biffi, Mauro; Carboni, Angelo; Bandini, Alberto; Casali, Edoardo; Tomasi, Corrado; Toselli, Tiziano; Baraldi, Paolo; Bottoni, Nicola; Barbato, Gaetano; Sassone, Biagio

    2014-02-01

    Consensus guidelines define indications for cardiac resynchronization therapy (CRT), but the variability in implant rates in 'real world' clinical practice, as well as the relationship with the epidemiology of heart failure are not defined. In Emilia-Romagna, an Italian region with around 4.4 million inhabitants, a registry was instituted to collect data on implanted devices for CRT, with (CRT-D) or without defibrillation (CRT-P) capabilities. Data from all consecutive patients resident in this region who underwent a first implant of a CRT device in years 2006-2010 were collected and standardized (considering each of the nine provinces of the region). The number of CRT implants increased progressively, with a 71% increase in 2010 compared to 2006. Between 84 and 90% of implants were with CRT-D devices. The variability in standardized implant rates among the provinces was substantial and the ratio between the provinces with the highest and the lowest implant rates was always greater than 2. Considering prevalent cases of heart failure in the period 2006-2010, the proportion of patients implanted with CRT per year ranged between 0.23 and 0.30%. The application in 'real world' clinical practice of CRT in heart failure is quite heterogeneous, with substantial variability even among areas belonging to the same region, with the need to make the access to this treatment more equitable. Despite the increased use of CRT, its overall rate of adoption is low, if a population of prevalent heart failure patients is selected on the basis of administrative data on hospitalizations.

  12. Contraceptive failure rates of etonogestrel subdermal implants in overweight and obese women.

    Science.gov (United States)

    Xu, Hanna; Wade, Jennifer A; Peipert, Jeffrey F; Zhao, Qiuhong; Madden, Tessa; Secura, Gina M

    2012-07-01

    To estimate the contraceptive failure rates of the etonogestrel subdermal contraceptive implant in overweight and obese women and compare failure rates with women of normal weight and women using intrauterine devices (IUDs). The Contraceptive CHOICE Project is a large prospective cohort study designed to promote the use of long-acting reversible contraceptive methods to reduce unintended pregnancies in the St Louis region. Participants are provided reversible contraception of their choice at no cost. We collected baseline height and weight of each participant. During each survey, participants were asked about missed menses and possible pregnancies. Any participant who suspected a pregnancy was asked to come in for urine pregnancy testing. Analysis includes the first 8,445 participants enrolled in CHOICE of which 1,168 chose the implant and 4,200 chose the IUD. Student's t test, χ test, and Kaplan-Meier survival curves were used to perform statistical analyses to estimate failure rates in overweight and obese women using the implant and IUDs. Of the women choosing the implant, 28% were overweight and 35% were obese. Of the women who chose an IUD, 27% were overweight and 35% were obese. The 3-year cumulative failure rates for implant and IUD users were less than one per 100 women-years and did not vary by body mass index. We found no decrease in the effectiveness of the implant in overweight or obese women. The implant may be offered as a first-line contraceptive method to any woman seeking a reversible and reliable birth control method.

  13. Catheterization during adrenal vein sampling for primary aldosteronism: failure to use (1-24) ACTH may increase apparent failure rate.

    Science.gov (United States)

    Kline, Gregory A; So, Benny; Dias, Valerian C; Harvey, Adrian; Pasieka, Janice L

    2013-07-01

    "Successful" adrenal vein catheterization in primary aldosteronism (PA) is often defined by a ratio of >3:1 of cortisol in the adrenal vein vs the inferior vena cava. Non-use of corticotropin (ACTH) during sampling may increase the apparent failure rate of adrenal vein catheterization due to lower cortisol levels. A retrospective study was performed on all patients with confirmed unilateral PA between June 2005 and August 2011. Adrenal vein sampling (AVS) included simultaneous bilateral baseline samples with repeat sampling 15 minutes after intravenous infusion of 250 μg of Cortrosyn (ACTH-S). Successful catheter placement was judged as adrenal cortisol:IVC cortisol of >3:1, applied to both baseline and ACTH-S samples and lateralization of aldosteronism was judged as normalized aldosterone/cortisol (A/C) ratio >3 times the contralateral A/C ratio. In ACTH-S samples, 94% of right-sided catheterizations were biochemically successful with 100% success on the left. Among baseline samples, only 47% of right- and 44% of left-sided samples met the 3:1 cortisol criteria. However, 95% of apparent "failed" baseline cortisol sets still showed lateralization of A/C ratios that matched the ultimate pathology. Non-ACTH-stimulated samples may be incorrectly judged as failed catheter placement when a 3:1 ratio is used. ACTH-stimulated sampling is the preferred means to confirm catheterization during AVS.

  14. HEART-RATE-VARIABILITY IN LEFT-VENTRICULAR DYSFUNCTION AND HEART-FAILURE - EFFECTS AND IMPLICATIONS OF DRUG-TREATMENT

    NARCIS (Netherlands)

    TUININGA, YS; VANVELDHUISEN, DJ; BROUWER, J; HAAKSMA, J; CRIJNS, HJGM; MANINTVELD, AJ; LIE, KI

    1994-01-01

    Objective-To review the importance of heart rate variability analysis in left ventricular dysfunction and heart failure and to assess the effects of drug treatment. In patients with left: ventricular dysfunction or heart failure, a low heart rate variability is a strong predictor of a low probabilit

  15. Effects of strain rate and confining pressure on the deformation and failure of shale

    Energy Technology Data Exchange (ETDEWEB)

    Cook, J.M. (Schlumberger Cambridge Research (GB)); Sheppard, M.C. (Anadrill/Schlumberger (US)); Houwen, O.H. (Sedco Forex (FR))

    1991-06-01

    Previous work on shale mechanical properties has focused on the slow deformation rates appropriate to wellbore deformation. Deformation of shale under a drill bit occurs at a very high rate, and the failure properties of the rock under these conditions are crucial in determining bit performance and in extracting lithology and pore-pressure information from drilling parameters. Triaxial tests were performed on two nonswelling shales under a wide range of strain rates and confining and pore pressures. At low strain rates, when fluid is relatively free to move within the shale, shale deformation and failure are governed by effective stress or pressure (i.e., total confining pressure minus pore pressure), as is the case for ordinary rock. If the pore pressure in the shale is high, increasing the strain rate beyond about 0.1%/sec causes large increases in the strength and ductility of the shale. Total pressure begins to influence the strength. At high stain rates, the influence of effective pressure decreases, except when it is very low (i.e., when pore pressure is very high); ductility then rises rapidly. This behavior is opposite that expected in ordinary rocks. This paper briefly discusses the reasons for these phenomena and their impact on wellbore and drilling problems.

  16. Heart rate dynamics during a treadmill cardiopulmonary exercise test in optimized beta-blocked heart failure patients

    OpenAIRE

    Vitor Oliveira Carvalho; Guilherme Veiga Guimarães; Emmanuel Gomes Ciolac; Edimar Alcides Bocchi

    2008-01-01

    BACKGROUND: Calculating the maximum heart rate for age is one method to characterize the maximum effort of an individual. Although this method is commonly used, little is known about heart rate dynamics in optimized beta-blocked heart failure patients. AIM: The aim of this study was to evaluate heart rate dynamics (basal, peak and % heart rate increase) in optimized beta-blocked heart failure patients compared to sedentary, normal individuals (controls) during a treadmill cardiopulmonary exer...

  17. A new ambiguity acceptance test threshold determination method with controllable failure rate

    Science.gov (United States)

    Wang, Lei; Verhagen, Sandra

    2015-04-01

    The ambiguity acceptance test is an important quality control procedure in high precision GNSS data processing. Although the ambiguity acceptance test methods have been extensively investigated, its threshold determine method is still not well understood. Currently, the threshold is determined with the empirical approach or the fixed failure rate (FF-) approach. The empirical approach is simple but lacking in theoretical basis, while the FF-approach is theoretical rigorous but computationally demanding. Hence, the key of the threshold determination problem is how to efficiently determine the threshold in a reasonable way. In this study, a new threshold determination method named threshold function method is proposed to reduce the complexity of the FF-approach. The threshold function method simplifies the FF-approach by a modeling procedure and an approximation procedure. The modeling procedure uses a rational function model to describe the relationship between the FF-difference test threshold and the integer least-squares (ILS) success rate. The approximation procedure replaces the ILS success rate with the easy-to-calculate integer bootstrapping (IB) success rate. Corresponding modeling error and approximation error are analysed with simulation data to avoid nuisance biases and unrealistic stochastic model impact. The results indicate the proposed method can greatly simplify the FF-approach without introducing significant modeling error. The threshold function method makes the fixed failure rate threshold determination method feasible for real-time applications.

  18. An implicit algorithm for a rate-dependent ductile failure model

    Science.gov (United States)

    Zuo, Q. H.; Rice, Jeremy R.

    2008-10-01

    An implicit numerical algorithm has been developed for a rate-dependent model for damage and failure of ductile materials under high-rate dynamic loading [F. L. Addessio and J. N. Johnson, J. Appl. Phys. 74, 1640 (1993)]. Over each time step, the algorithm first implicitly determines the equilibrium state on a Gurson surface, and then calculates the final state by solving viscous relaxation equations, also implicitly. Numerical examples are given to demonstrate the key features of the algorithm. Compared to the explicit algorithm used previously, the current algorithm allows significantly larger time steps that can be used in the analysis. As the viscosity of the material vanishes, the results of the rate-dependent model are shown here to converge to that of the corresponding rate-independent model, a result not achieved with the explicit algorithm.

  19. Prediction of Spring Rate and Initial Failure Load due to Material Properties of Composite Leaf Spring

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Sung Ha [Maxoft Inc., Seongnam (Korea, Republic of); Choi, Bok Lok [Gangneung-Wonju National University, Gangneung (Korea, Republic of)

    2014-12-15

    This paper presented analysis methods for adapting E-glass fiber/epoxy composite (GFRP) materials to an automotive leaf spring. It focused on the static behaviors of the leaf spring due to the material composition and its fiber orientation. The material properties of the GFRP composite were directly measured based on the ASTM standard test. A reverse implementation was performed to obtain the complete set of in-situ fiber and matrix properties from the ply test results. Next, the spring rates of the composite leaf spring were examined according to the variation of material parameters such as the fiber angles and resin contents of the composite material. Finally, progressive failure analysis was conducted to identify the initial failure load by means of an elastic stress analysis and specific damage criteria. As a result, it was found that damage first occurred along the edge of the leaf spring owing to the shear stresses.

  20. Reduced pre-hospital and in-hospital survival rates after out-of-hospital cardiac arrest of patients with type-2 diabetes mellitus : An observational prospective community-based study

    NARCIS (Netherlands)

    Van Hoeijen, Daniel A.; Blom, Marieke T.; Bardai, Abdennasser; Souverein, Patrick C.|info:eu-repo/dai/nl/243074948; De Boer, Anthonius|info:eu-repo/dai/nl/075097346; Tan, Hanno L.

    2015-01-01

    Aims Out-of-hospital cardiac arrest (OHCA) remains a major cause of death. We aimed to determine whether type-2 diabetes mellitus (T2DM) is associated with reduced pre-hospital and in-hospital survival rates after OHCA. Methods and results An observational community-based cohort study was performed

  1. Study of failures in a rabbit line selected for growth rate

    Directory of Open Access Journals (Sweden)

    C. Naturil-Alfonso

    2016-03-01

    Full Text Available Selection for growth rate is negatively related with reproductive fitness. The aim of this work was to analyse the causes of fertility failure in rabbit does selected for growth rate and characterised for reproductive deficiencies (line R. In the experiment, 82 does were divided into 2 groups: naturally mated (NM and artificially inseminated (AI, to relate luteinizing hormone (LH concentration with ovulation induction and pregnancy rate by laparoscopic determination. Additionally, in 38 of these females ovulation rate and metabolites determination (leptin, NEFA, BOHB and glucose were analysed and perirenal fat thickness measurement and live body weight (LBW determined. The results showed that all ovulated does (both NM and AI presented higher concentrations of LH than non-ovulated females. In addition, non-ovulated females showed high levels of leptin and BOHB, as well as LBW. Females from line R have an inherit reduced fertility due to ovulation failure as a consequence of a reduction in LH release, which could be explained by a heavier body weight and higher leptin concentrations.

  2. Is there a relationship between obesity, heart rate variability and inflammatory parameters in heart failure?

    Science.gov (United States)

    Taçoy, Gülten; Açikgöz, Kadri; Kocaman, Sinan Altan; Ozdemir, Murat; Cengel, Atiye

    2010-02-01

    To investigate the effect of body mass index (BMI) on heart rate variability (HRV) and inflammatory parameters in patients with heart failure. We analyzed 55 consecutive patients (mean age, 63.5 +/- 12.8 years; male/female, 39/16) with symptomatic left ventricular systolic (ejection fraction or= 30 kg/m2). The cause of heart failure was mainly ischemic heart disease (75%) with mean ejection fraction 30 +/- 7%. Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and C-reactive protein levels were measured, and time-domain HRV indices were determined on Holter electrocardiogram. The relationship between HRV indices and laboratory, inflammatory and echocardiographic parameters was investigated with correlation analysis. Age, sex, clinical characteristics (hypertension, diabetes mellitus, dyslipidemia, family history, smoking) were similar between groups. BMI was inversely correlated with NT-pro BNP levels (P = 0.001). HRV indices did not differ between groups. Correlation analysis demonstrated the relationship between HRV indices and fasting blood glucose (SDNN, SDANN, SDNNI, root mean square successive differences, VTI), C-reactive protein (SDANN, SDNNI, VTI), pulmonary artery pressure (SDNN, SDANN, VTI) levels. In systolic heart failure patients a higher BMI is associated with decreased NT-proBNP levels. Although HRV indices were not different between groups, inflammatory parameters, fasting blood glucose and pulmonary artery pressure were correlated with them.

  3. Bayesian Analysis of the Survival Function and Failure Rate of Weibull Distribution with Censored Data

    Directory of Open Access Journals (Sweden)

    Chris Bambey Guure

    2012-01-01

    Full Text Available The survival function of the Weibull distribution determines the probability that a unit or an individual will survive beyond a certain specified time while the failure rate is the rate at which a randomly selected individual known to be alive at time will die at time (. The classical approach for estimating the survival function and the failure rate is the maximum likelihood method. In this study, we strive to determine the best method, by comparing the classical maximum likelihood against the Bayesian estimators using an informative prior and a proposed data-dependent prior known as generalised noninformative prior. The Bayesian estimation is considered under three loss functions. Due to the complexity in dealing with the integrals using the Bayesian estimator, Lindley’s approximation procedure is employed to reduce the ratio of the integrals. For the purpose of comparison, the mean squared error (MSE and the absolute bias are obtained. This study is conducted via simulation by utilising different sample sizes. We observed from the study that the generalised prior we assumed performed better than the others under linear exponential loss function with respect to MSE and under general entropy loss function with respect to absolute bias.

  4. Patterns in Listings of Failure-Rate & MTTF Values and Listings of Other Data

    DEFF Research Database (Denmark)

    Becker, Peter W.

    1982-01-01

    It has been observed that the decimal parts of failure-rate and MTTF values as listed in tables tend to have a logarithmic distribution. A possible explanation for this phenomenon is given. When such tables have been generated they should be examined to see if the anticipated distribution...... is present; should that not be the case, a systematic error might well be present. Such testing is one practical application of the observation. The decimal-values from long lists of data quite often tend to have a logarithmic distribution as pointed out by Newcomb and Benford. The phenomenon may...

  5. Effect of confining pressure on deformation and failure of rock at higher strain rate

    Institute of Scientific and Technical Information of China (English)

    WANG Xue-bin; PAN Yi-shan

    2005-01-01

    Influence of confining pressure from 0 to 28 MPa, which acts on the two lateral edges of rock specimen in plane strain compression, on the shear failure processes and patterns as well as on the macroscopically mechanical responses were numerically modeled by use of FLAC. A material imperfection with lower strength in comparison with the intact rock, which is close to the lower-left corner of the specimen, was prescribed. In elastic stage, the adopted constitutive relation of rock was linear elastic; in strain-softening stage, a composite Mohr-Coulomb criterion with tension cut-off and a post-peak linear constitutive relation were adopted. The numerical results show that with an increase of confining pressure the peak strength of axial stress-axial strain curve and the corresponding axial strain linearly increase; the residual strength and the stress drop from the peak strength to the residual strength increase; the failure modes of rock transform form the multiple shear bands close to the loading end of the specimen (confining pressure=0~0.1MPa), to the conjugate shear bands (0.5~2.0 MPa), and then to the single shear band (4~28 MPa). Once the tip of the band reaches the loading end of the specimen, the direction of the band changes so that the reflection of the band occurs. At higher confining pressure, the new-formed shear band does not intersect the imperfection, bringing extreme difficulties in prediction of the failure of rock structure, such as rock burst. The present results enhance the understanding of the shear failure processes and patterns of rock specimen in higher confining pressure and higher loading strain rate.

  6. RNAi-mediated knockdown of catalase causes cell cycle arrest in SL-1 cells and results in low survival rate of Spodoptera litura (Fabricius.

    Directory of Open Access Journals (Sweden)

    Haiming Zhao

    Full Text Available Deregulated reactive oxygen species (ROS production can lead to the disruption of structural and functional integrity of cells as a consequence of reactive interaction between ROS and various biological components. Catalase (CAT is a common enzyme existing in nearly all organisms exposed to oxygen, which decomposes harmful hydrogen peroxide, into water and oxygen. In this study, the full length sequence that encodes CAT-like protein from Spodoptera litura named siltCAT (GenBank accession number: JQ_663444 was cloned and characterized. Amino acid sequence alignment showed siltCAT shared relatively high conservation with other insect, especially the conserved residues which defined heme and NADPH orientation. Expression pattern analysis showed that siltCAT mRNA was mainly expressed in the fat body, midgut, cuticle and malpighian tube, and as well as over last instar larvae, pupa and adult stages. RNA interference was used to silence CAT gene in SL-1 cells and the fourth-instar stage of S. litura larvae respectively. Our results provided evidence that CAT knockdown induced ROS generation, cell cycle arrest and apoptosis in SL-1 cells. It also confirmed the decrease in survival rate because of increased ROS production in experimental groups injected with double-stranded RNA of CAT (dsCAT. This study implied that ROS scavenging by CAT is important for S. litura survival.

  7. Prognostic significance of early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation

    Institute of Scientific and Technical Information of China (English)

    臧芝栋

    2014-01-01

    Objective To investigate the prognostic significanceof early lactate clearance rate for severe acute respiratory failure patients on extracorporeal membrane oxygenation(ECMO).Methods Forty-three patients with severe acute respiratory failure supported by venous-venous(v-v)ECMO were enrolled from January 2007 to January 2013.Arterial blood lactate at pre-ECMO support(0 h)and at

  8. Association between atrial fibrillatory rate and heart rate variability in patients with atrial fibrillation and congestive heart failure.

    Science.gov (United States)

    Corino, Valentina D A; Cygankiewicz, Iwona; Mainardi, Luca T; Stridh, Martin; Vasquez, Rafael; Bayes de Luna, Antonio; Holmqvist, Fredrik; Zareba, Wojciech; Platonov, Pyotr G

    2013-01-01

    Even if atrial fibrillatory rate (AFR) has been related to clinical outcome in patients with atrial fibrillation (AF), its relation with ventricular response has not been deeply studied. The aim of this study was to investigate the relation between AFR and RR series variability in patients with AF. Twenty-minute electrocardiograms in orthogonal leads were processed to extract AFR, using spatiotemporal QRST cancellation and time frequency analysis, and RR series in 127 patients (age 69 ± 11 years) with congestive heart failure (NYHA II-III) enrolled in the MUSIC study (MUerte Subita en Insufficiencia Cardiaca). Heart rate variability and irregularity were assessed by time domain parameters and entropy-based indices, respectively and their correlation with AFR investigated. Variability measures seem not to be related to AFR, while irregularity measures do. A significant correlation between AFR and variability parameters of heart rate variability during AF was found only in patients not treated with antiarrhythmics drugs (correlation = 0.56 P < 0.05 for pNN50), while this correlation was lost in patients taking rate- or rhythm-control drugs. A significant positive correlation between AFR and indices of RR irregularity was found, showing that a higher AFR is related to a less organized RR series (correlation = 0.33 P < 0.05 for regularity index for all patients, correlation increased in subgroups of patients treated with the same drug). These results suggest that a higher AFR is associated with a higher degree of irregularity of ventricular response that is observed regardless of the use of rate-controlling drugs. ©2012, Wiley Periodicals, Inc.

  9. Post-exercise heart rate recovery independently predicts mortality risk in patients with chronic heart failure.

    Science.gov (United States)

    Tang, Yi-Da; Dewland, Thomas A; Wencker, Detlef; Katz, Stuart D

    2009-12-01

    Post-exercise heart rate recovery (HRR) is an index of parasympathetic function associated with clinical outcomes in populations with and without documented coronary heart disease. Decreased parasympathetic activity is thought to be associated with disease progression in chronic heart failure (HF), but an independent association between post-exercise HRR and clinical outcomes among such patients has not been established. We measured HRR (calculated as the difference between heart rate at peak exercise and after 1 minute of recovery) in 202 HF subjects and recorded 17 mortality and 15 urgent transplantation outcome events over 624 days of follow-up. Reduced post-exercise HRR was independently associated with increased event risk after adjusting for other exercise-derived variables (peak oxygen uptake and change in minute ventilation per change in carbon dioxide production slope), for the Heart Failure Survival Score (adjusted HR 1.09 for 1 beat/min reduction, 95% CI 1.05-1.13, P Heart Failure Model score (adjusted HR 1.08 for one beat/min reduction, 95% CI 1.05-1.12, P exercise HRR (>or=30 beats/min) had low risk of events irrespective of the risk predicted by the survival scores. In a subgroup of 15 subjects, reduced post-exercise HRR was associated with increased serum markers of inflammation (interleukin-6, r = 0.58, P = .024; high-sensitivity C-reactive protein, r = 0.66, P = .007). Post-exercise HRR predicts mortality risk in patients with HF and provides prognostic information independent of previously described survival models. Pathophysiologic links between autonomic function and inflammation may be mediators of this association.

  10. The clinical significance of detection to heart rate deceleration capacity and heart rate variability in patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Jiang-rong Zhou

    2015-01-01

    Full Text Available Objective: To study the change of heart rate deceleration capacity ( DC and heart rate variability in patients with chronic heart failure (CHF and its relationship with left ventricular ejection fraction (LVEF. Methods: DC, LVEF, time and frequency domain parameters of HRV were measured in 66 patients with CHF and 34 healthy adults (control group by using 24h Holter recordings and Echocardiography. The standard deviation of normal R-R intervals( SDNN, squares of differences between adjacent NN intervals ( RMSSD,low frequency power( LFn and high frequency power( HFn and the changes of LVEF were compared between  the two groups,the relationship between DC,LVEF and HRV were studied in patients with CHF. Results: The median value of DC in the patients with CHF was significantly lower than that in control group( 3.1 ± 2.4 ms vs 7.2 ± 1.3 ms,P <0.01.Incidence of abnormal DC in the CHF group was 57.5%,which was significantly higher than that in the control group (P <0.01.The HRV index, including SDNN、RMSSD、LFn、HFn, in the CHF group was significantly lower than that in normal control group (P < 0.01. Significant positive correlation between HRV index and LVEF were confirmed (P < 0.01. Conclusions: DC and HRV index are lower in patients with CHF and have a good correlation with the left ventricular ejection fraction.

  11. Survival rate in patients after sudden cardiac arrest at the university hospital of northern Norway treated with or without opioids: A retrospective evaluation

    Directory of Open Access Journals (Sweden)

    Vladimir Kuklin

    2013-01-01

    Full Text Available Background: Experimental studies both in vivo and in vitro show significantly increased survival rate in animals and in cortical neurons respectively exposed to acute hypoxia and pre-treated with opioids compared to non-treated counterparts. Thus, the main aim of the study was to examine survival rates in patients after sudden cardiac arrest (SCA in the hospital who were or were not treated with opioids before and/or during cardiac pulmonary resuscitation (CPR. Methods: The registry SCA database at the University Hospital of Northern Norway (UNN for the period of January 2006-December 2009 was used to obtain data for the evaluation. Inclusion criteria were observed SCA at UNN for patients with American Society of Anesthesiologists (ASA 1-3. Exclusion criteria included ASA four to five patients and unobserved SCA. Study patients were divided into two groups: Those not treated with opioids and those treated with opioids not more then 3 h before and/or during CPR. Survival rate 1, 2, 3 and 28 days post CPR were compared for the two groups. Results: A total of 117 patients were registered in the SCA database at UNN for the period from January 2006 to December 2009. Sixty seven patients were excluded from the study: 17 patients had an unknown time of SCA dιbut, two patients had only syncope and 48 were ASA four to five patients. A total of 50 ASA one to three patients were included in the study, 33 and 17 patients respectively in the control and opioid-treated groups. The patients who were treated with opioids before or during CPR had a significantly higher 1, 2, 3 and 28 days survival rate as compared to those receiving only conventional CPR. The model was adjusted for duration of CPR (P=0.047 and treatment with adrenaline (P=0.779 in the groups. Adjusted Odds ratio was 0.075 (95% confidence interval (CI: 0.015-0.387. Relative risk of fatal outcome in the opioids group was 0.2944 (95% CI: 0.1549-0.5594. Conclusion: Significantly higher 1, 2, 3 and

  12. Effect of Selective Heart Rate Slowing in Heart Failure With Preserved Ejection Fraction.

    Science.gov (United States)

    Pal, Nikhil; Sivaswamy, Nadiya; Mahmod, Masliza; Yavari, Arash; Rudd, Amelia; Singh, Satnam; Dawson, Dana K; Francis, Jane M; Dwight, Jeremy S; Watkins, Hugh; Neubauer, Stefan; Frenneaux, Michael; Ashrafian, Houman

    2015-11-03

    Heart failure with preserved ejection fraction (HFpEF) is associated with significant morbidity and mortality but is currently refractory to therapy. Despite limited evidence, heart rate reduction has been advocated, on the basis of physiological considerations, as a therapeutic strategy in HFpEF. We tested the hypothesis that heart rate reduction improves exercise capacity in HFpEF. We conducted a randomized, crossover study comparing selective heart rate reduction with the If blocker ivabradine at 7.5 mg twice daily versus placebo for 2 weeks each in 22 symptomatic patients with HFpEF who had objective evidence of exercise limitation (peak oxygen consumption at maximal exercise [o2 peak] change in o2 peak. Secondary outcomes included tissue Doppler-derived E/e' at echocardiography, plasma brain natriuretic peptide, and quality-of-life scores. Ivabradine significantly reduced peak heart rate compared with placebo in the HFpEF (107 versus 129 bpm; Pchange in o2 peak in the HFpEF cohort (-2.1 versus 0.9 mL·kg(-1)·min(-1); P=0.003) and significantly reduced submaximal exercise capacity, as determined by the oxygen uptake efficiency slope. No significant effects on the secondary end points were discernable. Our observations bring into question the value of heart rate reduction with ivabradine for improving symptoms in a HFpEF population characterized by exercise limitation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT02354573. © 2015 The Authors.

  13. Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients.

    Science.gov (United States)

    Kula, Ayse O; Riess, Matthias L; Ellinas, Elizabeth H

    2017-02-01

    Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of "difficulty" and "failure" of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement. Single center retrospective chart review. Labor and Delivery Unit of an inner city academic teaching hospital. 2485 parturients, ASA status 2 to 4, receiving labor epidural analgesia for anticipated vaginal delivery. None. We reviewed quality assurance and anesthesia records over a 12-month period. "Failure" was defined as either inadequate analgesia or a positive test dose, requiring replacement, and/or when the anesthesia record stated they failed. "Difficulty" was defined as six or more needle redirections or a note indicating difficulty in the anesthesia record. Overall epidural failure and difficulty rates were 4.3% and 3.0%, respectively. Patients with a BMI of 30kg/m(2) or higher had a higher chance of both failure and difficulty with two and almost three fold increases, respectively. Regression analysis indicated that failure was best predicted by BMI and less provider training while difficulty was best predicted by BMI. Additionally, increased BMI was associated with increased time of discovery of epidural catheter failure. Obesity is associated with increasing technical difficulty and failure of neuraxial analgesia for labor. Practitioners should consider allotting extra time for obese parturients in order to manage potential problems. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Rate Dependent Multicontinuum Progressive Failure Analysis of Woven Fabric Composite Structures under Dynamic Impact

    Directory of Open Access Journals (Sweden)

    James Lua

    2004-01-01

    Full Text Available Marine composite materials typically exhibit significant rate dependent response characteristics when subjected to extreme dynamic loading conditions. In this work, a strain-rate dependent continuum damage model is incorporated with multicontinuum technology (MCT to predict damage and failure progression for composite material structures. MCT treats the constituents of a woven fabric composite as separate but linked continua, thereby allowing a designer to extract constituent stress/strain information in a structural analysis. The MCT algorithm and material damage model are numerically implemented with the explicit finite element code LS-DYNA3D via a user-defined material model (umat. The effects of the strain-rate hardening model are demonstrated through both simple single element analyses for woven fabric composites and also structural level impact simulations of a composite panel subjected to various impact conditions. Progressive damage at the constituent level is monitored throughout the loading. The results qualitatively illustrate the value of rate dependent material models for marine composite materials under extreme dynamic loading conditions.

  15. Optimization of pharmacotherapy in chronic heart failure: is heart rate adequately addressed?

    Science.gov (United States)

    Franke, Jennifer; Wolter, Jan Sebastian; Meme, Lillian; Keppler, Jeannette; Tschierschke, Ramon; Katus, Hugo A; Zugck, Christian

    2013-01-01

    The aim of the study is to evaluate the use of beta-blockers in chronic heart failure (CHF) and the extent of heart rate reduction achieved in clinical practice and to determine differences in outcome of patients who fulfilled select inclusion criteria of the SHIFT study according to resting heart rate modulated by beta-blocker therapy. We evaluated an all-comer population of our dedicated CHF outpatient clinic between 2006 and 2010. For inclusion, individually optimized doses of guideline-recommended pharmacotherapy including beta-blockers had to be maintained for at least 3 months and routine follow-up performed at our outpatient CHF-clinic thereafter. Treatment dosages of beta-blockers, and demographic and clinical profiles including resting heart rate were assessed. The outcome of patients who fulfilled select inclusion criteria of the SHIFT study (left-ventricular ejection fraction (LVEF) ≤35 %, sinus rhythm, NYHA II-IV) and were followed-up for at least 1 year was stratified according to resting heart rates: ≥75 versus <75 bpm and ≥70 versus <70 bpm. The composite primary endpoint was defined as all-cause death or hospital admission for worsening heart failure during 12-month follow-up. In total, 3,181 patients were assessed in regard to treatment dosages of beta-blockers, and demographic and clinical profiles including resting heart rate. Of the overall studied population, 443 patients fulfilled all inclusion criteria and entered outcome analysis. Median observation time of survivors was 27.5 months with 1,039.7 observation-years in total. Up-titration to at least half the evidence-based target dose of beta-blockers was achieved in 69 % and full up-titration in 29 % of these patients. Patients with increased heart rates were younger, more often male, exhibited a higher NYHA functional class and lower LVEF. The primary endpoint occurred in 21 % of patients in the ≥70 bpm group versus 9 % of patients in the group with heart rates <70

  16. Rate-dependent activation failure in isolated cardiac cells and tissue due to Na+ channel block.

    Science.gov (United States)

    Varghese, Anthony; Spindler, Anthony J; Paterson, David; Noble, Denis

    2015-11-15

    While it is well established that class-I antiarrhythmics block cardiac sodium channels, the mechanism of action of therapeutic levels of these drugs is not well understood. Using a combination of mathematical modeling and in vitro experiments, we studied the failure of activation of action potentials in single ventricular cells and in tissue caused by Na(+) channel block. Our computations of block and unblock of sodium channels by a theoretical class-Ib antiarrhythmic agent predict differences in the concentrations required to cause activation failure in single cells as opposed to multicellular preparations. We tested and confirmed these in silico predictions with in vitro experiments on isolated guinea-pig ventricular cells and papillary muscles stimulated at various rates (2-6.67 Hz) and exposed to various concentrations (5 × 10(-6) to 500 × 10(-6) mol/l) of lidocaine. The most salient result was that whereas large doses (5 × 10(-4) mol/l or higher) of lidocaine were required to inhibit action potentials temporarily in single cells, much lower doses (5 × 10(-6) mol/l), i.e., therapeutic levels, were sufficient to have the same effect in papillary muscles: a hundredfold difference. Our experimental results and mathematical analysis indicate that the syncytial nature of cardiac tissue explains the effects of clinically relevant doses of Na(+) channel blockers.

  17. Exercise stroke volume and heart rate response differ in right and left heart failure.

    Science.gov (United States)

    Groepenhoff, Herman; Westerhof, Nico; Jacobs, Wouter; Boonstra, Anco; Postmus, Piet E; Vonk-Noordegraaf, Anton

    2010-07-01

    In pulmonary arterial hypertension (PAH), the exercise-induced increase in stroke volume (SV) is limited by the increase in pulmonary artery pressure. In left heart failure (LHF), systemic arterial pressure increases little during exercise, and the SV increase is limited by the left ventricle itself. These differences might be reflected by a dissimilar SV and heart rate (HR) response to exercise, which could have important therapeutic implications, for example in beta-blocker therapy. Therefore, we tested the hypothesis that SV and HR responses during exercise are different between PAH and LHF patients. We included 28 PAH and 18 LHF patients (recruited from the heart failure unit) matched on a maximal oxygen uptake of exercise test. Only patients who had not been exposed to beta-blockers were included. Pulmonary arterial hypertension and LHF patient groups had equally impaired exercise tolerance (about 42% of predicted) with a maximal oxygen uptake of 0.80 +/- 0.29 and 0.86 +/- 0.19 L/min. The peak SV response to exercise was significantly lower in PAH patients (-14 mL, P = 0.01); this was compensated by a steeper slope of HR relating to oxygen uptake (0.03 beats/mL, P = 0.001). We conclude that PAH patients have a smaller SV response, but a larger HR response than LHF patients.

  18. Potential radiological exposure rates resulting from hypothetical dome failure at Tank W-10

    Energy Technology Data Exchange (ETDEWEB)

    1994-07-01

    The main plant area at Oak Ridge National Laboratory (ORNL) contains 12 buried Gunite tanks that were used for the storage and transfer of liquid radioactive waste. Although the tanks are no longer in use, they are known to contain some residual contaminated sludges and liquids. In the event of an accidental tank dome failure, however unlikely, the liquids, sludges, and radioactive contaminants within the tank walls themselves could create radiation fields and result in above-background exposures to workers nearby. This Technical Memorandum documents a series of calculations to estimate potential radiological exposure rates and total exposures to workers in the event of a hypothetical collapse of a Gunite tank dome. Calculations were performed specifically for tank W-10 because it contains the largest radioactivity inventory (approximately half of the total activity) of all the Gunite tanks. These calculations focus only on external, direct gamma exposures for prescribed, hypothetical exposure scenarios and do not address other possible tank failure modes or routes of exposure. The calculations were performed with established, point-kernel gamma ray modeling codes.

  19. Heart rate turbulence predicts all-cause mortality and sudden death in congestive heart failure patients.

    Science.gov (United States)

    Cygankiewicz, Iwona; Zareba, Wojciech; Vazquez, Rafael; Vallverdu, Montserrat; Gonzalez-Juanatey, Jose R; Valdes, Mariano; Almendral, Jesus; Cinca, Juan; Caminal, Pere; de Luna, Antoni Bayes

    2008-08-01

    Abnormal heart rate turbulence (HRT) has been documented as a strong predictor of total mortality and sudden death in postinfarction patients, but data in patients with congestive heart failure (CHF) are limited. The aim of this study was to evaluate the prognostic significance of HRT for predicting mortality in CHF patients in New York Heart Association (NYHA) class II-III. In 651 CHF patients with sinus rhythm enrolled into the MUSIC (Muerte Subita en Insuficiencia Cardiaca) study, the standard HRT parameters turbulence onset (TO) and slope (TS), as well as HRT categories, were assessed for predicting total mortality and sudden death. HRT was analyzable in 607 patients, mean age 63 years (434 male), 50% of ischemic etiology. During a median follow up of 44 months, 129 patients died, 52 from sudden death. Abnormal TS and HRT category 2 (HRT2) were independently associated with increased all-cause mortality (HR: 2.10, CI: 1.41 to 3.12, P 120 ms. HRT is a potent risk predictor for both heart failure and arrhythmic death in patients with class II and III CHF.

  20. Catheter failure rates and time course with epidural versus combined spinal-epidural analgesia in labor.

    Science.gov (United States)

    Groden, J; Gonzalez-Fiol, A; Aaronson, J; Sachs, A; Smiley, R

    2016-05-01

    The combined spinal-epidural technique for labor analgesia has several advantages over the traditional epidural technique, including faster onset, greater maternal satisfaction, and decreased need for physician boluses. Proponents of the epidural technique criticize the combined spinal-epidural technique, arguing that the epidural catheter remains untested and thus may not be reliable if needed for surgical intervention. We compared failure rates and time of failure between techniques in our tertiary-care academic practice. Data regarding failed catheters were collected from October 2012 to September 2014 as part of our Quality Assurance program. Failed catheters were defined as any catheter replaced after it was considered to be properly placed and then determined to be intravascular, one sided or resulting in poor maternal analgesia or anesthesia. A total of 5487 analgesics were performed (3980 combined spinal-epidural; 1507 epidural). Eighty-five combined spinal-epidural catheters (2.1%) and 59 epidural catheters (3.9%) were replaced during labor (Plabor and that the time to detection of a failed catheter was significantly longer in the combined spinal-epidural group. Our findings validate the combined spinal-epidural technique as reliable for labor analgesia and tend to refute the theory of the untested catheter. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Cardiac arrest: comparison of paramedic and conventional ambulance services.

    OpenAIRE

    1983-01-01

    A prospective study conducted in the Greater Vancouver area compared survival rates in prehospital cardiac arrest managed by an advanced life support (paramedic) service with those in cardiac arrest managed by conventional ambulance service. Management by the paramedic service was associated with higher survival rates for patients found in cardiac arrest but not for patients who suffered the arrest while the ambulance was present. Cardiopulmonary resuscitation by bystanders was associated wit...

  2. Interim report on the state-of-the-art of solid-state motor controllers. Part 4. Failure-rate and failure-mode data

    Energy Technology Data Exchange (ETDEWEB)

    Jaross, R.A.

    1983-09-01

    An assessment of the reliability of solid-state motor controllers for nuclear power plants is made. Available data on failure-rate and failure-mode data for solid-state motor controllers based on industrial operating experience is meager; the data are augmented by data on other solid-state power electronic devices that are shown to have components similar to those found in solid-state motor controllers. In addition to large nonnuclear solid-state adjustable-speed motor drives, the reliability of nuclear plant inverter systems and high-voltage solid-state dc transmission-line converters is assessed. Licensee Event Report analyses from several sources, the open literature, and personal communications are used to determine the realiability of solid-state devices typical of those expected to be used in nuclear power plants in terms of failures per hour.

  3. Vacuum Bellows, Vacuum Piping, Cryogenic Break, and Copper Joint Failure Rate Estimates for ITER Design Use

    Energy Technology Data Exchange (ETDEWEB)

    L. C. Cadwallader

    2010-06-01

    The ITER international project design teams are working to produce an engineering design in preparation for construction of the International Thermonuclear Experimental Reactor (ITER) tokamak. During the course of this work, questions have arisen in regard to safety barriers and equipment reliability as important facets of system design. The vacuum system designers have asked several questions about the reliability of vacuum bellows and vacuum piping. The vessel design team has asked about the reliability of electrical breaks and copper-copper joints used in cryogenic piping. Research into operating experiences of similar equipment has been performed to determine representative failure rates for these components. The following chapters give the research results and the findings for vacuum system bellows, power plant stainless steel piping (amended to represent vacuum system piping), cryogenic system electrical insulating breaks, and copper joints.

  4. In-Vessel Coil Material Failure Rate Estimates for ITER Design Use

    Energy Technology Data Exchange (ETDEWEB)

    L. C. Cadwallader

    2013-01-01

    The ITER international project design teams are working to produce an engineering design for construction of this large tokamak fusion experiment. One of the design issues is ensuring proper control of the fusion plasma. In-vessel magnet coils may be needed for plasma control, especially the control of edge localized modes (ELMs) and plasma vertical stabilization (VS). These coils will be lifetime components that reside inside the ITER vacuum vessel behind the blanket modules. As such, their reliability is an important design issue since access will be time consuming if any type of repair were necessary. The following chapters give the research results and estimates of failure rates for the coil conductor and jacket materials to be used for the in-vessel coils. Copper and CuCrZr conductors, and stainless steel and Inconel jackets are examined.

  5. Optimal Cardiac Resynchronization Therapy Pacing Rate in Non-Ischemic Heart Failure Patients

    DEFF Research Database (Denmark)

    Ghotbi, Adam Ali; Sander, Mikael; Køber, Lars

    2015-01-01

    by microneurography (MSNA), peak oxygen consumption (pVO2), N-terminal pro-brain natriuretic peptide (p-NT-proBNP), echocardiography and QoL. RESULTS: DDD-80 pacing for 3 months increased the mean heart rate from 77.3 to 86.1 (p = 0.001) and reduced sympathetic activity compared to DDD-60 (51±14 bursts/100 cardiac......BACKGROUND: The optimal pacing rate during cardiac resynchronization therapy (CRT) is unknown. Therefore, we investigated the impact of changing basal pacing frequencies on autonomic nerve function, cardiopulmonary exercise capacity and self-perceived quality of life (QoL). METHODS: Twelve CRT...... patients with non-ischemic heart failure (NYHA class II-III) were enrolled in a randomized, double-blind, crossover trial, in which the basal pacing rate was set at DDD-60 and DDD-80 for 3 months (DDD-R for 2 patients). At baseline, 3 months and 6 months, we assessed sympathetic nerve activity...

  6. Heart rate variability (HRV) in kidney failure: measurement and consequences of reduced HRV.

    Science.gov (United States)

    Ranpuria, Reena; Hall, Martica; Chan, Chris T; Unruh, Mark

    2008-02-01

    A common cause of death in end-stage renal disease (ESRD) patients on dialysis is sudden cardiac death (SCD). Compared to the general population, the percentage of cardiovascular deaths that are attributed to SCD is higher in patients treated by dialysis. While coronary artery disease (CAD) is the predominant cause of SCD in dialysis patients, reduced heart rate variability (HRV) may play a role in the higher risk of SCD among other risk factors. HRV refers to beat-to-beat alterations in heart rate as measured by periodic variation in the R-R interval. HRV provides a non-invasive method for investigating autonomic input into the heart. It quantifies the amount by which the R-R interval or heart rate changes from one cardiac cycle to the next. The autonomic nervous system transmits impulses from the central nervous system to peripheral organs and is responsible for controlling the heart rate, blood pressure and respiratory activity. In normal individuals, without cardiac disease, the heart rate has a high degree of beat-to-beat variability. HRV fluctuates with respiration: it increases with inspiration and decreases with expiration and is primarily mediated by parasympathetic activity. HRV has been used to evaluate and quantify the cardiac risk associated with a variety of conditions including cardiac disorders, stroke, multiple sclerosis and diabetes. In this narrative review, we will examine the association between HRV and SCD. This report explains the measurement of HRV and the consequences of reduced HRV in the general population and dialysis patients. Lastly, this review will outline the possible use of HRV as a clinical predictor for SCD in the dialysis population. The current understanding of SCD based on HRV findings among the ESRD population support the use of more aggressive treatment of CAD; greater use of angiotensin converting enzyme inhibitor (ACE-i)/angiotensin receptor blockers (ARBs) and beta-blockers and more frequent and/or nocturnal haemodialysis

  7. Postoperative Ambulatory Performance Status Significantly Affects Implant Failure Rate Among Surgical Treatment Strategies in Patients With Proximal Femur Metastasis.

    Science.gov (United States)

    Tsai, Shang-Wen; Wu, Po-Kuei; Chen, Cheng-Fong; Chang, Ming-Chau; Chen, Wei-Ming

    2016-11-08

    Surgical treatment strategies for proximal femur metastasis have been reported with mixed results. Little is known about risk factor for implant failure except for longer patient survival. Therefore, we determined whether implant survivorship differed among treatment strategies, as well as risk factors for implant failure. We retrospectively reviewed a consecutive 106 patients with proximal femur metastasis treated with prosthesis replacement (n = 38), intramedullary nail (n = 32), and dynamic hip screw (DHS) (n = 36). Eastern Cooperative Oncology Group (ECOG) scale and Karnofsky index were used to evaluate functional outcome. Patient characteristics and postoperative ambulatory performance status were assessed for their values in determining implant failure. Overall implant failure rate was 11.3% (12 of 106). Prosthesis replacement was related to better implant survivorship (P = 0.041), without mechanical failures. On the contrary, 7 of the 10 implant failures in the fixation group were considered mechanical failures. Better postoperative ambulatory status (ECOG ≤ 2) was a risk factor for implant failure (P = 0.03). Notably, for patients with poor ambulatory status (ECOG ≥ 3), implant survivorship was not different among choice of implants. In conclusion, prosthesis replacement would be a more durable option in the treatment of proximal femur metastasis. Postoperative ambulatory status could be an additional consideration. For patients with poor expected ambulatory performance status, fixation with intramedullary nail or DHS might be considered for a less technical demanding procedure.

  8. Myocardial strain and strain rate in monitoring subclinical heart failure in asymptomatic long-term survivors of childhood cancer.

    NARCIS (Netherlands)

    Mavinkurve-Groothuis, A.M.C.; Groot-Loonen, J.J.; Marcus, K.A.; Bellersen, L.; Feuth, T.; Bokkerink, J.P.M.; Hoogerbrugge, P.M.; Korte, C.L. de; Kapusta, L.

    2010-01-01

    We studied the role of global myocardial strain and strain rate in monitoring subclinical heart failure in a large group of asymptomatic long-term survivors of childhood cancer. Global strain (rate) parameters of survivors were compared with those in healthy controls and were related to conventional

  9. [The exercise training restores the heart rate variability in heart failure patients. A systematic review].

    Science.gov (United States)

    Segovia, Victoria; Manterola, Carlos; González, Marcelo; Rodríguez-Núñez, Iván

    2017-01-05

    Cardiovascular diseases are an important cause of morbidity and mortality in the general population. In this sense the autonomic imbalance is the cornerstone of the physiopathology underlying the development of these diseases. The aim of this study was to determine the efficacy of exercise training on heart rate variability (HRV) in adult patients with chronic heart failure. A systematic literature review was conducted on electronic databases. The considered studies were randomized clinical trials, quasi-experimental studies with non-randomized control group, quasi-experimental studies with analysis of pre and post intervention and crossover studies with randomly assigned training and detraining periods. The standardized mean differences were calculated between pre and post intervention in both control and experimental group. Intra-subject analysis of control group showed no statistical significance in the standardized mean differences of HRV. In the experimental group, the standardized mean differences were positive for the root mean square of successive difference (+0.468±0.215; P=.032), high frequency band (HF) (0.934±0.256; P<.001) and low frequency band (LF) (<0.415±0.096; P=.001). Moreover, the standardized mean difference was negative for LF/HF (-0.747±0.369, P=<.044). On the other hands, only 3 studies entered the meta-analysis of comparative studies. The effect of exercise training was favorable for experimental group in LF/HF (-2.21±95% CI: -3.83 to -0.60), HF and LF. The exercise training was effective in augmenting HRV and restores autonomic balance in patients with heart failure. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Deep breathing heart rate variability is associated with inspiratory muscle weakness in chronic heart failure.

    Science.gov (United States)

    Reis, Michel Silva; Arena, Ross; Archiza, Bruno; de Toledo, Carlos Fischer; Catai, Aparecida Maria; Borghi-Silva, Audrey

    2014-03-01

    There is a synchronism between the respiratory and cardiac cycles. However, the relationship of inspiratory muscle weakness in chronic heart failure (CHF) on cardiac autonomic modulation is unknown. The purpose of the present investigation was to evaluate the impact of inspiratory muscle strength on the magnitude of respiratory sinus arrhythmia. Ten CHF (62 ± 7 years--left ventricle eject fraction of 40 ± 5% and New York Heart Association class I-III) and nine matched-age healthy volunteers (64 ± 5 years) participated in this study. Heart rate variability (HRV) was obtained at rest and during deep breathing manoeuvre (DB-M) by electrocardiograph. CHF patients demonstrated impaired cardiac autonomic modulation at rest and during DB-M when compared with healthy subjects (p heart rate was associated with inspiratory muscle weakness in CHF. Based on this evidence, recommendations for future research applications of respiratory muscle training can bring to light a potentially valuable target for rehabilitation. Copyright © 2013 John Wiley & Sons, Ltd.

  11. Using Roadside Billboard Posters to Increase Admission Rates to Problem Gambling Services: Reflections on Failure.

    Science.gov (United States)

    Calderwood, Kimberly A; Wellington, William J

    2015-07-01

    Based on the stimulus-response model of advertising, this study sought to increase admission rates to a local problem gambling service (PGS) in Windsor, Ontario, Canada, by adding a series of locally based 10 foot by 20 foot roadside billboard posters to PGS's existing communications tools for a 24-week period. Using proof of performance reports, a pre-post survey of new callers to PGS, a website visit counter, and a media awareness survey, the findings showed that at least some individuals were influenced by billboard exposure, but admission rates continued to decline during the billboard campaign period. While one possible explanation for the communications failure was that the whole PGS communications campaign was below the minimal threshold for communications perception, another possible explanation is that the stimulus-response model of advertising used may not have been appropriate for such advertising that targets behavior change. Reflections on using an information-processing model instead of a stimulus-response model, and considerations of a two-step flow of communication, are provided. Recommendations are made regarding matching communications messages to stages of behavior change, use of online promotion, and strategies for future research. © 2015 Society for Public Health Education.

  12. Cardiac Arrest Secondary to Lightning Strike: Case Report and Review of the Literature.

    Science.gov (United States)

    Rotariu, Elena L; Manole, Mioara D

    2017-08-01

    Lightning strike injuries, although less common than electrical injuries, have a higher morbidity rate because of critical alterations of the circulatory system, respiratory system, and central nervous system. Most lightning-related deaths occur immediately after injury because of arrhythmia or respiratory failure. We describe the case of a pediatric patient who experienced cardiorespiratory arrest secondary to a lightning strike, where the Advanced Cardiac Life Support and Basic Life Support chain of survival was well executed, leading to return of spontaneous circulation and intact neurological survival. We review the pathophysiology of lightning injuries, prognostic factors of favorable outcome after cardiac arrest, including bystander cardiopulmonary resuscitation, shockable rhythm, and automatic external defibrillator use, and the importance of temperature management after cardiac arrest.

  13. In-Flight Validation of a Pilot Rating Scale for Evaluating Failure Transients in Electronic Flight Control Systems

    Science.gov (United States)

    Kalinowski, Kevin F.; Tucker, George E.; Moralez, Ernesto, III

    2006-01-01

    Engineering development and qualification of a Research Flight Control System (RFCS) for the Rotorcraft Aircrew Systems Concepts Airborne Laboratory (RASCAL) JUH-60A has motivated the development of a pilot rating scale for evaluating failure transients in fly-by-wire flight control systems. The RASCAL RFCS includes a highly-reliable, dual-channel Servo Control Unit (SCU) to command and monitor the performance of the fly-by-wire actuators and protect against the effects of erroneous commands from the flexible, but single-thread Flight Control Computer. During the design phase of the RFCS, two piloted simulations were conducted on the Ames Research Center Vertical Motion Simulator (VMS) to help define the required performance characteristics of the safety monitoring algorithms in the SCU. Simulated failures, including hard-over and slow-over commands, were injected into the command path, and the aircraft response and safety monitor performance were evaluated. A subjective Failure/Recovery Rating (F/RR) scale was developed as a means of quantifying the effects of the injected failures on the aircraft state and the degree of pilot effort required to safely recover the aircraft. A brief evaluation of the rating scale was also conducted on the Army/NASA CH-47B variable stability helicopter to confirm that the rating scale was likely to be equally applicable to in-flight evaluations. Following the initial research flight qualification of the RFCS in 2002, a flight test effort was begun to validate the performance of the safety monitors and to validate their design for the safe conduct of research flight testing. Simulated failures were injected into the SCU, and the F/RR scale was applied to assess the results. The results validate the performance of the monitors, and indicate that the Failure/Recovery Rating scale is a very useful tool for evaluating failure transients in fly-by-wire flight control systems.

  14. Oxygen Kinetics and Heart Rate Response during Early Recovery from Exercise in Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Charalampos D. Kriatselis

    2012-01-01

    Full Text Available Background. The purpose of this study was to assess the post-exercise O2 uptake and heart rate response in patients with heart failure (HF in comparison to healthy individuals. Methods and Results. Exercise testing of all subjects was conducted according to the RITE-protocol. The study subjects were classified according to their peak oxygen uptake (peak VO2 in four groups: healthy individuals with a peak VO2 >22 mL/kg/min (group 1, : 50, and patients with HF and a peak VO2 of 18–22 mL/kg/min, (group 2, : 48, 14–18 mL/kg/min (group 3, : 57, and <14 mL/kg/min (group 4, : 31. Both peak VO2 and HR declined more slowly in the patients with HF than in the normal subjects. Recovery of VO2 and HR followed monoexponential kinetics in the early post-recovery phase. This enabled the determination of a time constant for both HR and VO2 (TC VO2 and TC HR. From group 1 to 4 there was a prolongation of the time constant for VO2 and HR: TC VO2 (group 1: 110±34, group 2: 197±43, group 3: 238±80, and group 4: 278±50 sec, and TC HR (group 1: 148±82, group 2: 290±65, group 3: 320±58, and group 4: 376±55 sec. Conclusion. The rate of decline of VO2 and HR in the early post-exercise phase is inversely related to the peak VO2. The time constant for oxygen uptake (TC VO2 and heart rate (TC HR might prove a useful parameter for more precise monitoring and grading of HF.

  15. Probabilistic exposure assessment model to estimate aseptic-UHT product failure rate.

    Science.gov (United States)

    Pujol, Laure; Albert, Isabelle; Magras, Catherine; Johnson, Nicholas Brian; Membré, Jeanne-Marie

    2015-01-02

    Aseptic-Ultra-High-Temperature (UHT) products are manufactured to be free of microorganisms capable of growing in the food at normal non-refrigerated conditions at which the food is likely to be held during manufacture, distribution and storage. Two important phases within the process are widely recognised as critical in controlling microbial contamination: the sterilisation steps and the following aseptic steps. Of the microbial hazards, the pathogen spore formers Clostridium botulinum and Bacillus cereus are deemed the most pertinent to be controlled. In addition, due to a relatively high thermal resistance, Geobacillus stearothermophilus spores are considered a concern for spoilage of low acid aseptic-UHT products. A probabilistic exposure assessment model has been developed in order to assess the aseptic-UHT product failure rate associated with these three bacteria. It was a Modular Process Risk Model, based on nine modules. They described: i) the microbial contamination introduced by the raw materials, either from the product (i.e. milk, cocoa and dextrose powders and water) or the packaging (i.e. bottle and sealing component), ii) the sterilisation processes, of either the product or the packaging material, iii) the possible recontamination during subsequent processing of both product and packaging. The Sterility Failure Rate (SFR) was defined as the sum of bottles contaminated for each batch, divided by the total number of bottles produced per process line run (10(6) batches simulated per process line). The SFR associated with the three bacteria was estimated at the last step of the process (i.e. after Module 9) but also after each module, allowing for the identification of modules, and responsible contamination pathways, with higher or lower intermediate SFR. The model contained 42 controlled settings associated with factory environment, process line or product formulation, and more than 55 probabilistic inputs corresponding to inputs with variability

  16. Poor quality evidence suggests that failure rates for atraumatic restorative treatment and conventional amalgam are similar.

    Science.gov (United States)

    Hurst, Dominic

    2012-06-01

    The Medline, Cochrane CENTRAL, Biomed Central, Database of Open Access Journals (DOAJ), OpenJ-Gate, Bibliografia Brasileira de Odontologia (BBO), LILACS, IndMed, Sabinet, Scielo, Scirus (Medicine), OpenSIGLE and Google Scholar databases were searched. Hand searching was performed for journals not indexed in the databases. References of included trials were checked. Prospective clinical trials with test and control groups with a follow up of at least one year were included. Data abstraction was conducted independently and clinical and methodologically homogeneous data were pooled using a fixed-effects model. Eighteen trials were included. From these 32 individual dichotomous datasets were extracted and analysed. The majority of the results show no differences between both types of intervention. A high risk of selection-, performance-, detection- and attrition bias was identified. Existing research gaps are mainly due to lack of trials and small sample size. The current evidence indicates that the failure rate of high-viscosity GIC/ART restorations is not higher than, but similar to that of conventional amalgam fillings after periods longer than one year. These results are in line with the conclusions drawn during the original systematic review. There is a high risk that these results are affected by bias, and thus confirmation by further trials with suitably high numbers of participants is needed.

  17. Loss of lag-response curvilinearity of indices of heart rate variability in congestive heart failure

    Directory of Open Access Journals (Sweden)

    Smith Michael L

    2006-06-01

    Full Text Available Abstract Background Heart rate variability (HRV is known to be impaired in patients with congestive heart failure (CHF. Time-domain analysis of ECG signals traditionally relies heavily on linear indices of an essentially non-linear phenomenon. Poincaré plots are commonly used to study non-linear behavior of physiologic signals. Lagged Poincaré plots incorporate autocovariance information and analysis of Poincaré plots for various lags can provide interesting insights into the autonomic control of the heart. Methods Using Poincaré plot analysis, we assessed whether the relation of the lag between heart beats and HRV is altered in CHF. We studied the influence of lag on estimates of Poincaré plot indices for various lengths of beat sequence in a public domain data set (PhysioNet of 29 subjects with CHF and 54 subjects with normal sinus rhythm. Results A curvilinear association was observed between lag and Poincaré plot indices (SD1, SD2, SDLD and SD1/SD2 ratio in normal subjects even for a small sequence of 50 beats (p value for quadratic term 3 × 10-5, 0.002, 3.5 × 10-5 and 0.0003, respectively. This curvilinearity was lost in patients with CHF even after exploring sequences up to 50,000 beats (p values for quadratic term > 0.5. Conclusion Since lagged Poincaré plots incorporate autocovariance information, these analyses provide insights into the autonomic control of heart rate that is influenced by the non-linearity of the signal. The differences in lag-response in CHF patients and normal subjects exist even in the face of the treatment received by the CHF patients.

  18. Association between Severity of Anemia and 30-Day Readmission Rate: Archival Data of 847 Patients with Acute Decompensated Heart Failure

    Directory of Open Access Journals (Sweden)

    Jorge C. Busse

    2014-01-01

    Full Text Available Hospitals today are facing adjustments to reimbursements from excessive readmission rates. One of the most common and expensive causes of readmissions is exacerbation of a heart failure condition. The objective of this paper was to determine if there was an association between the presence of anemia in patients with acute decompensated heart failure and their readmission rate. Using archival data of 4 hospitals in the Miami area, a sample of 847 inpatients with a diagnostic related group (DRG of HF at discharge was considered. There was a significant association between low hemoglobin values and a high rate of readmissions at 14 days and at 30 days in subjects with normal sodium and creatinine values. For subjects with low sodium and high creatinine values, a higher readmission rate was seen in men with low hemoglobin but not in women. These results support a prospective effort to measure the impact of anemia and its treatment on readmission rates.

  19. [Cardiopulmonary resuscitation in cardiac arrest following trauma].

    Science.gov (United States)

    Leidel, B A; Kanz, K-G

    2016-11-01

    For decades, survival rates of cardiac arrest following trauma were reported between 0 and 2 %. Since 2005, survival rates have increased with a wide range up to 39 % and good neurological recovery in every second person injured for unknown reasons. Especially in children, high survival rates with good neurologic outcomes are published. Resuscitation following traumatic cardiac arrest differs significantly from nontraumatic causes. Paramount is treatment of reversible causes, which include massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade. Treatment of reversible causes should be simultaneous. Chest compression is inferior following traumatic cardiac arrest and should never delay treatment of reversible causes of the traumatic cardiac arrest. In massive bleeding, bleeding control has priority. Damage control resuscitation with permissive hypotension, aggressive coagulation therapy, and damage control surgery represent the pillars of initial treatment. Cardiac arrest due to hypoxia should be resolved by airway management and ventilation. Tension pneumothorax should be decompressed by finger thoracostomy, pericardial tamponade by resuscitative thoracotomy. In addition, resuscitative thoracotomy allows direct and indirect bleeding control. Untreated impact brain apnea may rapidly lead to cardiac arrest and requires quick opening of the airway and effective oxygenation. Established algorithms for treatment of cardiac arrest following trauma enable a safe, structured, and effective management.

  20. High rate of failure of allograft reconstruction of the extensor mechanism after total knee arthroplasty.

    Science.gov (United States)

    Leopold, S S; Greidanus, N; Paprosky, W G; Berger, R A; Rosenberg, A G

    1999-11-01

    Disruption of the extensor mechanism is an uncommon but devastating complication of total knee arthroplasty. Several techniques for reconstruction of the extensor mechanism after total knee arthroplasty have been reported, but we do not know of any study in which the results of one group's method were corroborated by a second group using the same technique. In the present series, we evaluated the results of reconstruction of the extensor mechanism with use of allograft according to the method described by Emerson et al. Seven reconstructions of the extensor mechanism with use of a bone-tendon-bone allograft were performed with the technique of Emerson et al. in six patients. The patients were evaluated before and after the operation. The knee score according to the system of The Hospital for Special Surgery, evidence of an extensor lag, use of walking aids, and the ambulatory status of each patient were recorded. The patients were also asked about, and the medical records were reviewed for, episodes of falling related to weakness of the quadriceps after the reconstruction. The mean duration of follow-up was thirty-nine months (range, six to 115 months). As these reconstructions often fail early, the minimum duration of follow-up was six months. All seven reconstructions were rated as clinical failures on the basis of a persistent or recurrent extensor lag of more than 30 degrees. All but one patient needed an assistive device full time for walking, and four patients (five knees) had at least one documented episode of falling that was due to giving-way of the affected knee. Four of the reconstructions were revised; one revision was performed with use of another extensor mechanism allograft and three were performed with use of a medial gastrocnemius rotation flap. The other three clinical failures had not been revised at the time of writing. At the time of the most recent follow-up (or at the time of revision of the extensor reconstruction), the mean extensor lag was

  1. Creatinine excretion rate, a marker of muscle mass, is related to clinical outcome in patients with chronic systolic heart failure

    NARCIS (Netherlands)

    ter Maaten, Jozine M.; Damman, Kevin; Hillege, Hans L.; Bakker, Stephan J.; Anker, Stefan D.; Navis, Gerjan; Voors, Adriaan A.

    2014-01-01

    Aims In chronic heart failure (CHF), low body mass as a reflection of low muscle mass has been associated with poor outcome. Urinary creatinine excretion rate (CER) is an established marker of muscle mass, but has not been investigated in CHF. This study aims to evaluate urinary CER as a marker of m

  2. Method to calculate failure rate of submarine flexible pipes; Metodo para calculo da taxa de falha de dutos flexiveis submarinos

    Energy Technology Data Exchange (ETDEWEB)

    Simoes Filho, Salvador [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)

    2003-07-01

    This report presents calculation method for failure rate of submarine flexible pipes in PETROBRAS using the distribution of Weibull in comparison with the traditional method of PARLOC that uses the exponential distribution. PARLOC - Pipeline and Riser Loss of Containment Study - Pipeline Offshore Reliability Data - database of pipes of the North Sea. (author)

  3. The nursing measures of acute myocardial infarction with cardiac arrest and the value of it preventing the multiple organ failure%急性心肌梗死合并心肺骤停护理措施及预防多脏器衰竭的价值

    Institute of Scientific and Technical Information of China (English)

    钟旭

    2014-01-01

    目的:探讨急性心肌梗死合并心肺骤停护理措施,并分析其预防多脏器衰竭的临床价值。方法选择患者80例,分为两组,各40例,观察组实施本研究护理干预方法,对照组则实施常规护理,比较两组心跳恢复时间、呼吸恢复时间,并统计两组发生的并发症及整体抢救成功率。结果观察组心跳恢复时间和呼吸恢复时间均显著快于对照组(P <0.05),观察组发生肋骨骨折、急性肾功能衰竭及脑梗死的比例显著低于对照组(P <0.05),且抢救成功率显著高于对照组(P <0.05)。结论有效的护理配合对于提高患者抢救成功率,减少全身重要脏器损伤具有积极意义。%Objective To study the care measures of acute myocardial infarction with cardiopulmonary arrest, and to analyze the value of it in preventing multiple organ failure. Methods 80 patients were divided into two groups, each 40 cases, the observation group were used the nursing interventions in this study, the control group were implemented routine care, then heart rate recovery time, breathing recovery time were compared and complications occurred and overall success rate in both groups were statisticed. Results The observation group with heartbeat and breathing recovery time were significantly faster than control group(P < 0.05),the occurrence of rib fractures,acute renal failure and cerebral infarction in the observation group was significantly lower than that of control group(P < 0.05),the success rescue rate was significantly higher than that of the control group(P < 0.05). Conclusion Effective nursing meatures is of positive significance to improve the success rate of patients, and to reduce body organs injury.

  4. Prognostic impact of heart rate in elderly with systolic heart failure and concomitant atrial fibrillation.

    Science.gov (United States)

    Barywani, Salim; Petzold, Max

    2017-08-01

    The present study aimed to investigate the impact of resting heart rate (HR) on 5-year all-cause mortality in patients ≥80 years with heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant atrial fibrillation (AF) after optimal up-titration of beta-blockers (BBs). Patients (n = 185) aged ≥80 years with HF and left ventricular ejection fraction ≤40% were included between January 2000 and January 2008 from two university hospitals, Sahlgrenska and Östra and retrospectively studied from January 2 to May 30, 2013. Up-titrations of guideline recommended medications were performed at HF outpatient clinics. Of whole study population, 54% (n= 100) had AF. After optimal up-titration of BBs and angiotensin converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), mean HR in patients with AF was 73 ± 15 beats/minute (bpm), 36% had resting HR ≤65 bpm. Five-year all-cause mortality among patients with AF was significantly lower in patients with HR ≤65 bpm (63%) compared to HR >65 (80%). Cox proportional-hazard regression analysis adjusted for clinically important baseline variables and doses of ACEIs/ARBs and BBs demonstrated resting HR ≤65 bpm as an independent predictor of improved survival compared to resting HR >65 bpm (HR 0.3, 95%CI 0.1-0.7, P 0.005). In octogenarians with HFrEF and concomitant AF, lowering resting HR to levels as low as HR ≤65 bpm was still associated with improved survival from all-cause mortality. Our data indicate that mortality in AF became comparable to SR when patients were on maximally up-titrated beta-blocker doses with HR as low as 75 bpm.

  5. Plerixafor as preemptive strategy results in high success rates in autologous stem cell mobilization failure.

    Science.gov (United States)

    Worel, Nina; Fritsch, Gerhard; Agis, Hermine; Böhm, Alexandra; Engelich, Georg; Leitner, Gerda C; Geissler, Klaus; Gleixner, Karoline; Kalhs, Peter; Buxhofer-Ausch, Veronika; Keil, Felix; Kopetzky, Gerhard; Mayr, Viktor; Rabitsch, Werner; Reisner, Regina; Rosskopf, Konrad; Ruckser, Reinhard; Zoghlami, Claudia; Zojer, Niklas; Greinix, Hildegard T

    2016-08-31

    Plerixafor in combination with granulocyte-colony stimulating factor (G-CSF) is approved for autologous stem cell mobilization in poor mobilizing patients with multiple myeloma or malignant lymphoma. The purpose of this study was to evaluate efficacy and safety of plerixafor in an immediate rescue approach, administrated subsequently to G-CSF alone or chemotherapy and G-CSF in patients at risk for mobilization failure. Eighty-five patients mobilized with G-CSF alone or chemotherapy were included. Primary endpoint was the efficacy of the immediate rescue approach of plerixafor to achieve ≥2.0 × 10(6) CD34(+) cells/kg for a single or ≥5 × 10(6) CD34(+) cells/kg for a double transplantation and potential differences between G-CSF and chemotherapy-based mobilization. Secondary objectives included comparison of stem cell graft composition including CD34(+) cell and lymphocyte subsets with regard to the mobilization regimen applied. No significant adverse events were recorded. A median 3.9-fold increase in CD34(+) cells following plerixafor was observed, resulting in 97% patients achieving at least ≥2 × 10(6) CD34+ cells/kg. Significantly more differentiated granulocyte and monocyte forming myeloid progenitors were collected after chemomobilization whereas more CD19(+) and natural killer cells were collected after G-CSF. Fifty-two patients underwent transplantation showing rapid and durable engraftment, irrespectively of the stem cell mobilization regimen used. The addition of plerixafor in an immediate rescue model is efficient and safe after both, G-CSF and chemomobilization and results in extremely high success rates. Whether the differences in graft composition have a clinical impact on engraftment kinetics, immunologic recovery, and graft durability have to be analysed in larger prospective studies.

  6. Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcelo Rodrigues dos; Sayegh, Ana Luiza Carrari; Groehs, Raphaela Vilar Ramalho; Fonseca, Guilherme [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Trombetta, Ivani Credidio [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Universidade Nove de Julho (UNINOVE) (Brazil); Barretto, Antônio Carlos Pereira [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Arap, Marco Antônio [Faculdade de medicina da Universidade de São Paulo - Urologia (Brazil); Negrão, Carlos Eduardo [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil); Escola de Educação Física e Esporte da Universidade de São Paulo, São Paulo, SP (Brazil); Middlekauff, Holly R. [Division of Cardiology - David Geffen School of Medicine - University of California (United States); Alves, Maria-Janieire de Nazaré Nunes, E-mail: janieire.alves@incor.usp.br [Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo (Brazil)

    2015-09-15

    Testosterone deficiency in patients with heart failure (HF) is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown. We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF. Total testosterone (TT) and free testosterone (FT) were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66) and normal testosterone (NT; n = 44) groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA) was recorded by microneurography in a subpopulation of 27 patients. Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008). Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001). In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02) predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009) and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02) predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001). These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.

  7. Testosterone Deficiency Increases Hospital Readmission and Mortality Rates in Male Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Marcelo Rodrigues dos Santos

    2015-01-01

    Full Text Available Background: Testosterone deficiency in patients with heart failure (HF is associated with decreased exercise capacity and mortality; however, its impact on hospital readmission rate is uncertain. Furthermore, the relationship between testosterone deficiency and sympathetic activation is unknown. Objective: We investigated the role of testosterone level on hospital readmission and mortality rates as well as sympathetic nerve activity in patients with HF. Methods: Total testosterone (TT and free testosterone (FT were measured in 110 hospitalized male patients with a left ventricular ejection fraction < 45% and New York Heart Association classification IV. The patients were placed into low testosterone (LT; n = 66 and normal testosterone (NT; n = 44 groups. Hypogonadism was defined as TT < 300 ng/dL and FT < 131 pmol/L. Muscle sympathetic nerve activity (MSNA was recorded by microneurography in a subpopulation of 27 patients. Results: Length of hospital stay was longer in the LT group compared to in the NT group (37 ± 4 vs. 25 ± 4 days; p = 0.008. Similarly, the cumulative hazard of readmission within 1 year was greater in the LT group compared to in the NT group (44% vs. 22%, p = 0.001. In the single-predictor analysis, TT (hazard ratio [HR], 2.77; 95% confidence interval [CI], 1.58–4.85; p = 0.02 predicted hospital readmission within 90 days. In addition, TT (HR, 4.65; 95% CI, 2.67–8.10; p = 0.009 and readmission within 90 days (HR, 3.27; 95% CI, 1.23–8.69; p = 0.02 predicted increased mortality. Neurohumoral activation, as estimated by MSNA, was significantly higher in the LT group compared to in the NT group (65 ± 3 vs. 51 ± 4 bursts/100 heart beats; p < 0.001. Conclusion: These results support the concept that LT is an independent risk factor for hospital readmission within 90 days and increased mortality in patients with HF. Furthermore, increased MSNA was observed in patients with LT.

  8. Neurological and circulatory outcomes of cardiopulmonary resuscitation in progress: influence of pre-arrest and arrest factors.

    Science.gov (United States)

    Jørgensen, E O

    1998-01-01

    Possible correlations between the circulatory and neurological responses to cardiopulmonary resuscitation (CPR) and the influence of pre-arrest factors (demographic data, medical history and aetiology of circulatory arrest) and arrest factors (location of arrest, ECG configurations, and duration of resuscitation) on the course of circulatory and neurological recovery were investigated in 111 victims of circulatory arrest. At the start of resuscitation 57 patients (Group I) had some brain function and 54 (Group II) had no brain function. Sixty nine patients (62%) had circulation restored but 54 (78%) were left with heart failure. Forty one patients (39%) survived the first day, 26 (63%) with heart failure; only 34 (31%) were alive after 48 h, 17 (50%) with heart failure. Half of the patients surviving 24 or 48 h had awakened. Consciousness returned in 32 patients (29%) during the first 48 h, more frequently in Group I than in Group II. Patients in Group I had a higher incidence of in-hospital arrest and had their circulation restored more often than those in Group II. Survival and post-resuscitation heart failure was alike in the groups. The pre-arrest factors explored did not modify the circulatory or neurological outcome whereas initial ventricular fibrillation was significantly related to recovery of consciousness. The revivability of spontaneous circulation and of neurological functions was found thus mainly to be determined by global ischaemia sustained prior to and during CPR.

  9. Performance analysis of multi-radio routing protocol in cognitive radio ad hoc networks under different path failure rate

    Science.gov (United States)

    Che-Aron, Z.; Abdalla, A. H.; Abdullah, K.; Hassan, W. H.

    2013-12-01

    In recent years, Cognitive Radio (CR) technology has largely attracted significant studies and research. Cognitive Radio Ad Hoc Network (CRAHN) is an emerging self-organized, multi-hop, wireless network which allows unlicensed users to opportunistically access available licensed spectrum bands for data communication under an intelligent and cautious manner. However, in CRAHNs, a lot of failures can easily occur during data transmission caused by PU (Primary User) activity, topology change, node fault, or link degradation. In this paper, an attempt has been made to evaluate the performance of the Multi-Radio Link-Quality Source Routing (MR-LQSR) protocol in CRAHNs under different path failure rate. In the MR-LQSR protocol, the Weighted Cumulative Expected Transmission Time (WCETT) is used as the routing metric. The simulations are carried out using the NS-2 simulator. The protocol performance is evaluated with respect to performance metrics like average throughput, packet loss, average end-to-end delay and average jitter. From the simulation results, it is observed that the number of path failures depends on the PUs number and mobility rate of SUs (Secondary Users). Moreover, the protocol performance is greatly affected when the path failure rate is high, leading to major service outages.

  10. RBANS embedded measures of suboptimal effort in dementia: effort scale has a lower failure rate than the effort index.

    Science.gov (United States)

    Burton, Rachel L; Enright, Joe; O'Connell, Megan E; Lanting, Shawnda; Morgan, Debra

    2015-02-01

    The importance of evaluating effort in neuropsychological assessments has been widely acknowledged, but measuring effort in the context of dementia remains challenging due to the impact of dementia severity on effort measure scores. Two embedded measures have been developed for the repeatable battery for the assessment of neuropsychological status (RBANS; Randolph, C., Tierney, M. C., Mohr, E., & Chase, T. N. (1998). The repeatable battery for the assessment of neuropsychological status (RBANS): Preliminary clinical validity. Journal of Clinical and Experimental Neuropsychology, 20 (3), 310-319): the Effort Index (EI; Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. (2007). An effort index for the repeatable battery for the assessment of neuropsychological status (RBANS). Clinical Neuropsychologist, 21 (5), 841-854) and the Effort Scale (ES; Novitski, J., Steele, S., Karantzoulis, S., & Randolph, C. (2012). The repeatable battery for the assessment of neuropsychological status effort scale. Archives of Clinical Neuropsychology, 27 (2), 190-195). We explored failure rates on these effort measures in a non-litigating mixed dementia sample (N = 145). Failure rate on the EI was high (48%) and associated with dementia severity. In contrast, failure on the ES was 14% but differed based on type of dementia. ES failure was low (4%) when dementia was due to Alzheimer disease (AD), but high (31%) for non-AD dementias. These data raise concerns about use of the RBANS embedded effort measures in dementia evaluations.

  11. Comparison of compact bone failure under two different loadings rates: experimental and modelling approaches

    CERN Document Server

    Pithioux, M; Chabrand, P; Pithioux, Martine

    2004-01-01

    Understanding the mechanical behaviour of bones up to failure is necesary for diagnosis and prevention of accident and trauma. As far as we know, no authors have yet studied the tensile behaviour of compact bone including failure under dynamic loadings (1m/s). The originality of this study comes from not only the analysis of compact bone failure under dynamic loadings, the results of which are compared to those obtained under quasi static loadings but also the development of a statistical model. We developed a protocol using three different devices. Firstly, an X-ray scanner to analyse bone density, secondly, a common tensile device to perform quasi static experiments and thirdly, a special device based upon a hydraulic cylinder to perform dynamic tests. For all the tests, we used the same sample shape which took into account the brittleness of the compact bone. We first performed relaxation and hysteresis tests followed by tensile tests up to failure. Viscous and plastic effects were not relevant to the comp...

  12. Bathtub-Shaped Failure Rate of Sensors for Distributed Detection and Fusion

    Directory of Open Access Journals (Sweden)

    Junhai Luo

    2014-01-01

    Log-likelihood Ratio Test (ELRT rule is derived. Finally, the ROC curve for this model is presented. The simulation results show that the ELRT rule improves the robust performance of the system, compared with the traditional fusion rule without considering sensor failures.

  13. Effect of mibefradil on heart rate variability in patients with chronic heart failure

    NARCIS (Netherlands)

    Brouwer, J; de Kam, PJ; Haaksma, J; Crijns, HJGM; van Veldhuisen, DJ

    2000-01-01

    Background: Mibefradil was recently withdrawn from the market because of an unfavorable clinical profile in patients with chronic heart failure. Although drug interactions appear to play a role, other mechanisms such as proarrhythmia and autonomic deterioration could also be relevant. Chronic heart

  14. Effect of mibefradil on heart rate variability in patients with chronic heart failure

    NARCIS (Netherlands)

    Brouwer, J; de Kam, PJ; Haaksma, J; Crijns, HJGM; van Veldhuisen, DJ

    2000-01-01

    Background: Mibefradil was recently withdrawn from the market because of an unfavorable clinical profile in patients with chronic heart failure. Although drug interactions appear to play a role, other mechanisms such as proarrhythmia and autonomic deterioration could also be relevant. Chronic heart

  15. Electrophysiological analyses of threshold conditions and rate-dependent failure of excitation in single myocytes from rabbit ventricle.

    Science.gov (United States)

    Firek, L; Giles, W R

    1997-11-01

    The changes in transmembrane ionic currents that underlie normal excitability and rate-dependent failure were studied in single cells from rabbit ventricle by using whole cell voltage clamp methods. When trains of brief (1 to 2 ms) stimuli are applied at strengths very close to the threshold for excitation, a number of different patterns of action potential entrainment and failure are observed. In an individual cell, a characteristic pattern of entrainment or failure can be maintained for a relatively long time, allowing both a detailed description and a quantitative investigation of the ionic basis for this phenomenon. Three hypotheses for rate-dependent failure of excitation in rabbit ventricle were examined. The first is that following relatively high rates of stimulation, the intracellular calcium ion concentration increases and, secondarily, a background inwardly rectifying potassium ion current (IK1) decreases, thereby lowering the excitation threshold. The second hypothesis is that residual activation of the delayed rectifier potassium ion current (IK) causes the stimulus to become subthreshold as the rate of stimulation increases. The third hypothesis is that small changes in the time and voltage dependence of the inactivation and reactivation of the sodium ion current (INa) result in less net inward ion current for a given waveform of depolarization, and the cell therefore becomes inexcitable (eg, to every second stimulus). The calcium ion hypothesis was tested by buffering changes in intracellular calcium ion concentrations with BAPTA. The results strongly suggest that changes in intracellular calcium ion concentrations do not contribute significantly to the observed patterns of failure of excitation. The delayed rectifier hypothesis was evaluated using the class III antiarrhythmic drug dofetilide, which selectively blocks a large fraction of the IK current in rabbit ventricle. Dofetilide slightly decreased the stimulus threshold, suggesting that residual

  16. Cardiac arrest in children

    Directory of Open Access Journals (Sweden)

    Tress Erika

    2010-01-01

    Full Text Available Major advances in the field of pediatric cardiac arrest (CA were made during the last decade, starting with the publication of pediatric Utstein guidelines, the 2005 recommendations by the International Liaison Committee on Resuscitation, and culminating in multicenter collaborations. The epidemiology and pathophysiology of in-hospital and out-of-hospital CA are now well described. Four phases of CA are described and the term "post-cardiac arrest syndrome" has been proposed, along with treatment goals for each of its four phases: immediate post-arrest, early post-arrest, intermediate and recovery phase. Hypothermia is recommended to be considered as a therapy for post-CA syndrome in comatose patients after CA, and large multicenter prospective studies are underway. We reviewed landmark articles related to pediatric CA published during the last decade. We present the current knowledge of epidemiology, pathophysiology and treatment of CA relevant to pre-hospital and acute care health practitioners.

  17. Pittsburgh Police Arrest Data

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Arrest data contains information on people taken into custody by City of Pittsburgh police officers. More serious crimes such as felony offenses are more likely to...

  18. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques.

    Science.gov (United States)

    Spencer, H T; Hsu, L; Sodl, J; Arianjam, A; Yian, E H

    2016-04-01

    To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. ©2016 The British Editorial

  19. Surface Electrocardiogram Predictors of Sudden Cardiac Arrest

    Science.gov (United States)

    Abdelghani, Samy A.; Rosenthal, Todd M.; Morin, Daniel P.

    2016-01-01

    Background: Heart disease is a major cause of death in industrialized nations, with approximately 50% of these deaths attributable to sudden cardiac arrest. If patients at high risk for sudden cardiac arrest can be identified, their odds of surviving fatal arrhythmias can be significantly improved through prophylactic implantable cardioverter defibrillator placement. This review summarizes the current knowledge pertaining to surface electrocardiogram (ECG) predictors of sudden cardiac arrest. Methods: We conducted a literature review focused on methods of predicting sudden cardiac arrest through noninvasive electrocardiographic testing. Results: Several electrocardiographic-based methods of risk stratification of sudden cardiac arrest have been studied, including QT prolongation, QRS duration, fragmented QRS complexes, early repolarization, Holter monitoring, heart rate variability, heart rate turbulence, signal-averaged ECG, T wave alternans, and T-peak to T-end. These ECG findings have shown variable effectiveness as screening tools. Conclusion: At this time, no individual ECG finding has been found to be able to adequately stratify patients with regard to risk for sudden cardiac arrest. However, one or more of these candidate surface ECG parameters may become useful components of future multifactorial risk stratification calculators. PMID:27660578

  20. Lenient vs. strict rate control in patients with atrial fibrillation and heart failure : a post-hoc analysis of the RACE II study

    NARCIS (Netherlands)

    Mulder, Bart A.; Van Veldhuisen, Dirk J.; Crijns, Harry J. G. M.; Tijssen, Jan G. P.; Hillege, Hans L.; Alings, Marco; Rienstra, Michel; Groenveld, Hessel F.; Van den Berg, Maarten P.; Van Gelder, Isabelle C.

    2013-01-01

    AIMS: It is unknown whether lenient rate control is an acceptable strategy in patients with AF and heart failure. We evaluated differences in outcome in patients with AF and heart failure treated with lenient or strict rate control. METHODS AND RESULTS: This post-hoc analysis of the RACE II trial in

  1. Visibility graph analysis of heart rate time series and bio-marker of congestive heart failure

    Science.gov (United States)

    Bhaduri, Anirban; Bhaduri, Susmita; Ghosh, Dipak

    2017-09-01

    Study of RR interval time series for Congestive Heart Failure had been an area of study with different methods including non-linear methods. In this article the cardiac dynamics of heart beat are explored in the light of complex network analysis, viz. visibility graph method. Heart beat (RR Interval) time series data taken from Physionet database [46, 47] belonging to two groups of subjects, diseased (congestive heart failure) (29 in number) and normal (54 in number) are analyzed with the technique. The overall results show that a quantitative parameter can significantly differentiate between the diseased subjects and the normal subjects as well as different stages of the disease. Further, the data when split into periods of around 1 hour each and analyzed separately, also shows the same consistent differences. This quantitative parameter obtained using the visibility graph analysis thereby can be used as a potential bio-marker as well as a subsequent alarm generation mechanism for predicting the onset of Congestive Heart Failure.

  2. Success rate and risk factors of failure of the induced membrane technique in children: a systematic review.

    Science.gov (United States)

    Aurégan, Jean-Charles; Bégué, Thierry; Rigoulot, Guillaume; Glorion, Christophe; Pannier, Stéphanie

    2016-12-01

    The induced membrane technique was designed by Masquelet et al. to address segmental bone defects of critical size in adults. It has been used after bone defects of traumatic, infectious and tumoral origin with satisfactory results. Recently, it has been used in children but, after an initial enthusiasm, several cases of failure have been reported. The purpose of this study was to assess the success rate and the risk factors of failure of the induced membrane for children. We conducted a systematic review of all the studies reporting the results of the induced membrane technique to address bone defects of critical size in children. Our primary outcome was the success rate of the technique defined as a bone union before any iterative surgery. Our secondary outcomes were the complications and the risk factors of failure. We searched Medline via Pubmed, EMBASE and the Cochrane Library. Twelve studies, including 69 patients, met the inclusion criteria. There were 41 boys and 28 girls. Mean age at surgery was 10 years. Mean size of resection was 12.38 cm and the mean time between the two stages was 5.86 months. Mean rate of bone union after the two stages of the induced membrane technique was 58% (40/69) but this rate increased to 87% after revision surgeries (60/69). Main complications were non-unions (19/69), lysis of the graft (6/69) and fractures of the bone graft (6/69). Only 1/69 deep infection was reported. Other non specific complications were regularly reported such limb length discrepancies, joint stiffness and protruding wires. Risk factor of failure that could be suspected comprised the resection of a malignant tumour, a bone defect located at the femur, a wide resection, a long time between the two stages, an unstable osteosynthesis and a bone graft associating autograft to other graft materials. The induced membrane technique is suitable for bone defects of critical size in children. It is a reliable technique with no need of micro vascular surgery

  3. Ductile failure of steel HY80 under high strain rates and triaxial stress states, experimental results and damage description

    Science.gov (United States)

    Abdel-Malek, S.; Halle, Th.; Meyer, L. W.

    2003-09-01

    Ductile fracture investigations are an important part in current research. The simulation of fracture by means of numerical codes needs precise material data that may be reached from accurate mechanical testing. In order to predict failure processes, the stress state history as a function of strain development has to be known. In this work tensile tests on HY80 steel were performed under quasistatic and high strain rate loading conditions at room temperature using smooth and notched specimens. The force-time and displacement-time behaviour was measured during testing. Additionally, scanning electron microscopy was used to investigate the fractured surfaces. Furthermore, different models were applied to describe the failure process. FE-calculations were used to receive the stress state in the material in the region of the notch as a function of strain development.

  4. Does sequential embryo transfer improve pregnancy rate in patients with repeated implantation failure? A randomized control study

    Directory of Open Access Journals (Sweden)

    Wael A. Ismail Madkour

    2015-12-01

    Full Text Available Background: Repeated failure of in vitro fertilization treatment is frustrating to the patients and their clinicians. Various treatment plans and a change of protocol have been suggested for “low responders”; however, patients who fail treatment repeatedly inspite of good quality embryos pose a special therapeutic challenge. Additional challenge would be imposed on that particular group when the local IVF regulating low does not permit surplus embryo freezing. Objective: To examine whether sequential transfer of embryos on day 3 and on day 5 after ovum pick-up improves IVF/ET success rates in patients with repeated consecutive IVF failures (⩾ 3 trials compared to day 3 alone, with the background that local regulation prohibits embryo freezing. Study design: Randomized controlled study. Women scheduled for IVF/ET with repeated consecutive IVF failures (⩾ 3 trials were randomized to either sequential transfer of embryos on day 3 and on day 5 after ovum pick-up (Group I = 74 or conventional day 3 transfer (Group II = 73 as a control. The primary outcome measures were clinical pregnancy rate and implantation rate. The secondary outcome measures were ongoing pregnancy rate and early pregnancy loss. Results: Baseline and cycle characteristics were comparable in both groups. Clinical pregnancy rate (per embryo transfer was significantly higher in sequential ET group (37. 8% compared to that in day 3 group (21.9% (P value <0.05. Also, implantation rate (per embryos transferred was significantly higher in sequential ET group (17.1% compared to that in control group (10.5% (P value <0.01. Similarly, ongoing pregnancy (per embryo transfer was significantly higher in sequential ET group (33. 8% compared to that in day 3 group (19.2% (P value <0.05. Conclusions: Patients with repeated implantation failures, treatment with the sequential embryo transfer approach had significantly improved pregnancy outcomes compared to regular day 3 transfers

  5. Reducing the failure rate of hip resurfacing in dysplasia patients: a retrospective analysis of 363 cases.

    Science.gov (United States)

    Gaillard, Melissa D; Gross, Thomas P

    2016-06-07

    Arthritis secondary to developmental hip dysplasia often mandates implant surgery at a relatively young age. Hip resurfacing arthroplasty (HRA), compared with standard stemmed total hip arthroplasty (THA), affords a more active lifestyle including extreme-motion activities but stimulates concerns pertaining to implant failure. We addressed the primary modes of failure through a series of interventions, including a new guideline for achieving proper implant alignment through intraoperative x-rays. We then compared two sequential cohorts in a single-surgeon practice: patients with developmental dysplasia who underwent HRA before (Group 1; 121 hips in 105 patients) and after (Group 2; 242 hips in 210 patients) June 2008, at which time the four interventions were all in place. Implants in Group 2 failed less frequently within two years (0.8 % vs. 6.6 %, p = 0.002) and were more likely to have projected seven-year Kaplan-Meier survivorship (99 % vs. 89 %, p dysplasia a more active lifestyle with favorable implant survival.

  6. Postoperative cardiac arrest in children with congenital heart abnormalities

    OpenAIRE

    2013-01-01

    BACKGROUND The exact survival rates and markers of survival after postoperative cardiac arrest in children with congenital heart abnormalities are unknown. METHODS In this one-year study, we identified children younger than seven years of age with postoperative cardiac arrest in our pediatric cardiac intensive care unit database. Parameters from perioperative, pre-arrest, and resuscitation periods were analyzed for these patients. Comparisons were made between survivors and non-survivors afte...

  7. Barriers and Facilitators to Learning and Performing Cardiopulmonary Resuscitation (CPR) in Neighborhoods with Low Bystander CPR Prevalence and High Rates of Cardiac Arrest in Columbus, Ohio

    Science.gov (United States)

    Sasson, Comilla; Haukoos, Jason S.; Bond, Cindy; Rabe, Marilyn; Colbert, Susan H.; King, Renee; Sayre, Michael; Heisler, Michele

    2013-01-01

    Background Residents who live in neighborhoods that are primarily African-American, Latino, or poor are more likely to have an out-of-hospital cardiac arrest (OHCA), less likely to receive cardiopulmonary resuscitation (CPR), and less likely to survive. No prior studies have been conducted to understand the contributing factors that may decrease the likelihood of residents learning and performing CPR in these neighborhoods. The goal of this study was to identify barriers and facilitators to learning and performing CPR in three low-income, “high-risk” predominantly African American, neighborhoods in Columbus, Ohio. Methods and Results Community-Based Participatory Research (CBPR) approaches were used to develop and conduct six focus groups in conjunction with community partners in three target high-risk neighborhoods in Columbus, Ohio in January-February 2011. Snowball and purposeful sampling, done by community liaisons, was used to recruit participants. Three reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. Three major barriers to learning CPR were identified and included financial, informational, and motivational factors. Four major barriers were identified for performing CPR and included fear of legal consequences, emotional issues, knowledge, and situational concerns. Participants suggested that family/self-preservation, emotional, and economic factors may serve as potential facilitators in increasing the provision of bystander CPR. Conclusion The financial cost of CPR training, lack of information, and the fear of risking one's own life must be addressed when designing a community-based CPR educational program. Using data from the community can facilitate improved design and implementation of CPR programs. PMID:24021699

  8. Genetic deletion of NOS3 increases lethal cardiac dysfunction following mouse cardiac arrest.

    Science.gov (United States)

    Beiser, David G; Orbelyan, Gerasim A; Inouye, Brendan T; Costakis, James G; Hamann, Kimm J; McNally, Elizabeth M; Vanden Hoek, Terry L

    2011-01-01

    Cardiac arrest mortality is significantly affected by failure to obtain return of spontaneous circulation (ROSC) despite cardiopulmonary resuscitation (CPR). Severe myocardial dysfunction and cardiovascular collapse further affects mortality within hours of initial ROSC. Recent work suggests that enhancement of nitric oxide (NO) signaling within minutes of CPR can improve myocardial function and survival. We studied the role of NO signaling on cardiovascular outcomes following cardiac arrest and resuscitation using endothelial NO synthase knockout (NOS3(-/-)) mice. Adult female wild-type (WT) and NOS3(-/-) mice were anesthetized, intubated, and instrumented with left-ventricular pressure-volume catheters. Cardiac arrest was induced with intravenous potassium chloride. CPR was performed after 8min of untreated arrest. ROSC rate, cardiac function, whole-blood nitrosylhemoglobin (HbNO) concentrations, heart NOS3 content and phosphorylation (p-NOS3), cyclic guanosine monophosphate (cGMP), and phospho-troponin I (p-TnI) were measured. Despite equal quality CPR, NOS3(-/-) mice displayed lower rates of ROSC compared to WT (47.6% [10/21] vs. 82.4% [14/17], pNOS3(-/-) vs. WT mice exhibited increased left-ventricular dysfunction and 120min mortality. Prior to ROSC, myocardial effectors of NO signaling including cGMP and p-TnI were decreased in NOS3(-/-) vs. WT mice (pNOS3-dependent increases in circulating HbNO were seen by 120min. Significant increases in cardiac p-NOS3 occurred between end-arrest and 15min post-ROSC, while total NOS3 content was increased by 120min post-ROSC (pNOS3 decreases ROSC rate and worsens post-ROSC left-ventricular function. Poor cardiovascular outcomes are associated with differences in NOS3-dependent myocardial cGMP signaling and circulating NO metabolites. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  9. The European Arrest Warrant

    Directory of Open Access Journals (Sweden)

    Minodora-Ioana Balan-Rusu

    2012-05-01

    Full Text Available In the paper it is generally examined the institution of the European arrest warrant according to the latest changes and additions through the adoption of a new European legislative act. The paper is a continuation of research in the area of judicial cooperation in criminal matters in the European Union. It may be useful to the judicial bodies with the responsibilities of issuing and executing a specific European arrest warrant and to academics and students in law schools. The research results, the essential contribution, the originality consist of the general examination of the institution, the critical remarks and proposals for amending and completing certain provisions insufficiently clear.

  10. Strain rate dependent deformation and failure behavior of laser welded DP780 steel joint under dynamic tensile loading

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Yang, E-mail: liuyang@mail.neu.edu.cn [Key Laboratory for Anisotropy and Texture of Materials, Ministry of Education, Northeastern University, Shenyang 110819 (China); Dong, Danyang, E-mail: dongdanyang@mail.neu.edu.cn [College of Science, Northeastern University, Shenyang 110819 (China); Wang, Lei, E-mail: wanglei@mail.neu.edu.cn [Key Laboratory for Anisotropy and Texture of Materials, Ministry of Education, Northeastern University, Shenyang 110819 (China); Chu, Xi, E-mail: chuxi.ok@163.com [College of Science, Northeastern University, Shenyang 110819 (China); Wang, Pengfei, E-mail: wpf1963871400@163.com [College of Science, Northeastern University, Shenyang 110819 (China); Jin, Mengmeng, E-mail: 24401878@163.com [College of Science, Northeastern University, Shenyang 110819 (China)

    2015-03-11

    Laser welded DP steel joints are used widely in the automotive industry for weight reduction. Understanding the deformation and fracture behavior of the base metal (BM) and its welded joint (WJ), especially at high strain rates, is critical for the design of vehicle structures. This paper is concerned with the effects of strain rate on the tensile properties, deformation and fracture behavior of the laser welded DP780 steel joint. Quasi-static and dynamic tensile tests were performed on the WJ and BM of the DP780 steel using an electromechanical universal testing machine and a high-speed tensile testing machine over a wide range of strain rate (0.0001–1142 s{sup −1}). The microstructure change and microhardness distribution of the DP780 steel after laser welding were examined. Digital image correlation (DIC) and high-speed photography were employed for the strain measurement of the DP780 WJ during dynamic tensile tests. The DP780 WJ is a heterogeneous structure with hardening in fusion zone (FZ) and inner heat-affected zone (HAZ), and softening in outer HAZ. The DP780 BM and WJ exhibit positive strain rate dependence on the YS and UTS, which is smaller at lower strain rates and becomes larger with increasing strain rate, while ductility in terms of total elongation (TE) tends to increase under dynamic loading. Laser welding leads to an overall reduction in the ductility of the DP780 steel. However, the WJ exhibits a similar changing trend of the ductility to that of the BM with respect to the strain rate over the whole strain rate range. As for the DP780 WJ, the distance of tensile failure location from the weld centerline decreases with increasing strain rate. The typical ductile failure characteristics of the DP780 BM and WJ do not change with increasing strain rate. DIC measurements reveal that the strain localization starts even before the maximum load is attained in the DP780 WJ and gradual transition from uniform strains to severely localized strains

  11. Arrests of women for driving under the influence.

    Science.gov (United States)

    Shore, E R; McCoy, M L; Toonen, L A; Kuntz, E J

    1988-01-01

    Police records of arrests of women in Wichita, Kansas for driving under the influence (DUI) of alcohol for a 5-year period (1980-1984) were studied. The proportion of arrests of women increased from 10.6 to 14.5% of total arrested. Women in their 20s comprised the largest age group; single women were greatly overrepresented. More than one-half of the arrested women were employed outside the home; a substantial proportion (30.8%) were unemployed at the time of arrest. The average blood alcohol level of those tested was 183 mg/dl. Characteristics of arrestees are discussed in terms of changes in the social roles and expectations of women. Although time of arrest was similar to that of men (i.e., night), arrests of women were more evenly spread across the days of the week. Within the 5-year period, the rate of recidivism for DUI was 7.43%. The implications of arrest and recidivism patterns are discussed. A change in legal and arrest procedures was found to have the same effect on arrests of women as it had on those of men, suggesting that the changes did not produce differential treatment by police.

  12. MTBF evaluation for 2-out-of-3 redundant repairable systems with common cause and cascade failures considering fuzzy rates for failures and repair: a case study of a centrifugal water pumping system

    Science.gov (United States)

    Mortazavi, Seyed Mohammad; Mohamadi, Maryam; Jouzdani, Javid

    2017-08-01

    In many cases, redundant systems are beset by both independent and dependent failures. Ignoring dependent variables in MTBF evaluation of redundant systems hastens the occurrence of failure, causing it to take place before the expected time, hence decreasing safety and creating irreversible damages. Common cause failure (CCF) and cascading failure are two varieties of dependent failures, both leading to a considerable decrease in the MTBF of redundant systems. In this paper, the alpha-factor model and the capacity flow model are combined so as to incorporate CCF and cascading failure in the evaluation of MTBF of a 2-out-of-3 repairable redundant system. Then, using a transposed matrix, the MTBF function of the system is determined. Due to the fact that it is difficult to estimate the independent and dependent failure rates, industries are interested in considering uncertain failure rates. Therefore, fuzzy theory is used to incorporate uncertainty into the model presented in this study, and a nonlinear programming model is used to determine system's MTBF. Finally, in order to validate the proposed model, evaluation of MTBF of the redundant system of a centrifugal water pumping system is presented as a practical example.

  13. Pitfalls and Precautions When Using Predicted Failure Data for Quantitative Analysis of Safety Risk for Human Rated Launch Vehicles

    Science.gov (United States)

    Hatfield, Glen S.; Hark, Frank; Stott, James

    2016-01-01

    Launch vehicle reliability analysis is largely dependent upon using predicted failure rates from data sources such as MIL-HDBK-217F. Reliability prediction methodologies based on component data do not take into account system integration risks such as those attributable to manufacturing and assembly. These sources often dominate component level risk. While consequence of failure is often understood, using predicted values in a risk model to estimate the probability of occurrence may underestimate the actual risk. Managers and decision makers use the probability of occurrence to influence the determination whether to accept the risk or require a design modification. The actual risk threshold for acceptance may not be fully understood due to the absence of system level test data or operational data. This paper will establish a method and approach to identify the pitfalls and precautions of accepting risk based solely upon predicted failure data. This approach will provide a set of guidelines that may be useful to arrive at a more realistic quantification of risk prior to acceptance by a program.

  14. Prediction of Basic Math Course Failure Rate in the Physics, Meteorology, Mathematics, Actuarial Sciences and Pharmacy Degree Programs

    Directory of Open Access Journals (Sweden)

    Luis Rojas-Torres

    2014-09-01

    Full Text Available This paper summarizes a study conducted in 2013 with the purpose of predicting the failure rate of math courses taken by Pharmacy, Mathematics, Actuarial Science, Physics and Meteorology students at Universidad de Costa Rica (UCR. Using the Logistics Regression statistical techniques applied to the 2010 cohort, failure rates were predicted of students in the aforementioned programs in one of their Math introductory courses (Calculus 101 for Physics and Meteorology, Math Principles for Mathematics and Actuarial Science and Applied Differential Equations for Pharmacy. For these models, the UCR admission average, the student’s genre, and the average correct answers in the Quantitative Skills Test were used as predictor variables. The most important variable for all models was the Quantitative Skills Test, and the model with the highest correct classification rate was the Logistics Regression. For the estimated Physics-Meteorology, Pharmacy and Mathematics-Actuarial Science models, correct classifications were 89.8%, 73.6%, and 93.9%, respectively.

  15. Can We Rely on Predicted Basal Metabolic Rate in Patients With Intestinal Failure on Home Parenteral Nutrition?

    DEFF Research Database (Denmark)

    Andersen, Anders Skallerup; Pedersen, Louis Nygaard; Olesen, Søren Schou

    2017-01-01

    evaluated the accuracy of predicted BMR in clinically stable patients with IF dependent on home parenteral nutrition (HPN). METHODS: In total, 103 patients with IF were included. We used indirect calorimetry for assessment of BMR and calculated predicted BMR using different equations based on anthropometric......BACKGROUND AND AIMS: Intestinal failure (IF) is a serious and common complication of short bowel syndrome with patients depending on parental nutrition (PN) support. Effective nutrition management requires an accurate estimation of the patient's basal metabolic rate (BMR) to avoid underfeeding...

  16. RELIABILITY ANALYSIS FOR A REPAIRABLE PARALLEL SYSTEM WITH TIMEVARYING FAILURE RATES%失效率随时间变化的可修的并联系统的可靠性分析

    Institute of Scientific and Technical Information of China (English)

    汤胜道; 汪凤泉

    2005-01-01

    To solve a real problem:how to calculate the reliability of a system with time v arying failure rates in industry systems,this paper studies a model for the load sharing parallel system with timevarying failure rates,and obtains calculati ng formulas of reliability and availability of the system by solving differentia l equations.In this paper,the failure rates are expressed in polynomial configur ation.The constant,linear and Weibull failure rate are in their special form.The polynomial failure rates provide flexibility in modeling the practical timevar ying failure rates.

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

    Science.gov (United States)

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

    2009-01-01

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

  18. The European arrest warrant

    Directory of Open Access Journals (Sweden)

    Đurđić Vojislav

    2012-01-01

    Full Text Available The paper portrays the new European Union extradition system, established by the Framework Decision on the European arrest warrant and the surrender procedures between Member States of 2002. In the introductory remarks, the author explains the formation and development of the traditional extradition procedure, depicts relevant legal sources, and points to its flaws, which boil down to tardiness and inefficiency. The main author's standpoint is that the European arrest warrant is based on mutual trust in the member-states' legal systems, and that it depoliticizes the extradition procedure by transforming interstate cooperation into cooperation between member - states' law enforcement authorities. On these grounds, the author determines the nature of this new legal institute, that introduces radical changes into the paradigm of the classical extradition, and explains its main features as well as the scope of application. Further on, the paper explores the conditions for issuance of the European arrest warrant, which are proscribed by negative formulations - as absolute and relative obstacles for extradition. Finally, the author explains the standardized formal elements of the European arrest warrant content, which should make its application easier and more expeditious.

  19. Runway Arrested Landing Site (RALS)

    Data.gov (United States)

    Federal Laboratory Consortium — The Runway Arrested Landing Site includes an underground complex located on a Mod 2, Mod 3, and Mod 3+ arresting gear and are located under the runway and accurately...

  20. High parasitological failure rate of visceral leishmaniasis to sodium stibogluconate among HIV co-infected adults in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Ermias Diro

    2014-05-01

    Full Text Available BACKGROUND: Antimonials are still being used for visceral leishmaniasis (VL treatment among HIV co-infected patients in East-Africa due to the shortage of alternative safer drugs like liposomal amphotericin B. Besides tolerability, emergence of resistance to antimonials is a major concern. OBJECTIVES: This study was aimed at assessing the clinical outcome of VL-HIV co-infected patients when treated with sodium stibogluconate (SSG. METHODS: Retrospective patient record analysis of VL-HIV co-infected patients treated at a clinical trial site in north-west Ethiopia was done. Patients with parasitologically confirmed VL and HIV co-infection treated with SSG were included. The dose of SSG used was 20 mg Sb5 (pentavalent antimony/kg and maximum of 850 mg Sb5 for 30 days. The clinical outcomes were defined based on the tissue aspiration results as cure or failure, and additionally the safety and mortality rates were computed. RESULTS: The study included 57 patients treated with SSG and by the end of treatment only 43.9% of patients were cured. The parasitological treatment failure and the case fatality rate were 31.6% and 14.0% respectively. SSG was discontinued temporarily or permanently for 12 (21.1% cases due to safety issues. High baseline parasite load (graded more than 4+ was significantly associated with treatment failure (odds ratio = 8.9, 95% confidence interval = .5-51.7. CONCLUSION: SSG is not only unsafe, but also has low effectiveness for VL-HIV patients. Safe and effective alternative medications are very urgently needed. Drug sensitivity surveillance should be introduced in the region.

  1. Hospital Variation in Survival Trends for In‐hospital Cardiac Arrest

    Science.gov (United States)

    Girotra, Saket; Cram, Peter; Spertus, John A.; Nallamothu, Brahmajee K.; Li, Yan; Jones, Philip G.; Chan, Paul S.

    2014-01-01

    Background During the past decade, survival after in‐hospital cardiac arrest has improved markedly. It remains unknown whether the improvement in survival has occurred uniformly at all hospitals or was driven by large improvements at only a few hospitals. Methods and Results We identified 93 342 adults with an in‐hospital cardiac arrest at 231 hospitals in the Get With The Guidelines®‐Resuscitation registry during 2000–2010. Using hierarchical regression models, we evaluated hospital‐level trends in survival to discharge. Mean age was 66 years, 59% were men, and 21% were black. Between 2000 and 2010, there was a significant decrease in age, prevalence of heart failure and myocardial infarction, and cardiac arrests due to shockable rhythms (Phospital rates of in‐hospital cardiac arrest survival improved by 7% per year (odds ratio [OR] 1.07, 95% CI 1.06 to 1.08, Phospital quartile to 11% in the top hospital quartile. Compared with minor teaching hospitals (OR 1.04, 95% CI 1.02 to 1.06), hospital rate of survival improvement was greater at major teaching (OR 1.08, 95% CI 1.06 to 1.10) and nonteaching hospitals (OR 1.07, 95% CI 1.05 to 1.09, P value for interaction=0.03). Conclusion Although in‐hospital cardiac arrest survival has improved during the past decade, the magnitude of improvement varied across hospitals. Future studies are needed to identify hospital processes that have led to the largest improvement in survival. PMID:24922627

  2. Particulate Air Pollution and the Rate of Hospitalization for Congestive Heart Failure among Medicare Beneficiaries in Pittsburgh, Pennsylvania.

    Science.gov (United States)

    Wellenius, Gregory A.; Bateson, Thomas F.; Mittleman, Murray A.; Schwartz., Joel

    2006-01-01

    We used a case-crossover approach to evaluate the association between ambient air pollution and the rate of hospitalization for congestive heart failure (CHF) among Medicare recipients (age ≥ 65) residing in Allegheny County (Pittsburgh area), PA, during 1987–1999. We also explored effect modification by age, gender, and specific secondary diagnoses. During follow-up, there were 55,019 admissions with a primary diagnosis of CHF. We found that particulate matter with aerodynamic diameter ≤ 10 μm (PM10), carbon monoxide (CO), nitrogen dioxide (NO2), and sulfur dioxide – but not ozone – were positively and significantly associated with the rate of admission on the same day in single-pollutant models. The strongest associations were observed with CO, NO2 and PM10. The associations with CO and NO2 were the most robust in two-pollutant models, remaining statistically significant even after adjusting for other pollutants. Patients with a recent myocardial infarction were at greater risk of particulate-related admission, but there was otherwise no significant effect modification by age, gender, or other secondary diagnoses. These results suggest that short-term elevations in air pollution from traffic-related sources may trigger acute cardiac decompensation of heart failure patients and that those with certain comorbid conditions may be more susceptible to these effects. PMID:15901623

  3. Six-Year Survival and Early Failure Rate of 2918 Implants with Hydrophobic and Hydrophilic Enossal Surfaces

    Directory of Open Access Journals (Sweden)

    Olivier Le Gac

    2015-02-01

    Full Text Available The aim of this chart review was to obtain an objective, quantitative assessment of the clinical performance of an implant line used in an implantological office setting. Implants with hydrophilic (INICELL and hydrophobic (TST; both: Thommen Medical AG, Grenchen, Switzerland enossal surfaces were compared and the cumulative implant survival rate was calculated. The data of 1063 patients that received 2918 implants (1337 INICELL, 1581 TST was included. The average follow up time was 2.1 (1.1–5.4 years for INICELL and 4.5 (1.3–5.9 years for TST implants (Thommen Medical AG, Switzerland. In the reported period 7 implants with INICELL (0.5% and 23 TST implants (1.5% failed. This difference was statistically significant. The analysis of cases treated and followed up in a single implantological office for 6 years confirmed the very good clinical outcome that was achieved with both used implant lines. Within the limitations of this retrospective analysis, the overall early failure rate of the hydrophilic implants was significantly lower than that of hydrophobic implants. The use of hydrophilic implants allows the clinician to obtain less early failures, hence the interest of an up-to-date surface for the daily work of an implant practice.

  4. Benefits of Heart Rate Slowing With Ivabradine in Patients With Systolic Heart Failure and Coronary Artery Disease.

    Science.gov (United States)

    Borer, Jeffrey S; Deedwania, Prakash C; Kim, Jae B; Böhm, Michael

    2016-12-15

    Heart rate (HR) is a risk factor in patients with chronic systolic heart failure (HF) that, when reduced, provides outcome benefits. It is also a target for angina pectoris prevention and a risk marker in chronic coronary artery disease without HF. HR can be reduced by drugs; however, among those used clinically, only ivabradine reduces HR directly in the sinoatrial nodal cells without other known effects on the cardiovascular system. This review provides current information regarding the safety and efficacy of HR reduction with ivabradine in clinical studies involving >36,000 patients with chronic stable coronary artery disease and >6,500 patients with systolic HF. The largest trials, Morbidity-Mortality Evaluation of the If Inhibitor Ivabradine in Patients With Coronary Disease and Left Ventricular Dysfunction and Study Assessing the Morbidity-Mortality Benefits of the If Inhibitor Ivabradine in Patients With Coronary Artery Disease, showed no effect on outcomes. The Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial, a randomized controlled trial in >6,500 patients with HF, revealed marked and significant HR-mediated reduction in cardiovascular mortality or HF hospitalizations while improving quality of life and left ventricular mechanical function after treatment with ivabradine. The adverse effects of ivabradine predominantly included bradycardia and atrial fibrillation (both uncommon) and ocular flashing scotomata (phosphenes) but otherwise were similar to placebo. In conclusion, ivabradine improves outcomes in patients with systolic HF; rates of overall adverse events are similar to placebo.

  5. Characteristics, outcome and predictors of one year mortality rate in patients with acute heart failure

    Directory of Open Access Journals (Sweden)

    Banović Marko

    2011-01-01

    Full Text Available Background/Aim. Acute heart failure (AHF is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and longterm mortality. The aim of this study was to investigate characteristics, outcomes and one year mortality of patients with AHF in the local population. Methods. This prospective study consisted of 64 consecutive unselected patients treated in the Coronary Care Unit of the Emergency Centre (Clinical Center of Serbia, Belgrade and were followed for one year after the discharge. Results. Mean age of the patients was 63.6 ± 12.6 years and 59.4% were males. Acute congestion (43.8% and pulmonary edema (39.1% were the most common presentations of AHF. Mean left ventricular ejection fraction (LVEF was 39.7% ± 9.25%, while 44.4% of the patients had LVEF ≥ 50%. At discharge, 55.9% of the patients received therapy with β-blockers, 94.9% diuretics, out of which 47.7% spironolactone, 94.9% patients were given ACE-inhibitors or angiotensin receptor blokcers (ARB. The 12-month all-cause mortality was 26.5%. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF, reduced fraction of shortening (FS and a higher tricuspid velocity. Conclusion. One year mortality of our patients with AHF was high, similar to the known European studies. Independent predictors of one year mortality were previous hospitalization due to heart disease, reduced LVEF and LVFS and a higher tricuspid velocity.

  6. RELATION BETWEEN SEVERITY OF DISEASE AND IMPAIRMENT OF HEART-RATE-VARIABILITY PARAMETERS IN PATIENTS WITH CHRONIC CONGESTIVE-HEART-FAILURE SECONDARY TO CORONARY-ARTERY DISEASE

    NARCIS (Netherlands)

    SZABO, BM; VANVELDHUISEN, DJ; BROUWER, J; HAAKSMA, J; LIE, KI

    1995-01-01

    Correlations between New York Heart Association functional class, left ventricular ejection fraction, and peak oxygen consumption were compared to heart rate variability and analyzed in 79 heart failure patients with left ventricular ejection fraction

  7. Cardiac arrest leadership: in need of resuscitation?

    Science.gov (United States)

    Robinson, Philip S; Shall, Emma; Rakhit, Roby

    2016-12-01

    Leadership skills directly correlate with the quality of technical performance of cardiopulmonary resuscitation (CPR) and clinical outcomes. Despite an improved focus on non-technical skills in CPR training, the leadership of cardiac arrests is often variable. To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs. Cross-sectional survey of 102 members of a cardiac arrest team at an Acute Hospital Trust in the UK with 892 inpatient beds. Responses sought from doctors, nurses and healthcare assistants to 12 rated statements and 4 dichotomous questions. Of 102 responses, 81 (79%) were from doctors and 21 (21%) from nurses. Among specialist registrars 90% agreed or strongly agreed that there was clear leadership at all arrests compared with between 28% and 49% of nurses and junior doctors respectively. Routine omission of key leadership tasks was reported by as many as 80% of junior doctors and 50% of nurses. Almost half of respondents reported non-adherence with Advanced Life Support (ALS) guidelines. Among junior members of the team, 36% felt confident to lead an arrest and 75% would welcome further dedicated cardiac arrest leadership training. Leadership training is integrated into the ALS (Resus Council, UK) qualification. However, this paper found that in spite of this training; standards of leadership are variable. The findings suggest a pressing need for further dedicated cardiac arrest leadership training with a focus on improving key leadership tasks such as role assignment, team briefing and debriefing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  8. Resistance profiles and adherence at primary virological failure in three different highly active antiretroviral therapy regimens: analysis of failure rates in a randomized study

    DEFF Research Database (Denmark)

    Roge, BT; Barfod, TS; Kirk, O;

    2004-01-01

    OBJECTIVES: To investigate the interplay between resistance and adherence in the virological failure of three fundamentally different highly active antiretroviral therapy (HAART) regimens. METHODS: We retrospectively identified 56 verified primary virological failures (viral load >400 HIV-1 RNA...... adherent patients on randomized treatment failed in the RS-arm, none in the NN-arm, and six in the ASD-arm. CONCLUSIONS: Primary virological failure was caused mainly by treatment interruption. No primary protease inhibitor (PI) mutations were found in patients failing on boosted saquinavir, whereas...

  9. Determination of crack morphology parameters from service failures for leak-rate analyses

    Energy Technology Data Exchange (ETDEWEB)

    Wilkowski, G.; Ghadiali, N.; Paul, D. [Battelle Memorial Institute, Columbus, OH (United States)] [and others

    1997-04-01

    In leak-rate analyses described in the literature, the crack morphology parameters are typically not well agreed upon by different investigators. This paper presents results on a review of crack morphology parameters determined from examination of service induced cracks. Service induced cracks were found to have a much more tortuous flow path than laboratory induced cracks due to crack branching associated with the service induced cracks. Several new parameters such as local and global surface roughnesses, as well as local and global number of turns were identified. The effect of each of these parameters are dependent on the crack-opening displacement. Additionally, the crack path is typically assumed to be straight through the pipe thickness, but the service data show that the flow path can be longer due to the crack following a fusion line, and/or the number of turns, where the number of turns in the past were included as a pressure drop term due to the turns, but not the longer flow path length. These parameters were statistically evaluated for fatigue cracks in air, corrosion-fatigue, IGSCC, and thermal fatigue cracks. A refined version of the SQUIRT leak-rate code was developed to account for these variables. Sample calculations are provided in this paper that show how the crack size can vary for a given leak rate and the statistical variation of the crack morphology parameters.

  10. Resting Heart Rate as Predictor for Left Ventricular Dysfunction and Heart Failure: The Multi-Ethnic Study of Atherosclerosis

    Science.gov (United States)

    Opdahl, Anders; Venkatesh, Bharath Ambale; Fernandes, Veronica R. S.; Wu, Colin O.; Nasir, Khurram; Choi, Eui-Young; Almeida, Andre L. C.; Rosen, Boaz; Carvalho, Benilton; Edvardsen, Thor; Bluemke, David A.; Lima, Joao A. C.

    2014-01-01

    OBJECTIVE To investigate the relationship between baseline resting heart rate and incidence of heart failure (HF) and global and regional left ventricular (LV) dysfunction. BACKGROUND The association of resting heart rate to HF and LV function is not well described in an asymptomatic multi-ethnic population. METHODS Participants in the Multi-Ethnic Study of Atherosclerosis had resting heart rate measured at inclusion. Incident HF was registered (n=176) during follow-up (median 7 years) in those who underwent cardiac MRI (n=5000). Changes in ejection fraction (ΔEF) and peak circumferential strain (Δεcc) were measured as markers of developing global and regional LV dysfunction in 1056 participants imaged at baseline and 5 years later. Time to HF (Cox model) and Δεcc and ΔEF (multiple linear regression models) were adjusted for demographics, traditional cardiovascular risk factors, calcium score, LV end-diastolic volume and mass in addition to resting heart rate. RESULTS Cox analysis demonstrated that for 1 bpm increase in resting heart rate there was a 4% greater adjusted relative risk for incident HF (Hazard Ratio: 1.04 (1.02, 1.06 (95% CI); Pheart rate was positively associated with deteriorating εcc and decrease in EF, even in analyses when all coronary heart disease events were excluded from the model. CONCLUSION Elevated resting heart rate is associated with increased risk for incident HF in asymptomatic participants in MESA. Higher heart rate is related to development of regional and global LV dysfunction independent of subclinical atherosclerosis and coronary heart disease. PMID:24412444

  11. Resting heart rate as predictor for left ventricular dysfunction and heart failure: MESA (Multi-Ethnic Study of Atherosclerosis).

    Science.gov (United States)

    Opdahl, Anders; Ambale Venkatesh, Bharath; Fernandes, Veronica R S; Wu, Colin O; Nasir, Khurram; Choi, Eui-Young; Almeida, Andre L C; Rosen, Boaz; Carvalho, Benilton; Edvardsen, Thor; Bluemke, David A; Lima, João A C

    2014-04-01

    The objective of this study was to investigate the relationship between baseline resting heart rate and incidence of heart failure (HF) and global and regional left ventricular (LV) dysfunction. The association of resting heart rate to HF and LV function has not been well described in an asymptomatic multi-ethnic population. Resting heart rate was measured in participants in the MESA (Multi-Ethnic Study of Atherosclerosis) trial at inclusion. Incident HF was registered (n = 176) during follow-up (median 7 years) in those who underwent cardiac magnetic resonance imaging (n = 5,000). Changes in ejection fraction (ΔEF) and peak circumferential strain (Δεcc) were measured as markers of developing global and regional LV dysfunction in 1,056 participants imaged at baseline and 5 years later. Time to HF (Cox model) and Δεcc and ΔEF (multiple linear regression models) were adjusted for demographics, traditional cardiovascular risk factors, calcium score, LV end-diastolic volume, and mass in addition to resting heart rate. Cox analysis demonstrated that for 1 beat/min increase in resting heart rate, there was a 4% greater adjusted relative risk for incident HF (hazard ratio: 1.04; 95% CI: 1.02 to 1.06; p heart rate was positively associated with deteriorating εcc and decrease in EF, even when all coronary heart disease events were excluded from the model. Elevated resting heart rate was associated with increased risk for incident HF in asymptomatic participants in the MESA trial. Higher heart rate was related to development of regional and global LV dysfunction independent of subclinical atherosclerosis and coronary heart disease. (Multi-Ethnic Study of Atherosclerosis [MESA]; NCT00005487). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Prevalence of vaccination rates in systolic heart failure: a prospective study of 549 patients by age, race, ethnicity, and sex in a heart failure disease management program.

    Science.gov (United States)

    Hebert, Kathy; Marzouka, George; Arcement, Lee; Julian, Elyse; Cortazar, Frank; Dias, Andre; Tamariz, Leonardo

    2010-01-01

    Healthy People 2010 aims at immunizing 60% of high-risk adults annually against influenza and once against pneumococcal disease. The aim of this study was to evaluate the use of a standardized approach to improve vaccination rates in patients with heart failure (HF); to determine whether disparities exist based on age, race, ethnicity, or sex at baseline and follow-up; and to evaluate the impact of clinical variables on the odds of being vaccinated. A prospective study of 549 indigent patients enrolled in a systolic HF disease management program (HFDMP) began enrollment from August 2007 to January 2009 at Jackson Memorial Hospital. Patients were interviewed at their initial visit for immunization status; those without vaccinations were offered the vaccines. Prevalence of vaccination (POV) for influenza and pneumococcal disease was obtained at baseline and at follow-up. The odds ratio for being vaccinated was calculated using logistic regression. The study population comprised mostly Hispanic (56%), black (37%), and male (70%) patients, with a mean age of 56 ± 12 years and a mean ejection fraction of 25% ± 10%. The initial POV for both was 22% at baseline. At follow-up, POV improved to 60.5%. Of those not vaccinated at baseline, 17.5% refused vaccination. Odds ratios at baseline for age, race/ethnicity, and sex were 0.99 (P=.99), 0.63 (P=.08), and 0.62 (P=.14), respectively. These did not change significantly at follow-up. Prevalence of vaccination in our cohort was low. Enrollment into the HFDMP improved immunization prevalence without creating age, race, ethnicity, or sex disparities. © 2010 Wiley Periodicals, Inc.

  13. Arrested larval development in cattle nematodes.

    Science.gov (United States)

    Armour, J; Duncan, M

    1987-06-01

    Most economically important cattle nematodes are able to arrest their larval development within the host - entering a period of dormancy or hypobiosis. Arrested larvae have a low death rate, and large numbers can accumulate in infected cattle during the grazing season. Because of this, outbreaks of disease caused by such nematodes can occur at times when recent infection with the parasites could not have occurred, for example during winter in temperature northern climates when cattle are normally housed. The capacity to arrest is a heritable trait. It is seen as an adaptation by the parasite to avoid further development to its free-living stages during times when the climate is unsuitable for free-living survival. But levels of arrestment can vary markedly in different regions, in different cattle, and under different management regimes. Climatic factors, previous conditioning, host immune status, and farm management all seem to affect arrestment levels. In this article, James Armour and Mary Duncan review the biological basis of the phenomenon, and discuss the apparently conflicting views on how it is controlled.

  14. A pilot rating scale for evaluating failure transients in electronic flight control systems

    Science.gov (United States)

    Hindson, William S.; Schroeder, Jeffery A.; Eshow, Michelle M.

    1990-01-01

    A pilot rating scale was developed to describe the effects of transients in helicopter flight-control systems on safety-of-flight and on pilot recovery action. The scale was applied to the evaluation of hardovers that could potentially occur in the digital flight-control system being designed for a variable-stability UH-60A research helicopter. Tests were conducted in a large moving-base simulator and in flight. The results of the investigation were combined with existing airworthiness criteria to determine quantitative reliability design goals for the control system.

  15. 50% Failure Rate in Final Year Medical Exams – Whose Fault is it?

    Directory of Open Access Journals (Sweden)

    Omran Bakoush

    2007-01-01

    Full Text Available To The Editor: Having read Dr Benamer’s views on medical teaching, we remembered our days as medical students [1]. We share Dr Benamer’s and other’s views that teaching in Libyan medical schools should shift from being subject focused to being learning focused [1,2].We remember one incident when our professor showed us an ECG and asked about the diagnosis. He was so furious when none of us was able to make the diagnosis to the extent that he left the lecture room without completing the teaching session. This is just one example among many that illustrates the lack of teaching skills so common in our medical institutions and the poor state of the Teacher-Student relationship.Therefore, it is not surprising that many students prefer not to attend lectures. In our view and from our experience, the formats of the lectures were organised around information designed for students to be memorised rather than learnt (spoon feeding Which is one of the reasons why many students have found the teaching sessions simply boring and useless.In their attempts to overcome this problem, students tried to find ways to learn; acquiring knowledge through the organisation of discussion groups and seeking the help of senior students when necessary. These discussion groups mimic what has been recently introduced as Problem Based Learning (PBL [3]. Even though these discussion groups may have lacked direction, they were perceived to be an important factor in the success of many students.Given the poor attendance rates to the lectures, the teachers failed to investigate the reasons behind this and take proactive steps to correct the problem. Because of the lack of teacher analysis and reflection it comes as no surprise that the format and quality of teaching has continued along the same traditional lines with the same problems being continually encountered.The point here is that many of these students went on to become highly successful physicians and surgeons in

  16. Young Adults Failure to Thrive Syndrome

    Directory of Open Access Journals (Sweden)

    Warren C. Sanderson

    2014-03-01

    Full Text Available Many young working age adults in developed countries are failing to thrive in economic, demographic and social terms. Their failure to thrive is a relatively new phenomenon that has not been widely recognized, but it affects young adults in virtually all the more developed countries for which we have relevant data. Young adults nowadays are more often in poverty. They are leaving their parental homes at ever later ages and in some countries the frequency of psychological problems increased. The seriousness of failure to thrive syndrome is reflected in the relationship between relative economic conditions and increased suicide rates. The syndrome is important because young adults are at the prime ages for finding employment, establishing long-run career paths and building an economic basis for founding a family. Developing strategies to arrest the spread of failure to thrive syndrome among young adults, in order to keep them vibrant contributors to our societies, should be a priority for policy makers.

  17. Numerical analysis of high strain rate failure of electro-magnetically loaded steel sheets

    Directory of Open Access Journals (Sweden)

    Erice Borja

    2015-01-01

    Full Text Available Electro-magnetic forces provide a potentially power full means in designing dynamic experiments with active control of the loading conditions. This article deals with the development of computational models to simulate the thermo-mechanical response of electro-magnetically loaded metallic structures. The model assumes linear electromagnetic constitutive equations and time-independent electric induction to estimate the Joule heating and the Lorentz forces. The latter are then taken into account when evaluating stress equilibrium. A thermo-visco-plastic model with Johnson-Cook type of temperature and strain rate dependence and combined Swift-Voce hardening is used to evaluate the material's thermo-mechanical response. As a first application, the model is used to analyse the effect of electro-magnetic loading on the ductility of advanced high strength steels.

  18. A Cost-Based Adaptive Handover Hysteresis Scheme to Minimize the Handover Failure Rate in 3GPP LTE System

    Directory of Open Access Journals (Sweden)

    Gil Gye-Tae

    2010-01-01

    Full Text Available We deal with a cost-based adaptive handover hysteresis scheme for the horizontal handover decision strategies, as one of the self-optimization techniques that can minimize the handover failure rate (HFR in the 3rd generation partnership project (3GPP long-term evolution (LTE system based on the network-controlled hard handover. Especially, for real-time operation, we propose an adaptive hysteresis scheme with a simplified cost function considering some dominant factors closely related to HFR performance such as the load difference between the target and serving cells, the velocity of user equipment (UE, and the service type. With the proposed scheme, a proper hysteresis value based on the dominant factors is easily obtained, so that the handover parameter optimization for minimizing the HFR can be effectively achieved. Simulation results show that the proposed scheme can support better HFR performance than the conventional schemes.

  19. Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy.

    Science.gov (United States)

    Fowble, Barbara; Park, Catherine; Wang, Frederick; Peled, Anne; Alvarado, Michael; Ewing, Cheryl; Esserman, Laura; Foster, Robert; Sbitany, Hani; Hanlon, Alex

    2015-07-01

    Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer. Ninety-seven percent had chemotherapy (doxorubicin and taxane-based), 22% underwent targeted therapies, and 78% had endocrine therapy. Radiation consisted of 5000 cGy given in 180 to 200 cGy to the reconstructed breast with or without treatment to the supraclavicular nodes. Median follow-up was 3.8 years. Total TE/I failure was 18% (12% without final reconstruction, 6% converted to autologous reconstruction). In univariate analysis, the strongest predictor of reconstruction failure (RF) was absence of total TE/I coverage (acellular dermal matrix and/or serratus muscle) at the time of radiation. RF occurred in 32.5% of patients without total coverage compared to 9% with coverage (P=.0069). For women with total coverage, the location of the mastectomy scar in the inframammary fold region was associated with higher RF (19% vs 0%, P=.0189). In multivariate analysis, weight was a significant factor for RF, with lower weight associated with a higher RF. Weight appeared to be a surrogate for the interaction of total coverage, thin skin flaps, interval to exchange, and location of the mastectomy scar. RFs in patients receiving PMRT were lowered with total TE/I coverage at the time of radiation by avoiding inframammary fold incisions and with a preferred interval of 6 months to exchange

  20. Cardiac catheterization is underutilized after in-hospital cardiac arrest.

    Science.gov (United States)

    Merchant, Raina M; Abella, Benjamin S; Khan, Monica; Huang, Kuang-Ning; Beiser, David G; Neumar, Robert W; Carr, Brendan G; Becker, Lance B; Vanden Hoek, Terry L

    2008-12-01

    Indications for immediate cardiac catheterization in cardiac arrest survivors without ST elevation myocardial infarction (STEMI) are uncertain as electrocardiographic and clinical criteria may be challenging to interpret in this population. We sought to evaluate rates of early catheterization after in-hospital ventricular fibrillation (VF) arrest and the association with survival. Using a billing database we retrospectively identified cases with an ICD-9 code of cardiac arrest (427.5) or VF (427.41). Discharge summaries were reviewed to identify in-hospital VF arrests. Rates of catheterization on the day of arrest were determined by identifying billing charges. Unadjusted analyses were performed using Chi-square, and adjusted analyses were performed using logistic regression. One hundred and ten in-hospital VF arrest survivors were included in the analysis. Cardiac catheterization was performed immediately or within 1 day of arrest in 27% (30/110) of patients and of these patients, 57% (17/30) successfully received percutaneous coronary intervention. Of those who received cardiac catheterization the indication for the procedure was STEMI or new left bundle branch block (LBBB) in 43% (13/30). Therefore, in the absence of standard ECG data suggesting acute myocardial infarction, 57% (17/30) received angiography. Patients receiving cardiac catheterization were more likely to survive than those who did not receive catheterization (80% vs. 54%, psurvival. Future recommendations need to be established to guide clinicians on which arrest survivors might benefit from immediate catheterization.

  1. Mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest : a systematic review

    NARCIS (Netherlands)

    Lameijer, Heleen; Immink, Rosa S.; Broekema, Josien J.; Ter Maaten, Jan C.

    2015-01-01

    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline p

  2. Mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest : a systematic review

    NARCIS (Netherlands)

    Lameijer, Heleen; Immink, Rosa S.; Broekema, Josien J.; Ter Maaten, Jan C.

    2015-01-01

    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline p

  3. Predictive Value of Brain Arrest Neurological Outcome Scale (BrANOS) on Mortality and Morbidity After Cardiac Arrest

    Science.gov (United States)

    Şahutoğlu, Cengiz; Uyar, Mehmet; Demirağ, Kubilay; İsayev, Hasan; Moral, Ali Reşat

    2016-01-01

    Objective There are several prediction scales and parameters for prognosis after a cardiac arrest. One of these scales is the brain arrest neurological outcome scale (BrANOS), which consists of duration of cardiac arrest, Glasgow Coma Scale score and Hounsfield unit measured on cranial computed tomography (CT) scan. The objective of this study is to investigate the effectiveness of BrANOS on predicting the mortality and disability after a cardiac arrest. Methods We retrospectively investigated cardiac arrest patients who were hospitalized in our intensive care unit (ICU) within a 3-year period. Inclusion criteria were age over 18 years old, survival of more than 24 hours after cardiac arrest and availability of cranial CT. We recorded the age, sex, diagnosis, duration of cardiac arrest and hospital stay, mortality, Glasgow Outcome Score (GOS) and BrANOS score. The primary endpoint of the study was to establish the relationship between mortality and BrANOS score in patients who survived for more than 24 hours after a cardiac arrest. The secondary endpoint of the study was to determine the 2-year life expectancy and GOS after cardiac arrest. Results The mean age of the patients was 57±17 years (33 females, 67 males). ICU mortality rate was 57%. The BrANOS mean score was 10.3±3.2. There was a significant difference between survivors and non-survivors in terms of the BrANOS score (8.8±3.2 vs. 11.6±2.7; p14 predicted death with 100% accuracy. All the patients without disability had a BrANOS score of <10. The BrANOS score also correlated well with GOS (p<0.001). The 2-year life expectancy rate was 31% in patients who survived more than 24 hours after a cardiac arrest. Conclusion In this study, we demonstrated that BrANOS provided reliable data for prognostic evaluation after a cardiac arrest. PMID:28058140

  4. The effect of heart rate reduction with ivabradine on renal function in patients with chronic heart failure : an analysis from SHIFT

    NARCIS (Netherlands)

    Voors, Adriaan A.; van Veldhuisen, Dirk J.; Robertson, Michele; Ford, Ian; Borer, Jeffrey S.; Boehm, Michael; Komajda, Michel; Swedberg, Karl; Tavazzi, Luigi

    2014-01-01

    Aims We studied the relationship between heart rate and renal function and the effects of heart rate reduction with ivabradine in heart failure patients with and without renal dysfunction. Methods and results From the 6505 patients who were randomized in SHIFT, baseline creatinine and at least one f

  5. The effects of baseline heart rate recovery normality and exercise training protocol on heart rate recovery in patients with heart failure.

    Science.gov (United States)

    Yaylalı, Yalın Tolga; Fındıkoğlu, Gülin; Yurtdaş, Mustafa; Konukçu, Sibel; Şenol, Hande

    2015-09-01

    It is unclear which exercise training protocol yields superior heart rate recovery (HRR) improvement in heart failure (HF) patients. Whether baseline HRR normality plays a role in the improvement is unknown. We hypothesized that an exercise training protocol and baseline HRR normality would be factors in altering HRR in HF patients. In this prospective, randomized, controlled and 3 group parallel study, 41 stable HF patients were randomly assigned to 3-times-weekly training sessions for 12 weeks, consisting of i) 30 minutes of interval training (IT) (n=17, 63.7±8.8 years old) versus ii) 30 minutes of continuous training (CT) (n=13, 59.6±6.8 years old) versus iii) no training (CON) (n=11, 60.6±9.9 years old). Each patient had cardiopulmonary exercise testing before and after the training program. Maximum heart rates attained during the test and heart rates at 1 and 2 min (HRR1 and HRR2) during the recovery phase were recorded. Paired samples t-test or Wilcoxon signed-rank test was used for comparisons before and after training. One-way ANOVA or Kruskal-Wallis variance analysis was used for comparisons among groups. HRR1 was unchanged after training. HRR2 improved in the IT group after training, and post-training HRR2 values were significantly faster in the IT group than in controls. Both HRR1 and HRR2 was significantly faster, irrespective of exercise protocol in patients with abnormal baseline values after training. HRR1 did not improve after training. HRR2 improved only in the IT group. Both HRRs in patients with abnormal baseline values improved after both exercise protocols. IT might be superior to CT in improving HRR2. Baseline HRR might play a role in its response to exercise.

  6. Correction factor determination on failure rate equation of MacLaurin series for low and high mode application

    Directory of Open Access Journals (Sweden)

    Totok R. Biyanto

    2016-06-01

    Full Text Available Safety Instrumented Function (SIF is implemented on the system to prevent hazard in process industry. In general, most of SIF implementation in process industry works in low demand condition. Safety valuation of SIF that works in low demand can be solved by using quantitative method. The quantitative method is a simplified exponential equation form of MacLaurin series, which can be called simplified equation. Simplified equation used in high demand condition will generate a higher Safety Integrity Level (SIL and it will affect the higher safety cost. Therefore, the value of low or high demand rate limit should be determined to prevent it. The result of this research is a first order equation that can fix the error of SIL, which arises from the usage of simplified equation, without looking the demand rate limit for low and high demand. This equation is applied for SIL determination on SIF with 1oo1 vote. The new equation from this research is λ = 0.9428 λMC + 1.062E−04 H/P, with 5% average of error, where λMC is a value of λ from the simplified equation, Hazardous event frequency (H is a probabilistic frequency of hazard event and P is Probability of Failure on Demand (PFD in Independent Protection Layers (IPLs. The equation generated from this research could correct SIL of SIF in various H and P. Therefore, SIL design problem could be solved and it provides an appropriate SIL.

  7. Rate-dependent force, intracellular calcium, and action potential voltage alternans are modulated by sarcomere length and heart failure induced-remodeling of thin filament regulation in human heart failure: A myocyte modeling study.

    Science.gov (United States)

    Zile, Melanie A; Trayanova, Natalia A

    2016-01-01

    Microvolt T-wave alternans (MTWA) testing identifies heart failure patients at risk for lethal ventricular arrhythmias at near-resting heart rates (voltage alternans (APV-ALT), the cellular driver of MTWA. Our goal was to uncover the mechanisms linking APV-ALT and FORCE-ALT in failing human myocytes and to investigate how the link between those alternans was affected by pacing rate and by physiological conditions such as sarcomere length and heart failure induced-remodeling of mechanical parameters. To achieve this, a mechanically-based, strongly coupled human electromechanical myocyte model was constructed. Reducing the sarcoplasmic reticulum calcium uptake current (Iup) to 27% was incorporated to simulate abnormal calcium handling in human heart failure. Mechanical remodeling was incorporated to simulate altered thin filament activation and crossbridge (XB) cycling rates. A dynamical pacing protocol was used to investigate the development of intracellular calcium concentration ([Ca]i), voltage, and active force alternans at different pacing rates. FORCE-ALT only occurred in simulations incorporating reduced Iup, demonstrating that alternans in the intracellular calcium concentration (CA-ALT) induced FORCE-ALT. The magnitude of FORCE-ALT was found to be largest at clinically relevant pacing rates (<110 bpm), where APV-ALT was smallest. We found that the magnitudes of FORCE-ALT, CA-ALT and APV-ALT were altered by heart failure induced-remodeling of mechanical parameters and sarcomere length due to the presence of myofilament feedback. These findings provide important insight into the relationship between heart-failure-induced electrical and mechanical alternans and how they are altered by physiological conditions at near-resting heart rates.

  8. Myocardial infarction and heart failure hospitalization rates in Maine, USA - variability along the urban-rural continuum.

    Science.gov (United States)

    Harris, D E; Aboueissa, A-M; Hartley, D

    2008-01-01

    Cardiovascular disease, including myocardial infarction (MI) and heart failure (HF), remains the leading cause of death in wealthy countries and is of increasing concern in low- and middle-income countries as risk factors such as smoking and obesity become more common around the globe. Within each country the health burden of MI and HF generally falls more heavily on those who live in rural areas and on those who live in communities with lower average socioeconomic status (SES). Hospitalization rates are an important measure of community health because high rates may indicate a high burden of poor health, while inappropriately low rates (low hospitalization rates absent evidence of average good health) may indicate underutilization of health services. The objective of this study was to determine the predictors of MI and HF hospitalization rates at town level in the State of Maine, USA. Maine has large variations in wealth and along the urban-rural continuum at town level. Because our results shed light on variations in health and health-seeking behavior for different Maine populations (such as those living closer vs further from hospitals) they may be of interest to providers of healthcare to people who live in areas remote from healthcare, and to people who face other barriers to good cardiovascular health. To determine predictors of HF and MI hospitalization in Maine, we constructed a geographic information system (GIS) for Maine's towns using publicly available electronic map layers, year 2000 census data, and electronic hospitalization records for all Maine hospitals. This GIS generated age-corrected MI and HF hospitalization rates for 1998-2002 as dependent variables and the following independent variables: poverty rate, unemployment rate, median income, educational attainment, rurality, physician density, and distance to the closest hospital. Univariable and multiple linear regression analysis were then performed to determine the significant predictors of MI

  9. Resistance profiles and adherence at primary virological failure in three different highly active antiretroviral therapy regimens: analysis of failure rates in a randomized study

    DEFF Research Database (Denmark)

    Roge, BT; Barfod, TS; Kirk, O

    2004-01-01

    copies/mL) among 293 patients randomized to two nucleoside reverse transcriptase inhibitors (NRTIs)+ritonavir+saquinavir (RS-arm) (n=115), two NRTIs+nevirapine+nelfinavir (NN-arm) (n=118), or abacavir+stavudine+didanosine (ASD-arm) (n=60) followed up for a median of 90 weeks. Data on adherence were...... collected from patient files, and genotyping was performed on plasma samples collected at time of failure. RESULTS: Treatment interruption or poor adherence was mainly caused by side effects and accounted for 74% of failures, and was associated with absence of resistance mutations. In the 30 failing...... patients not switched from randomized treatment, we found resistance in two of 12 patients in the RS-arm (M184 V only), four of six patients in the NN-arm [all four had non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations], and seven of 12 patients in the ASD-arm (NRTI mutations only). Two...

  10. A comparative clinical study of the failure rate of orthodontic brackets bonded with two adhesive systems: conventional and self-etching primer (SEP

    Directory of Open Access Journals (Sweden)

    Gladys Cristina Dominguez

    2013-04-01

    Full Text Available OBJECTIVE: This study compared the clinical performance of orthodontic brackets bonded with Transbond adhesive paste after two priming systems: a two-stage conventional system (acid etching + Transbond XT adhesive primer and a singlestage self-etching primer (SEP (Transbond Plus. METHODS: The sample comprised 480 metal brackets bonded to the teeth of 24 consecutive patients treated for 36 to 48 months. A split-mouth design was used for bonding, and both systems were used in each patient. Bracket failure rates for each system were analyzed; and failure causes as reported by the patients and the quadrant of teeth for which brackets failed were recorded. RESULTS: The conventional system group had a failure rate of 5.41%, whereas the rate for SEP was 4.58%. In this group, there were 5 failures (38.4% in the right maxillary quadrant, 2 (15.4% in the left maxillary quadrant, 4 (30.8% in the right mandibular quadrant, and 2 (15.4% in the left mandibular quadrant. In the SEP group, there were 4 (36.4% failures in the right maxillary quadrant, 1 (9% in the left maxillary quadrant, 3 (27.3% in the right mandibular quadrant, and 3 (27.3% in the left mandibular quadrant. Results of descriptive statistical analysis and odds ratio did not show any significant differences between rates (p = 0.67. CONCLUSION: The clinical efficiency of SEP was similar to that of the conventional system.

  11. Clinic and ambulatory heart rates in patients with ischaemic heart disease and/or chronic heart failure taking rate-limiting medications: are they interchangeable?

    Science.gov (United States)

    Javed, Omar; Koo, Kenneth; El-Omar, Omar; Allen, Stuart; Squires, Alexander; El-Omar, Magdi

    2015-01-01

    The prognostic benefit from heart rate (HR) reduction in patients with ischaemic heart disease (IHD) and/or chronic heart failure (CHF) is now firmly established. Most decisions regarding initiation and/or dose adjustment of HR-limiting medications in such patients are based on clinic HR. Yet, this is a highly variable parameter that may not necessarily reflect HR control over the 24 h period. To examine the level of agreement between mean clinic and mean ambulatory HRs in patients with IHD and/or CHF taking rate-limiting medications. Prospective, observational study. Fifty patients with IHD and/or CHF who attended cardiology outpatient clinics at the Manchester Heart Centre and underwent same-day 24 h continuous ECG recording between March and October 2013 were included in the study. Mean clinic HR was compared with mean 24 h, daytime and night-time HRs. Limits-of-agreement plots were constructed to examine the relationship between the two HR measures in more detail. The mean clinic HR was numerically similar to the mean HRs of all ambulatory time periods examined. However, on Bland-Altman plots, the limits of agreement between clinic and ambulatory HR means were quite wide, with the mean clinic HR ranging between 10.93 and 13.58 bpm below and 8.4 and 18.15 bpm above the mean ambulatory HR. Although numerically similar, the means of clinic and ambulatory HRs in patients with IHD and/or CHF display wide limits of agreement. As such, the two measures cannot be regarded as interchangeable. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  12. [Values of the sperm deformity index, acrosome abnormity rate, and sperm DNA fragmentation index of optimized sperm in predicting IVF fertilization failure].

    Science.gov (United States)

    Jiang, Wei-jie; Jin, Fan; Zhou, Li-ming

    2016-02-01

    To investigate the values of the sperm deformity index (SDI), acrosome abnormity rate (AAR), and DNA fragmentation index (DFI) of optimized sperm in the prediction of fertilization failure (fertilization rate fertilization (IVF). We selected 695 cycles of conventional IVF for pure oviductal infertility in this study, including 603 cycles of normal fertilization and 92 cycles of fertilization failure. On the day of oocyte retrieval, we examined sperm morphology, acrosome morphology, and DNA fragmentation using the Diff-Quik, PSA-FITC and SCD methods. We established the joint predictor (JP) by logistic equation and analyzed the values of different parameters in predicting fertilization failure with the receiver operating characteristic (ROC) curve. The fertilization rate was negatively correlated with SDI (r = - 0.07; P = 0.03), AAR (r = -0.49; P fertilization group were 1.24 ± 0.20, (7.75 ± 2.28)%, and (7.87 ± 3.15)%, and those in the fertilization failure group were 1.42 ± 0.15, (12.02 ± 3.06)%, and (13.32 ± 4.13)%, respectively, all with statistically significant differences between the two groups (P fertilization failure ( OR = 2.68, 14.11, and 3.85; P = 0.01, fertilization failure were approximately 1.45, 10%, and 12%. The SDI, AAR and DFI of optimized sperm are closely associated with the fertilization rate, and all have the value for predicting fertilization failure in IVF. The AAR is more valuable than the other single predictors, but JP is more effective than the AAR.

  13. Effect of Visit‐to‐Visit Variation of Heart Rate and Systolic Blood Pressure on Outcomes in Chronic Systolic Heart Failure: Results From the Systolic Heart Failure Treatment With the I f Inhibitor Ivabradine Trial (SHIFT) Trial

    OpenAIRE

    Böhm, Michael; Robertson, Michele; Borer, Jeffrey; Ford, Ian; Komajda, Michel; Mahfoud, Felix; Ewen, Sebastian; Swedberg, Karl; Tavazzi, Luigi

    2016-01-01

    Background Elevated resting heart rate (HR) and low systolic blood pressure (SBP) are related to poor outcomes in heart failure (HF). The association between visit‐to‐visit variation in SBP and HR and risk in HF is unknown. Methods and Results In Systolic Heart Failure Treatment with the I f inhibitor ivabradine Trial (SHIFT) patients, we evaluated relationships between mean HR, mean SBP, and visit‐to‐visit variations (coefficient of variation [CV]=SD/mean×100%) in SBP and HR (SBP‐CV and HR‐C...

  14. A Study to Compare the Failure Rates of Current Space Shuttle Ground Support Equipment with the New Pathfinder Equipment and Investigate the Effect that the Proposed GSE Infrastructure Upgrade Might Have to Reduce GSE Infrastructure Failures

    Science.gov (United States)

    Kennedy, Barbara J.

    2004-01-01

    The purposes of this study are to compare the current Space Shuttle Ground Support Equipment (GSE) infrastructure with the proposed GSE infrastructure upgrade modification. The methodology will include analyzing the first prototype installation equipment at Launch PAD B called the "Pathfinder". This study will begin by comparing the failure rate of the current components associated with the "Hardware interface module (HIM)" at the Kennedy Space Center to the failure rate of the neW Pathfinder components. Quantitative data will be gathered specifically on HIM components and the PAD B Hypergolic Fuel facility and Hypergolic Oxidizer facility areas which has the upgraded pathfinder equipment installed. The proposed upgrades include utilizing industrial controlled modules, software, and a fiber optic network. The results of this study provide evidence that there is a significant difference in the failure rates of the two studied infrastructure equipment components. There is also evidence that the support staff for each infrastructure system is not equal. A recommendation to continue with future upgrades is based on a significant reduction of failures in the new' installed ground system components.

  15. Acute right ventricular myocardial injury and sudden cardiac arrest in a patient with persistent spontaneous coronary vasospasm

    Institute of Scientific and Technical Information of China (English)

    Hung Ming-Yow; Li Ju-Chi; Hao Wen-Rui; Wu Cheng-Hsueh; Hung Ming-Jui

    2011-01-01

    Coronary vasospasm is a rare diagnosis resulting in sudden arrhythmic cardiac arrest. We report a case of a healthy,non-smoking elderly woman resuscitated from arrhythmic cardiac arrest. She had persistent spontaneous coronaxy vasospasm, leading to right ventricular myocardial injury and failure, and shock. She responded quickly to intravenous normal saline bolus infusion, but had irreversible neurological sequelae. Additionally, she had atrial fibrillation preceding ischemic ventricular fibrillation, a rare finding in coronary vasospasm-related cardiac arrest. We suggest immediate coronary angiography of patients in sudden arrhythmic cardiac arrest with acute right ventricular failure for a prompt,accurate diagnosis and appropriate management of the coronary vasospasm.

  16. ECPR for Refractory Out-Of-Hospital Cardiac Arrest

    Science.gov (United States)

    2017-05-17

    Cardiac Arrest; Heart Arrest; Sudden Cardiac Arrest; Cardiopulmonary Arrest; Death, Sudden, Cardiac; Cardiopulmonary Resuscitation; CPR; Extracorporeal Cardiopulmonary Resuscitation; Extracorporeal Membrane Oxygenation

  17. Multiscale entropy analysis of heart rate variability in heart failure, hypertensive, and sinoaortic-denervated rats: classical and refined approaches.

    Science.gov (United States)

    Silva, Luiz Eduardo Virgilio; Lataro, Renata Maria; Castania, Jaci Airton; da Silva, Carlos Alberto Aguiar; Valencia, Jose Fernando; Murta, Luiz Otavio; Salgado, Helio Cesar; Fazan, Rubens; Porta, Alberto

    2016-07-01

    The analysis of heart rate variability (HRV) by nonlinear methods has been gaining increasing interest due to their ability to quantify the complexity of cardiovascular regulation. In this study, multiscale entropy (MSE) and refined MSE (RMSE) were applied to track the complexity of HRV as a function of time scale in three pathological conscious animal models: rats with heart failure (HF), spontaneously hypertensive rats (SHR), and rats with sinoaortic denervation (SAD). Results showed that HF did not change HRV complexity, although there was a tendency to decrease the entropy in HF animals. On the other hand, SHR group was characterized by reduced complexity at long time scales, whereas SAD animals exhibited a smaller short- and long-term irregularity. We propose that short time scales (1 to 4), accounting for fast oscillations, are more related to vagal and respiratory control, whereas long time scales (5 to 20), accounting for slow oscillations, are more related to sympathetic control. The increased sympathetic modulation is probably the main reason for the lower entropy observed at high scales for both SHR and SAD groups, acting as a negative factor for the cardiovascular complexity. This study highlights the contribution of the multiscale complexity analysis of HRV for understanding the physiological mechanisms involved in cardiovascular regulation.

  18. Is heart rate reduction more important than target dose in chronic heart failure therapy with a beta-blocker?

    Institute of Scientific and Technical Information of China (English)

    Yong-Fang Guo; Yi An

    2011-01-01

    1 IntroductionBeta-adrenoceptor blocking agents (beta-blockers) are now well established as cornerstone therapy in patients with systolic chronic heart failure (CHF).[1] Clinical data have overwhelmingly proven the beneficial effects of beta-blocker therapy in terms of improving patient prognosis,decreasing requirements for hospitalization,and postponing disease progression.[2-4] However,it remains unclear what the optimal efficacious and safe dose for an individual patient with CHF is,and whether this can simply be inferred from the target dose for each beta-blocking agent as used in the major clinical trials.Beta-blockers are a heterogeneous class of drugs,and due to the polymorphisms of beta-adrenoceptor gene expression,there is marked individual variation in responsiveness to specific agents.[5] If pharmacodynamic markers of responsiveness to beta-blockade (such as heart rate (HR) reduction) are more important than the achievement of a target dose,could they become another potential therapeutic target in beta-blocker therapy? We provide a discussion of the question in this article.

  19. Heart rate variability analysis in healthy subjects, patients suffering from congestive heart failure and heart transplanted patients

    Directory of Open Access Journals (Sweden)

    Argentina Leite

    2013-12-01

    Full Text Available This study aimed to find parameters to characterize heart rate variability (HRV and discriminate healthy subjects and patients with heart diseases. The parameters used for discrimination characterize the different components of HRV memory (short and long and are extracted from HRV recordings using parametric as well as non parametric methods. Thus, the parameters are: spectral components at low frequencies (LH and high frequencies (HF which are associated with the short memory of HRV and the long memory parameter (d obtained from autoregressive fractionally integrated moving average (ARFIMA models. In the non parametric context, short memory (α1 and long memory (α2 parameters are obtained from detrended fluctuation analysis (DFA. The sample used in this study contains 24-hour Holter HRV recordings of 30 subjects: 10 healthy individuals, 10 patients suffering from congestive heart failure and 10 heart transplanted patients from the Noltisalis database. It was found that short memory parameters present higher values for the healthy individuals whereas long memory parameters present higher values for the diseased individuals. Moreover, there is evidence that ARFIMA modeling allows the discrimination between the 3 groups under study, being advantageous over DFA.

  20. Adherence to optimal heart rate control in heart failure with reduced ejection fraction: insight from a survey of heart rate in heart failure in Sweden (HR-HF study).

    Science.gov (United States)

    Fu, M; Ahrenmark, U; Berglund, S; Lindholm, C J; Lehto, A; Broberg, A Månsson; Tasevska-Dinevska, G; Wikstrom, G; Ågard, A; Andersson, B

    2017-08-09

    Despite that heart rate (HR) control is one of the guideline-recommended treatment goals for heart failure (HF) patients, implementation has been painstakingly slow. Therefore, it would be important to identify patients who have not yet achieved their target heart rates and assess possible underlying reasons as to why the target rates are not met. The survey of HR in patients with HF in Sweden (HR-HF survey) is an investigator-initiated, prospective, multicenter, observational longitudinal study designed to investigate the state of the art in the control of HR in HF and to explore potential underlying mechanisms for suboptimal HR control with focus on awareness of and adherence to guidelines for HR control among physicians who focus on the contributing role of beta-blockers (BBs). In 734 HF patients the mean HR was 68 ± 12 beats per minute (bpm) (37.2% of the patients had a HR >70 bpm). Patients with HF with reduced ejection fraction (HFrEF) (n = 425) had the highest HR (70 ± 13 bpm, with 42% >70 bpm), followed by HF with preserved ejection fraction and HF with mid-range ejection fraction. Atrial fibrillation, irrespective of HF type, had higher HR than sinus rhythm. A similar pattern was observed with BB treatment. Moreover, non-achievement of the recommended target HR (bpm) in HFrEF and sinus rhythm was unrelated to age, sex, cardiovascular risk factors, cardiovascular diseases, and comorbidities, but was related to EF and the clinical decision of the physician. Approximately 50% of the physicians considered a HR of >70 bpm optimal and an equal number considered a HR of >70 bpm too high, but without recommending further action. Furthermore, suboptimal HR control cannot be attributed to the use of BBs because there was neither a difference in use of BBs nor an interaction with BBs for HR >70 bpm compared with HR bpm. Suboptimal control of HR was noted in HFrEF with sinus rhythm, which appeared to be attributable to physician decision making rather

  1. Relationship between Intrauterine Bacterial Infection and Early Embryonic Developmental Arrest

    Institute of Scientific and Technical Information of China (English)

    Shao-Fei Yan; Xin-Yan Liu; Yun-Fei Cheng; Zhi-Yi Li; Jie Ou; Wei Wang; Feng-Qin Li

    2016-01-01

    Background:Early embryonic developmental arrest is the most commonly understudied adverse outcome of pregnancy.The relevance of intrauterine infection to spontaneous embryonic death is rarely studied and remains unclear.This study aimed to investigate the relationship between intrauterine bacterial infection and early embryonic developmental arrest.Methods:Embryonic chorion tissue and uterine swabs for bacterial detection were obtained from 33 patients who underwent artificial abortion (control group) and from 45 patients who displayed early embryonic developmental arrest (trial group).Results:Intrauterine bacterial infection was discovered in both groups.The infection rate was 24.44% (11/45) in the early embryonic developmental arrest group and 9.09% (3/33) in the artificial abortion group.Classification analysis revealed that the highest detection rate for Micrococcus luteus in the early embryonic developmental arrest group was 13.33% (6/45),and none was detected in the artificial abortion group.M.luteus infection was significantly different between the groups (P < 0.05 as shown by Fisher's exact test).In addition,no correlation was found between intrauterine bacterial infection and history of early embryonic developmental arrest.Conclusions:M.luteus infection is related to early embryonic developmental arrest and might be one of its causative factors.

  2. Depressive symptoms are related to decreased low-frequency heart rate variability in older adults with decompensated heart failure

    NARCIS (Netherlands)

    Guinjoan, Salvador M.; Castro, Mariana N.; Vigo, Daniel E.; Weidema, Hylke; Berbara, Carlos; Fahrer, Rodolfo D.; Grancelli, Hugo; Nogues, Martin; Leiguarda, Ramon C.; Cardinali, Daniel P.

    2007-01-01

    Background/Aims: Depression has been associated with increased mortality among individuals with heart failure, but the mechanism for this association is unsettled. Depression is often found to result in autonomic dysfunction which, if present in heart failure, might help explain worsened outcomes. M

  3. Arresting developments: trends in female arrests for domestic violence and proposed explanations.

    Science.gov (United States)

    Deleon-Granados, William; Wells, William; Binsbacher, Ruddyard

    2006-04-01

    This article represents an effort to generate more systematic and specified discussion on the topic of unintended consequences in the movement to decrease violence against women. In this case, the consequence is increases in female arrests for domestic violence. This article builds on recent discussions by first using a sample of data to examine felony domestic violence arrest rates for men and women. The data support the conclusion that domestic violence arrests of women have increased. Second, the article presents six explanations that are derived from existing literature. Although the authors do not offer empirical tests of these explanations, this presentation can play an important part in better understanding the outcomes of criminal justice policies that are aimed at increasing victim safety.

  4. Heart rate recovery after exercise in chronic heart failure: role of vital exhaustion and type D personality.

    Science.gov (United States)

    von Känel, Roland; Barth, Jürgen; Kohls, Sonja; Saner, Hugo; Znoj, Hansjörg; Saner, Gaby; Schmid, Jean-Paul

    2009-04-01

    Vital exhaustion and type D personality previously predicted mortality and cardiac events in patients with chronic heart failure (CHF). Reduced heart rate recovery (HRR) also predicts morbidity and mortality in CHF. We hypothesized that elevated levels of vital exhaustion and type D personality are both associated with decreased HRR. Fifty-one patients with CHF (mean age 58+/-12 years, 82% men) and left ventricular ejection fraction (LVEF) exercise testing before receiving outpatient cardiac rehabilitation. They completed the 9-item short form of the Maastricht Vital Exhaustion Questionnaire and the 14-item type D questionnaire asking about negative affectivity and social inhibition. HRR was calculated as the difference between heart rate at the end of exercise and 1 min after abrupt cessation of exercise (HRR-1). Regression analyses were adjusted for gender, age, LVEF, and maximum exercise capacity. Vital exhaustion explained 8.4% of the variance in continuous HRR-1 (p=0.045). For each point increase on the vital exhaustion score (range 0-18) there was a mean+/-SEM decrease of 0.54+/-0.26 bpm in HRR-1. Type D personality showed a trend toward statistical significance for being associated with lower levels of HRR-1 explaining 6.5% of the variance (ptype D personality than in those without (odds ratio=7.62, 95% CI 1.50-38.80). Elevated levels of vital exhaustion and type D personality were both independently associated with reduced HRR-1. The findings provide a hitherto not explored psychobiological explanation for poor cardiac outcome in patients with CHF.

  5. Metabolic rates of ATP transfer through creatine kinase (CK Flux) predict clinical heart failure events and death.

    Science.gov (United States)

    Bottomley, Paul A; Panjrath, Gurusher S; Lai, Shenghan; Hirsch, Glenn A; Wu, Katherine; Najjar, Samer S; Steinberg, Angela; Gerstenblith, Gary; Weiss, Robert G

    2013-12-11

    Morbidity and mortality from heart failure (HF) are high, and current risk stratification approaches for predicting HF progression are imperfect. Adenosine triphosphate (ATP) is required for normal cardiac contraction, and abnormalities in creatine kinase (CK) energy metabolism, the primary myocardial energy reserve reaction, have been observed in experimental and clinical HF. However, the prognostic value of abnormalities in ATP production rates through CK in human HF has not been investigated. Fifty-eight HF patients with nonischemic cardiomyopathy underwent ³¹P magnetic resonance spectroscopy (MRS) to quantify cardiac high-energy phosphates and the rate of ATP synthesis through CK (CK flux) and were prospectively followed for a median of 4.7 years. Multiple-event analysis (MEA) was performed for HF-related events including all-cause and cardiac death, HF hospitalization, cardiac transplantation, and ventricular-assist device placement. Among baseline demographic, clinical, and metabolic parameters, MEA identified four independent predictors of HF events: New York Heart Association (NYHA) class, left ventricular ejection fraction (LVEF), African-American race, and CK flux. Reduced myocardial CK flux was a significant predictor of HF outcomes, even after correction for NYHA class, LVEF, and race. For each increase in CK flux of 1 μmol g⁻¹ s⁻¹, risk of HF-related composite outcomes decreased by 32 to 39%. These findings suggest that reduced CK flux may be a potential HF treatment target. Newer imaging strategies, including noninvasive ³¹P MRS that detect altered ATP kinetics, could thus complement risk stratification in HF and add value in conditions involving other tissues with high energy demands, including skeletal muscle and brain.

  6. Central exogenous nitric oxide decreases cardiac sympathetic drive and improves baroreflex control of heart rate in ovine heart failure.

    Science.gov (United States)

    Ramchandra, Rohit; Hood, Sally G; May, Clive N

    2014-08-01

    Heart failure (HF) is associated with increased cardiac and renal sympathetic drive, which are both independent predictors of poor prognosis. A candidate mechanism for the centrally mediated sympathoexcitation in HF is reduced synthesis of the inhibitory neuromodulator nitric oxide (NO), resulting from downregulation of neuronal NO synthase (nNOS). Therefore, we investigated the effects of increasing the levels of NO in the brain, or selectively in the paraventricular nucleus of the hypothalamus (PVN), on cardiac sympathetic nerve activity (CSNA) and baroreflex control of CSNA and heart rate in ovine pacing-induced HF. The resting level of CSNA was significantly higher in the HF than in the normal group, but the resting level of RSNA was unchanged. Intracerebroventricular infusion of the NO donor sodium nitroprusside (SNP; 500 μg · ml(-1)· h(-1)) in conscious normal sheep and sheep in HF inhibited CSNA and restored baroreflex control of heart rate, but there was no change in RSNA. Microinjection of SNP into the PVN did not cause a similar cardiac sympathoinhibition in either group, although the number of nNOS-positive cells was decreased in the PVN of sheep in HF. Reduction of endogenous NO with intracerebroventricular infusion of N(ω)-nitro-l-arginine methyl ester decreased CSNA in normal but not in HF sheep and caused no change in RSNA in either group. These findings indicate that endogenous NO in the brain provides tonic excitatory drive to increase resting CSNA in the normal state, but not in HF. In contrast, exogenously administered NO inhibited CSNA in both the normal and HF groups via an action on sites other than the PVN. Copyright © 2014 the American Physiological Society.

  7. Rate of change in physical fitness and quality of life and depression following exercise training in patients with congestive heart failure.

    Science.gov (United States)

    Smart, Neil A; Murison, Robert

    2013-01-01

    Exercise training appears to improve peak oxygen consumption (VO(2) ) and quality of life (QOL) in heart failure patients, although disease etiology, patient demographics and medication may alter the rate of adaptation. The authors sought to identify rate of change from baseline in fitness, QOL, and depression following exercise training in a cohort of patients with congestive heart failure. Thirty male systolic heart failure patients (aged 63.8±8.3 years, baseline peak VO(2) 12.2±4.8 mL/kg/min, left ventricular ejection fraction 28.2±9.4%, New York Heart Association class II/II 22/8) undertook 52 weeks of exercise training, 16 weeks as an outpatient and a further 36 weeks of home exercise. Peak VO(2) and QOL was measured using the Minnesota Living With Heart Failure (MLWHF) questionnaire and depression using the Hare-Davis scale. The authors analyzed the rate of change in peak VO(2) and MLWHF after grouping patients according to clinical, demographic, and pharmacologic characteristics. Peak VO(2) measurements varied over time, with no effect of disease pathology or β-blocker on peak VO(2) . The rate of change in physical MLWHF score was significantly greater (improved) during 0 to 16 weeks in patients with dilated pathology, but was not significantly affected by β-blocker use or age. The exercise training venue and supervision, or lack thereof, is the major determinant of adaptation to the intervention in heart failure patients, although age, β-adrenergic medication, and heart failure etiology also explain some of the variation in adaptive responses observed.

  8. Evaluation of therapy for dilated cardiomyopathy with heart failure by iodine-123 metaiodobenzyl-guanidine imaging. Comparison with heart rate variability power spectral analysis

    Energy Technology Data Exchange (ETDEWEB)

    Li, Shou-lin; Ikeda, Jun; Takita, Tamotsu; Sekiguchi, Yohei; Demachi, Jun; Chikama, Hisao; Goto, Atsushi; Shirato, Kunio [Tohoku Univ., Sendai (Japan). School of Medicine

    1998-11-01

    The relationship between the myocardial uptake of iodine-123 metaiodobenzylguanidine ({sup 123}I-MIBG) and heart rate variability parameters has not been determined. This study determined the relationship between the change in myocardial uptake of {sup 123}I-MIBG and improvement in left ventricular function after treatment, to determine the usefulness of {sup 123}I-MIBG imaging to assess the effect of therapy on heart failure due to dilated cardiomyopathy (DCM). {sup 123}I-MIBG imaging and power spectral analysis of heart rate variability were performed before and after treatment in 17 patients with heart failure due to DCM. The following parameters were compared before and after treatment: New York Heart Association (NYHA) functional class, radiographic cardiothoracic ratio (CTR), blood pressure, echocardiographic data (left ventricular end-systolic (LVDs) and end-diastolic (LVDd) diameters, left ventricular ejection fraction (LVEF)), plasma concentrations of norepinephrine and epinephrine, heart rate variability power spectral analysis data (mean low frequency (MLF) and high frequency power (MHF)) and the myocardium to mediastinum activity ratio (MYO/M) obtained in early and late images, and washout rate calculated by anterior planar imaging of {sup 123}I-MIBG. The NYHA functional class, LVEF, LVDs, CTR, MLF and MHF improved after treatment. Early MYO/M and late MYO/M improved after treatment. The rate of increase in late MYO/M was positively correlated with the rate of improvement of LVEF after treatment. Furthermore, the late MYO/M was negatively correlated with MLF. Washout rate revealed no correlation with hemodynamic parameters. These findings suggest that late MYO/M is more useful than washout rate to assess the effect of treatment on heart failure due to DCM. Furthermore, the {sup 123}I-MIBG imaging and heart rate variability parameters are useful to assess the autonomic tone in DCM with heart failure. (author)

  9. Annual failure rates and marginal bone-level changes of immediate compared to conventional loading of dental implants. A systematic review of the literature and meta-analysis.

    NARCIS (Netherlands)

    Engelhardt, S.; Papacosta, P.; Rathe, F.; Ozen, J.; Jansen, J.A.; Junker, R.

    2015-01-01

    BACKGROUND: Immediate loading of dental implants appears to be a successful option. Questions still remain whether annual failure rates (AFRs) as well as annual marginal bone-level changes are comparable with conventionally loaded implants. HYPOTHESIS: Immediately loaded implants (

  10. Heart failure patients demonstrate impaired changes in brachial artery blood flow and shear rate pattern during moderate-intensity cycle exercise.

    NARCIS (Netherlands)

    Benda, N.M.M.; Seeger, J.P.; Lier, D.P. van; Bellersen, L.; Dijk, A.P.J. van; Hopman, M.T.E.; Thijssen, D.H.

    2015-01-01

    NEW FINDINGS: What is the central question of this study? We explored whether heart failure (HF) patients demonstrate different exercise-induced brachial artery shear rate patterns compared with control subjects. What is the main finding and its importance? Moderate-intensity cycle exercise in HF

  11. A comparison of low versus high heart rate in patients with atrial fibrillation and advanced chronic heart failure : Effects on clinical profile, neurohormones and survival

    NARCIS (Netherlands)

    Rienstra, Michiel; Van Gelder, Isabelle C; Van den Berg, Maarten P; Boomsma, Frans; Hillege, Hans L; Van Veldhuisen, Dirk J

    2006-01-01

    BACKGROUND: Atrial fibrillation is common in chronic heart failure. Long-term restoration of sinus rhythm is generally unsuccessful. It may be speculated that higher heart rates are unfavorable, since this may lead to tachycardiomyopathy, but there are no data which have examined this. METHODS AND

  12. Contraceptive failure in China.

    Science.gov (United States)

    Wang, Duolao

    2002-09-01

    This study examines patterns and differentials of contraceptive failure rates by method and characteristics of users, using the Chinese Two-per-Thousand Fertility Survey data. The results show that contraceptive failure rates for modern methods including sterilization are some of the highest in the world. The first year failure rates are 4.2% for male sterilization, 0.7% for female sterilization, 10.3% for IUD, 14.5% for pill, and 19.0% for condom. There are also some differentials in contraceptive failure rates by users' sociodemographic and fertility characteristics. Contraceptive failure rate declines with women's age for all reversible methods. Rural women have higher sterilization, IUD, and condom contraceptive failure rates than urban women. Women with two or more children have a higher failure rate for sterilization methods but have lower failure rates for other methods.

  13. The effect of temperature and strain rate on elongation to failure in nanostructured Al-0.2wt% Zr alloy fabricated by ARB process

    Directory of Open Access Journals (Sweden)

    Hanieh Solouki

    2015-12-01

    Full Text Available A nano/ultra-fine grain Al-0.2wt% Zr alloy was produced by accumulated roll bonding (ARB processafter 10 cycles. The fraction of high angle grain boundaries increased from 8% to 65.4% during 10passes during ARB process. This alloy was subjected to tensile test at different temperatures (523,573and 623 K and strain rates (0.1 and 0.01 s-1. The optimum condition of temperature and strain rate of623k and 0.01s-1 was achieved for maximum elongation to failure, leading to 100% elongation,although maximum elongation was achieved at higher strain rate and maximum chosen temperature.In fracture surfaces after the test, dimples in higher temperature were deeper, bigger, and longer thanlow temperature. Because of presenting the superplasticity character at elevated temperature andhigher strain rate, there was no evidence of necking after failure.

  14. Global Bi-ventricular endocardial distribution of activation rate during long duration ventricular fibrillation in normal and heart failure canines.

    Science.gov (United States)

    Luo, Qingzhi; Jin, Qi; Zhang, Ning; Han, Yanxin; Wang, Yilong; Huang, Shangwei; Lin, Changjian; Ling, Tianyou; Chen, Kang; Pan, Wenqi; Wu, Liqun

    2017-04-13

    The objective of this study was to detect differences in the distribution of the left and right ventricle (LV & RV) activation rate (AR) during short-duration ventricular fibrillation (SDVF, 1 min) in normal and heart failure (HF) canine hearts. Ventricular fibrillation (VF) was electrically induced in six healthy dogs (control group) and six dogs with right ventricular pacing-induced congestive HF (HF group). Two 64-electrode basket catheters deployed in the LV and RV were used for global endocardium electrical mapping. The AR of VF was estimated by fast Fourier transform analysis from each electrode. In the control group, the LV was activated faster than the RV in the first 20 s, after which there was no detectable difference in the AR between them. When analyzing the distribution of the AR within the bi-ventricles at 3 min of LDVF, the posterior LV was activated fastest, while the anterior was slowest. In the HF group, a detectable AR gradient existed between the two ventricles within 3 min of VF, with the LV activating more quickly than the RV. When analyzing the distribution of the AR within the bi-ventricles at 3 min of LDVF, the septum of the LV was activated fastest, while the anterior was activated slowest. A global bi-ventricular endocardial AR gradient existed within the first 20 s of VF but disappeared in the LDVF in healthy hearts. However, the AR gradient was always observed in both SDVF and LDVF in HF hearts. The findings of this study suggest that LDVF in HF hearts can be maintained differently from normal hearts, which accordingly should lead to the development of different management strategies for LDVF resuscitation.

  15. High non-anatomic tunnel position rates in ACL reconstruction failure using both transtibial and anteromedial tunnel drilling techniques.

    Science.gov (United States)

    Jaecker, Vera; Zapf, Tabea; Naendrup, Jan-Hendrik; Pfeiffer, Thomas; Kanakamedala, Ajay C; Wafaisade, Arasch; Shafizadeh, Sven

    2017-07-18

    Although it is well known from cadaveric and biomechanical studies that transtibial femoral tunnel (TT) positioning techniques are associated with non-anatomic tunnel positions, controversial data exist as so far no clinical differences could have been found, comparing transtibial with anteromedial techniques (AM). The purpose of the study was to analyze if graft failure following TT ACL reconstruction was more commonly associated with non-anatomic tunnel position in comparison with the AM technique. We hypothesized that, compared to AM techniques, non-anatomic tunnel positions correlate with TT tunnel positioning techniques. A total of 147 cases of ACL revision surgery were analyzed retrospectively. Primary ACL reconstructions were analyzed regarding the femoral tunnel drilling technique. Femoral and tibial tunnel positions were determined on CT scans using validated radiographic measurement methods. Correlation analysis was performed to determine differences between TT and AM techniques. A total of 101 cases were included, of whom 64 (63.4%) underwent the TT technique and 37 (36.6%) the AM technique for primary ACL reconstruction. Non-anatomic femoral tunnel positions were found in 77.2% and non-anatomical tibial tunnel positions in 40.1%. No correlations were found comparing tunnel positions in TT and AM techniques, revealing non-anatomic femoral tunnel positions in 79.7 and 73% and non-anatomic tibial tunnel positions in 43.7 and 35.1%, respectively (p > 0.05). Considerable rates of non-anatomic femoral and tibial tunnel positions were found in ACL revisions with both transtibial and anteromedial femoral drilling techniques. Despite the potential of placing tunnels more anatomically using an additional AM portal, this technique does not ensure anatomic tunnel positioning. Consequently, the data highlight the importance of anatomic tunnel positioning in primary ACL reconstruction, regardless of the applied drilling technique.

  16. Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States

    Science.gov (United States)

    Safavi, Kyan C.; Dharmarajan, Kumar; Kim, Nancy; Strait, Kelly M.; Li, Shu-Xia; Chen, Serene I.; Lagu, Tara; Krumholz, Harlan M.

    2013-01-01

    Background Despite increasing attention on reducing relatively costly hospital practices while maintaining the quality of care, few studies have examined how hospitals use the intensive care unit (ICU), a high-cost setting, for patients admitted with heart failure (HF). We characterized hospital patterns of ICU admission for patients with HF and determined their association with the use of ICU-level therapies and patient outcomes. Methods and Results We identified 166,224 HF discharges from 341 hospitals in the 2009–10 Premier Perspective® database. We excluded hospitals with transfers. We defined ICU as including medical ICU, coronary ICU, and surgical ICU. We calculated the percent of patients admitted directly to an ICU. We compared hospitals in the top-quartile (high ICU admission) with the remaining quartiles. The median percentage of ICU admission was 10% (Interquartile Range 6% to 16%; range 0% to 88%). In top-quartile hospitals, treatments requiring an ICU were used less often: percentage of ICU days receiving mechanical ventilation (6% top quartile versus 15% others), non-invasive positive pressure ventilation (8% versus 19%), vasopressors and/or inotropes (9% versus 16%), vasodilators (6% versus 12%), and any of these interventions (26% versus 51%). Overall HF in-hospital risk standardized mortality was similar (3.4% versus 3.5%; P = 0.2). Conclusions ICU admission rates for HF varied markedly across hospitals and lacked association with in-hospital risk-standardized mortality. Greater ICU use correlated with fewer patients receiving ICU interventions. Judicious ICU use could reduce resource consumption without diminishing patient outcomes. PMID:23355624

  17. Sleeping and resting respiratory rates in dogs and cats with medically-controlled left-sided congestive heart failure.

    Science.gov (United States)

    Porciello, F; Rishniw, M; Ljungvall, I; Ferasin, L; Haggstrom, J; Ohad, D G

    2016-01-01

    Sleeping and resting respiratory rates (SRR and RRR, respectively) are commonly used to monitor dogs and cats with left-sided cardiac disease and to identify animals with left-sided congestive heart failure (L-CHF). Dogs and cats with subclinical heart disease have SRRmean values dogs and cats with CHF that is well controlled with medical therapy. In this study, SRR and RRR were measured by the owners of 51 dogs and 22 cats with stable, well-controlled CHF. Median canine SRRmean was 20 breaths/min (7-39 breaths/min); eight dogs were ≥25 breaths/min and one dog only was ≥30 breaths/min. Canine SRRmean was unrelated to pulmonary hypertension or diuretic dose. Median feline SRRmean was 20 breaths/min (13-31 breaths/min); four cats were ≥25 breaths/min and only one cat was ≥30 breaths/min. Feline SRRmean was unrelated to diuretic dose. SRR remained stable during collection in both species with little day-to-day variability. The median canine RRRmean was 24 breaths/min (12-44 breaths/min), 17 were ≥25 breaths/min, seven were ≥30 breaths/min, two were >40 breaths/min. Median feline RRRmean was 24 breaths/min (15-45 breaths/min); five cats had RRRmean ≥25 breaths/min; one had ≥30 breaths/min, and two had ≥40 breaths/min. These data suggest that most dogs and cats with CHF that is medically well-controlled and stable have SRRmean and RRRmean dogs and cats. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Acquired Upper Extremity Growth Arrest.

    Science.gov (United States)

    Gauger, Erich M; Casnovsky, Lauren L; Gauger, Erica J; Bohn, Deborah C; Van Heest, Ann E

    2017-01-01

    This study reviewed the clinical history and management of acquired growth arrest in the upper extremity in pediatric patients. The records of all patients presenting from 1996 to 2012 with radiographically proven acquired growth arrest were reviewed. Records were examined to determine the etiology and site of growth arrest, management, and complications. Patients with tumors or hereditary etiology were excluded. A total of 44 patients (24 boys and 20 girls) with 51 physeal arrests who presented at a mean age of 10.6 years (range, 0.8-18.2 years) were included in the study. The distal radius was the most common site (n=24), followed by the distal humerus (n=8), metacarpal (n=6), distal ulna (n=5), proximal humerus (n=4), radial head (n=3), and olecranon (n=1). Growth arrest was secondary to trauma (n=22), infection (n=11), idiopathy (n=6), inflammation (n=2), compartment syndrome (n=2), and avascular necrosis (n=1). Twenty-six patients (59%) underwent surgical intervention to address deformity caused by the physeal arrest. Operative procedures included ipsilateral unaffected bone epiphysiodesis (n=21), shortening osteotomy (n=10), lengthening osteotomy (n=8), excision of physeal bar or bone fragment (n=2), angular correction osteotomy (n=1), and creation of single bone forearm (n=1). Four complications occurred; 3 of these required additional procedures. Acquired upper extremity growth arrest usually is caused by trauma or infection, and the most frequent site is the distal radius. Growth disturbances due to premature arrest can be treated effectively with epiphysiodesis or osteotomy. In this series, the specific site of anatomic growth arrest was the primary factor in determining treatment. [Orthopedics. 2017; 40(1):e95-e103.]. Copyright 2016, SLACK Incorporated.

  19. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore

    2011-11-01

    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  20. [Arrest of maturation in spermatogenesis].

    Science.gov (United States)

    Francavilla, S; Bellocci, M; Martini, M; Bruno, B; Moscardelli, S; Fabbrini, A; Properzi, G

    1982-07-30

    The ultrastructural aspects of the germinal epithelium of 10 infertile men affected by maturative arrest of spermatogenesis were studied. We noted an increased number of malformed germinal cells. Marginal nuclear vescicles were present in spermatogonia of patients affected by spermatogonial arrest. The few spermatid present in the germinal epithelium of the patients affected by a spermatidic arrest presented changes of the nuclear condensation, the acrosome, and the tail. The Sertoli cells presented an immature aspect of the nucleus and changes of the "mantle". A possible correlation between the Sertoli cells changes and the altered spermatogenesis was proposed.

  1. Medically inoperable endometrial cancer in patients with a high body mass index (BMI): Patterns of failure after 3-D image-based high dose rate (HDR) brachytherapy

    DEFF Research Database (Denmark)

    Acharya, Sahaja; Esthappan, Jacqueline; Badiyan, Shahed

    2016-01-01

    BACKGROUND AND PURPOSE: High BMI is a reason for medical inoperability in patients with endometrial cancer in the United States. Definitive radiation is an alternative therapy for these patients; however, data on patterns of failure after definitive radiotherapy are lacking. We describe...... the patterns of failure after definitive treatment with 3-D image-based high dose rate (HDR) brachytherapy for medically inoperable endometrial cancer. MATERIALS AND METHODS: Forty-three consecutive patients with endometrial cancer FIGO stages I-III were treated definitively with HDR brachytherapy...

  2. High rate of virological failure and low rate of switching to second-line treatment among adolescents and adults living with HIV on first-line ART in Myanmar, 2005-2015

    Science.gov (United States)

    Harries, Anthony D.; Kumar, Ajay M. V.; Oo, Myo Minn; Kyaw, Khine Wut Yee; Win, Than; Aung, Thet Ko; Min, Aung Chan; Oo, Htun Nyunt

    2017-01-01

    Background The number of people living with HIV on antiretroviral treatment (ART) in Myanmar has been increasing rapidly in recent years. This study aimed to estimate rates of virological failure on first-line ART and switching to second-line ART due to treatment failure at the Integrated HIV Care program (IHC). Methods Routinely collected data of all adolescent and adult patients living with HIV who were initiated on first-line ART at IHC between 2005 and 2015 were retrospectively analyzed. The cumulative hazard of virological failure on first-line ART and switching to second-line ART were estimated. Crude and adjusted hazard ratios were calculated using the Cox regression model to identify risk factors associated with the two outcomes. Results Of 23,248 adults and adolescents, 7,888 (34%) were tested for HIV viral load. The incidence rate of virological failure among those tested was 3.2 per 100 person-years follow-up and the rate of switching to second-line ART among all patients was 1.4 per 100 person-years follow-up. Factors associated with virological failure included: being adolescent; being lost to follow-up at least once; having WHO stage 3 and 4 at ART initiation; and having taken first-line ART elsewhere before coming to IHC. Of the 1032 patients who met virological failure criteria, 762 (74%) switched to second-line ART. Conclusions We found high rates of virological failure among one third of patients in the cohort who were tested for viral load. Of those failing virologically on first-line ART, about one quarter were not switched to second-line ART. Routine viral load monitoring, especially for those identified as having a higher risk of treatment failure, should be considered in this setting to detect all patients failing on first-line ART. Strategies also need to be put in place to prevent treatment failure and to treat more of those patients who are actually failing. PMID:28182786

  3. Do Insect Populations Die at Constant Rates as They Become Older? Contrasting Demographic Failure Kinetics with Respect to Temperature According to the Weibull Model.

    Directory of Open Access Journals (Sweden)

    Petros Damos

    Full Text Available Temperature implies contrasting biological causes of demographic aging in poikilotherms. In this work, we used the reliability theory to describe the consistency of mortality with age in moth populations and to show that differentiation in hazard rates is related to extrinsic environmental causes such as temperature. Moreover, experiments that manipulate extrinsic mortality were used to distinguish temperature-related death rates and the pertinence of the Weibull aging model. The Newton-Raphson optimization method was applied to calculate parameters for small samples of ages at death by estimating the maximum likelihoods surfaces using scored gradient vectors and the Hessian matrix. The study reveals for the first time that the Weibull function is able to describe contrasting biological causes of demographic aging for moth populations maintained at different temperature regimes. We demonstrate that at favourable conditions the insect death rate accelerates as age advances, in contrast to the extreme temperatures in which each individual drifts toward death in a linear fashion and has a constant chance of passing away. Moreover, slope of hazard rates shifts towards a constant initial rate which is a pattern demonstrated by systems which are not wearing out (e.g. non-aging since the failure, or death, is a random event independent of time. This finding may appear surprising, because, traditionally, it was mostly thought as rule that in aging population force of mortality increases exponentially until all individuals have died. Moreover, in relation to other studies, we have not observed any typical decelerating aging patterns at late life (mortality leveling-off, but rather, accelerated hazard rates at optimum temperatures and a stabilized increase at the extremes.In most cases, the increase in aging-related mortality was simulated reasonably well according to the Weibull survivorship model that is applied. Moreover, semi log- probability hazard

  4. An airline cardiac arrest program

    National Research Council Canada - National Science Library

    O'Rourke, M F; Donaldson, E; Geddes, J S

    1997-01-01

    ...) available for use on airline passengers with cardiac arrest. AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation...

  5. Heart rate variability and n-3 fatty acids in patients with chronic renal failure--a pilot study.

    Science.gov (United States)

    Christensen, J H; Aarøe, J; Knudsen, N; Dideriksen, K; Kornerup, H J; Dyerberg, J; Schmidt, E B

    1998-02-01

    Patients with chronic renal failure (CRF) often have autonomic cardiac dysfunction, which can be assessed by measuring heart rate variability (HRV). This dysfunction prediposes the patients to sudden cardiac death. This study describes 24-hour HRV in patients with CRF compared to HRV in patients with a previous myocardial infarction (MI). Furthermore, associations between HRV in patients with CRF and the content of n-3 polyunsaturated fatty acids (PUFA) in cell membranes were examined, because n-3 PUFA may improve HRV. Twenty-nine patients with CRF treated with dialysis were enrolled. A 24-hour Holter recording was obtained at baseline and the HRV variables, RR (= mean of all normal RR intervals during the 24-hour recording) and SDNN (= standard deviation of all normal RR intervals in the entire 24-hour recording) were analyzed. Also, granulocyte fatty acid composition was determined. The patients were allocated to dietary supplementation with either 5.2 g of n-3 PUFA or a placebo oil (olive oil) daily for 12 weeks in a double-blind design. At the end of the supplementation period the Holter recording and blood sampling were repeated. At baseline the CRF patients' mean SDNN ws 86 ms compared to 118 ms (p < 0.01) in patients with a previous MI. After supplementation with either n-3 PUFA or placebo a highly significant correlation was observed between the content of n-3 PUFA in cell membranes and HRV (r = 0.71, p < 0.01). Furthermore, when the patients were dichotomized according to their mean SDNN, it was found, that those with the highest SDNN had a higher content of n-3 PUFA in cell membranes compared to those with the lowest SDNN (7.8% vs 4.2%, p < 0.05). In conclusion, HRV was decreased in CRF patients indicating a cardiovascular autonomic dysfunction. The positive correlation between the n-3 PUFA content in cell membranes and HRV suggests that the effects of an increased intake of n-3 PUFA in CRF patients should be further studied.

  6. Heart rate at baseline influences the effect of ivabradine on cardiovascular outcomes in chronic heart failure: analysis from the SHIFT study.

    Science.gov (United States)

    Böhm, Michael; Borer, Jeffrey; Ford, Ian; Gonzalez-Juanatey, Jose R; Komajda, Michel; Lopez-Sendon, Jose; Reil, Jan-Christian; Swedberg, Karl; Tavazzi, Luigi

    2013-01-01

    We analysed the effect of ivabradine on outcomes in heart failure (HF) patients on recommended background therapies with heart rates ≥75 bpm and bpm in the SHIFT trial. A cut-off value of ≥75 bpm was chosen by the EMEA for approval for the use of ivabradine in chronic heart failure. The SHIFT population was divided by baseline heart rate ≥75 or bpm. The effect of ivabradine was analysed for primary composite endpoint (cardiovascular death or HF hospitalization) and other endpoints. In the ≥75 bpm group, ivabradine reduced primary endpoint (HR 0.76, 95 % CI 0.68-0.85, P bpm or reductions >10 bpm. None of the endpoints was significantly reduced in the bpm group, though there were trends for risk reductions in HF death and hospitalization for heart rate bpm and reductions >10 bpm. Ivabradine was tolerated similarly in both groups. The effect of ivabradine on outcomes is greater in patients with heart rate ≥75 bpm with heart rates achieved bpm or heart rate reductions >10 bpm predicting best risk reduction. Our findings emphasize the importance of identification of high-risk HF patients by high heart rates and their treatment with heart rate-lowering drugs such as ivabradine.

  7. Effect of Visit-to-Visit Variation of Heart Rate and Systolic Blood Pressure on Outcomes in Chronic Systolic Heart Failure: Results From the Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial (SHIFT) Trial.

    Science.gov (United States)

    Böhm, Michael; Robertson, Michele; Borer, Jeffrey; Ford, Ian; Komajda, Michel; Mahfoud, Felix; Ewen, Sebastian; Swedberg, Karl; Tavazzi, Luigi

    2016-02-12

    Elevated resting heart rate (HR) and low systolic blood pressure (SBP) are related to poor outcomes in heart failure (HF). The association between visit-to-visit variation in SBP and HR and risk in HF is unknown. In Systolic Heart Failure Treatment with the If inhibitor ivabradine Trial (SHIFT) patients, we evaluated relationships between mean HR, mean SBP, and visit-to-visit variations (coefficient of variation [CV]=SD/mean×100%) in SBP and HR (SBP-CV and HR-CV, respectively) and primary composite endpoint (cardiovascular mortality or HF hospitalization), its components, all-cause mortality, and all-cause hospitalization. High HR and low SBP were closely associated with risk for primary endpoint, all-cause mortality, and HF hospitalization. The highest number of primary endpoint events occurred in the highest HR tertile (38.8% vs 16.4% lowest tertile; PHeart Association, Inc., by Wiley Blackwell.

  8. Failure to activate the in-hospital emergency team: causes and outcomes

    Science.gov (United States)

    Barbosa, Vera; Gomes, Ernestina; Vaz, Senio; Azevedo, Gustavo; Fernandes, Gonçalo; Ferreira, Amélia; Araujo, Rui

    2016-01-01

    Objective To determine the incidence of afferent limb failure of the in-hospital Medical Emergency Team, characterizing it and comparing the mortality between the population experiencing afferent limb failure and the population not experiencing afferent limb failure. Methods A total of 478 activations of the Medical Emergency Team of Hospital Pedro Hispano occurred from January 2013 to July 2015. A sample of 285 activations was obtained after excluding incomplete records and activations for patients with less than 6 hours of hospitalization. The sample was divided into two groups: the group experiencing afferent limb failure and the group not experiencing afferent limb failure of the Medical Emergency Team. Both populations were characterized and compared. Statistical significance was set at p ≤ 0.05. Result Afferent limb failure was observed in 22.1% of activations. The causal analysis revealed significant differences in Medical Emergency Team activation criteria (p = 0.003) in the group experiencing afferent limb failure, with higher rates of Medical Emergency Team activation for cardiac arrest and cardiovascular dysfunction. Regarding patient outcomes, the group experiencing afferent limb failure had higher immediate mortality rates and higher mortality rates at hospital discharge, with no significant differences. No significant differences were found for the other parameters. Conclusion The incidence of cardiac arrest and the mortality rate were higher in patients experiencing failure of the afferent limb of the Medical Emergency Team. This study highlights the need for health units to invest in the training of all healthcare professionals regarding the Medical Emergency Team activation criteria and emergency medical response system operations. PMID:28099639

  9. Mitochondrial dysfunction contributes to alveolar developmental arrest in hyperoxia-exposed mice.

    Science.gov (United States)

    Ratner, Veniamin; Starkov, Anatoly; Matsiukevich, Dzmitry; Polin, Richard A; Ten, Vadim S

    2009-05-01

    This study investigated whether mitochondrial dysfunction contributes to alveolar developmental arrest in a mouse model of bronchopulmonary dysplasia (BPD). To induce BPD, 3-day-old mice were exposed to 75% O2. Mice were studied at two time points of hyperoxia (72 h or 2 wk) and after 3 weeks of recovery in room air (RA). A separate cohort of mice was exposed to pyridaben, a complex-I (C-I) inhibitor, for 72 hours or 2 weeks. Alveolarization was quantified by radial alveolar count and mean linear intercept methods. Pulmonary mitochondrial function was defined by respiration rates, ATP-production rate, and C-I activity. At 72 hours, hyperoxic mice demonstrated significant inhibition of C-I activity, reduced respiration and ATP production rates, and significantly decreased radial alveolar count compared with controls. Exposure to pyridaben for 72 hours, as expected, caused significant inhibition of C-I and ADP-phosphorylating respiration. Similar to hyperoxic littermates, these pyridaben-exposed mice exhibited significantly delayed alveolarization compared with controls. At 2 weeks of exposure to hyperoxia or pyridaben, mitochondrial respiration was inhibited and associated with alveolar developmental arrest. However, after 3 weeks of recovery from hyperoxia or 2 weeks after 72 hours of exposure to pyridaben alveolarization significantly improved. In addition, there was marked normalization of C-I and mitochondrial respiration. The degree of hyperoxia-induced pulmonary simplification and recovery strongly (r(2) = 0.76) correlated with C-I activity in lung mitochondria. Thus, the arrest of alveolar development induced by either hyperoxia or direct inhibition of mitochondrial oxidative phosphorylation indicates that bioenergetic failure to maintain normal alveolar development is one of the fundamental mechanisms responsible for BPD.

  10. Cortical bone tissue resists fatigue fracture by deceleration and arrest of microcrack growth.

    Science.gov (United States)

    Akkus, O; Rimnac, C M

    2001-06-01

    Knowledge of kinetics of fatigue crack growth of microcracks is important so as to understand the dynamics of bone adaptation, remodeling, and the etiology of fatigue-based failures of cortical bone tissue. In this respect, theoretical models (Taylor, J. Biomech., 31 (1998) 587-592; Taylor and Prendergast, Proc. Instn. Mech. Engrs. Part H 211 (1997) 369-375) of microcrack growth in cortical bone have predicted a decreasing microcrack growth rate with increasing microcrack length. However, these predictions have not been observed directly. This study investigated microcrack growth and arrest through observations of surface microcracks during cyclic loading (R=0.1, 50-80MPa) of human femoral cortical bone (male, n=4, age range: 37-40yr) utilizing a video microscopy system. The change in crack length and orientation of eight surface microcracks were measured with the number of fatigue cycles from four specimens. At the applied cyclic stresses, the microcracks propagated and arrested in generally less than 10,000 cycles. The fatigue crack growth rate of all microcracks decreased with increasing crack length following initial identification, consistent with theoretical predictions. The growth rate of the microcracks was observed to be in the range of 5x10(-5) to 5x10(-7)mmcycle(-1). In addition, many of the microcracks were observed not to grow beyond 150 microm and a cyclic stress intensity factor of 0.5MNm(-3/2). The results of this study suggest that cortical bone tissue may resist fracture at the microscale by deceleration of fatigue crack growth and arrest of microcracks.

  11. Anxiety sensitivity moderates prognostic importance of rhythm-control versus rate-control strategies in patients with atrial fibrillation and congestive heart failure: insights from the Atrial Fibrillation and Congestive Heart Failure Trial.

    Science.gov (United States)

    Frasure-Smith, Nancy; Lespérance, François; Talajic, Mario; Khairy, Paul; Dorian, Paul; O'Meara, Eileen; Roy, Denis

    2012-05-01

    Patients with high anxiety sensitivity (AS) become extremely anxious with heart rate increases, palpitations, and symptoms of psychological arousal. AS predicts panic attacks. In atrial fibrillation (AF), AS correlates with symptom preoccupation and reduced quality of life. We assessed whether AS is associated with outcomes of rhythm-control versus rate-control in congestive heart failure (CHF) patients with AF. Before random assignment, 933 participants (172 women) in the Atrial Fibrillation and Congestive Heart Failure Trial completed the Anxiety Sensitivity Inventory (ASI). Cox proportional hazards models showed no main effects of treatment (P=0.61) or AS (P=0.72) for time to cardiovascular death, but these factors interacted significantly (P=0.020). High AS patients (upper quartile, ASI ≥33) randomly assigned to rhythm-control had significantly lower cardiovascular mortality than those receiving rate-control (hazard ratio, 0.54; 95% confidence interval, 0.32-0.93; P=0.022). With lower ASI scores (<33), treatments did not differ (hazard ratio, 1.12; 95% confidence interval, 0.83-1.51; P=0.46). The interaction between treatment and dichotomized ASI scores remained significant (P=0.009) after adjustment for covariates including age, sex, hypertension, diabetes, creatinine, ejection fraction, time since first diagnosis of AF, New York Heart Association functional class, depression symptoms, marital status, and baseline β-blockers, angiotensin-converting enzyme inhibitors, oral anticoagulants, and implantable cardioverter-defibrillators. Atrial fibrillation and congestive heart failure patients with high AS had better long-term prognosis with rhythm- than rate-control. If replicated, AS should be considered in treatment selection. Research is also needed concerning mechanisms and possible joint AS-AF treatments. URL: http://www.clinicaltrials.gov. Unique identifier: NCT88597077.

  12. Cardiac Arrest in Acute Ischemic Stroke: Incidence, Predisposing Factors, and Clinical Outcomes.

    Science.gov (United States)

    Joundi, Raed A; Rabinstein, Alejandro A; Nikneshan, Davar; Tu, Jack V; Fang, Jiming; Holloway, Robert; Saposnik, Gustavo

    2016-07-01

    Cardiac arrest is a devastating complication of acute ischemic stroke, but little is known about its incidence and characteristics. We studied a large ischemic stroke inpatient population and compared patients with and without cardiac arrest. We studied consecutive patients from the Ontario Stroke Registry who had an ischemic stroke between July 2003 and June 2008 at 11 tertiary care stroke centers in Ontario. Multivariable analyses were used to determine independent predictors of cardiac arrest and associated outcomes. Adjusted survival curves were computed, and hazard ratios for mortality at 30 days and 1 year were determined for cardiac arrest and other major outcomes. Among the 9019 patients with acute ischemic stroke, 352 had cardiac arrest, for an overall incidence of 3.9%. In a sensitivity analysis with palliative patients removed, the incidence of cardiac arrest was 2.5%. Independent predictors of cardiac arrest were as follows: older age, greater stroke severity, preadmission dependence, and a history of diabetes, myocardial infarction, congestive heart failure, and atrial fibrillation. Systemic complications associated with cardiac arrest were as follows: myocardial infarction, pulmonary embolism, sepsis, gastrointestinal hemorrhage, and pneumonia. Patients with cardiac arrest had higher disability at discharge, and a markedly increased 30-day mortality of 82.1% compared with 9.3% without cardiac arrest. Cardiac arrest had a high incidence and was associated with poor outcomes after ischemic stroke, including multiple medical complications and very high mortality. Predictors of cardiac arrest identified in this study could help risk stratify ischemic stroke patients for cardiac investigations and prolonged cardiac monitoring. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Heart Rate and Rhythm and the Benefit of Beta-Blockers in Patients With Heart Failure.

    Science.gov (United States)

    Kotecha, Dipak; Flather, Marcus D; Altman, Douglas G; Holmes, Jane; Rosano, Giuseppe; Wikstrand, John; Packer, Milton; Coats, Andrew J S; Manzano, Luis; Böhm, Michael; van Veldhuisen, Dirk J; Andersson, Bert; Wedel, Hans; von Lueder, Thomas G; Rigby, Alan S; Hjalmarson, Åke; Kjekshus, John; Cleland, John G F

    2017-06-20

    The relationship between mortality and heart rate remains unclear for patients with heart failure with reduced ejection fraction in either sinus rhythm or atrial fibrillation (AF). This analysis explored the prognostic importance of heart rate in patients with heart failure with reduced ejection fraction in randomized controlled trials comparing beta-blockers and placebo. The Beta-Blockers in Heart Failure Collaborative Group performed a meta-analysis of harmonized individual patient data from 11 double-blind randomized controlled trials. The primary outcome was all-cause mortality, analyzed with Cox proportional hazard ratios (HR) modeling heart rate measured at baseline and approximately 6 months post-randomization. A higher heart rate at baseline was associated with greater all-cause mortality for patients in sinus rhythm (n = 14,166; adjusted HR: 1.11 per 10 beats/min; 95% confidence interval [CI]: 1.07 to 1.15; p rate by 12 beats/min in both sinus rhythm and AF. Mortality was lower for patients in sinus rhythm randomized to beta-blockers (HR: 0.73 vs. placebo; 95% CI: 0.67 to 0.79; p heart rate (interaction p = 0.35). Beta-blockers had no effect on mortality in patients with AF (HR: 0.96, 95% CI: 0.81 to 1.12; p = 0.58) at any heart rate (interaction p = 0.48). A lower achieved resting heart rate, irrespective of treatment, was associated with better prognosis only for patients in sinus rhythm (HR: 1.16 per 10 beats/min increase, 95% CI: 1.11 to 1.22; p heart rate, beta-blockers reduce mortality in patients with heart failure with reduced ejection fraction in sinus rhythm. Achieving a lower heart rate is associated with better prognosis, but only for those in sinus rhythm. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  14. Heart failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970284 Effects of enalapril on heart rate variabilityin patients with congestive heart failure. ZHANGYouhua(章友华), et a1. Dept Cardiol, Cardiovasc Instit& Fuwai Hosp, CAMS & PUMC, Beijing, 100037. ChinCir J 1996; 11(2): 729-732.

  15. Assessing the interaction of respiration and heart rate in heart failure and controls using ambulatory Holter recordings.

    Science.gov (United States)

    Haigney, Mark; Zareba, Wojceich; La Rovere, Maria Teresa; Grasso, Ian; Mortara, David

    2014-01-01

    Breathing is a critical component of cardiopulmonary function, but few tools exist to evaluate respiration in ambulatory patients. Holter monitoring allows accurate diagnosis of a host of cardiac issues, and several investigators have demonstrated the ability to detect respiratory effort on the electrocardiogram. In this study we introduce a myogram signal derived from 12-lead, high frequency Holter as a means of detecting respiratory effort. Using the combined myogram and ECG signal, four novel variables were created: total number of Cheyne-Stokes episodes; the BWRatio, the ratio of power (above baseline) measured one second after peak-to-peak respiratory power, an assessment of the "shape" of the respiratory effort; DRR, the change in RR interval centering around peak inspiration; and minutes of synchronized breathing, a fixed ratio of heart beats to respiratory cycles. These variables were assessed in 24-hour recordings from three cohorts: healthy volunteers (n=33), heart failure subjects from the GISSI HF trial (n=383), and subjects receiving implantable defibrillators with severely depressed left ventricular function enrolled in the M2Risk trial (n=470). We observed a statistically significant 6-fold increase in the number of Cheyne-Stokes episodes (p=0.01 by ANOVA), decreases in BWRatio (pHolter-derived respiration can distinguish healthy subjects from heart failure. The utility of these variables for predicting heart failure, arrhythmia, and death risk in prospective studies needs to be assessed.

  16. Application and Analysis for Surge Arrester on Lightning Protection of Distribution Network

    Directory of Open Access Journals (Sweden)

    Wang Daxing

    2016-01-01

    Full Text Available In order to effectively reduce lightning stroke outage rate, effect of lightning protection with surge arrester on transmission line has been generally acknowledged relative to other lightning protection measures. This article introduces in such aspects as the working principle of line surge arrester and effect of lightning protection, and also explores application for lightning arrester of distribution network to achieve difference lightning protection and improve the lightning protection performance of distribution network.

  17. Cross-talk between the fat body and brain regulates insect developmental arrest

    OpenAIRE

    Xu, Wei-Hua; Lu, Yu-Xuan; Denlinger, David L.

    2012-01-01

    Developmental arrest, a critical component of the life cycle in animals as diverse as nematodes (dauer state), insects (diapause), and vertebrates (hibernation), results in dramatic depression of the metabolic rate and a profound extension in longevity. Although many details of the hormonal systems controlling developmental arrest are well-known, we know little about the interactions between metabolic events and the hormones controlling the arrested state. Here, we show that diapause is regul...

  18. Application and Analysis for Surge Arrester on Lightning Protection of Distribution Network

    Directory of Open Access Journals (Sweden)

    Wang Daxing

    2015-01-01

    Full Text Available In order to effectively reduce lightning stroke outage rate, effect of lightning protection with surge arrester on transmission line has been generally acknowledged relative to other lightning protection measures. This article introduces in such aspects as the working principle of line surge arrester and effect of lightning protection, and also explores application for lightning arrester of distribution network to achieve difference lightning protection and improve the lightning protection performance of distribution network.

  19. Sperm DNA fragmentation index does not correlate with the sperm or embryo aneuploidy rate in recurrent miscarriage or implantation failure patients.

    Science.gov (United States)

    Bronet, F; Martínez, E; Gaytán, M; Liñán, A; Cernuda, D; Ariza, M; Nogales, M; Pacheco, A; San Celestino, M; Garcia-Velasco, J A

    2012-07-01

    The aneuploidy rate is higher in poor-quality sperm samples, which also have higher DNA fragmentation index values. The aim of this study was to assess the relationship between sperm DNA fragmentation in samples from infertile men belonging to couples with recurrent miscarriage or implantation failure and the aneuploidy rate in spermatozoa as well as in embryos from patients. This prospective study evaluated DNA damage and the aneuploidy rate in fresh and processed (density gradient centrifugation) ejaculated sperm as well as the aneuploidy rate in biopsied embryos from fertility cycles. Fluorescence in situ hybridization was used for the aneuploidy analysis. Results were compared using linear regression and analysis of variance. A total of 154 embryos were evaluated from 38 patients undergoing PGD cycles; 35.2% of the embryos were chromosomally normal. Analysis of the same sperm samples showed an increased DNA fragmentation after sperm preparation in 76% of the patients. There was no correlation between DNA fragmentation and the aneuploidy rate in embryos or in fresh or processed sperm samples. Sperm DNA fragmentation is not related to chromosomal anomalies in embryos from patients with recurrent miscarriage or implantation failure. However, we cannot rule out the possibility that a relationship between DNA fragmentation and aneuploidy exists for other causes of infertility. Furthermore, the different methods used to evaluate DNA fragmentation may produce different results.

  20. Predictors for outcome among cardiac arrest patients

    DEFF Research Database (Denmark)

    Wibrandt-Johansen, Ida Maria; Norsted, Kristine; Schmidt, Henrik

    2015-01-01

    BackgroundIn the past decade, early treatment of cardiac arrest (CA) victims has been improved in several ways, leading to more optimistic over all prognoses. However, the global survival rate after out-of-hospital CA (OHCA) is still not more than 5-10%. With a better knowledge of the predictors...... circulation (ROSC).ResultsThe overall mortality was 44% and a favorable neurological outcome was seen among 52%. Strong predictors for survival and favorable neurological outcome were ventricular tachycardia/ventricular fibrillation (VT/VF) as initial rhythm, cardiac etiology and time to ROSC¿... rhythm of VT/VF and a cardiac etiology were the strongest....

  1. Problems of house arrest application

    Directory of Open Access Journals (Sweden)

    Mikhail Vladimirovich Kolesnikov

    2015-06-01

    Full Text Available Objective to determine the position of house arrest in the system of preventive measures and to identify the main problems of criminal procedural regulation that prevent its broader use during the preliminary investigation and trial. Methods dialectical approach to the analysis of social phenomena allowing to view them in static and dynamic aspect evolutionarysynergetic paradigm providing the opportunity to explore the phenomenon under investigation with respect to the system subordinate and coordinating relationships within the system. Dialectical approach and the evolutionarysynergetic paradigm determined the choice of specific methods of research historical comparative law comparative formallegal statistical. Results the problems arising with application of house arrest are grouped by author depending on the structure of the provisions of Article 107 of the CriminalProcedural Code of the Russian Federation. The first group of problems includes the determination of the location of the accused suspect under house arrest and the scope of the legal restrictions imposed. The second group includes the establishment of terms of house arrest and their subsequent renewal or change of the preventive measure. The third group is the identification of persons to which the house arrest will be the best preventive measure. The results of the study allow to make proposals to change the current wording of Art. 107 of the CriminalProcedural Code of Russia. Scientific novelty a comprehensive study of current state of the normativelegal regulation of house arrest in the context of its practical application. Practical value the main provisions and conclusions of the article can be used in scientific and pedagogical activity when considering questions about the nature of preventive measures related to the restraint of personal liberty of the accused. nbsp

  2. Analysis of Crack Arrest Toughness.

    Science.gov (United States)

    1988-01-15

    vload(m) vp tn(m) Vertical Source Load (kN) on wedge HY80 Finite Element 0.0122 0.0099 3.81x10 -4 144 Steel Calculations Experiment 0.0122 --- 3.74x10-4...curve, are bona fide measures of the fracture arrest capability of tough ductile steels . The second is that the J-values represent the crack driving...fibrous mode of crack extension. (b) A new test method for studying fast fracture and arrest in tough steels . (c) Measurements of fast fracture and crack

  3. Identification of first-stage labor arrest by electromyography in term nulliparous women after induction of labor.

    Science.gov (United States)

    Vasak, Blanka; Graatsma, Elisabeth M; Hekman-Drost, Elske; Eijkemans, Marinus J; Schagen van Leeuwen, Jules H; Visser, Gerard H A; Jacod, Benoit C

    2017-07-01

    Worldwide induction and cesarean delivery rates have increased rapidly, with consequences for subsequent pregnancies. The majority of intrapartum cesarean deliveries are performed for failure to progress, typically in nulliparous women at term. Current uterine registration techniques fail to identify inefficient contractions leading to first-stage labor arrest. An alternative technique, uterine electromyography has been shown to identify inefficient contractions leading to first-stage arrest of labor in nulliparous women with spontaneous onset of labor at term. The objective of this study was to determine whether this finding can be reproduced in induction of labor. Uterine activity was measured in 141 nulliparous women with singleton term pregnancies and a fetus in cephalic position during induced labor. Electrical activity of the myometrium during contractions was characterized by its power density spectrum. No significant differences were found in contraction characteristics between women with induced labor delivering vaginally with or without oxytocin and women with arrested labor with subsequent cesarean delivery. Uterine electromyography shows no correlation with progression of labor in induced labor, which is in contrast to spontaneous labor. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  4. Long-term prognostic importance of resting heart rate in patients with left ventricular dysfunction in connection with either heart failure or myocardial infarction: the DIAMOND study

    DEFF Research Database (Denmark)

    Fosbøl, Emil Loldrup; Seibaek, Marie; Brendorp, Bente

    2010-01-01

    dysfunction in connection with either heart failure (HF) or myocardial infarction (MI). METHODS: In the Danish Investigations and Arrhythmia ON Dofetilide (DIAMOND) study; patients with left ventricular dysfunction were randomized to Dofetilide (class III antiarrhythmic drug) or placebo. One part of the study......BACKGROUND: Elevated resting heart rate is associated with increased mortality in a variety of cardiac diseases, but comparisons between different clinical settings are lacking. We investigated the long-term prognostic importance of resting heart rate in patients hospitalized with left ventricular...... increment in baseline heart rate of 10 bpm was associated with an increase in mortality in both MI-patients (hazard ratio, 1.14; 95%-confidence interval (CI): 1.09-1.19; Pheart rate on short-term prognosis...

  5. Programmed cell cycle arrest is required for infection of corn plants by the fungus Ustilago maydis.

    Science.gov (United States)

    Castanheira, Sónia; Mielnichuk, Natalia; Pérez-Martín, José

    2014-12-01

    Ustilago maydis is a plant pathogen that requires a specific structure called infective filament to penetrate the plant tissue. Although able to grow, this filament is cell cycle arrested on the plant surface. This cell cycle arrest is released once the filament penetrates the plant tissue. The reasons and mechanisms for this cell cycle arrest are unknown. Here, we have tried to address these questions. We reached three conclusions from our studies. First, the observed cell cycle arrest is the result of the cooperation of at least two distinct mechanisms: one involving the activation of the DNA damage response (DDR) cascade; and the other relying on the transcriptional downregulation of Hsl1, a kinase that modulates the G2/M transition. Second, a sustained cell cycle arrest during the infective filament step is necessary for the virulence in U. maydis, as a strain unable to arrest the cell cycle was severely impaired in its ability to infect corn plants. Third, production of the appressorium, a structure required for plant penetration, is incompatible with an active cell cycle. The inability to infect plants by strains defective in cell cycle arrest seems to be caused by their failure to induce the appressorium formation process. In summary, our findings uncover genetic circuits to arrest the cell cycle during the growth of this fungus on the plant surface, thus allowing the penetration into plant tissue.

  6. Effects of body mass index and age on N-terminal pro brain natriuretic peptide are associated with glomerular filtration rate in chronic heart failure patients

    DEFF Research Database (Denmark)

    Schou, Morten; Gustafsson, Finn; Kistorp, Caroline N

    2007-01-01

    BACKGROUND: Obesity is a state characterized by glomerular hyperfiltration and age-related decreases in glomerular filtration rate (GFR). Body mass index (BMI), age, and GFR are associated with plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) in chronic heart failure...... (CHF) patients. We hypothesized that the effects of BMI and age on plasma concentrations of NT-proBNP are associated with GFR. METHODS: We obtained clinical data and laboratory test results from 345 CHF patients at the baseline visit in our heart failure clinic and examined the hypothesis using...... multiple linear regression models. RESULTS: Age (P = 0.0184), BMI (P = 0.0098), hemoglobin (P = 0.0043), heart rhythm (P proBNP). After adjustment for GFR estimated by the Cockcroft and Gault equation, the parameter...

  7. DAF-16/FOXO regulates transcription of cki-1/Cip/Kip and repression of lin-4 during C. elegans L1 arrest.

    Science.gov (United States)

    Baugh, L Ryan; Sternberg, Paul W

    2006-04-18

    Development is typically studied as a continuous process under laboratory conditions, but wild animals often develop in variable and stressful environments. C. elegans larvae hatch in a developmentally arrested state (L1 arrest) and initiate post-embryonic development only in the presence of food (E. coli in lab). In contrast to the well-studied dauer arrest, L1 arrest occurs without morphological modification, although larvae in L1 arrest are more resistant to environmental stress than developing larvae . Consistent with its role in dauer formation and aging, we show that insulin/insulin-like growth factor (IGF) signaling regulates L1 arrest. daf-2 insulin/IGF receptor mutants have a constitutive-L1-arrest phenotype when fed and extended survival of L1 arrest when starved. Conversely, daf-16/FOXO mutants have a defective-arrest phenotype, failing to arrest development and dying rapidly when starved. We show that DAF-16 is required for transcription of the cyclin-dependent kinase inhibitor cki-1 in stem cells in response to starvation, accounting for the failure of daf-16/FOXO mutants to arrest cell division during L1 arrest. Other developmental events such as cell migration, cell fusion, and expression of the microRNA lin-4, a temporal regulator of post-embryonic development, are also observed in starved daf-16/FOXO mutants. These results suggest that DAF-16/FOXO promotes developmental arrest via transcriptional regulation of numerous target genes that control various aspects of development.

  8. Oscillatory behaviour of ventricular action potential duration in heart failure patients at respiratory rate and low frequency

    Directory of Open Access Journals (Sweden)

    Ben eHanson

    2014-10-01

    Full Text Available Oscillations of arterial pressure occur spontaneously at a frequency of approx. 0.1Hz coupled with synchronous oscillations of sympathetic nerve activity (Mayer waves. This study investigated the extent to which corresponding oscillations may occur in ventricular action potential duration (APD.14 ambulatory (outpatient heart failure patients with biventricular pacing devices were studied while seated upright watching movie clips to maintain arousal. Activation recovery intervals (ARI as a measure of ventricular APD were obtained from unipolar electrograms recorded from the LV epicardial pacing lead during steady state RV pacing from the device. Arterial blood pressure was measured non-invasively (Finapress and respiration monitored. Oscillations were quantified using time frequency and coherence analysis.Oscillatory behaviour of ARI at the respiratory frequency was observed in all subjects. The magnitude of the ARI variation ranged from 2.2 ms to 6.9 ms (mean 5.0 ms. Coherence analysis showed a correlation with respiratory oscillation for an average of 43% of the recording time at a significance level of p < 0.05. Oscillations in systolic blood pressure in the Mayer wave frequency range were observed in all subjects for whom blood pressure was recorded (n=13. ARI oscillation in the Mayer wave frequency range was observed in 6/13 subjects (46% over a range of 2.9ms to 9.2ms. Coherence with Mayer waves at the p < 0.05 significance level was present for an average of 29 % of the recording time. In ambulatory patients with heart failure during enhanced mental arousal, left ventricular epicardial APD (ARI oscillated at the respiratory frequency (approx. 0.25Hz. In 6 patients (46% APD oscillated at the slower Mayer wave frequency (approx. 0.1 Hz. These findings may be important in understanding sympathetic activity-related arrhythmogenesis.

  9. Influence of Cardiovascular and Noncardiovascular Co-morbidities on Outcomes and Treatment Effect of Heart Rate Reduction With Ivabradine in Stable Heart Failure (from the SHIFT Trial).

    Science.gov (United States)

    Böhm, Michael; Robertson, Michele; Ford, Ian; Borer, Jeffrey S; Komajda, Michel; Kindermann, Ingrid; Maack, Christoph; Lainscak, Mitja; Swedberg, Karl; Tavazzi, Luigi

    2015-12-15

    Incidence of chronic heart failure (HF) increases with age and cardiovascular (CV) morbidity. Co-morbidities increase hospitalization and mortality in HF, and non-CV co-morbidities may lead to preventable hospitalizations. We studied the impact of co-morbidities on mortality and morbidity in Systolic Heart Failure Treatment with the I(f) Inhibitor Ivabradine Trial, and investigated whether the impact of ivabradine was affected by co-morbidities. We analyzed the Systolic Heart Failure Treatment with the I(f) Inhibitor Ivabradine Trialpopulation, with moderate-to-severe HF and left ventricular dysfunction (in sinus rhythm with heart rate at rest ≥70 beats/min), according to co-morbidity: chronic obstructive pulmonary disease, diabetes mellitus, anemia, stroke, impaired renal function, myocardial infarction, hypertension, and peripheral artery disease. Co-morbidity load was classed as 0, 1, 2, 3, 4+ or 1 to 2 co-morbidities, or 3+ co-morbidities. Co-morbidities were evenly distributed between the placebo and ivabradine groups. Patients with more co-morbidities were likely to be older, women, had more advanced HF, were less likely to be on β blockers, with an even distribution on ivabradine 2.5, 5, or 7.5 mg bid and placebo at all co-morbidity loads. Number of co-morbidities was related to outcomes. Cardiovascular death or HF hospitalization events significantly increased (p 3 co-morbidities for both, ivabradine and placebo. There was no interaction between co-morbidity load and the treatment effects of ivabradine. Hospitalization rate was lower at all co-morbidity loads for ivabradine. In conclusion, cardiac and noncardiac co-morbidities significantly affect CV outcomes, particularly if there are >3 co-morbidities. The effect of heart rate reduction with ivabradine is maintained at all co-morbidity loads.

  10. The stringent response and cell cycle arrest in Escherichia coli.

    Directory of Open Access Journals (Sweden)

    Daniel J Ferullo

    2008-12-01

    Full Text Available The bacterial stringent response, triggered by nutritional deprivation, causes an accumulation of the signaling nucleotides pppGpp and ppGpp. We characterize the replication arrest that occurs during the stringent response in Escherichia coli. Wild type cells undergo a RelA-dependent arrest after treatment with serine hydroxamate to contain an integer number of chromosomes and a replication origin-to-terminus ratio of 1. The growth rate prior to starvation determines the number of chromosomes upon arrest. Nucleoids of these cells are decondensed; in the absence of the ability to synthesize ppGpp, nucleoids become highly condensed, similar to that seen after treatment with the translational inhibitor chloramphenicol. After induction of the stringent response, while regions corresponding to the origins of replication segregate, the termini remain colocalized in wild-type cells. In contrast, cells arrested by rifampicin and cephalexin do not show colocalized termini, suggesting that the stringent response arrests chromosome segregation at a specific point. Release from starvation causes rapid nucleoid reorganization, chromosome segregation, and resumption of replication. Arrest of replication and inhibition of colony formation by ppGpp accumulation is relieved in seqA and dam mutants, although other aspects of the stringent response appear to be intact. We propose that DNA methylation and SeqA binding to non-origin loci is necessary to enforce a full stringent arrest, affecting both initiation of replication and chromosome segregation. This is the first indication that bacterial chromosome segregation, whose mechanism is not understood, is a step that may be regulated in response to environmental conditions.

  11. Heart rate variability parameters of myxomatous mitral valve disease in dogs with and without heart failure obtained using 24-hour Holter electrocardiography.

    Science.gov (United States)

    Oliveira, M S; Muzzi, R A L; Araújo, R B; Muzzi, L A L; Ferreira, D F; Nogueira, R; Silva, E F

    2012-06-16

    Time-domain heart rate variability (HRV) parameters and the correlation between echocardiography and Holter examinations in dogs with myxomatous mitral valve disease (MMVD) were determined. Holter examination was also performed at different time frames: an entire 24-hour period, a four-hour period during sleep, and a four-hour period while awake. Ten healthy (control group) and 28 MMVD dogs, 15 with and 13 without heart failure, were evaluated. The SDANN (sd of the mean normal RR intervals for all five-minute segments during 24-hour Holter) and pNN(50) (percentage of differences between adjacent normal RR intervals that are >50 ms computed over 24-hour Holter) variables were significantly lower in the dogs with MMVD heart failure. The differences in HRV between the groups were only detected during the 24-hour evaluation period (PHolter and echocardiography examinations when considering pNN(50), SDANN, and LA/AO (left atrial to aortic root ratio) (r=0.92; P<0.05), indicating that both are important in evaluating MMVD dogs. SDANN and pNN(50) are measures of parasympathetic control of the heart, and thus, it is possible to infer that the MMVD dogs exhibit parasympathetic withdrawal during the development of heart failure.

  12. Combining heart rate and systolic blood pressure to improve risk stratification in older patients with heart failure: Findings from the RICA Registry.

    Science.gov (United States)

    Sánchez-Gil, Justo; Manzano, Luis; Flather, Marcus; Formiga, Francesc; Martel, Alicia Conde; Molinero, Alberto Muela; López, Raul Quirós; Jiménez, Jose Luis Arias; Iborra, Pau Llácer; Perez-Calvo, Juan Ignacio; Montero-Pérez-Barquero, Manuel

    2017-03-01

    Heart rate (HR) and systolic blood pressure (SBP) are independent prognostic variables in patients with heart failure (HF). We evaluated if combining HR and SBP could improve prognostic assessment in older patients. Variables associated with all-cause mortality and readmission for HF during 9months of follow-up were analyzed from the Spanish Heart Failure Registry (RICA). HR and SBP values were stratified in three combined groups. We evaluated 1551 patients, 82years and 56% women. Using HR strata of rates of 9.8 and 13.6%, respectively (hazard ratio 1.0 and 1.35). For SBP≥140, 120-140 and rates were 8.2, 10.4 and 20.3%. respectively (hazard ratio 1.0, 1.34 and 2.76). Using combined strata of HRrates of 4.5%, 11.0% and 24.0%, respectively. Multivariate Cox regression for all-cause mortality shows for low-, middle- and high-risk groups was 1 (reference), 1.93 (95% CI: 0.93-3.99, p=0.077) and 4.32 (95% CI: 2.04-9.14, p<0.001). BMI, NYHA, MDRD, hypertension and sodium were also independent prognostic factors. The combination provides better risk discrimination than use of HR and SBP alone and may provide a simple and reliable tool for risk assessment for older HF patients in clinical practice. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. 14 CFR 1203b.103 - Arrest authority.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Arrest authority. 1203b.103 Section 1203b.103 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SECURITY PROGRAMS; ARREST AUTHORITY AND USE OF FORCE BY NASA SECURITY FORCE PERSONNEL § 1203b.103 Arrest authority. (a) NASA...

  14. 33 CFR 154.822 - Detonation arresters, flame arresters, and flame screens.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Detonation arresters, flame arresters, and flame screens. 154.822 Section 154.822 Navigation and Navigable Waters COAST GUARD... BULK Vapor Control Systems § 154.822 Detonation arresters, flame arresters, and flame screens. (a)...

  15. Fewer Heart Failure Patients Dying of Cardiac Arrest

    Science.gov (United States)

    ... new therapies. However, Fonarow isn't convinced that heart implants are no longer necessary for many patients. "Patients ... doctors have more time to decide whether an implant is needed for individual patients, added O'Connor, CEO of the Inova Heart and Vascular Institute in Falls Church, Va. He ...

  16. Fretting fatigue crack propagation rate under variable loading conditions

    Directory of Open Access Journals (Sweden)

    C. Gandiolle

    2016-01-01

    Full Text Available Fretting fatigue experiments aim to represent industrial problems and most of them endure variable loading. Being able to assess lifetime of assemblies, especially for low propagation rate conditions, is essential as experimental validation is often too expensive. Both experimental and numerical approaches are proposed to follow the crack propagation rate of steel on steel cylinder/plane fretting fatigue contact submitted to variable loading conditions. An original experimental monitoring has been implemented on the fretting-fatigue test device to observe crack propagation using a potential drop technique. A calibration curve relating crack length and electrical potential was established for the studied contact. It allows direct knowledge of the crack length and crack propagation rate. It was applied to mixed load test showing crack arrest for the last loading condition. To explain this behavior, a 2-dimensional FE modeling was implemented to simulate the complexes multi-axial contact stressing. The crack propagation rate was formalized using an effective stress intensity factor amplitude ΔKeff coupled with Paris law of the material. The crack arrest condition for a given loading was related to ΔKeff along the expected crack path crossing the material crack arrest threshold ΔK0. The failure was related to ΔKeff reaching the critical stress intensity factor KIC. A good correlation with experiments was observed allowing to predict the crack arrest condition although the model tends to overestimate the final crack length extension.

  17. Glomerular filtration rate estimated from the uptake phase of 99mTc-DTPA renography in chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Talleruphuus, U

    1999-01-01

    The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea.......The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea....

  18. Glomerular filtration rate estimated from the uptake phase of 99mTc-DTPA renography in chronic renal failure

    DEFF Research Database (Denmark)

    Petersen, L J; Petersen, J R; Talleruphuus, U

    1999-01-01

    The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea.......The purpose of the study was to compare the estimation of glomerular filtration rate (GFR) from 99mTc-DTPA renography with that estimated from the renal clearance of 51Cr-EDTA, creatinine and urea....

  19. Evaluation of failure modes of computerized planning phase of interstitial implants with high dose rate brachytherapy using HFMEA; Avaliacao dos modos de falha do planejamento computadorizado em implantes intersticiais com braquiterapia de alta taxa de dose usando HFMEA

    Energy Technology Data Exchange (ETDEWEB)

    Biazotto, Bruna; Tokarski, Marcio, E-mail: bruna@ceb.unicamp.br [Universidade Estadual de Campinas (UNICAMP), SP (Brazil). Centro de Engenharia Biomedica

    2014-08-15

    This paper evaluates the failure modes of the computerized planning step in interstitial implants with high dose rate brachytherapy. The prospective tool of risk management Health Care Failure Mode and Effects Analysis (HFMEA) was used. Twelve subprocesses were identified, and 33 failure modes of which 21 justified new safety actions, and 9 of them were intolerable risks. The method proved itself useful in identifying failure modes, but laborious and subjective in their assessment. The main risks were due to human factors, which require training and commitment of management to their mitigation. (author)

  20. Enforcement following 0.08% BAC law change: sex-specific consequences of changing arrest practices?

    Science.gov (United States)

    Schwartz, Jennifer; Davaran, Ardavan

    2013-10-01

    This research evaluated effects of stricter 0.08% BAC drunken driving law on changes in sex-specific DUI arrest rates, controlling for increased law enforcement resources and shifts in DUI-related behaviors. Another main purpose, the study assessed female/male differences in arrest increases due to broader enforcement standards and efforts. Panel data was assembled for 24 states over 1990-2007 on DUI arrests, alcohol policy, law enforcement resources, drinking and drunken driving prevalence. Two-way fixed-effects seemingly unrelated regression models predicted female versus male changes in DUI arrests following implementation of lower legal limits of intoxication, net controls. Findings suggest, first, that a broader legal definition of drunken driving intending to officially sanction less serious offenders (0.08% vs. 0.10% BAC) was associated with increased DUI arrests for both sexes. Second, growth in specialized DUI-enforcement units also was related to increased arrests. Whereas male and female arrest trends were equally affected by the direct net-widening effects of 0.08% BAC alcohol-policy, specialized DUI-enforcement efforts to dig deeper into the offender-pool had stronger arrest-producing effects on females, particularly prior to law change. Specifying how changes in law and enforcement resources affect arrest outcomes is an important pre-cursor to alcohol-policy analyses of effectiveness. A potential unintended consequence, effects of law and enforcement may differ across population segments. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. A Randomized Trial to Evaluate the Effect of Local Endometrial Injury on the Clinical Pregnancy Rate of Frozen Embryo Transfer Cycles in Patients With Repeated Implantation Failure

    Directory of Open Access Journals (Sweden)

    Ensieh Shahrokh-Tehraninejad

    2016-12-01

    Full Text Available Objective: Repeated implantation failure (RIF is a condition in which the embryos implantation decreases in the endometrium. So, our aim was to evaluate the effect of local endometrial injury on embryo transfer results.Materials and methods: In this simple randomized clinical trial (RCT, a total of 120 patients were selected. The participants were less than 40 years old, and they are in their minimum two cycles of vitro fertilization (IVF. Patients were divided randomly into two groups of LEI (Local endometrial injury and a control group (n = 60 in each group. The first group had four small endometrial injuries from anterior, posterior, and lateral uterus walls which were obtained from people who were in 21th day of their previous IVF cycle. The second group was the patients who have not received any intervention.Results: The experimental and control patients were matched in the following factors. Regarding the clinical pregnancy rate, there was no significant difference noted between the experimental and the control group.Conclusion: Local endometrial injury in a preceding cycle does not increase the clinical pregnancy rate in the subsequent FET cycle of patients with repeated implantation failure.

  2. Lipid emulsion improves recovery from bupivacaine-induced cardiac arrest, but not from ropivacaine- or mepivacaine-induced cardiac arrest.

    Science.gov (United States)

    Zausig, York A; Zink, Wolfgang; Keil, Meike; Sinner, Barbara; Barwing, Juergen; Wiese, Christoph H R; Graf, Bernhard M

    2009-10-01

    Cardiac toxicity significantly correlates with the lipophilicity of local anesthetics (LAs). Recently, the infusion of lipid emulsions has been shown to be a promising approach to treat LA-induced cardiac arrest. As the postulated mechanism of action, the so-called "lipid sink" effect may depend on the lipophilicity of LAs. In this study, we investigated whether lipid effects differ with regard to the administered LAs. In the isolated rat heart, cardiac arrest was induced by administration of equipotent doses of bupivacaine, ropivacaine, and mepivacaine, respectively, followed by cardiac perfusion with or without lipid emulsion (0.25 mL x kg(-1) x min(-1)). Subsequently, the times from the start of perfusion to return of first heart activity and to recovery of heart rate and rate-pressure product (to 90% of baseline values) were assessed. In all groups, lipid infusion had no effects on the time to the return of any cardiac activity. However, recovery times of heart rate and rate-pressure product (to 90% of baseline values) were significantly shorter with the administration of lipids in bupivacaine-induced cardiac toxicity, but not in ropivacaine- or mepivacaine-induced cardiac toxicity. These data show that the effects of lipid infusion on LA-induced cardiac arrest are strongly dependent on the administered LAs itself. We conclude that lipophilicity of LAs has a marked impact on the efficacy of lipid infusions to treat cardiac arrest induced by these drugs.

  3. Angiopoietin-2 in chronic renal failure patients on hemodialysis: Relationship with glomerular filtration rate in the predialysis stages

    Directory of Open Access Journals (Sweden)

    Fatma A Attia

    2013-01-01

    Conclusion Circulating angiopoietin-2 is a putative marker and potential mediator of atherosclerosis, is inversely related to glomerular filtration rate, and is increased with advanced chronic kidney disease. Normolipidemia in chronic kidney disease patients does not prevent atherosclerotic burden; this is because of the presence of other markers such as angiopoietin-2.

  4. Transcapillary escape rate of albumin and right atrial pressure in chronic congestive heart failure before and after treatment

    DEFF Research Database (Denmark)

    Hesse, B; Parving, H H; Lund-Jacobsen, H;

    1976-01-01

    The transcapillary escape rate of albumin (TERalb), i.e., the fraction of intravascular mass of albumin that passes to the extravascular space per unit of time, was determined from the disappearance of intravenously injected 125I-labeled human serum albumin during the first 60 minutes after injec...

  5. Associations of estimated glomerular filtration rate and albuminuria with mortality and renal failure by sex: a meta-analysis

    NARCIS (Netherlands)

    Nitsch, D.; Grams, M.; Sang, Y.; Black, C.; Cirillo, M.; Djurdjev, O.; Iseki, K.; Jassal, S.K.; Kimm, H.; Kronenberg, F.; Oien, C.M.; Levey, A.S.; Levin, A.; Woodward, M.; Hemmelgarn, B.R.; Wetzels, J.F.

    2013-01-01

    OBJECTIVE: To assess for the presence of a sex interaction in the associations of estimated glomerular filtration rate and albuminuria with all-cause mortality, cardiovascular mortality, and end stage renal disease. DESIGN: Random effects meta-analysis using pooled individual participant data. SETTI

  6. International Geographic Variation in Event Rates in Trials of Heart Failure With Preserved and Reduced Ejection Fraction

    DEFF Research Database (Denmark)

    Kristensen, Søren L; Køber, Lars; Jhund, Pardeep S

    2015-01-01

    -cause or cardiovascular mortality. CONCLUSIONS: The differences in event rates observed suggest there is international geographic variation in 1 or more of the definition and diagnosis of HF-PEF, the risk profile of patients enrolled, and the threshold for hospitalization, which has implications for the conduct of future...

  7. Trends and variations in the rates of hospital complications, failure-to-rescue and 30-day mortality in surgical patients in New South Wales, Australia, 2002-2009.

    Directory of Open Access Journals (Sweden)

    Lixin Ou

    Full Text Available BACKGROUND: Despite the increased acceptance of failure-to-rescue (FTR as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications, there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. METHODS: We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs after adjusting for a range of patient and hospital characteristics. RESULTS: The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best and bottom 20% of hospitals (worst for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively. Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. CONCLUSIONS: The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups

  8. Neurologic management following cardiac arrest.

    Science.gov (United States)

    Bircher, N G

    1989-10-01

    Optimal neurologic outcome after cardiac arrest requires careful attention to the details of both intracranial and extracranial homeostasis. A high index of suspicion regarding the potential causes and complications of cardiac arrest facilitates discovery and treatment of problems before they adversely affect neurologic outcome. The future is bright for resuscitation research: Our fundamental understanding of cerebral ischemia and its consequences has dramatically improved, and this knowledge can hopefully be transferred to clinical useful modes of therapy. However, the transition from a promising, therapeutically effective intervention in animals to the demonstration that treatment is effective following cardiac arrest in humans is an important and difficult step. The patient population is heterogeneous before the insult, the duration and severity of the insult are variable, and the effectiveness of cardiopulmonary resuscitation varies among institutions. Therefore, the only means of demonstrating clinical efficacy is the performance of a large clinical trial. The Resuscitation Research Center at the University of Pittsburgh has developed and coordinated a multicenter, multinational team of investigators who have completed one definitive trial of postarrest barbiturate therapy and are currently completing a similar trial using a calcium entry blocker. Despite the formidable obstacles posed by such comprehensive efforts, they provide the mechanism for determining whether the cost of a new treatment modality is justified by the likelihood of improved mortality or morbidity.

  9. Cardiac arrest during gamete release in chum salmon regulated by the parasympathetic nerve system.

    Directory of Open Access Journals (Sweden)

    Yuya Makiguchi

    Full Text Available Cardiac arrest caused by startling stimuli, such as visual and vibration stimuli, has been reported in some animals and could be considered as an extraordinary case of bradycardia and defined as reversible missed heart beats. Variability of the heart rate is established as a balance between an autonomic system, namely cholinergic vagus inhibition, and excitatory adrenergic stimulation of neural and hormonal action in teleost. However, the cardiac arrest and its regulating nervous mechanism remain poorly understood. We show, by using electrocardiogram (ECG data loggers, that cardiac arrest occurs in chum salmon (Oncorhynchus keta at the moment of gamete release for 7.39+/-1.61 s in females and for 5.20+/-0.97 s in males. The increase in heart rate during spawning behavior relative to the background rate during the resting period suggests that cardiac arrest is a characteristic physiological phenomenon of the extraordinarily high heart rate during spawning behavior. The ECG morphological analysis showed a peaked and tall T-wave adjacent to the cardiac arrest, indicating an increase in potassium permeability in cardiac muscle cells, which would function to retard the cardiac action potential. Pharmacological studies showed that the cardiac arrest was abolished by injection of atropine, a muscarinic receptor antagonist, revealing that the cardiac arrest is a reflex response of the parasympathetic nerve system, although injection of sotalol, a beta-adrenergic antagonist, did not affect the cardiac arrest. We conclude that cardiac arrest during gamete release in spawning release in spawning chum salmon is a physiological reflex response controlled by the parasympathetic nervous system. This cardiac arrest represents a response to the gaping behavior that occurs at the moment of gamete release.

  10. Heart rate and outcome in heart failure with reduced ejection fraction: Differences between atrial fibrillation and sinus rhythm-A CIBIS II analysis.

    Science.gov (United States)

    Mulder, Bart A; Damman, Kevin; Van Veldhuisen, Dirk J; Van Gelder, Isabelle C; Rienstra, Michiel

    2017-09-01

    Heart rate has been associated with prognosis in patients with heart failure with reduced ejection fraction (HFREF) and sinus rhythm; whether this also holds true in patients with atrial fibrillation (AF) is unknown. To evaluate cardiac rhythm and baseline heart rate and the influence of outcome in patients with HFREF enrolled in the Cardiac Insufficiency Bisoprolol Study II. In total, 2539 patients were stratified according to their baseline heart rhythm (AF or sinus rhythm) and into quartiles of heart rate (≤70 bpm, 71-78 bpm, 79-90 bpm, and >90 bpm). The primary outcome was all-cause mortality. Mean follow-up was 1.3 years. Mean age was 61 years, mean left ventricular ejection fraction was 28%, and 80% were male. A total of 521 (21%) patients had AF at baseline. The risk associated with all-cause mortality for each 5 bpm increase in heart rate in patients with sinus rhythm (hazard ratio [HR]: 1.06, 95% confidence interval [CI]: 1.01-1.11, P = 0.012) was significantly different from those with AF (HR: 1.00, 95% CI: 0.94-1.07, P = 0.90, P for interaction = 0.041). The risk associated with higher heart rate in sinus rhythm was primarily attributable to excess risk in the highest quartile (HR: 1.64, 95% CI: 1.18-2.30, P = 0.003). Allocation to bisoprolol did not modify the interaction between heart rate, rhythm and outcome. In HFREF patients with AF, a higher heart rate is not associated with increased event rates in contrast to HFREF patients with sinus rhythm. © 2017 Wiley Periodicals, Inc.

  11. Clinical significance of power spectral analysis of heart rate variability and {sup 123}I-metaiodobenzylguanidine (MIBG) myocardial imaging for assessing the severity of heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Ishida, Yoshio; Fukuoka, Shuji; Shimotsu, Yoriko; Sasaki, Tatsuya; Kamakura, Shiro; Yasumura, Yoshio; Miyatake, Kunio; Shimomura, Katsuro [National Cardiovascular Center, Suita, Osaka (Japan); Tani, Akihiro

    1997-04-01

    The significance of power spectral analysis of heart rate variability and of MIBG myocardial imaging to see the sympathetic nervous function was evaluated in patients with congestive heart failure due to dilated cardiomyopathy. Subjects were 10 normal volunteers and 8 patients with severity NYHA II; 10 normals and 25 patients with NYHA II and III; and 17 patients treated with a beta-blocker (metoprolol 5-40 mg). ECG was recorded with a portable ECG recorder for measuring RR intervals for 24 hr, which were applied for power spectral analysis. Early and delayed imagings with 111 MBq of {sup 123}I-MIBG were performed at 15 min and 4 hr, respectively, after its intravenous administration for acquisition of anterior planar and SPECT images. Myocardial blood flow SPECT was also done with 111 MBq of {sup 201}Tl given intravenously, and difference of total defect scores between MIBG and Tl images was computed. MIBG myocardial sympathetic nerve imaging in those patients was found useful to assess the severity of heart failure, to predict the risk patients for beta-blocker treatment and to assess the risk in complicated ventricular tachycardia. (K.H.)

  12. Potential for the G2/M arrest assay to predict patient susceptibility to severe reactions following radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Perez, A.; Grabenbauer, G.G.; Sauer, R.; Distel, L.V.R. [Dept. of Radiation Oncology, Friedrich Alexander Univ. Erlangen-Nuremberg (Germany); Sprung, C.N. [Div. of Research, Peter MacCallum Cancer Centre, and Dept. of Biochemistry and Molecular Biology, Melbourne Univ., VIC (Australia)

    2007-02-15

    Background and purpose: cell-cycle regulation and checkpoint activation are crucial factors for radiation-induced DNA damage processing. The G2/M phase arrest was assessed in lymphoblastoid cell lines and phytohemagglutinin-stimulated T-lymphocytes of different radiosensitivities to study the relationship of G2/M arrest to radiosensitivity. Material and methods: G2/M arrest was analyzed after in vitro irradiation by 2 and 5 Gy of ionizing radiation up to 6 days using 17 lymphoblastoid cell lines from healthy individuals, ataxia-telangiectasia (AT) patients, Nijmegen breakage syndrome (NBS) patients and cancer patients with clinically increased radiosensitivity. In a second approach, phytohemagglutinin-stimulated T-lymphocytes from 15 healthy individuals, twelve cancer patients, and five cancer patients hypersensitive to ionizing radiation were studied. Image cytometry was performed to analyze G2/M arrest. Results: two of the three AT cell lines showed markedly increased G2/M arrest compared to controls. NBS cells were comparable to controls up to day 3, but then demonstrated a slightly increased G2/M arrest. Two of the six radiosensitive lymphoblast cell lines and the five radiosensitive cancer patients' T-lymphocytes assayed showed a reduction in G2/M arrest, while healthy individuals showed no difference from cancer patients. Conclusion: the interrelation between G2/M arrest and radiosensitivity is not readily apparent since a variety of radiosensitive cells from patients with radiosensitive syndromes and patients identified as radiosensitive following radiation treatment showed inconsistent G2/M arrest dynamics. Secondary effects, like loss of clonogenicity, G1/S phase arrest and failure of G2/M arrest may contribute to variation of the G2/M arrest endpoint and obscure assessment of cellular radiosensitivity using this method. (orig.)

  13. Validation of RNAi Silencing Efficiency Using Gene Array Data shows 18.5% Failure Rate across 429 Independent Experiments

    Directory of Open Access Journals (Sweden)

    Gyöngyi Munkácsy

    2016-01-01

    Full Text Available No independent cross-validation of success rate for studies utilizing small interfering RNA (siRNA for gene silencing has been completed before. To assess the influence of experimental parameters like cell line, transfection technique, validation method, and type of control, we have to validate these in a large set of studies. We utilized gene chip data published for siRNA experiments to assess success rate and to compare methods used in these experiments. We searched NCBI GEO for samples with whole transcriptome analysis before and after gene silencing and evaluated the efficiency for the target and off-target genes using the array-based expression data. Wilcoxon signed-rank test was used to assess silencing efficacy and Kruskal–Wallis tests and Spearman rank correlation were used to evaluate study parameters. All together 1,643 samples representing 429 experiments published in 207 studies were evaluated. The fold change (FC of down-regulation of the target gene was above 0.7 in 18.5% and was above 0.5 in 38.7% of experiments. Silencing efficiency was lowest in MCF7 and highest in SW480 cells (FC = 0.59 and FC = 0.30, respectively, P = 9.3E−06. Studies utilizing Western blot for validation performed better than those with quantitative polymerase chain reaction (qPCR or microarray (FC = 0.43, FC = 0.47, and FC = 0.55, respectively, P = 2.8E−04. There was no correlation between type of control, transfection method, publication year, and silencing efficiency. Although gene silencing is a robust feature successfully cross-validated in the majority of experiments, efficiency remained insufficient in a significant proportion of studies. Selection of cell line model and validation method had the highest influence on silencing proficiency.

  14. Rates and determinants of progression to graft failure in kidney allograft recipients with de novo donor-specific antibody.

    Science.gov (United States)

    Wiebe, C; Gibson, I W; Blydt-Hansen, T D; Pochinco, D; Birk, P E; Ho, J; Karpinski, M; Goldberg, A; Storsley, L; Rush, D N; Nickerson, P W

    2015-11-01

    Understanding rates and determinants of clinical pathologic progression for recipients with de novo donor-specific antibody (dnDSA), especially subclinical dnDSA, may identify surrogate endpoints and inform clinical trial design. A consecutive cohort of 508 renal transplant recipients (n = 64 with dnDSA) was studied. Recipients (n = 388) without dnDSA or dysfunction had an eGFR decline of -0.65 mL/min/1.73 m(2) /year. In recipients with dnDSA, the rate eGFR decline was significantly increased prior to dnDSA onset (-2.89 vs. -0.65 mL/min/1.73 m(2) /year, p < 0.0001) and accelerated post-dnDSA (-3.63 vs. -2.89 mL/min/1.73 m(2) /year, p < 0.0001), suggesting that dnDSA is both a marker and contributor to ongoing alloimmunity. Time to 50% post-dnDSA graft loss was longer in recipients with subclinical versus a clinical dnDSA phenotype (8.3 vs. 3.3 years, p < 0.0001). Analysis of 1091 allograft biopsies found that dnDSA and time independently predicted chronic glomerulopathy (cg), but not interstitial fibrosis and tubular atrophy (IFTA). Early T cell-mediated rejection, nonadherence, and time were multivariate predictors of IFTA. Independent risk factors for post-dnDSA graft survival available prior to, or at the time of, dnDSA detection were delayed graft function, nonadherence, dnDSA mean fluorescence intensity sum score, tubulitis, and cg. Ultimately, dnDSA is part of a continuum of mixed alloimmune-mediated injury, which requires solutions targeting T and B cells.

  15. Performance analysis of surge arrester on high voltage systems using ATP

    Energy Technology Data Exchange (ETDEWEB)

    Nallagownden, P.; Magumane, A.H. [Univ. Teknologi Petronas, Perak (Malaysia); Kanth, K.S.R. [Tenaga National Berhad (Malaysia)

    2008-07-01

    Lightning strikes are among the major factors that cause failures in electrical power systems. Phase to ground arresters are commonly installed at power transformer terminals to offer some lightning protection. However, it is important to understand the performance of metal oxide arresters under very fast transient overvoltages in order to determine the protection zone of the arrester and to achieve economical benefits. This study investigated lightning overvoltage protection in a complete three-phase scheme of a 500 KV substation. Overvoltages originated from direct lightning stroke on a phase of a real overhead line (OHL) model. The effect of the separation distance of the arrester from the transformer connected at the open end of the substations was investigated as well as the performance of the arrester for different substation configurations. In the first scenario, the connection of the arrester and transformer was done with a direct connection of an overhead line. In the second scenario, the connection of these devices was done through a cable. Both the overhead line and cable lengths were varied and the maximum overvoltages coming to the transformer were recorded. The results showed that there is a direct proportionality between overvoltages and length of the overhead line or cable. As long the length of the line or cable between the arrester and the transformer was increased, the vulnerability of the transformer to receive high overvoltages also increased. Surge overvoltages were found to be very sensitive to impedance of the line or cable. The direct connections of overhead lines between the arrester and transformer make it necessary to add some protective device. It was suggested that surge arresters should be installed every 200 meters along the overhead lines in order to ensure the safety of equipment. 12 refs., 4 tabs., 8 figs.

  16. Heart rate reduction and exercise performance in recent onset heart failure with reduced ejection fraction: arguments for beta-blocker hypo-response.

    Science.gov (United States)

    Verbrugge, Frederik H; Vrijsen, Jeroen; Vercammen, Jan; Grieten, Lars; Dupont, Matthias; Mullens, Wilfried

    2015-10-01

    Beta blockers reduce all-cause mortality and readmissions in heart failure with reduced ejection fraction (HFrEF), which may be explained by their effect on heart rate (HR). This study assessed the impact of HR reduction with beta blockers on exercise capacity in recent onset HFrEF. Fifty consecutive patients with recent onset HFrEF (exercise protocol with respiratory gas analysis at baseline as well as after 6 and 12 months. Patients participated in a quality of care programme aiming to achieve guideline-recommended target doses for beta-blocker therapy. At baseline, 6 and 12 months, 36%, 70% and 62% of patients, respectively, had a resting HRexercise performance was better when resting HR was controlled <70 bpm with beta-blocker therapy. However, despite aggressive dose uptitration, many patients did not achieve this target as they had little HR reduction with beta-blocker therapy.

  17. Multi-scale defect interactions in high-rate brittle material failure. Part I: Model formulation and application to ALON

    Science.gov (United States)

    Tonge, Andrew L.; Ramesh, K. T.

    2016-01-01

    Within this two part series we develop a new material model for ceramic protection materials to provide an interface between microstructural parameters and bulk continuum behavior to provide guidance for materials design activities. Part I of this series focuses on the model formulation that captures the strength variability and strain rate sensitivity of brittle materials and presents a statistical approach to assigning the local flaw distribution within a specimen. The material model incorporates a Mie-Grüneisen equation of state, micromechanics based damage growth, granular flow and dilatation of the highly damaged material, and pore compaction for the porosity introduced by granular flow. To provide initial qualitative validation and illustrate the usefulness of the model, we use the model to investigate Edge on Impact experiments (Strassburger, 2004) on Aluminum Oxynitride (AlON), and discuss the interactions of multiple mechanisms during such an impact event. Part II of this series is focused on additional qualitative validation and using the model to suggest material design directions for boron carbide.

  18. Heart failure patients demonstrate impaired changes in brachial artery blood flow and shear rate pattern during moderate-intensity cycle exercise.

    Science.gov (United States)

    Benda, Nathalie M M; Seeger, Joost P H; van Lier, Dirk P T; Bellersen, Louise; van Dijk, Arie P J; Hopman, Maria T E; Thijssen, Dick H J

    2015-04-01

    What is the central question of this study? We explored whether heart failure (HF) patients demonstrate different exercise-induced brachial artery shear rate patterns compared with control subjects. What is the main finding and its importance? Moderate-intensity cycle exercise in HF patients is associated with an attenuated increase in brachial artery anterograde and mean shear rate and skin temperature. Differences between HF patients and control subjects cannot be explained fully by differences in workload. HF patients demonstrate a less favourable shear rate pattern during cycle exercise compared with control subjects. Repeated elevations in shear rate (SR) in conduit arteries, which occur during exercise, represent a key stimulus to improve vascular function. We explored whether heart failure (HF) patients demonstrate distinct changes in SR in response to moderate-intensity cycle exercise compared with healthy control subjects. We examined brachial artery SR during 40 min of cycle exercise at a work rate equivalent to 65% peak oxygen uptake in 14 HF patients (65 ± 7 years old, 13 men and one woman) and 14 control subjects (61 ± 5 years old, 12 men and two women). Brachial artery diameter, SR and oscillatory shear index (OSI) were assessed using ultrasound at baseline and during exercise. The HF patients demonstrated an attenuated increase in mean and anterograde brachial artery SR during exercise compared with control subjects (time × group interaction, P = 0.003 and P exercise and remained increased throughout the exercise period in both groups (time × group interaction, P = 0.11). In control subjects, the immediate increase in OSI during exercise (time, P exercise did not normalize in HF patients (time × group interaction, P = 0.029). Subgroup analysis of five HF patients and five control subjects with comparable workload (97 ± 13 versus 90 ± 22 W, P = 0.59) confirmed the presence of distinct changes in mean SR during exercise (time × group

  19. FFOP Prediction Method Based on Bathtub-shaped Failure Rate Function%基于浴盆曲线故障率函数的FFOP预计方法

    Institute of Scientific and Technical Information of China (English)

    马纪明; 万蔚; 曾声奎

    2012-01-01

    Failure free operating period (FFOP) is defined as a period during which no failures resulting in a loss of system functionality occur. First, the concept of FFOP and the difference between FFOP and mean time between failures (MTBF) are introduced. Three hypotheses are held as the preconditions of the presented methodology. First, the fault event is a Possion process. Second, the failure rate function is shaped like a bathtub curve. Third, constant interval scheduled maintenance is permitted during which the product must maintain trouble-free function. A modified Weibull distribution function is used to model the bathtub-shaped failure rate function. Furthermore, based on the probability and stochastic processes theory, FFOP prediction algorithm and procedure are developed, whose accuracy is verified through simulation. Finally, an actuator is selected as the sample case to validate the feasibility of the proposed method. The result shows the FFOP is correlated with maintenance free operating period (MFOP) and the predefined confidence coefficient. Shorter MFOP will deliver both higher maintenance and operating costs and longer FFOP. In engineering practice, a tradeoff between FFOP and maintenance and operation cost should be considered.%与传统可靠性指标中假设产品的随机失效不可避免不同,无故障工作期(FFOP)内产品不会发生任何故障(即零故障).首先阐述了FFOP的概念内涵、与平均故障间隔时间(MTBF)的区别和联系,提出了一种FFOP的预计方法.该方法假设产品的故障率函数具有浴盆曲线特征、故障发生过程为泊松过程、产品具有固定的免维修工作期.然后以一种改进的Weibull分布函数描述具有浴盆曲线函数特征产品的故障率.基于泊松过程理论,给出了FFOP的预计算法、流程和仿真验证手段.最后以某型无人机舵机为案例对研究方法的可用性进行了验证.结果表明:FFOP与免维修工作期(MFOP)、

  20. Elevated Heart Rate is Associated with Cardiac Denervation in Patients with Heart Failure: A 123-Iodine-MIBG Myocardial Scintigraphy Study

    Science.gov (United States)

    Villacorta, Aline Sterque; Villacorta, Humberto; de Souza, Jenne Serrão; Teixeira, José Antônio Caldas; Muradas, Maria Clara S. S. S.; Alves, Christiane Rodrigues; Precht, Bernardo Campanário; Porto, Pilar; Ubaldo, Letícia; Mesquita, Cláudio Tinoco; da Nóbrega, Antônio Cláudio Lucas

    2016-01-01

    Background In the Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial (SHIFT), heart rate (HR) reduction with ivabradine was associated with improved survival and reduced hospitalizations in patients with heart failure (HF). The mechanisms by which elevated HR increases mortality are not fully understood. Objective To assess the relationship of baseline HR with clinical, neurohormonal and cardiac sympathetic activity in patients with chronic HF and elevated HR. Method Patients with chronic HF who were in sinus rhythm and had resting HR>70 bpm despite optimal medical treatment were included in a randomized, double-blind study comparing ivabradine versus pyridostigmine. This report refers to the baseline data of 16 initial patients. Baseline HR (before randomization to one of the drugs) was assessed, and patients were classified into two groups, with HR below or above mean values. Cardiac sympathetic activity was assessed by 123-iodine-metaiodobenzylguanidine myocardial scintigraphy. Results Mean HR was 83.5±11.5 bpm (range 72 to 104), and seven (43.7%) patients had HR above the mean. These patients had lower 6-min walk distance (292.3±93 vs 465.2±97.1 m, p=0.0029), higher values of N-Terminal-proBNP (median 708.4 vs 76.1, p=0.035) and lower late heart/mediastinum rate, indicating cardiac denervation (1.48±0.12 vs 1.74±0.09, p<0.001). Conclusion Elevated resting HR in patients with HF under optimal medical treatment was associated with cardiac denervation, worse functional capacity, and neurohormonal activation. PMID:27982270

  1. Elevated Heart Rate is Associated with Cardiac Denervation in Patients with Heart Failure: A 123-Iodine-MIBG Myocardial Scintigraphy Study

    Directory of Open Access Journals (Sweden)

    Aline Sterque Villacorta

    Full Text Available Abstract Background: In the Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial (SHIFT, heart rate (HR reduction with ivabradine was associated with improved survival and reduced hospitalizations in patients with heart failure (HF. The mechanisms by which elevated HR increases mortality are not fully understood. Objective: To assess the relationship of baseline HR with clinical, neurohormonal and cardiac sympathetic activity in patients with chronic HF and elevated HR. Method: Patients with chronic HF who were in sinus rhythm and had resting HR>70 bpm despite optimal medical treatment were included in a randomized, double-blind study comparing ivabradine versus pyridostigmine. This report refers to the baseline data of 16 initial patients. Baseline HR (before randomization to one of the drugs was assessed, and patients were classified into two groups, with HR below or above mean values. Cardiac sympathetic activity was assessed by 123-iodine-metaiodobenzylguanidine myocardial scintigraphy. Results: Mean HR was 83.5±11.5 bpm (range 72 to 104, and seven (43.7% patients had HR above the mean. These patients had lower 6-min walk distance (292.3±93 vs 465.2±97.1 m, p=0.0029, higher values of N-Terminal-proBNP (median 708.4 vs 76.1, p=0.035 and lower late heart/mediastinum rate, indicating cardiac denervation (1.48±0.12 vs 1.74±0.09, p<0.001. Conclusion: Elevated resting HR in patients with HF under optimal medical treatment was associated with cardiac denervation, worse functional capacity, and neurohormonal activation.

  2. Wide, short bore magnetic resonance at 1.5 t: reducing the failure rate in claustrophobic patients.

    Science.gov (United States)

    Hunt, C H; Wood, C P; Lane, J I; Bolster, B D; Bernstein, M A; Witte, R J

    2011-09-01

    Claustrophobic reactions in patients undergoing magnetic resonance imaging (MRI) have a significant impact on the workflow, patient acceptance and ultimately the costs involved in obtaining a diagnostic scan. The purpose of this study was to determine if the use of a wide, short bore MRI scanner could reduce the need for general anesthesia assistance in these cases. Between September 2006 and March 2008, all patients for whom MRI examinations of the head and/or spine were canceled or prematurely terminated due to claustrophobia on a standard 60 cm bore, 1.5 T scanner were scheduled to be re-scanned on a 70 cm wide bore, 1.25 m long 1.5 T scanner. This re-scanning attempt was made 2 or more days prior to a scheduled anesthesia-assisted MRI appointment. If the patient successfully completed the wide bore MRI examination then the anesthesia-assisted MRI appointment was canceled. A total of 56 patients were included in this study. The examinations included individual body regions as well as combination examinations (head and cervical spine, entire spine etc.). A total of 72 body regions were examined in 56 patients. Of these regions, 65 (90%) were completed successfully, 50 patients (89%) successfully completed a diagnostic examination on the 70 cm scanner and 6 patients (11%), all of whom were scheduled for examinations which included the head, were unable to complete the examination on the wide bore scanner. A 1.5 T wide short bore scanner increases the examination success rate in patients with claustrophobia and substantially reduces the need for anesthesia-assisted MRI examinations even when claustrophobia is severe.

  3. Cognitive impairment after sudden cardiac arrest

    OpenAIRE

    Jaszke-Psonka, Magdalena; Piegza, Magdalena; Ścisło, Piotr; Pudlo, Robert; Piegza, Jacek; Badura-Brzoza, Karina; Leksowska, Aleksandra; Hese, Robert T.; Gorczyca, Piotr W.

    2016-01-01

    Aim To evaluate the incidence and severity of the impairment of selected cognitive functions in patients after sudden cardiac arrest (SCA) in comparison to patients after myocardial infarction without SCA and healthy subjects and to analyze the influence of sociodemographic and clinical parameters and the duration of cardiac arrest on the presence and severity of the described disorders. Material and methods The study group comprised 30 cardiac arrest survivors, the reference group comprised ...

  4. Association of Holter-Derived Heart Rate Variability Parameters With the Development of Congestive Heart Failure in the Cardiovascular Health Study.

    Science.gov (United States)

    Patel, Vaiibhav N; Pierce, Brian R; Bodapati, Rohan K; Brown, David L; Ives, Diane G; Stein, Phyllis K

    2017-06-01

    This study sought to determine whether Holter-based parameters of heart rate variability (HRV) are independently associated with incident heart failure among older adults in the CHS (Cardiovascular Health Study) as evidenced by an improvement in the predictive power of the Health Aging and Body Composition Heart Failure (Health ABC) score. Abnormal HRV, a marker of autonomic dysfunction, has been associated with multiple adverse cardiovascular outcomes but not the development of congestive heart failure (CHF). Asymptomatic CHS participants with interpretable 24-h baseline Holter recordings were included (n = 1,401). HRV measures and premature ventricular contraction (PVC) counts were compared between participants with (n = 260) and without (n = 1,141) incident CHF on follow-up. Significantly different parameters between groups were added to the components of the Health ABC score, a validated CHF prediction tool, using stepwise Cox regression. The final model included components of the Health ABC score, In PVC counts (adjusted hazard ratio [aHR]: 1.12; 95% confidence interval [CI]: 1.07 to 1.19; p < 0.001) and the following HRV measures: abnormal heart rate turbulence onset (aHR: 1.52; 95% CI: 1.11 to 2.08; p = 0.009), short-term fractal scaling exponent (aHR: 0.27; 95% CI: 0.14 to 0.53; p < 0.001), in very low frequency power (aHR: 1.28; 95% CI: 1.02 to 1.60; p = 0.037), and coefficient of variance of N-N intervals (aHR: 0.94; 95% CI: 0.90 to 0.99; p = 0.009). The C-statistic for the final model was significantly improved over the Health ABC model alone (0.77 vs. 0.73; p = 0.0002). Abnormal HRV parameters were significantly and independently associated with incident CHF in asymptomatic, older adults. When combined with increased PVCs, HRV improved the predictive power of the Health ABC score. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Rates of Reconstruction Failure in Patients Undergoing Immediate Reconstruction With Tissue Expanders and/or Implants and Postmastectomy Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fowble, Barbara, E-mail: BFowble@radonc.ucsf.edu [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Park, Catherine [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Wang, Frederick; Peled, Anne [Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California (United States); Alvarado, Michael; Ewing, Cheryl; Esserman, Laura [Carol Franc Buck Breast Care Center, Department of Surgery, University of California San Francisco, San Francisco, California (United States); Foster, Robert; Sbitany, Hani [Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California (United States); Hanlon, Alex [University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania (United States)

    2015-07-01

    Objectives: Mastectomy rates for breast cancer have increased, with a parallel increase in immediate reconstruction. For some women, tissue expander and implant (TE/I) reconstruction is the preferred or sole option. This retrospective study examined the rate of TE/I reconstruction failure (ie, removal of the TE or I with the inability to replace it resulting in no final reconstruction or autologous tissue reconstruction) in patients receiving postmastectomy radiation therapy (PMRT). Methods and Materials: Between 2004 and 2012, 99 women had skin-sparing mastectomies (SSM) or total nipple/areolar skin-sparing mastectomies (TSSM) with immediate TE/I reconstruction and PMRT for pathologic stage II to III breast cancer. Ninety-seven percent had chemotherapy (doxorubicin and taxane-based), 22% underwent targeted therapies, and 78% had endocrine therapy. Radiation consisted of 5000 cGy given in 180 to 200 cGy to the reconstructed breast with or without treatment to the supraclavicular nodes. Median follow-up was 3.8 years. Results: Total TE/I failure was 18% (12% without final reconstruction, 6% converted to autologous reconstruction). In univariate analysis, the strongest predictor of reconstruction failure (RF) was absence of total TE/I coverage (acellular dermal matrix and/or serratus muscle) at the time of radiation. RF occurred in 32.5% of patients without total coverage compared to 9% with coverage (P=.0069). For women with total coverage, the location of the mastectomy scar in the inframammary fold region was associated with higher RF (19% vs 0%, P=.0189). In multivariate analysis, weight was a significant factor for RF, with lower weight associated with a higher RF. Weight appeared to be a surrogate for the interaction of total coverage, thin skin flaps, interval to exchange, and location of the mastectomy scar. Conclusions: RFs in patients receiving PMRT were lowered with total TE/I coverage at the time of radiation by avoiding inframammary fold incisions and

  6. Validation of rate of perceived exertion-based exercise training in patients with heart failure: insights from autonomic nervous system adaptations.

    Science.gov (United States)

    Iellamo, Ferdinando; Manzi, Vincenzo; Caminiti, Giuseppe; Vitale, Cristiana; Massaro, Michele; Cerrito, Anna; Rosano, Giuseppe; Volterrani, Maurizio

    2014-09-20

    Exercise prescription in cardiac patients is based on heart rate (HR) response to exercise. How to prescribe long-term exercise training outside medically-supervised settings also considering changes in individual physical capacity over time is unknown. In this study we hypothesized that in patients with chronic heart failure (CHF) the session-rate of perceived exertion (RPE), a subjective-based training methodology, provides autonomic and functional capacity changes superimposable to those observed with HR-based Training Impulses (TRIMPi) method. Twenty patients with stable CHF were randomized to either aerobic continuous training (ACT) or aerobic interval training (AIT) for 12 weeks. For each TRIMPi-guided exercise session, the session-RPE was recorded. By this method, internal training load (TL) is quantified by multiplying the RPE of the whole training session, using the Borg CR10-scale, by its duration. Heart rate variability (HRV), and baroreflex sensitivity (BRS) were assessed at baseline and at 3 weeks intervals. Significant correlations were found between TRIMPi and individual session-RPE, for both ACT and AIT (r=0.63 to 0.81), (Pexercise prescription and health maintenance, consistent with objective physiological indices of training, that could be used for long-term physical activity in patients with CHF. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Arresting relaxation in Pickering Emulsions

    Science.gov (United States)

    Atherton, Tim; Burke, Chris

    2015-03-01

    Pickering emulsions consist of droplets of one fluid dispersed in a host fluid and stabilized by colloidal particles absorbed at the fluid-fluid interface. Everyday materials such as crude oil and food products like salad dressing are examples of these materials. Particles can stabilize non spherical droplet shapes in these emulsions through the following sequence: first, an isolated droplet is deformed, e.g. by an electric field, increasing the surface area above the equilibrium value; additional particles are then adsorbed to the interface reducing the surface tension. The droplet is then allowed to relax toward a sphere. If more particles were adsorbed than can be accommodated by the surface area of the spherical ground state, relaxation of the droplet is arrested at some non-spherical shape. Because the energetic cost of removing adsorbed colloids exceeds the interfacial driving force, these configurations can remain stable over long timescales. In this presentation, we present a computational study of the ordering present in anisotropic droplets produced through the mechanism of arrested relaxation and discuss the interplay between the geometry of the droplet, the dynamical process that produced it, and the structure of the defects observed.

  8. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation.

    Science.gov (United States)

    Cunningham, Lee M; Mattu, Amal; O'Connor, Robert E; Brady, William J

    2012-10-01

    Over the last decade, the importance of delivering high-quality cardiopulmonary resuscitation (CPR) for cardiac arrest patients has become increasingly emphasized. Many experts are in agreement concerning the appropriate compression rate, depth, and amount of chest recoil necessary for high-quality CPR. In addition to these factors, there is a growing body of evidence supporting continuous or uninterrupted chest compressions as an equally important aspect of high-quality CPR. An innovative resuscitation protocol, called cardiocerebral resuscitation, emphasizes uninterrupted chest compressions and has been associated with superior rates of survival when compared with traditional CPR with standard advanced life support. Interruptions in chest compressions during CPR can negatively impact outcome in cardiac arrest; these interruptions occur for a range of reasons, including pulse determinations, cardiac rhythm analysis, electrical defibrillation, airway management, and vascular access. In addition to comparing cardiocerebral resuscitation to CPR, this review article also discusses possibilities to reduce interruptions in chest compressions without sacrificing the benefit of these interventions. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children.

    Science.gov (United States)

    Moler, Frank W; Silverstein, Faye S; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Nadkarni, Vinay M; Meert, Kathleen L; Browning, Brittan; Pemberton, Victoria L; Page, Kent; Gildea, Marianne R; Scholefield, Barnaby R; Shankaran, Seetha; Hutchison, Jamie S; Berger, John T; Ofori-Amanfo, George; Newth, Christopher J L; Topjian, Alexis; Bennett, Kimberly S; Koch, Joshua D; Pham, Nga; Chanani, Nikhil K; Pineda, Jose A; Harrison, Rick; Dalton, Heidi J; Alten, Jeffrey; Schleien, Charles L; Goodman, Denise M; Zimmerman, Jerry J; Bhalala, Utpal S; Schwarz, Adam J; Porter, Melissa B; Shah, Samir; Fink, Ericka L; McQuillen, Patrick; Wu, Theodore; Skellett, Sophie; Thomas, Neal J; Nowak, Jeffrey E; Baines, Paul B; Pappachan, John; Mathur, Mudit; Lloyd, Eric; van der Jagt, Elise W; Dobyns, Emily L; Meyer, Michael T; Sanders, Ronald C; Clark, Amy E; Dean, J Michael

    2017-01-26

    Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited. In a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest. The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse

  10. Effect of N-Acetylcysteine on Mortality and Liver Transplantation Rate in Non-Acetaminophen-Induced Acute Liver Failure: A Multicenter Study.

    Science.gov (United States)

    Darweesh, Samar K; Ibrahim, Mona F; El-Tahawy, Mahmoud A

    2017-05-01

    Previous studies and systematic reviews have not provided conclusive evidence on the effect of N-acetylcysteine (NAC) in non-acetaminophen-induced acute liver failure (NAI-ALF). We aimed to study the value of intravenous NAC in reducing liver transplantation and mortality in NAI-ALF. In a prospective, multicenter, observational study, acute liver failure patients without clinical or historical evidence of acetaminophen overdose were enrolled. NAC infusion (in empirical dose) was given as 150 mg/kg in 100 ml dextrose 5% over half an hour, then 70 mg/kg in 500 ml dextrose 5% over 4 h, then 70 mg/kg in 500 ml dextrose 5% over 16 h. Thereafter continuous infusion was administered over 24 h of 150 mg/kg in 500 ml dextrose 5% until up to two consecutive normal international normalized ratios (INRs) were obtained. Our endpoints were recovery, transplantation, or death. The primary outcome of the study was to assess reduction in mortality or liver transplantation. The secondary outcome was the evaluation of other clinical outcomes (length of ICU and hospital stays, organ system failure, and hepatic encephalopathy). The study included a total of 155 adults; the NAC group (n = 85) were given NAC between January 2011 to December 2013 and the control group (n = 70) were not given NAC and were included from files dating between 2010 and 2011. Both groups (before NAC) were comparable with regard to etiology, age, sex, smoking, presence of co-morbidities, encephalopathy, liver profile, and INR. The success rate (transplant-free survival) in the NAC group was 96.4%. While in the control group, 17 patients (23.3%) recovered and 53 (76.6%) did not recover, of these 37 (53.3%) had liver transplantation and 16 (23.3%) died (p < 0.01). The NAC group had significantly shorter hospital stays (p < 0.001), less encephalopathy (p = 0.02), and less bleeding (p < 0.01) than the control group. The control group reported a higher ICU admission (p = 0.01) rate and

  11. Utility of overnight pulse oximetry and heart rate variability analysis to screen for sleep-disordered breathing in chronic heart failure.

    Science.gov (United States)

    Ward, Neil R; Cowie, Martin R; Rosen, Stuart D; Roldao, Vitor; De Villa, Manuel; McDonagh, Theresa A; Simonds, Anita; Morrell, Mary J

    2012-11-01

    Sleep-disordered breathing (SDB) is under diagnosed in chronic heart failure (CHF). Screening with simple monitors may increase detection of SDB in a cardiology setting. This study aimed to evaluate the accuracy of heart rate variability analysis and overnight pulse oximetry for diagnosis of SDB in patients with CHF. 180 patients with CHF underwent simultaneous polysomnography, ambulatory electrocardiography and wrist-worn overnight pulse oximetry. SDB was defined as an apnoea-hypopnoea index ≥15/h. To identify SDB from the screening tests, the per cent very low frequency increment (%VLFI) component of heart rate variability was measured with a pre-specified cutoff ≥2.23%, and the 3% oxygen desaturation index was measured with a pre-specified cutoff >7.5 desaturations/h. 173 patients with CHF had adequate sleep study data; SDB occurred in 77 (45%) patients. Heart rate variability was measurable in 78 (45%) patients with area under the %VLFI receiver operating characteristic curve of 0.50. At the ≥2.23% cutoff, %VLFI sensitivity was 58% and specificity was 48%. The 3% oxygen desaturation index was measurable in 171 (99%) patients with area under the curve of 0.92. At the pre-specified cutoff of >7.5 desaturations/h, the 3% oxygen desaturation index had a sensitivity of 97%, specificity of 32%, negative likelihood ratio of 0.08 and positive likelihood ratio of 1.42. Diagnostic accuracy was increased using a cutoff of 12.5 desaturations/h, with sensitivity of 93% and specificity of 73%. The high sensitivity and low negative likelihood ratio of the 3% oxygen desaturation index indicates that pulse oximetry would be of use as a simple screening test to rule out SDB in patients with CHF in a cardiology setting. The %VLFI component of heart rate variability is not suitable for detection of SDB in CHF.

  12. Management and outcome of mechanically ventilated patients after cardiac arrest.

    Science.gov (United States)

    Sutherasan, Yuda; Peñuelas, Oscar; Muriel, Alfonso; Vargas, Maria; Frutos-Vivar, Fernando; Brunetti, Iole; Raymondos, Konstantinos; D'Antini, Davide; Nielsen, Niklas; Ferguson, Niall D; Böttiger, Bernd W; Thille, Arnaud W; Davies, Andrew R; Hurtado, Javier; Rios, Fernando; Apezteguía, Carlos; Violi, Damian A; Cakar, Nahit; González, Marco; Du, Bin; Kuiper, Michael A; Soares, Marco Antonio; Koh, Younsuck; Moreno, Rui P; Amin, Pravin; Tomicic, Vinko; Soto, Luis; Bülow, Hans-Henrik; Anzueto, Antonio; Esteban, Andrés; Pelosi, Paolo

    2015-05-08

    The aim of this study was to describe and compare the changes in ventilator management and complications over time, as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest. We performed a secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 ICUs from 40 countries. We screened 18,302 patients receiving MV for more than 12 hours during a one-month-period. We included 812 patients receiving MV after cardiac arrest. We collected data on demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios, determining which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and occurrence of acute respiratory distress syndrome (ARDS) and pneumonia acquired during ICU stay at 48 hours after admission. Among 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time, with decreased tidal volumes (VT) (1998: mean 8.9 (standard deviation (SD) 2) ml/kg actual body weight (ABW), 2010: 6.7 (SD 2) ml/kg ABW; 2004: 9 (SD 2.3) ml/kg predicted body weight (PBW), 2010: 7.95 (SD 1.7) ml/kg PBW) and increased positive end-expiratory pressure (PEEP) (1998: mean 3.5 (SD 3), 2010: 6.5 (SD 3); P <0.001). Patients included from 2010 had more sepsis, cardiovascular dysfunction and neurological failure, but 28-day hospital mortality was similar over time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO2 <60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher VT, and plateau pressure with lower PEEP were associated with occurrence of ARDS and pneumonia acquired during ICU stay. Protective mechanical ventilation with lower VT and higher PEEP is more

  13. The goitre rate, its association with reproductive failure, and the knowledge of iodine deficiency disorders (IDD among women in Ethiopia: Cross-section community based study

    Directory of Open Access Journals (Sweden)

    Berhane Yemane

    2007-11-01

    Full Text Available Abstract Background Iodine deficiency is severe public health problem in Ethiopia. Although urinary iodine excretion level (UIE is a better indicator for IDD the goitre rate is commonly used to mark the public health significance. The range of ill effect of IDD is however beyond goitre in Ethiopia. In this study the prevalence of goitre and its association with reproductive failure, and the knowledge of women on Iodine Deficiency were investigated. Methods A cross-section community based study was conducted during February to May 2005 in 10998 women in child bearing age of 15 to 49 years. To assess the state of iodine deficiency in Ethiopia, a multistage "Proportional to Population Size" (PPS sampling methods was used, and WHO/UNICEF/ICCIDD recommended method for goitre classification. Results Total goitre prevalence (weighted was 35.8% (95% CI 34.5–37.1, 24.3% palpable and 11.5% visible goitre. This demonstrates that more than 6 million women were affected by goitre. Goitre prevalence in four regional states namely Southern Nation Nationalities and People (SNNP, Oromia, Bebshandul-Gumuz and Tigray was greater than 30%, an indication of severe iodine deficiency. In the rest of the regions except Gambella, the IDD situation was mild to moderate. According to WHO/UNICEF/ICCIDD this is a lucid indication that IDD is a major public health problem in Ethiopia. Women with goitre experience more pregnancy failure (X2 = 16.5, p 2 = 67.52; p Conclusion Ethiopia is at risk of iodine deficiency disorders. The findings presented in this report emphasis on a sustainable iodine intervention program targeted at population particularly reproductive age women. Nutrition education along with Universal Salt Iodization program and iodized oil capsule distribution in some peripheries where iodine deficiency is severe is urgently required.

  14. Cyclic variation in heart rate score by holter electrocardiogram as screening for sleep-disordered breathing in subjects with heart failure.

    Science.gov (United States)

    Shimizu, Takeshi; Yoshihisa, Akiomi; Iwaya, Shoji; Abe, Satoshi; Sato, Takamasa; Suzuki, Satoshi; Yamaki, Takayoshi; Sugimoto, Koichi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu-Ichi; Takeishi, Yasuchika

    2015-01-01

    Sleep-disordered breathing (SDB) is critically associated with cardiovascular mortality and morbidity, especially in patients with heart failure (HF). However, the majority of SDB patients remain undiagnosed. In contrast, abnormality in heart rate variability has been reported in patients with SDB. To explore an efficient electrocardiogram (ECG)-based screening tool for SDB, we examined the usefulness of cyclic variation in heart rate score (CVHRS) by Holter ECG in subjects with HF. In this study, 102 subjects with HF were enrolled. We simultaneously performed Holter ECG with overnight portable sleep monitoring, and we measured the respiratory disturbance index (RDI) and CVHRS. We determined the temporal position of the individual dips comprising the CVHRS using time-domain methods. CVHRS was measured as cyclic and autocorrelated dips in smoothed interbeat interval time series. There were 25 subjects with severe SDB (RDI ≥ 30 events/h) and 77 subjects with none-to-moderate SDB (0 ≤ RDI Holter ECG is a useful screening index for severe SDB in subjects with HF. Copyright © 2015 by Daedalus Enterprises.

  15. Rate of change in cerebral oxygenation and blood pressure in response to passive changes in posture: a comparison between pure autonomic failure patients and controls.

    Science.gov (United States)

    Tachtsidis, Ilias; Elwell, Clare E; Leung, Terence S; Bleasdale-Barr, Katharine; Hunt, Katharine; Toms, Nathan; Smith, Martin; Mathias, Christopher J; Delpy, David T

    2005-01-01

    The cardiovascular and cerebrovascular responses to head-up postural change are compromised in pure autonomic failure (PAF) patients because of sympathetic denervation. The aim of this study was to characterize the rate of change of systemic mean blood pressure (MBP) and cerebral haemodynamics in response to passive posture changes. Nine PAF patients and 9 age-matched controls took part in this study. MBP and oxy- (O2Hb), deoxy-haemoglobin (HHb), and tissue oxygenation index (TOI) on the forehead were continuously monitored non-invasively using the Portapres and near-infrared spectroscopy (NIRS), respectively. From visual inspection of the haemoglobin difference signal (Hb(diff) = O2Hb-HHb), seven distinct phases were marked (1: supine, 2: start passive tilt, 3: head up to 60 degrees degrees, 4: end of tilt, 5: tilt reversal, 6: return to supine, 7: rest); the same time points were used for all of the other signals. For each phase, the slope was calculated using a linear regression algorithm. Significant differences were found between PAF patients and controls in the Hb(diff) slope magnitudes for phases 3 (P rate of change suggest differences in blood vessel resistance related to sympathetic activation.

  16. Fretting and Corrosion Between a Metal Shell and Metal Liner May Explain the High Rate of Failure of R3 Modular Metal-on-Metal Hips.

    Science.gov (United States)

    Ilo, Kevin C; Derby, Emma J; Whittaker, Robert K; Blunn, Gordon W; Skinner, John A; Hart, Alister J

    2017-05-01

    The R3 acetabular system used with its metal liner has higher revision rates when compared to its ceramic and polyethylene liner. In June 2012, the medical and healthcare products regulatory agency issued an alert regarding the metal liner of the R3 acetabular system. Six retrieved R3 acetabular systems with metal liners underwent detailed visual analysis using macroscopic and microscopic techniques. Visual analysis discovered corrosion on the backside of the metal liners. There was a distinct border to the areas of corrosion that conformed to antirotation tab insertions on the inner surface of the acetabular shell, which are for the polyethylene liner. Scanning electron microscopy indicated evidence of crevice corrosion, and energy-dispersive X-ray analysis confirmed corrosion debris rich in titanium. The high failure rate of the metal liner option of the R3 acetabular system may be attributed to corrosion on the backside of the liner which appear to result from geometry and design characteristics of the acetabular shell. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Psychopathology in Women Arrested for Domestic Violence

    Science.gov (United States)

    Stuart, Gregory L.; Moore, Todd M.; Gordon, Kristina Coop; Ramsey, Susan E.; Kahler, Christopher W.

    2006-01-01

    This study examined the prevalence of psychopathology among women arrested for violence and whether the experience of intimate partner violence (IPV) was associated with Axis I psychopathology. Women who were arrested for domestic violence perpetration and court referred to violence intervention programs (N=103) completed measures of IPV…

  18. Arrested segregative phase separation in capillary tubes

    NARCIS (Netherlands)

    Tromp, R. Hans; Lindhoud, Saskia

    2006-01-01

    Phase separation in a capillary tube with one of the phases fully wetting the capillary wall is arrested when the typical size of the phase domains reaches the value of the diameter of the tube. The arrested state consists of an alternating sequence of concave-capped and convex-capped cylindrical

  19. Physeal arrest of the distal radius.

    Science.gov (United States)

    Abzug, Joshua M; Little, Kevin; Kozin, Scott H

    2014-06-01

    Fractures of the distal radius are among the most common pediatric fractures. Although most of these fractures heal without complication, some result in partial or complete physeal arrest. The risk of physeal arrest can be reduced by avoiding known risk factors during fracture management, including multiple attempts at fracture reduction. Athletes may place substantial compressive and shear forces across the distal radial physes, making them prone to growth arrest. Timely recognition of physeal arrest can allow for more predictable procedures to be performed, such as distal ulnar epiphysiodesis. In cases of partial arrest, physeal bar excision with interposition grafting can be performed. Once ulnar abutment is present, more invasive procedures may be required, including ulnar shortening osteotomy or radial lengthening.

  20. Postoperative Cardiac Arrest after Heart Surgery: Does Extracorporeal Perfusion Support a Paradigm Change in Management?

    Directory of Open Access Journals (Sweden)

    Edward Gologorsky

    2010-01-01

    Full Text Available Early institution of extracorporeal perfusion support (ECPS may improve survival after cardiac arrest. Two patients sustained unexpected cardiac arrest in the Intensive Care Unit (ICU following cardiac interventions. ECPS was initiated due to failure to restore hemodynamics after prolonged (over 60 minutes advanced cardiac life support (ACLS protocol-guided cardiopulmonary resuscitation. Despite relatively late institution of ECPS, both patients survived with preserved neurological function. This communication focuses on the utility of ECPS in the ICU as a part of resuscitative efforts.

  1. To Explore The Method of Reducing The Failure Rate of County Electric Power Supply Company%探究降低县级供电公司农网故障率的方法

    Institute of Scientific and Technical Information of China (English)

    王顺刚

    2015-01-01

    本文简要叙述县级供电公司农网故障及原因,提出农网故障的检测方法及有效降低县级供电公司农网故障率的方法。%With the rapid development of national economy, the construction and development of county-level power supply company website speed also appear gradually accelerated condition, this paper analyzes the reasons of the failure of the county-level power supply company's web site, in a timely and properly handle the rural power failures, can effectively reduce the rate of contribution to the company website at the county level, improve the rural power supply reliability, stability and security. Due to the particularity of county electric power supply company public network cable, cable buried underground, most of the rural power failures can't directly find the fault point, and then use the instrument test site failure. This paper briefly describes the failure and the reason of county-level power supply company website, rural electricity fault detection method is proposed, puts forward the effective method to reduce the failure rate at the county level power supply company.

  2. Patients with cardiac arrest are ventilated two times faster than guidelines recommend : An observational prehospital study using tracheal pressure measurement

    NARCIS (Netherlands)

    Maertens, Vicky L.; De Smedt, Lieven E. G.; Lemoyne, Sabine; Huybrechts, Sofie A. M.; Wouters, Kristien; Kalmar, Alain F.; Monsieurs, Koenraad G.

    Aim: To measure ventilation rate using tracheal airway pressures in prehospitally intubated patients with and without cardiac arrest. Methods: Prospective observational study. In 98 patients (57 with and 41 without cardiac arrest) an air-filled catheter was inserted into the endotracheal tube and

  3. Patients with cardiac arrest are ventilated two times faster than guidelines recommend : An observational prehospital study using tracheal pressure measurement

    NARCIS (Netherlands)

    Maertens, Vicky L.; De Smedt, Lieven E. G.; Lemoyne, Sabine; Huybrechts, Sofie A. M.; Wouters, Kristien; Kalmar, Alain F.; Monsieurs, Koenraad G.

    2013-01-01

    Aim: To measure ventilation rate using tracheal airway pressures in prehospitally intubated patients with and without cardiac arrest. Methods: Prospective observational study. In 98 patients (57 with and 41 without cardiac arrest) an air-filled catheter was inserted into the endotracheal tube and co

  4. Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children's center.

    Science.gov (United States)

    Hunt, Elizabeth A; Zimmer, Karen P; Rinke, Michael L; Shilkofski, Nicole A; Matlin, Carol; Garger, Catherine; Dickson, Conan; Miller, Marlene R

    2008-02-01

    To study the effect of an intervention on prevention of respiratory arrest and cardiopulmonary arrest (CPA) and to characterize ward CPAs by preceding signs and symptoms and initial cardiac rhythm. A before-and-after interventional trial (12 months preintervention and 12 months postintervention). A tertiary care, academic children's hospital. Admitted patients who subsequently had either the code team or pediatric medical emergency team (PMET) called or who had a respiratory arrest or CPA on the wards. Intervention Transition from a traditional code team to a PMET that responds to clinically deteriorating children in noncritical care areas. Combined rate of respiratory arrests and CPAs, rate of CPAs, and rate of respiratory arrests on the wards and agreement between independent reviewers on categorization of CPAs. There was no change in the rate of CPAs on the wards. However, there was a 73% decrease in the incidence of respiratory arrests (0.23 respiratory arrests/1000 patient-days pre-PMET vs 0.06 post-PMET, P = .03). There was 100% agreement between reviewers on categorization of CPAs. Transition to a PMET was not associated with a change in CPAs but was associated with a significant decrease in the incidence of ward respiratory arrests. We also describe children who may have benefited from the PMET but whose data were not captured by current outcome measures. Finally, we present a new method for categorization of ward CPAs based on preceding signs and symptoms and initial cardiac rhythm.

  5. Ventilatory expired gas at constant-rate low-intensity exercise predicts adverse events and is related to neurohormonal markers in patients with heart failure.

    Science.gov (United States)

    Arena, Ross; MacCarter, Dean; Olson, Thomas P; Lalande, Sophie; Ceridon, Maile L; Olson, Lyle J; Johnson, Bruce

    2009-08-01

    Ventilatory efficiency (VE/VCO(2) ratio) and the partial pressure of end-tidal carbon dioxide (P(ET)CO(2)), obtained during moderate to high levels of physical exertion demonstrate prognostic value in heart failure (HF). The present investigation assesses the clinical utility of these variables during low-intensity exercise. One hundred and thirty subjects diagnosed with HF underwent a 2-minute, constant-rate treadmill session at 2 miles per hour. Both the VE/VCO(2) ratio and P(ET)CO(2) were recorded during exercise (30-second average) and their change (Delta) from rest. B-type and atrial natriuretic peptide (BNP and ANP) were also determined. Only P(ET)CO(2) and DeltaP(ET)CO(2) emerged from the multivariate Cox regression. Receiver operating characteristic curve analysis revealed the prognostic classification schemes were significant with thresholds of or=34 mm Hg (hazard ratio: 4.2, 95% CI: 2.2-8.0, P or=1 mm Hg (hazard ratio: 3.5, 95% CI: 1.9-6.6, P or=34 mm Hg had a significantly lower BNP (214.1 +/- 431.9 vs. 1110.5 +/- 1854.0 pg/mL, P=.005) and ANP (108.2 +/- 103.6 vs. 246.2 +/- 200.4 pg/mL, P exercise may provide insight into prognosis and cardiac stability.

  6. Dose-response relationship of baroreflex sensitivity and heart rate variability to individually-tailored exercise training in patients with heart failure.

    Science.gov (United States)

    Iellamo, Ferdinando; Manzi, Vincenzo; Caminiti, Giuseppe; Sposato, Barbara; Massaro, Michele; Cerrito, Anna; Rosano, Giuseppe; Volterrani, Maurizio

    2013-06-20

    Heart Rate Variability (HRV) and Baroreflex Sensitivity (BRS) are impaired in patients with Chronic Heart Failure (CHF) and carry negative prognosis. Exercise training improves these parameters. However, the relationship between exercise training with HRV and BRS has been investigated without regard for individual training loads. We tested the hypothesis that in CHF patients changes in HRV and BRS are dose-response related to individual volume/intensity training load (TL). Twenty patients with stable postinfarction CHF under optimal medical treatment were randomized to either aerobic continuous training (ACT) or aerobic interval training (AIT) for 12weeks. Individualized TL was monitored by the Training Impulses (TRIMPi) method, which was determined using the individual HR and lactate profiling determined during a treadmill test at baseline. HRV (standard deviation of mean R-R interval) and BRS were assessed at rest and 3weeks apart, throughout the study. HRV, BRS and R-R interval increased significantly with training, being very highly correlated to the dose of exercise with a second-order regression model (r(2) ranged from 0.75 to 0.96; Pincrease in functional capacity. No significant differences were detected between ACT and AIT in any variable. These results suggest that improvements in HRV and BRS by exercise training in CHF patients are dose related to TL in a non-linear fashion on an individual basis, with optimal results at moderate doses of exercise. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  7. Effect of Multiple Lightning Strikes on .the Performance of ZnOLightning Arrester Block%Effect of Multiple Lightning Strikes on .the Performance of ZnOLightning Arrester Block

    Institute of Scientific and Technical Information of China (English)

    Haryono T; Sirait K T; Tumiran; Hamzah Berahim

    2011-01-01

    A lightning arrester is used for electrical equipment protection against damage due to lightning strikes. One example of protected electrical equipment is electrical power transformer. If there is no lightning arrester installed to the transformer, when a lightning strike happens, it may receive a very high lightning overvoltage, which is certainly resulted in the transformer damage at its insulation. Usually, a lightning arrester specification data attached to a light- ning arrester contains the rating data of the lightning arrester current and voltage. In the use of lightning arrester, the possibility of receiving multiple lightning strikes is not taken into account sometimes. In fact, in some places, the number of multiple strikes in short duration is quiet high in number. This condition makes the lightning arrester being stroked by multiple lightning strikes. Therefore, it may change the lightning arrester's properties, and then the arrester may not be able to provide good electrical equipment protection against lightning strike anymore. This condition will result in great loss to electrical companies and electrical consumers. Therefore, this research studied the effect of applying multiple lightning strikes to ZnO lightning arrester block. Every time a group of lightning impulse current is applied to the ZnO lightning arrester block, it is followed by the measuring of its 50 Hz voltage and current characteristic. The changing in the ZnO lightning arrester block 50 Hz characteristic then can be analyzed. It was found that by applying more numbers of lightning strikes which made the arrester becoming worse, even though, actually, the lightning impulse peak current was still under the rating of the lightning arrester current. In this ease for a 5 kA, 24 kV lightning arrester, even though the lightning impulse peak current flowing through the ZnO lightning arrester block was still 2500 A, the lightning arrester ZnO block had already been damaged. Having been

  8. Theory of dynamic arrest in colloidal mixtures.

    Science.gov (United States)

    Juárez-Maldonado, R; Medina-Noyola, M

    2008-05-01

    We present a first-principles theory of dynamic arrest in colloidal mixtures based on the multicomponent self-consistent generalized Langevin equation theory of colloid dynamics [M. A. Chávez-Rojo and M. Medina-Noyola, Phys. Rev. E 72, 031107 (2005); M. A. Chávez-Rojo and M. Medina-Noyola, Phys. Rev. E76, 039902 (2007)]. We illustrate its application with a description of dynamic arrest in two simple model colloidal mixtures: namely, hard-sphere and repulsive Yukawa binary mixtures. Our results include observation of the two patterns of dynamic arrest, one in which both species become simultaneously arrested and the other involving the sequential arrest of the two species. The latter case gives rise to mixed states in which one species is arrested while the other species remains mobile. We also derive the ("bifurcation" or fixed-point") equations for the nonergodic parameters of the system, which takes the surprisingly simple form of a system of coupled equations for the localization length of the particles of each species. The solution of this system of equations indicates unambiguously which species is arrested (finite localization length) and which species remains ergodic (infinite localization length). As a result, we are able to draw the entire ergodic-nonergodic phase diagram of the binary hard-sphere mixture.

  9. Predicting survival in heart failure case and control subjects by use of fully automated methods for deriving nonlinear and conventional indices of heart rate dynamics

    Science.gov (United States)

    Ho, K. K.; Moody, G. B.; Peng, C. K.; Mietus, J. E.; Larson, M. G.; Levy, D.; Goldberger, A. L.

    1997-01-01

    BACKGROUND: Despite much recent interest in quantification of heart rate variability (HRV), the prognostic value of conventional measures of HRV and of newer indices based on nonlinear dynamics is not universally accepted. METHODS AND RESULTS: We have designed algorithms for analyzing ambulatory ECG recordings and measuring HRV without human intervention, using robust methods for obtaining time-domain measures (mean and SD of heart rate), frequency-domain measures (power in the bands of 0.001 to 0.01 Hz [VLF], 0.01 to 0.15 Hz [LF], and 0.15 to 0.5 Hz [HF] and total spectral power [TP] over all three of these bands), and measures based on nonlinear dynamics (approximate entropy [ApEn], a measure of complexity, and detrended fluctuation analysis [DFA], a measure of long-term correlations). The study population consisted of chronic congestive heart failure (CHF) case patients and sex- and age-matched control subjects in the Framingham Heart Study. After exclusion of technically inadequate studies and those with atrial fibrillation, we used these algorithms to study HRV in 2-hour ambulatory ECG recordings of 69 participants (mean age, 71.7+/-8.1 years). By use of separate Cox proportional-hazards models, the conventional measures SD (Psurvival over a mean follow-up period of 1.9 years; other measures, including ApEn (P>.3), were not. In multivariable models, DFA was of borderline predictive significance (P=.06) after adjustment for the diagnosis of CHF and SD. CONCLUSIONS: These results demonstrate that HRV analysis of ambulatory ECG recordings based on fully automated methods can have prognostic value in a population-based study and that nonlinear HRV indices may contribute prognostic value to complement traditional HRV measures.

  10. Effect of Loss of Heart Rate Variability on T-Wave Heterogeneity and QT Variability in Heart Failure Patients: Implications in Ventricular Arrhythmogenesis.

    Science.gov (United States)

    Nayyar, Sachin; Hasan, Muhammad A; Roberts-Thomson, Kurt C; Sullivan, Thomas; Baumert, Mathias

    2017-03-03

    Heart rate variability (HRV) modulates dynamics of ventricular repolarization. A diminishing value of HRV is associated with increased vulnerability to life-threatening ventricular arrhythmias, however the causal relationship is not well-defined. We evaluated if fixed-rate atrial pacing that abolishes the effect of physiological HRV, will alter ventricular repolarization wavefronts and is relevant to ventricular arrhythmogenesis. The study was performed in 16 subjects: 8 heart failure patients with spontaneous ventricular tachycardia [HFVT], and 8 subjects with structurally normal hearts (H Norm). The T-wave heterogeneity descriptors [total cosine angle between QRS and T-wave loop vectors (TCRT, negative value corresponds to large difference in the 2 loops), T-wave morphology dispersion, T-wave loop dispersion] and QT intervals were analyzed in a beat-to-beat manner on 3-min records of 12-lead surface ECG at baseline and during atrial pacing at 80 and 100 bpm. The global T-wave heterogeneity was expressed as mean values of each of the T-wave morphology descriptors and variability in QT intervals (QTV) as standard deviation of QT intervals. Baseline T-wave morphology dispersion and QTV were higher in HFVT compared to H Norm subjects (p ≤ 0.02). While group differences in T-wave morphology dispersion and T-wave loop dispersion remained unaltered with atrial pacing, TCRT tended to fall more in HFVT patients compared to H Norm subjects (interaction p value = 0.086). Atrial pacing failed to reduce QTV in both groups, however group differences were augmented (p < 0.0001). Atrial pacing and consequent loss of HRV appears to introduce unfavorable changes in ventricular repolarization in HFVT subjects. It widens the spatial relationship between wavefronts of ventricular depolarization and repolarization. This may partly explain the concerning relation between poorer HRV and the risk of ventricular arrhythmias.

  11. Comparison of biochemical failure rates between permanent prostate brachytherapy and radical retropubic prostatectomy as a function of posttherapy PSA nadir plus 'X'.

    Science.gov (United States)

    Ahmed, Kamran A; Davis, Brian J; Mynderse, Lance A; Slezak, Jeffrey M; Bergstralh, Eric J; Wilson, Torrence M; Choo, C Richard

    2014-07-29

    Prostate-specific antigen (PSA) nadir + 2 ng/mL, also known as the Phoenix definition, is the definition most commonly used to establish biochemical failure (BF) after external beam radiotherapy for prostate cancer management. The purpose of this study is to compare BF rates between permanent prostate brachytherapy (PPB) and radical retropubic prostatectomy (RRP) as a function of PSA nadir plus varying values of X and examine the associated implications. We retrospectively searched for patients who underwent PPB or RRP at our institution between 1998 and 2004. Only primary patients not receiving androgen-deprivation therapy were included in the study. Three RRP patients were matched to each PPB patient on the basis of prognostic factors. BF rates were estimated for PSA nadirs + different values of X. A total of 1,164 patients were used for analysis: 873 in the RRP group and 291 in the PPB group. Patients were equally matched by clinical stage, biopsy Gleason sum, primary Gleason grade, and pretherapy PSA value. Median follow-up was 3.1 years for RRP patients and 3.6 years in the PPB group (P = .01). Using PSA nadir + 0.1 ng/mL for the definition of BF, the 5-year BF rate was 16.3% for PPB patients and 13.5% for RRP patients (P = .007), whereas at nadir + 2 ng/mL or greater, the BF rates were less than 3% and were indistinguishable between PPB and RRP patients. In a cohort of well-matched patients who had prostatectomy or brachytherapy, we examined BF as a function of nadir + X, where X was treated as a continuous variable. As X increases from 0.1 to 2.0 ng/mL, the BF curves converge, and above 2.0 ng/mL they are essentially indistinguishable. The data presented are of interest as BF definitions continue to evolve.

  12. Being on sick leave due to heart failure: self-rated health, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work.

    Science.gov (United States)

    Nordgren, Lena; Söderlund, Anne

    2015-01-01

    Younger people with heart failure often experience poor self-rated health. Furthermore, poor self-rated health is associated with long-term sick leave and disability pension. Socio-demographic factors affect the ability to return to work. However, little is known about people on sick leave due to heart failure. The aim of this study was to investigate associations between self-rated health, mood, socio-demographic factors, sick leave compensation, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work, for people on sick leave due to heart failure. This population-based investigation had a cross-sectional design. Data were collected in Sweden in 2012 from two official registries and from a postal questionnaire. In total, 590 subjects, aged 23-67, responded (response rate 45.8%). Descriptive statistics, correlation analyses (Spearman bivariate analysis) and logistic regression analyses were used to investigate associations. Poor self-rated health was strongly associated with full sick leave compensation (OR = 4.1, p work (OR = 3.3, p work imposes reduced quality of life. Positive encounters with healthcare professionals and social insurance officers can be supportive when people with heart failure struggle to remain in working life.

  13. Heart Failure

    Science.gov (United States)

    ... heart failure due to systolic dysfunction. http://www.uptodate.com/home. Accessed Sept. 26, 2014. Colucci WS. ... patient with heart failure or cardiomyopathy. http://www.uptodate.com/home. Accessed Sept. 26, 2014. Colucci WS. ...

  14. Heart failure - medicines

    Science.gov (United States)

    ... are working and to measure your potassium levels. Beta Blockers Beta blockers slow your heart rate and decrease the strength ... muscle contracts in the short term. Long term beta blockers help keep your heart failure from becoming worse. ...

  15. Cardiac Arrest: Obstetric CPR/ACLS.

    Science.gov (United States)

    Cobb, Benjamin; Lipman, Steven

    2017-01-10

    In contrast with other high-resource countries, maternal mortality has seen an increase in the United States. Caring for pregnant women in cardiac arrest may prove uniquely challenging given the rarity of the event coupled by the physiological changes of pregnancy. Optimization of resuscitative efforts warrants special attention as described in the 2015 American Heart Association's "Scientific Statement on Maternal Cardiac Arrest." Current recommendations address a variety of topics ranging from the basic components of chest compressions and airway management to some of the logistical complexities and operational challenges involved in maternal cardiac arrest.

  16. A Case of Morgagni Hernia Resulting with Respiratory Arrest

    Directory of Open Access Journals (Sweden)

    Cavit Çöl

    2011-05-01

    Full Text Available Morgagni’s hernia is seen at a rate of 3-4% among all diaphragmatic hernias. It develops from a defect in the pleuroperitoneal membrane. Herniation of the omentum is seen most commonly, that of the colon frequently, and herniation of small bowel and stomach is seen rarely. When being examined due to anemia and dyspnea, a 53-year-old male patient suffered from a respiratory arrest and was hence intubated and placed under treatment at the intensive care unit. On radiological examination, a giant diaphragmatic hernia was observed bilaterally, more marked on the right side. On laparotomy, especially on the right side, the caecum, the ascending colon, the transverse colon, the appendix, the omentum and part of the small bowel was seen to be herniated. Primary diaphragmatic repair + right hemicolectomy + end-to-end ileo-transversostomy was performed. We have reported this case because it was a giant hernia which caused respiratory arrest.

  17. Mutation of EMG1 causing Bowen-Conradi syndrome results in reduced cell proliferation rates concomitant with G2/M arrest and 18S rRNA processing delay.

    Science.gov (United States)

    Armistead, Joy; Hemming, Richard; Patel, Nehal; Triggs-Raine, Barbara

    2014-06-01

    Bowen-Conradi syndrome (BCS) is a lethal autosomal recessive disorder caused by a D86G substitution in the protein, Essential for Mitotic Growth 1 (EMG1). EMG1 is essential for 18S rRNA maturation and 40S ribosome biogenesis in yeast, but no studies of its role in ribosome biogenesis have been done in mammals. To assess the effect of the EMG1 mutation on cell growth and ribosomal biogenesis in humans, we employed BCS patient cells. The D86G substitution did not interfere with EMG1 nucleolar localization. In BCS patient lymphoblasts, cells accumulated in G2/M, resulting in reduced proliferation rates; however, patient fibroblasts showed normal proliferation. The rate of 18S rRNA processing was consistently delayed in patient cells, although this did not lead to a difference in the levels of 40S ribosomes, or a change in protein synthesis rates. These results demonstrate that as in yeast, EMG1 in mammals has a role in ribosome biogenesis. The obvious phenotype in lymphoblasts compared to fibroblasts suggests a greater need for EMG1 in rapidly dividing cells. Tissue-specific effects have been seen in other ribosomal biogenesis disorders, and it seems likely that the impact of EMG1 deficiency would be larger in the rapidly proliferating cells of the developing embryo.

  18. Mutation of EMG1 causing Bowen–Conradi syndrome results in reduced cell proliferation rates concomitant with G2/M arrest and 18S rRNA processing delay

    Directory of Open Access Journals (Sweden)

    Joy Armistead

    2014-06-01

    Full Text Available Bowen–Conradi syndrome (BCS is a lethal autosomal recessive disorder caused by a D86G substitution in the protein, Essential for Mitotic Growth 1 (EMG1. EMG1 is essential for 18S rRNA maturation and 40S ribosome biogenesis in yeast, but no studies of its role in ribosome biogenesis have been done in mammals. To assess the effect of the EMG1 mutation on cell growth and ribosomal biogenesis in humans, we employed BCS patient cells. The D86G substitution did not interfere with EMG1 nucleolar localization. In BCS patient lymphoblasts, cells accumulated in G2/M, resulting in reduced proliferation rates; however, patient fibroblasts showed normal proliferation. The rate of 18S rRNA processing was consistently delayed in patient cells, although this did not lead to a difference in the levels of 40S ribosomes, or a change in protein synthesis rates. These results demonstrate that as in yeast, EMG1 in mammals has a role in ribosome biogenesis. The obvious phenotype in lymphoblasts compared to fibroblasts suggests a greater need for EMG1 in rapidly dividing cells. Tissue-specific effects have been seen in other ribosomal biogenesis disorders, and it seems likely that the impact of EMG1 deficiency would be larger in the rapidly proliferating cells of the developing embryo.

  19. Use of Automated External Defibrillators in Cardiac Arrest

    Science.gov (United States)

    2005-01-01

    trained in CPR). If the witness cannot initiate CPR, or the first responders of the 911 system (e.g., firefighters/police) have arrived, the first responders initiate CPR. Third, the witness or first responders apply an AED to the patient. The device reads the patient’s heart rhythm and prompts for shock when indicated. Fourth, the patient is handed over to the advanced life-support team with subsequent admission to an intensive care unit in a hospital. The use of AEDs requires developing and implementing a program at sites where the cardiac arrest rate is high, where a number of potential first responders are trained and retained, and where patients are transferred to an advanced care facility after initiating resuscitation. Obviously, placing an AED at a site where no cardiac arrests are likely to occur would be futile, as would placing an AED at a site where no one knows how to use it. Moreover, abandoning patients after initial resuscitation by not transferring them to an advanced care facility would negate all earlier efforts. Thus, it is important to identify the essential components of an AED program that might also optimize the effectiveness of AED use. Methods There is a large body of literature on the use of AEDs in various settings ranging from closed environments such as hospitals, airlines, and casinos to open places such as sports fields and highways. There is little doubt regarding the effectiveness and safety of AEDs to treat people in cardiac arrest. It is intuitive that these devices should be provided in hospitals in areas that are not readily accessible to the traditional responders, the “code blue team.” Similarly, it is intuitive to provide AEDs in out-of-hospital settings where the risk of cardiac arrest is high and a response plan involving trained first responders in the use of AEDs is in place. Thus, the Medical Advisory Secretariat reviewed the literature and focused on the components of an AED program in out-of-hospital settings that

  20. Phosphorylation-triggered CUEDC2 degradation promotes UV-induced G1 arrest through APC/C(Cdh1) regulation.

    Science.gov (United States)

    Zhang, Wei-Na; Zhou, Jie; Zhou, Tao; Li, Ai-Ling; Wang, Na; Xu, Jin-Jing; Chang, Yan; Man, Jiang-Hong; Pan, Xin; Li, Tao; Li, Wei-Hua; Mu, Rui; Liang, Bing; Chen, Liang; Jin, Bao-Feng; Xia, Qing; Gong, Wei-Li; Zhang, Xue-Min; Wang, Li; Li, Hui-Yan

    2013-07-02

    DNA damage triggers cell cycle arrest to provide a time window for DNA repair. Failure of arrest could lead to genomic instability and tumorigenesis. DNA damage-induced G1 arrest is generally achieved by the accumulation of Cyclin-dependent kinase inhibitor 1 (p21). However, p21 is degraded and does not play a role in UV-induced G1 arrest. The mechanism of UV-induced G1 arrest thus remains elusive. Here, we have identified a critical role for CUE domain-containing protein 2 (CUEDC2) in this process. CUEDC2 binds to and inhibits anaphase-promoting complex/cyclosome-Cdh1 (APC/C(Cdh1)), a critical ubiquitin ligase in G1 phase, thereby stabilizing Cyclin A and promoting G1-S transition. In response to UV irradiation, CUEDC2 undergoes ERK1/2-dependent phosphorylation and ubiquitin-dependent degradation, leading to APC/C(Cdh1)-mediated Cyclin A destruction, Cyclin-dependent kinase 2 inactivation, and G1 arrest. A nonphosphorylatable CUEDC2 mutant is resistant to UV-induced degradation. Expression of this stable mutant effectively overrides UV-induced G1-S block. These results establish CUEDC2 as an APC/C(Cdh1) inhibitor and indicate that regulated CUEDC2 degradation is critical for UV-induced G1 arrest.

  1. 充血性心力衰竭患者心率变异性分析%Analysis of Heart Rate Variability of Patients With Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    骆小梅; 徐洁; 王贵鹏

    2016-01-01

    目的:探讨充血性心力衰竭患者心率变异性的变化规律。方法收集我院2014年6月~2015年12月门诊及住院部收治的充血性心力衰竭患者97例,根据NYHA心功能分级标准分为心功能Ⅰ~Ⅳ级,选择同期于我院体检健康志愿者100例为对照组。采用Holter系统记录分析仪对受检者进行24 h连续动态心电图监测,应用时域分析法分析心率变异性各指标。结果观察组SDNN、SDANN、SDNNI、RMSSD及PNN50指标均低于对照组,差异有统计学意义(P<0.05);随心功能的降低,SDNN、SDANN呈现下降趋势,但各分级之间差异无统计学意义(P>0.05),心功能Ⅲ级、Ⅳ级患者SDNNI、RMSSD及PNN50低于心功能Ⅰ级患者,心功能Ⅲ级患者RMSSD及PNN50低于心功能Ⅰ级患者,差异均有统计学意义(P<0.05)。结论充血性心力衰竭患者心率变异性下降,并与心功能的改变有关。%Objective To explore the change rule of heart rate variability of patients with congestive heart failure. Methods From June 2014 to December 2015, 97 cases of patients in our hospital were selected and divided into Ⅰ~ Ⅳ stages by NYHA classification criterion of cardiac function. 100 cases of healthy volunteers in the same period were selected as control group. All subjects were examined for 24 hours dynamic electrocardiogram by Holter recording and analyzing instrument. By means of time-domain analysis method, the HRV parameters were analyzed. Results The index of SDNN, SDANN, SDNNI, RMSSD and PNN50 in observation group were lower than control group, differences between two groups were statistically significant (P0.05). The index of SDNNI, RMSSD and PNN50 in Ⅲ and Ⅳ cardiac function patients were low that inⅠcardiac function;the index of RMSSD and PNN50 inⅢcardiac function patients were low that in Ⅰ cardiac function, differences between two groups were statistically significant (P<0.05). Conclusion The heart

  2. The obesity paradox in cardiac arrest patients.

    Science.gov (United States)

    Chalkias, Athanasios; Xanthos, Theodoros

    2014-02-01

    Evidence from clinical cohorts indicates an obesity paradox in overweight and obese patients who seem to have a more favorable short-term and long-term prognosis than leaner patients. Although obese cardiac arrest victims are theoretically more difficult to be resuscitated due to difficulties in providing adequate chest compressions, ventilation, and oxygenation, research so far has shown that there is an obesity paradox in cardiac arrest.

  3. Novel application of multi dynamic trend analysis as a sensitive tool for detecting the effects of aging and congestive heart failure on heart rate variability

    Science.gov (United States)

    Lin, Yu-Cheng; Lin, Yu-Hsuan; Lo, Men-Tzung; Peng, Chung-Kang; Huang, Norden E.; Yang, Cheryl C. H.; Kuo, Terry B. J.

    2016-02-01

    The complex fluctuations in heart rate variability (HRV) reflect cardiac autonomic modulation and are an indicator of congestive heart failure (CHF). This paper proposes a novel nonlinear approach to HRV investigation, the multi dynamic trend analysis (MDTA) method, based on the empirical mode decomposition algorithm of the Hilbert-Huang transform combined with a variable-sized sliding-window method. Electrocardiographic signal data obtained from the PhysioNet database were used. These data were from subjects with CHF (mean age = 59.4 ± 8.4), an age-matched elderly healthy control group (59.3 ± 10.6), and a healthy young group (30.3 ± 4.8); the HRVs of these subjects were processed using the MDTA method, time domain analysis, and frequency domain analysis. Among all HRV parameters, the MDTA absolute value slope (MDTS) and MDTA deviation (MDTD) exhibited the greatest area under the curve (AUC) of the receiver operating characteristics in distinguishing between the CHF group and the healthy controls (AUC = 1.000) and between the healthy elderly subject group and the young subject group (AUC = 0.834 ± 0.067 for MDTS; 0.837 ± 0.066 for MDTD). The CHF subjects presented with lower MDTA indices than those of the healthy elderly subject group. Furthermore, the healthy elderly subjects exhibited lower MDTA indices than those of the young controls. The MDTA method can adaptively and automatically identify the intrinsic fluctuation on variable temporal and spatial scales when investigating complex fluctuations in the cardiac autonomic regulation effects of aging and CHF.

  4. Inhalation of diluted diesel engine emission impacts heart rate variability and arrhythmia occurrence in a rat model of chronic ischemic heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Anselme, Frederic [Rouen University Hospital, Service de Cardiologie, Rouen (France); Loriot, Stephane; Henry, Jean-Paul; Thuillez, Christian; Morin, Jean-Paul [University of Rouen France, INSERM U644, School of Medicine-Pharmacy, Rouen, Cedex (France); Dionnet, Frederic [Centre d' Etudes et de Recherches Technologiques en Aerothermique et Moteurs, Saint Etienne du Rouvray (France); Napoleoni, Jean-Gerard [EMKA Technologies, Paris (France)

    2007-04-15

    Both increase in cardiac arrhythmia incidence and decrease in heart rate variability (HRV) have been described following human and experimental animal exposures to air pollutants. However, the potential causal relationship between these two factors remains unclear. Incidence of ventricular arrhythmia and HRV were evaluated during and after a 3 h period of Diesel engine exhaust exposure in ten healthy and ten chronic ischemic heart failure (CHF, 3 months after coronary ligation) Wistar rats using implantable ECG telemetry. Air pollutants were delivered to specifically designed whole body individual exposure chambers at particulate matter concentrations similar to those measured inside cabins of cars inserted in congested urban traffic. Recordings were obtained from unrestraint and unsedated vigil rats. Immediate decrease in RMSSD was observed in both healthy (6.64 {+-} 2.62 vs. 4.89 {+-} 1.67 ms, P < 0.05) and CHF rats (8.01 {+-} 0.89 vs. 6.6 {+-} 1.37 ms, P < 0.05) following exposure. An immediate 200-500% increase in ventricular premature beats was observed in CHF rats only. Whereas HRV progressively returned to baseline values within 2.5 h after exposure start, the proarrhythmic effect persisted as late as 5 h after exposure termination in CHF rats. Persistence of ventricular proarrhythmic effects after HRV normalization suggests that HRV reduction is not the mechanism of cardiac arrhythmias in this model. Our methodological approach, closely reflecting the real clinical situations, appeared to be a unique tool to provide further insight into the pathophysiological mechanisms of traffic related airborne pollution health impact. (orig.)

  5. Interfacial Crack Arrest in Sandwich Panels with Embedded Crack Stoppers Subjected to Fatigue Loading

    Science.gov (United States)

    Martakos, G.; Andreasen, J. H.; Berggreen, C.; Thomsen, O. T.

    2017-02-01

    A novel crack arresting device has been implemented in sandwich panels and tested using a special rig to apply out-of-plane loading on the sandwich panel face-sheets. Fatigue crack propagation was induced in the face-core interface of the sandwich panels which met the crack arrester. The effect of the embedded crack arresters was evaluated in terms of the achieved enhancement of the damage tolerance of the tested sandwich panels. A finite element (FE) model of the experimental setup was used for predicting propagation rates and direction of the crack growth. The FE simulation was based on the adoption of linear fracture mechanics and a fatigue propagation law (i.e. Paris law) to predict the residual fatigue life-time and behaviour of the test specimens. Finally, a comparison between the experimental results and the numerical simulations was made to validate the numerical predictions as well as the overall performance of the crack arresters.

  6. Optimizing Neurologically Intact Survival from Sudden Cardiac Arrest: A Call to Action

    Directory of Open Access Journals (Sweden)

    Jeffrey M. Goodloe

    2014-11-01

    Full Text Available The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function. [West J Emerg Med. 2014;15(7:-0.

  7. Interfacial Crack Arrest in Sandwich Panels with Embedded Crack Stoppers Subjected to Fatigue Loading

    Science.gov (United States)

    Martakos, G.; Andreasen, J. H.; Berggreen, C.; Thomsen, O. T.

    2016-08-01

    A novel crack arresting device has been implemented in sandwich panels and tested using a special rig to apply out-of-plane loading on the sandwich panel face-sheets. Fatigue crack propagation was induced in the face-core interface of the sandwich panels which met the crack arrester. The effect of the embedded crack arresters was evaluated in terms of the achieved enhancement of the damage tolerance of the tested sandwich panels. A finite element (FE) model of the experimental setup was used for predicting propagation rates and direction of the crack growth. The FE simulation was based on the adoption of linear fracture mechanics and a fatigue propagation law (i.e. Paris law) to predict the residual fatigue life-time and behaviour of the test specimens. Finally, a comparison between the experimental results and the numerical simulations was made to validate the numerical predictions as well as the overall performance of the crack arresters.

  8. Abnormal mitosis triggers p53-dependent cell cycle arrest in human tetraploid cells.

    Science.gov (United States)

    Kuffer, Christian; Kuznetsova, Anastasia Yurievna; Storchová, Zuzana

    2013-08-01

    Erroneously arising tetraploid mammalian cells are chromosomally instable and may facilitate cell transformation. An increasing body of evidence shows that the propagation of mammalian tetraploid cells is limited by a p53-dependent arrest. The trigger of this arrest has not been identified so far. Here we show by live cell imaging of tetraploid cells generated by an induced cytokinesis failure that most tetraploids arrest and die in a p53-dependent manner after the first tetraploid mitosis. Furthermore, we found that the main trigger is a mitotic defect, in particular, chromosome missegregation during bipolar mitosis or spindle multipolarity. Both a transient multipolar spindle followed by efficient clustering in anaphase as well as a multipolar spindle followed by multipolar mitosis inhibited subsequent proliferation to a similar degree. We found that the tetraploid cells did not accumulate double-strand breaks that could cause the cell cycle arrest after tetraploid mitosis. In contrast, tetraploid cells showed increased levels of oxidative DNA damage coinciding with the p53 activation. To further elucidate the pathways involved in the proliferation control of tetraploid cells, we knocked down specific kinases that had been previously linked to the cell cycle arrest and p53 phosphorylation. Our results suggest that the checkpoint kinase ATM phosphorylates p53 in tetraploid cells after abnormal mitosis and thus contributes to proliferation control of human aberrantly arising tetraploids.

  9. Intraoperative cardiac arrest during anesthesia:a retrospective study of 218 274 anesthetics undergoing non-cardiac surgery in a US teaching hospital

    Institute of Scientific and Technical Information of China (English)

    AN Jian-xiong; Li-Ming Zhang; Erin A.Sullivan; GUO Qu-lian; John P.Williams

    2011-01-01

    Background Patient safety has been gained much more attention in recent years.The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center,USA.The main objectives of the study were to determine the incidence of intraoperative cardiac arrest,to identify possible causes of cardiac arrest and to explore amenable modifications.Methods With approval by the University of Pittsburgh Institutional Review Board,patients experienced cardiac arrest during surgery were retrieved from medical records,surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS),a hospital electronic searching system.Cases of cardiac arrest were collected over a period of thirteen years from the Pre byteria University Hospital (PUH),USA.Results We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000).Fourteen patients (60.8%) died in the operating room,leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics.Immediate overall survival rate after arrest was 39% (9/23).Half of the patients (12/23) were emergency cases with 41% survival rate (5/12).One fourth of the arrests were trauma patients (6/23).Most arrest patients (87%,20/23) were American Society of Anesthesiologists Physical Status (ASA PS) Ⅳ and Ⅴ,while only three patients were ASA PS-Ⅰ,Ⅱ and Ⅲ,respectively.One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.Conclusions Most intraoperative cardiac arrests were not due to anesthesia-related causes.Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

  10. Sudden cardiac arrest in a patient with epilepsy induced by chronic inflammation on the cerebral surface

    Institute of Scientific and Technical Information of China (English)

    Yuxi Liu; Weicheng Hao; Xiaoming Yang; Yimin Wang; Yu Su

    2012-01-01

    The present study analyzed a patient with epilepsy due to chronic inflammation on the cerebral surface underwent sudden cardiac arrest. Paradoxical brain discharge, which occurred prior to epileptic seizures, induced a sudden cardiac arrest. However, when the focal brain pressure was relieved, cardiac arrest disappeared. A 27-year-old male patient underwent pre-surgical video-electroencephalogram monitoring for 160 hours. During monitoring, secondary tonic-clonic seizures occurred five times. A burst of paradoxical brain discharges occurred at 2-19 seconds (mean 8 seconds) prior to epileptic seizures. After 2-3 seconds, sudden cardiac arrest occurred and lasted for 12-22 seconds (average 16 seconds). The heart rate subsequently returned to a normal rate. Results revealed arachnoid pachymenia and adhesions, as well as mucus on the focal cerebral surface, combined with poor circulation and increased pressure. Intracranial electrodes were placed using surgical methods. Following removal of the arachnoid adhesions and mucus on the local cerebral surface, paradoxical brain discharge and epileptic seizures occurred three times, but sudden cardiac arrest was not recorded during 150-hour monitoring. Post-surgical histological examination indicated meningitis. Experimental findings suggested that paradoxical brain discharge led to cardiac arrest instead of epileptic seizures; the insult was associated with chronic inflammation on the cerebral surface, which subsequently led to hypertension and poor blood circulation in focal cerebral areas.

  11. Sex Disparities in Arrest Outcomes for Domestic Violence

    Science.gov (United States)

    Hamilton, Melissa; Worthen, Meredith G. F.

    2011-01-01

    Domestic violence arrests have been historically focused on protecting women and children from abusive men. Arrest patterns continue to reflect this bias with more men arrested for domestic violence compared to women. Such potential gender variations in arrest patterns pave the way to the investigation of disparities by sex of the offender in…

  12. Four faces of baroreflex failure: hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia

    Science.gov (United States)

    Ketch, Terry; Biaggioni, Italo; Robertson, RoseMarie; Robertson, David

    2002-01-01

    BACKGROUND: The baroreflex normally serves to buffer blood pressure against excessive rise or fall. Baroreflex failure occurs when afferent baroreceptive nerves or their central connections become impaired. In baroreflex failure, there is loss of buffering ability, and wide excursions of pressure and heart rate occur. Such excursions may derive from endogenous factors such as stress or drowsiness, which result in quite high and quite low pressures, respectively. They may also derive from exogenous factors such as drugs or environmental influences. METHODS AND RESULTS: Impairment of the baroreflex may produce an unusually broad spectrum of clinical presentations; with acute baroreflex failure, a hypertensive crisis is the most common presentation. Over succeeding days to weeks, or in the absence of an acute event, volatile hypertension with periods of hypotension occurs and may continue for many years, usually with some attenuation of pressor surges and greater prominence of depressor valleys during long-term follow-up. With incomplete loss of baroreflex afferents, a mild syndrome of orthostatic tachycardia or orthostatic intolerance may appear. Finally, if the baroreflex failure occurs without concomitant destruction of the parasympathetic efferent vagal fibers, a resting state may lead to malignant vagotonia with severe bradycardia and hypotension and episodes of sinus arrest. CONCLUSIONS: Although baroreflex failure is not the most common cause of the above conditions, correct differentiation from other cardiovascular disorders is important, because therapy of baroreflex failure requires specific strategies, which may lead to successful control.

  13. Performance of Fixed Heart Rate Increment Targets of 20 vs 30 Beats per Minute for Exercise Rehabilitation Prescription in Outpatients With Heart Failure.

    Science.gov (United States)

    Reed, Jennifer L; Blais, Angelica Z; Keast, Marja-Leena; Pipe, Andrew L; Reid, Robert D

    2017-06-01

    Patients with heart failure (HF) should exercise at 40%-60% heart rate reserve (HRR) during the first 3 weeks of an outpatient cardiac rehabilitation (CR) program and at 50%-80% HRR thereafter. Arbitrary methods to prescribe exercise intensity such as resting HR (RHR) plus 20 or 30 beats per minute (bpm) (RHR + 20 or RHR + 30) are recommended for inpatients after a myocardial infarction or those recovering from heart surgery. This approach has been repurposed by outpatient CR programs to prescribe exercise intensity for patients with HF, yet its efficacy has not been evaluated. We examined the appropriateness of RHR + 20/30 for prescribing exercise intensity and improving functional capacity for 55 patients with HF in an outpatient CR program. RHR + 20/30 values were compared to % HRR derived from peak exercise testing in patients with HF. Changes in functional capacity as measured by 6-minute walk test (6MWT) distance, and differences in ratings of perceived exertion (RPE), were examined between patients exercising at RHR + 20-29 and those exercising at RHR + ≥ 30. During weeks 1-3 and exercise at RHR + 20, 26% of participants would exercise at 40%-60% HRR. At RHR + 30, 38% would exercise at 40%-60% HRR. During weeks 4-12 and exercise at RHR + 20, 20% of participants would exercise at 50%-80% HRR. At RHR + 30, 41% would exercise at 50%-80% HRR. A smaller change in 6MWT distance was observed in participants exercising at RHR + 20-29 than in those exercising at RHR + ≥ 30 (Δ86.6 ± 70.3 vs Δ135.8 ± 73.7 m; P = 0.005). No differences in RPE were observed between participants exercising at RHR + 20-29 and those exercising at RHR + ≥ 30 (P > 0.05). RHR + 30 was more effective than RHR + 20 in assisting outpatients with HF achieve recommended exercise intensities and improve functional capacity. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  14. Cardiopulmonary resuscitation of adults with in-hospital cardiac arrest using the Utstein style

    Science.gov (United States)

    da Silva, Rose Mary Ferreira Lisboa; Silva, Bruna Adriene Gomes de Lima e; Silva, Fábio Junior Modesto e; Amaral, Carlos Faria Santos

    2016-01-01

    Objective The objective of this study was to analyze the clinical profile of patients with in-hospital cardiac arrest using the Utstein style. Methods This study is an observational, prospective, longitudinal study of patients with cardiac arrest treated in intensive care units over a period of 1 year. Results The study included 89 patients who underwent cardiopulmonary resuscitation maneuvers. The cohort was 51.6% male with a mean age 59.0 years. The episodes occurred during the daytime in 64.6% of cases. Asystole/bradyarrhythmia was the most frequent initial rhythm (42.7%). Most patients who exhibited a spontaneous return of circulation experienced recurrent cardiac arrest, especially within the first 24 hours (61.4%). The mean time elapsed between hospital admission and the occurrence of cardiac arrest was 10.3 days, the mean time between cardiac arrest and cardiopulmonary resuscitation was 0.68 min, the mean time between cardiac arrest and defibrillation was 7.1 min, and the mean duration of cardiopulmonary resuscitation was 16.3 min. Associations between gender and the duration of cardiopulmonary resuscitation (19.2 min in women versus 13.5 min in men, p = 0.02), the duration of cardiopulmonary resuscitation and the return of spontaneous circulation (10.8 min versus 30.7 min, p < 0.001) and heart disease and age (60.6 years versus 53.6, p < 0.001) were identified. The immediate survival rates after cardiac arrest, until hospital discharge and 6 months after discharge were 71%, 9% and 6%, respectively. Conclusions The main initial rhythm detected was asystole/bradyarrhythmia; the interval between cardiac arrest and cardiopulmonary resuscitation was short, but defibrillation was delayed. Women received cardiopulmonary resuscitation for longer periods than men. The in-hospital survival rate was low. PMID:28099640

  15. 核电厂可修设备失效数据的处理方法%Failure Data Process Considering Trend of Failure Rate for Repairable Equipments in Nuclear Power Plants

    Institute of Scientific and Technical Information of China (English)

    王大林; 刘井泉; 黄祥瑞

    2011-01-01

    To solve the problem of failure data processing for reliability assessment for repairable facilities in nuclear power plants,a improved approach based on the renewal theory,trend testing and Weibull process(a kind of NHP)is proposed. After analyzing the error risk of traditional life data processing methods,an actual example is calculated based on the failure data of water-cooling pumps in generator stator at some nuclear power stations to compare the two processing methods. The result proves that Weibull process fitting reflects the failure characteristics of repairable equipments failures with less complicate calculation process.%针对核电厂设备可靠性评估对失效数据处理的需求,基于统计的经典寿命数据处理方法分析了核电厂可修设备失效数据处理中的缺点,提出应用基于威布尔( Weibull)过程的数据处理方法处理可修设备现场数据,并以某核电厂定子冷却水用泵失效数据为例进行了实例计算,对两种方法处理结果进行了比较分析.计算证明,引入威布尔过程拟合数据处理方法可更好地符合可修设备失效特点,且计算过程不复杂.

  16. Elevated Heart Rate is Associated with Cardiac Denervation in Patients with Heart Failure: A 123-Iodine-MIBG Myocardial Scintigraphy Study.

    Science.gov (United States)

    Villacorta, Aline Sterque; Villacorta, Humberto; Souza, Jenne Serrão de; Teixeira, José Antônio Caldas; Muradas, Maria Clara S S S; Alves, Christiane Rodrigues; Precht, Bernardo Campanário; Porto, Pilar; Ubaldo, Letícia; Mesquita, Cláudio Tinoco; Nóbrega, Antônio Cláudio Lucas da

    2016-11-01

    In the Systolic Heart Failure Treatment With the If Inhibitor Ivabradine Trial (SHIFT), heart rate (HR) reduction with ivabradine was associated with improved survival and reduced hospitalizations in patients with heart failure (HF). The mechanisms by which elevated HR increases mortality are not fully understood. To assess the relationship of baseline HR with clinical, neurohormonal and cardiac sympathetic activity in patients with chronic HF and elevated HR. Patients with chronic HF who were in sinus rhythm and had resting HR>70 bpm despite optimal medical treatment were included in a randomized, double-blind study comparing ivabradine versus pyridostigmine. This report refers to the baseline data of 16 initial patients. Baseline HR (before randomization to one of the drugs) was assessed, and patients were classified into two groups, with HR below or above mean values. Cardiac sympathetic activity was assessed by 123-iodine-metaiodobenzylguanidine myocardial scintigraphy. Mean HR was 83.5±11.5 bpm (range 72 to 104), and seven (43.7%) patients had HR above the mean. These patients had lower 6-min walk distance (292.3±93 vs 465.2±97.1 m, p=0.0029), higher values of N-Terminal-proBNP (median 708.4 vs 76.1, p=0.035) and lower late heart/mediastinum rate, indicating cardiac denervation (1.48±0.12 vs 1.74±0.09, pHeart Failure Treatment With the If Inhibitor Ivabradine Trial, ou Estudo do Tratamento da Insuficiência Cardíaca Sistólica com o Inibidor de If Ivabradina), a redução da frequência cardíaca (FC) com ivabradina associou-se com melhor sobrevida e redução das hospitalizações em pacientes com insuficiência cardíaca (IC). Os mecanismos pelos quais a FC elevada aumenta a mortalidade não são totalmente compreendidos. Avaliar a relação da FC basal com atividade clínica, neuro-hormonal e simpática cardíaca em pacientes com IC crônica e FC elevada. Pacientes com IC crônica em ritmo sinusal e FC≥70 apesar de tratamento adequado foram inclu

  17. Early primary graft failure after a pediatric heart transplant and successful rescue with plasmapheresis, immunoglobulins, and alemtuzumab

    Directory of Open Access Journals (Sweden)

    Shashi Raj

    2017-01-01

    Full Text Available Early primary graft failure after pediatric orthotopic heart transplantation (OHT has a high mortality rate and can occur due to several causes including but not limited to prolonged graft ischemia time, suboptimal preimplant myocardial preservation, hyperacute rejection, and maladaptation of the graft to the host's hemodynamic status. Mechanical circulatory support with either extracorporeal membrane oxygenation (ECMO or ventricular assist device has been used for the rescue of primary graft failure in pediatric patients after heart transplant. Cardiac arrest before ECMO initiation in these patients is associated with adverse neurologic outcome although those surviving to hospital discharge generally have excellent long-term outcome. We report a case of early primary graft failure after OHT who required ECMO support and successful rescue with plasmapheresis, immunoglobulins, and alemtuzumab.

  18. First permanent molar root development arrest associated with compound odontoma.

    Science.gov (United States)

    Gunda, Sachin A; Patil, Anil; Varekar, Aniruddha

    2013-07-04

    Trauma or infection to the primary tooth may have deleterious effects on the underlying developing tooth buds. Anatomically the root apices of primary teeth are in close proximity to the developing permanent tooth buds; hence spread of infection originating from pulp necrosis of primary tooth may not only affect the underlying tooth bud but may also affect the adjacent tooth buds. The extent of malformation depends on the developmental stage of tooth or the age of patient. Presented here is a rare case of complete arrest of maxillary first permanent molar root growth due to spread of periapical infection originating from second primary molar leading to failure of its eruption and finally extraction. Histopathlogical analysis revealed compound odontoma associated with maxillary first permanent molar.

  19. Systems failure.

    OpenAIRE

    Macleod, Anna

    1998-01-01

    Systems Failure A solo exhibition of new work by Anna Macleod developed in conversation with curator Liz Burns. The Dock, Carrick on Shannon, Co Leitrim. Ireland. 12th February – 17th April 2010. The works for the exhibition Systems Failure include drawings, prints and small constructions that examine the delicate balance that exists between need and aspects of failure rooted in the relationship between humanity and land use. The work seeks to question the relationship between scient...

  20. Arrests, Recent Life Circumstances, and Recurrent Job Loss for At-Risk Young Men: An Event-History Analysis

    Science.gov (United States)

    Wiesner, Margit; Capaldi, Deborah M.; Kim, Hyoun K.

    2010-01-01

    This study used longitudinal data from 202 at-risk young men to examine effects of arrests, prior risk factors, and recent life circumstances on job loss across a 7-year period in early adulthood. Repeated failure-time continuous event-history analysis indicated that occurrence of job loss was primarily related to prior mental health problems,…

  1. Women's perspectives on the context of violence and role of police in their intimate partner violence arrest experiences.

    Science.gov (United States)

    Li, Simiao; Levick, Ani; Eichman, Adelaide; Chang, Judy C

    2015-02-01

    Intimate partner violence (IPV) accounts for up to 50% of all calls to police. In an effort to standardize arrest criteria, mandatory arrest laws were established. It is unclear whether subsequent increased rates of female arrest are due to greater recognition of female IPV perpetrators or of women acting in self-defense. This study aims to understand the context and consequences of IPV-related arrest from perspectives of women arrested in a single metropolitan area. Semi-structured qualitative interviews were conducted with women arrested and court-ordered to attend IPV education groups at a women's shelter in the Northeast United States. Interviews addressed circumstances surrounding arrest, experience with past violence, and reasoning regarding use of partner violence. Two researchers independently coded transcripts and met to iteratively refine the code and review transcripts for themes. Eighteen women were interviewed. Major themes that emerged were as follows: (a) Women's use of violence occurred within the context of their own victimization; (b) the arrest included a complex interplay between subject, partner, and police; (c) women perceived police arrest decisions to be based on a limited understanding of context; and (d) women experienced both positive and negative consequences of arrest. Many relationships did not fall under the traditional victim/perpetrator construct. Rather, women's use of violence evolved, influenced by prior experiences with violence. More appropriate methods must be developed for making arrest decisions, guiding justice system responses, and developing interventions for couples experiencing IPV. Recognition that women's use of partner violence often represented either a retaliatory or self-defensive gesture within the context of prior victimization suggests that victims' interventions should not only focus on empowerment but also provide skills and strategies to avoid temptation to adopt aggression as a primary method of self-protection.

  2. Exercise related cardiac arrest in amateur athletes on the tennis court.

    Science.gov (United States)

    Stratil, Peter; Sterz, Fritz; Haugk, Moritz; Wallmüller, Christian; Schober, Andreas; Hörburger, David; Weiser, Christoph; Stöckl, Matthias; Testori, Christoph; Krizanac, Danica; Havel, Christof

    2011-08-01

    The aim of this study was to study exercise-related cardiac arrests on the tennis court and investigate the impact of early initiation of cardiopulmonary resuscitation on survival rate and outcome. This study was based on the cardiac arrest registry of the Department of Emergency Medicine at the General Hospital Vienna in Austria. Between February 1993 and April 2010 non-professional athletes were identified, who experienced exercise-related cardiac arrest on the tennis court. The analysis was accomplished using descriptive statistics. Results are presented as mean±standard-deviation or median and interquartile range (IQR). The subjects (n=27) were predominantly male (96%) with a median age of 58 years; 52% of all patients had underlying cardiovascular risk factors. All cardiac arrests were witnessed. Bystander CPR was documented in 17 cases (63%). Median time from collapse to initiation of CPR was 1(IQR 0-2) minute. Ventricular fibrillation was the initial rhythm in 25 patients (93%) and in 3 an automated external defibrillator was used by bystanders. Twenty-four patients (89%) had return of spontaneous circulation before admission to the hospital and four (15%) followed verbal commands thereafter. The survival rate at 6 months was 82% with 20 patients (74%) having favourable neurologic outcome. Cardiac arrest on the tennis court is a predominantly witnessed event with a respectively high rate of bystander CPR, which reflects in a high successful survival rate. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  3. The ATM signaling cascade promotes recombination-dependent pachytene arrest in mouse spermatocytes.

    Directory of Open Access Journals (Sweden)

    Sarai Pacheco

    2015-03-01

    Full Text Available Most mutations that compromise meiotic recombination or synapsis in mouse spermatocytes result in arrest and apoptosis at the pachytene stage of the first meiotic prophase. Two main mechanisms are thought to trigger arrest: one independent of the double-strand breaks (DSBs that initiate meiotic recombination, and another activated by persistent recombination intermediates. Mechanisms underlying the recombination-dependent arrest response are not well understood, so we sought to identify factors involved by examining mutants deficient for TRIP13, a conserved AAA+ ATPase required for the completion of meiotic DSB repair. We find that spermatocytes with a hypomorphic Trip13 mutation (Trip13mod/mod arrest with features characteristic of early pachynema in wild type, namely, fully synapsed chromosomes without incorporation of the histone variant H1t into chromatin. These cells then undergo apoptosis, possibly in response to the arrest or in response to a defect in sex body formation. However, TRIP13-deficient cells that additionally lack the DSB-responsive kinase ATM progress further, reaching an H1t-positive stage (i.e., similar to mid/late pachynema in wild type despite the presence of unrepaired DSBs. TRIP13-deficient spermatocytes also progress to an H1t-positive stage if ATM activity is attenuated by hypomorphic mutations in Mre11 or Nbs1 or by elimination of the ATM-effector kinase CHK2. These mutant backgrounds nonetheless experience an apoptotic block to further spermatogenic progression, most likely caused by failure to form a sex body. DSB numbers are elevated in Mre11 and Nbs1 hypomorphs but not Chk2 mutants, thus delineating genetic requirements for the ATM-dependent negative feedback loop that regulates DSB numbers. The findings demonstrate for the first time that ATM-dependent signaling enforces the normal pachytene response to persistent recombination intermediates. Our work supports the conclusion that recombination defects trigger

  4. Rapid Response Systems Reduce In-Hospital Cardiopulmonary Arrest: A Pilot Study and Motivation for a Nationwide Survey

    Directory of Open Access Journals (Sweden)

    Yeonhee Park

    2017-08-01

    Full Text Available Background Early recognition of the signs and symptoms of clinical deterioration could diminish the incidence of cardiopulmonary arrest. The present study investigates outcomes with respect to cardiopulmonary arrest rates in institutions with and without rapid response systems (RRSs and the current level of cardiopulmonary arrest rate in tertiary hospitals. Methods This was a retrospective study based on data from 14 tertiary hospitals. Cardiopulmonary resuscitation (CPR rate reports were obtained from each hospital to include the number of cardiopulmonary arrest events in adult patients in the general ward, the annual adult admission statistics, and the structure of the RRS if present. Results Hospitals with RRSs showed a statistically significant reduction of the CPR rate between 2013 and 2015 (odds ratio [OR], 0.731; 95% confidence interval [CI], 0.577 to 0.927; P = 0.009. Nevertheless, CPR rates of 2013 and 2015 did not change in hospitals without RRS (OR, 0.988; 95% CI, 0.868 to 1.124; P = 0.854. National university-affiliated hospitals showed less cardiopulmonary arrest rate than private university-affiliated in 2015 (1.92 vs. 2.40; OR, 0.800; 95% CI, 0.702 to 0.912; P = 0.001. High-volume hospitals showed lower cardiopulmonary arrest rates compared with medium-volume hospitals in 2013 (1.76 vs. 2.63; OR, 0.667; 95% CI, 0.577 to 0.772; P < 0.001 and in 2015 (1.55 vs. 3.20; OR, 0.485; 95% CI, 0.428 to 0.550; P < 0.001. Conclusions RRSs may be a feasible option to reduce the CPR rate. The discrepancy in cardiopulmonary arrest rates suggests further research should include a nationwide survey to tease out factors involved in in-hospital cardiopulmonary arrest and differences in outcomes based on hospital characteristics.

  5. Using mechanical force to probe the mechanism of pausing and arrest during continuous elongation by Escherichia coli RNA polymerase

    Science.gov (United States)

    Forde, Nancy R.; Izhaky, David; Woodcock, Glenna R.; Wuite, Gijs J. L.; Bustamante, Carlos

    2002-09-01

    Escherichia coli RNA polymerase translocates along the DNA discontinuously during the elongation phase of transcription, spending proportionally more time at some template positions, known as pause and arrest sites, than at others. Current models of elongation suggest that the enzyme backtracks at these locations, but the dynamics are unresolved. Here, we study the role of lateral displacement in pausing and arrest by applying force to individually transcribing molecules. We find that an assisting mechanical force does not alter the translocation rate of the enzyme, but does reduce the efficiency of both pausing and arrest. Moreover, arrested molecules cannot be rescued by force, suggesting that arrest occurs by a bipartite mechanism: the enzyme backtracks along the DNA followed by a conformational change of the ternary complex (RNA polymerase, DNA and transcript), which cannot be reversed mechanically.

  6. Descriptive Analysis of Medication Administration During Inpatient Cardiopulmonary Arrest Resuscitation (from the Mayo Registry for Telemetry Efficacy in Arrest Study).

    Science.gov (United States)

    Snipelisky, David; Ray, Jordan; Matcha, Gautam; Roy, Archana; Dumitrascu, Adrian; Harris, Dana; Bosworth, Veronica; Clark, Brooke; Thomas, Colleen S; Heckman, Michael G; Vadeboncoeur, Tyler; Kusumoto, Fred; Burton, M Caroline

    2016-05-15

    Advanced cardiovascular life support guidelines exist, yet there are variations in clinical practice. Our study aims to describe the utilization of medications during resuscitation from in-hospital cardiopulmonary arrest. A retrospective review of patients who suffered a cardiopulmonary arrest from May 2008 to June 2014 was performed. Clinical and resuscitation data, including timing and dose of medications used, were extracted from the electronic medical record and comparisons made. A total of 94 patients were included in the study. Patients were divided into different groups based on the medication combination used during resuscitation: (1) epinephrine; (2) epinephrine and bicarbonate; (3) epinephrine, bicarbonate, and calcium; (4) epinephrine, bicarbonate, and epinephrine drip; and (5) epinephrine, bicarbonate, calcium, and epinephrine drip. No difference in baseline demographics or clinical data was present, apart from history of dementia and the use of calcium channel blockers. The number of medications given was correlated with resuscitation duration (Spearman's rank correlation = 0.50, p <0.001). The proportion of patients who died during the arrest was 12.5% in those who received epinephrine alone, 30.0% in those who received only epinephrine and bicarbonate, and 46.7% to 57.9% in the remaining groups. Patients receiving only epinephrine had shorter resuscitation durations compared to that of the other groups (p <0.001) and improved survival (p = 0.003). In conclusion, providers frequently use nonguideline medications in resuscitation efforts for in-hospital cardiopulmonary arrests. Increased duration and mortality rates were found in those resuscitations compared with epinephrine alone, likely due to the longer resuscitation duration in the former groups. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Heart failure in community-dwelling older persons: aims, design and adherence rate of the ICARe Dicomano project: an epidemiologic study. Insufficienza Cardiaca negli Anziani Residenti a Dicomano.

    Science.gov (United States)

    Di Bari, M; Marchionni, N; Ferrucci, L; Pini, R; Antonini, E; Chiarlone, M; Marsilii, A; De Alfieri, W; Fumagalli, S; Masotti, G

    1999-06-01

    The prevalence of heart failure (HF) increases with age, and HF is a major cause of disability and mortality in older persons. Detection of HF in epidemiological studies has relied on criteria validated only in young and middle-age adults, and, therefore, may prove inadequate in older subjects, because they do not take into account the pathophysiologic and clinical peculiarities of HF in old age. Thus, the true prevalence of HF in the older general population remains uncertain and has probably been underestimated in previous studies. Moreover, the mechanism and the extent by which HF hinders physical functioning in older people has not been fully elucidated. This paper describes the design of the ICARe study, carried out in an older home-dwelling population to collect data about: (1) the sensitivity and specificity of diagnostic criteria used previously in epidemiological studies of HF; (2) the prevalence of the different pathophysiologic forms of HF; and (3) the impact of HF on overall health status, and on physical functioning, in the absence or presence of chronic comorbidity. This was a cross-sectional survey. Eligible were all community-dwelling persons aged 65 years or older recorded in the Registry Office of Dicomano, a small town nearby Florence (Italy). All the domains of multidimensional geriatric assessment were explored through different phases of the study (home interview, laboratory testing, geriatric visit) that comprised an extensive cardiopulmonary instrumental assessment including: color Doppler echocardiography, echotomography of the carotid arteries used in an original method to determine arterial compliance, and bell spirometry. Presence of major chronic conditions was ascertained by predefined, standard algorithms that were based largely on clinical examination. There were 864 older persons eligible for the ICARe study. Even with a substantial decline from home interview (91.2%) to the cardiopulmonary study (71.1%), the adherence rate remained

  8. Co-ordination of spark-gap protection with zinc-oxide surge arresters

    Energy Technology Data Exchange (ETDEWEB)

    Haddad, A.; German, D.M.; Waters, R.T. [Cardiff Univ., School of Engineering, Cardiff (United Kingdom); Abdul-Malek, Z. [University of Technology (Malaysia)

    2001-01-01

    Zinc-oxide (ZnO) surge arresters are now well established as a very efficient and reliable form of overvoltage protection against both fast surges, such as those generated by lightning and gas-insulated switchgear, and high-energy surges generated by switching operations and temporary faults on the network. The addition of ZnO surge arresters to existing protection schemes reinforces the system's reliability and the security of supply. The protection characteristics of the parallel configuration formed by arresters and existing spark gaps at distribution voltages are studied. Tests on various spark-gap geometries, with and without surge arresters in parallel, have been carried out to determine breakdown characteristics, probability curves and voltage-time characteristics for different impulse shapes. It is found that the introduction of the arrester in the circuit modifies the prospective impulse which results in the shift of the breakdown characteristics towards higher voltages. A proposed circuit model, based on laboratory test data, is used to simulate such parallel configurations. Good agreement between test and simulated results is obtained. As a result of these tests, it is recommended that gap-sparkover characteristics based on short-tail (about 5{mu}s) impulses are used for insulation co-ordination. The role of parallel airgaps in preserving the arrester energy-rating limits is also discussed. (Author)

  9. History and current use of mild therapeutic hypothermia after cardiac arrest.

    Science.gov (United States)

    Bonaventura, Jiří; Alan, David; Vejvoda, Jiri; Honek, Jakub; Veselka, Josef

    2016-10-01

    In spite of many years of development and implementation of pre-hospital advanced life support programmes, the survival rate of out-of-hospital cardiac arrest (OHCA) used to be very poor. Neurologic injury from cerebral hypoxia is the most common cause of death in patients with OHCA. In the past two decades, post-resuscitation care has developed many new concepts aimed at improving the neurological outcome and survival rate of patients after cardiac arrest. Systematic post-cardiac arrest care after the return of spontaneous circulation, including induced mild therapeutic hypothermia (TH) in selected patients, is aimed at significantly improving rates of long-term neurologically intact survival. This review summarises the history and current knowledge in the field of mild TH after OHCA.

  10. Renal failure (chronic)

    OpenAIRE

    Clase, Catherine

    2011-01-01

    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  11. Evaluation of the rate of bond failure of Discovery and Smart-Clip self-ligating brackets%Discovery自锁托槽和Smart-Clip自锁托槽脱落率的分析研究

    Institute of Scientific and Technical Information of China (English)

    陈慧霞; 沈云娟; 秦燕军; 许晓聪; 李媛; 陈文静

    2012-01-01

    目的 分析Discovery自锁托槽和Smart - Clip自锁托槽光固化湿粘接后托槽的脱落率.方法 随机抽取2009-2011年临床应用Discovery自锁托槽及Smart - Clip自锁托槽进行矫治的正畸病例,分别采用3M公司生产的TransbondTM XT光固化粘接剂管装+ TransbondTM MIP耐湿性处理液和APCTMⅡ预置粘接剂托槽+ TransbondTM MIP耐湿性处理液严格按照粘接要求进行粘接,记录其脱落情况,计算脱落率,并分析脱落原冈及其与口腔卫生之间的关系.结果 口腔卫生情况对于托槽脱落率有一定的影响;下颌同名牙托槽脱落率明显高于上颌;托槽脱落再粘接后发生再次脱落者主要集中在下颌.结论 临床应重视自锁托槽的粘接,加强患者口腔卫生保健,以降低托槽脱落率.%Objective To evaluate the rate of bond failure of Discovery and Smart-Clip self-ligating brackets. Methods Patients treated with Discovery or Smart-Clip self-ligating brackets in the year of 2009-2011 were selected randomly. Discovery self-ligating brackets were bonded with Transbond? XT and Transbond? MIP; Smart-Clip self-ligating brackets were bonded with APC? II and Transbond? MIP. The rate of bond failure was calculated. Its causes and its relationship with oral hygiene were analyzed. Results Oral hygiene had an effect on the rate of bond failure;the failure rates of lower teeth were obviously higher than those of upper teeth;the failure of rebonding mainly happened to lower teeth. Conclusions It is of great importance to bond self-ligating brackets properly and improve oral hygiene of patients,so that we can reduce the rate of bond failure.

  12. Adulthood animal abuse among men arrested for domestic violence.

    Science.gov (United States)

    Febres, Jeniimarie; Brasfield, Hope; Shorey, Ryan C; Elmquist, Joanna; Ninnemann, Andrew; Schonbrun, Yael C; Temple, Jeff R; Recupero, Patricia R; Stuart, Gregory L

    2014-09-01

    Learning more about intimate partner violence (IPV), perpetrators could aid the development of more effective treatments. The prevalence of adulthood animal abuse (AAA) perpetration and its association with IPV perpetration, antisociality, and alcohol use in 307 men arrested for domestic violence were examined. Forty-one percent (n = 125) of the men committed at least one act of animal abuse since the age of 18, in contrast to the 1.5% prevalence rate reported by men in the general population. Controlling for antisociality and alcohol use, AAA showed a trend toward a significant association with physical and severe psychological IPV perpetration.

  13. Case study: flame arresters and exploding gasoline containers.

    Science.gov (United States)

    Hasselbring, Lori C

    2006-03-17

    This paper describes the case study of a portable plastic gasoline container explosion and fire. While working at home on a science project to determine the burn rates of different types of wood fuel, a 14-year-old boy was severely burned after flames traveled back up into the portable gasoline container and exploded. A witness heard the explosion and reports that the flames went perhaps 10 ft in the air. It is shown by experimentation that a flame arrester installed in the pour opening of the portable gasoline container would have prevented an explosion inside the gasoline container.

  14. [Cardiac arrest in newborn of mother treated with labetalol].

    Science.gov (United States)

    Sala, X; Monsalve, C; Comas, C; Botet, F; Nalda, M A

    1993-01-01

    The use of beta-adrenergic antagonists for the control of high blood pressure associated to pregnancy is frequent. Their use is related with the appearance of undesirable effects of the fetus. The case of neonatal cardiac arrest attributed, to the administration of labetalol to the mother is presented. The high transplacentary passage, the different pharmacokinetics of the drug in the newborn and the clinical evolution of the patient suggests its involvement. It is concluded that labetalol may cause severe undesirable effects in newborns and fetal heart rate of the mother and neonate should be monitored upon use of this drug.

  15. Outcomes of Cardiac Arrest in Residential Care Homes for the Elderly in Hong Kong.

    Science.gov (United States)

    Fan, Kit Ling; Leung, Ling Pong

    2017-05-03

    Studies done in the 1990's suggested nursing home residents with cardiac arrest had minimal chance of survival and resuscitation was not recommended. More recent studies showed opposing results. In Hong Kong, the proportion of elderly living in the residential care homes for the elderly is increasing. There is no study of out-of-hospital cardiac arrest outcomes in this population. This study aimed at evaluating the prognosis of out-of-hospital cardiac arrest occurring in the residential care homes for the elderly. It is hoped that the findings may inform the local emergency medical service concerning the issue of futility of resuscitating the residents with cardiac arrest in the residential care homes. This study was a retrospective analysis of a database of all patients aged 65 years or above with atraumatic out-of-hospital cardiac arrest and who were attended by the emergency medical service in a 12-month period. Data in the database were prospectively collected by the emergency medical service. The characteristics of patients and cardiac arrests, timeliness of the emergency medical service, and survival were analyzed. Comparison was made between elderly living in and not living in the residential care homes. Predictors of survival were evaluated with logistic regression. 3919 patients aged ≥ 65 years were analyzed. There were 1506 cases of cardiac arrest occurring in the residential care homes for the elderly. Resuscitation was discontinued at the emergency department in over 70% of these cases. The survival to hospital admission rate and the 30-day survival rate were 9.6% and 0.3% respectively. Both were lower than patients not residing in the residential care homes. Younger age, witnessed arrest, bystander defibrillation, and shorter call to ED interval were associated with higher chance of surviving to hospital admission. Elderly suffering from cardiac arrest in residential care homes had a poor chance of survival. Except age, witnessed arrest, bystander

  16. Failure of cell cleavage induces senescence in tetraploid primary cells.

    Science.gov (United States)

    Panopoulos, Andreas; Pacios-Bras, Cristina; Choi, Justin; Yenjerla, Mythili; Sussman, Mark A; Fotedar, Rati; Margolis, Robert L

    2014-10-15

    Tetraploidy can arise from various mitotic or cleavage defects in mammalian cells, and inheritance of multiple centrosomes induces aneuploidy when tetraploid cells continue to cycle. Arrest of the tetraploid cell cycle is therefore potentially a critical cellular control. We report here that primary rat embryo fibroblasts (REF52) and human foreskin fibroblasts become senescent in tetraploid G1 after drug- or small interfering RNA (siRNA)-induced failure of cell cleavage. In contrast, T-antigen-transformed REF52 and p53+/+ HCT116 tumor cells rapidly become aneuploid by continuing to cycle after cleavage failure. Tetraploid primary cells quickly become quiescent, as determined by loss of the Ki-67 proliferation marker and of the fluorescent ubiquitination-based cell cycle indicator/late cell cycle marker geminin. Arrest is not due to DNA damage, as the γ-H2AX DNA damage marker remains at control levels after tetraploidy induction. Arrested tetraploid cells finally become senescent, as determined by SA-β-galactosidase activity. Tetraploid arrest is dependent on p16INK4a expression, as siRNA suppression of p16INK4a bypasses tetraploid arrest, permitting primary cells to become aneuploid. We conclude that tetraploid primary cells can become senescent without DNA damage and that induction of senescence is critical to tetraploidy arrest.

  17. Association of prenatal and childhood blood lead concentrations with criminal arrests in early adulthood.

    Directory of Open Access Journals (Sweden)

    John Paul Wright

    2008-05-01

    Full Text Available BACKGROUND: Childhood lead exposure is a purported risk factor for antisocial behavior, but prior studies either relied on indirect measures of exposure or did not follow participants into adulthood to examine the relationship between lead exposure and criminal activity in young adults. The objective of this study was to determine if prenatal and childhood blood lead concentrations are associated with arrests for criminal offenses. METHODS AND FINDINGS: Pregnant women were recruited from four prenatal clinics in Cincinnati, Ohio if they resided in areas of the city with a high concentration of older, lead-contaminated housing. We studied 250 individuals, 19 to 24 y of age, out of 376 children who were recruited at birth between 1979 and 1984. Prenatal maternal blood lead concentrations were measured during the first or early second trimester of pregnancy. Childhood blood lead concentrations were measured on a quarterly and biannual basis through 6.5 y. Study participants were examined at an inner-city pediatric clinic and the Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio. Total arrests and arrests for offenses involving violence were collected from official Hamilton County, Ohio criminal justice records. Main outcomes were the covariate-adjusted rate ratios (RR for total arrests and arrests for violent crimes associated with each 5 microg/dl (0.24 micromol/l increase in blood lead concentration. Adjusted total arrest rates were greater for each 5 microg/dl (0.24 micromol/l increase in blood lead concentration: RR = 1.40 (95% confidence interval [CI] 1.07-1.85 for prenatal blood lead, 1.07 (95% CI 0.88-1.29 for average childhood blood lead, and 1.27 (95% CI 1.03-1.57 for 6-year blood lead. Adjusted arrest rates for violent crimes were also greater for each 5 microg/dl increase in blood lead: RR = 1.34 (95% CI 0.88-2.03 for prenatal blood lead, 1.30 (95% CI 1.03-1.64 for average childhood blood lead, and 1.48 (95% CI 1

  18. Higher rates of triple-class virological failure in perinatally HIV-infected teenagers compared with heterosexually infected young adults in Europe

    DEFF Research Database (Denmark)

    Judd, A; Lodwick, R; Noguera-Julian, A

    2017-01-01

    OBJECTIVES: The aim of the study was to determine the time to, and risk factors for, triple-class virological failure (TCVF) across age groups for children and adolescents with perinatally acquired HIV infection and older adolescents and adults with heterosexually acquired HIV infection. METHODS......: We analysed individual patient data from cohorts in the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). A total of 5972 participants starting antiretroviral therapy (ART) from 1998, aged

  19. What Causes Sudden Cardiac Arrest?

    Science.gov (United States)

    ... heart pumps little or no blood to the body. V-fib is fatal if not treated within a few minutes. Other problems with the heart's electrical system also can cause SCA. For example, SCA can occur if the rate of the heart's electrical signals becomes very slow and stops. SCA also can ...

  20. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008275 Relationship of calcineure in mRNA level in peripheral blood and cardiac muscle of patients with heart failure.WANG Mengmeng(王萌萌),et al.Dept Cardiol,Shandong Prov Hosp,Shandong Univ,Jinan 250021.Chin Cir J 2008;23(2):113-116.Objective To study the relationship of calcineurin mRNA level between peripheral lymphocytes and cardiac muscles of patients with chronic heart failure.Methods

  1. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008037 Factors associated with efficacy of cardiac resynchronization therapy for patients with congestive heart failure. SHI Haoying(史浩颖), et al. Dept Cardiol, Zhongshan Hosp Fudan Univ, Shanghai 200032. Chin J Cardiol 2007;35(12):1099-1163. Objective The efficacy of cardiac resynchronization therapy (CRT) in patients with congestive heart failure and the potential factors associated with responder or nonresponder were investigated. Methods Fifty

  2. Sudden cardiac arrest in a child with nemaline myopathy.

    Science.gov (United States)

    Marseglia, Lucia; D'Angelo, Gabriella; Manti, Sara; Salpietro, Vincenzo; Arrigo, Teresa; Cavallari, Vittorio; Gitto, Eloisa

    2015-03-21

    Nemaline myopathy is a rare, non progressive congenital skeletal muscle disorder defined by the presence of inclusions known as nemaline rods in muscle fibers. Several clinical subtypes have been described, according to degree of muscle weakness, severity and age at onset. The course of nemaline myopathy is very slowly progressive, and death is usually due to respiratory failure. Cardiac involvement is rare and generally considered to be the result of ACTA1 mutations. We report the case of a 6 year old boy with typical congenital nemaline myopathy. Nemaline myopathy was confirmed at 3 years of age by muscle biopsy. No mutation of ACTA1, TPM2 and TNNT1 genes was detected. The child died suddenly of cardiac arrest and associated hypoxic-ischemic brain injury, in absence of acute respiratory failure or swallowing difficulties. Nemaline cardiomyopathy was suspected, but post mortem cardiac biopsy did not show findings consistent with nemaline myopathy. Congenital typical nemaline myopathy is not necessarily a static or very slowly progressive disorder and acute cardiac deterioration can lead to early death.

  3. Juvenile Arrests, 2007. Juvenile Justice Bulletin

    Science.gov (United States)

    Puzzanchera, Charles

    2009-01-01

    This Bulletin summarizes 2007 juvenile crime and arrest data reported by local law enforcement agencies across the country and cited in the FBI report, "Crime in the United States 2007." The Bulletin describes the extent and nature of juvenile crime that comes to the attention of the justice system. It serves as a baseline for comparison for…

  4. Het arrest Residex: terugvordering moet, nietigverklaring mag

    NARCIS (Netherlands)

    Montijn, J.; Saanen, N.

    2012-01-01

    Het recente arrest Residex van het Hof van Justitie geeft inzicht in de maatregelen die de nationale rechterlijke instanties kunnen en moeten treffen indien sprake is van onwettige steun. Deze maatregelen zijn niet altijd eenvoudig in het nationale recht te passen. Ook zijn de maatregelen die op gro

  5. Failure Rate Model of Mechanical Components Based on Four Elements%基于四要素的机械零部件失效率计算模型

    Institute of Scientific and Technical Information of China (English)

    王正

    2011-01-01

    The factors affecting the typical failure rate curve were analyzed, and four elements including load, strength, strength degradation and life index(namely, the number of load application and time) were proposed for calculating the failure rate of components. Taking the number of load application and time as the life index, respectively, the failure rate models of components consisting of four elements were developed, which can embody the parameters of load, strength, strength degradation and life. Then, the behaviors of the reliability and failure rate of components changing as the life index were studied. The results show that the failure rate curves of components have the partial or whole characteristics of bathtub curve. For different parameters of load, strength and the rule of strength degradation, the failure rate curves of components have different shapes. The models derived herein can calculate the failure rate of components as long as the known parameters of load, strength and its degradation and life index, and can direct the reliability-based design of components more scientifically.%分析了影响典型失效率曲线变化的因素,提出了零部件失效率计算的四要素,即载荷、强度、强度退化规律以及寿命指标(载荷作用次数或时间)。分别在以载荷作用次数和时间为寿命度量指标框架下,建立了能够全面地体现载荷、强度、强度退化规律以及寿命指标等参数影响的零部件失效率计算四要素模型,并研究了零部件可靠度与失效率随寿命指标的变化规律。研究表明,零部件的可靠度随寿命指标的增大而逐渐减小,零部件的失效率随寿命指标变化具有浴盆曲线全部(或部分)特征。对于不同的强度分布、载荷分布和强度退化规律组合,零部件具有不同的可靠度,失效率曲线具有不同的形状。所建立的失效率模型无需依赖产品的失效数据信息,而只要在载荷、

  6. Computation Molecular Kinetics Model of HZE Induced Cell Cycle Arrest

    Science.gov (United States)

    Cucinotta, Francis A.; Ren, Lei

    2004-01-01

    Cell culture models play an important role in understanding the biological effectiveness of space radiation. High energy and charge (HZE) ions produce prolonged cell cycle arrests at the G1/S and G2/M transition points in the cell cycle. A detailed description of these phenomena is needed to integrate knowledge of the expression of DNA damage in surviving cells, including the determination of relative effectiveness factors between different types of radiation that produce differential types of DNA damage and arrest durations. We have developed a hierarchical kinetics model that tracks the distribution of cells in various cell phase compartments (early G1, late G1, S, G2, and M), however with transition rates that are controlled by rate-limiting steps in the kinetics of cyclin-cdk's interactions with their families of transcription factors and inhibitor molecules. The coupling of damaged DNA molecules to the downstream cyclin-cdk inhibitors is achieved through a description of the DNA-PK and ATM signaling pathways. For HZE irradiations we describe preliminary results, which introduce simulation of the stochastic nature of the number of direct particle traversals per cell in the modulation of cyclin-cdk and cell cycle population kinetics. Comparison of the model to data for fibroblast cells irradiated photons or HZE ions are described.

  7. The Effects of Local Police Surges on Crime and Arrests in New York City.

    Science.gov (United States)

    MacDonald, John; Fagan, Jeffrey; Geller, Amanda

    2016-01-01

    The New York Police Department (NYPD) under Operation Impact deployed extra police officers to high crime areas designated as impact zones. Officers were encouraged to conduct investigative stops in these areas. City officials credited the program as one of the leading causes of New York City's low crime rate. We tested the effects of Operation Impact on reported crimes and arrests from 2004 to 2012 using a difference-in-differences approach. We used Poisson regression models to compare differences in crime and arrest counts before and after census block groups were designated as impact zones compared to census block groups in the same NYPD precincts but outside impact zones. Impact zones were significantly associated with reductions in total reported crimes, assaults, burglaries, drug violations, misdemeanor crimes, felony property crimes, robberies, and felony violent crimes. Impact zones were significantly associated with increases in total reported arrests, arrests for burglary, arrests for weapons, arrests for misdemeanor crimes, and arrests for property felony crimes. Impact zones were also significantly associated with increases in investigative stops for suspected crimes, but only the increase in stops made based on probable cause indicators of criminal behaviors were associated with crime reductions. The largest increase in investigative stops in impact zones was based on indicators of suspicious behavior that had no measurable effect on crime. The findings suggest that saturating high crime blocks with police helped reduce crime in New York City, but that the bulk of the investigative stops did not play an important role in the crime reductions. The findings indicate that crime reduction can be achieved with more focused investigative stops.

  8. The Effects of Local Police Surges on Crime and Arrests in New York City

    Science.gov (United States)

    MacDonald, John; Fagan, Jeffrey; Geller, Amanda

    2016-01-01

    The New York Police Department (NYPD) under Operation Impact deployed extra police officers to high crime areas designated as impact zones. Officers were encouraged to conduct investigative stops in these areas. City officials credited the program as one of the leading causes of New York City’s low crime rate. We tested the effects of Operation Impact on reported crimes and arrests from 2004 to 2012 using a difference-in-differences approach. We used Poisson regression models to compare differences in crime and arrest counts before and after census block groups were designated as impact zones compared to census block groups in the same NYPD precincts but outside impact zones. Impact zones were significantly associated with reductions in total reported crimes, assaults, burglaries, drug violations, misdemeanor crimes, felony property crimes, robberies, and felony violent crimes. Impact zones were significantly associated with increases in total reported arrests, arrests for burglary, arrests for weapons, arrests for misdemeanor crimes, and arrests for property felony crimes. Impact zones were also significantly associated with increases in investigative stops for suspected crimes, but only the increase in stops made based on probable cause indicators of criminal behaviors were associated with crime reductions. The largest increase in investigative stops in impact zones was based on indicators of suspicious behavior that had no measurable effect on crime. The findings suggest that saturating high crime blocks with police helped reduce crime in New York City, but that the bulk of the investigative stops did not play an important role in the crime reductions. The findings indicate that crime reduction can be achieved with more focused investigative stops. PMID:27310252

  9. 两种正畸粘接剂与氟斑牙粘接临床效果观察%CLINICAL OBSERVATION OF THE FAILURE RATE AFTER APPLYING TWO KINDS OF THE ORTHODONTIC ADHESIVES TO THE DENTAL FLUOROSIS

    Institute of Scientific and Technical Information of China (English)

    回宏伟; 齐素青

    2011-01-01

    [目的]比较光固化复合树脂祜接剂与京津釉质粘接剂应用于氟斑牙上对托槽脱落率的影响.[方法]选择24例氰斑牙正畸固定矫治病例,通过随机排列法将两种粘接剂分别与用于患者左右两侧上下颌的托槽粘接,比较其在4周、8周、12周时的托槽脱落情况.[结果]两种粘接剂的托槽脱落率经t检验差异有统计学意义(P<0.05).[结论]光固化复合树脂粘接剂的托槽脱落率明显低于京津釉质粘接剂,建议在临床上对于氟斑牙患者有条件还是选用光固化复合树脂粘接剂,以减少托槽脱落.%[Objective]To compare the influence on the failure rate of the bracket bonding to the dental fluorosis between the groups which applied the light-cured resin composite bond and the Jingjin enamel adhesive.[Methods]24 patients who had the dental fluorosis and received the fixed orthodontic treatment were chosen.Two kinds of the adhesives were used to bond the brackets randomly.Compared the failure rates at the 4th week, 8th week and 12lh week.[Results]The bracket bonding failure rates by using two kinds of the adhesives were statistically significant after t test (P < 0.05).[Conclusion]The group which using the light-cured resin composite bind has significantly lower failure rate.It suggest we should use the light-cured resin composite bond to reduce the bracket bonding failure for the patients with the dental fluorosis.

  10. Development of a Web GIS Application for Visualizing and Analyzing Community Out of Hospital Cardiac Arrest Patterns

    Science.gov (United States)

    Semple, Hugh; Qin, Han; Sasson, Comilla

    2013-01-01

    Improving survival rates at the neighborhood level is increasingly seen as a priority for reducing overall rates of out-of-hospital cardiac arrest (OHCA) in the United States. Since wide disparities exist in OHCA rates at the neighborhood level, it is important for public health officials and residents to be able to quickly locate neighborhoods where people are at elevated risk for cardiac arrest and to target these areas for educational outreach and other mitigation strategies. This paper describes an OHCA web mapping application that was developed to provide users with interactive maps and data for them to quickly visualize and analyze the geographic pattern of cardiac arrest rates, bystander CPR rates, and survival rates at the neighborhood level in different U.S. cities. The data comes from the CARES Registry and is provided over a period spanning several years so users can visualize trends in neighborhood out-of-hospital cardiac arrest patterns. Users can also visualize areas that are statistical hot and cold spots for cardiac arrest and compare OHCA and bystander CPR rates in the hot and cold spots. Although not designed as a public participation GIS (PPGIS), this application seeks to provide a forum around which data and maps about local patterns of OHCA can be shared, analyzed and discussed with a view of empowering local communities to take action to address the high rates of OHCA in their vicinity. PMID:23923097

  11. Development of a Web GIS Application for Visualizing and Analyzing Community Out of Hospital Cardiac Arrest Patterns.

    Science.gov (United States)

    Semple, Hugh; Qin, Han; Sasson, Comilla

    2013-01-01

    Improving survival rates at the neighborhood level is increasingly seen as a priority for reducing overall rates of out-of-hospital cardiac arrest (OHCA) in the United States. Since wide disparities exist in OHCA rates at the neighborhood level, it is important for public health officials and residents to be able to quickly locate neighborhoods where people are at elevated risk for cardiac arrest and to target these areas for educational outreach and other mitigation strategies. This paper describes an OHCA web mapping application that was developed to provide users with interactive maps and data for them to quickly visualize and analyze the geographic pattern of cardiac arrest rates, bystander CPR rates, and survival rates at the neighborhood level in different U.S. cities. The data comes from the CARES Registry and is provided over a period spanning several years so users can visualize trends in neighborhood out-of-hospital cardiac arrest patterns. Users can also visualize areas that are statistical hot and cold spots for cardiac arrest and compare OHCA and bystander CPR rates in the hot and cold spots. Although not designed as a public participation GIS (PPGIS), this application seeks to provide a forum around which data and maps about local patterns of OHCA can be shared, analyzed and discussed with a view of empowering local communities to take action to address the high rates of OHCA in their vicinity.

  12. Transient Central Diabetes Insipidus and Marked Hypernatremia following Cardiorespiratory Arrest

    Directory of Open Access Journals (Sweden)

    Sahar H. Koubar

    2017-01-01

    Full Text Available Central Diabetes Insipidus is often an overlooked complication of cardiopulmonary arrest and anoxic brain injury. We report a case of transient Central Diabetes Insipidus (CDI following cardiopulmonary arrest. It developed 4 days after the arrest resulting in polyuria and marked hypernatremia of 199 mM. The latter was exacerbated by replacing the hypotonic urine by isotonic saline.

  13. Modes of induced cardiac arrest: hyperkalemia and hypocalcemia - Literature review

    OpenAIRE

    Oliveira,Marcos Aurélio Barboza de; Brandi, Antônio Carlos; dos Santos, Carlos Alberto; Botelho, Paulo Henrique Husseini; Cortez, José Luis Lasso; Braile, Domingo Marcolino

    2014-01-01

    The entry of sodium and calcium play a key effect on myocyte subjected to cardiac arrest by hyperkalemia. They cause cell swelling, acidosis, consumption of adenosine triphosphate and trigger programmed cell death. Cardiac arrest caused by hypocalcemia maintains intracellular adenosine triphosphate levels, improves diastolic performance and reduces oxygen consumption, which can be translated into better protection to myocyte injury induced by cardiac arrest.

  14. Organ failure associated with severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Ai-Jun Zhu; Jing-Sen Shi; Xue-Jun Sun

    2003-01-01

    AIM: To investigate the relationship between severe acute pancreatitis (SAP) and organ failure.METHODS: Clinical data of 74 cases of SAP from Jan. 1993 to Dec. 2002 were retrospectively reviewed, and the relationship between organ failure and age, gender, etiology,extent of necrosis, infection of necrosis and mortality was analyzed.RESULTS: A total of 47 patients (63.5 %) showed organ failure, 20 patients (27.0 %) multiple organ failure, whereas 27 patients (36.5 %) with dysfunction of a single organ system. Pulmonary failure was the most common organ dysfunction (23.0 %) among single organ failures. There were no significant differences in age, gender and gallstone pancreatitis among patients with or without organ failure (P>0.05). The incidence of organ failure in infected necrosis was not higher compared with sterile necrosis, and patients with increased amount of necrosis did not have an increased prevalence of organ failure (P>0.05). Patients with organ failure had a higher mortality rate compared with those without organ failure (P<0.05). The death of SAP was associated with multiple organ failure (P<0.005), pulmonary failure (P<0.005), cardiovascular dysfunction (P<0.05) and gastrointestinal dysfunction (P<0.05).CONCLUSION: Organ failure is common in patients with SAP, and patients with multiple organ failure and pulmonary failure have a higher mortality rate. Prevention and active treatment of organ failure can improve the outcome of patients with SAP.

  15. School failure.

    Science.gov (United States)

    Dworkin, P H

    1989-04-01

    Numerous factors may contribute to a child's failure to learn. Certain causes of school failure, such as specific learning disabilities, mental retardation, sensory impairment, and chronic illness may be regarded as intrinsic characteristics of the child. Other causes, such as family dysfunction, social problems, and ineffective schooling, are characteristics of the child's environment. Still other influences on school performance, such as temperamental dysfunction, attention deficits, and emotional illness, may be viewed as the consequence of the interaction between the child and his or her environment. The reasons for a child's school failure must not be considered in isolation but rather within the context of social and environmental circumstances. Evaluation must consider the myriad of reasons for a child's school failure and attempt to identify "clusters" of adverse influences on school performance. Detailed information must be sought from the student, parents, and school system through the history and physical examination. Questionnaires are useful in data gathering. Ancillary methods of assessment that may be of value include neurodevelopmental screening and laboratory studies. Further investigations and referrals, particularly psychoeducational evaluation, are of major importance. Traditional roles of the pediatrician in school failure include the treatment of underlying medical conditions, counseling, the coordination of further investigations and referrals, and the facilitation of communication with community services and resources. Participation with other disciplines in the development of a child's educational plan is feasible and useful.

  16. Main Complications of Mild Induced Hypothermia after Cardiac Arrest: A Review Article

    Directory of Open Access Journals (Sweden)

    Hassan Soleimanpour

    2014-03-01

    Full Text Available The aim of the present study is to assess the complications of mild induced hypothermia (MIH in patients with cardiac arrest. Presently, based on the guidelines of the American heart Association, MIH following successful cardiopulmonary resuscitation (CPR in unconscious adult patients due to ventricular fibrillation (VF with out-of-hospital cardiac arrest (OOHCA is essential and required. However, MIH could be associated with complications in Patients with cardiac arrest. Studies conducted on the precautions and care following cardiac arrest and MIH were included. Valid scientific data bases were used for data collection. The obtained results from different studies revealed that mild MIH could be associated with numerous complications and the knowledge and awareness of the medical staff from the complications is required to guarantee successful therapeutic approaches in MIH following cardiac arrest which is a novel medical facility with different styles and complications. Overall, further future studies are required to improve the quality of MIH, to increase survival and to decrease complications rates.

  17. 品管圈活动在降低多导睡眠监测失败率的应用%The Application of Quality Control Circle in Reducing Polysomnography Failure Rate

    Institute of Scientific and Technical Information of China (English)

    卢南锦; 常雪娟; 龚荣娣; 陈绍森

    2016-01-01

    Objective:To study the the application of quality control circle in reducing polysomnography failure rate.Methods:10 people in the department form a quality control circle team,through the activity pro-cedure,using quality management tools to analyze and improve the failing reason of polysomnography and compare the failure rate before and after the improvement.Results:The polysomnography failure rate reduced from 12.02% to 2.88% afater the activity.The passing rate of the theoretical knowledge and operation of nurses increased from 70% and 81% to 98% and 100%.Moreover,the comprehensive ability of team mem-bers improved significantly.Conclusion:The correct use of quality management tools can effectively reduce polysomnography failure rate as well as improve quality management ability.%目的::探讨品管圈活动在呼吸内科睡眠中心多导睡眠监测中降低多导睡眠监测的失败应用效果。方法:科内10人成立品管圈小组,通过品管圈活动步骤,运用质量管理工具对多导睡眠监测失败的原因进行分析改进,并将改进前后多导睡眠监测失败率行比较。结果:多导睡眠监测的失败率从开展活动前12.02%下降至活动后的2.88%,超出了预期目标。护士睡眠监测理论知识、操作考核合格率分别由70%、81%提高至98%、100%。此外圈员综合能力明显提升。结论:正确运用品管圈质量改进工具可有效降低多导睡眠监测的失败率,提高圈员品质和质量管理能力。

  18. New ground switches for metal oxide arresters; Nuevos desconectadores de tierra para pararrayos de oxidos metalicos

    Energy Technology Data Exchange (ETDEWEB)

    Fernandez Hevia, D.

    2011-07-01

    Metal oxide arrester (PCM) for distribution lines disconnect devices used ground wire (DCT's) to disconnect power system failure. Often, these DCT are the least reliable of the arrester, and despite its crucial role to ensure continuity, quality and ability of supply. Surprising that standards bodies have not been worked to establish criteria and tests to ensure the reliability and proper functionality of this component. In this paper we analyze the most common designs of DCT's and the problems they present. It also introduces a new generation of DCT's that solves these problems and an improvement in the guarantees of reliability and functionality of these devices. (Author) 5 refs.

  19. Secondary pseudohypoaldosteronism causing cardiopulmonary arrest and cholelithiasis.

    Science.gov (United States)

    Kibe, Tetsuya; Sobajima, Takehiro; Yoshimura, Ayumi; Uno, Yuichi; Wada, Naohiro; Ueta, Ikuya

    2014-04-01

    A 4-month-old boy presented with cardiopulmonary arrest on arrival after a brief period of lethargy. Laboratory examination indicated severe hyperkalemia, hyponatremia, metabolic acidosis, and slightly elevated C-reactive protein. Whole body computed tomography identified left-dominant hydronephrosis, hydroureter and cholelithiasis. Despite cardiac arrest >30 min, he was successfully resuscitated and treated with therapeutic hypothermia. Escherichia coli was detected on urine culture. Renal ultrasound showed bilateral hydronephrosis, grade II in the right and grade IV in the left. Retrospective analysis of the blood sample at admission indicated a high level of aldosterone. The patient recovered almost fully with no electrolyte imbalance and normal plasma renin and aldosterone, leading to the diagnosis of secondary pseudohypoaldosteronism associated with bilateral infected hydronephrosis. In this case, cholelithiasis, which may account for chronic dehydration, was a diagnostic clue in the absence of information of pre-existing situations. © 2014 The Authors. Pediatrics International © 2014 Japan Pediatric Society.

  20. Association of serum lactate with outcome after out-of-hospital cardiac arrest treated with therapeutic hypothermia

    Science.gov (United States)

    Novain, Michaël; Cattet, Florian; Plattier, Rémi; Nefzaoui, Mohamed; Hyvernat, Hervé; Raguin, Olivier; Kaidomar, Michel; Kerever, Sébastien; Ichai, Carole

    2017-01-01

    Aims Lactate reflects hypoxic insult in many conditions and is considered as a prognosis factor. But, after cardiac arrest, its interest is still debated. Our study aimed to assess the prognosis value of lactate in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. Methods This retrospective observational study included out-of-hospital cardiac arrest patients treated with therapeutic hypothermia in four ICUs. Lactate levels were compared at different times during the first 24 hours according to outcome at ICU discharge and to the type of death (multiorgan or neurologic failure). Results Two hundred and seventy-two patients were included, 89 good outcome and 183 poor outcome. In the latter group, 171 patients died, from multiorgan failure in 30% and neurologic failure in 70%. Lactate levels were higher in the poor compared to the good outcome patients at admission (5.4 (3.3–9.4) vs. 2.2 (1.5–3.6) mmol/L; padmission (7.9 (3.9–12.0) vs. 5.2 (3.3–8.8) mmol/L; p<0.01), H12 (4.9 (2.1–8.9) vs. 2.2 (1.4–3.4) mmol/L; p<0.01) and H24 (3.3 (1.8–5.5) vs. 1.4 (1.1–2.5) mmol/L; p<0.01). Initial lactate levels showed an increasing proportion of poor outcome from the first to fourth quartile. Conclusions After out-of-hospital cardiac arrest treated with therapeutic hypothermia, lactate levels during the first 24 hours seem linked with ICU outcome. Patients dying from multiorgan failure exhibit higher initial lactate concentrations than patients succumbing from neurological failure. PMID:28282398

  1. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970318 A study on evoked potentials in cor pul-monale patients with chronic respiratory failure.QIAO Hui(乔慧), et al. Beijing Neurosurg Instit,Beijing, 100050. Chin J Geriatr 1997; 16(1): 43-45. Objective: Evoked protential was used to detect thechange of brain function in cor pulmonale patients with

  2. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009170 Curcumin attenuates left ventricular dysfunction and remodeling in rabbits with chronic heart failure. TANG Yanhong(唐艳红),et al.Dept Cardiol,Renmin Hosp,Wuhan Univ,Wuhan 430060.Chin J Cardiol,2009;37(3):262-267.

  3. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008411 Expression of S100B during heart failure in rats. JIANG Zhenni(蒋珍妮), et al. Dept Cardiol, 2nd Affili Hosp, Zhejiang Univ, Coll Med Hangzhou 310009. Chin J Emerg Med 2008;17(5):475-478. Objective To evaluate the value of S100B gene on cardiovascular remodeling in rats with abdominal aorta coarctation.

  4. Failure Modes

    DEFF Research Database (Denmark)

    Jakobsen, K. P.; Burcharth, H. F.; Ibsen, Lars Bo;

    1999-01-01

    The present appendix contains the derivation of ten different limit state equations divided on three different failure modes. Five of the limit state equations can be used independently of the characteristics of the subsoil, whereas the remaining five can be used for either drained or undrained...

  5. Dental Calculus Arrest of Dental Caries

    Science.gov (United States)

    Keyes, Paul H.; Rams, Thomas E.

    2016-01-01

    Background An inverse relationship between dental calculus mineralization and dental caries demineralization on teeth has been noted in some studies. Dental calculus may even form superficial layers over existing dental caries and arrest their progression, but this phenomenon has been only rarely documented and infrequently considered in the field of Cariology. To further assess the occurrence of dental calculus arrest of dental caries, this study evaluated a large number of extracted human teeth for the presence and location of dental caries, dental calculus, and dental plaque biofilms. Materials and methods A total of 1,200 teeth were preserved in 10% buffered formal saline, and viewed while moist by a single experienced examiner using a research stereomicroscope at 15-25× magnification. Representative teeth were sectioned and photographed, and their dental plaque biofilms subjected to gram-stain examination with light microscopy at 100× magnification. Results Dental calculus was observed on 1,140 (95%) of the extracted human teeth, and no dental carious lesions were found underlying dental calculus-covered surfaces on 1,139 of these teeth. However, dental calculus arrest of dental caries was found on one (0.54%) of 187 evaluated teeth that presented with unrestored proximal enamel caries. On the distal surface of a maxillary premolar tooth, dental calculus mineralization filled the outer surface cavitation of an incipient dental caries lesion. The dental calculus-covered carious lesion extended only slightly into enamel, and exhibited a brown pigmentation characteristic of inactive or arrested dental caries. In contrast, the tooth's mesial surface, without a superficial layer of dental calculus, had a large carious lesion going through enamel and deep into dentin. Conclusions These observations further document the potential protective effects of dental calculus mineralization against dental caries. PMID:27446993

  6. Nuclear reactor melt arrest and coolability device

    Energy Technology Data Exchange (ETDEWEB)

    Theofanous, Theo G.; Dinh, Nam Truc; Wachowiak, Richard M.

    2016-06-14

    Example embodiments provide a Basemat-Internal Melt Arrest and Coolability device (BiMAC) that offers improved spatial and mechanical characteristics for use in damage prevention and risk mitigation in accident scenarios. Example embodiments may include a BiMAC having an inclination of less than 10-degrees from the basemat floor and/or coolant channels of less than 4 inches in diameter, while maintaining minimum safety margins required by the Nuclear Regulatory Commission.

  7. Rheology and structural arrest of casein suspensions

    OpenAIRE

    Dahbi, Louisa; Alexander, M.; Trappe, Véronique; Dhont, J. K. G.; Schurtenberger, Peter

    2010-01-01

    The rheology of milk powder suspensions is investigated up to very high concentrations, where structural arrest occurs. The main component of the milk powder investigated is casein, so that the suspensions can be regarded as casein suspensions. Four concentration regimes are identified. For effective casein volume fractions less than 0.54 the concentration dependence of the zero-shear viscosity is similar to that of hard-sphere suspensions. However, due to the elastic deformation of the casei...

  8. Prognostic indices in childhood heart failure

    African Journals Online (AJOL)

    hood heart failure and highlight the factors that affect out- come among cases of heart failure ... month period were studied prospectively. Diagnosis of heart ... a case-fatality rate of 24% among the study population. Poor prognostic indices ...

  9. 运用精益六西格玛降低分立器件芯片测试设备的故障率%Reduce the Use of Lean Six Sigma Discrete Chip Testing Equipment Failure Rate

    Institute of Scientific and Technical Information of China (English)

    易华波

    2013-01-01

    目的:为了提高芯片测试工序的测试产能,通过改进分立器件芯片测试工序的设备管理与流程,降低生产设备的故障率。方法:采用精益六西格玛,并通过其定义、测量、分析、改进、控制5个步骤研究,改进我公司分立器件芯片测试工序的设备管理与流程。结果:设备故障率由改进前的2.5%降低到1.4%。结论:精益六西格玛可减少设备管理与流程中存在的缺陷,降低分立器件生产设备的故障率,以便进一步提高芯片测试产能和设备管理水平。%Objective: To improve the test process test chip production capacity through improved discrete chip testing equip-ment management processes and procedures to reduce the failure rate of production equipment. Methods:Using Lean Six Sigma, and through its definition, measure, analyze, improve, control 5 steps to study and improve my company discrete chip testing equipment management processes and procedures. Results: Improved equipment failure rate decreased to 2.5% before to 1.4%Conclusion:Lean Six Sigma to reduce device management and process defects, reduce discrete manufacturing equipment failure rate, in order to further improve productivity and chip testing equipment management.

  10. Aerodynamically generated noise by lightning arrester

    Directory of Open Access Journals (Sweden)

    Váchová J.

    2007-10-01

    Full Text Available This paper presents the general solution of aerodynamically generated noise by lightning arrester. Governing equations are presented in form of Lighthill acoustic analogy, as embodied in the Ffowcs Williams-Hawkings (FW-H equation. This equation is based on conservation laws of fluid mechanics rather than on the wave equation. Thus, the FW-H equation is valid even if the integration surface is in nonlinear region. That’s why the FWH method is superior in aeroacoustics. The FW-H method is implemented in program Fluent and the numerical solution is acquired by Fluent code.The general solution of acoustic signal generated by lightning arrester is shown and the results in form of acoustic pressure and frequency spectrum are presented. The verification of accuracy was made by evaluation of Strouhal number. A comparison of Strouhal number for circumfluence of a cylinder and the lightning arrester was done, because the experimental data for cylinder case are known and these solids are supposed to be respectively in shape relation.

  11. Prognosis value of heart rate variability in children with heart failure%心率变异性测定对心力衰竭患儿预后的意义

    Institute of Scientific and Technical Information of China (English)

    褚茂平; 吴蓉洲; 荣星; 张园海; 徐强; 项如莲; 任跃

    2008-01-01

    目的 观察心力衰竭患儿心力衰竭程度与心率变异性(HRV)的关系,探讨HRV对心力衰竭患儿预后的意义.方法 对46例心力衰竭患儿[心功能Ⅰ~Ⅱ级(NYHA分级)21例,Ⅲ~Ⅳ级25例]和30例健康儿童进行24 h动态心电图HRV测定.结果 (1)心力衰竭组HRV各参数均较对照组明显降低,心功能Ⅲ~Ⅳ级HRV各参数较Ⅰ~Ⅱ级明显降低(P<0.05).(2)所有心力衰竭患儿随访(5.0±2.5)年,随访过程中死亡15例,病死率32.6%,死亡患儿HRV各参数明显降低,与存活患儿比较差异有统计学意义(P<0.01).结论 HRV可反映心力衰竭的严重程度,对心力衰竭患儿预后具有参考价值.%Objective To investigate the relationship between the heart rate variability (HRV)and severity of heart failure in children and to explore the prognosis value of HRV in children with heart faliure. Methods Forty-six children with heart failure (cardiac function of Ⅰ~Ⅱ class 21 cases and cardiac function of Ⅲ~Ⅳ class 25 cases) and 30 healthy children as the control group were measured HRV value (SDNN、 SDANN、 PNNS0、rMSSD、 TF、 VLF、 LF、 HF、 LF/HF) by 24 h dynamic electrocardiogram. Results (1) Each HRV parameter of children with heart failure was obviously lower than that of healthy children, and each of cardiac function of Ⅲ~Ⅳ class was also lower than that of Ⅰ~Ⅱ class(P <0. 05). (2) There were 15 children with DCM died in the follow-up of(5.0 ± 2. 5)years, 31 cases survived, mortality rate was 32. 6% ;HRV parameters of the died children were significantly decreased than those of survival children (P <0. 01). Conclusions HRV may be a target to evaluate the severity degree of patient's condition in the heart failure children, can be a predict factor for the prognosis of the children with heart failure.

  12. Arrest scenarios in concentrated protein solutions - from hard sphere glasses to arrested spinodal decomposition

    Science.gov (United States)

    Stradner, Anna; Bucciarelli, Saskia; Casal, Lucia; Foffi, Giuseppe; Thurston, George; Farago, Bela; Schurtenberger, Peter

    2014-03-01

    The occurrence of an arrest transition in concentrated colloid suspensions and its dependence on the interaction potential is a hot topic in soft matter. Such arrest transitions can also occur in concentrated protein solutions, as they exist e.g. in biological cells or are increasingly used in pharmaceutical formulations. Here we demonstrate the applicability of concepts from colloid science to understand the dynamics of concentrated protein solutions. In this presentation we report a combination of 3D light scattering, small-angle X-ray scattering and neutron spin echo measurements to study the structural properties as well as the collective and self diffusion of proteins in highly concentrated solutions on the relevant length and time scales. We demonstrate that various arrest scenarios indeed exist for different globular proteins. The proteins chosen are different bovine lens crystallins. We report examples of hard and attractive glass transitions and arrested spinodal decomposition directly linked to the effective pair potentials determined in static scattering experiments for the different proteins. We discuss these different arrest scenarios in view of possible applications of dense protein solutions as well as in view of their possible relevance for living systems.

  13. Arrest History and Intimate Partner Violence Perpetration in a Sample of Men and Women Arrested for Domestic Violence.

    Science.gov (United States)

    Shorey, Ryan C; Ninnemann, Andrew; Elmquist, Joanna; Labrecque, Lindsay; Zucosky, Heather; Febres, Jeniimarie; Brasfield, Hope; Temple, Jeff R; Stuart, Gregory L

    2012-01-01

    Intimate partner violence (IPV) is a serious and prevalent problem throughout the United States. Currently, individuals arrested for domestic violence are often court mandated to batterer intervention programs (BIPs). However, little is known about the arrest histories of these individuals, especially women. The current study examined the arrest histories of men (n = 303) and women (n = 82) arrested for domestic violence and court-referred to BIPs. Results demonstrated that over 30% of the entire sample had been previously arrested for a non-violent offense, and over 25% of the participants had been previously arrested for a violent offense other than domestic violence. Moreover, men were arrested significantly more frequently for violence-related and non-violent offenses than their female counterparts. In addition, men were more likely than women to have consumed binge-levels of alcohol prior to the offense that led to their most recent arrest and court-referral to a BIP. Lastly, arrest history was positively associated with physical and psychological aggression perpetration against an intimate partner for men only, such that more previous arrests were associated with more frequent aggression. These results provide evidence that many men and women arrested for domestic violence have engaged in a number of diverse criminal acts during their lifetimes, suggesting that BIPs may need to address general criminal behavior.

  14. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  15. Heart failure

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920647 Comparative effects of commonvasodilators on experimental cardiac fai-lure. LI Zhijian (李志坚), et al. Dept Cardiol,2nd Hosp, Tianjin Med Coll. Tianjin Med J1992; 20(8): 456-458. A 9×9 latin square design was employed forcomparing the effects of (1) placebo, (2) nitr-oprusside, (3) phentolamine, (4) isosorbide dini-trate. (5) captopril, (6) captopril-isosorbide

  16. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005186 The diagnostic application of bedside measurement of plasma brain natriuretic in patients with heart failure. SHAO Le-wen (邵乐文) , Advanced Ward Dept, 1st Hosp, Med Sch, Zhejiang Univ, Hangzhou 310003. Chin J Intern Med, 2005;44(2): 99-101. Objective: To investigate differential diagnosis value of ultra-rapid bedside measurement of brain na-triuretic peptide (BNP) in patients with dyspnea.

  17. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    2010316 Tissue doppler imaging observation on effect of long-term use of gingko biloba tabtet on left ventricular function in patients with chronic heart failure. ZHANG Hui(张辉),et al. Dept Cardiovasc Med, 2nd Hosp, Hebei Med Univ,Shijiazhuang 050000. Chin J Integr Tradit & West Med 2010;30(5):478-481. Objective To quantitatively observe the effect of long-term

  18. Renal failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  19. Real-world examples of sensitivity failures of the 3%/3mm pass rate metric and published action levels when used in IMRT/VMAT system commissioning

    Science.gov (United States)

    Nelms, B.; Jarry, G.; Chan, M.; Hampton, C.; Watanabe, Y.; Feygelman, V.

    2013-06-01

    In IMRT/VMAT system commissioning (as with any system), quality is improved by striving for tight tolerances of stringent metrics of accuracy. For 5 cases, passing rates for 3%/3mm gamma analysis were generated following the TG119 instructions. Subsequently, more stringent/sensitive criteria combined with advanced volumetric dose analysis were applied, and in each case significant systematic errors were clearly identified despite the high 3%/3mm passing rates. In 4 of 5 cases, the error was easily remedied. These real-world examples of observed "false negatives" (insensitivities) point towards the inappropriateness of the 3%/3mm gamma passing rate metric as the basis for acceptance testing/commissioning of the IMRT/VMAT delivery chain.

  20. 手术室马丁无影灯损坏率调查及分析%Investigation and Analysis of Failure Rate of KLS Martin Operating Astral Lamp

    Institute of Scientific and Technical Information of China (English)

    杨宪章; 王晓民; 刘乃智; 辛泉军

    2012-01-01

    目的:解决手术室无影灯故障率高发问题.方法:统计记录手术室无影灯灯泡损坏率,进行数学分析,根据分析结果现场排除故障.结果:发现了无影灯灯泡寿命较短的多重原因,通过更换部件、调试直流供电终端电压的方法排除了故障.结论:在进口马丁无影灯初次安装后,一定要对其进行灯泡输入电压测试,避免因电压过高而降低灯泡使用寿命.%Objective To cut the high failure rate of the operating astral lamp. Methods The failure rate of the operating astral lamp was counted and analyzed, and the problem was solved according to mathematical analysis results. Results Multiple causes of the low lifetime of operating astral lamps were discovered. The Problems were conquered by replacing the components and debugging the DC voltage of power supply terminal. Conclusion It is necessary to test the input voltage to avoid reducing the lamp lifetime for higher voltage after installing operating astral lamps imported from KLS Martin.

  1. Location of out-of-hospital cardiac arrest as a determinant in the survival of patients

    Directory of Open Access Journals (Sweden)

    Jokšić-Mazinjanin Radojka

    2016-01-01

    Full Text Available Introduction. Cardiac arrest (CA is defined as a sudden cessation of normal circulation of blood due to failure of the heart to contract effectively during systole. Objective. The aim of this study was to determine the difference in outcome among patients, depending on the location of out-of-hospital CA; to determine the influence of observed determinants on the survival rate. Methods. Observational and retrospective study was conducted in the Institute for Emergency Medical Service Novi Sad (IEMS NS. It included patients who underwent cardiopulmonary resuscitation (CPR by medical ambulance squads. Patients were divided into three groups, based on the location of CA: private place, public place, and medical institution. Results. CA occurred in private places in 151 cases (76.26%. The shortest duration of a phone call with the dispatcher and Reaction Time I was in the group of patients with CA in a public place (59.1 ± 36.4 seconds and 137.1 ± 89.8 seconds, respectively. CA was recognized in more than 80% of cases, but CPR was initiated in only 9.09% of patients in private places and in 19.35% of patients in public places. Though they initially presented with shockable rhythm in 57.14% of cases in public places, this group has the worst immediate outcome (11.43%, in contrast to the patients with CA in medical institutions (58.33%. Factors determining the survival of patients with CA were CPR attempted immediately after collapse, initial rhythm and eyewitnesses of CA. Conclusion. In order to improve survival of patients with out-of-hospital CA, both education of laymen and introduction of standard questioning protocol in the IEMS Call Centre are necessary. [Projekat Ministarstva nauke Republike Srbije, br. 175007

  2. Heart failure - tests

    Science.gov (United States)

    CHF - tests; Congestive heart failure - tests; Cardiomyopathy - tests; HF - tests ... the best test to: Identify which type of heart failure (systolic versus diastolic, valvular) Monitor your heart failure ...

  3. Heart failure - home monitoring

    Science.gov (United States)

    ... failure - discharge Heart failure - fluids and diuretics Heart failure - what to ask ... Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, ...

  4. Hydroxylated PBDEs induce developmental arrest in zebrafish

    Energy Technology Data Exchange (ETDEWEB)

    Usenko, Crystal Y., E-mail: Crystal_usenko@baylor.edu; Hopkins, David C.; Trumble, Stephen J., E-mail: Stephen_trumble@baylor.edu; Bruce, Erica D., E-mail: Erica_bruce@baylor.edu

    2012-07-01

    The ubiquitous spread of polybrominated diphenyl ethers (PBDEs) has led to concerns regarding the metabolites of these congeners, in particular hydroxylated PBDEs. There are limited studies regarding the biological interactions of these chemicals, yet there is some concern they may be more toxic than their parent compounds. In this study three hydroxylated PBDEs were assessed for toxicity in embryonic zebrafish: 3-OH-BDE 47, 5-OH-BDE 47, and 6-OH-BDE 47. All three congeners induced developmental arrest in a concentration-dependent manner; however, 6-OH-BDE 47 induced adverse effects at lower concentrations than the other congeners. Furthermore, all three induced cell death; however apoptosis was not observed. In short-term exposures (24–28 hours post fertilization), all hydroxylated PBDEs generated oxidative stress in the region corresponding to the cell death at 5 and 10 ppm. To further investigate the short-term effects that may be responsible for the developmental arrest observed in this study, gene regulation was assessed for embryos exposed to 0.625 ppm 6-OH-BDE 47 from 24 to 28 hpf. Genes involved in stress response, thyroid hormone regulation, and neurodevelopment were significantly upregulated compared to controls; however, genes related to oxidative stress were either unaffected or downregulated. This study suggests that hydroxylated PBDEs disrupt development, and may induce oxidative stress and potentially disrupt the cholinergic system and thyroid hormone homeostasis. -- Highlights: ► OH-PBDEs induce developmental arrest in a concentration-dependent manner. ► Hydroxyl group location influences biological interaction. ► OH-PBDEs induce oxidative stress. ► Thyroid hormone gene regulation was disrupted following exposure. ► To our knowledge, this is the first whole organism study of OH-PBDE toxicity.

  5. Brain stem death as the vital determinant for resumption of spontaneous circulation after cardiac arrest in rats.

    Directory of Open Access Journals (Sweden)

    Alice Y W Chang

    bioenergetic failure in RVLM by coenzyme Q10, the mobile electron carrier in mitochondrial respiratory chain, or oxygenation restored spontaneous circulation further established a causal relationship between functionality of RVLM and resumed spontaneous circulation after cardiac arrest. CONCLUSIONS/SIGNIFICANCE: We conclude that whereas necrotic cell death because of bioenergetic failure triggered by anoxia in RVLM, which precipitates brain stem death, negates resuscitation of an arrested heart, maintained functional integrity of this neural substrate holds the key to resumption of spontaneous circulation after cardiac arrest in rats.

  6. High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo

    Directory of Open Access Journals (Sweden)

    Mounerou Salou

    2016-04-01

    Full Text Available Introduction: Antiretroviral treatment (ART has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. Methods: HIV viral load (VL testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014. Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA. Genotypic drug resistance was done for all samples with VL>1000 copies/ml. Results and discussion: Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59% were adolescents and 116 (41% were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months. For 228 (80.6%, the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs (zidovudine and lamivudine and one non-nucleoside reverse transcriptase inhibitor (NNRTI (nevirapine or efavirenz. Only 28 (9.9% were on a protease inhibitor (PI-based regimen. VL was below the detection limit (i.e. 40 copies/ml for 102 (36%, between 40 and 1000 copies/ml for 35 (12.4% and above 1000 copies/ml for 146 (51.6%. Genotypic drug-resistance testing was successful for 125/146 (85.6%; 110/125 (88.0% were resistant to both NRTIs and NNRTIs, 1/125 (0.8% to NRTIs only, 4/125 (3.2% to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125 of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in

  7. High rates of virological failure and drug resistance in perinatally HIV-1-infected children and adolescents receiving lifelong antiretroviral therapy in routine clinics in Togo

    Science.gov (United States)

    Salou, Mounerou; Dagnra, Anoumou Y; Butel, Christelle; Vidal, Nicole; Serrano, Laetitia; Takassi, Elom; Konou, Abla A; Houndenou, Spero; Dapam, Nina; Singo-Tokofaï, Assetina; Pitche, Palokinam; Atakouma, Yao; Prince-David, Mireille; Delaporte, Eric; Peeters, Martine

    2016-01-01

    Introduction Antiretroviral treatment (ART) has been scaled up over the last decade but compared to adults, children living with HIV are less likely to receive ART. Moreover, children and adolescents are more vulnerable than adults to virological failure (VF) and emergence of drug resistance. In this study we determined virological outcome in perinatally HIV-1-infected children and adolescents receiving ART in Togo. Methods HIV viral load (VL) testing was consecutively proposed to all children and adolescents who were on ART for at least 12 months when attending HIV healthcare services for their routine follow-up visit (June to September 2014). Plasma HIV-1 VL was measured using the m2000 RealTime HIV-1 assay (Abbott Molecular, Des Plaines, IL, USA). Genotypic drug resistance was done for all samples with VL>1000 copies/ml. Results and discussion Among 283 perinatally HIV-1-infected children and adolescents included, 167 (59%) were adolescents and 116 (41%) were children. The median duration on ART was 48 months (interquartile range: 28 to 68 months). For 228 (80.6%), the current ART combination consisted of two nucleoside reverse transcriptase inhibitors (NRTIs) (zidovudine and lamivudine) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) (nevirapine or efavirenz). Only 28 (9.9%) were on a protease inhibitor (PI)-based regimen. VL was below the detection limit (i.e. 40 copies/ml) for 102 (36%), between 40 and 1000 copies/ml for 35 (12.4%) and above 1000 copies/ml for 146 (51.6%). Genotypic drug-resistance testing was successful for 125/146 (85.6%); 110/125 (88.0%) were resistant to both NRTIs and NNRTIs, 1/125 (0.8%) to NRTIs only, 4/125 (3.2%) to NNRTIs only and three harboured viruses resistant to reverse transcriptase and PIs. Overall, 86% (108/125) of children and adolescents experiencing VF and successfully genotyped, corresponding thus to at least 38% of the study population, had either no effective ART or had only a single effective drug in

  8. A case of thyroid storm with cardiac arrest

    Directory of Open Access Journals (Sweden)

    Nakashima Y

    2014-05-01

    Full Text Available Yutaka Nakashima,1 Tsuneaki Kenzaka,2 Masanobu Okayama,3 Eiji Kajii31Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, 2Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan; 3Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, JapanAbstract: A 23-year-old man became unconscious while jogging. He immediately received basic life support from a bystander and was transported to our hospital. On arrival, his spontaneous circulation had returned from a state of ventricular fibrillation and pulseless electrical activity. Following admission, hyperthyroidism led to a suspicion of thyroid storm, which was then diagnosed as a possible cause of the cardiac arrest. Although hyperthyroidism-induced cardiac arrest including ventricular fibrillation is rare, it should be considered when diagnosing the cause of treatable cardiac arrest.Keywords: hyperthyroidism, ventricular fibrillation, treatable cardiac arrest, cardiac arrest, cardiopulmonary arrest

  9. Sign and magnitude scaling properties of heart rate variability in patients with end-stage renal failure: Are these properties useful to identify pathophysiological adaptations?

    Science.gov (United States)

    Lerma, Claudia; Echeverría, Juan C.; Infante, Oscar; Pérez-Grovas, Héctor; González-Gómez, Hortensia

    2017-09-01

    The scaling properties of heart rate variability data are reliable dynamical features to predict mortality and for the assessment of cardiovascular risk. The aim of this manuscript was to determine if the scaling properties, as provided by the sign and magnitude analysis, can be used to differentiate between pathological changes and those adaptations basically introduced by modifications of the mean heart rate in distinct manoeuvres (active standing or hemodialysis treatment, HD), as well as clinical conditions (end stage renal disease, ESRD). We found that in response to active standing, the short-term scaling index (α1) increased in healthy subjects and in ESRD patients only after HD. The sign short-term scaling exponent (α1sign) increased in healthy subjects and ESRD patients, showing a less anticorrelated behavior in active standing. Both α1 and α1sign did show covariance with the mean heart rate in healthy subjects, while in ESRD patients, this covariance was observed only after HD. A reliable estimation of the magnitude short-term scaling exponent (α1magn) required the analysis of time series with a large number of samples (>3000 data points). This exponent was similar for both groups and conditions and did not show covariance with the mean heart rate. A surrogate analysis confirmed the presence of multifractal properties (α1magn > 0.5) in the time series of healthy subjects and ESDR patients. In conclusion, α1 and α1sign provided insights into the physiological adaptations during active standing, which revealed a transitory impairment before HD in ESRD patients. The presence of multifractal properties indicated that a reduced short-term variability does not necessarily imply a declined regulatory complexity in these patients.

  10. Evaluation of deceleration capacity rate for short-term prognosis in patients with chronic heart failure%心率减速力对慢性心力衰竭患者近期预后的评估价值

    Institute of Scientific and Technical Information of China (English)

    张萍; 娄美娜; 章慧娣

    2015-01-01

    Objective To assess the deceleration capacity (DC) rate for the severity and short-term prognosis in patients with chronic heart failure (CHF). Methods Eighty CHF patients in the First Affiliated Hospital of Wenzhou Medical University from October 2012 to May 2013 were enrolled as the CHF group, and the same period of age, gender matched seventy-six healthy cases served as the control group. The levels of DC and average heart rate parameter were detected by dynamic electrocardiogram, and the left ventricular end-diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were measured by echocardiography. According to the NewYork Heart Association classification, CHF patients were divided into the classⅡgroup (26 cases), classⅢgroup (28 cases) and classⅣgroup (26 cases), and DC LVEDd and LVEF were compared between the CHF subgroups. The levels of DC and average heart rate parameter were compared between the CHF group and control group. Pearsonˊs method was employed to analyze the DC, LVEDd and LVEF. CHF patients were followed up for 6-12 months. The cardiac death, malignant ventricular arrhythmia, cardiac shock and re-hospitalization due to heart failure were further analyzed according to the different DC values in the CHF patients (low, intermediate and high risk groups). Results Compared with the control group, DC value decreased and average heart rate increased in the CHF group (t=2.28, 2.24; all P 0.05). The incidence of cardiac death, malignant ventricular arrhythmia and re-hospitalization due to heart failure in the high-risk group were higher than those in the low and intermediate risk groups (χ2=5.08, 7.65, 6.08; all P0.05)。随访结果发现,高危组患者心源性猝死,恶性室性心律失常及反复心力衰竭发作再住院的发生率明显高于低中危组(χ2=5.08、7.65、6.08,P均<0.05)。结论CHF患者血清DC值明显降低,且随着心功能的恶化而下降,DC值不仅能反映心力衰竭的严

  11. 慢性心力衰竭患者肝、肾功能不全发生率及其与心衰严重程度的关系%The incidence rate of liver and renal insufficiency in the patients with chronic cardiac failure and its relationship with heart failure severity

    Institute of Scientific and Technical Information of China (English)

    戴希友

    2014-01-01

    Objective:To explore the incidence rate of liver and renal insufficiency in the patients with chronic cardiac failure(CHF) and its relationship with heart failure severity.Methods:96 cases with CHF were selected.According to the NYHA heart function classification,they were randomly divided into cardiac function Ⅰ,Ⅱ,Ⅲ,Ⅳ group.The incidence rates of liver and renal insufficiency of each groups were respectively calculated.The changs of alanine aminotransferase(ALT)、 glomerular filtration rate(eGFR) level and the relationship with heart failure severity.Results:The incidence rates of liver and renal insufficiency in the patients with chronic cardiac failure were respectively 42.0% and 38.5% .With the rise of heart function classification,the incidence rate of liver and renal insufficiency was rised.With the continuous deterioration of heart function, serum ALT and eGFR concentration were gradually increased,and there was significant difference in 4 groups(P<0.05). Conclusion:The phenomenon of liver and renal insufficiency in the patients with chronic cardiac failure is quite common.The cardiac functional grading of patients is more higher.The liver and kidney function damage will be more serious.%目的:探讨慢性心力衰竭(CHF)患者肝、肾功能不全发生率及其与心衰严重程度的关系。方法:收治CHF患者96例,按照NYHA心功能分级随机分为心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级组,分别计算各组肝、肾功能不全发生率,探讨丙氨酸氨基转移酶(ALT)、肾小球滤过率(eGFR)水平的变化与心衰严重程度的关系。结果:慢性心衰患者肝、肾功能不全的发生率分别为42.0%、38.5%,并且随心功能分级的升高,肝、肾功能不全发生率也在升高;随着心功能的不断恶化,血清ALT、eGFR浓度也逐渐升高,且4组组间差异有统计学意义(P<0.05)。结论:慢性心衰患者中肝、肾功能不全的现象相当普遍,且患者心功能分级越

  12. Electrothermal model for complete metal-oxide surge arresters

    Energy Technology Data Exchange (ETDEWEB)

    Costa, E. Guedes da; Naidu, S.R. [UFPB, Dept. of Electrical Engineering, Campina Grande, PB (Brazil); Lima, A. Guedes de [CEFET-PB, Dept. of Mechanical Engineering, Joao Pessoa, PB (Brazil)

    2001-01-01

    A computational, electrothermal model for a complete metal-oxide surge arrester based on the implicit form of the finite-differences method is presented. The model is used to calculate the cooling curve after the application of overvoltages and the temperature variations during standard test. The model has been checked against experiments carried out on a test section and a complete surge arrester and the behaviour of a hypothetical surge arrester during standard tests simulated. (Author)

  13. The insulation coordination and surge arrester design for HTS cable system in Icheon substation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hansang, E-mail: Hansang80@korea.ac.kr [School of Railway and Electrical Engineering, Kyungil University, Hayang-eup, Gyeongsan-si, Gyeongsangbuk-do 712-701 (Korea, Republic of); Yoon, Dong-Hee [Department of New and Renewable Energy, Kyungil University, Hayang-eup, Gyeongsan-si, Gyeongsangbuk-do 712-701 (Korea, Republic of); Lee, Seung-Ryul [Korea Electrotechnology Research Institute, Naeson-dong, Uiwang-si, Gyeonggi-do 437-080 (Korea, Republic of); Yang, Byeong-Mo [Korea Electric Power Research Institute, Munji-dong, Yuseong-gu, Daejeon 305-760 (Korea, Republic of); Jang, Gilsoo, E-mail: gjang@korea.ac.kr [School of Electrical Engineering, Korea University, Anam-dong 5-ga, Seongbuk-gu, Seoul 136-713 (Korea, Republic of)

    2013-01-15

    Highlights: ► It is necessary to study lightning response of the HTS cable. ► The analytic model has been developed for the HTS cable in the Icheon substation. ► Well-designed surge arrester has been verified through PSCAD/EMTDC simulations. -- Abstract: This paper proposes an insulation coordination and surge arrester design for HTS (High-Temperature Superconducting) cable system in Icheon substation in Korea. In the aspect of the economic analysis, since the HTS cable is very expensive, the insulation coordination to prevent the dielectric breakdown caused by the lightning surge should be considered carefully. Also, in the aspect of the power system reliability, since the HTS cable has much more capacity compared than conventional power cables and the ripple effect from the HTS cable failure may lead to the wide area blackout, an intensive study for insulation coordination from lightning surge is one of the most important considerations. In this paper, the insulation coordination for lightning surge is verified using HTS cable and power equipment models and the design of the proper surge arrester is proposed.

  14. Mayo Registry for Telemetry Efficacy in Arrest (MR TEA) study: An analysis of code status change following cardiopulmonary arrest.

    Science.gov (United States)

    Snipelisky, David; Ray, Jordan; Matcha, Gautam; Roy, Archana; Chirila, Razvan; Maniaci, Michael; Bosworth, Veronica; Whitman, Anastasia; Lewis, Patricia; Vadeboncoeur, Tyler; Kusumoto, Fred; Burton, M Caroline

    2015-07-01

    Code status discussions are important during a hospitalization, yet variation in its practice exists. No data have assessed the likelihood of patients to change code status following a cardiopulmonary arrest. A retrospective review of all patients that experienced a cardiopulmonary arrest between May 1, 2008 and June 30, 2014 at an academic medical center was performed. The proportion of code status modifications to do not resuscitate (DNR) from full code was assessed. Baseline clinical characteristics, resuscitation factors, and 24-h post-resuscitation, hospital, and overall survival rates were compared between the two subsets. A total of 157 patients survived the index event and were included. One hundred and fifteen (73.2%) patients did not have a change in code status following the index event, while 42 (26.8%) changed code status to DNR. Clinical characteristics were similar between subsets, although patients in the change to DNR subset were older (average age 67.7 years) compared to the full code subset (average age 59.2 years; p = 0.005). Patients in the DNR subset had longer overall resuscitation efforts with less attempts at defibrillation. Compared to the DNR subset, patients that remained full code demonstrated higher 24-h post-resuscitation (n = 108, 93.9% versus n = 32, 76.2%; p = 0.001) and hospital (n = 50, 43.5% versus n = 6, 14.3%; p = 0.001) survival rates. Patients in the DNR subset were more likely to have neurologic deficits on discharge and shorter overall survival. Patient code status wishes do tend to change during critical periods within a hospitalization, adding emphasis for continued code status evaluation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Embryo quality before and after slow freezing: Viability, implantation and pregnancy rates in 627 single frozen-thawed embryo replacement cycles following failure of fresh transfer.

    Science.gov (United States)

    Capodanno, Francesco; De Feo, Gaetano; Gizzo, Salvatore; Nicoli, Alessia; Palomba, Stefano; La Sala, Giovanni Battista

    2016-06-01

    Frozen embryo transfer cycles are now common practice, however, various aspects regarding the potential of frozen embryos remain unclear. The main goal of the present study was to assess embryo quality before and after slow freezing procedure, and more specifically blastomere loss and embryo quality as indicator of viability. A single center retrospective analysis of single frozen-thawed embryo replacements (s-FER) was performed. The embryo quality before and after slow freezing and thawing, implantation, and pregnancy rates were recorded. One hundred and twenty seven s-FER were included in the final analysis. The probability of achieving an ongoing pregnancy was significantly associated with embryo quality and the percentage of blastomere loss after thawing. Considering thawed embryos, a non-significant difference in term of implantation rate was observed, regardless to their post-thawing quality and the percentage of blastomeres loss. In conclusion, current data suggest that thawed embryos are capable of implantation regardless of their morphological quality and the degree of cryoinjury sustained.

  16. Knowledge-sharing Behavior and Post-acquisition Integration Failure

    DEFF Research Database (Denmark)

    Gammelgaard, Jens; Husted, Kenneth; Michailova, Snejina

    2004-01-01

    AbstractNot achieving the anticipated synergy effects in the post-acquisition integration context is a serious causefor the high acquisition failure rate. While existing studies on failures of acquisitions exist fromeconomics, finance, strategy, organization theory, and human resources management...... important insights toexplaining the high failure rate in acquisitions.Descriptors: post-acquisition integration, acquisition failure, individual knowledge-sharing behavior...

  17. Change and significance of heart rate turbulence in patients with chronic heart failure%慢性心力衰竭患者心率震荡现象的变化及其意义

    Institute of Scientific and Technical Information of China (English)

    石菲菲; 邰竞竞; 辛雨; 李晓东

    2011-01-01

    目的 探讨慢性心力衰竭(CHF)患者心率震荡(HRT)现象的特征,及其与左室射血分数(LVEF),心率变异性(HRV)等的相关性.方法 选择心衰患者58名(心衰组)和非心衰患者65名(对照组),从动态心电图和超声心动图获得HRT、HRV、左室舒张末期内径(LVEDD)、LVEF等指标,并对这些指标进行分析.结果 心衰组和对照组的HRT、HRV、LVEF、LVEDD、QT间期离散度(QTcd)、平均心事有显著统计学差异,而24h室性期前收缩的数量没有统计学意义.HRT与LVEF、LVEDD、SDNN等指标呈相关关系.结论 心衰组患者HRT减弱,HRT可以反映心脏自主神经功能的状态.%Objective To analyze the feature of heart rate turbulence ( HRT) in patients with chronic heart failure ( CHF) and the relation between HRT, left ventricular ejection fraction ( LVEF) , heart rate variability (HRV) and so on. Methods 58 patients with chronic heart failure ( CHF group) and 65 cases of non-chronic heart failure ( control group) were chosen , these indexes were recorded including HRT,HRV,LVEF,LVEDD and so on from echocardiography and 24-hour Holter monitoring. Statistical method was used to analyze all the data. Results There was statistical difference in HRT, HRV, LVEF, LVEDD, QTcd and mean heart rate, while there was no statistical difference in ventricular premature complexes of 24 hours between CHF patients and control group. HRT were correlated with LVEF, LVEDD and SDNN. Conclusion The HRT in patients with CHF was decreased. HRT could reflect cardiac autonomic nerve status.

  18. Breeding performance of blue tits (Cyanistes cæruleus ultramarinus) in relation to lead pollution and nest failure rates in rural, intermediate, and urban sites in Algeria.

    Science.gov (United States)

    Brahmia, Zahra; Scheifler, Renaud; Crini, Nadia; Maas, Samuel; Giraudoux, Patrick; Benyacoub, Slim

    2013-03-01

    The breeding parameters and the egg and nestling morphology of Cyanistes caeruleus populations from rural, intermediate, and urban sites in Algeria and the relationships of those variables with lead contamination were studied during three consecutive years. Breeding success was explained only by predation and vandalism rates. Predation was higher in the rural area, whereas vandalism was higher in the urban site. The other measured breeding parameters and egg characteristics were relatively insensitive to study site. The morphology of urban nestlings exhibited a trend toward smaller body size and mass compared to individuals from intermediate and rural sites. Although lead concentrations were higher in the tissues of urban birds than in intermediate and rural individuals, we did not detect a clear influence of this variable on nestling morphology. We conclude that urbanization influenced blue tit breeding parameters through predation and vandalism and nestling morphology through mechanisms other than lead pollution. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Liquefaction, flow, and associated ground failure

    Science.gov (United States)

    Youd, T. Leslie

    1973-01-01

    Ambiguities in the use of the term liquefaction and in defining the relation between liquefaction and ground failure have led to encumbered communication between workers in various fields and between specialists in the same field, and the possibility that evaluations of liquefaction potential could be misinterpreted or misapplied. Explicit definitions of liquefaction and related concepts are proposed herein. These definitions, based on observed laboratory behavior, are then used to clarify the relation between liquefaction and ground failure. Soil liquefaction is defined as the transformation of a granular material from a solid into a liquefied state as a consequence of increased pore-water pressures. This definition avoids confusion between liquefaction and possible flow-failure conditions after liquefaction. Flow-failure conditions are divided into two types: (1) unlimited flow if pore-pressure reductions caused by dilatancy during flow deformation are not sufficient to solidify the material and thus arrest flow, and (2) limited flow if they are sufficient to solidify the material after a finite deformation. After liquefaction in the field, unlimited flow commonly leads to flow landslides, whereas limited flow leads at most to lateral-spreading landslides. Quick-condition failures such as loss of bearing capacity form a third type of ground failure associated with liquefaction.

  20. Tooth anomalies associated with failure of eruption of first and second permanent molars.

    Science.gov (United States)

    Baccetti, T

    2000-12-01

    The occurrence of tooth anomalies in association with failure of the first and second molars to erupt was assessed in a sample of 1520 nonsyndromic subjects with uncrowded dental arches (mean age, 14 years 4 months) and compared with the prevalence rate calculated in a matched control group of 1000 subjects. The tooth anomalies examined included infraocclusion of deciduous molars, palatal displacement of maxillary canines, rotation of maxillary lateral incisors, aplasia of second premolars, and small size of maxillary lateral incisors. Associations among arrested eruption of first and second permanent molars and anomalies in tooth eruption and position (infraoccluded deciduous molars, palatally displaced canines, rotated maxillary lateral incisors) were highly significant (P position, most likely under genetic influence.

  1. Phenomenological Studies of Macroscale Failure in Metals

    Energy Technology Data Exchange (ETDEWEB)

    Kashiwa, Bryan Andrew [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Hull, Lawrence Mark [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-12-06

    Highlights of recent phenomenological studies of metal failure are given. Failure leading to spallation and fragmentation are typically of interest. The current ‘best model’ includes the following; a full history stress in tension; nucleation initiating dynamic relaxation; toward a tensile yield function; failure dependent on strain, strain rate, and temperature; a mean-preserving ‘macrodefect’ is introduced when failure occurs in tension; and multifield theoretical refinements

  2. Dux4 induces cell cycle arrest at G1 phase through upregulation of p21 expression

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Hongliang; Wang, Zhaoxia; Jin, Suqin; Hao, Hongjun [Department of Neurology, Peking University First Hospital, Beijing 100034 (China); Zheng, Lemin [The Institute of Cardiovascular Sciences, Peking University Health Science Center, Key Laboratory of Molecular Cardiovascular Sciences of Education Ministry, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides of Health Ministry, Beijing 100191 (China); Zhou, Boda [The Department of Cardiology, Peking University Third Hospital, Beijing 100191 (China); Zhang, Wei; Lv, He [Department of Neurology, Peking University First Hospital, Beijing 100034 (China); Yuan, Yun, E-mail: yuanyun2002@sohu.com [Department of Neurology, Peking University First Hospital, Beijing 100034 (China)

    2014-03-28

    Highlights: • Dux4 induced TE671 cell proliferation defect and G1 phase arrest. • Dux4 upregulated p21 expression without activating p53. • Silencing p21 rescued Dux4 mediated proliferation defect and cell cycle arrest. • Sp1 binding site was required for Dux4-induced p21 promoter activation. - Abstract: It has been implicated that Dux4 plays crucial roles in development of facioscapulohumeral dystrophy. But the underlying myopathic mechanisms and related down-stream events of this retrogene were far from clear. Here, we reported that overexpression of Dux4 in a cell model TE671 reduced cell proliferation rate, and increased G1 phase accumulation. We also determined the impact of Dux4 on p53/p21 signal pathway, which controls the checkpoint in cell cycle progression. Overexpression of Dux4 increased p21 mRNA and protein level, while expression of p53, phospho-p53 remained unchanged. Silencing p21 rescued Dux4 mediated proliferation defect and cell cycle arrest. Furthermore, we demonstrated that enhanced Dux4 expression increased p21 promoter activity and elevated expression of Sp1 transcription factor. Mutation of Sp1 binding site decreased dux4 induced p21 promoter activation. Chromatin immunoprecipitation (ChIP) assays confirmed the Dux4-induced binding of Sp1 to p21 promoter in vivo. These results suggest that Dux4 might induce proliferation inhibition and G1 phase arrest through upregulation of p21.

  3. Willingness to Perform Chest Compression Only in Witnessed Cardiac Arrest Victims versus Cardiopulmonary Resuscitation in Iran

    Directory of Open Access Journals (Sweden)

    Nesreen Yaghmour

    2015-03-01

    Full Text Available Background: Performing immediate bystander Cardio Pulmonary Resuscitation (CPR is the most important factor that determines survival from cardiac arrest. Recommended mouth to mouth ventilation maneuver during CPR has led to lower rate of CPR performance in the population. Objectives: The present survey aimed to evaluate the willingness of nurses at Shiraz University of Medical Sciences for performing CPR versus chest-compression-only CPR. Patients and Methods: During a CPR course, we performed a survey on 25 nurses from Shiraz University of Medical Sciences, Iran. This survey included age and gender of the participants. In the first question, they were asked about their willingness to perform CPR with mouth to mouth breathing for witnessed cardiac arrest victims. In the second question, they were asked about their willingness to perform chest compression only for cardiac arrest victims. Results: Among the participating nurses, 96% were female with a mean age of 31 years. Only 40% were willing to perform CPR that requires mouth to mouth ventilation. On the other hand, 92% were willing to perform chest compression only without mouth to mouth ventilation. The mean age of the nurses who would do CPR was lower compared to those who would not. Conclusions: In this survey, we demonstrated that eliminating mouth to mouth ventilation maneuver could lead to markedly higher willingness to perform CPR for witnessed cardiac arrest victims in CPR trained nursing personnel. Our study is in agreement with other studies advocating that chest-compression-only CPR could lead to higher bystander resuscitation efforts.

  4. Study regarding the survival of patients suffering a traumatic cardiac arrest.

    Science.gov (United States)

    Georgescu, V; Tudorache, O; Nicolau, M; Strambu, V

    2015-01-01

    Severe trauma is the most frequent cause of death in young people, in civilized countries with major social and vital costs. The speed of diagnostic decision making and the precocity of treatment approaches are both essential and depend on the specialists' colaboration. The present study aims to emphasize the actual situation of medical interventions in case of cardiorespiratory arrest due to trauma. 1387 patients who suffered a cardio respiratory arrest both traumatic and non-traumatic were included in order to point out the place of traumatic arrest. Resuscitation of such patients is considered useless and resource consumer by many trauma practitioners who are reporting survival rates of 0%-3.5%. As the determinant of lesions, trauma etiology was as it follows car accidents - 43%, high falls - 30%, suicidal attempts - 3%, domestic violence - 3%, other causes - 21%. Hypovolemia remains the major cause of cardiac arrest and death and that is why the efforts of emergency providers (trauma team) must be oriented towards "hidden death" in order to avoid it. This condition could be revealed and solved easier with minimal diagnostic and therapeutic maneuvers in the emergency department.

  5. Perioperative acute renal failure.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  6. Heart rate is a marker of amiodarone mortality reduction in severe heart failure. The GESICA-GEMA Investigators. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina-Grupo de Estudios Multicéntricos en Argentina.

    Science.gov (United States)

    Nul, D R; Doval, H C; Grancelli, H O; Varini, S D; Soifer, S; Perrone, S V; Prieto, N; Scapin, O

    1997-05-01

    The impact of amiodarone on mortality in patients with severe congestive heart failure (CHF) (New York Heart Association functional classes II [advanced], III and IV; left ventricular ejection fraction Cardiaca en Argentina (GESICA) trial was analyzed in relation to initial mean baseline heart rate (BHR) and its change after 6 months of follow-up. Trials of amiodarone therapy in CHF have produced discordant results, suggesting that the effect is not uniform in all patient subgroups with regard to survival. The present analysis was carried out in 516 patients randomized to receive amiodarone, 300 mg/day (n = 260), or nonantiarrhythmic therapy (n = 256, control group) and followed up for 2 years. Survival was evaluated for patients with a BHR > or = 90 beats/min (control: n = 132; amiodarone: n = 122) and or = 90 beats/min, amiodarone therapy reduced mortality to 38.4% compared with 62.4% in control patients (relative risk [RR] 0.55, 95% confidence interval [CI] 0.35 to 0.95, p or = 90 beats/min, which was reduced at 6 months. Elevated rest heart rates in severe CHF identify a subgroup of patients who benefit from treatment with amiodarone. Amiodarone-induced heart rate slowing may be an important benefit for patients.

  7. Predicting Failure Progression and Failure Loads in Composite Open-Hole Tension Coupons

    Science.gov (United States)

    Arunkumar, Satyanarayana; Przekop, Adam

    2010-01-01

    Failure types and failure loads in carbon-epoxy [45n/90n/-45n/0n]ms laminate coupons with central circular holes subjected to tensile load are simulated using progressive failure analysis (PFA) methodology. The progressive failure methodology is implemented using VUMAT subroutine within the ABAQUS(TradeMark)/Explicit nonlinear finite element code. The degradation model adopted in the present PFA methodology uses an instantaneous complete stress reduction (COSTR) approach to simulate damage at a material point when failure occurs. In-plane modeling parameters such as element size and shape are held constant in the finite element models, irrespective of laminate thickness and hole size, to predict failure loads and failure progression. Comparison to published test data indicates that this methodology accurately simulates brittle, pull-out and delamination failure types. The sensitivity of the failure progression and the failure load to analytical loading rates and solvers precision is demonstrated.

  8. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S

    2010-01-01

    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  9. Arrested puberty associated with a Sertoli-Leydig cell tumor.

    Science.gov (United States)

    Kelly, A C; Feinman, M A; Husami, N

    1985-06-01

    Androgen-producing ovarian tumors are rarely recognized as a cause of delayed or arrested puberty, despite their frequent association with secondary amenorrhea in the older patient. A case is discussed of a Sertoli-Leydig cell tumor in an 18-year-old girl resulting in arrest of breast development and primary amenorrhea.

  10. Evolution of the dragonfly head-arresting system

    Science.gov (United States)

    Gorb, S. N.

    1999-01-01

    The arrester or fixation system of the head in adult Odonata is unique among arthropods. This system involves the organs of two body segments: the head and the neck. It consists of a skeleton–muscle apparatus that sets the arrester parts in motion. The parts comprise formations covered with complicated microstructures: fields of microtrichia on the rear surface of the head and post-cervical sclerites of the neck. The arrester immobilizes the head during feeding or when the dragonfly is in tandem flight. Thus, it may serve as an adaptation to save the head from violent mechanical disturbance and to stabilize gaze in a variety of behavioural situations. This study shows the evolutionary trend of the arrester in the order Odonata by using scanning electron microscopy and measurements of arrester structures in 227 species from 26 odonate families. The arrester design occurring in the Epiophlebiidae, Gomphidae, Neopetaliidae, Petaluridae and Chlorogomphinae is suggested to be the basic one. Two convergent pathways of head-arrester evolution among Zygoptera and Anisoptera are proposed. The possible functional significance of the arrester system is discussed.

  11. Sustained virologic response rates with telaprevir by response after 4 weeks of lead-in therapy in patients with prior treatment failure.

    Science.gov (United States)

    Foster, Graham R; Zeuzem, Stefan; Andreone, Pietro; Pol, Stanislas; Lawitz, Eric J; Diago, Moises; Roberts, Stuart; Pockros, Paul J; Younossi, Zobair; Lonjon-Domanec, Isabelle; De Meyer, Sandra; Luo, Don; George, Shelley; Beumont, Maria; Picchio, Gaston

    2013-03-01

    For hepatitis C virus (HCV)-infected patients who have not responded to previous PegIFN/ribavirin treatment, it is unclear whether subsequent direct-acting antiviral therapy outcomes are better predicted by prior treatment response or by on-treatment response to a PegIFN/ribavirin lead-in. In REALIZE, treatment-experienced patients randomized to the lead-in telaprevir arm received 4 weeks of PegIFN-α-2a (180 μg/week) and ribavirin (1000-1200 mg/day), then 12 weeks of telaprevir (750 mg every 8h) plus PegIFN-α-2a/ribavirin, followed by 32 weeks of PegIFN-α-2a/ribavirin. This subanalysis only included patients in the lead-in telaprevir arm with available week 4 on-treatment response data (n=240). After 4weeks of PegIFN/ribavirin, 90% of relapsers, 60% of partial responders, and 41% of null responders in the lead-in telaprevir arm had ⩾1 log(10) HCV RNA reduction. Sustained virologic response (SVR) rates for telaprevir-treated patients with ≥1 versus <1 log(10) HCV RNA reduction after the PegIFN/ribavirin lead-in were 94% versus 62% in relapsers, 59% versus 56% in partial responders and 54% versus 15% in null responders. In prior relapsers and partial responders there is no apparent benefit of assessing response after a PegIFN/ribavirin lead-in with the aim of guiding telaprevir-based treatment. For patients known to be prior null responders, on-treatment response after a 4-week PegIFN/ribavirin lead-in may provide clinically useful prognostic information. However, withholding telaprevir-containing therapy in uncategorised treatment-experienced patient populations (i.e., that could include prior relapsers or partial responders), using response after a PegIFN/ribavirin lead-in could potentially exclude some patients with a high chance of SVR. Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  12. Racial/Ethnic Differences in the Association between Arrest and Unprotected Anal Sex among Young Men Who Have Sex with Men: The P18 Cohort Study.

    Science.gov (United States)

    Ompad, Danielle C; Kapadia, Farzana; Bates, Francesca C; Blachman-Forshay, Jaclyn; Halkitis, Perry N

    2015-08-01

    This analysis aimed to determine whether the relationship between a history of arrest and unprotected anal sex (UAS) is the same for Black/Latino gay, bisexual, and other young men who have sex with men (YMSM) as compared to White/Asian/Pacific Islander (API) YMSM in New York City (NYC). Baseline audio-computer-assisted self-interview (ACASI) and interviewer-administered survey data from a sample of 576 YMSM aged 18-19 years old who self-reported being HIV-negative were analyzed. Data included history of arrest and incarceration as well as UAS in the past 30 days. Race/ethnicity was an effect modifier of the association between arrest and UAS among YMSM: White/API YMSM with a lifetime arrest history were more than three times as likely to report UAS, and Black/Latino YMSM with a lifetime history of arrest were approximately 70 % less likely to report UAS as compared with White/API YMSM with no reported arrest history. Race/ethnicity may modify the relationship between arrest and sexual risk behavior because the etiology of arrest differs by race, as partially evidenced by racial/ethnic disparities in police stop, arrest, and incarceration rates in NYC. Arrest could not only be an indicator of risky behavior for White/API YMSM but also an indicator of discrimination for Black/Latino YMSM. Further research is needed to assess whether the differential associations observed here vis-à-vis race/ethnicity are robust across different populations and different health outcomes.

  13. Structural arrest in an ideal gas.

    Science.gov (United States)

    van Ketel, Willem; Das, Chinmay; Frenkel, Daan

    2005-04-08

    We report a molecular dynamics study of a simple model system that has the static properties of an ideal gas, yet exhibits nontrivial "glassy" dynamics behavior at high densities. The constituent molecules of this system are constructs of three infinitely thin hard rods of length L, rigidly joined at their midpoints. The crosses have random but fixed orientation. The static properties of this system are those of an ideal gas, and its collision frequency can be computed analytically. For number densities NL(3)/V>1, the single-particle diffusivity goes to zero. As the system is completely structureless, standard mode-coupling theory cannot describe the observed structural arrest. Nevertheless, the system exhibits many dynamical features that appear to be mode-coupling-like. All high-density incoherent intermediate scattering functions collapse onto master curves that depend only on the wave vector.

  14. Incidence and outcomes of out-of-hospital cardiac arrest in the eastern part of Yamaguchi prefecture.

    Science.gov (United States)

    Shiraki, Teruo; Osawa, Kazuhiro; Suzuki, Hideyuki; Yoshida, Masatoki; Takahashi, Natsuki; Takeuchi, Kazufumi; Tanakaya, Machiko; Kohno, Kunihisa; Saito, Daiji

    2009-07-01

    The aim of the present study was to evaluate the factors related to poor prognosis of out-of-hospital cardiac arrest patients in one local area of Japan. From May 1, 2002 to April 30, 2008, a total of 442 patients with cardiopulmonary arrest were transferred for resuscitation to the National Hospital Organization, Iwakuni Clinical Center. Of 325 patients with cardiopulmonary arrest of cardiac etiology, 126 patients were witnessed by a bystander. However, only 37 received bystander cardiopulmonary resuscitation, 13 had shockable cardiac rhythm, 3 survived 1 month, and 2 had a good neurological discharge. Multivariate analysis of overall cardiac arrest showed that 1-month survival and neurologically favorable discharge were associated with bystander cardiopulmonary resuscitation (P=0.049 and 0.013) and initial shockable cardiac rhythm (P=0.001 and 0.007). In this region, the survival rate for patients with cardiopulmonary arrest was lower than that reported in other areas, probably because fewer patients received bystander CPR or had shockable cardiac rhythm. This may result from CPR being less popularized in this region than in other areas, suggesting that raising the awareness of CPR would improve the survival rate.

  15. Out-of-Hospital Cardiac Arrest in Denmark

    DEFF Research Database (Denmark)

    Wissenberg Jørgensen, Mads

    challenges, due to the victim’s physical location, which brings an inherent risk of delay (or altogether absence) of recognition and treatment of cardiac arrest. A low frequency of bystander cardiopulmonary resuscitation and low 30-day survival after out-of-hospital cardiac arrest were identified nearly ten......BACK COVER TEXT Cardiac arrest is an emergency medical condition characterized by the cessation of cardiac mechanical activity; without immediate and decisive treatment, a victim’s chances of survival are minimal. Out-of-hospital cardiac arrest is a particular arrest subgroup that poses additional...... years ago in Denmark. These findings led to several national initiatives to strengthen bystander resuscitation attempts and advance care. Despite these nationwide efforts, it was unknown prior to this project whether these efforts resulted in changes in resuscitation attempts by bystanders and changes...

  16. Sublingual Microcirculation is Impaired in Post-cardiac Arrest Patients

    DEFF Research Database (Denmark)

    G. Omar, Yasser; Massey, Michael; Wiuff Andersen, Lars;

    2013-01-01

    AIM: We hypothesized that microcirculatory dysfunction, similar to that seen in sepsis, occurs in post-cardiac arrest patients and that better microcirculatory flow will be associated with improved outcome. We also assessed the association between microcirculatory dysfunction and inflammatory...... markers in the post-cardiac arrest state. METHODS: We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using...... the microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients. RESULTS: We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual...

  17. 应变率对红砂岩渐进破坏过程和特征应力的影响%Influence of strain rate on progressive failure process and characteristic stresses of red sandstone

    Institute of Scientific and Technical Information of China (English)

    王洪亮; 范鹏贤; 王明洋; 李文培; 钱岳红

    2011-01-01

    In order to investigate the progressive failure process of brittle rock, the mechanical properties of red sandstone from south area of Shandong province are studied by the RMT-150C rock mechanical experimental system.The stress-strain curves of samples under different strain rates are recorded The deformation and progressive failure process of rock samples is divided into several stages.including crack closure stage, linear elastic deformation stage, crack initiation and stable crack growth stage and unstable crack growth stage.Then the crack initial stresses and crack damage stresses are determined by the moving point technique according to the data of stress-strain curves and other deduced data.The influence of strain rate on the ultimate critical strength the crack initial stress and the crack damage stress are also investigatect The results show that the ultimate critical strength first decreases and then increases as the strain rate increases; and the rate of crack initial stress and crack damage with the ultimate critical strength decreases.The mechanism of the experimcntal results are analyzed and explained by the stress concentration model of rock with mmuniformities.And the influence of strain rate on the progressive failure process is studied%为了深入研究脆性岩石的渐进破坏过程,利用RMT-150C型岩石力学试验系统对产自鲁南地区的一种红砂岩进行了系统的力学性质试验研究,得出该类型砂岩试样在不同应变率条件下的力学表现.将试件的渐进破坏过程通过特征应力分为裂纹闭合阶段、线弹性变形阶段、裂纹起裂和稳定扩展阶段以及裂纹不稳定扩展阶段,通过对应力-应变曲线、轴向变形刚度、体积应变曲线和裂纹体积应变等数据的分析,以及采用动点回归技术确定了试样的起裂应力和致损应力,并进一步研究了该类红砂岩的渐进破坏过程及红砂岩峰值强度、起裂应力等参数和应变率之间的

  18. Representative bureaucracy:does female police leadership affect gender-based violence arrests?

    OpenAIRE

    K. Johnston; Houston, John

    2016-01-01

    Representative bureaucracy theory postulates that passive representation leads to active representation of minority groups. This article investigates the passive representation of female police officers at leadership levels and the active representation of women vis-a-vis gender-based violence arrest rates in the UK. Much of the extant research on representative bureaucracy is located at street level, with evidence showing that discretionary power of minority bureaucrats can lead to active re...

  19. Performance of metal oxide gapless surge arresters for HVDC systems

    Energy Technology Data Exchange (ETDEWEB)

    Diseko, N.L.

    1990-09-01

    An examination of the electrical stresses which may be imposed upon metal oxide surge arresters in a dc converter station is undertaken by means of simulation of the dc system and associated ac systems in the time domain using a digital computer program. Detailed models of a dc link are developed for temporary overvoltage stresses and steep front stresses. The most critical stresses for each type of dc station arrester due to converter faults and converter malfunctions are identified. The energy stresses were generally determined to be dependent on the converter control and protection strategies adopted during the faults. The arrester energy stresses for faults on both the line side and valve side busses of the converter transformer were determined to be sensitive to the instant of fault application and the duration of the fault. The arrester stresses for ac bus faults were analyzed in detail to determine their statistical distribution relative to the point on wave at which the fault occurred in each affected phase, and to the instant of fault clearance in each phase. Generally, the highest stresses occur for sequential fault occurrence in the phases compared with simultaneous faults. The studies indicate that the stresses in the arresters in a dc pile experiencing the worst duty depend on the number of arresters represented. Modelling only one arrester of a series-connected group does not provide correct results when the fault condition imposes duty on more than one of the arresters in the group. The study also indicates that the highest stresses do not necessarily occur in the single arrester connected across the valve with the highest prospective overvoltage. Hence the capability to represent all valve arresters within one pole is necessary when determining the most onerous stresses. 11 refs., 79 figs., 28 tabs.

  20. Asystolic Cardiac Arrest of Unknown Duration in Profound Hypothermia and Polysubstance Overdose: A Case Report of Complete Recovery.

    Science.gov (United States)

    Lubana, Sandeep Singh; Genin, Dennis Iilya; Singh, Navdeep; De La Cruz, Angel

    2015-06-08

    Opioid addiction and overdose is a serious problem worldwide. Fatal overdoses from opioids are responsible for numerous deaths and are increasing, especially if taken in combination with other psychoactive substances. Combined with environmental exposure, opioid overdose can cause profound hypothermia. Opioid abuse and other drugs of abuse impair thermoregulation, leading to severe hypothermia. Both drug overdose and severe hypothermia can cause cardiac arrest. We report a case of 20-year-old man with history of polysubstance abuse presenting with severe hypothermia and asystole of unknown duration with return of spontaneous circulation (ROSC) achieved after 28 minutes of cardiopulmonary resuscitation (CPR). Urine toxicology was positive for cocaine, heroin, and benzodiazepine, along with positive blood alcohol level. The patient was rewarmed using non-invasive techniques. Hospital course was complicated by acute renal failure (ARF), severe rhabdomyolysis, severe hyperkalemia, ST-elevation myocardial infarction (STEMI), shock liver, coagulopathy, and aspiration pneumonia. Survival with full cardiovascular and neurologic recovery after a cardiac arrest caused by drug overdose in the setting of severe hypothermia is still possible, even if the cardiac arrest is of unknown or prolonged duration. Patients with severe hypothermia experiencing cardiac arrest/hemodynamic instability can be rewarmed using non-invasive methods and may not necessarily need invasive rewarming techniques.

  1. Effect of four resuscitation methods on lung ventilation of pigs with respiratory arrest

    Directory of Open Access Journals (Sweden)

    Ya-hua LIU

    2012-03-01

    Full Text Available Objective To observe the effects of four cardiopulmonary resuscitation (CPR methods on lung ventilation of pigs with respiratory arrest. The four CPR methods included chest compression CPR (C-CPR, compression under the diaphragm CPR (D-CPR, abdominal compression CPR (A-CPR, and abdominal wall lifting and compression CPR (L-CPR. Methods  A total of 28 healthy domestic pigs were randomly divided into four groups. The pig respiratory arrest model was reproduced by intravenous injection of suxamethonium. Instantly after respiratory arrest, one of the 4 CPR methods was performed immediately on the groups of pigs respectively. After 2min of CPR, compression was stopped. The experimental pigs were given assisted respiration using a ventilator until autonomous respiration recovered. The tidal volume (VT in basic status and that during resuscitation by the four respective resuscitation methods was determined, and minute ventilation (MV was calculated. Furthermore, heart rate (HR, mean arterial blood pressure, and recovery time of autonomous respiration were compared between all the groups. Results In basic status, there was no statistical difference (P > 0.05 in VT and MV between the four groups. Approximately 2min after resuscitation, the VT and MV of D-CPR were higher than that of C-CPR; that of A-CPR was higher than that of D-CPR; and that of L-CPR was higher than that of A-CPR. The differences were statistically significant (P 0.05. HR in C-CPR and D-CPR were notably lower than the basic value (P < 0.01. Two minutes after resuscitation, mechanical ventilation was given, and HR in all the groups was close to the basic value 5 min after resuscitation. In the respiratory arrest pig model, L-CPR could provide more effective VT and MV than the other methods. Conclusion For the porcine respiratory arrest model, L-CPR can provide more effective lung ventilation than the other methods.

  2. Advanced airway management does not improve outcome of out-of-hospital cardiac arrest.

    Science.gov (United States)

    Hanif, M Arslan; Kaji, Amy H; Niemann, James T

    2010-09-01

    The goal of out-of-hospital endotracheal intubation (ETI) is to reduce mortality and morbidity for patients with airway and ventilatory compromise. Yet several studies, mostly involving trauma patients, have demonstrated similar or worse neurologic outcomes and survival-to-hospital discharge rates after out-of-hospital ETI. To date, there is no study comparing out-of-hospital ETI to bag-valve-mask (BVM) ventilation for the outcome of survival to hospital discharge among nontraumatic adult out-of-hospital cardiac arrest (OOHCA) patients. The objective was to compare survival to hospital discharge among adult OOHCA patients receiving ETI to those managed with BVM. In this retrospective cohort study, the records of all OOHCA patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The type of field airway provided, age, sex, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether the arrest was witnessed, site of arrest, return of spontaneous circulation (ROSC), survival to hospital admission, comorbid illnesses, and survival to hospital discharge were noted. A univariate odds ratio (OR) was first computed to describe the association between the type of airway and survival to hospital discharge. A multivariable logistic regression analysis was performed, adjusting for rhythm, bystander CPR, and whether the arrest was witnessed. A cohort of 1,294 arrests was evaluated. A total of 1,027 (79.4%) received ETI, while 131 (10.1%) had BVM, 131 (10.1%) had either a Combitube or an esophageal obturator airway, and five (0.4%) had incomplete prehospital records. Fifty-five of 1,294 (4.3%) survived to hospital discharge; there were no survivors in the Combitube/esophageal obturator airway cohort. Even after multivariable adjustment for age, sex, site of arrest, bystander CPR, witnessed arrest, and rhythm on paramedic arrival, the OR for survival to hospital discharge for BVM

  3. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930118 Facial or nasal mask pressure supportventilation in managing acute exacerbation ofchronic respiratory failure in COPD patients.CHEN Rongchang(陈荣昌),et al.GuangzhouInstit Respir Dis,Guangzhou 510120.Chin Tu-berc & Respir Dis 1992;15(5)285-287.Eleven COPD patients(age:65±9 yrs)withacute exacerbation of chronic respiratory failure(PaCO2 11.3±1.1kPa)were treated with maskpressure support ventilation,another 10 similarpatients(age:68±12yrs)served as controls.Bi-PAP ventilator was used with the followingmodifications:(1)Non-rehreathing valve set-in proximal to mask;(2)5 LPM oxygen flow de-livered into mask to reduce the dead space ef-fect.Mask ventilation was given 2-3 hours ev-ery time and 1-2 times daily for 7 days.Syn-

  4. Mayo registry for telemetry efficacy in arrest (MR TEA) study: An assessment of the effect of admission diagnosis on outcomes from in-hospital cardiopulmonary arrest.

    Science.gov (United States)

    Snipelisky, David; Ray, Jordan; Matcha, Gautam; Roy, Archana; Clark, Brooke; Dumitrascu, Adrian; Bosworth, Veronica; Whitman, Anastasia; Lewis, Patricia; Vadeboncoeur, Tyler; Kusumoto, Fred; Burton, M Caroline

    2015-12-01

    Little data exists evaluating how different risk factors influence outcomes following in-hospital arrests. A retrospective review of patients that suffered a cardiopulmonary arrest between 1 May 2008 and 30 June 2014 was performed. Patients were stratified into subsets based on cardiac versus non-cardiac reasons for admission. 199 patients met inclusion criteria, of which 138 (69.3%) had a non-cardiac reason for admission and 61 (30.7%) a cardiac etiology. No difference in demographics and non-cardiac comorbidities were present. Cardiac-related comorbidities were more prevalent in the cardiac etiology subset. Arrests with a shockable rhythm were more common in the cardiac group (P < 0.0001), yet return of spontaneous circulation from the index event was similar (P = 0.254). More patients in the cardiac group were alive at 24-h post resuscitation (n = 34, 55.7% versus n = 49, 35.5%; P = 0.0085), discharge (n = 21, 34.4% versus n = 19, 13.8%; P = 0.0018), and at last follow-up (n = 13, 21.3% versus n = 14, 10.1%; P = 0.0434). Although patients with cardiac and non-cardiac etiologies for admission have similar rates of return of spontaneous circulation, those with cardiac etiologies are more likely to survive to hospital discharge and outpatient follow-up.

  5. Modulation of medium pH by Caulobacter crescentus facilitates recovery from uranium-induced growth arrest.

    Science.gov (United States)

    Park, Dan M; Jiao, Yongqin

    2014-09-01

    The oxidized form of uranium [U(VI)] predominates in oxic environments and poses a major threat to ecosystems. Due to its ability to mineralize U(VI), the oligotroph Caulobacter crescentus is an attractive candidate for U(VI) bioremediation. However, the physiological basis for U(VI) tolerance is unclear. Here we demonstrated that U(VI) caused a temporary growth arrest in C. crescentus and three other bacterial species, although the duration of growth arrest was significantly shorter for C. crescentus. During the majority of the growth arrest period, cell morphology was unaltered and DNA replication initiation was inhibited. However, during the transition from growth arrest to exponential phase, cells with shorter stalks were observed, suggesting a decoupling between stalk development and the cell cycle. Upon recovery from growth arrest, C. crescentus proliferated with a growth rate comparable to that of a control without U(VI), although a fraction of these cells appeared filamentous with multiple replication start sites. Normal cell morphology was restored by the end of exponential phase. Cells did not accumulate U(VI) resistance mutations during the prolonged growth arrest, but rather, a reduction in U(VI) toxicity occurred concomitantly with an increase in medium pH. Together, these data suggest that C. crescentus recovers from U(VI)-induced growth arrest by reducing U(VI) toxicity through pH modulation. Our finding represents a unique U(VI) detoxification strategy and provides insight into how microbes cope with U(VI) under nongrowing conditions, a metabolic state that is prevalent in natural environments.

  6. 运用失效模式效应分析降低不合格检验标本的发生率%Reducing the happen rate of unquaHfied laboratory specimen by using Failure Mode Effect Analysis

    Institute of Scientific and Technical Information of China (English)

    黄忠琴

    2008-01-01

    Objective To perfact the procedure of specimen acquaring and transfering so as to reduce the happen rate of unqualified laboratory specimen.Methods The relative factors in the procedure of specimen acquaring and transfering were analysed by using Failure Mode Effect Analysis(FMEA)so that the preventative emphases could be based on the caculated Risk Priority Number(RPN)and rectifying measurements could be adopted according to the existing problems.Results The RPNs of unqualified laboratory specimen were reduced from 1 476 in the January of 2007 to 1 196 in the May of 2007,among them the prominent reducing RPN was 936in the March of 2007 and the happen rates of unqualified laboratory specimen were reduced accordingly.Conclusion FMEA is an effective rask management method by reducing the happen rate of unqualified laboratory specimen.%目的 完善检验标本采集和送检流程,降低不合格检验标本的发生率.方法 应用失效模式效应分析(Failure Mode Effect Analysis,FMEA)对标本采集及送检各个流程中的相关因数进行分析,计算出事件发生的RPN值(Risk Priority Number),并根据RPN值的大小确定预防的重点,针对存在的问题及时进行整改.结果 发生不合格检验标本的RPN值由2007年1月的1 476,降低到2007年5月的1 196,其中2007年3月达到936,为最低点,标本的不合格率相应降低.结论 使用FMEA有效地降低了送检标本的不合格率,是一种行之有效的风险管理方法.

  7. A Literature Review Revisiting Phenytoin-Induced Sinus Arrest.

    Science.gov (United States)

    Parsai, Shireen; Hariri, Imad; Taleb, Mohammad; Yoon, Youngsook

    2016-01-01

    Classically, phenytoin (PTN) infusion for the treatment of status epilepticus has been proven to be associated with cardiovascular toxicity, including dysrhythmias, hypotension, and cardiovascular collapse. Subsequently, fosphenytoin (FOS) was introduced on the market in 1997 with claims of having less cardiac toxicity. However, since then, many accounts of cardiac events have been reported undermining these claims. FOS gained popularity due to its water solubility, which allows 3 times faster infusion in comparison with PTN with less venous irritation and local toxicity. FOS is the phosphate ester prodrug of PTN and is rapidly converted to PTN independent of the dose and rate of administration. Intravenous FOS and PTN are bioequivalent. Adverse cardiac effects of both intravenous FOS and PTN have been correlated to the rate of infusion, concentration of the agent, known risk factors, or pre-existing hypersensitivity, and most cases have been identified after infusing a loading dose of these medications. This case report is unique, in that, the patient developed sinus arrest while concurrently receiving oral PTN and intravenous FOS. Clinicians should be more cognizant of the association of FOS and PTN with adverse cardiac events. Baseline electrocardiogram should be obtained on all patients prescribed FOS or PTN to identify underlying cardiac problems that may place the patient in a higher risk category. Telemetry should be performed on all patients receiving PTN in an inpatient setting.

  8. Wee-1 kinase inhibition overcomes cisplatin resistance associated with high-risk TP53 mutations in head and neck cancer through mitotic arrest followed by senescence.

    Science.gov (United States)

    Osman, Abdullah A; Monroe, Marcus M; Ortega Alves, Marcus V; Patel, Ameeta A; Katsonis, Panagiotis; Fitzgerald, Alison L; Neskey, David M; Frederick, Mitchell J; Woo, Sang Hyeok; Caulin, Carlos; Hsu, Teng-Kuei; McDonald, Thomas O; Kimmel, Marek; Meyn, Raymond E; Lichtarge, Olivier; Myers, Jeffrey N

    2015-02-01

    Although cisplatin has played a role in "standard-of-care" multimodality therapy for patients with advanced squamous cell carcinoma of the head and neck (HNSCC), the rate of treatment failure remains particularly high for patients receiving cisplatin whose tumors have mutations in the TP53 gene. We found that cisplatin treatment of HNSCC cells with mutant TP53 leads to arrest of cells in the G2 phase of the cell cycle, leading us to hypothesize that the wee-1 kinase inhibitor MK-1775 would abrogate the cisplatin-induced G2 block and thereby sensitize isogenic HNSCC cells with mutant TP53 or lacking p53 expression to cisplatin. We tested this hypothesis using clonogenic survival assays, flow cytometry, and in vivo tumor growth delay experiments with an orthotopic nude mouse model of oral tongue cancer. We also used a novel TP53 mutation classification scheme to identify which TP53 mutations are associated with limited tumor responses to cisplatin treatment. Clonogenic survival analyses indicate that nanomolar concentration of MK-1775 sensitizes HNSCC cells with high-risk mutant p53 to cisplatin. Consistent with its ability to chemosensitize, MK-1775 abrogated the cisplatin-induced G2 block in p53-defective cells leading to mitotic arrest associated with a senescence-like phenotype. Furthermore, MK-1775 enhanced the efficacy of cisplatin in vivo in tumors harboring TP53 mutations. These results indicate that HNSCC cells expressing high-risk p53 mutations are significantly sensitized to cisplatin therapy by the selective wee-1 kinase inhibitor, supporting the clinical evaluation of MK-1775 in combination with cisplatin for the treatment of patients with TP53 mutant HNSCC.

  9. Microcircuit Device Reliability. Digital Failure Rate Data

    Science.gov (United States)

    1981-01-01

    U- OjO ^-*mog«tOf-< r-t^Of-Hf-Hi-’POOO a* a» o oo oo a* <M o co *r r^ u> m u> *ä m o^ -H c\\j •-» o * in csi oo o ^ ^ •-• * o ^t...a :HAMIPACTUBEB :OPEBATI( MAL TYPE RELIABILITY ANALYSIS CENTER t PAW 1 M. : DIVICI : PUNCTIOM : SOU. 1 CLASS : PACKAGE/ ■ 1 PINS

  10. Teenage cardiac arrest following abuse of synthetic cannabis.

    Science.gov (United States)

    Davis, C; Boddington, D

    2015-10-01

    The cardiac effects of many illegal substances (cocaine, methadone) have previously been well described [1,2]. However the association between synthetic cannabis and cardiac arrest is less well documented. Here we describe an out-of-hospital cardiac arrest in a previously healthy 16-year-old female associated with the use of inhaled synthetic cannabis. An electronic systematic search of online databases PubMed and Embase was performed using keywords, "synthetic cannabis death" and "cardiac arrest". In this case study a previously healthy 16-year-old had a cardiac arrest after synthetic cannabis use. Despite extensive investigations no other cause for her arrest was found. To the best of our knowledge there has been one previous case report of cardiac arrest following synthetic cannabis use in a 56-year-old man [3]. This case report augments the relationship between synthetic cannabis and cardiac arrest in the medical community. More awareness surrounding the risk of synthetic cannabinoids is warranted. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  11. Failure Mode and Effect Analysis of Active Magnetic Bearings

    Directory of Open Access Journals (Sweden)

    K.P. Lijesh

    2016-03-01

    Full Text Available In the present research work Failure Mode and Effect Analysis (FMEA of an Active Magnetic Bearing (AMB has been presented. Various possible failures modes of AMBs and the corresponding effects of those failures on performance of AMBs have been identified. The identified failure modes of AMBs will facilitate designer to incorporate necessary design features that would prevent the occurrence of the failure. The severity, occurrence and detection of the failures modes are determined based on a rating scale of 1 to 5 to quantify the Risk Priority Number (RPN of the failure modes. The methods to eliminate or reduce the high-risk-failure modes are proposed.