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Sample records for discontinued treatment due

  1. Why do couples discontinue unlimited free IVF treatments?

    Science.gov (United States)

    Lande, Yechezkel; Seidman, Daniel S; Maman, Ettie; Baum, Micha; Hourvitz, Ariel

    2015-03-01

    Worldwide, IVF is often discontinued before a live birth is achieved due to high costs. Even when partial financial coverage is provided, often medical providers advise treatment discontinuation. In Israel, unlimited IVF is offered free of charge for a couples' first two children. Our objective was to assess the reasons couples discontinue IVF treatments before achieving two children in a completely unlimited cost-free environment. This cohort study included all primary infertile women, reason they ceased treatments. Of the 134 couples included, only 46 ceased IVF treatments without achieving two children, after performing an average of 6.2 IVF cycles to achieve their first birth. The reasons given were: lost hope of success (13), psychological burden (18), divorce (6), medical staff recommendation (5), bureaucratic difficulties (3) and general medical condition (1). The main reasons for "drop out" in our cost-free environment were as follows: psychological burden and lost hope of success. Due to high availability of treatments, medical staff recommendation was a less significant factor in our study.

  2. [Discontinuation of depression treatment from the perspective of suicide prevention].

    Science.gov (United States)

    Cho, Yoshinori

    2012-01-01

    It is assumed that discontinuation of treatment for depression may increase the risk of suicide. A population-based register study in Denmark did not find a lower risk among people over age 50 who followed treatment in comparison with those who discontinued treatment with antidepressants at an early stage. This result, however, does not allow us to think superficially that early discontinuation of treatment does not increase the risk of suicide. It is because the study has limitations without information of such as psychiatric diagnoses, severity of the depressed state, and reasons of discontinuation. It is safe for clinicians to aim at preventing discontinuation of treatment. Particularly, in Japan and South Korea where there is a sociocultural climate of tolerability for suicide, suicide can occur in milder depressed state and discontinuation of treatment should be taken more seriously than in Western countries.

  3. Factors associated with poor satisfaction with treatment and trial discontinuation in chronic schizophrenia.

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    Schoemaker, Joep H; Vingerhoets, Ad J J M; Emsley, Robin A

    2018-06-05

    IntroductionDespite consistently high discontinuation rates due to withdrawal of consent (WOC) and insufficient therapeutic effect (ITE) in schizophrenia trials, insight into the underlying factors contributing to poor satisfaction with treatment and dropout is limited. A better understanding of these factors could help to improve trial design and completion rates. Using data from 1,136 trial participants with schizophrenia or schizoaffective disorder, we explored associations between predictor variables with (1) dropout due to WOC and ITE and (2) satisfaction with treatment among patients and investigators by means of hierarchic multiple regression analyses. ITE was associated with poor clinical improvement, poor investigator satisfaction with treatment, and poor patient insight into their own disease, whereas WOC only showed a meaningful association with poor patient satisfaction with treatment. Investigator satisfaction with treatment appeared most strongly associated with Positive and Negative Syndrome Scale (PANSS) positive factor endpoint scores, whereas patient satisfaction with treatment was best predicted by the endpoint score on the PANSS emotional distress factor. The occurrence of severe side effects showed no meaningful association to satisfaction with treatment among investigators and patients, and neither did a patient's experienced psychopathology, nor their self-rating of functional impairment. Whereas trial discontinuation due to ITE is associated with poor treatment effectiveness, a patient's decision to withdraw from an antipsychotic trial remains unpredictable and may occur even when the investigator observes a global clinical improvement and is satisfied with the treatment.

  4. Early Discontinuation of Montelukast Treatment; A Danish Nationwide Utilization Study

    DEFF Research Database (Denmark)

    Farah, Rahmo I; Damkier, Per; Christiansen, Anders

    2018-01-01

    Montelukast, a leukotriene receptor antagonist, was marketed in 1998 as an oral supplementary treatment to patients with mild to moderate asthma. The aim of this study was to describe the early discontinuation pattern among montelukast users in Denmark in the period of 1 March 1998 to 31 December....... Early discontinuation was defined as failing to fill a second prescription for montelukast within at least a year after the initial montelukast prescription. Among 135,271 included montelukast users, 47,480 (35%) discontinued the use of montelukast after a single redeemed prescription. The trend...

  5. Risk factors for early treatment discontinuation in patients with obsessive-compulsive disorder

    Directory of Open Access Journals (Sweden)

    Juliana Belo Diniz

    2011-01-01

    Full Text Available INTRODUCTION: In obsessive-compulsive disorder, early treatment discontinuation can hamper the effectiveness of first-line treatments. OBJECTIVE: This study aimed to investigate the clinical correlates of early treatment discontinuation among obsessive-compulsive disorder patients. METHODS: A group of patients who stopped taking selective serotonin reuptake inhibitors (SSRIs or stopped participating in cognitive behavioral therapy before completion of the first twelve weeks (total n = 41; n = 16 for cognitive behavioral therapy and n = 25 for SSRIs were compared with a paired sample of compliant patients (n = 41. Demographic and clinical characteristics were obtained at baseline using structured clinical interviews. Chisquare and Mann-Whitney tests were used when indicated. Variables presenting a p value <0.15 for the difference between groups were selected for inclusion in a logistic regression analysis that used an interaction model with treatment dropout as the response variable. RESULTS: Agoraphobia was only present in one (2.4% patient who completed the twelve-week therapy, whereas it was present in six (15.0% patients who dropped out (p = 0.044. Social phobia was present in eight (19.5% patients who completed the twelve-week therapy and eighteen (45% patients who dropped out (p = 0.014. Generalized anxiety disorder was present in eight (19.5% patients who completed the twelve-week therapy and twenty (50% dropouts (p = 0.004, and somatization disorder was not present in any of the patients who completed the twelveweek therapy; however, it was present in six (15% dropouts (p = 0.010. According to the logistic regression model, treatment modality (p = 0.05, agoraphobia, the Brown Assessment of Beliefs Scale scores (p = 0.03 and the Beck Anxiety Inventory (p = 0.02 scores were significantly associated with the probability of treatment discontinuation irrespective of interactions with other variables. DISCUSSION AND CONCLUSION: Early treatment

  6. BEHAVIORAL ASPECTS IN COMMUNITY ORAL HEALTH PROBLEMS: A STUDY ON DENTAL TREATMENT DISCONTINUATION

    Directory of Open Access Journals (Sweden)

    Felix Aryadi Joelimar

    2015-08-01

    Full Text Available The low value of F/DMF-T ration on Performed Treatment Index in Indoneisa gives an indication of great problems in dental treatment utilization. Dental treatment utilization is affected by several obstacles, the greatest among which is psychosocial obstacles. In this study the psychosocial obstacles were detected through Intrinsic Obstacles, Obstacles in Transportation, and Obstacles in Dental Clinic related to their effects on their discontinuation of dental treatments at Balkesmas Kiara, Kecamatan Senen, Jakarta Pusat. The discontinuation of dental treatments was mostly affected by Intrinsic Obstacles, through its components as Types of Cases, Dental Anxiety Scale, and Intrinsic Motivation. Generally Obstacles in Transportation had no effects, excpet its components of Travel Time and Tiredness. Obstacles in Dental Clinic had a significant effect on the discontinuation of dental treatments through the unpleasant manner of the druggist, the hot waiting room, and the high expense on drugs.

  7. Successful retreatment with grazoprevir and elbasvir for patients infected with hepatitis C virus genotype 1b, who discontinued prior treatment with NS5A inhibitor-including regimens due to adverse events.

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    Kanda, Tatsuo; Yasui, Shin; Nakamura, Masato; Nakamoto, Shingo; Takahashi, Koji; Wu, Shuang; Sasaki, Reina; Haga, Yuki; Ogasawara, Sadahisa; Saito, Tomoko; Kobayashi, Kazufumi; Kiyono, Soichiro; Ooka, Yoshihiko; Suzuki, Eiichiro; Chiba, Tetsuhiro; Maruyama, Hitoshi; Moriyama, Mitsuhiko; Kato, Naoya

    2018-03-23

    Sustained virologic response (SVR) by interferon and interferon-free treatment can results in the reduction of advanced liver fibrosis and the occurrence of hepatocellular carcinoma in patients infected with hepatitis C virus (HCV). Recent interferon-free treatment for HCV shortens the duration of treatment and leads to higher SVR rates, without any serious adverse events. However, it is important to retreat patients who have had treatment-failure with HCV non-structural protein 5A (NS5A) inhibitor-including regimens. Combination of sofosbuvir and ledipasvir only leads to approximately 100% SVR rates in HCV genotype (GT1b), NS5A inhibitor-naïve patients in Japan. This combination is not an indication for severe renal disease or heart disease, and these patients should be treated or retreated with a different regimen. Retreatment with HCV non-structural protein 3/4A inhibitor, grazoprevir, and HCV NS5A inhibitor, elbasvir, successfully eradicated HCV RNA in three patients with HCV genotype 1b infection who discontinued prior interferon-free treatments including HCV NS5A inhibitors due to adverse events within 2 weeks. Retreatment with the 12-week combination regimen of grazoprevir and elbasvir is effective for HCV GT1b patients who discontinue the HCV NS5A inhibitor-including regimens within 2 weeks. The treatment response may be related to the short duration of initial treatment, which did not produce treatment-emergent RASs.

  8. Early discontinuation of attention-deficit/hyperactivity disorder drug treatment: a danish nationwide drug utilization study

    DEFF Research Database (Denmark)

    Pottegård, Anton; Bjerregaard, B. K.; Kortegaard, L. S.

    2015-01-01

    Knowledge of patterns of treatment discontinuation in attention-deficit/hyperactivity disorder (ADHD) drug treatment is of importance, for both the clinical practice and the study of long-term treatment outcomes. The purpose of this study was to describe early discontinuation of ADHD drug treatme...

  9. Measuring persistence to hormonal therapy in patients with breast cancer: accounting for temporary treatment discontinuation.

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    Huiart, Laetitia; Ferdynus, Cyril; Dell'Aniello, Sophie; Bakiri, Naciba; Giorgi, Roch; Suissa, Samy

    2014-08-01

    Several studies have been conducted to estimate persistence to hormonal therapy among women with breast cancer (BC). Most studies focus on first treatment discontinuation. Patients, however, can have numerous periods of treatment discontinuation or treatment exposure. Our objective is to estimate persistence to tamoxifen in patients with BC while accounting for temporary treatment discontinuations and this by using multi-state (MS) models. A cohort of 10,806 women with BC having received at least one prescription of tamoxifen between 1998 and 2008 was constituted from the UK General Practice Research Database. We fitted a semi-Markov model with three states to estimate the probability of being off treatment over a 5-year period while accounting for temporary treatment discontinuations (transition between on treatment and off treatment) and competing risks (recurrence of BC or death). Non-persistence, as estimated from the MS model, ranged from 12.1% (95% confidence interval [95%CI]: 9.2-15.1) at 1 year to 14.9% (95%CI: 11.7-18.1) at 5 years. Estimations of non-persistence based on the Kaplan-Meier model were higher, i.e., 29.3% (95%CI: 28.1-30.6) at 5 years, as well as those obtained from a competing risk model, i.e., 24.0% (95%CI: 22.9-25.1). Most temporary discontinuations (94.7%) lasted less than 6 months. Temporary treatment discontinuations are frequent and should be accounted for when measuring adherence to treatment. MS models can provide a useful framework for this sort of analysis insofar as they help describe patients' complex behavior. This may help tailor interventions that improve persistence to hormonal therapy among women with BC. Copyright © 2014 John Wiley & Sons, Ltd.

  10. Predictors of premature discontinuation of outpatient treatment after discharge of patients with posttraumatic stress disorder.

    Science.gov (United States)

    Wang, Hee Ryung; Woo, Young Sup; Jun, Tae-Youn; Bahk, Won-Myong

    2015-01-01

    This study aimed to examine the sociodemographic and disease-related variables associated with the premature discontinuation of psychiatric outpatient treatment after discharge among patients with noncombat-related posttraumatic stress disorder. We retrospectively reviewed the medical records of patients who were discharged with a diagnosis of posttraumatic stress disorder. Fifty-five percent of subjects (57/104) prematurely discontinued outpatient treatment within 6 months of discharge. Comparing sociodemographic variables between the 6-month non-follow-up group and 6-month follow-up group, there were no variables that differed between the two groups. However, comparing disease-related variables, the 6-month follow-up group showed a longer hospitalization duration and higher Global Assessment of Function score at discharge. The logistic regression analysis showed that a shorter duration of hospitalization predicted premature discontinuation of outpatient treatment within 6 months of discharge. The duration of psychiatric hospitalization for posttraumatic stress disorder appeared to influence the premature discontinuation of outpatient treatment after discharge.

  11. NATURAL COURSE OF PATIENTS DISCONTINUING TREATMENT FOR AGE-RELATED MACULAR DEGENERATION AND FACTORS ASSOCIATED WITH VISUAL PROGNOSIS.

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    Kim, Jae Hui; Chang, Young Suk; Kim, Jong Woo

    2017-12-01

    To evaluate the 24-month natural course of visual changes in patients discontinuing treatment despite persistent or recurrent fluid and factors predictive of visual prognosis. This retrospective, observational study included 35 patients (35 eyes) who initially received anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration (AMD), but discontinued treatment despite persistent or recurrent fluid. The best-corrected visual acuity (BCVA) at treatment discontinuation was determined and compared with the 24-month BCVA, which was then compared between polypoidal choroidal vasculopathy and other neovascular age-related macular degeneration subtypes. Baseline characteristics predictive of visual outcome and the degree of visual change were also analyzed. The mean number of anti-vascular endothelial growth factor injections before treatment discontinuation was 4.0 ± 1.6. The mean logarithm of minimal angle of resolution of BCVA at treatment discontinuation and that at 24 months were 1.02 ± 0.20 (Snellen equivalents = 20/209) and 1.60 ± 0.56 (20/796), respectively (P age-related macular degeneration subtypes (P = 0.803). The type of fluid (intraretinal fluid vs. no intraretinal fluid) was predictive of 24-month BCVA (P = 0.004) and the degree of changes in BCVA (P = 0.043). Marked deterioration in visual acuity was noted in patients discontinuing treatment, regardless of neovascular age-related macular degeneration subtypes. The presence of intraretinal fluid was associated with worse visual prognosis, suggesting that patients with intraretinal fluid should be strongly warned about their poor prognosis before they decide to discontinue treatment.

  12. Interferon alpha 2 maintenance therapy may enable high rates of treatment discontinuation in chronic myeloid leukemia.

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    Burchert, A; Saussele, S; Eigendorff, E; Müller, M C; Sohlbach, K; Inselmann, S; Schütz, C; Metzelder, S K; Ziermann, J; Kostrewa, P; Hoffmann, J; Hehlmann, R; Neubauer, A; Hochhaus, A

    2015-06-01

    A minority of chronic myeloid leukemia (CML) patients is capable of successfully discontinuing imatinib. Treatment modalities to increase this proportion are currently unknown. Here, we assessed the role of interferon alpha 2a (IFN) on therapy discontinuation in a previously reported cohort of 20 chronic phase CML patients who were treated upfront with IFN alpha plus imatinib followed by IFN monotherapy to maintain cytogenetic or molecular remission (MR) after imatinib discontinuation. After a median follow-up of 7.9 years (range, 5.2-12.2), relapse-free survival was 73% (8/11 patients) and 84% (5/6 patients) for patients who discontinued imatinib in major MR (MMR) and MR4/MR4.5, respectively. Ten patients discontinued IFN after a median of 4.5 years (range, 0.24-9.3). After a median of 2.8 years (range, 0.7-5.1), nine of them remain in ongoing treatment-free remission with MR5 (n=6) and MR4.5 (n=3). The four patients who still administer IFN are in stable MR5, MR4.5, MR4, and MMR, respectively. In conclusion, an IFN/imatinib induction treatment followed by a temporary IFN maintenance therapy may enable a high rate of treatment discontinuation in CML patients in at least MMR when stopping imatinib.

  13. Metallicity at interphase boundaries due to polar catastrophe induced by charge density discontinuity

    KAUST Repository

    Albar, Arwa

    2018-02-09

    The electronic properties of interphase boundaries are of basic importance for most materials, particularly when those properties deviate strongly from the bulk behavior. We introduce a mechanism that can result in metallicity at stoichiometric interphase boundaries between semiconductors based on the idea of polar catastrophe, which is usually considered only in the context of heterostructures. To this end, we perform ab initio calculations within density functional theory to investigate the electronic states at stoichiometric SnO/SnO2 (110) interphase boundaries. In this system, one would not expect polar catastrophe to have a role according to state-of-the-art theory because the interface lacks formal charge discontinuity. However, we observe the formation of a hole gas between the semiconductors SnO and SnO2. To explain these findings, we provide a generalized theory based on the idea that the charge density discontinuity between SnO and SnO2, a consequence of lattice mismatch, drives a polar catastrophe scenario. As a result, SnO/SnO2 (110) interphase boundaries can develop metallicity depending on the grain size. The concept of metallicity due to polar catastrophe induced by charge density discontinuity is of general validity and applies to many interphase boundaries with lattice mismatch.

  14. Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study.

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    Öhlund, Louise; Ott, Michael; Oja, Sofia; Bergqvist, Malin; Lundqvist, Robert; Sandlund, Mikael; Salander Renberg, Ellinor; Werneke, Ursula

    2018-02-07

    Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium's proven benefits concerning the prevention of severe affective episodes and suicide. Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good. Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001). Stopping lithium treatment is

  15. Metronomic capecitabine as second-line treatment for hepatocellular carcinoma after sorafenib discontinuation.

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    Trevisani, Franco; Brandi, Giovanni; Garuti, Francesca; Barbera, Maria Aurelia; Tortora, Raffaella; Casadei Gardini, Andrea; Granito, Alessandro; Tovoli, Francesco; De Lorenzo, Stefania; Inghilesi, Andrea Lorenzo; Foschi, Francesco Giuseppe; Bernardi, Mauro; Marra, Fabio; Sacco, Rodolfo; Di Costanzo, Giovan Giuseppe

    2018-02-01

    Metronomic capecitabine (MC) is a well-tolerated systemic treatment showing promising results in one retrospective study, as second-line therapy after sorafenib failure, in patients with hepatocellular carcinoma (HCC). 117 patients undergoing MC were compared to 112 patients, eligible for this treatment, but undergoing best supportive care (BSC) after sorafenib discontinuation for toxicity or HCC progression. The two groups were compared for demographic and clinical features. A multivariate regression analysis was conducted to detect independent prognostic factors. To balance confounding factors between the two groups, a propensity score model based on independent prognosticators (performance status, neoplastic thrombosis, causes of sorafenib discontinuation and pre-sorafenib treatment) was performed. Patients undergoing MC showed better performance status, lower tumor burden, lower prevalence of portal vein thrombosis, and better cancer stage. Median (95% CI) post-sorafenib survival (PSS) was longer in MC than in BSC patients [9.5 (7.5-11.6) vs 5.0 (4.2-5.7) months (p < 0.001)]. Neoplastic thrombosis, cause of sorafenib discontinuation, pre-sorafenib treatment and MC were independent prognosticators. The benefit of capecitabine was confirmed in patients after matching with propensity score [PSS: 9.9 (6.8-12.9) vs. 5.8 (4.8-6.8) months, (p = 0.001)]. MC lowered the mortality risk by about 40%. MC achieved better results in patients who stopped sorafenib for adverse events than in those who progressed during it [PSS: 17.3 (10.5-24.1) vs. 7.8 (5.2-10.1) months, (p = 0.035)]. Treatment toxicity was low and easily manageable with dose modulation. MC may be an efficient and safe second-line systemic therapy for HCC patients who discontinued sorafenib for toxicity or tumor progression.

  16. Dropout in the treatment of erectile dysfunction with PDE5: a study on predictors and a qualitative analysis of reasons for discontinuation.

    Science.gov (United States)

    Carvalheira, Ana A; Pereira, Nuno Monteiro; Maroco, João; Forjaz, Vera

    2012-09-01

    Phosphodiesterase type 5 inhibitors (PDE5) are currently the first line treatment for erectile dysfunction (ED). However, previous research shows that PDE5 treatments have high discontinuation rates. Understanding the reasons for discontinuing PDE5 will be necessary to optimize the response to treatment. The main goals were: (i) to analyze discontinuation rate of PDE5; (ii) to identify the discontinuation predictors; and (iii) to study the reasons for discontinuation using a qualitative methodology. The PDE5 discontinuation rates, predictors, and reasons for discontinuation treatment. A total of 327 men with clinical diagnosis for ED who had been treated with PDE5 were successfully interviewed by telephone, after giving their informed consent by snail mail. Telephone interviews, concerning their ongoing treatment, were carried out using a standardized questionnaire form with quantitative and qualitative items. Participation rate was 71.8%. Of the total sample, 160 men (48.9%) had discontinued PDE5 treatment. The discontinuation rate was higher among men with diabetes (73%) and in iatrogenic group (65%), and lower in venogenic etiology (38.7%). We differentiated three groups of men who discontinued treatment (i) during the first 3 months (55.1%); (ii) between 4 and 12 months (26.9%); and (iii) after a period of 12 months (18%). Qualitative analyses revealed diverse reasons for discontinuation: non-effectiveness of PDE5 (36.8%), psychological factors (e.g., anxiety, negative emotions, fears, concerns, dysfunctional beliefs) (17.5%), erection recovery (14.4%), and concerns about the cardiovascular safety of PDE5 (8.7%) were the most common. Older men and men whose partners were involved in the treatment, were less likely to discontinue treatment. Half the subjects discontinued medication. Mostly, there was a combination of factors that led to discontinuation: non-effectiveness and psychosocial factors appear to be the main reasons. Addressing those factors will allow

  17. Predictors of premature discontinuation of outpatient treatment after discharge of patients with posttraumatic stress disorder

    Directory of Open Access Journals (Sweden)

    Wang HR

    2015-03-01

    Full Text Available Hee Ryung Wang, Young Sup Woo, Tae-Youn Jun, Won-Myong Bahk Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea Objective: This study aimed to examine the sociodemographic and disease-related variables associated with the premature discontinuation of psychiatric outpatient treatment after discharge among patients with noncombat-related posttraumatic stress disorder. Methods: We retrospectively reviewed the medical records of patients who were discharged with a diagnosis of posttraumatic stress disorder. Results: Fifty-five percent of subjects (57/104 prematurely discontinued outpatient treatment within 6 months of discharge. Comparing sociodemographic variables between the 6-month non-follow-up group and 6-month follow-up group, there were no variables that differed between the two groups. However, comparing disease-related variables, the 6-month follow-up group showed a longer hospitalization duration and higher Global Assessment of Function score at discharge. The logistic regression analysis showed that a shorter duration of hospitalization predicted premature discontinuation of outpatient treatment within 6 months of discharge. Conclusion: The duration of psychiatric hospitalization for posttraumatic stress disorder appeared to influence the premature discontinuation of outpatient treatment after discharge. Keywords: posttraumatic stress disorder, discontinuation, compliance, predictor

  18. Biomarker-based strategy for early discontinuation of empirical antifungal treatment in critically ill patients: a randomized controlled trial.

    Science.gov (United States)

    Rouzé, Anahita; Loridant, Séverine; Poissy, Julien; Dervaux, Benoit; Sendid, Boualem; Cornu, Marjorie; Nseir, Saad

    2017-11-01

    The aim of this study was to determine the impact of a biomarker-based strategy on early discontinuation of empirical antifungal treatment. Prospective randomized controlled single-center unblinded study, performed in a mixed ICU. A total of 110 patients were randomly assigned to a strategy in which empirical antifungal treatment duration was determined by (1,3)-β-D-glucan, mannan, and anti-mannan serum assays, performed on day 0 and day 4; or to a routine care strategy, based on international guidelines, which recommend 14 days of treatment. In the biomarker group, early stop recommendation was determined using an algorithm based on the results of biomarkers. The primary outcome was the percentage of survivors discontinuing empirical antifungal treatment early, defined as a discontinuation strictly before day 7. A total of 109 patients were analyzed (one patient withdraw consent). Empirical antifungal treatment was discontinued early in 29 out of 54 patients in the biomarker strategy group, compared with one patient out of 55 in the routine strategy group [54% vs 2%, p strategy compared with routine strategy [median (IQR) 6 (4-13) vs 13 (12-14) days, p strategy increased the percentage of early discontinuation of empirical antifungal treatment among critically ill patients with suspected invasive Candida infection. These results confirm previous findings suggesting that early discontinuation of empirical antifungal treatment had no negative impact on outcome. However, further studies are needed to confirm the safety of this strategy. This trial was registered at ClinicalTrials.gov, NCT02154178.

  19. Vertebral Fractures After Discontinuation of Denosumab

    DEFF Research Database (Denmark)

    Cummings, Steven R; Ferrari, Serge; Eastell, Richard

    2018-01-01

    . We analyzed the risk of new or worsening vertebral fractures, especially multiple vertebral fractures, in participants who discontinued denosumab during the FREEDOM study or its Extension. Participants received ≥2 doses of denosumab or placebo Q6M, discontinued treatment, and stayed in the study ≥7...... months after the last dose. Of 1001 participants who discontinued denosumab during FREEDOM or Extension, the vertebral fracture rate increased from 1.2 per 100 participant-years during the on-treatment period to 7.1, similar to participants who received and then discontinued placebo (n = 470; 8.5 per 100....... Therefore, patients who discontinue denosumab should rapidly transition to an alternative antiresorptive treatment. Clinicaltrails.gov: NCT00089791 (FREEDOM) and NCT00523341 (Extension). © 2017 American Society for Bone and Mineral Research....

  20. Twenty-four months of antipsychotic treatment in children and adolescents with first psychotic episode: discontinuation and tolerability.

    Science.gov (United States)

    Noguera, Ana; Ballesta, Patricia; Baeza, Immaculada; Arango, Celso; de la Serna, Elena; González-Pinto, Ana; Parellada, Mara; Graell, Montserrat; Moreno, Carmen; Otero, Soraya; Castro-Fornieles, Josefina

    2013-08-01

    The Child and Adolescent First-Episode Psychosis Study is a longitudinal study of early-onset first psychotic episodes. This report describes the naturalistic psychopharmacological treatment administered during a 24-month follow-up period, as well as discontinuation rates, reasons for discontinuation, and adverse effects. The sample comprised 110 patients, aged 9 to 17 years, with a first psychotic episode. Pharmacological treatment, changes, reasons for discontinuation, and the UKU (Udvalg for Kliniske Undersogelser) Side Effect Rating Scale were registered at 6, 12, and 24 months of follow-up. Second-generation antipsychotics, especially risperidone, quetiapine, and olanzapine, were the most commonly used. The discontinuation rate was 44.5% at 6 months, 59.1% at 12 months, and 70.9% at 24 months. Discontinuation rates or reasons for discontinuation (adverse reaction, insufficient response, and other) did not differ significantly between antipsychotics. At 6 months, significant differences were found in body mass index increase and body mass index z score increase, which were higher with olanzapine, and in neurological effects, which were higher with risperidone; at 12 and 24 months, these differences were no longer significant. High maintenance rates were found in the clozapine group, although they had higher scores on the autonomic subscale of the UKU. A long follow-up period reveals high discontinuation rates similar to those observed in adults, particularly during the first year. No differences were found between antipsychotics. Differences in adverse effects were found at 6 months but not subsequently after changes in treatment. Clozapine had a high maintenance rate, and its tolerability was comparable to that of other antipsychotics.

  1. Time to discontinuation of atypical versus typical antipsychotics in the naturalistic treatment of schizophrenia

    Directory of Open Access Journals (Sweden)

    Swartz Marvin

    2006-02-01

    Full Text Available Abstract Background There is an ongoing debate over whether atypical antipsychotics are more effective than typical antipsychotics in the treatment of schizophrenia. This naturalistic study compares atypical and typical antipsychotics on time to all-cause medication discontinuation, a recognized index of medication effectiveness in the treatment of schizophrenia. Methods We used data from a large, 3-year, observational, non-randomized, multisite study of schizophrenia, conducted in the U.S. between 7/1997 and 9/2003. Patients who were initiated on oral atypical antipsychotics (clozapine, olanzapine, risperidone, quetiapine, or ziprasidone or oral typical antipsychotics (low, medium, or high potency were compared on time to all-cause medication discontinuation for 1 year following initiation. Treatment group comparisons were based on treatment episodes using 3 statistical approaches (Kaplan-Meier survival analysis, Cox Proportional Hazards regression model, and propensity score-adjusted bootstrap resampling methods. To further assess the robustness of the findings, sensitivity analyses were performed, including the use of (a only 1 medication episode for each patient, the one with which the patient was treated first, and (b all medication episodes, including those simultaneously initiated on more than 1 antipsychotic. Results Mean time to all-cause medication discontinuation was longer on atypical (N = 1132, 256.3 days compared to typical antipsychotics (N = 534, 197.2 days; p Conclusion In the usual care of schizophrenia patients, time to medication discontinuation for any cause appears significantly longer for atypical than typical antipsychotics regardless of the typical antipsychotic potency level. Findings were primarily driven by clozapine and olanzapine, and to a lesser extent by risperidone. Furthermore, only clozapine and olanzapine therapy showed consistently and significantly longer treatment duration compared to perphenazine, a medium

  2. Discontinuing treatment in children with chronic, critical illnesses.

    Science.gov (United States)

    Mahon, M M; Deatrick, J A; McKnight, H J; Mohr, W K

    2000-03-01

    Decisions about optimal treatment for critically ill children are qualitatively different from those related to adults. Technological advances over the past several decades have resulted in myriad treatment options that leave many children chronically, critically ill. These children are often technology dependent. With new technologies and new patient populations comes the responsibility to understand how, when, and why these technologies are applied and when technology should not be used or should be withdrawn. Much has been written about ethical decision making in the care of chronically, critically ill adults and newborns. In this article, relevant factors about the care of children older than neonates are described: standards, decision makers, age of the child, and pain management. A case study is used as a mechanism to explore these issues. Dimensions of futility, discontinuing aggressive treatment, and a consideration of benefits and burdens are integrated throughout the discussion to inform nurse practitioner practice.

  3. System dynamics with interaction discontinuity

    CERN Document Server

    Luo, Albert C J

    2015-01-01

    This book describes system dynamics with discontinuity caused by system interactions and presents the theory of flow singularity and switchability at the boundary in discontinuous dynamical systems. Based on such a theory, the authors address dynamics and motion mechanism of engineering discontinuous systems due to interaction. Stability and bifurcations of fixed points in nonlinear discrete dynamical systems are presented, and mapping dynamics are developed for analytical predictions of periodic motions in engineering discontinuous dynamical systems. Ultimately, the book provides an alternative way to discuss the periodic and chaotic behaviors in discontinuous dynamical systems.

  4. A comparison of discontinuation rates of tofacitinib and biologic disease-modifying anti-rheumatic drugs in rheumatoid arthritis: a systematic review and Bayesian network meta-analysis.

    Science.gov (United States)

    Park, Sun-Kyeong; Lee, Min-Young; Jang, Eun-Jin; Kim, Hye-Lin; Ha, Dong-Mun; Lee, Eui-Kyung

    2017-01-01

    The purpose of this study was to compare the discontinuation rates of tofacitinib and biologics (tumour necrosis factor inhibitors (TNFi), abatacept, rituximab, and tocilizumab) in rheumatoid arthritis (RA) patients considering inadequate responses (IRs) to previous treatment(s). Randomised controlled trials of tofacitinib and biologics - reporting at least one total discontinuation, discontinuation due to lack of efficacy (LOE), and discontinuation due to adverse events (AEs) - were identified through systematic review. The analyses were conducted for patients with IRs to conventional synthetic disease-modifying anti-rheumatic drugs (cDMARDs) and for patients with biologics-IR, separately. Bayesian network meta-analysis was used to estimate rate ratio (RR) of a biologic relative to tofacitinib with 95% credible interval (CrI), and probability of RR being tofacitinib and biologics in the cDMARDs-IR group. In the biologics-IR group, however, TNFi (RR 0.17, 95% CrI 0.01-3.61, P[RRtofacitinib did. Despite the difference, discontinuation cases owing to LOE and AEs revealed that tofacitinib was comparable to the biologics. The comparability of discontinuation rate between tofacitinib and biologics was different based on previous treatments and discontinuation reasons: LOE, AEs, and total (due to other reasons). Therefore, those factors need to be considered to decide the optimal treatment strategy.

  5. Discontinuation Decision in Assisted Reproductive Techniques

    Directory of Open Access Journals (Sweden)

    Ashraf Moini

    2009-01-01

    Full Text Available Background: In vitro fertilization (IVF and intra cytoplasmic sperm injection (ICSI are recognizedas established and increasingly successful forms of treatment for infertility, yet significant numbersof couples discontinue treatment without achieving a live birth. This study aims to identify majorfactors that influence the decision to discontinue IVF/ICSI treatments.Materials and Methods: We studied the data of 338 couples who discontinued their infertilitytreatments after three cycles; based on medical records and phone contact. The main measure wasthe reason for stopping their treatments.Results: Economical problems were cited by 212 couples (62.7%, as their mean income wassignificantly less than other couples (p<0.0001. Lack of success was reported as a reason by229 (67.8%, from whom 165 (72% also had economical problems. Achieving independent-ART pregnancy was the reason for discontinuation in 20 (5.9% couples. Psychological stress,depression and anxiety were reported as other cessation factors by 169 (50%, 148 (43.8% and 182(53.8% couples, respectively.Conclusion: This survey suggests that the most common reasons for assisted reproductivetechnique (ART discontinuation after three cycles are: prior unsuccessful cycles, economicaland psychological problems. Therefore, the substantial proportion of couples could benefit frompsychological intervention, increasing awareness of ART outcomes and health funding to copemore adequately with failed treatments.

  6. Effect of Discontinuous Ultrasonic Treatment on Mechanical Properties and Microstructure of Cast Al413-SiCnp Nanocomposites

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    M.R. Dehnavi

    2015-05-01

    Full Text Available Effects of discontinuous ultrasonic treatment on the microstructure, nanoparticle distribution, and mechanical properties of cast Al413-SiCnp nanocomposites were studied. The results showed that discontinuous ultrasonic treatment was more effective in improving the mechanical properties of the cast nanocomposites than the equally timed continuous treatment. The yield and ultimate tensile strengths of Al413-2%SiCnp nanocomposites discontinuously treated for two 20 minute periods increased by about 126% and 100% compared to those of the monolithic sample, respectively. These improvements were about 107% and 94% for the nanocomposites continuously treated for a single 40 minute period. The improvement in the mechanical properties was associated with severe refinement of the microstructure, removal of the remaining gas layers on the particles surfaces, more effective fragmentation of the remaining agglomerates as well as improved wettability and distribution of the reinforcing particles during the first stage of solidification.

  7. Host population structure impedes reversion to drug sensitivity after discontinuation of treatment.

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    Jonas I Liechti

    2017-08-01

    Full Text Available Intense use of antibiotics for the treatment of diseases such as tuberculosis, malaria, Staphylococcus aureus or gonorrhea has led to rapidly increasing population levels of drug resistance. This has generally necessitated a switch to new drugs and the discontinuation of older ones, after which resistance often only declines slowly or even persists indefinitely. These long-term effects are usually ascribed to low fitness costs of resistance in absence of the drug. Here we show that structure in the host population, in particular heterogeneity in number of contacts, also plays an important role in the reversion dynamics. Host contact structure acts both during the phase of intense treatment, leading to non-random distributions of the resistant strain among the infected population, and after the discontinuation of the drug, by affecting the competition dynamics resulting in a mitigation of fitness advantages. As a consequence, we observe both a lower rate of reversion and a lower probability that reversion to sensitivity on the population level occurs after treatment is stopped. Our simulations show that the impact of heterogeneity in the host structure is maximal in the biologically most plausible parameter range, namely when fitness costs of resistance are small.

  8. Reasons for discontinuation of subcutaneous biologic therapy in the treatment of rheumatoid arthritis: a patient perspective

    Directory of Open Access Journals (Sweden)

    Bolge SC

    2015-01-01

    Full Text Available Susan C Bolge,1 Amir Goren,2 Neeta Tandon1 1Health Economics and Outcomes Research, Janssen Scientific Affairs, LLC, Horsham, PA, USA; 2Health Outcomes Practice, Kantar Health, New York, NY, USA Objective: To examine reasons why rheumatoid arthritis patients discontinued subcutaneous (SQ anti-tumor necrosis factor (anti-TNF treatment in the past 12 months, so as to help inform successful, uninterrupted therapy.Methods: Data were collected in March and April 2011 using self-reported, internet-based questionnaires. Study inclusion criteria comprised: rheumatoid arthritis diagnosis; discontinuation of SQ anti-TNF medication (adalimumab, certolizumab, etanercept, or golimumab within the past 12 months; aged ≥18 years; United States residency; and consent to participate. Patients reported primary and other reasons for discontinuation of their most recently discontinued anti-TNF.Results: Questionnaires from 250 patients were analyzed; 72.8% were female, 80.8% were white, and median age was 51 years. Patients had discontinued etanercept (n=109, adalimumab (n=98, certolizumab (n=24, or golimumab (n=19 within the past 12 months. When prompted about their primary reason for discontinuation, lack of effectiveness (40.8% was cited most often, followed by injection experience (18.4%. Combining prompted primary and other reasons for discontinuation, 60.8% of patients reported lack of effectiveness, while 40.8% reported injection experience, which included: pain/burning/discomfort after injection (14.4%; pain/burning/discomfort during injection (13.2%; injection reactions such as redness/swelling after injection (12.4%; dislike of self-injection (11.6%; dislike of frequency of injection (10.4%; and fear of injection/needles (6.8%. Conclusion: From the patient perspective, there are unmet needs with regard to the effectiveness and injection experience associated with SQ anti-TNF medications, which may lead to discontinuation. Treatment options with a

  9. Outcomes Following Discontinuation of E. coli l-Asparaginase Upon Severe Allergic Reactions in Children With Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Yen, Hsiu-Ju; Chang, Wan-Hui; Liu, Hsi-Che; Yeh, Ting-Chi; Hung, Giun-Yi; Wu, Kang-Hsi; Peng, Ching-Tien; Chang, Yu-Hsiang; Chang, Te-Kao; Hsiao, Chih-Cheng; Sheen, Jiunn-Ming; Chao, Yu-Hua; Chang, Tai-Tsung; Chiou, Shyh-Shin; Lin, Pei-Chin; Wang, Shih-Chung; Lin, Ming-Tsan; Ho, Wan-Ling; Chen, Yu-Chieh; Liang, Der-Cherng

    2016-04-01

    Discontinuation of E. coli l-asparaginase in patients with acute lymphoblastic leukemia (ALL) is unavoidable upon severe allergic reaction. We sought to examine outcomes following E. coli l-asparaginase discontinuation due to severe allergic reactions. We evaluated the outcome of children enrolled in Taiwan Pediatric Oncology Group-2002-ALL protocol between 2002 and 2012, who had E. coli l-asparaginase discontinued due to severe allergic reactions, and compared the outcomes of those who continued with Erwinia l-asparaginase (Erwinase) with those who did not. Among 700 patients enrolled in this study, 33 patients had E. coli l-asparaginase treatment discontinued due to severe allergic reactions. Five-year overall survival did not differ significantly among the 648 patients without discontinuation (81 ± 1.6%, mean ± SE), compared to 17 patients with allergic reactions and treated with Erwinase (88 ± 7.8%) and 16 patients with allergic reactions but not treated with Erwinase (87 ± 8.6%). Among 16 patients who did not receive Erwinase, all 10 who received ≥50% of the scheduled doses of E. coli l-asparaginase before discontinuation survived without events. Erwinase treatment may not be needed for some ALL patients with severe allergy to E. coli l-asparaginase if ≥50% of prescribed doses were received and/or therapy is augmented with other agents. © 2015 Wiley Periodicals, Inc.

  10. Discontinuance of ADHD Treatment in Adolescents

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    J Gordon Millichap

    2009-04-01

    Full Text Available Prevalence of ADHD drug discontinuance in adolescents and young adults was studied in the UK by using the General Practice Database for patients aged 15-21 years from 1999 to 2006.

  11. Predictors of Relapse after Discontinuing Systemic Treatment in Childhood Autoimmune Chronic Uveitis.

    Science.gov (United States)

    Simonini, Gabriele; Bracaglia, Claudia; Cattalini, Marco; Taddio, Andrea; Brambilla, Alice; De Libero, Cinzia; Pires Marafon, Denise; Caputo, Roberto; Cimaz, Rolando

    2017-06-01

    To identify clinical predictors of relapse in childhood autoimmune chronic uveitis after stopping systemic treatment. A retrospective, multicenter, cohort study. Ninety-four children in remission, receiving no treatments and with at least a 6-month followup, were enrolled. A higher probability of maintaining remission after discontinuing treatment was shown in idiopathic compared with juvenile idiopathic arthritis uveitis (Mantel-Cox chi-square = 23.21) if inactivity had been obtained within 6 months from starting systemic treatment (Mantel-Cox chi-square = 24.17) and by antitumor necrosis factor-α treatment (Mantel-Cox chi-square = 6.43). Type of disease, time, and type of systemic therapy to achieve inactivity predict different duration of uveitis remission after treatment withdrawal.

  12. Retroviral rebound syndrome after treatment discontinuation in a 15 year old girl with HIV attracted through mother-to-child transmission: case report

    OpenAIRE

    Gisslén Magnus; Friman Vanda

    2007-01-01

    Abstract A case of a 15 year old girl with retroviral rebound syndrome after discontinuation of highly active antiretroviral treatment (HAART) due to side effects is presented. The patient was transmitted with HIV at birth by her mother. She had recovered from severe AIDS after HAART was initiated five years earlier. This is the first case reported in the literature of retroviral rebound syndrome in a vertically transmitted HIV-infected patient.

  13. Ultrasonic assessment of shrinkage type discontinuities

    International Nuclear Information System (INIS)

    Hubber, John

    2010-01-01

    This investigation into ultrasonic internal discontinuities is intended to demonstrate typical examples of internal 'shrinkage' type discontinuities and its connection with the casting suitability, integrity and reliability in service. This type of discontinuity can be misinterpreted by ultrasonic technicians and can lead to the rejection of castings unnecessarily, due to the mis-characterization of fine shrinkage - discrete porosity. The samples for this investigation were taken from thirty ton heavy section ductile iron mill flange castings, manufactured by Graham Campbell Ferrum International. The sampled area was of discontinuities that were recorded for sizing on an area due to loss of back wall echo, but had acceptable reflectivity. A comparative sample was taken adjacent to the area of discrete porosity. The discontinuities found by this investigation are of a 'spongy' type, gaseous in appearance and are surrounded by acoustically sound material. All discontinuities discussed in this paper are centrally located in the through thickness of the casting. The porous nature of this type of discontinuity consisting of approximately 80-90% metal has its own residual strength, as indicated by the proof stress results which reveal a residual strength of up to 50-60% of that of the unaffected area of the casting. The affected areas are elliptical in shape and vary in density and through thickness throughout.

  14. Priapism Followed by Discontinuation of Methadone: A rare Case Report

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    Seyed-Ali Mostafavi

    2015-10-01

    Full Text Available Objective: Priapism is defined by persistent, painful penile erection which occurs without sexual stimulation. Methadone is used as an analgesic and is also used in detoxification and maintenance protocol for opioid dependence treatment. Here we will report a case of a male with priapism after rapid discontinuation doses of methadone.Case presentation: The case was a young married male who referred to a psychiatry clinic due to long-time spontaneous erections. The patient had no history of mental disorders, trauma or sickle cell anemia. He used to smoke opium for five years and used methadone for four years at a dose of 17 cc daily, which he abruptly discontinued. Then he often experienced spontaneous and painful erections without physical or mental stimulation that caused him shame and embarrassment .Conclusion: In this case, chronology indicates that rapid discontinuation of methadone was possibly responsible for the occurrence of priapism. This may have happened due to a compensatory reaction to methadone side effect of erectile dysfunction, followed by its rapid withdrawal.

  15. Discontinuation of Biologic Therapy in Rheumatoid Arthritis: Analysis from the Corrona RA Registry.

    Science.gov (United States)

    Strand, Vibeke; Miller, Paul; Williams, Setareh A; Saunders, Katherine; Grant, Shannon; Kremer, Joel

    2017-12-01

    Despite the availability of multiple effective therapies, discontinuation/switching of treatment is common for many patients with rheumatoid arthritis (RA). This study was designed to examine initiation of biologic disease-modifying anti-rheumatic drugs (bDMARDs) within the Consortium of Rheumatology Researchers of North America (Corrona) RA Registry, and characterize reasons for discontinuation. Inclusion criteria were: Corrona-registered adults (≥18 years) with RA (2002-2011); age of RA onset: ≥16 years; ≥6 months' follow-up after initiation of first/subsequent bDMARD. Patients receiving both tumor necrosis factor antagonists and non-TNF antagonists were included. Treatment discontinuation was defined as first report of stopping initial therapy or initiation of new bDMARD at/between visits, using a follow-up physician questionnaire. Overall, 6209 patients met inclusion criteria and 80.7% received TNF antagonists. Median time to discontinuation/change of therapy was 25.1 months (26.5 months with TNF antagonists vs. 20.5 months with non-TNF antagonists; log-rank p < 0.0001); 82.2, 67.3, and 51.1% of patients remained on therapy at 6, 12, and 24 months, respectively. Reasons for discontinuation were captured for 49.2% of patients, including: loss of efficacy (35.8%); physician preference (27.8%); safety (20.1%); patient preference (17.9%); and no access to treatment (9.0%). Baseline factors with greatest correlation to discontinuation were modified Health Assessment Questionnaire scores, patient-reported anxiety/depression, initiation of bDMARD treatment in 2007-2010 versus 2002-2003, and Clinical Disease Activity Index scores. Almost one-third of patients in the US discontinue currently available bDMARD therapies for RA by 12 months and almost half by 24 months, most commonly due to loss of efficacy. Corrona LLC and MedImmune.

  16. Successful retreatment with sofosbuvir plus ledipasvir for cirrhotic patients with hepatitis C virus genotype 1b, who discontinued the prior treatment with asunaprevir plus daclatasvir: A case series and review of the literature

    Science.gov (United States)

    Haga, Yuki; Kanda, Tatsuo; Yasui, Shin; Nakamura, Masato; Ooka, Yoshihiko; Takahashi, Koji; Wu, Shuang; Nakamoto, Shingo; Arai, Makoto; Chiba, Tetsuhiro; Maruyama, Hitoshi; Yokosuka, Osamu; Takada, Nobuo; Moriyama, Mitsuhiko; Imazeki, Fumio; Kato, Naoya

    2018-01-01

    Background Interferon-free treatment results in higher sustained virologic response (SVR) rates, with no serious adverse events in hepatitis C virus (HCV)-infected patients. However, in some patients with treatment-failure in HCV NS5A inhibitor-including interferon-free regimens, the treatment-emergent HCV NS5A resistance-associated variants (RAVs), which are resistant to interferon-free retreatment including HCV NS5A inhibitors, are observed. In HCV-infected Japanese patients with daclatasvir and asunaprevir treatment failure, retreatment with sofosbuvir and ledipasvir could lead to only ∼70% SVR rates. Case summary Three HCV genotype (GT)-1b-infected cirrhotic patients who discontinued the combination of daclatasvir and asunaprevir due to adverse drug reactions within 4 weeks; retreatment with sofosbuvir and ledipasvir combination could result in SVR in these patients without RAVs. One HCV GT-1b-infected cirrhotic patient who discontinued the combination of daclatasvir and asunaprevir due to viral breakthrough at week 10; retreatment with sofosbuvir and ledipasvir combination for this patient with the treatment-emergent HCV NS5A RAV-Y93H resulted in viral relapse at week 4 after the end of the treatment. Conclusion Retreatment with sofosbuvir and ledipasvir is effective for HCV GT-1b patients who discontinue the combination of daclatasvir and asunaprevir within 4 weeks. The treatment response should be related to the existence of treatment-emergent HCV NS5A RAVs, but may not be related to the short duration of treatment. PMID:29435197

  17. Natalizumab Discontinuation and Treatment Strategies in Patients with Multiple Sclerosis (MS): A Retrospective Study from Two Italian MS Centers.

    Science.gov (United States)

    Lo Re, Marianna; Capobianco, Marco; Ragonese, Paolo; Realmuto, Sabrina; Malucchi, Simona; Berchialla, Paola; Salemi, Giuseppe; Bertolotto, Antonio

    2015-12-01

    Natalizumab (NTZ) discontinuation can be followed by multiple sclerosis (MS) disease reactivation. Currently no disease-modifying drug (DMD) has been shown to be able to abolish disease reactivation. The aims of the current study were: (1) to determine the frequency of MS reactivation after NTZ discontinuation; (2) to evaluate predictors of reactivation risk, and (3) to compare the effect of different treatments in reducing this risk. Data from 132 patients with MS followed-up for 2 years before NTZ treatment and 1 year after interruption were collected from two Italian MS centers and retrospectively evaluated. Overall, 72 of 132 patients (54.5%) had relapses after NTZ discontinuation and 60 of 125 patients (48%), who had magnetic resonance imaging, had radiological reactivation. Rebound was observed in 28 of 132 patients (21.2%). A higher number of relapses in the 2 years before NTZ treatment, a longer washout period, and a lower number NTZ infusions correlated with reactivation and rebound. Untreated patients (n = 37) had higher clinical and radiological activity and rebound in comparison to patients receiving DMDs. Moreover, a lower risk of relapses was found in patients treated with second-line therapies (NTZ and fingolimod) than in those treated with first-line therapies (interferon beta, glatiramer acetate, teriflunomide, azathioprine). Interestingly, no disease reactivation in off-label treatment (rituximab, autologous hematopoietic stem cell transplantation) was observed. NTZ discontinuation is a risk for MS reactivation and rebound. An alternative treatment should be promptly resumed mainly in patients with a previous very active disease course and with a shorter NTZ therapy. Second-line therapies demonstrate superiority in preventing relapses after NTZ discontinuation.

  18. Predictors of early treatment discontinuation and severe anemia in a Brazilian cohort of hepatitis C patients treated with first-generation protease inhibitors

    Directory of Open Access Journals (Sweden)

    N. Miotto

    2016-01-01

    Full Text Available The aim of this study was to determine risk factors for adverse events (AE-related treatment discontinuation and severe anemia among patients with chronic hepatitis C virus (HCV genotype 1 infection, treated with first-generation protease inhibitor (PI-based therapy. We included all patients who initiated treatment with PI-based therapy at a Brazilian university hospital between November 2013 and December 2014. We prospectively collected data from medical records using standardized questionnaires and used Epi Info 6.0 for analysis. Severe anemia was defined as hemoglobin ≤8.5 mg/dL. We included 203 patients: 132 treated with telaprevir (TVR and 71 treated with boceprevir (BOC. AE-related treatment discontinuation rate was 19.2% and anemia was the main reason (38.5%. Risk factors for treatment discontinuation were higher comorbidity index (OR=1.85, CI=1.05-3.25 for BOC, and higher bilirubin count (OR=1.02, CI=1.01-1.04 and lower BMI (OR=0.98, CI=0.96-0.99 for TVR. Severe anemia occurred in 35 (17.2% patients. Risk factors for this outcome were lower estimated glomerular filtration rate (eGFR; OR=0.95, CI=0.91-0.98 for patients treated with TVR, and higher comorbidity index (OR=2.21, CI=1.04-4.67 and ribavirin dosage (OR=0.84, CI=0.72-0.99 for those treated with BOC. Fifty-five (57.3% patients treated with TVR and 15 (27.3% patients treated with BOC achieved sustained virological response (SVR. Among patients who received TVR and interrupted treatment due to AE (n=19, only 26.3% (n=5 achieved SVR (P=0.003. Higher number of comorbidities, lower eGFR and advanced liver disease are associated with severe anemia and early treatment cessation, which may compromise SVR achievement.

  19. What happens when people discontinue taking medications? Lessons from COMBINE.

    Science.gov (United States)

    Stout, Robert L; Braciszewski, Jordan M; Subbaraman, Meenakshi Sabina; Kranzler, Henry R; O'Malley, Stephanie S; Falk, Daniel

    2014-12-01

    We use intensive longitudinal data methods to illuminate processes affecting patients' drinking in relation to the discontinuation of medications within an alcohol treatment study. Although previous work has focused on broad measures of medication adherence, we focus on dynamic changes in drinking both before and after patients discontinue. We conducted secondary data analyses using the COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study, focused on participants who discontinued medications prior to the planned end of treatment. Using an interrupted time-series analysis, we analysed drinking in the weeks before and after discontinuation and also studied outcomes at the end of the COMBINE follow-up. Unites States of America. We describe the subsample of COMBINE participants who discontinued medications (n = 450), and compare them with those who were medication-adherent (n = 559) and with those who discontinued but had substantial missing data (n = 217). The primary outcomes were percentage of days abstinent (PDA) and percentage of heavy drinking days (PHDD). Medication adherence data were used to approximate the date of discontinuation. For many patients, an increase in drinking began weeks before discontinuation (PDA: F(1,4803) = 19.07, P < 0.001; PHDD: F(1,4804) = 8.58, P = 0.003) then escalated at discontinuation (PDA: F(1,446) = 5.05, P = 0.025; PHDD: F(1,446) = 4.52, P = 0.034). Among other effects, the amount of change was moderated by the reason for discontinuation (e.g. adverse event; PDA: F(2,4803) = 3.85, P = 0.021; PHDD: F(2,4804) = 5.36, P = 0.005) and also whether it occurred in the first or second half of treatment (PDA: F(1,4803) = 5.23, P = 0.022; PHDD: F(1,4804) = 8.79, P = 0.003). A patient's decision to stop taking medications during alcohol treatment appears to take place during a weeks-long process of disengagement from treatment. Patients who discontinue medications early in treatment or without

  20. Hippocampal agenesis in an individual who engaged in violent criminal behaviors after discontinuing carbamazepine and paroxetine treatment.

    Science.gov (United States)

    Hanada, Hiroaki; Akiyoshi, Jotaro; Kanehisa, Masayuki; Ishitobi, Yoshinobu; Tsuru, Jusen; Tanaka, Yoshihiro; Shimomura, Tsuyoshi; Kawano, Yoshihisa

    2013-01-01

    Antidepressant discontinuation syndrome (ADS) occurs after abrupt discontinuation of an antidepressant medication. A 23-year-old man with right hippocampal agenesis demonstrated sexual crime (hypersexuality) since the age of eight and had been successfully treated with carbamazepine since the age of 13. He had required increased doses of paroxetine and carbamazepine owing to the development of an unstable affect after quitting his job. He abruptly stopped taking his medication for 3 days and his criminal behaviors re-emerged. We examined changes in brain structure and activity before and after medication cessation, using MRI and functional MRI (fMRI). The image of a girl in a swimsuit increased activity in the thalamus only after medication discontinuation. The alteration in thalamic activity might induce hypersexuality. We conclude that a primary hypersexuality had been suppressed with carbamazepine and paroxetine treatment, and the discontinuation of the medication caused the hypersexuality. © 2012 American Academy of Forensic Sciences.

  1. Passive noise control by enhancing aeroacoustic interference due to structural discontinuities in close proximity

    Science.gov (United States)

    Leung, R. C. K.; So, R. M. C.; Tang, S. K.; Wang, X. Q.

    2011-07-01

    In-duct devices are commonly installed in flow ducts for various flow management purposes. The structural construction of these devices indispensably creates disruption to smooth flow through duct passages so they exist as structural discontinuities in duct flow. The presence of these discontinuities provides additional possibility of noise generation. In real practice, in-duct devices do not exist alone in any duct system. Even though each in-duct device would generate its own noise, it might be possible that these devices could be properly arranged so as to strengthen the interference between individual noise; thus giving rise to an overall reduction of noise radiation in the in-duct far field. This concept of passive noise control is investigated by considering different configurations of two structural discontinuities of simple form (i.e., a cavity) in tandem in an unconfined flow and in opposing setting within a flow duct. It is known that noise generated by a cavity in unconfined domain (unconfined cavity) is strongly dependent on flow-resonant behavior within the cavity so the interference it produces is merely aeroacoustic. The objective of the present study is to verify the concept of passive noise reduction through enhancement of aeroacoustic interference due to two cavities by considering laminar flow only. A two-dimensional approach is adopted for the direct aeroacoustic calculations using a direct numerical simulation (DNS) technique. The position and geometries of the cavities and the Mach number are varied; the resultant aeroacoustic behavior and acoustic power are calculated. The numerical results are compared with a single cavity case to highlight the effect of introducing additional cavities to the aeroacoustic problem. Resonant flow oscillations occur when two unconfined cavities are very close and the associated acoustic field is very intense with no noise reduction possible. However, for duct aeroacoustics, it is found that a 7.9 db reduction

  2. Patient- and population-level health consequences of discontinuing antiretroviral therapy in settings with inadequate HIV treatment availability

    Directory of Open Access Journals (Sweden)

    Kimmel April D

    2012-09-01

    Full Text Available Abstract Background In resource-limited settings, HIV budgets are flattening or decreasing. A policy of discontinuing antiretroviral therapy (ART after HIV treatment failure was modeled to highlight trade-offs among competing policy goals of optimizing individual and population health outcomes. Methods In settings with two available ART regimens, we assessed two strategies: (1 continue ART after second-line failure (Status Quo and (2 discontinue ART after second-line failure (Alternative. A computer model simulated outcomes for a single cohort of newly detected, HIV-infected individuals. Projections were fed into a population-level model allowing multiple cohorts to compete for ART with constraints on treatment capacity. In the Alternative strategy, discontinuation of second-line ART occurred upon detection of antiretroviral failure, specified by WHO guidelines. Those discontinuing failed ART experienced an increased risk of AIDS-related mortality compared to those continuing ART. Results At the population level, the Alternative strategy increased the mean number initiating ART annually by 1,100 individuals (+18.7% to 6,980 compared to the Status Quo. More individuals initiating ART under the Alternative strategy increased total life-years by 15,000 (+2.8% to 555,000, compared to the Status Quo. Although more individuals received treatment under the Alternative strategy, life expectancy for those treated decreased by 0.7 years (−8.0% to 8.1 years compared to the Status Quo. In a cohort of treated patients only, 600 more individuals (+27.1% died by 5 years under the Alternative strategy compared to the Status Quo. Results were sensitive to the timing of detection of ART failure, number of ART regimens, and treatment capacity. Although we believe the results robust in the short-term, this analysis reflects settings where HIV case detection occurs late in the disease course and treatment capacity and the incidence of newly detected patients are

  3. Fast Numerical Simulation of Focused Ultrasound Treatments During Respiratory Motion With Discontinuous Motion Boundaries.

    Science.gov (United States)

    Schwenke, Michael; Georgii, Joachim; Preusser, Tobias

    2017-07-01

    Focused ultrasound (FUS) is rapidly gaining clinical acceptance for several target tissues in the human body. Yet, treating liver targets is not clinically applied due to a high complexity of the procedure (noninvasiveness, target motion, complex anatomy, blood cooling effects, shielding by ribs, and limited image-based monitoring). To reduce the complexity, numerical FUS simulations can be utilized for both treatment planning and execution. These use-cases demand highly accurate and computationally efficient simulations. We propose a numerical method for the simulation of abdominal FUS treatments during respiratory motion of the organs and target. Especially, a novel approach is proposed to simulate the heating during motion by solving Pennes' bioheat equation in a computational reference space, i.e., the equation is mathematically transformed to the reference. The approach allows for motion discontinuities, e.g., the sliding of the liver along the abdominal wall. Implementing the solver completely on the graphics processing unit and combining it with an atlas-based ultrasound simulation approach yields a simulation performance faster than real time (less than 50-s computing time for 100 s of treatment time) on a modern off-the-shelf laptop. The simulation method is incorporated into a treatment planning demonstration application that allows to simulate real patient cases including respiratory motion. The high performance of the presented simulation method opens the door to clinical applications. The methods bear the potential to enable the application of FUS for moving organs.

  4. Identifying the factors underlying discontinuation of triptans.

    Science.gov (United States)

    Wells, Rebecca E; Markowitz, Shira Y; Baron, Eric P; Hentz, Joseph G; Kalidas, Kavita; Mathew, Paul G; Halker, Rashmi; Dodick, David W; Schwedt, Todd J

    2014-02-01

    To identify factors associated with triptan discontinuation among migraine patients. It is unclear why many migraine patients who are prescribed triptans discontinue this treatment. This study investigated correlates of triptan discontinuation with a focus on potentially modifiable factors to improve compliance. This multicenter cross-sectional survey (n = 276) was performed at US tertiary care headache clinics. Headache fellows who were members of the American Headache Society Headache Fellows Research Consortium recruited episodic and chronic migraine patients who were current triptan users (use within prior 3 months and for ≥1 year) or past triptan users (no use within 6 months; prior use within 2 years). Univariate analyses were first completed to compare current triptan users to past users for: migraine characteristics, other migraine treatments, triptan education, triptan efficacy, triptan side effects, type of prescribing provider, Migraine Disability Assessment (MIDAS) scores and Beck Depression Inventory (BDI) scores. Then, a multivariable logistic regression model was selected from all possible combinations of predictor variables to determine the factors that best correlated with triptan discontinuation. Compared with those still using triptans (n = 207), those who had discontinued use (n = 69) had higher rates of medication overuse (30 vs. 18%, P = .04) and were more likely to have ever used opioids for migraine treatment (57 vs. 38%, P = .006) as well as higher MIDAS (mean 63 vs. 37, P = .001) and BDI scores (mean 10.4 vs. 7.4, P = .009). Compared with discontinued users, current triptan users were more likely to have had their triptan prescribed by a specialist (neurologist, headache specialist, or pain specialist) (74 vs. 54%, P = .002) and were more likely to report headache resolution (53 vs. 14%, P  24 (2.6, [1.5, 4.6]), BDI >4 (2.5, [1.4, 4.5]), and a history of ever using opioids for migraine therapy (2.2, [1

  5. Green's function approach to neutron flux discontinuities

    International Nuclear Information System (INIS)

    Saad, E.A.; El-Wakil, S.A.

    1980-01-01

    The present work is devoted to the presentation of analytical method for the calculation of elastically and inelastically slowed down neutrons in an infinite non-absorbing medium. On the basis of the central limit theory (CLT) and the integral transform technique the slowing down equation including inelastic scattering, in terms of the Green function of elastic scattering, is solved. The Green function is decomposed according to the number of collisions. Placzec discontinuity associated with elastic scattering in addition to two discontinuities due to inelastic scattering are investigated. Numerical calculations for Fe 56 show that the elastic discontinuity produces about 41.8% change in the collision density whilst the ratio of the inelastic collision density discontinuity at qsub(o)sup(+) to the Placzec discontinuity at usub(o) + 1n 1/oc gives 55.7 percent change. (author)

  6. A randomized clinical trial of the effect of intensive versus non-intensive counselling on discontinuation rates due to bleeding disturbances of three long-acting reversible contraceptives.

    Science.gov (United States)

    Modesto, Waleska; Bahamondes, M Valeria; Bahamondes, Luis

    2014-07-01

    Does intensive counselling before insertion and throughout the first year of use have any influence on discontinuation rates due to unpredictable menstrual bleeding in users of three long-acting reversible contraceptives (LARCs)? Intensive counselling had a similar effect to routine counselling in terms of discontinuation rates due to unpredictable menstrual bleeding in new users of the contraceptives. Contraceptive efficacy and satisfaction rates are very high with LARCs, including the etonogestrel (ENG)-releasing implant, the levonorgestrel-releasing intrauterine system (LNG-IUS) and the TCu380A intrauterine device (IUD). However, unpredictable menstrual bleeding constitutes the principal reason for premature discontinuation, particularly in the cases of the ENG-implant and the LNG-IUS. A randomized clinical trial was conducted between 2011 and 2013, and involved 297 women: 98 ENG-implant users, 99 LNG-IUS users and 100 TCu380A IUD users. Women accepting each contraceptive method were randomized into two groups after the women chose their contraceptive method. Group I received routine counselling at the clinic, including information on safety, efficacy and side effects, as well as what to expect regarding bleeding disturbances. Group II received 'intensive counselling'. In addition to the information provided to those in Group I, these women also received leaflets on their chosen method and were seen by the same three professionals, the most experienced at the clinic, throughout the year of follow-up. These three professionals went over all the information provided at each consultation. Women in both groups were instructed to return to the clinic after 45 (±7) days and at 6 and 12 (±1) months after insertion. They were instructed to record all bleeding episodes on a menstrual calendar specifically provided for this purpose. Additionally, satisfaction with the method was evaluated by a questionnaire completed by the women after 12 months of use of the

  7. Efficacy and Safety Outcomes in Patients With Advanced Melanoma Who Discontinued Treatment With Nivolumab and Ipilimumab Because of Adverse Events: A Pooled Analysis of Randomized Phase II and III Trials.

    Science.gov (United States)

    Schadendorf, Dirk; Wolchok, Jedd D; Hodi, F Stephen; Chiarion-Sileni, Vanna; Gonzalez, Rene; Rutkowski, Piotr; Grob, Jean-Jacques; Cowey, C Lance; Lao, Christopher D; Chesney, Jason; Robert, Caroline; Grossmann, Kenneth; McDermott, David; Walker, Dana; Bhore, Rafia; Larkin, James; Postow, Michael A

    2017-12-01

    Purpose Approximately 40% of patients with advanced melanoma who received nivolumab combined with ipilimumab in clinical trials discontinued treatment because of adverse events (AEs). We conducted a retrospective analysis to assess the efficacy and safety of nivolumab plus ipilimumab in patients who discontinued treatment because of AEs. Methods Data were pooled from phase II and III trials of patients who received nivolumab 1 mg/kg plus ipilimumab 3 mg/kg, every 3 weeks for four doses, followed by nivolumab monotherapy 3 mg/kg every 2 weeks (N = 409). Efficacy was assessed in all randomly assigned patients who discontinued because of AEs during the induction phase (n = 96) and in those who did not discontinue because of AEs (n = 233). Safety was assessed in treated patients who discontinued because of AEs (n = 176) at any time and in those who did not discontinue because of AEs (n = 231). Results At a minimum follow-up of 18 months, median progression-free survival was 8.4 months for patients who discontinued treatment because of AEs during the induction phase and 10.8 months for patients who did not discontinue because of AEs ( P = .97). Median overall survival had not been reached in either group ( P = .23). The objective response rate was 58.3% for patients who discontinued because of AEs during the induction phase and 50.2% for patients who did not discontinue. The vast majority of grade 3 or 4 AEs occurred during the induction phase, with most resolving after appropriate management. Conclusion Efficacy outcomes seemed similar between patients who discontinued nivolumab plus ipilimumab treatment because of AEs during the induction phase and those who did not discontinue because of AEs. Therefore, even after discontinuation, many patients may continue to derive benefit from combination therapy.

  8. Discontinuous Galerkin Method for Hyperbolic Conservation Laws

    KAUST Repository

    Mousikou, Ioanna

    2016-11-11

    Hyperbolic conservation laws form a special class of partial differential equations. They describe phenomena that involve conserved quantities and their solutions show discontinuities which reflect the formation of shock waves. We consider one-dimensional systems of hyperbolic conservation laws and produce approximations using finite difference, finite volume and finite element methods. Due to stability issues of classical finite element methods for hyperbolic conservation laws, we study the discontinuous Galerkin method, which was recently introduced. The method involves completely discontinuous basis functions across each element and it can be considered as a combination of finite volume and finite element methods. We illustrate the implementation of discontinuous Galerkin method using Legendre polynomials, in case of scalar equations and in case of quasi-linear systems, and we review important theoretical results about stability and convergence of the method. The applications of finite volume and discontinuous Galerkin methods to linear and non-linear scalar equations, as well as to the system of elastodynamics, are exhibited.

  9. Discontinuous Galerkin Method for Hyperbolic Conservation Laws

    KAUST Repository

    Mousikou, Ioanna

    2016-01-01

    Hyperbolic conservation laws form a special class of partial differential equations. They describe phenomena that involve conserved quantities and their solutions show discontinuities which reflect the formation of shock waves. We consider one-dimensional systems of hyperbolic conservation laws and produce approximations using finite difference, finite volume and finite element methods. Due to stability issues of classical finite element methods for hyperbolic conservation laws, we study the discontinuous Galerkin method, which was recently introduced. The method involves completely discontinuous basis functions across each element and it can be considered as a combination of finite volume and finite element methods. We illustrate the implementation of discontinuous Galerkin method using Legendre polynomials, in case of scalar equations and in case of quasi-linear systems, and we review important theoretical results about stability and convergence of the method. The applications of finite volume and discontinuous Galerkin methods to linear and non-linear scalar equations, as well as to the system of elastodynamics, are exhibited.

  10. Active postoperative acromegaly: sustained remission after discontinuation of somatostatin analogues

    Directory of Open Access Journals (Sweden)

    Cristina Alvarez-Escola

    2016-11-01

    Full Text Available In patients with active acromegaly after pituitary surgery, somatostatin analogues are effective in controlling the disease and can even be curative in some cases. After treatment discontinuation, the likelihood of disease recurrence is high. However, a small subset of patients remains symptom-free after discontinuation, with normalized growth hormone (GH and insulin-like growth factor (IGF1 levels. The characteristics of patients most likely to achieve sustained remission after treatment discontinuation are not well understood, although limited evidence suggests that sustained remission is more likely in patients with lower GH and IGF1 levels before treatment withdrawal, in those who respond well to low-dose treatment, in those without evidence of adenoma on an MRI scan and/or in patients who receive long-term treatment. In this report, we describe the case of a 56-year-old female patient treated with lanreotide Autogel for 11 years. Treatment was successfully discontinued, and the patient is currently disease-free on all relevant parameters (clinical, biochemical and tumour status. The successful outcome in this case adds to the small body of literature suggesting that some well-selected patients who receive long-term treatment with somatostatin analogues may achieve sustained remission.

  11. The optimal time of discontinuing methimazole before radioiodine therapy

    International Nuclear Information System (INIS)

    Moosavi, Z.; Zakavi, R.

    2001-01-01

    Hyperthyroidism is a common disease and one of the best methods for its treatment is radioiodine therapy with Treatment with antithyroid drugs brings patients to euthyroidism before radioiodine therapy. Antithyroid drugs should be discontinued before radioiodine therapy to increase thyroid uptake. The purpose of this study was to determine the optimal time of methimazole discontinuation. One hundred eighty four patients, who were referred for radioiodine therapy were classified in 3 groups according to the duration of methimazole discontinuation before thyroid uptake (RAIU) measurement. Group 1,2 and 3 were patients who discontinued methimazole (48-72 h rs), (72-120 h rs) and more than 120 h rs before RAIU measurement, respectively. Mean thyroid uptake in group 1, 2 and 3 was (64±151.1%), (60.1±14.1%) and (59.3±12.8), respectively. No significant difference was noted in thyroid uptake between these groups (F= 1.83, P<0.16). This study shows that 48-72 h rs of methimazole discontinuation before radioiodine therapy is enough and longer term abstention is not associated with higher uptake

  12. Metallicity at interphase boundaries due to polar catastrophe induced by charge density discontinuity

    KAUST Repository

    Albar, Arwa; Tahini, Hassan Ali; Schwingenschlö gl, Udo

    2018-01-01

    the electronic states at stoichiometric SnO/SnO2 (110) interphase boundaries. In this system, one would not expect polar catastrophe to have a role according to state-of-the-art theory because the interface lacks formal charge discontinuity. However, we observe

  13. Are specific antiretrovirals associated with an increased risk of discontinuation due to toxicities or patient/physician choice in patients with hepatitis C virus coinfection?

    DEFF Research Database (Denmark)

    Mocroft, A; Rockstroh, J; Soriano, V

    2005-01-01

    clinical trials as patients with HCV are often excluded. AIMS: To compare incidence rates of discontinuation due to TOXPC associated with specific antiretrovial drugs in patients with or without HCV. PATIENTS/METHODS: A total of 4929 patients from EuroSIDA under follow-up from January 1999 on a specific...

  14. Spontaneous Healing of Corneal Perforation after Temporary Discontinuation of Erlotinib Treatment

    Directory of Open Access Journals (Sweden)

    Naoyuki Morishige

    2014-01-01

    Full Text Available Purpose: To report a case of corneal perforation associated with oral administration of erlotinib and its spontaneous healing after temporary discontinuation of drug treatment. Case Report: A 65-year-old man with metastatic lung cancer was treated with erlotinib (150 mg/day, a specific tyrosine kinase inhibitor of the epidermal growth factor receptor. He was referred to our corneal service for the treatment of bilateral corneal disorders, diagnosed with mild aqueous-deficient dry eye, and treated by insertion of punctal plugs. His corneal epithelial disorders initially improved, but subsequently worsened, as manifested by the development of bilateral corneal ulceration with corneal perforation in the right eye. The oral administration of erlotinib was interrupted in preparation for tectonic keratoplasty, but 2 days later the corneal perforation of the right eye and the bilateral epithelial defects had healed spontaneously. Treatment with erlotinib was resumed at half the initial dose, and the cornea of both eyes has remained apparently healthy. Discussion: Erlotinib may be secreted into tear fluid and thereby adversely affect the corneal epithelium. The development of corneal epithelial disorders in patients receiving this drug may be reversed by reducing its dose.

  15. Estimating Unbiased Treatment Effects in Education Using a Regression Discontinuity Design

    Directory of Open Access Journals (Sweden)

    William C. Smith

    2014-08-01

    Full Text Available The ability of regression discontinuity (RD designs to provide an unbiased treatment effect while overcoming the ethical concerns plagued by Random Control Trials (RCTs make it a valuable and useful approach in education evaluation. RD is the only explicitly recognized quasi-experimental approach identified by the Institute of Education Statistics to meet the prerequisites of a causal relationship. Unfortunately, the statistical complexity of the RD design has limited its application in education research. This article provides a less technical introduction to RD for education researchers and practitioners. Using visual analysis to aide conceptual understanding, the article walks readers through the essential steps of a Sharp RD design using hypothetical, but realistic, district intervention data and provides additional resources for further exploration.

  16. General practitioners' decisions about discontinuation of medication: an explorative study.

    Science.gov (United States)

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-06-20

    Purpose - The purpose of this paper is to investigate how general practitioners' (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach - In total, 24 GPs were interviewed, three practices were observed and documents were collected. The Gioia methodology was used to analyse data, drawing on a theoretical framework that integrate the sensemaking perspective and institutional theory. Findings - Most GPs, who actively consider discontinuation, are reluctant to discontinue medication, because the safest course of action for GPs is to continue prescriptions, rather than discontinue them. The authors conclude that this is in part due to the ambiguity about the appropriateness of discontinuing medication, experienced by the GPs, and in part because the clinical guidelines do not encourage discontinuation of medication, as they offer GPs a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value - The analysis offers new insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de-stigmatising discontinuation on an institutional level may be beneficial, allowing GPs to better justify discontinuation in light of the ambiguity they experience.

  17. Discontinuation of Hemodialysis in a Patient with Anti-GBM Disease by the Treatment with Corticosteroids and Plasmapheresis despite Several Predictors for Dialysis-Dependence

    Directory of Open Access Journals (Sweden)

    Yoshihide Fujigaki

    2017-01-01

    Full Text Available A 26-year-old man highly suspected of having antiglomerular basement membrane (GBM disease was treated with corticosteroid pulse therapy 9 days after initial infection-like symptoms with high procalcitonin value. The patient required hemodialysis the next day of the treatment due to oliguria. In addition to corticosteroid therapy, plasmapheresis was introduced and the patient could discontinue hemodialysis 43 days after the treatment. Kidney biopsy after initiation of hemodialysis confirmed anti-GBM disease with 86.3% crescent formation. Physician should keep in mind that active anti-GBM disease shows even high procalcitonin value in the absence of infection. To pursue recovery of renal function, the challenge of the immediate and persistent treatment with high-dose corticosteroids plus plasmapheresis for highly suspected anti-GBM disease is vitally important despite the presence of reported predictors for dialysis-dependence including oliguria and requiring hemodialysis at presentation.

  18. Delirium Associated With Fluoxetine Discontinuation: A Case Report.

    Science.gov (United States)

    Fan, Kuang-Yuan; Liu, Hsing-Cheng

    Withdrawal symptoms on selective serotonin reuptake inhibitor (SSRI) discontinuation have raised clinical attention increasingly. However, delirium is rarely reported in the SSRI discontinuation syndrome. We report a case of delirium developing after fluoxetine discontinuation in a 65-year-old female patient with major depressive disorder. She experienced psychotic depression with limited response to treatment of fluoxetine 40 mg/d and quetiapine 100 mg/d for 3 months. After admission, we tapered fluoxetine gradually in 5 days because of its limited effect. However, delirious pictures developed 2 days after we stopped fluoxetine. Three days later, we added back fluoxetine 10 mg/d. Her delirious features gradually improved, and the clinical presentation turned into previous psychotic depression state. We gradually increased the medication to fluoxetine 60 mg/d and olanzapine 20 mg/d in the following 3 weeks. Her psychotic symptoms decreased, and there has been no delirious picture noted thereafter. Delirium associated with fluoxetine discontinuation is a much rarer complication in SSRI discontinuation syndrome. The symptoms of SSRI discontinuation syndrome may be attributable to a rapid decrease in serotonin availability. In general, the shorter the half-life of any medication, the greater the likelihood patients will experience discontinuation symptoms. Genetic vulnerability might be a potential factor to explain that SSRI discontinuation syndrome also occurred rapidly in people taking long-half-life fluoxetine. The genetic polymorphisms of both pharmacokinetic and pharmacodynamic pathways might be potentially associated with SSRI discontinuation syndrome.

  19. Predictors of adalimumab drug survival in psoriasis differ by reason for discontinuation: long-term results from the Bio-CAPTURE registry.

    Science.gov (United States)

    van den Reek, J M P A; Tummers, M; Zweegers, J; Seyger, M M B; van Lümig, P P M; Driessen, R J B; van de Kerkhof, P C M; Kievit, W; de Jong, E M G J

    2015-03-01

    Drug survival is an indicator for treatment success; insight in predictors associated with drug survival is important. To analyse the long-term drug survival for adalimumab in patients with psoriasis treated in daily practice and (II) to identify predictors of prolonged drug survival for adalimumab split for different reasons of discontinuation. Data were extracted from a prospective psoriasis cohort and analysed using Kaplan-Meier survival curves split for reasons of discontinuation. Baseline predictors associated with longer drug survival were identified using multivariate Cox-regression analysis. One hundred and sixteen patients were included with a total of 208 patient-years. Overall drug survival was 76% after 1 year and 52% after 4.5 years. In patients who stopped due to ineffectiveness, longer drug survival was associated with the absence of specific comorbidities (P = 0.03). In patients who stopped due to side-effects, longer drug survival was associated with male gender (P = 0.02). Predictors of adalimumab drug survival in psoriasis differ by reason for discontinuation. Strong, specific predictors can lead to patient-tailored treatment. © 2014 European Academy of Dermatology and Venereology.

  20. The influence of patient beliefs and treatment satisfaction on the discontinuation of current first-line antiretroviral regimens.

    Science.gov (United States)

    Casado, J L; Marín, A; Romero, V; Bañón, S; Moreno, A; Perez-Elías, M J; Moreno, S; Rodriguez-Sagrado, M A

    2016-01-01

    Large cohort studies have shown a high rate of first-line combination antiretroviral therapy (cART) regimen discontinuation in HIV-infected patients, attributed to characteristics of the cART regimen or toxicity. A cohort study of 274 patients receiving a first-line regimen was carried out. Patients' perceptions and beliefs prior to initiation were assessed using an attitude towards medication scale (0-15 points), and their satisfaction during therapy was assessed using an HIV treatment satisfaction questionnaire (HIVTSQ). Treatment discontinuation was defined as any switch in the cART regimen. During 474.8 person-years of follow-up, 63 (23%) patients changed their cART regimen, mainly because of toxicity/intolerance (42; 67%). The overall rate of change was 13.2 per 100 patient-years [95% confidence interval (CI) 11.1-16.4 per 100 patient-years]. An efavirenz (EFV)-based single tablet regimen showed the highest rate of adverse events (27%), but the lowest rate of change (16%; 7.44 per 100 patient-years). Cox regression revealed a decreased hazard of first regimen termination with better initial attitude towards drugs [hazard ratio (HR) 0.76; 95% CI 0.62-0.93; P satisfaction (HR 0.94; 95% CI 0.89-0.99; P = 0.01), and an increased hazard of termination with the presence of adverse events (HR 7.7; 95% CI 2.4-11.6; P patients (18 of 59; 31%) with mild/moderate adverse events (which were mainly central nervous system symptoms) continued the regimen; these patients, compared with those discontinuing therapy, showed better perception of therapy (mean score 14.4 versus 12.1, respectively; P = 0.05) and greater satisfaction during therapy (mean score 50.6 versus 44.6, respectively; P = 0.04). Patients' beliefs and satisfaction with therapy influence the durability of the first antiretroviral regimen. These patient-related factors modulate the impact of mild adverse events, and could explain differences in the rate of discontinuation. © 2015 British HIV

  1. First-line antiretroviral drug discontinuations in children.

    Directory of Open Access Journals (Sweden)

    Melony Fortuin-de Smidt

    Full Text Available There are a limited number of paediatric antiretroviral drug options. Characterising the long term safety and durability of different antiretrovirals in children is important to optimise management of HIV infected children and to determine the estimated need for alternative drugs in paediatric regimens. We describe first-line antiretroviral therapy (ART durability and reasons for discontinuations in children at two South African ART programmes, where lopinavir/ritonavir has been recommended for children <3 years old since 2004, and abacavir replaced stavudine as the preferred nucleoside reverse transcriptase inhibitor in 2010.We included children (<16 years at ART initiation who initiated ≥3 antiretrovirals between 2004-2014 with ≥1 follow-up visit on ART. We estimated the incidence of first antiretroviral discontinuation using Kaplan-Meier analysis. We determined the reasons for antiretroviral discontinuations using competing risks analysis. We used Cox regression to identify factors associated with treatment-limiting toxicity.We included 3579 children with median follow-up duration of 41 months (IQR 14-72. At ART initiation, median age was 44 months (IQR 13-89 and median CD4 percent was 15% (IQR 9-21%. At three and five years on ART, 72% and 26% of children respectively remained on their initial regimen. By five years on ART, the most common reasons for discontinuations were toxicity (32%, treatment failure (18%, treatment simplification (5%, drug interactions (3%, and other or unspecified reasons (18%. The incidences of treatment limiting toxicity were 50.6 (95% CI 46.2-55.4, 1.6 (0.5-4.8, 2.0 (1.2-3.3, and 1.3 (0.6-2.8 per 1000 patient years for stavudine, abacavir, efavirenz and lopinavir/ritonavir respectively.While stavudine was associated with a high risk of treatment-limiting toxicity, abacavir, lopinavir/ritonavir and efavirenz were well-tolerated. This supports the World Health Organization recommendation to replace stavudine with

  2. Stacking and discontinuous buffers in capillary zone electrophoresis.

    Science.gov (United States)

    Shihabi, Z K

    2000-08-01

    Discontinuous buffers for capillary zone electrophoresis (CZE) can be used under less rigid conditions compared to those for isotachophoresis for stacking. They can be prepared simply by modifying the sample itself, either by addition of small inorganic ions, low conductivity diluents, or both, and also by adjusting its pH, meanwhile injecting a large volume on the capillary. Zwitterionic and organic-based buffers such as triethanolamine and tris(hydroxymethyl)aminomethane (Tris) are well suited for stacking due to their low conductivity, provided the buffer is discontinuous as demonstrated here. A simple mechanism based on discontinuous buffers is described to explain many of the observed stacking types in CZE, pointing out the many similarities to transient isotachophoresis.

  3. Organising medication discontinuation

    DEFF Research Database (Denmark)

    Nixon, Michael; Kousgaard, Marius Brostrøm

    2016-01-01

    medication? Methods: Twenty four GPs were interviewed using a maximum variation sample strategy. Participant observations were done in three general practices, for one day each, totalling approximately 30 consultations. Results: The results show that different discontinuation cues (related to the type...... a medication, in agreement with the patients, from a professional perspective. Three research questions were examined in this study: when does medication discontinuation occur in general practice, how is discontinuing medication handled in the GP’s practice and how do GPs make decisions about discontinuing...

  4. Early discontinuation

    DEFF Research Database (Denmark)

    Hansen, Dorte Gilså; Felde, Lina; Gichangi, Anthony

    2007-01-01

    prevalence and rate of early discontinuation of different drugs consisting of, in this study, lipid-lowering drugs, antihypertensive drugs, antidepressants, antidiabetics and drugs against osteoporosis. Material and methods This was a register study based on prescription data covering a 4-year period...... and consisting of 470,000 citizens. For each practice and group of drug, a 1-year prevalence for 2002 and the rate of early discontinuation among new users in 2002-2003 were estimated. Early discontinuation was defined as no prescriptions during the second half-year following the first prescription....... There was a positive association between the prevalence of prescribing for the specific drugs studied (antidepressants, antidiabetics, drugs against osteoporosis and lipid-lowering drugs) and early discontinuation (r = 0.29 -0.44), but not for anti-hypertensive drugs. The analysis of the association between prevalence...

  5. Second tyrosine kinase inhibitor discontinuation attempt in patients with chronic myeloid leukemia.

    Science.gov (United States)

    Legros, Laurence; Nicolini, Franck E; Etienne, Gabriel; Rousselot, Philippe; Rea, Delphine; Giraudier, Stéphane; Guerci-Bresler, Agnès; Huguet, Françoise; Gardembas, Martine; Escoffre, Martine; Ianotto, Jean-Christophe; Noël, Marie-Pierre; Varet, Bruno R; Pagliardini, Thomas; Touitou, Irit; Morisset, Stéphane; Mahon, Francois-Xavier

    2017-11-15

    Several studies have demonstrated that approximately one-half of patients with chronic myeloid leukemia (CML) who receive treatment with tyrosine kinase inhibitors (TKIs) and achieve and maintain a deep molecular response (DMR) are able to successfully discontinue therapy. In patients who have a molecular relapse, a DMR is rapidly regained upon treatment re-initiation. The authors report the results from RE-STIM, a French observational, multicenter study that evaluated treatment-free remission (TFR) in 70 patients who re-attempted TKI discontinuation after a first unsuccessful attempt. After the second TKI discontinuation attempt, the trigger for treatment re-introduction was the loss of a major molecular response in all patients. The median follow-up was 38.3 months (range, 4.7-117 months), and 45 patients (64.3%) lost a major molecular response after a median time off therapy of 5.3 months (range, 2-42 months). TFR rates at 12, 24, and 36 months were 48% (95% confidence interval [CI], 37.6%-61.5%), 42% (95% CI, 31.5%-55.4%), and 35% (95% CI, 24.4%-49.4%), respectively. No progression toward advanced-phase CML occurred, and no efficacy issue was observed upon TKI re-introduction. In univariate analysis, the speed of molecular relapse after the first TKI discontinuation attempt was the only factor significantly associated with outcome. The TFR rate at 24 months was 72% (95% CI, 48.8%-100%) in patients who remained in DMR within the first 3 months after the first TKI discontinuation and 36% (95% CI, 25.8%-51.3%) for others. This study is the first to demonstrate that a second TKI discontinuation attempt is safe and that a first failed attempt at discontinuing TKI does not preclude a second successful attempt. Cancer 2017;123:4403-10. © 2017 American Cancer Society. © 2017 American Cancer Society.

  6. Carbohydrate metabolism during long-term growth hormone (GH) treatment and after discontinuation of GH treatment in girls with Turner syndrome participating in a randomized dose-response study. Dutch Advisory Group on Growth Hormone

    NARCIS (Netherlands)

    T.C.J. Sas (Theo); S.M.P.F. de Muinck Keizer-Schrama (Sabine); Th. Stijnen (Theo); H-J. Aanstoot (Henk-Jan); S.L.S. Drop (Stenvert)

    2000-01-01

    textabstractTo assess possible side-effects of GH treatment with supraphysiological doses on carbohydrate (CH) metabolism in girls with Turner syndrome (TS) during long term GH treatment and after discontinuation of GH treatment, the results of oral glucose tolerance

  7. A longitudinal examination of alcohol pharmacotherapy adoption in substance use disorder treatment programs: patterns of sustainability and discontinuation.

    Science.gov (United States)

    Abraham, Amanda J; Knudsen, Hannah K; Roman, Paul M

    2011-07-01

    The objectives of this study were to (a) identify the patterns of disulfiram (Antabuse) and tablet naltrexone (Revia) adoption over a 48-month period in a nationally representative sample of privately funded programs that deliver substance use disorder treatment; (b) examine predictors of sustainability, later adoption, discontinuation, and nonadoption of disulfiram and tablet naltrexone; and (c) measure reasons for medication discontinuation. Two waves of data were collected via face-to-face structured interviews with 223 program administrators. These data demonstrated that adoption of medications for alcohol use disorders (AUDs) was a dynamic process. Although nonadoption was the most common pattern, approximately 20% of programs sustained use of the AUD medications and 30% experienced organizational change in adoption over the study period. Bivariate multinomial logistic regression models revealed that organizational characteristics were associated with sustainability including location in a hospital setting, program size, accreditation, revenues from private insurance, referrals from the criminal justice system, number of medical staff, and use of selective serotonin reuptake inhibitors at baseline. Two patterns of discontinuation were found: Programs either discontinued use of all substance use disorder medications or replaced disulfiram/tablet naltrexone with a newer AUD medication. These findings suggest that adoption of AUD medications may be positively affected by pressure from accreditation bodies, partnering with primary care physicians, medication-specific training for medical staff, greater availability of resources to cover the costs associated with prescribing AUD medications, and amending criminal justice contracts to include support for AUD medication use.

  8. Mammographic density changes following discontinuation of tamoxifen in premenopausal women with oestrogen receptor-positive breast cancer.

    Science.gov (United States)

    Kim, Won Hwa; Cho, Nariya; Kim, Young-Seon; Yi, Ann

    2018-04-06

    To evaluate the changes in mammographic density after tamoxifen discontinuation in premenopausal women with oestrogen receptor-positive breast cancers and the underlying factors METHODS: A total of 213 consecutive premenopausal women with breast cancer who received tamoxifen treatment after curative surgery and underwent three mammograms (baseline, after tamoxifen treatment, after tamoxifen discontinuation) were included. Changes in mammographic density after tamoxifen discontinuation were assessed qualitatively (decrease, no change, or increase) by two readers and measured quantitatively by semi-automated software. The association between % density change and clinicopathological factors was evaluated using univariate and multivariate regression analyses. After tamoxifen discontinuation, a mammographic density increase was observed in 31.9% (68/213, reader 1) to 22.1% (47/213, reader 2) by qualitative assessment, with a mean density increase of 1.8% by quantitative assessment compared to density before tamoxifen discontinuation. In multivariate analysis, younger age (≤ 39 years) and greater % density decline after tamoxifen treatment (≥ 17.0%) were independent factors associated with density change after tamoxifen discontinuation (p density change with a mean density increase of 1.8%, which was associated with younger age and greater density change after tamoxifen treatment. • Increased mammographic density after tamoxifen discontinuation can occur in premenopausal women. • Mean density increase after tamoxifen discontinuation was 1.8%. • Density increase is associated with age and density decrease after tamoxifen.

  9. Anterior segment optical coherence tomography changes with introduction and discontinuation of tamsulosin.

    Science.gov (United States)

    Al-Kharashi, Abdullah; Azimzadeh, Amir A; Leung, Jerry; Radomski, Sidney; Radomski, Lenny; Lam, Wai-Ching

    2016-01-01

    The aim of this study was to quantify changes and reversibility in pupil dilation and iris dilator muscle region thickness associated with introduction and subsequent discontinuation of tamsulosin in patients naïve to this drug with the aid of an anterior OCT system. The study was carried out on 7 patients (14 eyes) naïve to tamsulosin and with benign prostatic hypertrophy (BHP). Measurements taken by Vistante OCT were done pre- and post-dilation of the following: pupil size, iris dilator muscle region (DMR) thickness, sphincter muscle region (SMR) thickness, and anterior chamber depth. These measurement were taken at Day 0 (tamsulosin naive), Day 30 (after one month of tamsulosin, the treatment period) and day 60 (after one month of no tamsulosin, the discontinuation period). Post-dilation pupil diameter significantly increased during the discontinuation period ( P  = 0.047). Iris DMR thickness measurements post-dilation significantly decreased during treatment ( P  = 0.00044), discontinuation (0.00011), and combined periods ( P  = 0.000050). Anterior chamber depth measurements in post-dilation were significantly decreased during treatment ( P  = 0.0016), discontinuation ( P  = 0.017), and combined periods ( P  = 0.00022). Tamsulosin discontinuation effectively increases dilated pupil size, a measure that has been inversely linked to IFIS incidence pre-operatively. Decreased DMR thickness in this short term likely illustrates changes aside from atrophy, such as vascular changes. Decreased anterior chamber depths suggest aqueous humor production is decreased as well.

  10. A non-conventional discontinuous Lagrangian for viscous flow

    Science.gov (United States)

    Marner, F.

    2017-01-01

    Drawing an analogy with quantum mechanics, a new Lagrangian is proposed for a variational formulation of the Navier–Stokes equations which to-date has remained elusive. A key feature is that the resulting Lagrangian is discontinuous in nature, posing additional challenges apropos the mathematical treatment of the related variational problem, all of which are resolvable. In addition to extending Lagrange's formalism to problems involving discontinuous behaviour, it is demonstrated that the associated equations of motion can self-consistently be interpreted within the framework of thermodynamics beyond local equilibrium, with the limiting case recovering the classical Navier–Stokes equations. Perspectives for applying the new formalism to discontinuous physical phenomena such as phase and grain boundaries, shock waves and flame fronts are provided. PMID:28386415

  11. Discontinuation of nicotine replacement therapy among smoking-cessation attempters.

    Science.gov (United States)

    Burns, Emily K; Levinson, Arnold H

    2008-03-01

    Nicotine replacement therapy (NRT) doubles successful quitting, but more than half of NRT users do not comply with optimal treatment regimens. From the 2005 Colorado state tobacco survey, quit attempters who utilized NRT (N=366) were analyzed in spring 2007. Descriptive and regression analyses were used to examine reasons for discontinuing NRT, length of time on NRT, and quit intentions. The reasons for discontinuing NRT were resuming smoking (34%), side effects (17%), NRT not helping with quitting (14%), quitting smoking (10%), and cost (5%). Poverty, age, and non-Latino minority status were associated with reasons for discontinuation other than quitting smoking. Having side effects was associated with a short duration of NRT use and 95% lower odds of intending to quit in the next month. In the first population-level study examining reasons for discontinuing NRT, general-population smokers who initiate NRT use when attempting to quit are highly likely to discontinue NRT prematurely. Age and culturally-appropriate medication management interventions may increase NRT compliance and improve cessation outcomes.

  12. Organising medication discontinuation: a qualitative study exploring the views of general practitioners toward discontinuing statins.

    Science.gov (United States)

    Nixon, Michael; Kousgaard, Marius Brostrøm

    2016-07-07

    Discontinuing medications is a complex decision making process and an important medical practice. It is a tool in reducing polypharmacy, reducing health system expenditure and improving patient quality of life. Few studies have looked at how general practitioners (GPs) discontinue a medication, in agreement with the patients, from a professional perspective. Three research questions were examined in this study: when does medication discontinuation occur in general practice, how is discontinuing medication handled in the GP's practice and how do GPs make decisions about discontinuing medication? Twenty four GPs were interviewed using a maximum variation sample strategy. Participant observations were done in three general practices, for one day each, totalling approximately 30 consultations. The results show that different discontinuation cues (related to the type of consultation, medical records and the patient) create situations of dissonance that can lead to the GP considering the option of discontinuation. We also show that there is a lot of ambiguity in situations of discontinuing and that some GPs trialled discontinuing as means of generating more information that could be used to deal with the ambiguity. We conclude that the practice of discontinuation should be conceptualised as a continually evaluative process and one that requires sustained reflection through a culture of systematically scheduled check-ups, routinely eliciting the patient's experience of taking drugs and trialling discontinuation. Some policy recommendations are offered including supporting GPs with lists or handbooks that directly address discontinuation and by developing more person centred clinical guidelines that discuss discontinuation more explicitly.

  13. Kinetics of cardiac and vascular remodeling by spontaneously hypertensive rats after discontinuation of long-term captopril treatment

    Directory of Open Access Journals (Sweden)

    W.A. Rocha

    2010-04-01

    Full Text Available Angiotensin-converting enzyme inhibitors reduce blood pressure and attenuate cardiac and vascular remodeling in hypertension. However, the kinetics of remodeling after discontinuation of the long-term use of these drugs are unknown. Our objective was to investigate the temporal changes occurring in blood pressure and vascular structure of spontaneously hypertensive rats (SHR. Captopril treatment was started in the pre-hypertensive state. Rats (4 weeks were assigned to three groups: SHR-Cap (N = 51 treated with captopril (1 g/L in drinking water from the 4th to the 14th week; SHR-C (N = 48 untreated SHR; Wistar (N = 47 control rats. Subgroups of animals were studied at 2, 4, and 8 weeks after discontinuation of captopril. Direct blood pressure was recorded in freely moving animals after femoral artery catheterism. The animals were then killed to determine left ventricular hypertrophy (LVH and the aorta fixed at the same pressure measured in vivo. Captopril prevented hypertension (105 ± 3 vs 136 ± 5 mmHg, LVH (2.17 ± 0.05 vs 2.97 ± 0.14 mg/g body weight and the increase in cross-sectional area to luminal area ratio of the aorta (0.21 ± 0.01 vs 0.26 ± 0.02 μm² (SHR-Cap vs SHR-C. However, these parameters increased progressively after discontinuation of captopril (22nd week: 141 ± 2 mmHg, 2.50 ± 0.06 mg/g, 0.27 ± 0.02 μm². Prevention of the development of hypertension in SHR by using captopril during the prehypertensive period prevents the development of cardiac and vascular remodeling. Recovery of these processes follows the kinetic of hypertension development after discontinuation of captopril.

  14. Problems with Discontinuous Diffusion/Dispersion Coefficients

    Directory of Open Access Journals (Sweden)

    Stefano Ferraris

    2012-01-01

    accurate on smooth solutions and based on a special numerical treatment of the diffusion/dispersion coefficients that makes its application possible also when such coefficients are discontinuous. Numerical experiments confirm the convergence of the numerical approximation and show a good behavior on a set of benchmark problems in two space dimensions.

  15. Validation of a patient interview for assessing reasons for antipsychotic discontinuation and continuation

    Directory of Open Access Journals (Sweden)

    Matza LS

    2012-07-01

    Full Text Available Louis S Matza,1 Glenn A Phillips,2 Dennis A Revicki,1 Haya Ascher-Svanum,3 Karen G Malley,4 Andrew C Palsgrove,1 Douglas E Faries,3 Virginia Stauffer,3 Bruce J Kinon,3 A George Awad,5 Richard SE Keefe,6 Dieter Naber71Outcomes Research, United BioSource Corporation, Bethesda, MD, 2Formerly with Eli Lilly and Company, Indianapolis, IN, 3Eli Lilly and Company, Indianapolis, IN, 4Malley Research Programming, Inc, Rockville, MD, USA; 5Department of Psychiatry and Behavioral Sciences; University of Toronto, Toronto, Canada; 6Duke University Medical Center, Durham NC, USA; 7Universitaetsklinikum Hamburg-Eppendorf, Hamburg, GermanyIntroduction: The Reasons for Antipsychotic Discontinuation Interview (RAD-I was developed to assess patients’ perceptions of reasons for discontinuing or continuing an antipsychotic. The current study examined reliability and validity of domain scores representing three factors contributing to these treatment decisions: treatment benefits, adverse events, and distal reasons other than direct effects of the medication.Methods: Data were collected from patients with schizophrenia or schizoaffective disorder and their treating clinicians. For approximately 25% of patients, a second rater completed the RAD-I for assessment of inter-rater reliability.Results: All patients (n = 121; 81 discontinuation, 40 continuation reported at least one reason for discontinuation or continuation (mean = 2.8 reasons for discontinuation; 3.4 for continuation. Inter-rater reliability was supported (kappas = 0.63–1.0. Validity of the discontinuation domain scores was supported by associations with symptom measures (the Positive and Negative Syndrome Scale for Schizophrenia, the Clinical Global Impression – Schizophrenia Scale; r = 0.30 to 0.51; all P < 0.01, patients’ primary reasons for discontinuation, and adverse events. However, the continuation domain scores were not significantly associated with these other indicators

  16. Discontinuation of tofacitinib after achieving low disease activity in patients with rheumatoid arthritis: a multicentre, observational study.

    Science.gov (United States)

    Kubo, Satoshi; Yamaoka, Kunihiro; Amano, Koichi; Nagano, Shuji; Tohma, Shigeto; Suematsu, Eiichi; Nagasawa, Hayato; Iwata, Kanako; Tanaka, Yoshiya

    2017-08-01

    To determine whether tofacitinib can be discontinued in patients with RA who achieve low disease activity (LDA). RA patients with LDA after tofacitinib treatment in a phase III and long-term extension study were enrolled in this multicentre, non-randomized, open, prospective, observational study. The decision of discontinuation or continuation of tofacitinib was determined based on patient-physician decision making with informed consent. The primary endpoint was the proportion of patients who remained tofacitinib-free at post-treatment week 52. Clinical outcome was compared between those who continued and those who discontinued tofacitinib. The last observation carried forward method was used for patients who could not discontinue tofacitinib before week 52. Of 64 patients, 54 discontinued and 10 continued tofacitinib therapy. At post-treatment week 52, 20 of the 54 patients (37%) of the discontinuation group remained tofacitinib-free without disease flare. Disease activity at post-treatment week 52 was higher in the discontinuation group than the continuation group. Among the discontinuation group, the RF titre at baseline was significantly lower in patients who remained tofacitinib-free than those who did not (40 vs 113 U/ml). In fact, a higher proportion of patients with lower RF remained tofacitinib-free at week 52 compared with those with higher RF at baseline. In patients who could not achieve tofacitinib-free status, re-initiation of tofacitinib or other biologics improved disease activity. It is possible to discontinue tofacitinib without flare in about a third of patients with RA. A low RF predicts maintenance of LDA after discontinuation of tofacitinib. © The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com

  17. Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association?

    LENUS (Irish Health Repository)

    Haroon, Muhammad

    2011-08-01

    There have been numerous reports of granulomatous diseases developing in patients receiving anti-tumour necrosis factor (TNF) therapy. Herein, we report a patient who developed sarcoidosis 6 months after discontinuation of etanercept. To date, all reported cases have occurred in patients undergoing ongoing treatment with TNF blockers with resolution on its discontinuation. A 47-year-old man was diagnosed with seropositive rheumatoid arthritis (RA) in 2003. He was initially treated with methotrexate and corticosteroids. In 2005, adalimumab was added due to ongoing disease activity. However, he had persistent low-grade synovitis of bilateral wrist joints and remained oral glucocorticoids dependent. In October 2008, adalimumab was switched to etanercept with marginal benefit; however, etanercept was continued until March 2009. Rituximab was discontinued due to an immediate allergic reaction. In September 2009, he developed bilateral ankle synovitis with erythema nodosum. Further investigations (chest X-ray and CT scan of thorax) revealed new development of bilateral hilar lymphadenopathy and interstitial nodular changes typical of sarcoidosis. His baseline therapy of methotrexate was continued. His recent repeat chest X-ray and CT scan of thorax (March 2010) has shown significant spontaneous resolution of his mediastinal lymphadenopathy and pulmonary nodules. Apart from the initial brief course of NSAIDs, his sarcoidosis resolved spontaneously without requiring any further therapy. For his rheumatoid arthritis, he has been recently commenced on abatacept and his baseline therapy of methotrexate has been continued. It remains speculative as to whether the concurrence of RA and sarcoidosis is purely serendipitous, or is related to an immunodysregulatory state attributable to TNF blockade.

  18. The Influence of Antithyroid Drug Discontinuation to the Therapeutic Efficacy of 131I in Hyperthyroidism

    International Nuclear Information System (INIS)

    Kartamihardja, A. Hussein Sundawa; Massora, Stepanus

    2016-01-01

    The influence of antithyroid drugs (ATDs) on the therapeutic efficacy of radioactive iodine in hyperthyroidism is still controversial. The aim of this study was to evaluate the effect of ATD discontinuation to the therapeutic efficacy of I-131 in hyperthyroidism patients with long-term ATD treatment. Retrospective study was done to 39 subjects with hyperthyroidism who had been treated with doses of 300 MBq radioactive iodine. The subjects were divided into three groups: Group I (n = 14) had been using ATDs for more than one year and discontinued more than three days; group II (n = 14) had been using ATDs for more than one year but discontinued only for three days or less, and group III (n = 11) has never been used any ATD before radioactive iodine treatment. There was a significant difference in the therapeutic efficacy after three months of radioactive iodine treatment between group I and group II (P = 0.018), group II and group III (P = 0.017), but not between group I and group III (P = 1.0). There was no observed difference on the therapeutic efficacy between the three groups at 6 months after radioactive iodine therapy (P = 0.143). Administration of ATDs more than 1 year without discontinuation decreased response of radioactive iodine treatment in 3 months follow-up. Discontinuation of ATDs for more than 3 days before radioactive iodine treatment is recommended

  19. The Influence of Antithyroid Drug Discontinuation to the Therapeutic Efficacy of (131)I in Hyperthyroidism.

    Science.gov (United States)

    Kartamihardja, A Hussein Sundawa; Massora, Stepanus

    2016-01-01

    The influence of antithyroid drugs (ATDs) on the therapeutic efficacy of radioactive iodine in hyperthyroidism is still controversial. The aim of this study was to evaluate the effect of ATD discontinuation to the therapeutic efficacy of I-131 in hyperthyroidism patients with long-term ATD treatment. Retrospective study was done to 39 subjects with hyperthyroidism who had been treated with doses of 300 MBq radioactive iodine. The subjects were divided into three groups: Group I (n = 14) had been using ATDs for more than one year and discontinued more than three days; group II (n = 14) had been using ATDs for more than one year but discontinued only for three days or less, and group III (n = 11) has never been used any ATD before radioactive iodine treatment. There was a significant difference in the therapeutic efficacy after three months of radioactive iodine treatment between group I and group II (P = 0.018), group II and group III (P = 0.017), but not between group I and group III (P = 1.0). There was no observed difference on the therapeutic efficacy between the three groups at 6 months after radioactive iodine therapy (P = 0.143). Administration of ATDs more than 1 year without discontinuation decreased response of radioactive iodine treatment in 3 months follow-up. Discontinuation of ATDs for more than 3 days before radioactive iodine treatment is recommended.

  20. The Influence of Antithyroid Drug Discontinuation to the Therapeutic Efficacy of 131I in Hyperthyroidism

    Science.gov (United States)

    Kartamihardja, A. Hussein Sundawa; Massora, Stepanus

    2016-01-01

    The influence of antithyroid drugs (ATDs) on the therapeutic efficacy of radioactive iodine in hyperthyroidism is still controversial. The aim of this study was to evaluate the effect of ATD discontinuation to the therapeutic efficacy of I-131 in hyperthyroidism patients with long-term ATD treatment. Retrospective study was done to 39 subjects with hyperthyroidism who had been treated with doses of 300 MBq radioactive iodine. The subjects were divided into three groups: Group I (n = 14) had been using ATDs for more than one year and discontinued more than three days; group II (n = 14) had been using ATDs for more than one year but discontinued only for three days or less, and group III (n = 11) has never been used any ATD before radioactive iodine treatment. There was a significant difference in the therapeutic efficacy after three months of radioactive iodine treatment between group I and group II (P = 0.018), group II and group III (P = 0.017), but not between group I and group III (P = 1.0). There was no observed difference on the therapeutic efficacy between the three groups at 6 months after radioactive iodine therapy (P = 0.143). Administration of ATDs more than 1 year without discontinuation decreased response of radioactive iodine treatment in 3 months follow-up. Discontinuation of ATDs for more than 3 days before radioactive iodine treatment is recommended. PMID:27134556

  1. Long-term outcomes for patients with chronic lymphocytic leukemia who discontinue ibrutinib.

    Science.gov (United States)

    Jain, Preetesh; Thompson, Philip A; Keating, Michael; Estrov, Zeev; Ferrajoli, Alessandra; Jain, Nitin; Kantarjian, Hagop; Burger, Jan A; O'Brien, Susan; Wierda, William G

    2017-06-15

    Ibrutinib is a Bruton tyrosine kinase inhibitor and is approved for the treatment of patients with chronic lymphocytic leukemia (CLL) in frontline and relapsed/refractory settings. The authors previously reported poor outcomes for patients who discontinued ibrutinib; however, long-term outcomes were not reported. Data from 320 patients who received ibrutinib on clinical studies between 2010 and 2015 at The University of Texas MD Anderson Cancer Center were retrospectively analyzed. Long-term outcomes among patients with CLL after they discontinued ibrutinib were analyzed. Ninety of 320 patients (28%) who were treated on ibrutinib-based regimens discontinued ibrutinib. Of these, 80 had relapsed/refractory disease, and 10 were treatment-naive. The median time to discontinuation was 15 months (range, 1.2-54 months). After a median follow-up of 38 months after starting ibrutinib, 40 patients (44%) remained alive. Major reasons for ibrutinib discontinuation were intolerance (n = 29; 32%), miscellaneous (n = 28; 31%), progression (n = 19; 21%), and Richter transformation (RT) (n = 9; 10%). The median survival according to the reason for discontinuation was 33 months for ibrutinib intolerance, 11 months for miscellaneous causes, 16 months for progressive CLL, and 2 months for RT. Among the 19 patients who had progressive CLL, 42% responded to subsequent therapy. Ibrutinib discontinuation was observed during therapy. Patients with CLL who had disease transformation had especially poor outcomes, whereas those who developed progressive disease during ibrutinib therapy had a median survival of ibrutinib therapy is of critical importance. Cancer 2017;123:2268-2273. © 2017 American Cancer Society. © 2017 American Cancer Society.

  2. Discontinuation of anti-VEGF cancer therapy promotes metastasis through a liver revascularization mechanism

    DEFF Research Database (Denmark)

    Yang, Yunlong; Zhang, Yin; Iwamoto, Hideki

    2016-01-01

    The impact of discontinuation of anti-VEGF cancer therapy in promoting cancer metastasis is unknown. Here we show discontinuation of anti-VEGF treatment creates a time-window of profound structural changes of liver sinusoidal vasculatures, exhibiting hyper-permeability and enlarged open-pore size...

  3. Continued versus discontinued oxytocin stimulation, protocol of an rct

    DEFF Research Database (Denmark)

    Boie, Sidsel; Glavind, Julie; Uldbjerg, Niels

    Dutch Centres: AMC, Tergooi Hospital, and AMPHIA Hospital (inclusion expected late 2016) Intervention When the active phase of labour is established (defined as 6 cm dilated orificium), the women will be randomised to either: Continued Syntocinon® or Discontinued Syntocinon® (saline infusion) Primary......Problem Statement: Previous studies on induced labour suggest that, continued stimulation with Syntocinon® in the active phase of labour increases the risk of fetal distress and caesarean delivery whereas discontinued stimulation with Syntocinon® increases the risk of caesarean delivery due to lack...... of progression. No double-blind trial with a study population large enough to show differences in maternal and neonatal outcomes has ever been conducted. The purpose of the study is to investigate how the caesarean delivery rate is affected if Syntocinon® is discontinued at the onset of active phase of labour...

  4. Thyroid function in children and adolescents with Hashimoto’s thyroiditis after l-thyroxine discontinuation

    Directory of Open Access Journals (Sweden)

    Giorgio Radetti

    2017-04-01

    Full Text Available Objective: Thyroid function may recover in patients with Hashimoto’s thyroiditis (HT. Design: To investigate thyroid function and the need to resume l-thyroxine treatment after its discontinuation. Setting: Nine Italian pediatric endocrinology centers. Patients: 148 children and adolescents (25 m and 123 f with HT on treatment with l-thyroxine for at least one year. Intervention and main outcome measure: Treatment was discontinued in all patients, and serum TSH and fT4 concentrations were measured at the time of treatment discontinuation and then after 2, 6, 12 and 24 months. Therapy with l-thyroxine was re-instituted when TSH rose >10 U/L and/or fT4 was below the normal range. The patients were followed up when TSH concentrations were between 5 and 10 U/L and fT4 was in the normal range. Results: At baseline, TSH was in the normal range in 139 patients, and was between 5 and 10 U/L in 9 patients. Treatment was re-instituted after 2 months in 37 (25.5% patients, after 6 months in 13 patients (6.99%, after 12 months in 12 patients (8.6%, and after 24 months in an additional 3 patients (3.1%. At 24 months, 34 patients (34.3% still required no treatment. TSH concentration >10 U/L at the time of diagnosis was the only predictive factor for the deterioration of thyroid function after l-thyroxine discontinuation. Conclusions: This study confirms that not all children with HT need life-long therapy with l-thyroxine, and the discontinuation of treatment in patients with a TSH level <10 U/L at the time of diagnosis should be considered.

  5. Treatment Discontinuation and Clinical Events in Type 2 Diabetes Patients Treated with Dipeptidyl Peptidase-4 Inhibitors or NPH Insulin as Third-Line Therapy

    Directory of Open Access Journals (Sweden)

    Cristiano S. Moura

    2018-01-01

    Full Text Available Objective. To compare dipeptidyl peptidase-4 (DPP-4 inhibitors with neutral protamine Hagedorn (NPH insulin, in terms of effectiveness and safety for the management of patients with type 2 diabetes mellitus (DM2 not controlled on metformin and sulfonylureas. Methods. A retrospective cohort study of individuals with DM2 newly dispensed with either DPP-4 inhibitors or NPH as third-line therapy, after metformin and sulfonylurea. Treatment discontinuation, macrovascular outcomes, and hypoglycemia were compared using multivariable Cox regression models, adjusted for sex, age, year of cohort entry, place of residence, hypertension, past history of hypoglycemia, diabetic ketoacidosis, comorbidities, and number of visits to emergency departments, outpatient physician, and hospitalizations. Results. Treatment discontinuation and hypoglycemia occurred more frequently with NPH than with DPP-4 inhibitor users. In the adjusted Cox model, the use of NPH compared to that of DPP-4 inhibitors was associated with a higher risk of discontinuation (HR: 1.33; 95% CI 1.27–1.40 and hypoglycemia (HR: 2.98; 95% CI 2.72–3.28. Risk of cardiovascular events was similar across groups. Conclusions. This real-world analysis suggests that DM2 patients initiating third-line therapy with NPH have poorer control of diabetes when compared to DPP-4 inhibitor initiators.

  6. Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors

    Directory of Open Access Journals (Sweden)

    Anne Sverdrup Efjestad

    2017-02-01

    Full Text Available Background/Aims: Reduced clinical effect on cognitive decline in dementia by acetylcholinesterase inhibitors (AChEIs may be due to concurrent use of drugs with anticholinergic properties. The aim was to analyze the incidence of AChEI use and comedication with drugs with anticholinergic properties and other potential unfavorable effects. Methods: A prospective study applying drug use data from the Norwegian Prescription Database. Anticholinergic Drug Scale (ADS scores were used as a measure of overall anticholinergic burden. Results: Patients with high ADS scores were more frequently discontinuing treatment early. Coprescribing of antipsychotics was strongly associated with early discontinuation of AChEI treatment. Conclusion: Coprescribing with potentially unfavorable medications was common. A high ADS score was associated with early discontinuation of treatment.

  7. A Bayesian Nonparametric Causal Model for Regression Discontinuity Designs

    Science.gov (United States)

    Karabatsos, George; Walker, Stephen G.

    2013-01-01

    The regression discontinuity (RD) design (Thistlewaite & Campbell, 1960; Cook, 2008) provides a framework to identify and estimate causal effects from a non-randomized design. Each subject of a RD design is assigned to the treatment (versus assignment to a non-treatment) whenever her/his observed value of the assignment variable equals or…

  8. Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study.

    Science.gov (United States)

    Sundström, Johan; Hedberg, Jakob; Thuresson, Marcus; Aarskog, Pernilla; Johannesen, Kasper Munk; Oldgren, Jonas

    2017-09-26

    There are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events. We performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk. During a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34-1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time. In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal. © 2017 American Heart Association, Inc.

  9. On the stability of rotational discontinuities

    International Nuclear Information System (INIS)

    Richter, P.; Scholer, M.

    1989-01-01

    The stability of symmetric rotational discontinuities in which the magnetic field rotates by 180 degree is investigated by means of a one-dimensional self-consistent hybrid code. Rotational discontinuities with an angle Θ > 45 degree between the discontinuity normal direction and the upstream magnetic field are found to be relatively stable. The discontinuity normal is in the x direction and the initial magnetic field has finite y component only in the transition region. In the case of the ion (left-handed) sense of rotation of the tangential magnetic field, the transition region does not broaden with time. In the case of the electron (right-handed) sense of rotation, a damped wavetrain builds up in the B y component downstream of the rotational discontinuity and the discontinuity broadens with time. Rotational discontinuities with smaller angles, Θ, are unstable. Examples for a rotational discontinuity with Θ = 30 degree and the electron sense of rotation as well as a rotational discontinuity with Θ = 15 degree and the ion sense of rotation show that these discontinuities into waves. These waves travel approximately with Alfven velocity in the upstream direction and are therefore phase standing in the simulation system. The magnetic hodograms of these disintegrated discontinuities are S-shaped. The upstream portion of the hodogram is always right-handed; the downstream portion is always left-handed

  10. Effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment: the DANTE Study Leiden.

    Science.gov (United States)

    Moonen, Justine E F; Foster-Dingley, Jessica C; de Ruijter, Wouter; van der Grond, Jeroen; de Craen, Anton J M; van der Mast, Roos C

    2016-03-01

    the relationship between antihypertensive medication and orthostatic hypotension in older persons remains ambiguous, due to conflicting observational evidence and lack of data of clinical trials. to assess the effect of discontinuation of antihypertensive medication on orthostatic hypotension in older persons with mild cognitive impairment. a total of 162 participants with orthostatic hypotension were selected from the Discontinuation of Antihypertensive Treatment in Elderly people (DANTE) Study. This randomised clinical trial included community-dwelling participants aged ≥75 years, with mild cognitive impairment, using antihypertensive medication and without serious cardiovascular disease. Participants were randomised to discontinuation or continuation of antihypertensive treatment (ratio 1:1). Orthostatic hypotension was defined as a drop of at least 20 mmHg in systolic blood pressure and/or 10 mmHg in diastolic blood pressure on standing from a seated position. Outcome was the absence of orthostatic hypotension at 4-month follow-up. Relative risks (RR) were calculated by intention-to-treat and per-protocol analyses. at follow-up, according to intention-to-treat analyses, of the 86 persons assigned to discontinuation of antihypertensive medication, 43 (50%) were free from orthostatic hypotension, compared with 29 (38%) of the 76 persons assigned to continuation of medication [RR 1.31 (95% confidence interval (CI) 0.92-1.87); P = 0.13]. Per-protocol analysis showed that recovery from orthostatic hypotension was significantly higher in persons who completely discontinued all antihypertensive medication (61%) compared with the continuation group (38%) [RR 1.60 (95% CI 1.10-2.31); P = 0.01]. in older persons with mild cognitive impairment and orthostatic hypotension receiving antihypertensive medication, discontinuation of antihypertensive medication may increase the probability of recovery from orthostatic hypotension. © The Author 2016. Published by Oxford

  11. Discontinuous finite element treatment of duct problems in transport calculations

    International Nuclear Information System (INIS)

    Mirza, A. M.; Qamar, S.

    1998-01-01

    A discontinuous finite element approach is presented to solve the even-parity Boltzmann transport equation for duct problems. Presence of ducts in a system results in the streaming of particles and hence requires the employment of higher order angular approximations to model the angular flux. Conventional schemes based on the use of continuous trial functions require the same order of angular approximations to be used everywhere in the system, resulting in wastage of computational resources. Numerical investigations for the test problems presented in this paper indicate that the discontinuous finite elements eliminate the above problems and leads to computationally efficient and economical methods. They are also found to be more suitable for treating the sharp changes in the angular flux at duct-observer interfaces. The new approach provides a single-pass alternate to extrapolation and interactive schemes which need multiple passes of the solution strategy to acquire convergence. The method has been tested with the help of two case studies, namely straight and dog-leg duct problems. All results have been verified against those obtained from Monte Carlo simulations and K/sup +/ continuous finite element method. (author)

  12. Abrupt opium discontinuation has no significant triggering effect on acute myocardial infarction.

    Science.gov (United States)

    Masoomi, Mohammad; Zare, Jahangir; Nasri, Hamidreza; Mirzazadeh, Ali; Sheikhvatan, Mehrdad

    2011-04-01

    A deleterious effect of withdrawal symptoms due to abrupt discontinuation of opium on the cardiovascular system is one of the recent interesting topics in the cardiovascular field. The current study hypothesized that the withdrawal syndrome due to discontinuing opium might be an important trigger for the appearance of acute myocardial infarction. Eighty-one opium-addicted individuals who were candidates for cardiovascular clinical evaluation and consecutively hospitalized in the coronary care unit (CCU) ward of Shafa Hospital in Kerman between January and July 2009 were included in the study and categorized in the case group, including patients experiencing withdrawal symptoms within 6-12 h after the reduced or discontinued use of opium according to the Diagnostic and Statistical Manual of Mental Disorders-revised IV version (DSM-IV-R) criteria for opium dependence and withdrawal, and the control group, without opium withdrawal symptoms. The appearance of acute myocardial infarction was compared between the two groups using multivariable regression models. Acute myocardial infarction occurred in 50.0% of those with withdrawal symptoms and in 45.1% of patients without evidence of opium withdrawal (P = 0.669). Multivariable analysis showed that opium withdrawal symptoms were not a trigger for acute myocardial infarction adjusting for demographic characteristics, marital status, education level and common coronary artery disease risk profiles [odds ratio (OR) = 0.920, 95% confidence interval (CI) = 0.350-2.419, P = 0.866]. Also, daily dose of opium before reducing or discontinuing use did not predict the appearance of myocardial infarction in the presence of confounder variables (OR = 0.975, 95% CI = 0.832-1.143, P = 0.755). Withdrawal syndrome due to abrupt discontinuation of opium does not have a triggering role for appearance of acute myocardial infarction.

  13. Recurrent Thrombotic Events after Discontinuation of Vitamin K Antagonist Treatment for Splanchnic Vein Thrombosis: A Multicenter Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Nicoletta Riva

    2015-01-01

    Full Text Available It is generally recommended that patients with splanchnic vein thrombosis (SVT should receive a minimum of 3 months of anticoagulant treatment. However, little information is available on the long-term risk of recurrent thrombotic events. The aim of this study was to evaluate the risk of venous and arterial thrombosis after discontinuation of vitamin K antagonist (VKA in SVT patients. Retrospective information from a cohort of SVT patients treated with VKA and followed by 37 Italian Anticoagulation Clinics, up to June 2013, was collected. Only patients who discontinued VKA and did not receive any other anticoagulant drug were enrolled in this study. Thrombotic events during follow-up were centrally adjudicated. Ninety patients were included: 33 unprovoked SVT, 27 SVT secondary to transient risk factors, and 30 with permanent risk factors. During a median follow-up of 1.6 years, 6 venous and 1 arterial thrombosis were documented, for an incidence of 3.3/100 patient-years (pt-y. The recurrence rate was highest in the first year after VKA discontinuation (8.2/100’pt-y and in patients with permanent risk factors (10.2/100’pt-y. Liver cirrhosis significantly increased the risk of recurrence. In conclusion, the rate of recurrent vascular complications after SVT is not negligible, at least in some patient subgroups.

  14. Stable and high order accurate difference methods for the elastic wave equation in discontinuous media

    KAUST Repository

    Duru, Kenneth; Virta, Kristoffer

    2014-01-01

    to be discontinuous. The key feature is the highly accurate and provably stable treatment of interfaces where media discontinuities arise. We discretize in space using high order accurate finite difference schemes that satisfy the summation by parts rule. Conditions

  15. Reasons for Discontinuation of Implanon among Users in Buffalo ...

    African Journals Online (AJOL)

    USER

    African Journal of Reproductive Health March 2018; 22(1):113 ... other medical treatments: 24 participants on the anti-retroviral drugs, one on antipsychotic and anti- ... The side effects of implanon were the reason for early discontinuation of.

  16. Risk of Vascular Thrombotic Events Following Discontinuation of Antithrombotics After Peptic Ulcer Bleeding.

    Science.gov (United States)

    Kim, Seung Young; Hyun, Jong Jin; Suh, Sang Jun; Jung, Sung Woo; Jung, Young Kul; Koo, Ja Seol; Yim, Hyung Joon; Park, Jong Jae; Chun, Hoon Jai; Lee, Sang Woo

    2016-04-01

    To evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. Peptic ulcer bleeding associated with antithrombotics has increased due to the increase in the proportion of elderly population. Little is known about the long-term effects of discontinuing antithrombotics after peptic ulcer bleeding. The aim of this study was to evaluate whether the risk of cardiovascular events increases when antithrombotics are discontinued after ulcer bleeding. We reviewed the medical records of patients with ulcer bleeding who were taking antiplatelet agents or anticoagulants at the time of ulcer bleeding. Cox-regression model was used to adjust for potential confounders, and analyzed association between discontinuation of antithrombotic drugs after ulcer bleeding and thrombotic events such as ischemic heart disease or stroke. Of the 544 patients with ulcer bleeding, 72 patients who were taking antithrombotics and followed up for >2 months were analyzed. Forty patients discontinued antithrombotics after ulcer bleeding (discontinuation group) and 32 patients continued antithrombotics with or without transient interruption (continuation group). Thrombotic events developed more often in discontinuation group than in the continuation group [7/32 (21.9%) vs. 1/40 (2.5%), P=0.019]. Hazard ratio for thrombotic event when antithrombotics were continuously discontinued was 10.9 (95% confidence interval, 1.3-89.7). There were no significant differences in recurrent bleeding events between the 2 groups. Discontinuation of antithrombotics after peptic ulcer bleeding increases the risk of cardiovascular events. Therefore, caution should be taken when discontinuing antithrombotics after ulcer bleeding.

  17. Effect of Discontinuation of Antihypertensive Treatment in Elderly People on Cognitive Functioning-the DANTE Study Leiden

    DEFF Research Database (Denmark)

    Moonen, Justine E F; Foster-Dingley, Jessica C; de Ruijter, Wouter

    2015-01-01

    whether discontinuation of antihypertensive treatment in older persons with mild cognitive deficits improves cognitive, psychological, and general daily functioning. DESIGN, SETTING, AND PARTICIPANTS: A community-based randomized clinical trial with a blinded outcome assessment at the 16-week follow...... in secondary outcomes, including differences (95% CIs) in change in compound scores of the 3 cognitive domains (executive function, -0.07 [-0.29 to 0.15; P = .52], memory, 0.08 [-0.12 to 0.29; P = .43], and psychomotor speed, -0.85 [-1.72 to 0.02; P = .06]), symptoms of apathy (0.17 [-0.65 to 0.99; P = .68...

  18. Reversible brain inactivation induces discontinuous gas exchange in cockroaches.

    Science.gov (United States)

    Matthews, Philip G D; White, Craig R

    2013-06-01

    Many insects at rest breathe discontinuously, alternating between brief bouts of gas exchange and extended periods of breath-holding. The association between discontinuous gas exchange cycles (DGCs) and inactivity has long been recognised, leading to speculation that DGCs lie at one end of a continuum of gas exchange patterns, from continuous to discontinuous, linked to metabolic rate (MR). However, the neural hypothesis posits that it is the downregulation of brain activity and a change in the neural control of gas exchange, rather than low MR per se, which is responsible for the emergence of DGCs during inactivity. To test this, Nauphoeta cinerea cockroaches had their brains inactivated by applying a Peltier-chilled cold probe to the head. Once brain temperature fell to 8°C, cockroaches switched from a continuous to a discontinuous breathing pattern. Re-warming the brain abolished the DGC and re-established a continuous breathing pattern. Chilling the brain did not significantly reduce the cockroaches' MR and there was no association between the gas exchange pattern displayed by the insect and its MR. This demonstrates that DGCs can arise due to a decrease in brain activity and a change in the underlying regulation of gas exchange, and are not necessarily a simple consequence of low respiratory demand.

  19. Discontinuation of furosemide decreases PaCO(2) in patients with COPD.

    NARCIS (Netherlands)

    Brijker, F.; Heijdra, Y.F.; Elshout, F.J.J. van den; Folgering, H.T.M.

    2002-01-01

    STUDY OBJECTIVE: To evaluate whether the discontinuation of furosemide treatment resulted in a decrease in PaCO(2) and an increase in daytime and nocturnal oxygenation. BACKGROUND: Furosemide is widely prescribed in patients with COPD for the treatment of peripheral edema. It is known that

  20. Stress-assisted discontinuous precipitation during creep of Ti3Al-Nb alloys

    International Nuclear Information System (INIS)

    Rowe, R.G.; Hall, E.L.

    1991-01-01

    Stress-assisted discontinuous precipitation was observed during creep of Ti-25Al-12.5Nb at. pct and associated with microstructures in which large primary creep strains were observed earlier. It was found that a large shift between the equilibrium beta(0) (B2) phase composition at the heat treatment temperature and disordered beta (bcc) phase at the creep temperature provided a driving force for discontinuous precipitation of disordered beta phase. Applied stress accelerated the growth of discontinuous beta phase at grain boundaries perpendicular to the principal stress axis, but did not produce a significant shift in composition. The difference between beta and ordered beta phase boundaries in the Ti-Al-Nb system at 650 C and 1040 C suggests that discontinuous precipitation or related dissolution should occur in all Ti3Al-Nb alloys. 11 refs

  1. The synergistic effect of breastfeeding discontinuation and cesarean section delivery on postpartum depression: A nationwide population-based cohort study in Korea.

    Science.gov (United States)

    Nam, Jin Young; Choi, Young; Kim, Juyeong; Cho, Kyoung Hee; Park, Eun-Cheol

    2017-08-15

    The relationships between breastfeeding discontinuation and cesarean section delivery, and the occurrence of postpartum depression (PPD) remain unclear. Therefore, we aimed to investigate the association of breastfeeding discontinuation and cesarean section delivery with PPD during the first 6 months after delivery. Data were extracted from the Korean National Health Insurance Service-National Sample Cohort for 81,447 women who delivered during 2004-2013. PPD status was determined using the diagnosis code at outpatient or inpatient visit during the 6-month postpartum period. Breastfeeding discontinuation and cesarean section delivery were identified from prescription of lactation suppression drugs and diagnosis, respectively. Cox proportional hazards models were used to calculate adjusted hazard ratios. Of the 81,447 women, 666 (0.82%) had PPD. PPD risk was higher in women who discontinued breastfeeding than in those who continued breastfeeding (hazard ratio=3.23, Pwomen with cesarean section delivery than in those with vaginal delivery (hazard ratio=1.26, P=0.0040), and in women with cesarean section delivery who discontinued breastfeeding than in those with vaginal delivery who continued breastfeeding (hazard ratio=4.92, Pworking status, which could introduce selection bias and errors due to miscoding; and potential lack of adjustment for important confounders. Breastfeeding discontinuation and cesarean section delivery were associated with PPD during the 6-month postpartum period. Our results support the implementation of breastfeeding promoting policies, and PPD screening and treatment programs during the early postpartum period. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Toxic keratopathy due to abuse of topical anesthetic drugs.

    Science.gov (United States)

    Yeniad, Baris; Canturk, Serife; Esin Ozdemir, Fatma; Alparslan, Nilufer; Akarcay, Koray

    2010-06-01

    To describe 8 cases of toxic keratopathy due to abuse of topical anesthetic drugs. Clinical findings from patients with toxic keratopathy were investigated retrospectively. Two patients had toxic keratopathy bilaterally. Five of 8 patients had an ocular history of a corneal foreign body, 1 had basal membrane dystrophy, 1 had ultraviolet radiation, and 1 had chemical burn. All patients had undergone psychiatric consultation. Four patients had anxiety disorder and 1 had bipolar disease. Clinical signs were improved in all patients with discontinuation of topical anesthetic drug use along with adjunctive psychiatric treatment. Penetrating keratoplasty was performed in 2 patients. Toxic keratopathy due to topical anesthetic abuse is a curable disease. Early diagnosis and prevention of topical anesthetic drug use are the most important steps in the treatment of this condition. As these patients commonly exhibit psychiatric disorders, adjunctive psychiatric treatment may help to break the chemical addiction.

  3. General Practitioners’ Decisions about Discontinuation of Medication

    DEFF Research Database (Denmark)

    Nixon, Michael Simon; Vendelø, Morten Thanning

    2016-01-01

    insights about decision making when discontinuing medication. It also offers one of the first examinations of how the institutional context embedding GPs influences their decisions about discontinuation. For policymakers interested in the discontinuation of medication, the findings suggest that de......Purpose – The purpose of this paper is to investigate how general practitioners’ (GPs) decisions about discontinuation of medication are influenced by their institutional context. Design/methodology/approach – In total, 24 GPs were interviewed, three practices were observed and documents were...... a weak frame for discontinuation. Three reasons for this are identified: the guidelines provide dominating triggers for prescribing, they provide weak priming for discontinuation as an option, and they underscore a cognitive constraint against discontinuation. Originality/value – The analysis offers new...

  4. Factors affecting IUCD discontinuation in Nepal

    DEFF Research Database (Denmark)

    Thapa, Subash; Paudel, Ishwari Sharma; Bhattarai, Sailesh

    2015-01-01

    Information related to contraception discontinuation, especially in the context of Nepal is very limited. A nested case-control study was carried out to determine the factors affecting discontinuation of intrauterine contraceptive devices (IUCDs). A total of 115 cases (IUCD discontinuers) and 115...

  5. Discontinuation of Preventive Drugs in General Practice

    DEFF Research Database (Denmark)

    Andersen, John Sahl; Lindberg, Laura Maria Glahder; Nixon, Michael Simon

    Introduction: In Denmark about 600,000 persons are treated for hypertension and more than 300,000 people are receiving cholesterol lowering drugs. The prevalence of hypertension in people aged 80 years is 70%. For antidepressants the defined daily doses/1000 aged >80 years/day exceed 200. By far...... the most preventive drugs are prescribed in general practice. Special considerations exist in relation to medication of elderly patients. The prevalence of polypharmacy and the subsequent increased risk of side effects and drug interactions is high. Drug-related problems represent the fifth leading cause...... of death in the United States. The public expenses to drug treatment are constantly increasing. The possibility to withdraw the medication must be taken into account but the decision to discontinue drugs is complex and poorly understood. Planned studies: 1. Patients’ views upon discontinuation...

  6. Immunosuppressive Drug Discontinuation in Noninfectious Uveitis From Real-Life Clinical Practice: A Survival Analysis.

    Science.gov (United States)

    Abásolo, Lydia; Rosales, Zulema; Díaz-Valle, David; Gómez-Gómez, Alejandro; Peña-Blanco, Rayma C; Prieto-García, Ángela; Benítez-Del-Castillo, José Manuel; Pato, Esperanza; García-Feijoo, Julián; Fernández-Gutiérrez, Benjamín; Rodriguez-Rodriguez, Luis

    2016-09-01

    To assess in uveitis patients the rate of immunosuppressive drug (ISD) discontinuation in real-life clinical practice, comparing this rate among ISDs. Longitudinal retrospective cohort study. We included uveitis patients attending a tertiary eye referral center from Madrid (Spain) between 1989 and 2015, prescribed any ISDs (cyclosporine, methotrexate, azathioprine, anti-TNF drugs, or others). Our main outcome was discontinuation of all ISDs owing to clinical efficacy, inefficacy, adverse drug reaction (ADR), and other medical causes. Discontinuation rates (DRs) per 100 patient-years were estimated. Variables associated with specific-cause discontinuations were analyzed using Cox bivariate and multivariate models. We analyzed 110 patients with 263 treatment courses and 665.2 patient-years of observation. Cyclosporine (66.4%), methotrexate (47.3%), azathioprine (30.9%), and anti-TNFs (30.9%) were the most frequently used ISDs. Treatment was suspended in 136 cases (mostly owing to clinical efficacy [38.2%], inefficacy [26.5%], and ADRs [22.8%]). All-cause DR with 95% confidence interval was 20.4 [17.3-24.2]. Retention rates at 1 and 10 years were 74% and 16%, respectively. In the multivariate analysis, combined treatment exhibited higher DRs owing to clinical efficacy than other ISDs in monotherapy. Conversely, nonbiologic combination therapy with azathioprine exhibited the highest DR owing to ADRs. Clinical efficacy was the most frequent cause for ISD discontinuation, followed by inefficacy and ADRs. DR owing to efficacy was higher for combination therapy. Furthermore, nonbiologic combination therapy with azathioprine was associated with a higher DR owing to ADRs. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Validation of a questionnaire to monitor symptoms in HIV-infected patients during hepatitis C treatment.

    Science.gov (United States)

    Cachay, Edward R; Ballard, Craig; Colwell, Bradford; Torriani, Francesca; Hicks, Charles; Mathews, Wm Christopher

    2017-09-20

    Clinicians are incorporating patient-reported outcomes in the management of HIV-infected persons co-infected with hepatitis C virus (HCV), but there are no validated inventories to monitor symptoms of patients during HCV therapy. Five-year retrospective cohort analysis of persons living with HIV (PLWH) treated for HCV. The HCV symptom-inventory (HCV-SI) was administered before, during, and after HCV treatment. Discriminant validity was assessed, separately, in mixed model linear regression of HCV-SI T-scores on treatment regimens (pegylated-interferon and ribavirin; pegylated-interferon, ribavirin, and telaprevir; and interferon-free antivirals); and side effect-related premature treatment discontinuation (SE-DC). From the 103 patients who completed the HCV-SI, 7% were female, 26% non-white, 32% cirrhotics and 91% had undetectable HIV viral loads. Most had genotype 1 (83%) and were HCV treatment-naïve (78%). We treated 19% of patients with pegylated-interferon and ribavirin, 22% with pegylated-interferon, ribavirin, and telaprevir and 59% received interferon-free antivirals. Overall, 77% achieved a sustained virologic response, and 6% discontinued HCV treatment due to side effects. In the treatment discrimination model, compared to the no treatment period, HCV-SI scores were significantly (p < 0.01) lower for interferon-free antivirals and higher for interferon-containing regimens. In the SE-DC model, the total HCV-SI, somatic and neuropsychiatric scores significantly predicted those patients who prematurely discontinued HCV treatment (P < 0.05). The HCV-SI effectively differentiated among treatment regimens known to vary by side effect profiles and between patients with and without treatment discontinuation due to side effects. The HCV-SI may have value as a patient-reported outcome instrument predicting the risk of HCV treatment discontinuation.

  8. 27 CFR 555.128 - Discontinuance of business.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Discontinuance of business... Discontinuance of business. Where an explosive materials business or operations is discontinued and succeeded by... such facts and shall be delivered to the successor. Where discontinuance of the business or operations...

  9. 27 CFR 478.57 - Discontinuance of business.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Discontinuance of business... Licenses § 478.57 Discontinuance of business. (a) Where a firearm or ammunition business is either discontinued or succeeded by a new owner, the owner of the business discontinued or succeeded shall within 30...

  10. Efficacy, tolerability, and safety of aripiprazole once-monthly versus other long-acting injectable antipsychotic therapies in the maintenance treatment of schizophrenia: a mixed treatment comparison of double-blind randomized clinical trials.

    Science.gov (United States)

    Majer, Istvan M; Gaughran, Fiona; Sapin, Christophe; Beillat, Maud; Treur, Maarten

    2015-01-01

    Treatment with long-acting injectable (LAI) antipsychotic medication is an important element of relapse prevention in schizophrenia. Recently, the intramuscular once-monthly formulation of aripiprazole received marketing approval in Europe and the United States for schizophrenia. This study aimed to compare aripiprazole once-monthly with other LAI antipsychotics in terms of efficacy, tolerability, and safety. A systematic literature review was conducted to identify relevant double-blind randomized clinical trials of LAIs conducted in the maintenance treatment of schizophrenia. MEDLINE, MEDLINE In-Process, Embase, the Cochrane Library, PsycINFO, conference proceedings, clinical trial registries, and the reference lists of key review articles were searched. The literature search covered studies dating from January 2002 to May 2013. Studies were required to have ≥24 weeks of follow-up. Patients had to be stable at randomization. Studies were not eligible for inclusion if efficacy of acute and maintenance phase treatment was not reported separately. Six trials were identified (0.5% of initially identified studies), allowing comparisons of aripiprazole once-monthly, risperidone LAI, paliperidone palmitate, olanzapine pamoate, haloperidol depot, and placebo. Data extracted included study details, study duration, the total number of patients in each treatment arm, efficacy, tolerability, and safety outcomes. The efficacy outcome contained the number of patients that experienced a relapse, tolerability outcomes included the number of patients that discontinued treatment due to treatment-related adverse events (AEs), and that discontinued treatment due to reasons other than AEs (e.g., loss to follow-up). Safety outcomes included the incidence of clinically relevant weight gain and extrapyramidal symptoms. Data were analyzed by applying a mixed treatment comparison competing risks model (efficacy) and using binary models (safety). There was no statistically significant

  11. Management applications of discontinuity theory

    Science.gov (United States)

    Angeler, David G.; Allen, Craig R.; Barichievy, Chris; Eason, Tarsha; Garmestani, Ahjond S.; Graham, Nicholas A.J.; Granholm, Dean; Gunderson, Lance H.; Knutson, Melinda; Nash, Kirsty L.; Nelson, R. John; Nystrom, Magnus; Spanbauer, Trisha; Stow, Craig A.; Sundstrom, Shana M.

    2015-01-01

    Human impacts on the environment are multifaceted and can occur across distinct spatiotemporal scales. Ecological responses to environmental change are therefore difficult to predict, and entail large degrees of uncertainty. Such uncertainty requires robust tools for management to sustain ecosystem goods and services and maintain resilient ecosystems.We propose an approach based on discontinuity theory that accounts for patterns and processes at distinct spatial and temporal scales, an inherent property of ecological systems. Discontinuity theory has not been applied in natural resource management and could therefore improve ecosystem management because it explicitly accounts for ecological complexity.Synthesis and applications. We highlight the application of discontinuity approaches for meeting management goals. Specifically, discontinuity approaches have significant potential to measure and thus understand the resilience of ecosystems, to objectively identify critical scales of space and time in ecological systems at which human impact might be most severe, to provide warning indicators of regime change, to help predict and understand biological invasions and extinctions and to focus monitoring efforts. Discontinuity theory can complement current approaches, providing a broader paradigm for ecological management and conservation.

  12. The Reasons for Discontinuation of Infliximab Treatment in Patients with Crohn's Disease: A Review of Practice at NHS Teaching Hospital

    OpenAIRE

    Krupa, Lukasz Z.; Kennedy, Hugh J.; Jamieson, Crawford P.; Fisher, Nicola; Hart, Andrew R.

    2011-01-01

    Introduction. There is little information on the reasons for discontinuing infliximab treatment in patients with Crohn's disease. The aim of this study was to document these reasons to determine if any were preventable which would allow patients to continue the therapy. Aims & Methods. A review of the medical notes was conducted at the Norfolk and Norwich University Hospital on patients with Crohn's disease treated with infliximab between 2002–2008 to determine the reasons for stopping it. Re...

  13. Increments in plasma homovanillic acid concentrations after neuroleptic discontinuation are associated with worsening of schizophrenic symptoms.

    Science.gov (United States)

    Khan, R S; Amin, F; Powchik, P; Knott, P; Goldstein, M; Apter, S; Kerman, B; Jaff, S; Davidson, M

    1990-01-01

    1. Thirty-two male schizophrenic patients participated in this study. 2. Plasma concentrations of the dopamine metabolite, homovanillic acid (pHVA) were assessed once on neuroleptic medication and twice a week for a maximum of six weeks after its discontinuation. 3. Psychiatric symptomatology was assessed once on neuroleptic medication and once a week for a maximum of six weeks after its discontinuation, using the brief psychiatric rating scale (BPRS). 4. pHVA and total BPRS score increased significantly after discontinuation of neuroleptic as compared to baseline. 5. The magnitude of pHVA and BPRS increments after discontinuation of neuroleptic correlated significantly. 6. Results of this study suggest that worsening of schizophrenic symptoms after discontinuation of neuroleptic treatment is associated with increased pHVA concentrations.

  14. Adaptive mixed-hybrid and penalty discontinuous Galerkin method for two-phase flow in heterogeneous media

    KAUST Repository

    Hou, Jiangyong

    2016-02-05

    In this paper, we present a hybrid method, which consists of a mixed-hybrid finite element method and a penalty discontinuous Galerkin method, for the approximation of a fractional flow formulation of a two-phase flow problem in heterogeneous media with discontinuous capillary pressure. The fractional flow formulation is comprised of a wetting phase pressure equation and a wetting phase saturation equation which are coupled through a total velocity and the saturation affected coefficients. For the wetting phase pressure equation, the continuous mixed-hybrid finite element method space can be utilized due to a fundamental property that the wetting phase pressure is continuous. While it can reduce the computational cost by using less degrees of freedom and avoiding the post-processing of velocity reconstruction, this method can also keep several good properties of the discontinuous Galerkin method, which are important to the fractional flow formulation, such as the local mass balance, continuous normal flux and capability of handling the discontinuous capillary pressure. For the wetting phase saturation equation, the penalty discontinuous Galerkin method is utilized due to its capability of handling the discontinuous jump of the wetting phase saturation. Furthermore, an adaptive algorithm for the hybrid method together with the centroidal Voronoi Delaunay triangulation technique is proposed. Five numerical examples are presented to illustrate the features of proposed numerical method, such as the optimal convergence order, the accurate and efficient velocity approximation, and the applicability to the simulation of water flooding in oil field and the oil-trapping or barrier effect phenomena.

  15. Adaptive mixed-hybrid and penalty discontinuous Galerkin method for two-phase flow in heterogeneous media

    KAUST Repository

    Hou, Jiangyong; Chen, Jie; Sun, Shuyu; Chen, Zhangxin

    2016-01-01

    In this paper, we present a hybrid method, which consists of a mixed-hybrid finite element method and a penalty discontinuous Galerkin method, for the approximation of a fractional flow formulation of a two-phase flow problem in heterogeneous media with discontinuous capillary pressure. The fractional flow formulation is comprised of a wetting phase pressure equation and a wetting phase saturation equation which are coupled through a total velocity and the saturation affected coefficients. For the wetting phase pressure equation, the continuous mixed-hybrid finite element method space can be utilized due to a fundamental property that the wetting phase pressure is continuous. While it can reduce the computational cost by using less degrees of freedom and avoiding the post-processing of velocity reconstruction, this method can also keep several good properties of the discontinuous Galerkin method, which are important to the fractional flow formulation, such as the local mass balance, continuous normal flux and capability of handling the discontinuous capillary pressure. For the wetting phase saturation equation, the penalty discontinuous Galerkin method is utilized due to its capability of handling the discontinuous jump of the wetting phase saturation. Furthermore, an adaptive algorithm for the hybrid method together with the centroidal Voronoi Delaunay triangulation technique is proposed. Five numerical examples are presented to illustrate the features of proposed numerical method, such as the optimal convergence order, the accurate and efficient velocity approximation, and the applicability to the simulation of water flooding in oil field and the oil-trapping or barrier effect phenomena.

  16. Special discontinuities in nonlinearly elastic media

    Science.gov (United States)

    Chugainova, A. P.

    2017-06-01

    Solutions of a nonlinear hyperbolic system of equations describing weakly nonlinear quasitransverse waves in a weakly anisotropic elastic medium are studied. The influence of small-scale processes of dissipation and dispersion is investigated. The small-scale processes determine the structure of discontinuities (shocks) and a set of discontinuities with a stationary structure. Among the discontinuities with a stationary structure, there are special ones that, in addition to relations following from conservation laws, satisfy additional relations required for the existence of their structure. In the phase plane, the structure of such discontinuities is represented by an integral curve joining two saddles. Special discontinuities lead to nonunique self-similar solutions of the Riemann problem. Asymptotics of non-self-similar problems for equations with dissipation and dispersion are found numerically. These asymptotics correspond to self-similar solutions of the problems.

  17. Triaxiality in the even-mass Hg isotopes: A discontinuity at 200Hg

    International Nuclear Information System (INIS)

    Morrison, I.; Spear, R.H.

    1981-01-01

    The mass dependence of excitation energies of the 2 + 1 , 2 + 2 , and 4 + 1 states of the even-mass Hg isotopes, and of some related B(E2) values, shows a marked discontinuity at 200 Hg. Analysis of B(E2;0 + 1 →2 + 1 ) values in terms of an extended interacting boson approximation model suggests that this discontinuity is due to a change in the proton and neutron distributions at 200 Hg. Apart from 200 Hg, the data favor γ-soft models rather than the rigid triaxial-rotor model

  18. Discontinuation of the Bulletin's menu page

    CERN Document Server

    Publications Section

    2005-01-01

    The menus of the various CERN restaurants will no longer be published in the Bulletin as of Monday 4 April (issue No. 14/2005). The menu pages are being discontinued both as a savings measure and due to the low level of interest in this section of the Bulletin. The most recent survey of Bulletin readers showed that only 13% of the people questioned regularly read the menu section, compared to between 40% and 85% in the case of the other sections. Publications Section SG/CO Tel. 79971

  19. Discontinuation of the Bulletin's menu page

    CERN Multimedia

    Publications Section

    2005-01-01

    The menus of the various CERN restaurants will no longer be published in the Bulletin as of Monday 4 April (issue No. 14/2005). The menu pages are being discontinued both as a savings measure and due to the low level of interest in this section of the Bulletin. The most recent survey of Bulletin readers showed that only 13% of the people questioned regularly read the menu section, compared to between 40% and 85% in the case of the other sections. Publications Section DSU-CO Tel. 79971

  20. Stabilities of MHD rotational discontinuities

    International Nuclear Information System (INIS)

    Wang, S.

    1984-11-01

    In this paper, the stabilities of MHD rotational discontinuities are analyzed. The results show that the rotational discontinuities in an incompressible magnetofluid are not always stable with respect to infinitesimal perturbation. The instability condition in a special case is obtained. (author)

  1. A Gas-kinetic Discontinuous Galerkin Method for Viscous Flow Equations

    International Nuclear Information System (INIS)

    Liu, Hongwei; Xu, Kun

    2007-01-01

    This paper presents a Runge-Kutta discontinuous Galerkin (RKDG) method for viscous flow computation. The construction of the RKDG method is based on a gas-kinetic formulation, which not only couples the convective and dissipative terms together, but also includes both discontinuous and continuous representation in the flux evaluation at the cell interface through a simple hybrid gas distribution function. Due to the intrinsic connection between the gaskinetic BGK model and the Navier-Stokes equations, the Navier-Stokes flux is automatically obtained by the present method. Numerical examples for both one dimensional (10) and two dimensional(20) compressible viscous flows are presented to demonstrate the accuracy and shock capturing capability of the current RKDG method

  2. Discontinuous Schedule of Bevacizumab in Colorectal Cancer Induces Accelerated Tumor Growth and Phenotypic Changes

    Directory of Open Access Journals (Sweden)

    Selma Becherirat

    2018-04-01

    Full Text Available Antiangiogenics administration in colorectal cancer patients seemed promising therapeutic approach. Inspite of early encouraging results, it however gave only modest clinical benefits. When AAG was administered with discontinuous schedule, the disease showed acceleration in certain cases. Though resistance to AAG has been extensively studied, it is not documented for discontinuous schedules. To simulate clinical situations, we subjected a patient-derived CRC subcutaneous xenograft in mice to three different protocols: 1 AAG (bevacizumab treatment for 30 days (group A (group B was the control, 2 bevacizumab treatment for 50 days (group C and bevacizumab for 30 days and 20 without treatment (group D, and 3 bevacizumab treatment for 70 days (group E and 70 days treatment with a drug-break period between day 30 and 50 (group F. The tumor growth was monitored, and at sacrifice, the vascularity of tumors was measured and the proangiogenic factors quantified. Tumor phenotype was studied by quantifying cancer stem cells. Interrupting bevacizumab during treatment accelerated tumor growth and revascularization. A significant increase of proangiogenic factors was observed when therapy was stopped. On withdrawal of bevacizumab, as also after the drug-break period, the plasmatic VEGF increased significantly. Similarly, a notable increase of CSCs after the withdrawal and drug-break period of bevacizumab was observed (P<.01. The present study indicates that bevacizumab treatment needs to be maintained because discontinuous schedules tend to trigger tumor regrowth, and increase tumor resistance and CSC heterogeneity.

  3. Discontinuation of antiplatelet treatment and risk of recurrent stroke and all-cause death

    DEFF Research Database (Denmark)

    Ostergaard, Kamilla; Pottegård, Anton; Hallas, Jesper

    2014-01-01

    use and followed them up for stroke recurrence, or all-cause death. Person-time was classified by antiplatelet drug use into current use, recent use (≤150 days after last use), and non-use (>150 days after last use). Lipid-lowering drug (LLD) use was classified by the same rules. We used Cox......BACKGROUND: We wished to examine the impact of antiplatelet drug discontinuation on recurrent stroke and all-cause mortality. METHODS: We identified a cohort of incident ischaemic stroke patients in a Danish stroke registry, 2007-2011. Using population-based registries we assessed subjects' drug...... proportional hazard models to calculate the adjusted hazard ratio (HR) and corresponding 95% confidence intervals (CIs) for the risk of recurrent stroke or death associated with discontinuation of antiplatelet or LLD drugs. RESULTS: Among 4,670 stroke patients followed up for up a median of 1.5 years, 237...

  4. Stable and high order accurate difference methods for the elastic wave equation in discontinuous media

    KAUST Repository

    Duru, Kenneth

    2014-12-01

    © 2014 Elsevier Inc. In this paper, we develop a stable and systematic procedure for numerical treatment of elastic waves in discontinuous and layered media. We consider both planar and curved interfaces where media parameters are allowed to be discontinuous. The key feature is the highly accurate and provably stable treatment of interfaces where media discontinuities arise. We discretize in space using high order accurate finite difference schemes that satisfy the summation by parts rule. Conditions at layer interfaces are imposed weakly using penalties. By deriving lower bounds of the penalty strength and constructing discrete energy estimates we prove time stability. We present numerical experiments in two space dimensions to illustrate the usefulness of the proposed method for simulations involving typical interface phenomena in elastic materials. The numerical experiments verify high order accuracy and time stability.

  5. USING CUSTOM TRIFLANGE IMPLANT IN REVISION HIP ARTHROPLASTY IN PATIENT WITH PELVIC DISCONTINUITY (CASE REPORT

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2016-01-01

    Full Text Available Revision hip arthroplasty rate is growing, and pelvic discontinuity rate ranges from 1% to 5% of acetabular component revision reasons. According to AAOS acetabular defects classification, pelvic discontinuity is fourth type defect in which cranial part of hip bone is separated from caudal part at acetabular level. Usually it occurs from bone loss secondary to osteolysis, infection, fracture or aseptic loosening. There are a lot of techniques for pelvis discontinuity treatment. Published results of bulk allografts and antiprotrusion cages have generally been poor. More preferable methods with acceptable rate of good results are cup-cage systems and custom triflange acetabular components(CTAC. CTACs are designed based on preoperative CT scans to build a custom titanium 3D-printed implant to address the patient's specific bone defect and provide secure fixation in the ilium, pubis, and ischium. We faced pelvic discontinuity, in which extensive iliac bone loss was added to caudal hip bone part medial displacement and pelvic ring deformity, in patient with multiple hip surgeries. Preoperative investigation called into question the possibility of using off-the-shelf hip implants, which could restore the biomechanics of the hip and provide reliable primary fixation at the same time. We present case report of the patient with pelvic discontinuity and massive bone loss treatment using a custom triflange component.

  6. Survey of reasons for discontinuation from in vitro fertilization treatment among couples attending infertility clinic

    Directory of Open Access Journals (Sweden)

    Grishma Kulkarni

    2014-01-01

    Full Text Available Background: With the increase in infertility burden, more and more couples are opting for in vitro fertilization (IVF. Despite the availability of various treatment options, the major concern that needs to be addressed is the reasons why such couples, initially motivated so strongly, drop out in fairly high numbers from IVF cycles. With this point of view the study was designed. AIM: The objective of this study was to explore the reasons why couples discontinue fertility treatment. Settings and Design: This retrospective study was carried out among couples in the age group of 20-40 years who opted for IVF at Tertiary care hospital and a private infertility center. Materials and Methods: Medical records for 3 years (2009-2012 were taken out and included in the study for analysis. Socio-demographic details along with indication for IVF and reasons for drop-separate IVF therapy were recorded on case record form and were analyzed. Results: Twenty-one percent of the patients had tubal pathology, thus making it the commonest female related factor for indication of IVF. Oligoasthenospermia (13% was the commonest cause of male related infertility factor. Financial burden was the primary cause for terminating treatment in majority of the IVF cases. Conclusions: Financial burden (62.5% was the commonest reason for drop out among couples from IVF cycle.

  7. Management applications of discontinuity theory | Science ...

    Science.gov (United States)

    1.Human impacts on the environment are multifaceted and can occur across distinct spatiotemporal scales. Ecological responses to environmental change are therefore difficult to predict, and entail large degrees of uncertainty. Such uncertainty requires robust tools for management to sustain ecosystem goods and services and maintain resilient ecosystems. 2.We propose an approach based on discontinuity theory that accounts for patterns and processes at distinct spatial and temporal scales, an inherent property of ecological systems. Discontinuity theory has not been applied in natural resource management and could therefore improve ecosystem management because it explicitly accounts for ecological complexity. 3.Synthesis and applications. We highlight the application of discontinuity approaches for meeting management goals. Specifically, discontinuity approaches have significant potential to measure and thus understand the resilience of ecosystems, to objectively identify critical scales of space and time in ecological systems at which human impact might be most severe, to provide warning indicators of regime change, to help predict and understand biological invasions and extinctions and to focus monitoring efforts. Discontinuity theory can complement current approaches, providing a broader paradigm for ecological management and conservation This manuscript provides insight on using discontinuity approaches to aid in managing complex ecological systems. In part

  8. Insufficient recruitment and premature discontinuation of clinical trials in Switzerland: qualitative study with trialists and other stakeholders.

    Science.gov (United States)

    Briel, Matthias; Elger, Bernice; von Elm, Erik; Satalkar, Priya

    2017-11-29

    Premature discontinuation occurs in about 25% of randomised clinical trials in Switzerland; it mainly affects investigator-initiated trials and is mostly due to problems with recruitment of patients. The aim of this study was to qualitatively investigate reasons for trial discontinuation due to poor patient recruitment and suggestions to address those reasons in the Swiss context. We conducted semi-structured interviews with trialists whose trials were discontinued because of recruitment problems, other experienced trialists, and stakeholders in clinical research in Switzerland. Interviews were audio-recorded, transcribed verbatim, and anonymised. We analysed the transcripts using deductive coding and built up themes that were continuously discussed within the research team. Of 65 invited Swiss trialists and stakeholders, 39 (60%) agreed to be interviewed and contributed to this analysis. We identified four main themes of reasons for poor recruitment: (1) Switzerland has a decentralised healthcare system with many small hospitals and few patients per hospital, many research regulations, no standardisation of medical records across hospitals, and a heterogeneous ethics assessment of study protocols. There is little collaboration of different stakeholders in clinical research and a lack of prioritisation of projects. (2) Limited human and financial resources, especially in the academic setting, compromise research questions and size of clinical trials. When funding is used up this typically triggers discontinuation of already delayed clinical trials. (3) Investigators face underdeveloped research networks and a limited collaborative attitude among clinical researchers. They typically embark on clinical studies with a great deal of optimism but insufficient preparation. (4) Swiss patients have universal health coverage and many treatment options. Negative media coverage of clinical research and a lack of accessible information for patients about ongoing clinical

  9. Oral Effects and Early Implant Survival Results After Imatinib Discontinuation Therapy for Chronic Myelogenous Leukemia: A Case Report.

    Science.gov (United States)

    Dixon, Douglas R; Yassin, Alaa

    2017-08-01

    Little is known regarding the success, failure, or complication rates of advanced implant procedures in patients after discontinuation therapy of long-term medications for the treatment of chronic myelogenous leukemia (CML). This case report presents initial results of a case involving implant placement in the mandible and maxilla as well as reduction of palatal oral pigmentation in a patient discontinuing long-term tyrosine kinase inhibitor (TKI) therapy for CML. A 57-year-old male was referred to the Department of Periodontics, University of Washington, Seattle, Washington, for an assessment of edentulous areas (tooth sites #3 and #14) and failing tooth #19. Previous medical treatment included oral administration (>10 years) of TKI for the treatment of CML. Systemic complications arising from long-term TKI therapy were treated with discontinuation of this medication. Concurrently, after multispecialty dental and medical consultation, extraction of tooth #19 with immediate implant placement and bilateral sinus augmentation with simultaneous implant placement were successfully performed during three separate surgical appointments. Additionally, marked reduction of oral palatal pigmentation was observed during the surgical and restorative phases after TKI discontinuation. Patients with a history of long-term TKIs for CML are at risk for developing complications that result in discontinuation of therapy. Long-term benefits of therapy may allow these patients to enjoy remission with an extended and improved quality of life. Patients undergoing discontinuation therapy may seek dental care. Therefore, dental providers need to understand these systemic interactions and, with multispecialty consultation, may help effectively treat these individuals.

  10. 27 CFR 478.127 - Discontinuance of business.

    Science.gov (United States)

    2010-04-01

    ... business was located: Provided, however, Where State law or local ordinance requires the delivery of... 27 Alcohol, Tobacco Products and Firearms 3 2010-04-01 2010-04-01 false Discontinuance of business... Records § 478.127 Discontinuance of business. Where a licensed business is discontinued and succeeded by a...

  11. Discontinuity model for internal transport barrier formation in reversed magnetic shear plasmas

    International Nuclear Information System (INIS)

    Kishimoto, Y.; Kim, J-Y.; Horton, W.; Tajima, T.; LeBrun, M.J.

    2001-01-01

    To aid in understanding the internal transport barrier (ITB) being formed in reversed magnetic shear experiments, in addition to the well known shear flow effect, we point out an important nonlocal effect and/or finite size effect which comes from the complex behavior of the nonlocal mode over a finite radial region around the minimum q(safety factor)-surface. The nonlocal mode changes its structure depending on the sign of the magnetic shear and due to this fact, the nonlocal modes are weakly excited across the q min -surface. This leads to a discontinuity or gap which disconnects the phase relation in the global wave structure across the q min -surface. Once such a discontinuity (or gap) is formed, transport suppression occurs and therefore a transport barrier can be expected near the q min -surface. We confirm the existence of this discontinuity using a toroidal particle simulation. (author)

  12. Discontinuity formulas for multiparticle amplitudes

    International Nuclear Information System (INIS)

    Stapp, H.P.

    1976-03-01

    It is shown how discontinuity formulas for multiparticle scattering amplitudes are derived from unitarity and analyticity. The assumed analyticity property is the normal analytic structure, which was shown to be equivalent to the space-time macrocausality condition. The discontinuity formulas to be derived are the basis of multi-particle fixed-t dispersion relations

  13. Testing discontinuities in nonparametric regression

    KAUST Repository

    Dai, Wenlin

    2017-01-19

    In nonparametric regression, it is often needed to detect whether there are jump discontinuities in the mean function. In this paper, we revisit the difference-based method in [13 H.-G. Müller and U. Stadtmüller, Discontinuous versus smooth regression, Ann. Stat. 27 (1999), pp. 299–337. doi: 10.1214/aos/1018031100

  14. Testing discontinuities in nonparametric regression

    KAUST Repository

    Dai, Wenlin; Zhou, Yuejin; Tong, Tiejun

    2017-01-01

    In nonparametric regression, it is often needed to detect whether there are jump discontinuities in the mean function. In this paper, we revisit the difference-based method in [13 H.-G. Müller and U. Stadtmüller, Discontinuous versus smooth regression, Ann. Stat. 27 (1999), pp. 299–337. doi: 10.1214/aos/1018031100

  15. Impact of prior treatment status and reasons for discontinuation on the efficacy and safety of fingolimod: Subgroup analyses of the Fingolimod Research Evaluating Effects of Daily Oral Therapy in Multiple Sclerosis (FREEDOMS) study.

    Science.gov (United States)

    Kremenchutzky, Marcelo; O'Connor, Paul; Hohlfeld, Reinhard; Zhang-Auberson, Lixin; von Rosenstiel, Philipp; Meng, Xiangyi; Grinspan, Augusto; Hashmonay, Ron; Kappos, Ludwig

    2014-05-01

    Fingolimod is a once-daily, oral sphingosine 1-phosphate receptor modulator approved for the treatment of relapsing multiple sclerosis. This post-hoc analysis of phase 3 FREEDOMS data assessed whether the effects of fingolimod are consistent among subgroups of patients defined by prior treatment history. Annualized relapse rate and safety profile of treatment with fingolimod 0.5mg, 1.25mg, or placebo once-daily for 24 months were analyzed in 1272 relapsing multiple sclerosis patients, by subgroups based on disease-modifying therapy history (treatment-naive; prior interferon-β or glatiramer acetate), reason for discontinuation of prior disease-modifying therapy (unsatisfactory therapeutic response or adverse events), and prior disease-modifying therapy duration. Both fingolimod doses significantly reduced annualized relapse rate in patients that received prior interferon-β or glatiramer acetate, discontinued prior disease-modifying therapy owing to unsatisfactory therapeutic effect, were treatment-naive, or had prior disease-modifying therapy duration of >1-3 years (P≤0.0301 for all comparisons vs placebo). Fingolimod 1.25mg resulted in greater reductions in annualized relapse rate in patients that discontinued prior disease-modifying therapy for adverse events or had prior disease-modifying therapy duration of ≤1 year or >3 years (P≤0.0194 vs placebo). Fingolimod demonstrated similar efficacy in relapsing multiple sclerosis patients regardless of prior treatment history. Clinicaltrials.gov identifier: NCT00289978. © 2013 The Authors. Published by Elsevier B.V. All rights reserved.

  16. Regge calculus from discontinuous metrics

    International Nuclear Information System (INIS)

    Khatsymovsky, V.M.

    2003-01-01

    Regge calculus is considered as a particular case of the more general system where the linklengths of any two neighbouring 4-tetrahedra do not necessarily coincide on their common face. This system is treated as that one described by metric discontinuous on the faces. In the superspace of all discontinuous metrics the Regge calculus metrics form some hypersurface defined by continuity conditions. Quantum theory of the discontinuous metric system is assumed to be fixed somehow in the form of quantum measure on (the space of functionals on) the superspace. The problem of reducing this measure to the Regge hypersurface is addressed. The quantum Regge calculus measure is defined from a discontinuous metric measure by inserting the δ-function-like phase factor. The requirement that continuity conditions be imposed in a 'face-independent' way fixes this factor uniquely. The term 'face-independent' means that this factor depends only on the (hyper)plane spanned by the face, not on it's form and size. This requirement seems to be natural from the viewpoint of existence of the well-defined continuum limit maximally free of lattice artefacts

  17. Metabolic syndrome and drug discontinuation in schizophrenia: a randomized trial comparing aripiprazole olanzapine and haloperidol.

    Science.gov (United States)

    Parabiaghi, A; Tettamanti, M; D'Avanzo, B; Barbato, A

    2016-01-01

    To determine whether the prescription of aripiprazole, compared with olanzapine and haloperidol, was associated with a lower frequency of metabolic syndrome (MS) and treatment discontinuation at 1 year. Patients were randomly assigned to be treated open-label and according to usual clinical practice with either aripiprazole, olanzapine, or haloperidol and followed up for 1 year. Three hundred out-patients with persistent schizophrenia were recruited in 35 mental health services. The intention-to-treat (ITT) analysis found no significant differences in the rate of MS between aripiprazole (37%), olanzapine (47%), and haloperidol (42%). Treatment discontinuation for any cause was higher for aripiprazole (52%) than for olanzapine (33%; OR, 0.41; P = 0.004), or haloperidol (37%; OR, 0.51; P = 0.030). No significant difference was found between olanzapine and haloperidol. Time to discontinuation for any cause was longer for olanzapine than for aripiprazole (HR, 0.55; P haloperidol and aripiprazole, or between olanzapine and haloperidol. The prescription of aripiprazole did not significantly reduce the rates of MS, but its treatment retention was worse. Aripiprazole cannot be considered the safest and most effective drug for maintenance treatment of schizophrenia in routine care, although it may have a place in antipsychotic therapy. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. High-order dynamic modeling and parameter identification of structural discontinuities in Timoshenko beams by using reflection coefficients

    Science.gov (United States)

    Fan, Qiang; Huang, Zhenyu; Zhang, Bing; Chen, Dayue

    2013-02-01

    Properties of discontinuities, such as bolt joints and cracks in the waveguide structures, are difficult to evaluate by either analytical or numerical methods due to the complexity and uncertainty of the discontinuities. In this paper, the discontinuity in a Timoshenko beam is modeled with high-order parameters and then these parameters are identified by using reflection coefficients at the discontinuity. The high-order model is composed of several one-order sub-models in series and each sub-model consists of inertia, stiffness and damping components in parallel. The order of the discontinuity model is determined based on the characteristics of the reflection coefficient curve and the accuracy requirement of the dynamic modeling. The model parameters are identified through the least-square fitting iteration method, of which the undetermined model parameters are updated in iteration to fit the dynamic reflection coefficient curve with the wave-based one. By using the spectral super-element method (SSEM), simulation cases, including one-order discontinuities on infinite- and finite-beams and a two-order discontinuity on an infinite beam, were employed to evaluate both the accuracy of the discontinuity model and the effectiveness of the identification method. For practical considerations, effects of measurement noise on the discontinuity parameter identification are investigated by adding different levels of noise to the simulated data. The simulation results were then validated by the corresponding experiments. Both the simulation and experimental results show that (1) the one-order discontinuities can be identified accurately with the maximum errors of 6.8% and 8.7%, respectively; (2) and the high-order discontinuities can be identified with the maximum errors of 15.8% and 16.2%, respectively; and (3) the high-order model can predict the complex discontinuity much more accurately than the one-order discontinuity model.

  19. Excursions in fluvial (dis)continuity

    Science.gov (United States)

    Grant, Gordon E.; O'Connor, James E.; Safran, Elizabeth

    2017-01-01

    Lurking below the twin concepts of connectivity and disconnectivity are their first, and in some ways, richer cousins: continuity and discontinuity. In this paper we explore how continuity and discontinuity represent fundamental and complementary perspectives in fluvial geomorphology, and how these perspectives inform and underlie our conceptions of connectivity in landscapes and rivers. We examine the historical roots of continuum and discontinuum thinking, and how much of our understanding of geomorphology rests on contrasting views of continuity and discontinuity. By continuum thinking we refer to a conception of geomorphic processes as well as geomorphic features that are expressed along continuous gradients without abrupt changes, transitions, or thresholds. Balance of forces, graded streams, and hydraulic geometry are all examples of this perspective. The continuum view has played a prominent role in diverse disciplinary fields, including ecology, paleontology, and evolutionary biology, in large part because it allows us to treat complex phenomena as orderly progressions and invoke or assume equilibrium processes that introduce order and prediction into our sciences.In contrast the discontinuous view is a distinct though complementary conceptual framework that incorporates non-uniform, non-progressive, and non-equilibrium thinking into understanding geomorphic processes and landscapes. We distinguish and discuss examples of three different ways in which discontinuous thinking can be expressed: 1) discontinuous spatial arrangements or singular events; 2) specific process domains generally associated with thresholds, either intrinsic or extrinsic; and 3) physical dynamics or changes in state, again often threshold-linked. In moving beyond the continuous perspective, a fertile set of ideas comes into focus: thresholds, non-equilibrium states, heterogeneity, catastrophe. The range of phenomena that is thereby opened up to scientific exploration similarly expands

  20. Regression Discontinuity and Randomized Controlled Trial Estimates: An Application to The Mycotic Ulcer Treatment Trials.

    Science.gov (United States)

    Oldenburg, Catherine E; Venkatesh Prajna, N; Krishnan, Tiruvengada; Rajaraman, Revathi; Srinivasan, Muthiah; Ray, Kathryn J; O'Brien, Kieran S; Glymour, M Maria; Porco, Travis C; Acharya, Nisha R; Rose-Nussbaumer, Jennifer; Lietman, Thomas M

    2018-08-01

    We compare results from regression discontinuity (RD) analysis to primary results of a randomized controlled trial (RCT) utilizing data from two contemporaneous RCTs for treatment of fungal corneal ulcers. Patients were enrolled in the Mycotic Ulcer Treatment Trials I and II (MUTT I & MUTT II) based on baseline visual acuity: patients with acuity ≤ 20/400 (logMAR 1.3) enrolled in MUTT I, and >20/400 in MUTT II. MUTT I investigated the effect of topical natamycin versus voriconazole on best spectacle-corrected visual acuity. MUTT II investigated the effect of topical voriconazole plus placebo versus topical voriconazole plus oral voriconazole. We compared the RD estimate (natamycin arm of MUTT I [N = 162] versus placebo arm of MUTT II [N = 54]) to the RCT estimate from MUTT I (topical natamycin [N = 162] versus topical voriconazole [N = 161]). In the RD, patients receiving natamycin had mean improvement of 4-lines of visual acuity at 3 months (logMAR -0.39, 95% CI: -0.61, -0.17) compared to topical voriconazole plus placebo, and 2-lines in the RCT (logMAR -0.18, 95% CI: -0.30, -0.05) compared to topical voriconazole. The RD and RCT estimates were similar, although the RD design overestimated effects compared to the RCT.

  1. Lyophilized allogeneic bone grafts for cystic and discontinuity defects of the jaws

    International Nuclear Information System (INIS)

    Pill Hoon Choung; Eun Seok Kim

    1999-01-01

    Allogenic bone grafts have been used after various processing in each institute was made by lyophilized allogenic bone and used for maxillofacial reconstruction. Three types of lyophilized allogenic bone grafts as powder, chip and block form were performed to reconstruct the following defects: 1) maxillectomy, 2) mandiblectomy, 3) cystectomy, 4) cleft alveolus, 5) gap in orthognathic osteotomy, 6) peri-implant defect, 7) extraction socket, and 8) facial contouring. Above defects can be classified as cystic and discontinuity defects of the maxilia and the mandible. Because discontinuity defects have more difficult problems to reconstruct considering mechanical strength of the allogenic bone. We performed allogenic bone grafts on 50 cystic defects and 12 discontinuity defects of the jaws. Among them, 3 cases were removed due to infection, and the others had no complications. In reconstruction of cystic defects, the defects were filled with allogenic chip which were made from allogenic block bone at the surgery, which later were changed to host bone. Three cases of them showed tooth eruption through the allogenic bone grafting site, changing the eruption pathway, which was interrupted by the lesion. in reconstruction of discontinuity defects, usually allogenic bone has been used as a tray, in which PMCB or demineralized bone chips were filled. But we tried to reconstruct this discontinuity defect using allogeneic bone block without inside filling of PMCB different from tray type. We will present the results of allogenic bone grafts using cranial bone, costochondral graft, and the mandible

  2. Neural networks with discontinuous/impact activations

    CERN Document Server

    Akhmet, Marat

    2014-01-01

    This book presents as its main subject new models in mathematical neuroscience. A wide range of neural networks models with discontinuities are discussed, including impulsive differential equations, differential equations with piecewise constant arguments, and models of mixed type. These models involve discontinuities, which are natural because huge velocities and short distances are usually observed in devices modeling the networks. A discussion of the models, appropriate for the proposed applications, is also provided. This book also: Explores questions related to the biological underpinning for models of neural networks\\ Considers neural networks modeling using differential equations with impulsive and piecewise constant argument discontinuities Provides all necessary mathematical basics for application to the theory of neural networks Neural Networks with Discontinuous/Impact Activations is an ideal book for researchers and professionals in the field of engineering mathematics that have an interest in app...

  3. Assessing the feasibility of the Effectiveness of Discontinuing Bisphosphonates trial: a pilot study.

    Science.gov (United States)

    Wright, N C; Foster, P J; Mudano, A S; Melnick, J A; Lewiecki, M E; Shergy, W J; Curtis, J R; Cutter, G R; Danila, M I; Kilgore, M L; Lewis, E C; Morgan, S L; Redden, D T; Warriner, A H; Saag, K G

    2017-08-01

    The Effectiveness of Discontinuing Bisphosphonates (EDGE) study is a planned pragmatic clinical trial to guide "drug holiday" clinical decision making. This pilot study assessed work flow and feasibility of such a study. While participant recruitment and treatment adherence were suboptimal, administrative procedures were generally feasible and minimally disrupted clinic flow. The comparative effectiveness of continuing or discontinuing long-term alendronate (ALN) on fractures is unknown. A large pragmatic ALN discontinuation study has potential to answer this question. We conducted a 6-month pilot study of the planned the EDGE study among current long-term ALN users (women aged ≥65 with ≥3 years of ALN use) to determine study work flow and feasibility including evaluating the administrative aspects of trial conduct (e.g., time to contract, institutional review board (IRB) approval), assessing rates of site and participant recruitment, and evaluating post-randomization outcomes, including adherence, bisphosphonate-associated adverse events, and participant and site satisfaction. We assessed outcomes 1 and 6 months after randomization. Nine sites participated, including seven community-based medical practices and two academic medical centers. On average (SD), contract execution took 3.4 (2.3) months and IRB approval took 13.9 (4.1) days. Sites recruited 27 participants (13 to continue ALN and 14 to discontinue ALN). Over follow-up, 22% of participants did not adhere to their randomization assignment: 30.8% in the continuation arm and 14.3% in the discontinuation arm. No fractures or adverse events were reported. Sites reported no issues regarding work flow, and participants were highly satisfied with the study. Administrative procedures of the EDGE study were generally feasible, with minimal disruption to clinic flow. In this convenience sample, participant recruitment was suboptimal across most practice sites. Accounting for low treatment arm adherence, a

  4. Seismic Observations Indicating That the 2015 Ogasawara (Bonin) Earthquake Ruptured Beneath the 660 km Discontinuity

    Science.gov (United States)

    Kuge, Keiko

    2017-11-01

    The termination of deep earthquakes at a depth of 700 km is a key feature for understanding the physical mechanism of deep earthquakes. The 680 km deep 30 May 2015, Ogasawara (Bonin) earthquake (Mw 7.9) and its aftershocks were recorded by seismic stations at distances from 7° to 19°. Synthetic seismograms indicate that the P waveforms depend on whether the earthquake is located above or below the 660 km discontinuity. In this study, I show that broadband recordings indicate that the 2015 earthquake may have occurred below the 660 km velocity discontinuity. Recordings of the P wave from the strongest aftershock lack evidence for wave triplication expected when a subhorizontal discontinuity underlies the hypocenter. Theoretical waveforms computed with a 660 km discontinuity above the aftershock and mainshock match the observed waveforms more accurately. These observations may indicate earthquake ruptures due to mantle minerals other than olivine or strong deformation of the 660 km phase transition.

  5. Long-Term Follow-Up of Patients with Spasmodic Dysphonia and Improved Voice despite Discontinuation of Treatment.

    Science.gov (United States)

    Geneid, Ahmed; Lindestad, Per-Åke; Granqvist, Svante; Möller, Riitta; Södersten, Maria

    2016-01-01

    To evaluate voice function in patients with adductor spasmodic dysphonia (AdSD) who discontinued botulinum toxin (BTX) treatment because they felt that their voice had improved sufficiently. Twenty-eight patients quit treatment in 2004, of whom 20 fulfilled the inclusion criteria for the study, with 3 subsequently excluded because of return of symptoms, leaving 17 patients (11 males, 6 females) included in this follow-up study. A questionnaire concerning current voice function and the Voice Handicap Index were completed. Audio-perceptual voice assessments were done by 3 listeners. The inter- and intrarater reliabilities were r > 0.80. All patients had a subjectively good stable voice, but with differences in their audio-perceptual voice assessment scores. Based on the pre-/posttreatment auditory scores on the overall degree of AdSD, patients were divided into 2 subgroups showing more and less improvement, with 10 and 7 patients, respectively. The subgroup with more improvement had shorter duration from the onset of symptoms until the start of BTX treatment, and included 7 males compared to only 4 males in the subgroup with less improvement. It seems plausible that the symptoms of spasmodic dysphonia may decrease over time. Early intervention and male gender seem to be important factors for long-term reduction of the voice symptoms of AdSD. © 2016 S. Karger AG, Basel.

  6. Multistability of neural networks with discontinuous non-monotonic piecewise linear activation functions and time-varying delays.

    Science.gov (United States)

    Nie, Xiaobing; Zheng, Wei Xing

    2015-05-01

    This paper is concerned with the problem of coexistence and dynamical behaviors of multiple equilibrium points for neural networks with discontinuous non-monotonic piecewise linear activation functions and time-varying delays. The fixed point theorem and other analytical tools are used to develop certain sufficient conditions that ensure that the n-dimensional discontinuous neural networks with time-varying delays can have at least 5(n) equilibrium points, 3(n) of which are locally stable and the others are unstable. The importance of the derived results is that it reveals that the discontinuous neural networks can have greater storage capacity than the continuous ones. Moreover, different from the existing results on multistability of neural networks with discontinuous activation functions, the 3(n) locally stable equilibrium points obtained in this paper are located in not only saturated regions, but also unsaturated regions, due to the non-monotonic structure of discontinuous activation functions. A numerical simulation study is conducted to illustrate and support the derived theoretical results. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Hiccup Due to Aripiprazole Plus Methylphenidate Treatment in an Adolescent with Attention Deficit and Hyperactivity Disorder and Conduct Disorder: A Case Report.

    Science.gov (United States)

    Kutuk, Meryem Ozlem; Guler, Gulen; Tufan, Ali Evren; Kutuk, Ozgur

    2017-11-30

    Our case had hiccups arising in an adolescent with the attention deficit and hyperactivity disorder (ADHD) and conduct disorder (CD) after adding aripiprazole treatment to extended-release methylphenidate. Actually, antipsychotics are also used in the treatment of hiccups, but studies suggest that they can cause hiccups as well. Within 12 hours of taking 2.5 mg aripiprazole added to extended-release methylphenidate at a dose of 54 mg/day, 16-year-old boy began having hiccups in the morning, which lasted after 3-4 hours. As a result, aripiprazole was discontinued and methylphenidate was continued alone because we could not convince the patient to use another additional drug due to this side effect. Subsequently, when his behavior got worsened day by day, his mother administered aripiprazole alone again at the dose of 2.5 mg/day at the weekend and continued treatment because hiccup did not occur again. But when it was administered with methylphenidate on Monday, hiccup started again next morning and lasted one hour at this time. In conclusion, we concluded that concurrent use of methylphenidate and aripiprazole in this adolescent led to hiccups.

  8. The challenge of pelvic discontinuity: cup-cage reconstruction does better than conventional cages in mid-term.

    Science.gov (United States)

    Abolghasemian, M; Tangsaraporn, S; Drexler, M; Barbuto, R; Backstein, D; Safir, O; Kuzyk, P; Gross, A

    2014-02-01

    The use of ilioischial cage reconstruction for pelvic discontinuity has been replaced by the Trabecular Metal (Zimmer, Warsaw, Indiana) cup-cage technique in our institution, due to the unsatisfactory outcome of using a cage alone in this situation. We report the outcome of 26 pelvic discontinuities in 24 patients (20 women and four men, mean age 65 years (44 to 84)) treated by the cup-cage technique at a mean follow-up of 82 months (12 to 113) and compared them with a series of 19 pelvic discontinuities in 19 patients (18 women and one man, mean age 70 years (42 to 86)) treated with a cage at a mean follow-up of 69 months (1 to 170). The clinical and radiological outcomes as well as the survivorship of the groups were compared. In all, four of the cup-cage group (15%) and 13 (68%) of the cage group failed due to septic or aseptic loosening. The seven-year survivorship was 87.2% (95% confidence interval (CI) 71 to 103) for the cup-cage group and 49.9% (95% CI 15 to 84) for the cage-alone group (p = 0.009). There were four major complications in the cup-cage group and nine in the cage group. Radiological union of the discontinuity was found in all successful cases in the cup-cage group and three of the successful cage cases. Three hips in the cup-cage group developed early radiological migration of the components, which stabilised with a successful outcome. Cup-cage reconstruction is a reliable technique for treating pelvic discontinuity in mid-term follow-up and is preferred to ilioischial cage reconstruction. If the continuity of the bone graft at the discontinuity site is not disrupted, early migration of the components does not necessarily result in failure.

  9. The structure of rotational discontinuities

    International Nuclear Information System (INIS)

    Neugebauer, M.

    1989-01-01

    This study examines the structures of a set of rotational discontinuities detected in the solar wind by the ISEE-3 spacecraft. It is found that the complexity of the structure increases as the angle θ between the propagation vector k and the magnetic field decreases. For rotational discontinuities that propagate at a large angle to the field with an ion (left-hand) sense of rotation, the magnetic hodograms tend to be flattened, in agreement with prior numerical simulations. When θ is large, angular overshoots are often observed at one or both ends of the discontinuity. When the propagation is nearly parallel to the field (i.e., when θ is small), many different types of structure are seen, ranging from straight lines, the S-shaped curves, to complex, disorganized shapes

  10. The STOP-AB trial protocol: efficacy and safety of discontinuing patient antibiotic treatment when physicians no longer consider it necessary.

    Science.gov (United States)

    Llor, Carl; Moragas, Ana; Bayona, Carolina; Cots, Josep M; Molero, José M; Ribas, Joana; Fóthy, Julio Francisco; Gutiérrez, Isabel; Sánchez, Coro; Ortega, Jesús; Arranz, Javier; Botanes, Jenifer; Robles, Purificación

    2017-06-06

    Since 2011, the Spanish Society of Family Medicine has recommended general practitioners (GPs) to ask their patients to stop taking antibiotics when they suspect a viral infection. However, this practice is seldom used because uncertainty about diagnosis, and fear of consequences of discontinuing antibiotic therapy, as well as perceived pressure to continue prescribing antibiotics and potential conflict with patients are more of a concern for GPs than antibiotic resistance. The main objective of this study is to determine whether discontinuation of antibiotic therapy when a GP no longer considers it necessary has any impact on the number of days with severe symptoms. This is a multicentre, open-label, randomised controlled clinical trial. The study was conducted in 10 primary care centres in Spain. We included patients from 18 to 75 years of age with uncomplicated acute respiratory tract infections-acute rhinosinusitis, acute sore throat, influenza or acute bronchitis-who had previously taken any dose of antibiotic for antibiotic treatment or to discontinuing antibiotic therapy. A sample size of 240 patients per group was calculated on the basis of a reduction of 1 day in the duration of severe symptoms being a clinically relevant outcome. The primary outcome was the duration of severe symptoms, that is, symptoms scored 5 or 6 by means of validated symptom diaries. Secondary outcomes included antibiotics taken, adverse events, patient satisfaction and complications within the first 3 months. The study was approved by the Ethical Board of Fundació Jordi Gol i Gurina (reference number: 16/093). The findings of this trial will bedisseminated through research conferences and peer-reviewed journals. NCT02900820; pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Factors predicting successful discontinuation of continuous renal replacement therapy.

    Science.gov (United States)

    Katayama, S; Uchino, S; Uji, M; Ohnuma, T; Namba, Y; Kawarazaki, H; Toki, N; Takeda, K; Yasuda, H; Izawa, J; Tokuhira, N; Nagata, I

    2016-07-01

    This multicentre, retrospective observational study was conducted from January 2010 to December 2010 to determine the optimal time for discontinuing continuous renal replacement therapy (CRRT) by evaluating factors predictive of successful discontinuation in patients with acute kidney injury. Analysis was performed for patients after CRRT was discontinued because of renal function recovery. Patients were divided into two groups according to the success or failure of CRRT discontinuation. In multivariate logistic regression analysis, urine output at discontinuation, creatinine level and CRRT duration were found to be significant variables (area under the receiver operating characteristic curve for urine output, 0.814). In conclusion, we found that higher urine output, lower creatinine and shorter CRRT duration were significant factors to predict successful discontinuation of CRRT.

  12. Trapped particles at a magnetic discontinuity

    Science.gov (United States)

    Stern, D. P.

    1972-01-01

    At a tangential discontinuity between two constant magnetic fields a layer of trapped particles can exist, this work examines the conditions under which the current carried by such particles tends to maintain the discontinuity. Three cases are examined. If the discontinuity separates aligned vacuum fields, the only requirement is that they be antiparallel. With arbitrary relative orientations, the field must have equal intensities on both sides. Finally, with a guiding center plasma on both sides, the condition reduces to a relation which is also derivable from hydromagnetic theory. Arguments are presented for the occurrence of such trapped modes in the magnetopause and for the non-existence of specular particle reflection.

  13. Low body weight and type of protease inhibitor predict discontinuation and treatment-limiting adverse drug reactions among HIV-infected patients starting a protease inhibitor regimen: consistent results from a randomized trial and an observational cohort

    DEFF Research Database (Denmark)

    Kirk, O; Gerstoft, J; Pedersen, C

    2001-01-01

    OBJECTIVES: To assess predictors for discontinuation and treatment-limiting adverse drug reactions (TLADR) among patients starting their first protease inhibitor (PI). METHODS: Data on patients starting a PI regimen (indinavir, ritonavir, ritonavir/saquinavir and saquinavir hard gel) in a randomi......OBJECTIVES: To assess predictors for discontinuation and treatment-limiting adverse drug reactions (TLADR) among patients starting their first protease inhibitor (PI). METHODS: Data on patients starting a PI regimen (indinavir, ritonavir, ritonavir/saquinavir and saquinavir hard gel....... Low body weight and initiation of ritonavir relative to other PIs were associated with an increased risk of TLADRs. Very consistent results were found in a randomized trial and an observational cohort....

  14. Extreme interplanetary rotational discontinuities at 1 AU

    Science.gov (United States)

    Lepping, R. P.; Wu, C.-C.

    2005-11-01

    This study is concerned with the identification and description of a special subset of four Wind interplanetary rotational discontinuities (from an earlier study of 134 directional discontinuities by Lepping et al. (2003)) with some "extreme" characteristics, in the sense that every case has (1) an almost planar current sheet surface, (2) a very large discontinuity angle (ω), (3) at least moderately strong normal field components (>0.8 nT), and (4) the overall set has a very broad range of transition layer thicknesses, with one being as thick as 50 RE and another at the other extreme being 1.6 RE, most being much thicker than are usually studied. Each example has a well-determined surface normal (n) according to minimum variance analysis and corroborated via time delay checking of the discontinuity with observations at IMP 8 by employing the local surface planarity. From the variance analyses, most of these cases had unusually large ratios of intermediate-to-minimum eigenvalues (λI/λmin), being on average 32 for three cases (with a fourth being much larger), indicating compact current sheet transition zones, another (the fifth) extreme property. For many years there has been a controversy as to the relative distribution of rotational (RDs) to tangential discontinuities (TDs) in the solar wind at 1 AU (and elsewhere, such as between the Sun and Earth), even to the point where some authors have suggested that RDs with large ∣Bn∣s are probably not generated or, if generated, are unstable and therefore very rare. Some of this disagreement apparently has been due to the different selection criteria used, e.g., some allowed eigenvalue ratios (λI/λmin) to be almost an order of magnitude lower than 32 in estimating n, usually introducing unacceptable error in n and therefore also in ∣Bn∣. However, we suggest that RDs may not be so rare at 1 AU, but good quality cases (where ∣Bn∣ confidently exceeds the error in ∣Bn∣) appear to be uncommon, and further

  15. Cognitive function and discontinuation of adjuvant hormonal therapy in older breast cancer survivors: CALGB 369901 (Alliance).

    Science.gov (United States)

    Bluethmann, Shirley M; Alfano, Catherine M; Clapp, Jonathan D; Luta, George; Small, Brent J; Hurria, Arti; Cohen, Harvey J; Sugarman, Steven; B Muss, Hyman; Isaacs, Claudine; Mandelblatt, Jeanne S

    2017-10-01

    To investigate the effects of cognitive function on discontinuation of hormonal therapy in breast cancer survivors ages 65+ ("older"). Older breast cancer survivors with invasive, non-metastatic disease, and no reported cognitive difficulties were recruited from 78 Alliance sites between 2004 and 2011. Eligible survivors (n = 1280) completed baseline interviews; follow-up was conducted annually for up to 7 years. Survivors with estrogen-receptor-positive (ER+) cancers who initiated hormonal therapy (n = 990) were included. Self-reported cognitive function was measured using the EORTC-QLQ30 scale; a difference of eight points on the 0-100 scale was considered clinically significant. Based on varying rates of discontinuation over time, discontinuation was evaluated separately for three time periods: early (3-5 years). Cox models for each time period were used to evaluate the effects of cognition immediately preceding discontinuation, controlling for age, chemotherapy, and other covariates. Survivors were 65-91 years old (mean 72.6 years), and 79% had stages 1 or 2A disease. Overall, 43% discontinued hormonal therapy before 5 years. Survivors who reported lower cognitive function in the period before discontinuation had greater hazards of discontinuing therapy at the treatment midpoint (HR 1.22 per 8-point difference, CI 1.09-1.40, p cognition was not related to discontinuation in the other periods. Self-reported cognitive problems were a significant risk factor for discontinuation of hormonal therapy 1-3 years post-initiation. Additional research is needed on the temporality of cognitive effects and hormonal therapy to support survivorship care needs of older survivors.

  16. Discontinuity effects in dynamically loaded tilting pad journal bearings

    DEFF Research Database (Denmark)

    Thomsen, Kim; Klit, Peder; Vølund, Anders

    2011-01-01

    This paper describes two discontinuity effects that can occur when modelling radial tilting pad bearings subjected to high dynamic loads. The first effect to be treated is a pressure build-up discontinuity effect. The second effect is a contact-related discontinuity that disappears when a contact...... force is included in the theoretical model. Methods for avoiding the pressure build-up discontinuity effect are proposed....

  17. Utilization and discontinuation of contraceptive methods: the University of Calabar Teaching Hospital (UCTH experience

    Directory of Open Access Journals (Sweden)

    Njoku CO

    2014-09-01

    Full Text Available Background: Contraception has an important role to play in reducing the high rate of maternal morbidity and mortality in developing countries. Objective: The objective is to determine the prevalence rate, methods and reasons for discontinuation of contraceptive methods at UCTH, Calabar. Method: This was a retrospective study of all clients that utilised different forms of contraceptives at UCTH, Calabar from 1st January, 2009 to 31st December, 2013. Results: A total of 5,381 clients used various methods of contraception while 13,492 live births were recorded giving the prevalence rate of 39.9% of total live birth. Common methods were intrauterine contraceptive device (IUCD 1,745(32.8% and injectable contraceptives 1,268(23.8%. Most clients 1,876(35.2% were graduates while 81(1.5% had no formal education. A total of 535(10.1% clients discontinued different family planning method commonly due to desire for pregnancy and side effects. IUCD had the highest discontinuation rate. Conclusion: The study revealed low prevalence rate of contraceptive use which was more among teenagers and illiterate women. The main reasons for discontinuation of different methods were desire for pregnancy, side effects and menopause. Creating more contraceptive awareness, improvement in contraceptive counselling and female education will help to improve contraceptive utilisation rate and reduce discontinuation rate.

  18. Sm2Fe17Nx with discontinuous nitrogen profiles

    International Nuclear Information System (INIS)

    Skomski, R.; Kobayashi, K.; Brennan, S.; Coey, J.M.D.

    1995-01-01

    Microprobe analysis and theoretical calculations based on Hooke's law are used to investigate Sm 2 Fe 17 N x nitrides produced by N 2 and NH 3 interstitial modification. In the case of molecular nitrogen, stress and strain as well as Curie temperature, magnetization and anisotropy exhibit a smooth spatial variation, while nitrogen overloading due to the presence of ammonia leads to large excess strain and lattice incoherency. Discontinuous nitrogen profiles are associated with the occurrence of microcracks. ((orig.))

  19. The influence of traditional medicine and religion on discontinuation of ART in an urban informal settlement in Nairobi, Kenya.

    Science.gov (United States)

    Unge, Christian; Ragnarsson, Anders; Ekström, Anna Mia; Indalo, Dorcus; Belita, Alice; Carter, Jane; Ilako, Festus; Södergård, Björn

    2011-07-01

    The objective of this study was to explore the influence of traditional medicine and religion on discontinuation of antiretroviral therapy (ART) in one of Africa's largest informal urban settlement, Kibera, in Nairobi, Kenya. Semi-structured face-to-face interviews were conducted with 20 patients discontinuing the African Medical and Research Foundation (AMREF) ART program in Kibera due to issues related to traditional medicine and religion. Traditional medicine and religion remain important in many people's lives after ART initiation, but these issues are rarely addressed in a positive way during ART counseling. Many patients found traditional medicine and their religious beliefs to be in conflict with clinic treatment advice. Patients described a decisional process, prior to the actual drop-out from the ART program that involved a trigger event, usually a specific religious event, or a meeting with someone using traditional medicine that influenced them to take the decision to stop ART. Discontinuation of ART could be reduced if ART providers acknowledged and addressed the importance of religious issues and traditional medicine in the lives of patients, especially in similar resource-poor settings. Telling patients not to mix ART and traditional medicine appeared counter-productive in this setting. Introducing an open discussion around religious beliefs and the pros and cons of traditional medicine as part of standard counseling, may prevent drop-out from ART when side effects or opportunistic infections occur.

  20. Discontinuities during UV writing of waveguides

    DEFF Research Database (Denmark)

    Svalgaard, Mikael; Harpøth, Anders; Andersen, Marc

    2005-01-01

    UV writing of waveguides can be hampered by discontinuities where the index change process suddenly shuts down. We show that thermal effects may account for this behaviour.......UV writing of waveguides can be hampered by discontinuities where the index change process suddenly shuts down. We show that thermal effects may account for this behaviour....

  1. Continuous biological waste gas treatment in stirred trickle-bed reactor with discontinuous removal of biomass.

    Science.gov (United States)

    Laurenzis, A; Heits, H; Wübker, S; Heinze, U; Friedrich, C; Werner, U

    1998-02-20

    A new reactor for biological waste gas treatment was developed to eliminate continuous solvents from waste gases. A trickle-bed reactor was chosen with discontinuous movement of the packed bed and intermittent percolation. The reactor was operated with toluene as the solvent and an optimum average biomass concentration of between 5 and 30 kg dry cell weight per cubic meter packed bed (m3pb). This biomass concentration resulted in a high volumetric degradation rate. Reduction of surplus biomass by stirring and trickling caused a prolonged service life and prevented clogging of the trickle bed and a pressure drop increase. The pressure drop after biomass reduction was almost identical to the theoretical pressure drop as calculated for the irregular packed bed without biomass. The reduction in biomass and intermittent percolation of mineral medium resulted in high volumetric degradation rates of about 100 g of toluene m-3pb h-1 at a load of 150 g of toluene m-3pb h-1. Such a removal rate with a trickle-bed reactor was not reported before. Copyright 1998 John Wiley & Sons, Inc.

  2. Motion of Charged Particles near Magnetic Field Discontinuities

    International Nuclear Information System (INIS)

    Dodin, I.Y.; Fisch, N.J.

    2000-01-01

    The motion of charged particles in slowly changing magnetic fields exhibits adiabatic invariance even in the presence of abrupt magnetic discontinuities. Particles near discontinuities in magnetic fields, what we call ''boundary particles'', are constrained to remain near an arbitrarily fractured boundary even as the particle drifts along the discontinuity. A new adiabatic invariant applies to the motion of these particles

  3. Early Relapse of Unresectable Gallbladder Cancer after Discontinuation of Gemcitabine Monotherapy Administered for 5 Years in a Patient Who Had Complete Response to the Treatment

    Directory of Open Access Journals (Sweden)

    Koichi Suyama

    2013-10-01

    Full Text Available The tumor shrinkage effect of gemcitabine is considered to be limited in cases of advanced gallbladder cancer, and there are few reports of complete response to gemcitabine therapy in patients with this cancer. Therefore, the treatment continuation strategy in these patients, after a complete response has been achieved, still remains to be established. Here, we present the case of a 77-year-old patient with unresectable gallbladder cancer, who after showing complete response to gemcitabine monotherapy administered for 5 years, showed early relapse within only 11 months of discontinuation of the drug. Thus, it is necessary to establish a suitable treatment continuation strategy for patients who show complete response to gemcitabine treatment.

  4. Signal integrity analysis on discontinuous microstrip line

    International Nuclear Information System (INIS)

    Qiao, Qingyang; Dai, Yawen; Chen, Zipeng

    2013-01-01

    In high speed PCB design, microstirp lines were used to control the impedance, however, the discontinuous microstrip line can cause signal integrity problems. In this paper, we use the transmission line theory to study the characteristics of microstrip lines. Research results indicate that the discontinuity such as truncation, gap and size change result in the problems such as radiation, reflection, delay and ground bounce. We change the discontinuities to distributed parameter circuits, analysed the steady-state response and transient response and the phase delay. The transient response cause radiation and voltage jump.

  5. Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: Recommendations for clinical practice from the French Chronic Myeloid Leukemia Study Group.

    Science.gov (United States)

    Rea, Delphine; Ame, Shanti; Berger, Marc; Cayuela, Jean-Michel; Charbonnier, Aude; Coiteux, Valérie; Cony-Makhoul, Pascale; Dubruille, Viviane; Dulucq, Stéphanie; Etienne, Gabriel; Legros, Laurence; Nicolini, Franck; Roche-Lestienne, Catherine; Escoffre-Barbe, Martine; Gardembas, Martine; Guerci-Bresler, Agnès; Johnson-Ansah, Hyacinthe; Rigal-Huguet, Françoise; Rousselot, Philippe; Mahon, François-Xavier

    2018-05-03

    The ultimate goal of chronic myeloid leukemia management in the tyrosine kinase inhibitor (TKI) era for patients who obtain deep molecular responses is maintaining a durable off-treatment response after treatment discontinuation; this situation is called treatment-free remission (TFR). Knowledge accumulated during the last 10 years justifies moving TFR strategies from research to clinical practice. Twenty experts from the French Chronic Myeloid Leukemia Study Group (France Intergroupe des Leucémies Myéloïdes Chroniques), including 17 hematologists, 2 molecular biologists, and 1 cytogeneticist, critically reviewed published data with the goal of developing evidence-based recommendations for TKI discontinuation in clinical practice. Clinically relevant questions were addressed, including the selection of candidate patients (with known prognostic factors for outcomes taken into account), detailed monitoring procedures during the treatment-free phase, a definition of relapse requiring therapy resumption, and monitoring after treatment reintroduction. This work presents consensus statements with the aim of guiding physicians and biologists by means of pragmatic recommendations for safe TKI discontinuation in daily practice. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

  6. Accountability Accentuates Interindividual-Intergroup Discontinuity by Enforcing Parochialism

    OpenAIRE

    Wildschut, T.; Van Horen, F.; Hart, C.

    2015-01-01

    Interindividual-intergroup discontinuity is the tendency for relations between groups to be more competitive than relations between individuals. We examined whether the discontinuity effect arises in part because group members experience normative pressure to favor the ingroup (parochialism). Building on the notion that accountability enhances normative pressure, we hypothesized that the discontinuity effect would be larger when accountability is present (compared to absent). A prisoner’s dil...

  7. Discontinuities and the magnetospheric phenomena

    International Nuclear Information System (INIS)

    Rajaram, R.; Kalra, G.L.; Tandon, J.N.

    1978-01-01

    Wave coupling at contact discontinuities has an important bearing on the transmission of waves from the solar wind into the magnetosphere across the cusp region of the solar wind-magnetosphere boundary and on the propagation of geomagnetic pulsations in the polar exosphere. Keeping this in view, the problems of wave coupling across a contact discontinuity in a collisionless plasma, described by a set of double adiabatic fluid equations, is examined. The magnetic field is taken normal to the interface and it is shown that total reflection is not possible for any angle of incidence. The Alfven and the magneto-acoustic waves are not coupled. The transmission is most efficient for small density discontinuities. Inhibition of the transmission of the Alfven wave by the sharp density gradients above the F2-peak in the polar exosphere appears to account for the decrease in the pulsation amplitude, on the ground, as the poles are approached from the auroral zone. (author)

  8. Strategies for discontinuation of proton pump inhibitors

    DEFF Research Database (Denmark)

    Haastrup, Peter; Paulsen, Maja S; Begtrup, Luise M

    2014-01-01

    PURPOSE: Proton pump inhibitors (PPIs) are considered to be overprescribed. Consensus on how to attempt discontinuation is, however, lacking. We therefore conducted a systematic review of clinical studies on discontinuation of PPIs. METHODS: Systematic review based on clinical studies investigating...

  9. On the stability of rotational discontinuities and intermediate shocks

    International Nuclear Information System (INIS)

    Lee, L.C.; Huang, L.; Chao, J.K.

    1989-01-01

    The stability of rotational discontinuities and intermediate shocks is studied based on a hybrid simulation code. The simulation results show that rotational discontinuities are stable and intermediate shocks are not stationary. Intermediate shocks tend to evolve to rotational discontinuities and waves. The authors employ several different initial profiles for the magnetic field in the transition region and find that the final structure of the discontinuities or shocks is not sensitive to the initial magnetic field profile. The present results are different from those obtained from the resistive MHD simulations. Furthermore, their study indicates that the kinetic effect of particles plays an important role in the structure and stability of rotational discontinuities and intermediate shocks

  10. Utilizing Cognitive-Behavioral Therapy for Insomnia to Facilitate Discontinuation of Sleep Medication in Chronic Insomnia Patients

    Directory of Open Access Journals (Sweden)

    Jason Ong

    2012-04-01

    Full Text Available Many chronic insomnia patients use sleep medication well beyond the recommended duration, and patients who are hypnotic-dependent encounter several challenges when attempting to discontinue. The current article presents these challenges and reviews studies that have added cognitive-behavioral therapy for insomnia (CBTI to a gradual tapering program to facilitate discontinuation of hypnotic medication in chronic insomnia patients. The current literature provides substantial support for using CBTI to facilitate discontinuation of hypnotic medication in chronic insomnia patients. Across several randomized clinical trials, the majority of the findings indicate that using CBTI, delivered by a therapist or self-help, along with a supervised or gradual tapering program is superior to tapering only or CBTI only in terms of medication discontinuation. Although these results are promising, it should be noted that the long-term evidence is more equivocal, as over 40% of patients relapse in the need for sleep medication within 2 years, which may highlight the importance of adding follow-up booster sessions in hypnotic-dependent insomniacs. These findings indicate that rather than choosing between CBT and hypnotic medication, clinicians might be better served using both treatment modalities to optimize the relative strengths of each treatment. Such an approach represents a more modern view of treating chronic insomnia patients by using both pharmacological and non-pharmacological tools.

  11. Low-index discontinuity terahertz waveguides

    Science.gov (United States)

    Nagel, Michael; Marchewka, Astrid; Kurz, Heinrich

    2006-10-01

    A new type of dielectric THz waveguide based on recent approaches in the field of integrated optics is presented with theoretical and experimental results. Although the guiding mechanism of the low-index discontinuity (LID) THz waveguide is total internal reflection, the THz wave is predominantly confined in the virtually lossless low-index air gap within a high-index dielectric waveguide due to the continuity of electric flux density at the dielectric interface. Attenuation, dispersion and single-mode confinement properties of two LID structures are discussed and compared with other THz waveguide solutions. The new approach provides an outstanding combination of high mode confinement and low transmission losses currently not realizable with any other metal-based or photonic crystal approach. These exceptional properties might enable the breakthrough of novel integrated THz systems or endoscopy applications with sub-wavelength resolution.

  12. Socio-Economic Differentials in Contraceptive Discontinuation in India

    Directory of Open Access Journals (Sweden)

    Kiran Agrahari

    2016-05-01

    Full Text Available Fertility divergence amid declining in use of modern contraception in many states of India needs urgent research and programmatic attention. Although utilization of antenatal, natal, and post-natal care has shown spectacular increase in post National Rural Health Mission (NRHM period, the contraceptive use had shown a declining trend. Using the calendar data from the National Family Health Survey–3, this article examines the reasons of contraceptive discontinuation among spacing method users by socio-economic groups in India. Bivariate and multivariate analyses and life table discontinuation rates are used in the analyses. Results suggest that about half of the pill users, two fifths of the condom users, one third of traditional method users, and one fifth of IUD users discontinue a method in first 12 months of use. However, the discontinuation of all three modern spacing methods declines in subsequent period (within 12-36 months. The probability of method failure was highest among traditional method users and higher among poor and less educated that may lead to unwanted/mistimed birth. Although discontinuation of condom declines with economic status, it does not show any large variation for pill users. The contraceptive discontinuation was significantly associated with duration of use, age, parity, contraceptive method, religion, and contraceptive intention. Based on these findings, it is suggested that follow-up services to modern spacing method users, increasing counseling for spacing method users, motivating the traditional method user to use modern spacing method, and improving the overall quality of family planning services can reduce the discontinuation of spacing method.

  13. Discontinuation of antimicrobials and costs of treating patients with infection

    OpenAIRE

    Oliveira, Adriana Cristina de; Paula, Adriana Oliveira de

    2012-01-01

    OBJECTIVE: To evaluate the repercussions of discontinuation the cost with the antimicrobial treatment of patients with bloodstream infection. METHODS: A historical cohort study conducted in the intensive care unit of a hospital in Belo Horizonte (MG). The population included 62 patients with bloodstream infection caused by Staphylococcus aureus. Data were collected between March/2007 and March/2011 from patients' medical records, Commission of Hospital Infection Control and Sector of Costs, w...

  14. Discontinuation and non-publication of randomised clinical trials supported by the main public funding body in Switzerland: a retrospective cohort study.

    Science.gov (United States)

    Amstutz, Alain; Schandelmaier, Stefan; Frei, Roy; Surina, Jakub; Agarwal, Arnav; Olu, Kelechi Kalu; Alturki, Reem; Von Niederhäusern, Belinda; Von Elm, Erik; Briel, Matthias

    2017-08-01

    The Swiss National Science Foundation (SNSF) promotes academic excellence through competitive selection of study proposals and rigorous evaluation of feasibility, but completion status and publication history of SNSF-supported randomised clinical trials (RCTs) remain unclear. The main objectives were to review all healthcare RCTs supported by the SNSF for trial discontinuation and non-publication, to investigate potential risk factors for trial discontinuation due to poor recruitment and non-publication, and to compare findings to other Swiss RCTs not supported by the SNSF. We established a retrospective cohort of all SNSF-supported RCTs for which recruitment and funding had ended in 2015 or earlier. For each RCT, two investigators independently searched corresponding publications in electronic databases. In addition, we approached all principal investigators to ask for additional publications and information about trial discontinuation. Teams of two investigators independently extracted details about study design, recruitment of participants, outcomes, analysis and sample size from the original proposal and, if available, from trial registries and publications. We used multivariable regression analysis to explore potential risk factors associated with discontinuation due to poor recruitment and with non-publication, and to compare our results with data from a previous cohort of Swiss RCTs not supported by the SNSF. We included 101 RCTs supported by the SNSF between 1986 and 2015. Eighty-seven (86%) principal investigators responded to our survey. Overall, 69 (68%) RCTs were completed, 26 (26%) RCTs were prematurely discontinued (all due to slow recruitment) and the completion status remained unclear for 6 (6%) RCTs. For analysing publication status, we excluded 4 RCTs for which follow-up was still ongoing and 9 for which manuscripts were still in preparation. Of the remaining 88 RCTs, 53 (60%) were published as full articles in peer-reviewed journals

  15. Structured population dynamics: continuous size and discontinuous stage structures.

    Science.gov (United States)

    Buffoni, Giuseppe; Pasquali, Sara

    2007-04-01

    A nonlinear stochastic model for the dynamics of a population with either a continuous size structure or a discontinuous stage structure is formulated in the Eulerian formalism. It takes into account dispersion effects due to stochastic variability of the development process of the individuals. The discrete equations of the numerical approximation are derived, and an analysis of the existence and stability of the equilibrium states is performed. An application to a copepod population is illustrated; numerical results of Eulerian and Lagrangian models are compared.

  16. Automated extraction and analysis of rock discontinuity characteristics from 3D point clouds

    Science.gov (United States)

    Bianchetti, Matteo; Villa, Alberto; Agliardi, Federico; Crosta, Giovanni B.

    2016-04-01

    A reliable characterization of fractured rock masses requires an exhaustive geometrical description of discontinuities, including orientation, spacing, and size. These are required to describe discontinuum rock mass structure, perform Discrete Fracture Network and DEM modelling, or provide input for rock mass classification or equivalent continuum estimate of rock mass properties. Although several advanced methodologies have been developed in the last decades, a complete characterization of discontinuity geometry in practice is still challenging, due to scale-dependent variability of fracture patterns and difficult accessibility to large outcrops. Recent advances in remote survey techniques, such as terrestrial laser scanning and digital photogrammetry, allow a fast and accurate acquisition of dense 3D point clouds, which promoted the development of several semi-automatic approaches to extract discontinuity features. Nevertheless, these often need user supervision on algorithm parameters which can be difficult to assess. To overcome this problem, we developed an original Matlab tool, allowing fast, fully automatic extraction and analysis of discontinuity features with no requirements on point cloud accuracy, density and homogeneity. The tool consists of a set of algorithms which: (i) process raw 3D point clouds, (ii) automatically characterize discontinuity sets, (iii) identify individual discontinuity surfaces, and (iv) analyse their spacing and persistence. The tool operates in either a supervised or unsupervised mode, starting from an automatic preliminary exploration data analysis. The identification and geometrical characterization of discontinuity features is divided in steps. First, coplanar surfaces are identified in the whole point cloud using K-Nearest Neighbor and Principal Component Analysis algorithms optimized on point cloud accuracy and specified typical facet size. Then, discontinuity set orientation is calculated using Kernel Density Estimation and

  17. Uncertainty Quantification given Discontinuous Climate Model Response and a Limited Number of Model Runs

    Science.gov (United States)

    Sargsyan, K.; Safta, C.; Debusschere, B.; Najm, H.

    2010-12-01

    Uncertainty quantification in complex climate models is challenged by the sparsity of available climate model predictions due to the high computational cost of model runs. Another feature that prevents classical uncertainty analysis from being readily applicable is bifurcative behavior in climate model response with respect to certain input parameters. A typical example is the Atlantic Meridional Overturning Circulation. The predicted maximum overturning stream function exhibits discontinuity across a curve in the space of two uncertain parameters, namely climate sensitivity and CO2 forcing. We outline a methodology for uncertainty quantification given discontinuous model response and a limited number of model runs. Our approach is two-fold. First we detect the discontinuity with Bayesian inference, thus obtaining a probabilistic representation of the discontinuity curve shape and location for arbitrarily distributed input parameter values. Then, we construct spectral representations of uncertainty, using Polynomial Chaos (PC) expansions on either side of the discontinuity curve, leading to an averaged-PC representation of the forward model that allows efficient uncertainty quantification. The approach is enabled by a Rosenblatt transformation that maps each side of the discontinuity to regular domains where desirable orthogonality properties for the spectral bases hold. We obtain PC modes by either orthogonal projection or Bayesian inference, and argue for a hybrid approach that targets a balance between the accuracy provided by the orthogonal projection and the flexibility provided by the Bayesian inference - where the latter allows obtaining reasonable expansions without extra forward model runs. The model output, and its associated uncertainty at specific design points, are then computed by taking an ensemble average over PC expansions corresponding to possible realizations of the discontinuity curve. The methodology is tested on synthetic examples of

  18. Continuous and discontinuous transitions to synchronization.

    Science.gov (United States)

    Wang, Chaoqing; Garnier, Nicolas B

    2016-11-01

    We describe how the transition to synchronization in a system of globally coupled Stuart-Landau oscillators changes from continuous to discontinuous when the nature of the coupling is moved from diffusive to reactive. We explain this drastic qualitative change as resulting from the co-existence of a particular synchronized macrostate together with the trivial incoherent macrostate, in a range of parameter values for which the latter is linearly stable. In contrast to the paradigmatic Kuramoto model, this particular state observed at the synchronization transition contains a finite, non-vanishing number of synchronized oscillators, which results in a discontinuous transition. We consider successively two situations where either a fully synchronized state or a partially synchronized state exists at the transition. Thermodynamic limit and finite size effects are briefly discussed, as well as connections with recently observed discontinuous transitions.

  19. Actor Bonds in Situations of Discontinuous Business Activities

    DEFF Research Database (Denmark)

    Skaates, Maria Anne

    2000-01-01

    Demand in many industrial buying situations, e.g. project purchases or procurement related to virtual organizations, is discontinuous. In situations of discontinuity, networks are often more of an ad hos informational and social nature, as strong activity and resource links are not present....... Furthermore the governance structure of markets characterized by discontinuous business activities is either that of the "socially constructed market" (Skaates, 2000) or that of the (socially constructed) network (Håkansson and Johanson, 1993). Additionally relationships and actor bonds vary substantially...

  20. Continuing weight-loss effect after topiramate discontinuation in obese persons with schizophrenia: a pilot open-label study.

    Science.gov (United States)

    Liang, C-S; Yang, F-W; Huang, S-Y; Ho, P-S

    2014-07-01

    Few studies have investigated the likelihood of weight maintenance in obese persons with schizophrenia after their initial successful weight loss. This pilot open-label study examined the efficacy of topiramate in weight loss and the trajectory of weight changes after topiramate discontinuation. This study enrolled 10 obese persons with schizophrenia. A 4-month treatment phase was started, followed by a 12-month discontinuation phase. Body weight was measured as the primary outcome every month. Secondary outcomes included leptin levels, fasting glucose, lipid profiles, and insulin resistance index. After the 4-month addition of topiramate, participants lost 1.79 kg of their body weight (95% CI=-3.03 to -0.56, p=0.005). The maximum weight reduction was 4.32 kg, occurring when topiramate had been discontinued for 12 months (95% CI=-6.41 to -2.24, p<0.001). The continuing weight-loss effect after topiramate discontinuation might have resulted from topiramate's potential to improve leptin functioning. These findings demonstrate that topiramate's weight-loss effect could not only persist during its administration, but also continue to improve after its discontinuation. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Rotational discontinuities and the structure of the magnetopause

    International Nuclear Information System (INIS)

    Swift, D.W.; Lee, L.C.

    1983-01-01

    Symmetric and asymmetric rotational discontinuities are studied by means of a one-dimensional computer simulation and by single-particle trajectory calculations. The numerical simulations show the symmetric rotation to be stable for both ion and electron senses of rotation with a thickness of the order of a few ion gyroradii when the rotation angle of the tangential field is 180 0 or less. Larger rotation angles tend to be unstable. In an expansive discontinuity, when the magnetic field on the downstream side of the discontinuity is larger, an expanding transition layer separating the high-field from a low-field region develops on the downstream side, and a symmetric rotational discontinuity forms at the upstream edge. The implication of these results for magnetopause structure and energy flow through the magnetopause is described

  2. Hormonal contraception and physiology: a research-based theory of discontinuation due to side effects.

    Science.gov (United States)

    Vitzthum, Virginia J; Ringheim, Karin

    2005-03-01

    Side effects influence the acceptability and continuation of hormonal contraceptives. Counseling the client about the management of side effects is a principal approach advocated for increasing continuation. Evidence of a biological basis for variation in women's tolerance of hormonal contraceptives argues, however, that greater attention should be given to altering the product rather than principally attempting to alter a woman's ability to deal with the product. Discontinuation rates for hormonal contraceptives, largely attributable to side effects and health concerns, are high in nearly all less-developed countries for which Demographic and Health Survey data are available. Oral contraceptives appear to be particularly problematic for Latin American women, most notably in Bolivia. Clinical trials suggest substantial variation in the physiological response to exogenous hormones, and new evidence confirms the hypothesis that the normal hormonal profiles of Bolivian women are significantly lower than those of women in the United States. These findings suggest a need for more population-specific physiological research linked to analyses of the possible association between endogenous hormone differences and contraceptive continuation. Appropriately adjusting the level of the steroid delivered may benefit women's health and improve the acceptability and continuation of hormonal contraceptives.

  3. Risk of discontinuation of Advanced Therapy Medicinal Products clinical trials.

    Science.gov (United States)

    Hanna, Eve; Rémuzat, Cecile; Auquier, Pascal; Toumi, Mondher

    2016-01-01

    Advanced therapy medicinal products (ATMPs) constitute a class of innovative products that encompasses gene therapy, somatic cell therapy, and tissue-engineered products (TEP). There is an increased investment of commercial and non-commercial sponsors in this field and a growing number of ATMPs randomized clinical trials (RCT) and patients enrolled in such trials. RCT generate data to prove the efficacy of a new therapy, but the discontinuation of RCTs wastes scarce resources. Our objective is to identify the number and characteristics of discontinued ATMPs trials in order to evaluate the rate of discontinuation. We searched for ATMPs trials conducted between 1999 to June 2015 using three databases, which are Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the EU Drug Regulating Authorities Clinical Trials (EudraCT). We selected the ATMPs trials after elimination of the duplicates. We identified the disease areas and the sponsors as commercial or non-commercial organizations. We classified ATMPs by type and trial status, that is, ongoing, completed, terminated, discontinued, and prematurely ended. Then, we calculated the rate of discontinuation. Between 1999 and June 2015, 143 withdrawn, terminated, or prematurely ended ATMPs clinical trials were identified. Between 1999 and June 2013, 474 ongoing and completed clinical trials were identified. Therefore, the rate of discontinuation of ATMPs trials is 23.18%, similar to that for non-ATMPs drugs in development. The probability of discontinuation is, respectively, 27.35, 16.28, and 16.34% for cell therapies, gene therapies, and TEP. The highest discontinuation rate is for oncology (43%), followed by cardiology (19.2%). It is almost the same for commercial and non-commercial sponsors; therefore, the discontinuation reason may not be financially driven. No failure risk rate per development phase is available for ATMPs. The discontinuation rate may prove helpful when assessing the

  4. Strengthening the Regression Discontinuity Design Using Additional Design Elements: A Within-Study Comparison

    Science.gov (United States)

    Wing, Coady; Cook, Thomas D.

    2013-01-01

    The sharp regression discontinuity design (RDD) has three key weaknesses compared to the randomized clinical trial (RCT). It has lower statistical power, it is more dependent on statistical modeling assumptions, and its treatment effect estimates are limited to the narrow subpopulation of cases immediately around the cutoff, which is rarely of…

  5. 41 CFR 109-39.105 - Discontinuance or curtailment of service.

    Science.gov (United States)

    2010-07-01

    ... AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet Management Systems § 109-39.105 Discontinuance or... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Discontinuance or...

  6. Area Regge calculus and discontinuous metrics

    International Nuclear Information System (INIS)

    Wainwright, Chris; Williams, Ruth M

    2004-01-01

    Taking the triangle areas as independent variables in the theory of Regge calculus can lead to ambiguities in the edge lengths, which can be interpreted as discontinuities in the metric. We construct solutions to area Regge calculus using a triangulated lattice and find that on a spacelike or timelike hypersurface no such discontinuity can arise. On a null hypersurface however, we can have such a situation and the resulting metric can be interpreted as a so-called refractive wave

  7. Physics-based process model approach for detecting discontinuity during friction stir welding

    Energy Technology Data Exchange (ETDEWEB)

    Shrivastava, Amber; Pfefferkorn, Frank E.; Duffie, Neil A.; Ferrier, Nicola J.; Smith, Christopher B.; Malukhin, Kostya; Zinn, Michael

    2015-02-12

    The goal of this work is to develop a method for detecting the creation of discontinuities during friction stir welding. This in situ weld monitoring method could significantly reduce the need for post-process inspection. A process force model and a discontinuity force model were created based on the state-of-the-art understanding of flow around an friction stir welding (FSW) tool. These models are used to predict the FSW forces and size of discontinuities formed in the weld. Friction stir welds with discontinuities and welds without discontinuities were created, and the differences in force dynamics were observed. In this paper, discontinuities were generated by reducing the tool rotation frequency and increasing the tool traverse speed in order to create "cold" welds. Experimental force data for welds with discontinuities and welds without discontinuities compared favorably with the predicted forces. The model currently overpredicts the discontinuity size.

  8. Accountability Accentuates Interindividual-Intergroup Discontinuity by Enforcing Parochialism

    NARCIS (Netherlands)

    Wildschut, T.; Van Horen, F.; Hart, C.

    2015-01-01

    Interindividual-intergroup discontinuity is the tendency for relations between groups to be more competitive than relations between individuals. We examined whether the discontinuity effect arises in part because group members experience normative pressure to favor the ingroup (parochialism).

  9. Accountability Accentuates Interindividual-Intergroup Discontinuity by Enforcing Parochialism.

    Science.gov (United States)

    Wildschut, Tim; van Horen, Femke; Hart, Claire

    2015-01-01

    Interindividual-intergroup discontinuity is the tendency for relations between groups to be more competitive than relations between individuals. We examined whether the discontinuity effect arises in part because group members experience normative pressure to favor the ingroup (parochialism). Building on the notion that accountability enhances normative pressure, we hypothesized that the discontinuity effect would be larger when accountability is present (compared to absent). A prisoner's dilemma game experiment supported this prediction. Specifically, intergroup (compared to interindividual) interaction activated an injunctive ingroup-favoring norm, and accountability enhanced the influence of this norm on competitive behavior.

  10. A Simple Stochastic Differential Equation with Discontinuous Drift

    DEFF Research Database (Denmark)

    Simonsen, Maria; Leth, John-Josef; Schiøler, Henrik

    2013-01-01

    In this paper we study solutions to stochastic differential equations (SDEs) with discontinuous drift. We apply two approaches: The Euler-Maruyama method and the Fokker-Planck equation and show that a candidate density function based on the Euler-Maruyama method approximates a candidate density...... function based on the stationary Fokker-Planck equation. Furthermore, we introduce a smooth function which approximates the discontinuous drift and apply the Euler-Maruyama method and the Fokker-Planck equation with this input. The point of departure for this work is a particular SDE with discontinuous...

  11. The effect of manufacturing conditions on discontinuity population and fatigue fracture behavior in carbon/epoxy composites

    Science.gov (United States)

    Hakim, Issa; Laquai, Rene; Walter, David; Mueller, Bernd; Graja, Paul; Meyendorf, Norbert; Donaldson, Steven

    2017-02-01

    Carbon fiber composites have been increasingly used in aerospace, military, sports, automotive and other fields due to their excellent properties, including high specific strength, high specific modulus, corrosion resistance, fatigue resistance, and low thermal expansion coefficient. Interlaminar fracture is a serious failure mode leading to a loss in composite stiffness and strength. Discontinuities formed during manufacturing process degrade the fatigue life and interlaminar fracture resistance of the composite. In his study, three approaches were implemented and their results were correlated to quantify discontinuities effecting static and fatigue interlaminar fracture behavior of carbon fiber composites. Samples were fabricated by hand layup vacuum bagging manufacturing process under three different vacuum levels, indicated High (-686 mmHg), Moderate (-330 mmHg) and Poor (0 mmHg). Discontinuity content was quantified through-thickness by destructive and nondestructive techniques. Eight different NDE methods were conducted including imaging NDE methods: X-Ray laminography, ultrasonic, high frequency eddy current, pulse thermography, pulse phase thermography and lock-in-thermography, and averaging NDE techniques: X-Ray refraction and thermal conductivity measurements. Samples were subsequently destructively serial sectioned through-thickness into several layers. Both static and fatigue interlaminar fracture behavior under Mode I were conducted. The results of several imaging NDE methods revealed the trend in percentages of discontinuity. However, the results of averaging NDE methods showed a clear correlation since they gave specific values of discontinuity through-thickness. Serial sectioning exposed the composite's internal structure and provided a very clear idea about the type, shape, size, distribution and location of most discontinuities included. The results of mechanical testing showed that discontinuities lead to a decrease in Mode I static interlaminar

  12. Detection and Correction of Step Discontinuities in Kepler Flux Time Series

    Science.gov (United States)

    Kolodziejczak, J. J.; Morris, R. L.

    2011-01-01

    PDC 8.0 includes an implementation of a new algorithm to detect and correct step discontinuities appearing in roughly one of every 20 stellar light curves during a given quarter. The majority of such discontinuities are believed to result from high-energy particles (either cosmic or solar in origin) striking the photometer and causing permanent local changes (typically -0.5%) in quantum efficiency, though a partial exponential recovery is often observed [1]. Since these features, dubbed sudden pixel sensitivity dropouts (SPSDs), are uncorrelated across targets they cannot be properly accounted for by the current detrending algorithm. PDC detrending is based on the assumption that features in flux time series are due either to intrinsic stellar phenomena or to systematic errors and that systematics will exhibit measurable correlations across targets. SPSD events violate these assumptions and their successful removal not only rectifies the flux values of affected targets, but demonstrably improves the overall performance of PDC detrending [1].

  13. A study of upper mantle discontinuities beneath the Korean Peninsula using teleseismic receiver functions

    Science.gov (United States)

    Lee, S.; Park, Y.; Kim, K.; Rhie, J.

    2010-12-01

    The study on the topography of the upper mantle discontinuities helps us to understand the complex interactions between the subducting slabs and upper mantle discontinuities. To investigate the depth variation of the upper mantle discontinuities beneath the Korean Peninsula and surrounding regions, we applied the common conversion point stacking of the P-to-s receiver functions. The broadband seismic networks in South Korea and Japan were used to produce the high-resolution receiver function images of the region. The 410- and 660-km discontinuities (hereafter referred to as the 410 and the 660) are clearly imaged and their depth variations show interesting features, especially for the 660. In this region, the subducting Pacific slab bends to flatten over the 660 and several tomographic images indicate that the stagnant slab is extending to the west under China. If the depth of the 660 is affected by the temperature, the broad depression of the 660 is expected and several SS precursor studies support this idea. However, our observation shows that the 660 is locally depressed and its pattern is spatially changing. While the depressed 660 due to the Pacific slab is clearly imaged at lower latitudes (depressed 660 to the north. It indicates that the effect of the Pacific slab on the depth variation of the 660 is changing significantly in our study area.

  14. Durable Clinical Benefit in Metastatic Renal Cell Carcinoma Patients Who Discontinue PD-1/PD-L1 Therapy for Immune-Related Adverse Events.

    Science.gov (United States)

    Martini, Dylan J; Hamieh, Lana; McKay, Rana R; Harshman, Lauren C; Brandao, Raphael; Norton, Craig K; Steinharter, John A; Krajewski, Katherine M; Gao, Xin; Schutz, Fabio A; McGregor, Bradley; Bossé, Dominick; Lalani, Aly-Khan A; De Velasco, Guillermo; Michaelson, M Dror; McDermott, David F; Choueiri, Toni K

    2018-04-01

    The current standard of care for treatment of metastatic renal cell carcinoma (mRCC) patients is PD-1/PD-L1 inhibitors until progression or toxicity. Here, we characterize the clinical outcomes for 19 mRCC patients who experienced an initial clinical response (any degree of tumor shrinkage), but after immune-related adverse events (irAE) discontinued all systemic therapy. Clinical baseline characteristics, outcomes, and survival data were collected. The primary endpoint was time to progression from the date of treatment cessation (TTP). Most patients had clear cell histology and received anti-PD-1/PD-L1 therapy as second-line or later treatment. Median time on PD-1/PD-L1 therapy was 5.5 months (range, 0.7-46.5) and median TTP was 18.4 months (95% CI, 4.7-54.3) per Kaplan-Meier estimation. The irAEs included arthropathies, ophthalmopathies, myositis, pneumonitis, and diarrhea. We demonstrate that 68.4% of patients ( n = 13) experienced durable clinical benefit off treatment (TTP of at least 6 months), with 36% ( n = 7) of patients remaining off subsequent treatment for over a year after their last dose of anti-PD-1/PD-L1. Three patients with tumor growth found in a follow-up visit, underwent subsequent surgical intervention, and remain off systemic treatment. Nine patients (47.4%) have ongoing irAEs. Our results show that patients who benefitted clinically from anti-PD-1/PD-L1 therapy can experience sustained beneficial responses, not needing further therapies after the initial discontinuation of treatment due to irAEs. Investigation of biomarkers indicating sustained benefit to checkpoint blockers are needed. Cancer Immunol Res; 6(4); 402-8. ©2018 AACR . ©2018 American Association for Cancer Research.

  15. Analysis and development of adjoint-based h-adaptive direct discontinuous Galerkin method for the compressible Navier-Stokes equations

    Science.gov (United States)

    Cheng, Jian; Yue, Huiqiang; Yu, Shengjiao; Liu, Tiegang

    2018-06-01

    In this paper, an adjoint-based high-order h-adaptive direct discontinuous Galerkin method is developed and analyzed for the two dimensional steady state compressible Navier-Stokes equations. Particular emphasis is devoted to the analysis of the adjoint consistency for three different direct discontinuous Galerkin discretizations: including the original direct discontinuous Galerkin method (DDG), the direct discontinuous Galerkin method with interface correction (DDG(IC)) and the symmetric direct discontinuous Galerkin method (SDDG). Theoretical analysis shows the extra interface correction term adopted in the DDG(IC) method and the SDDG method plays a key role in preserving the adjoint consistency. To be specific, for the model problem considered in this work, we prove that the original DDG method is not adjoint consistent, while the DDG(IC) method and the SDDG method can be adjoint consistent with appropriate treatment of boundary conditions and correct modifications towards the underlying output functionals. The performance of those three DDG methods is carefully investigated and evaluated through typical test cases. Based on the theoretical analysis, an adjoint-based h-adaptive DDG(IC) method is further developed and evaluated, numerical experiment shows its potential in the applications of adjoint-based adaptation for simulating compressible flows.

  16. Accountability Accentuates Interindividual—Intergroup Discontinuity by Enforcing Parochialism

    Directory of Open Access Journals (Sweden)

    Tim eWildschut

    2015-11-01

    Full Text Available Interindividual-intergroup discontinuity is the tendency for relations between groups to be more competitive than relations between individuals. We examined whether the discontinuity effect arises in part because group members experience normative pressure to favor the ingroup (parochialism. Building on the notion that accountability enhances normative pressure, we hypothesized that the discontinuity effect would be larger when accountability is present (compared to absent. A prisoner’s dilemma game experiment supported this prediction. Specifically, intergroup (compared to interindividual interaction activated an injunctive ingroup-favoring norm, and accountability enhanced the influence of this norm on competitive behavior.

  17. Resistance to discontinuing breast cancer screening in older women: A qualitative study.

    Science.gov (United States)

    Housten, Ashley J; Pappadis, Monique R; Krishnan, Shilpa; Weller, Susan C; Giordano, Sharon H; Bevers, Therese B; Volk, Robert J; Hoover, Diana S

    2018-06-01

    Screening mammography is associated with reduced breast cancer-specific mortality; however, among older women, evidence suggests that the potential harms of screening may outweigh the benefits. We used a qualitative approach to examine the willingness of older women from different racial/ethnic groups to discontinue breast cancer screening. Women ≥70 years of age who reported having a screening mammogram in the past 3 years and/or reported that they intended to continue screening in the future were recruited for in-depth interviews. Participants who intended to continue screening were asked to describe how the following hypothetical scenarios would impact a decision to discontinue screening: health concerns or limited life expectancy, a physician's recommendation to discontinue, reluctance to undergo treatment, and recommendations from experts or governmental panels to stop screening. Semi-structured, face-to-face interviews were audio-recorded. Data coding and analysis followed inductive and deductive approaches. Regardless of the scenario, participants (n = 29) expressed a strong intention to continue screening. Based on the hypothetical physician recommendations, intentions to continue screening appeared to remain strong. They did not envision a change in their health status that would lead them to discontinue screening and were skeptical of expert/government recommendations. There were no differences observed according to age, race/ethnicity, or education. Among older women who planned to continue screening, intentions to continue breast cancer screening appear to be highly resilient and resistant to recommendations from physicians or expert/government panels. Copyright © 2018 John Wiley & Sons, Ltd.

  18. Adaptive Finite Element Methods for Elliptic Problems with Discontinuous Coefficients

    KAUST Repository

    Bonito, Andrea; DeVore, Ronald A.; Nochetto, Ricardo H.

    2013-01-01

    Elliptic PDEs with discontinuous diffusion coefficients occur in application domains such as diffusions through porous media, electromagnetic field propagation on heterogeneous media, and diffusion processes on rough surfaces. The standard approach to numerically treating such problems using finite element methods is to assume that the discontinuities lie on the boundaries of the cells in the initial triangulation. However, this does not match applications where discontinuities occur on curves, surfaces, or manifolds, and could even be unknown beforehand. One of the obstacles to treating such discontinuity problems is that the usual perturbation theory for elliptic PDEs assumes bounds for the distortion of the coefficients in the L∞ norm and this in turn requires that the discontinuities are matched exactly when the coefficients are approximated. We present a new approach based on distortion of the coefficients in an Lq norm with q < ∞ which therefore does not require the exact matching of the discontinuities. We then use this new distortion theory to formulate new adaptive finite element methods (AFEMs) for such discontinuity problems. We show that such AFEMs are optimal in the sense of distortion versus number of computations, and report insightful numerical results supporting our analysis. © 2013 Societ y for Industrial and Applied Mathematics.

  19. Effect of Discontinuation or Initiation of Methotrexate or Glucocorticoids on Tofacitinib Efficacy in Patients with Rheumatoid Arthritis: A Post Hoc Analysis.

    Science.gov (United States)

    Fleischmann, Roy; Wollenhaupt, Jürgen; Cohen, Stanley; Wang, Lisy; Fan, Haiyun; Bandi, Vara; Andrews, John; Takiya, Liza; Bananis, Eustratios; Weinblatt, Michael E

    2018-06-01

    Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We evaluated the effect of concomitant methotrexate (MTX) or glucocorticoid (GC) use on tofacitinib clinical efficacy. Data were pooled from two open-label, long-term extension studies of tofacitinib 5 or 10 mg twice daily in patients with RA. Response according to Clinical Disease Activity Index (CDAI) was assessed separately in patients who discontinued (no MTX/GC use within 30 days prior to year-3 visit; assessment at month 3/year 3) or initiated (on/before year 3; assessment at initiation and year 3) MTX/GC. By year 3, among patients receiving background MTX at baseline, 186/1608 (11.6%) discontinued MTX, and 319/1434 (22.2%) patients receiving GC at baseline discontinued GC. Overall, 70.4/69.1% of patients who discontinued/continued MTX and 72.7/65.9% who discontinued/continued GC achieved CDAI remission or low disease activity (LDA) at year 3. Month 3 remission/LDA rates were maintained at year 3 in the majority of patients, irrespective of MTX/GC discontinuation/continuation. By year 3, 6.2% of patients receiving tofacitinib without MTX at baseline had initiated concomitant MTX, and 25.1% receiving tofacitinib without GC initiated GC; 69.0% and 45.4% initiating MTX or GC, respectively, had a CDAI-defined incomplete response prior to initiation. RA signs/symptoms improved following MTX initiation; only modest improvement was observed with GC initiation. Patients achieving remission/LDA with tofacitinib may discontinue MTX or GC and maintain treatment response. Patients with an incomplete response may benefit from adding concomitant MTX. Pfizer Inc. Study A3921024 [NCT00413699] and Study A3921041 [NCT00661661].

  20. 39 CFR 241.3 - Discontinuance of post offices.

    Science.gov (United States)

    2010-07-01

    ... CLASSIFICATION, AND DISCONTINUANCE § 241.3 Discontinuance of post offices. (a) Introduction—(1) Coverage. This... justify in sufficient detail to Postal Service management and affected customers the proposed service... inspection during normal business hours at each post office where the Final Determination is posted for 30...

  1. Solutions of the Wheeler-Feynman equations with discontinuous velocities.

    Science.gov (United States)

    de Souza, Daniel Câmara; De Luca, Jayme

    2015-01-01

    We generalize Wheeler-Feynman electrodynamics with a variational boundary value problem for continuous boundary segments that might include velocity discontinuity points. Critical-point orbits must satisfy the Euler-Lagrange equations of the action functional at most points, which are neutral differential delay equations (the Wheeler-Feynman equations of motion). At velocity discontinuity points, critical-point orbits must satisfy the Weierstrass-Erdmann continuity conditions for the partial momenta and the partial energies. We study a special setup having the shortest time-separation between the (infinite-dimensional) boundary segments, for which case the critical-point orbit can be found using a two-point boundary problem for an ordinary differential equation. For this simplest setup, we prove that orbits can have discontinuous velocities. We construct a numerical method to solve the Wheeler-Feynman equations together with the Weierstrass-Erdmann conditions and calculate some numerical orbits with discontinuous velocities. We also prove that the variational boundary value problem has a unique solution depending continuously on boundary data, if the continuous boundary segments have velocity discontinuities along a reduced local space.

  2. Topography of upper mantle seismic discontinuities beneath the North Atlantic: the Azores, Canary and Cape Verde plumes

    Science.gov (United States)

    Saki, Morvarid; Thomas, Christine; Nippress, Stuart E. J.; Lessing, Stephan

    2015-04-01

    We are mapping the topography of upper mantle seismic discontinuities beneath the North Atlantic and surrounding regions by using precursor arrivals to PP and SS seismic waves that reflect off the seismic discontinuities. Many source-receiver combinations have been used in order to collect a large dataset of reflection points beneath our investigating area. We analyzed over 1700 seismograms from MW>5.8 events using array seismic methods to enhance the signal to noise ratio. The measured time lag between PP (SS) arrivals and their corresponding precursors on robust stacks are used to measure the depth of the transition zone boundaries. The reflectors' depths show a correlation between the location of hotspots and a significantly depressed 410 km discontinuity indicating a temperature increase of 200-300 K compared to the surrounding mantle. For the 660 km discontinuity three distinct behaviours are visible: i) normal depths beneath Greenland and at a distance of a few hundred kilometres away from the hotspots and ii) shallower 660 km discontinuity compared with the global average value near hotspots closer to the Mid-Atlantic Ridge and iii) very few observations of a 660 km discontinuity at the hotspot locations. We interpret our observations as a large upwelling beneath the southern parts of our study region, possibly due to the South Atlantic convection cell. The thermal anomaly may be blocked by endothermic phase transformation and likely does not extend through the top of the transition zone as whole except for those branches which appear as the Azores, Canaries and Cape Verde hotspots at the surface.

  3. Soliton shock wave fronts and self-similar discontinuities in dispersion hydrodynamics

    International Nuclear Information System (INIS)

    Gurevich, A.V.; Meshcherkin, A.P.

    1987-01-01

    Nonlinear flows in nondissipative dispersion hydrodynamics are examined. It is demonstrated that in order to describe such flows it is necessary to incorporate a new concept: a special discontinuity called a ''self-similar'' discontinuity consisting of a nondissipative shock wave and a powerful slow wave discontinuity in regular hydrodynamics. The ''self similar discontinuity'' expands linearly over time. It is demonstrated that this concept may be introduced in a solution to Euler equations. The boundary conditions of the ''self similar discontinuity'' that allow closure of Euler equations for dispersion hydrodynamics are formulated, i.e., those that replace the shock adiabatic curve of standard dissipative hydrodynamics. The structure of the soliton front and of the trailing edge of the shock wave is investigated. A classification and complete solution are given to the problem of the decay of random initial discontinuities in the hydrodynamics of highly nonisothermic plasma. A solution is derived to the problem of the decay of initial discontinuities in the hydrodynamics of magnetized plasma. It is demonstrated that in this plasma, a feature of current density arises at the point of soliton inversion

  4. Minimizers with discontinuous velocities for the electromagnetic variational method

    International Nuclear Information System (INIS)

    De Luca, Jayme

    2010-01-01

    The electromagnetic two-body problem has neutral differential delay equations of motion that, for generic boundary data, can have solutions with discontinuous derivatives. If one wants to use these neutral differential delay equations with arbitrary boundary data, solutions with discontinuous derivatives must be expected and allowed. Surprisingly, Wheeler-Feynman electrodynamics has a boundary value variational method for which minimizer trajectories with discontinuous derivatives are also expected, as we show here. The variational method defines continuous trajectories with piecewise defined velocities and accelerations, and electromagnetic fields defined by the Euler-Lagrange equations on trajectory points. Here we use the piecewise defined minimizers with the Lienard-Wierchert formulas to define generalized electromagnetic fields almost everywhere (but on sets of points of zero measure where the advanced/retarded velocities and/or accelerations are discontinuous). Along with this generalization we formulate the generalized absorber hypothesis that the far fields vanish asymptotically almost everywhere and show that localized orbits with far fields vanishing almost everywhere must have discontinuous velocities on sewing chains of breaking points. We give the general solution for localized orbits with vanishing far fields by solving a (linear) neutral differential delay equation for these far fields. We discuss the physics of orbits with discontinuous derivatives stressing the differences to the variational methods of classical mechanics and the existence of a spinorial four-current associated with the generalized variational electrodynamics.

  5. Identification of chronic myeloid leukemia patients treated with imatinib who are potentially eligible for treatment discontinuation by assessing real-life molecular responses on the international scale in a EUTOS-certified lab.

    Science.gov (United States)

    Heinrichs, Amélie; Dessars, Barbara; El Housni, Hakim; Pluymers, Wim; Peeters, Karen; Benghiat, Fleur S; Heimann, Pierre

    2018-04-01

    A retrospective study was performed to describe molecular responses (MR) on the international scale (IS) in patients with chronic myeloid leukemia (CML) treated with imatinib in routine clinical practice in Belgium and to identify patients potentially eligible for treatment discontinuation. The analysis included 116 patients with CML in chronic phase at treatment centers sending blood samples for molecular follow-up to a single EUTOS-certified laboratory. IS MR from the last patient visit between October 2014 and April 2015 were retrospectively collected. Most patients (93.1%) had an IS MR corresponding to an optimal response per European LeukemiaNet 2013 guidelines; 53.4% (62/116) of patients were in deep molecular responses ≥MR 4.5 at their last visit (mean treatment duration: 91.0 months) among whom 36.2% (42/116) had been receiving imatinib for >5.8 years and 26.7% (31/116) for >8 years (margins of error: 8.74% and 8.05%, respectively). These patients would likely have the highest chance of staying in treatment-free remission (TFR) upon discontinuation, based on published TFR trial data. Although our study only provides a snapshot in time of a patient's last MR reported, without precise information regarding MR duration, the study settings could nevertheless support the feasibility of attempting TFR outside clinical trials in the future. Copyright © 2018 Elsevier Ltd. All rights reserved.

  6. Toward Continuous GPS Carrier-Phase Time Transfer: Eliminating the Time Discontinuity at an Anomaly.

    Science.gov (United States)

    Yao, Jian; Levine, Judah; Weiss, Marc

    2015-01-01

    The wide application of Global Positioning System (GPS) carrier-phase (CP) time transfer is limited by the problem of boundary discontinuity (BD). The discontinuity has two categories. One is "day boundary discontinuity," which has been studied extensively and can be solved by multiple methods [1-8]. The other category of discontinuity, called "anomaly boundary discontinuity (anomaly-BD)," comes from a GPS data anomaly. The anomaly can be a data gap (i.e., missing data), a GPS measurement error (i.e., bad data), or a cycle slip. Initial study of the anomaly-BD shows that we can fix the discontinuity if the anomaly lasts no more than 20 min, using the polynomial curve-fitting strategy to repair the anomaly [9]. However, sometimes, the data anomaly lasts longer than 20 min. Thus, a better curve-fitting strategy is in need. Besides, a cycle slip, as another type of data anomaly, can occur and lead to an anomaly-BD. To solve these problems, this paper proposes a new strategy, i.e., the satellite-clock-aided curve fitting strategy with the function of cycle slip detection. Basically, this new strategy applies the satellite clock correction to the GPS data. After that, we do the polynomial curve fitting for the code and phase data, as before. Our study shows that the phase-data residual is only ~3 mm for all GPS satellites. The new strategy also detects and finds the number of cycle slips by searching the minimum curve-fitting residual. Extensive examples show that this new strategy enables us to repair up to a 40-min GPS data anomaly, regardless of whether the anomaly is due to a data gap, a cycle slip, or a combination of the two. We also find that interference of the GPS signal, known as "jamming", can possibly lead to a time-transfer error, and that this new strategy can compensate for jamming outages. Thus, the new strategy can eliminate the impact of jamming on time transfer. As a whole, we greatly improve the robustness of the GPS CP time transfer.

  7. Discontinuity of the incudo-stapedial joint within a fully aerated middle ear and mastoid on computed tomography: A clinico-radiological study of its aetiology and clinical consequence

    International Nuclear Information System (INIS)

    Connor, S.E.J.; Pai, I.; Jiang, D.; Spiers, A.J.D.; Fitzgerald-O'Connor, A.

    2012-01-01

    Aim: To investigate the aetiology and clinical consequences of incudo-stapedial (IS) discontinuity when it is demonstrated on computed tomography (CT) within a fully aerated middle ear and mastoid. Methods and materials: Patients with CT evidence of IS discontinuity within a fully aerated middle ear and mastoid were prospectively identified. Clinical history, otoscopic findings, audiometry, and CT data were evaluated. Predefined criteria were used to determine the likely aetiology of IS discontinuity, whether it was diagnosed prior to the CT study, and the clinical consequences in terms of degree of conductive hearing loss and requirement for surgical correction. The range of CT appearances was evaluated. Results: The IS discontinuity in 34/36 ears was felt to be due to incus erosion secondary to chronic otitis, on the basis of clinical history and otoscopic findings. The IS discontinuity was rarely evident prior to CT with long-process deficiency being identified in only 5/36 cases. The mean air bone gap was only 22.5 dB. The ossicular defect was surgically addressed in only four cases. The incus deficiency was confined to the lower-third on CT in 19/36 cases. Conclusion: When IS discontinuity is demonstrated within a fully aerated middle ear and mastoid, the most likely aetiology is of acquired incus erosion due to chronic otitis media. The IS discontinuity on CT is usually not evident otoscopically. It usually results in only mild conductive hearing loss and the ossicular discontinuity was rarely surgically addressed in the present series.

  8. Discontinuation risk comparison among 'real-world' newly anticoagulated atrial fibrillation patients

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Pan, Xianying; Kamble, Shital

    2018-01-01

    Discontinuation of oral anticoagulants may expose non-valvular atrial fibrillation (NVAF) patients to an increased risk of stroke. This study describes the real-world discontinuation rates and compared the risk of drug discontinuation among NVAF patients initiating apixaban, warfarin, dabigatran,...

  9. Seismic wave propagation in fractured media: A discontinuous Galerkin approach

    KAUST Repository

    De Basabe, Jonás D.

    2011-01-01

    We formulate and implement a discontinuous Galekin method for elastic wave propagation that allows for discontinuities in the displacement field to simulate fractures or faults using the linear- slip model. We show numerical results using a 2D model with one linear- slip discontinuity and different frequencies. The results show a good agreement with analytic solutions. © 2011 Society of Exploration Geophysicists.

  10. Derivative discontinuity with localized Hartree-Fock potential

    Energy Technology Data Exchange (ETDEWEB)

    Nazarov, V. U. [Research Center for Applied Sciences, Academia Sinica, Taipei 11529, Taiwan (China); Vignale, G. [Department of Physics, University of Missouri-Columbia, Columbia, Missouri 65211 (United States)

    2015-08-14

    The localized Hartree-Fock potential has proven to be a computationally efficient alternative to the optimized effective potential, preserving the numerical accuracy of the latter and respecting the exact properties of being self-interaction free and having the correct −1/r asymptotics. In this paper we extend the localized Hartree-Fock potential to fractional particle numbers and observe that it yields derivative discontinuities in the energy as required by the exact theory. The discontinuities are numerically close to those of the computationally more demanding Hartree-Fock method. Our potential enjoys a “direct-energy” property, whereby the energy of the system is given by the sum of the single-particle eigenvalues multiplied by the corresponding occupation numbers. The discontinuities c{sub ↑} and c{sub ↓} of the spin-components of the potential at integer particle numbers N{sub ↑} and N{sub ↓} satisfy the condition c{sub ↑}N{sub ↑} + c{sub ↓}N{sub ↓} = 0. Thus, joining the family of effective potentials which support a derivative discontinuity, but being considerably easier to implement, the localized Hartree-Fock potential becomes a powerful tool in the broad area of applications in which the fundamental gap is an issue.

  11. Convergent piecewise affine systems : analysis and design Part II: discontinuous case

    NARCIS (Netherlands)

    Pavlov, A.V.; Pogromski, A.Y.; Wouw, van de N.; Nijmeijer, H.; Rooda, J.E.

    2005-01-01

    In this paper convergence properties of piecewise affine (PWA) systems with discontinuous right-hand sides are studied. It is shown that for discontinuous PWA systems existence of a common quadratic Lyapunov function is not sufficient for convergence. For discontinuous bimodal PWA systems necessary

  12. TACROLIMUS OINTMENT FOR TREATMENT OF VKC

    Directory of Open Access Journals (Sweden)

    Navin Chandra

    2017-05-01

    Full Text Available BACKGROUND Vernal Keratoconjunctivitis (VKC is a bilateral recurrent chronic allergy inflammatory disorder of ocular surface, which is seasonally exacerbated mostly involving tarsal and bulbar conjunctiva in chronic and severe cases involves cornea as well. Affects mostly children and young adults with male predominance. Tacrolimus (FK-506 is a highly potent immune modulatory agent produced by the fungus Streptomyces tsukubaensis. MATERIALS AND METHODS This prospective, nonrandomised case series enrolled 20 patients (40 eyes with severe VKC who were treated with tacrolimus 0.1% ointment. The mean age of the patients was 18.25 ± 4.2 years (range, 9-31 years. Each patient completed a follow-up period of at least 12 months. The main outcome measure was the clinical response to treatment. RESULTS Significant improvements in clinical signs and symptoms were achieved in all patients 6 weeks after starting treatment with topical tacrolimus. Treatment was gradually reduced with increasing intervals between applications. VKC recurred in all patients who attempted to discontinue treatment. No additional medications were required and no significant changes in visual acuity or refraction were documented. Five patients discontinued treatment due to a severe burning sensation and were excluded from the study. CONCLUSION Tacrolimus 0.1% ointment is a safe and effective treatment for VKC refractory to standard treatment and maybe used as a substitute for steroid treatments used to controlled-disease activity. However, adverse effects could cause poor patient compliance.

  13. Level of response and safety of pharmacological monotherapy in the treatment of acute bipolar I disorder phases: a systematic review and meta-analysis

    Science.gov (United States)

    Tamayo, Jorge M.; Zarate, Carlos A.; Vieta, Eduard; Vázquez, Gustavo; Tohen, Mauricio

    2010-01-01

    In recent years, combinations of pharmacological treatments have become common for the treatment of bipolar disorder type I (BP I); however, this practice is usually not evidence-based and rarely considers monotherapy drug regimen (MDR) as an option in the treatment of acute phases of BP I. Therefore, we evaluated comparative data of commonly prescribed MDRs for both manic and depressive phases of BP I. Medline, PsycINFO, EMBASE, the Cochrane Library, the ClinicalStudyResults.org and other data sources were searched from 1949 to March 2009 for placebo and active controlled randomized clinical trials (RCTs). Risk ratios (RRs) for response, remission, and discontinuation rates due to adverse events (AEs), lack of efficacy, or discontinuation due to any cause, and the number needed to treat or harm (NNT or NNH) were calculated for each medication individually and for all evaluable trials combined. The authors included 31 RCTs in the analyses comparing a MDR with placebo or with active treatment for acute mania, and 9 RCTs comparing a MDR with placebo or with active treatment for bipolar depression. According to the collected evidence, most of the MDRs when compared to placebo showed significant response and remission rates in acute mania. In the case of bipolar depression only quetiapine and, to a lesser extent, olanzapine showed efficacy as MDR. Overall, MDRs were well tolerated with low discontinuation rates due to any cause or AE, although AE profiles differed among treatments. We concluded that most MDRs were efficacious and safe in the treatment of manic episodes, but very few MDRs have demonstrated being efficacious for bipolar depressive episodes. PMID:20128953

  14. Time-to-onset and -resolution of adverse events before/after atomoxetine discontinuation in adult patients with ADHD.

    Science.gov (United States)

    Upadhyaya, Himanshu; Tanaka, Yoko; Lipsius, Sarah; Kryzhanovskaya, Ludmila A; Lane, Jeannine R; Escobar, Rodrigo; Trzepacz, Paula T; Allen, Albert J

    2015-01-01

    Adults with attention-deficit/hyperactivity disorder treated with atomoxetine were examined for time-to-onset and -resolution of common treatment-emergent adverse events (TEAEs) and male sexual dysfunction, and for changes in blood pressure (BP) and heart rate (HR) upon atomoxetine discontinuation. 12-week open-label atomoxetine (40-100 mg/day) was followed by 12-week double-blind maintenance treatment (atomoxetine 80 or 100 mg/day). Responders were then randomized to atomoxetine (n = 266) or placebo (n = 258) for 25-week randomized withdrawal. Examined were (1) median time-to-onset and -resolution of TEAEs during atomoxetine treatment, and (2) within group, visitwise mean changes for sitting HR, systolic BP, and diastolic BP for the postrandomization placebo group. Common adverse events (AEs) appeared early, within week 1 of atomoxetine treatment. Some AEs resolve relatively rapidly, whereas others have a more lingering course of resolution (including male sexual side effects); median resolution times were 3 - 53 days. BP and HR increases during atomoxetine treatment returned to baseline upon atomoxetine discontinuation. Atomoxetine is associated with common AEs, with 3- to 53-day median resolution times. ClincialTrials.gov - NCT00700427.

  15. Evaluating an Organizational-Level Occupational Health Intervention in a Combined Regression Discontinuity and Randomized Control Design.

    Science.gov (United States)

    Sørensen, By Ole H

    2016-10-01

    Organizational-level occupational health interventions have great potential to improve employees' health and well-being. However, they often compare unfavourably to individual-level interventions. This calls for improving methods for designing, implementing and evaluating organizational interventions. This paper presents and discusses the regression discontinuity design because, like the randomized control trial, it is a strong summative experimental design, but it typically fits organizational-level interventions better. The paper explores advantages and disadvantages of a regression discontinuity design with an embedded randomized control trial. It provides an example from an intervention study focusing on reducing sickness absence in 196 preschools. The paper demonstrates that such a design fits the organizational context, because it allows management to focus on organizations or workgroups with the most salient problems. In addition, organizations may accept an embedded randomized design because the organizations or groups with most salient needs receive obligatory treatment as part of the regression discontinuity design. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Airline loyalty (programs) across borders : A geographic discontinuity approach

    NARCIS (Netherlands)

    de Jong, Gerben; Behrens, Christiaan; van Ommeren, Jos

    2018-01-01

    We analyze brand loyalty advantages of national airlines in their domestic countries using geocoded data from a major international frequent flier program. We employ a geographic discontinuity design that estimates discontinuities in program activity at the national borders of the program's

  17. Waiting-time distributions of magnetic discontinuities: Clustering or Poisson process?

    International Nuclear Information System (INIS)

    Greco, A.; Matthaeus, W. H.; Servidio, S.; Dmitruk, P.

    2009-01-01

    Using solar wind data from the Advanced Composition Explorer spacecraft, with the support of Hall magnetohydrodynamic simulations, the waiting-time distributions of magnetic discontinuities have been analyzed. A possible phenomenon of clusterization of these discontinuities is studied in detail. We perform a local Poisson's analysis in order to establish if these intermittent events are randomly distributed or not. Possible implications about the nature of solar wind discontinuities are discussed.

  18. Preparation and Mechanical Properties of Aligned Discontinuous Carbon Fiber Composites

    OpenAIRE

    DENG Hua; GAO Junpeng; BAO Jianwen

    2018-01-01

    Aligned discontinuous carbon fiber composites were fabricated from aligned discontinuous carbon fiber prepreg, which was prepared from continuous carbon fiber prepreg via mechanical high-frequency cutting. The internal quality and mechanical properties were characterized and compared with continuous carbon fiber composites. The results show that the internal quality of the aligned discontinuous carbon fiber composites is fine and the mechanical properties have high retention rate after the fi...

  19. Health Care Facility Choice and User Fee Abolition: Regression Discontinuity in a Multinomial Choice Setting

    OpenAIRE

    Steven F. Koch; Jeffrey S. Racine

    2013-01-01

    We apply parametric and nonparametric regression discontinuity methodology within a multinomial choice setting to examine the impact of public health care user fee abolition on health facility choice using data from South Africa. The nonparametric model is found to outperform the parametric model both in- and out-of-sample, while also delivering more plausible estimates of the impact of user fee abolition (i.e. the 'treatment effect'). In the parametric framework, treatment effects were relat...

  20. Discontinuation of angiotensin converting enzyme inhibitors (ACEIs) as a potential marker for adverse drug reactions (ADRs)

    NARCIS (Netherlands)

    Pour, Seyed Hamidreza Mahmoud; De Keyser, Catherine E.; Souverein, Patrick C.; Asselbergs, Folkert W.; Hofman, Albert; Stricker, Bruno H.; De Boer, Anthonius; Maitland-Van Der Zee, Anke-Hilse

    2014-01-01

    Background: ACEI-induced ADRs are the main reason to discontinue ACEI treatment. In prescription databases, information on ADRs is not available; therefore it is necessary to identify proxies for ADRs in such databases to study risk factors for ADRs. Objectives: To study prescription patterns for

  1. Convergence of Discontinuous Galerkin Methods for Incompressible Two-Phase Flow in Heterogeneous Media

    KAUST Repository

    Kou, Jisheng; Sun, Shuyu

    2013-01-01

    A class of discontinuous Galerkin methods with interior penalties is presented for incompressible two-phase flow in heterogeneous porous media with capillary pressures. The semidiscrete approximate schemes for fully coupled system of two-phase flow are formulated. In highly heterogeneous permeable media, the saturation is discontinuous due to different capillary pressures, and therefore, the proposed methods incorporate the capillary pressures in the pressure equation instead of saturation equation. By introducing a coupling approach for stability and error estimates instead of the conventional separate analysis for pressure and saturation, the stability of the schemes in space and time and a priori hp error estimates are presented in the L2(H 1) for pressure and in the L∞(L2) and L2(H1) for saturation. Two time discretization schemes are introduced for effectively computing the discrete solutions. © 2013 Societ y for Industrial and Applied Mathematics.

  2. The structure of rotational discontinuities. [in solar wind

    Science.gov (United States)

    Neugebauer, M.

    1989-01-01

    This study examines the structures of a set of rotational discontinuities detected in the solar wind by the ISEE-3 spacecraft. It is found that the complexity of the structure increases as the angle theta between the propagation vector k and the magnetic field decreases. For rotational discontinuities that propagate at a large angle to the field with an ion (left-hand) sense of rotation, the magnetic hodograms tend to be flattened, in agreement with prior numerical simulations. When theta is large, angular 'overshoots' are often observed at one or both ends of the discontinuity. When the propagation is nearly parallel to the field (when theta is small), many different types of structure are seen, ranging from straight lines, to S-shaped curves, to complex, disorganized shapes.

  3. News and views in discontinuous phase transitions

    Science.gov (United States)

    Nagler, Jan

    2014-03-01

    Recent progress in the theory of discontinuous percolation allow us to better understand the the sudden emergence of large-scale connectedness both in networked systems and on the lattice. We analytically study mechanisms for the amplification of critical fluctuations at the phase transition point, non-self-averaging and power law fluctuations. A single event analysis allow to establish criteria for discontinuous percolation transitions, even on the high-dimensional lattice. Some applications such as salad bowl percolation, and inverse fragmentation are discussed.

  4. Dynamic stability and failure modes of slopes in discontinuous rock mass

    International Nuclear Information System (INIS)

    Shimizu, Yasuhiro; Aydan, O.; Ichikawa, Yasuaki; Kawamoto, Toshikazu.

    1988-01-01

    The stability of rock slopes during earthquakes are of great concern in rock engineering works such as highway, dam, and nuclear power station constructions. As rock mass in nature is usually discontinuous, the stability of rock slopes will be geverned by the spatial distribution of discontinuities in relation with the geometry of slope and their mechanical properties rather than the rock element. The authors have carried out some model tests on discontinuous rock slopes using three different model tests techniques in order to investigate the dynamic behaviour and failure modes of the slopes in discontinuous rock mass. This paper describes the findings and observations made on model rock slopes with various discontinuity patterns and slope geometry. In addition some stability criterions are developed and the calculated results are compared with those of experiments. (author)

  5. Discontinuity of maximum entropy inference and quantum phase transitions

    International Nuclear Information System (INIS)

    Chen, Jianxin; Ji, Zhengfeng; Yu, Nengkun; Zeng, Bei; Li, Chi-Kwong; Poon, Yiu-Tung; Shen, Yi; Zhou, Duanlu

    2015-01-01

    In this paper, we discuss the connection between two genuinely quantum phenomena—the discontinuity of quantum maximum entropy inference and quantum phase transitions at zero temperature. It is shown that the discontinuity of the maximum entropy inference of local observable measurements signals the non-local type of transitions, where local density matrices of the ground state change smoothly at the transition point. We then propose to use the quantum conditional mutual information of the ground state as an indicator to detect the discontinuity and the non-local type of quantum phase transitions in the thermodynamic limit. (paper)

  6. MHD intermediate shock discontinuities: Pt. 1

    International Nuclear Information System (INIS)

    Kennel, C.F.; Blandford, R.D.; Coppi, P.

    1989-01-01

    Recent numerical investigations have focused attention once more on the role of intermediate shocks in MHD. Four types of intermediate shock are identified using a graphical representation of the MHD Rankine-Hugoniot conditions. This same representation can be used to exhibit the close relationship of intermediate shocks to switch-on shocks and rotational discontinuities. The conditions under which intermediate discontinuities can be found are elucidated. The variations in velocity, pressure, entropy and magnetic-field jumps with upstream parameters in intermediate shocks are exhibited graphically. The evolutionary arguments traditionally advanced against intermediate shocks may fail because the equations of classical MHD are not strictly hyperbolic. (author)

  7. Anaphylactic Reactions After Discontinuation of Hymenoptera Venom Immunotherapy: A Clonal Mast Cell Disorder Should Be Suspected.

    Science.gov (United States)

    Bonadonna, Patrizia; Zanotti, Roberta; Pagani, Mauro; Bonifacio, Massimiliano; Scaffidi, Luigi; Olivieri, Elisa; Franchini, Maurizio; Reccardini, Federico; Costantino, Maria Teresa; Roncallo, Chiara; Mauro, Marina; Boni, Elisa; Rizzini, Fabio Lodi; Bilò, Maria Beatrice; Marcarelli, Anna Rosaria; Passalacqua, Giovanni

    2017-12-16

    Up to 75% of patients with severe anaphylactic reactions after Hymenoptera sting are at risk of further severe reactions if re-stung. Venom immunotherapy (VIT) is highly effective in protecting individuals with ascertained Hymenoptera venom allergy (HVA) and previous severe reactions. After a 3- to 5-year VIT course, most patients remain protected after VIT discontinuation. Otherwise, a lifelong treatment should be considered in high-risk patients (eg, in mastocytosis). Several case reports evidenced that patients with mastocytosis and HVA, although protected during VIT, can re-experience severe and sometimes fatal reactions after VIT discontinuation. To evaluate whether patients who lost protection after VIT discontinuation may suffer from clonal mast cell disorders. The survey describes the characteristics of patients who received a full course of VIT for previous severe reactions and who experienced another severe reaction at re-sting after VIT discontinuation. Those with a Red Española de Mastocitosis score of 2 or more or a serum basal tryptase level of more than 25 ng/mL underwent a hematological workup (bone marrow biopsy, KIT mutation, expression of aberrant CD25) and/or skin biopsy. Nineteen patients (mean age, 56.3 years; 89.5% males) were evaluated. All of them had received at least 4 years of VIT and were protected. After VIT discontinuation they were re-stung and developed, in all but 1 case, severe anaphylactic reactions (12 with loss of consciousness, in the absence of urticaria/angioedema). Eighteen patients (94.7%) had a clonal mast cell disorder, 8 of them with normal tryptase. Looking at this selected population, we suggest that mastocytosis should be considered in patients developing severe reactions at re-sting after VIT discontinuation and, as a speculation, patients with mastocytosis and HVA should be VIT-treated lifelong. Copyright © 2017. Published by Elsevier Inc.

  8. Estimating the real-world effects of expanding antiretroviral treatment eligibility: Evidence from a regression discontinuity analysis in Zambia.

    Directory of Open Access Journals (Sweden)

    Aaloke Mody

    2018-06-01

    Full Text Available Although randomized trials have established the clinical efficacy of treating all persons living with HIV (PLWHs, expanding treatment eligibility in the real world may have additional behavioral effects (e.g., changes in retention or lead to unintended consequences (e.g., crowding out sicker patients owing to increased patient volume. Using a regression discontinuity design, we sought to assess the effects of a previous change to Zambia's HIV treatment guidelines increasing the threshold for treatment eligibility from 350 to 500 cells/μL to anticipate effects of current global efforts to treat all PLWHs.We analyzed antiretroviral therapy (ART-naïve adults who newly enrolled in HIV care in a network of 64 clinics operated by the Zambian Ministry of Health and supported by the Centre for Infectious Disease Research in Zambia (CIDRZ. Patients were restricted to those enrolling in a narrow window around the April 1, 2014 change to Zambian HIV treatment guidelines that raised the CD4 threshold for treatment from 350 to 500 cells/μL (i.e., August 1, 2013, to November 1, 2014. Clinical and sociodemographic data were obtained from an electronic medical record system used in routine care. We used a regression discontinuity design to estimate the effects of this change in treatment eligibility on ART initiation within 3 months of enrollment, retention in care at 6 months (defined as clinic attendance between 3 and 9 months after enrollment, and a composite of both ART initiation by 3 months and retention in care at 6 months in all new enrollees. We also performed an instrumental variable (IV analysis to quantify the effect of actually initiating ART because of this guideline change on retention. Overall, 34,857 ART-naïve patients (39.1% male, median age 34 years [IQR 28-41], median CD4 268 cells/μL [IQR 134-430] newly enrolled in HIV care during this period; 23,036 were analyzed after excluding patients around the threshold to allow for clinic

  9. Contribution of Strong Discontinuities to the Power Spectrum of the Solar Wind

    International Nuclear Information System (INIS)

    Borovsky, Joseph E.

    2010-01-01

    Eight and a half years of magnetic field measurements (2 22 samples) from the ACE spacecraft in the solar wind at 1 A.U. are analyzed. Strong (large-rotation-angle) discontinuities in the solar wind are collected and measured. An artificial time series is created that preserves the timing and amplitudes of the discontinuities. The power spectral density of the discontinuity series is calculated and compared with the power spectral density of the solar-wind magnetic field. The strong discontinuities produce a power-law spectrum in the ''inertial subrange'' with a spectral index near the Kolmogorov -5/3 index. The discontinuity spectrum contains about half of the power of the full solar-wind magnetic field over this ''inertial subrange.'' Warnings are issued about the significant contribution of discontinuities to the spectrum of the solar wind, complicating interpretation of spectral power and spectral indices.

  10. Discontinuous Galerkin finite element methods for hyperbolic differential equations

    NARCIS (Netherlands)

    van der Vegt, Jacobus J.W.; van der Ven, H.; Boelens, O.J.; Boelens, O.J.; Toro, E.F.

    2002-01-01

    In this paper a suryey is given of the important steps in the development of discontinuous Galerkin finite element methods for hyperbolic partial differential equations. Special attention is paid to the application of the discontinuous Galerkin method to the solution of the Euler equations of gas

  11. Clopidogrel discontinuation and platelet reactivity following coronary stenting

    LENUS (Irish Health Repository)

    2011-01-01

    Summary. Aims: Antiplatelet therapy with aspirin and clopidogrel is recommended for 1 year after drug-eluting stent (DES) implantation or myocardial infarction. However, the discontinuation of antiplatelet therapy has become an important issue as recent studies have suggested a clustering of ischemic events within 90 days of clopidogrel withdrawal. The objective of this investigation was to explore the hypothesis that there is a transient ‘rebound’ increase in platelet reactivity within 3 months of clopidogrel discontinuation. Methods and Results: In this prospective study, platelet function was assessed in patients taking aspirin and clopidogrel for at least 1 year following DES implantation. Platelet aggregation was measured using a modification of light transmission aggregometry in response to multiple concentrations of adenosine diphosphate (ADP), epinephrine, arachidonic acid, thrombin receptor activating peptide and collagen. Clopidogrel was stopped and platelet function was reassessed 1 week, 1 month and 3 months later. Thirty-two patients on dual antiplatelet therapy were recruited. Discontinuation of clopidogrel increased platelet aggregation to all agonists, except arachidonic acid. Platelet aggregation in response to ADP (2.5, 5, 10, and 20 μm) and epinephrine (5 and 20 μm) was significantly increased at 1 month compared with 3 months following clopidogrel withdrawal. Thus, a transient period of increased platelet reactivity to both ADP and epinephrine was observed 1 month after clopidogrel discontinuation. Conclusions: This study demonstrates a transient increase in platelet reactivity 1 month after clopidogrel withdrawal. This phenomenon may, in part, explain the known clustering of thrombotic events observed after clopidogrel discontinuation. This observation requires confirmation in larger populations.

  12. The myth of DSM's invention of new categories of disorder: Houts's diagnostic discontinuity thesis disconfirmed.

    Science.gov (United States)

    Wakefield, J C

    2001-05-01

    Houts (2001) argues that increases in DSM diagnostic categories are due to the invention of new disorders that are discontinuous with old conceptions of disorder and would not have been previously diagnosed. He maintains that DSM category increases are not comparable in nature to ICD category increases, which are mainly refinements of recognized disorders. I survey categories of disorder introduced after DSM-II and assess whether they are discontinuous with old concepts and categories of disorder. Candidate categories are identified from: Houts and Follette (1998), Mentalism, mechanisms, and medical analogues: Reply to Wakefield. Journal of Consulting and Clinical Psychology; Kutchins and Kirk (1997) Making us crazy: DSM: The psychiatric bible and the creation of mental disorders. New York: Free Press; and my own list. The result is that virtually none of the candidate categories are invented, discontinuous categories. In almost every case, the newly labeled conditions were considered disorders at the time of DSM-II and would have been diagnosed under DSM-II categories. I also reexamine DSM-IV sleep disorder categories, which Houts claims are discontinuous with past diagnostic conceptions. The result is that all DSM-IV sleep disorders were recognized as disorders at the time of DSM-II, and most were recognized as mental disorders. I conclude that DSM category increases are comparable in nature to ICD category increases, and that the invention-of-disorder account cannot explain the vast majority of such increases.

  13. Class of reconstructed discontinuous Galerkin methods in computational fluid dynamics

    International Nuclear Information System (INIS)

    Luo, Hong; Xia, Yidong; Nourgaliev, Robert

    2011-01-01

    A class of reconstructed discontinuous Galerkin (DG) methods is presented to solve compressible flow problems on arbitrary grids. The idea is to combine the efficiency of the reconstruction methods in finite volume methods and the accuracy of the DG methods to obtain a better numerical algorithm in computational fluid dynamics. The beauty of the resulting reconstructed discontinuous Galerkin (RDG) methods is that they provide a unified formulation for both finite volume and DG methods, and contain both classical finite volume and standard DG methods as two special cases of the RDG methods, and thus allow for a direct efficiency comparison. Both Green-Gauss and least-squares reconstruction methods and a least-squares recovery method are presented to obtain a quadratic polynomial representation of the underlying linear discontinuous Galerkin solution on each cell via a so-called in-cell reconstruction process. The devised in-cell reconstruction is aimed to augment the accuracy of the discontinuous Galerkin method by increasing the order of the underlying polynomial solution. These three reconstructed discontinuous Galerkin methods are used to compute a variety of compressible flow problems on arbitrary meshes to assess their accuracy. The numerical experiments demonstrate that all three reconstructed discontinuous Galerkin methods can significantly improve the accuracy of the underlying second-order DG method, although the least-squares reconstructed DG method provides the best performance in terms of both accuracy, efficiency, and robustness. (author)

  14. Research progress on criteria for discontinuation of EGFR inhibitor therapy

    Directory of Open Access Journals (Sweden)

    Zhuang HQ

    2012-10-01

    Full Text Available Hong-qing Zhuang, Zhi-yong Yuan, Jun Wang, Ping Wang, Lu-jun Zhao, Bai-lin ZhangDepartment of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin Lung Cancer Center, Tianjin, People's Republic of ChinaAbstract: The clinical success of the epidermal growth factor receptor (EGFR tyrosine kinase inhibitors (TKI as therapeutic agents has prompted great interest in their further development and clinical testing for a wide variety of malignancies. However, most studies have focused on the efficacy of TKI, and few studies have been done on the criteria for their discontinuation. The current standard for drug discontinuation is “until progression”, based on change in tumor size. However, tumor size is not related to the gene expression which determines the efficacy of TKI in the final analysis, and it is also difficult to make a thorough and correct prediction based on tumor size when the TKI is discontinued. Nevertheless, clinical evaluation of the criteria for TKI discontinuation is still in its early days. Some promising findings have started to emerge. With the improving knowledge of EGFR and its inhibitors, it is expected that the criteria for discontinuation of EGFR inhibitor therapy will become clearer.Keywords: epidermal growth factor receptor, drug discontinuation, acquired drug-resistance

  15. Discontinuous bifurcation and coexistence of attractors in a piecewise linear map with a gap

    International Nuclear Information System (INIS)

    Qu Shixian; Lu Yongzhi; Zhang Lin; He Daren

    2008-01-01

    Coexistence of attractors with striking characteristics is observed in this work, where a stable period-5 attractor coexists successively with chaotic band-11, period-6, chaotic band-12 and band-6 attractors. They are induced by different mechanisms due to the interaction between the discontinuity and the non-invertibility. A characteristic boundary collision bifurcation, is observed. The critical conditions are obtained both analytically and numerically. (general)

  16. Investigating Discontinuity of Age Relations in Cognitive Functioning, General Health Status, Activity Participation, and Life Satisfaction between Young-Old and Old-Old Age.

    Science.gov (United States)

    Ihle, Andreas; Jopp, Daniela S; Oris, Michel; Fagot, Delphine; Kliegel, Matthias

    2016-11-05

    Health research suggests that findings on young-old adults cannot be generalized to old-old adults and thus that old-old age seems not a simple continuation of young-old age due to qualitative changes that result in a discontinuity in old age. Specifically, it would be of conceptual and methodological importance to inform research regarding estimates around which chronological age the beginning of old-old age could be placed at a population level, and whether this is universal or domain-specific. To derive such criteria, we investigated potential discontinuity of age relations between young-old and old-old age in a large population-based sample considering measures in different domains (processing speed, verbal abilities, general health status, activity participation, and life satisfaction). For processing speed, verbal abilities, general health status, and life satisfaction we observed some very small indication that there might be a discontinuity of age relations at the end of individuals' eighties, and for activity participation already at the beginning of individuals' eighties. In conclusion, models conceptualizing aging as a gradual development might not suffice to adequately represent the differences between the stages of young-old and old-old age due to some very small indication that there might be discontinuity in late adulthood.

  17. Convergence Improvement of Response Matrix Method with Large Discontinuity Factors

    International Nuclear Information System (INIS)

    Yamamoto, Akio

    2003-01-01

    In the response matrix method, a numerical divergence problem has been reported when extremely small or large discontinuity factors are utilized in the calculations. In this paper, an alternative response matrix formulation to solve the divergence problem is discussed, and properties of iteration matrixes are investigated through eigenvalue analyses. In the conventional response matrix formulation, partial currents between adjacent nodes are assumed to be discontinuous, and outgoing partial currents are converted into incoming partial currents by the discontinuity factor matrix. Namely, the partial currents of the homogeneous system (i.e., homogeneous partial currents) are treated in the conventional response matrix formulation. In this approach, the spectral radius of an iteration matrix for the partial currents may exceed unity when an extremely small or large discontinuity factor is used. Contrary to this, an alternative response matrix formulation using heterogeneous partial currents is discussed in this paper. In the latter approach, partial currents are assumed to be continuous between adjacent nodes, and discontinuity factors are directly considered in the coefficients of a response matrix. From the eigenvalue analysis of the iteration matrix for the one-group, one-dimensional problem, the spectral radius for the heterogeneous partial current formulation does not exceed unity even if an extremely small or large discontinuity factor is used in the calculation; numerical stability of the alternative formulation is superior to the conventional one. The numerical stability of the heterogeneous partial current formulation is also confirmed by the two-dimensional light water reactor core analysis. Since the heterogeneous partial current formulation does not require any approximation, the converged solution exactly reproduces the reference solution when the discontinuity factors are directly derived from the reference calculation

  18. Schroedinger propagation of initial discontinuities leads to divergence of moments

    International Nuclear Information System (INIS)

    Marchewka, A.; Schuss, Z.

    2009-01-01

    We show that the large phase expansion of the Schroedinger propagation of an initially discontinuous wave function leads to the divergence of average energy, momentum, and displacement, rendering them unphysical states. If initially discontinuous wave functions are considered to be approximations to continuous ones, the determinant of the spreading rate of these averages is the maximal gradient of the initial wave function. Therefore a dilemma arises between the inclusion of discontinuous wave functions in quantum mechanics and the requirement of finite moments.

  19. Schroedinger propagation of initial discontinuities leads to divergence of moments

    Energy Technology Data Exchange (ETDEWEB)

    Marchewka, A., E-mail: avi.marchewka@gmail.co [Ruppin Academic Center, Emek-Hefer 40250 (Israel); Schuss, Z., E-mail: schuss@post.tau.ac.i [Department of Mathematics, Tel-Aviv University, Ramat-Aviv, 69978 Tel-Aviv (Israel)

    2009-09-21

    We show that the large phase expansion of the Schroedinger propagation of an initially discontinuous wave function leads to the divergence of average energy, momentum, and displacement, rendering them unphysical states. If initially discontinuous wave functions are considered to be approximations to continuous ones, the determinant of the spreading rate of these averages is the maximal gradient of the initial wave function. Therefore a dilemma arises between the inclusion of discontinuous wave functions in quantum mechanics and the requirement of finite moments.

  20. Significance of definitions of relapse after discontinuation of oral antivirals in HBeAg-negative chronic hepatitis B.

    Science.gov (United States)

    Papatheodoridis, George V; Manolakopoulos, Spilios; Su, Tung-Hung; Siakavellas, Spyros; Liu, Chun-Jen; Kourikou, Anastasia; Yang, Hung-Chih; Kao, Jia-Horng

    2017-08-31

    Relapses are observed in most hepatitis B e antigen (HBeAg)-negative chronic hepatitis B patients who discontinue treatment with nucleos(t)ide analogues (NAs); however, the rates of relapse vary widely among studies, and whether all patients with relapse need retreatment is unclear. The aim of this study was to assess the impact of different definitions on the rates of posttreatment relapse and therefore on the probability of retreatment in patients who have discontinued effective long-term NA therapy. In total, 130 HBeAg-negative chronic hepatitis B patients without cirrhosis and before NA treatment were included. All had on-therapy virological remission for ≥24 months and close follow-up for ≥12 months after stopping NA treatment or until retreatment, which started on stringent predefined criteria. Relapses rates based on several predetermined definitions of virological and perhaps biochemical criteria were assessed. The median duration of therapy was 60 months and the median duration of on-therapy virological remission was 43 months. During a median off-NAs follow-up of 15 months, no patient experienced liver decompensation or died. Cumulative relapse rates were 2%-49%, 4%-73%, 11%-82%, and 16%-90% at 3, 6, 12, and 24 months, respectively, whereas cumulative retreatment rates were 15%, 22%, and 40% at 6, 12, and 24 months, respectively, after discontinuation of NA therapy. No patient characteristic was independently associated with the probability of relapse based on at least two definitions or of retreatment. In HBeAg-negative chronic hepatitis B patients who discontinue NA therapy, the definition of relapse has a great impact on off-NAs relapse rates and potentially on the probability of retreatment. Regardless of definition, off-NAs relapses cannot be easily predicted by patient characteristics. A substantial proportion of such patients may not require retreatment if stringent criteria are adopted. (Hepatology 2017). © 2017 by the American Association

  1. Quetiapine monotherapy in acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Maneeton N

    2016-01-01

    Full Text Available Narong Maneeton,1 Benchalak Maneeton,1 Pakapan Woottiluk,2 Surinporn Likhitsathian,1 Sirijit Suttajit,1 Vudhichai Boonyanaruthee,1 Manit Srisurapanont1 1Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand Background: Some studies have indicated the efficacy of quetiapine in the treatment of generalized anxiety disorder (GAD.Objective: The purpose of this study was to systematically review the efficacy, acceptability, and tolerability of quetiapine in adult patients with GAD.Methods: The SCOPUS, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched in April 2015. All randomized controlled trials (RCTs of GAD were considered to be included in this meta-analysis. All RCTs of quetiapine in GAD patients providing endpoint outcomes relevant to severity of anxiety, response rate, remission rate, overall discontinuation rate, or discontinuation rate due to adverse events were included. The version reports from suitable clinical studies were explored, and the important data were extracted. Measurement for efficacy outcomes consisted of the mean-changed scores of the rating scales for anxiety, and response rate.Results: A total of 2,248 randomized participants in three RCTs were included. The pooled mean-changed score of the quetiapine-treated group was greater than that of the placebo-treated group and comparable to selective serotonin reuptake inhibitors (SSRIs. Unfortunately, the response and the remission rates in only 50 and 150 mg/day of quetiapine-XR (extended-release were better than those of the placebo. Their response and remission rates were comparable to SSRIs. The rates of pooled overall discontinuation and discontinuation due to adverse events of quetiapine-XR were greater than placebo. Only the overall discontinuation rate of quetiapine-XR at 50 and

  2. Forensic Excavation of Rock Masses: A Technique to Investigate Discontinuity Persistence

    Science.gov (United States)

    Shang, J.; Hencher, S. R.; West, L. J.; Handley, K.

    2017-11-01

    True persistence of rock discontinuities (areas with insignificant tensile strength) is an important factor controlling the engineering behaviour of fractured rock masses, but is extremely difficult to quantify using current geological survey methodologies, even where there is good rock exposure. Trace length as measured in the field or using remote measurement devices is actually only broadly indicative of persistence for rock engineering practice and numerical modelling. Visible traces of discontinuities are treated as if they were open fractures within rock mass classifications, despite many such traces being non-persistent and actually retaining considerable strength. The common assumption of 100% persistence, based on trace length, is generally extremely conservative in terms of strength and stiffness, but not always so and may lead to a wrong prediction of failure mechanism or of excavatability. Assuming full persistence would give hopelessly incorrect predictions of hydraulic conductivity. A new technique termed forensic excavation of rock masses is introduced, as a procedure for directly investigating discontinuity persistence. This technique involves non-explosive excavation of rock masses by injecting an expansive chemical splitter along incipient discontinuities. On expansion, the splitter causes the incipient traces to open as true joints. Experiments are described in which near-planar rock discontinuities, through siltstone and sandstone, were opened up by injecting the splitter into holes drilled along the lines of visible traces of the discontinuities in the laboratory and in the field. Once exposed the surfaces were examined to investigate the pre-existing persistence characteristics of the incipient discontinuities. One conclusion from this study is that visible trace length of a discontinuity can be a poor indicator of true persistence (defined for a fracture area with negligible tensile strength). An observation from this series of experiments

  3. The effect of discontinuities on the corrosion behaviour of copper canisters

    International Nuclear Information System (INIS)

    King, F.

    2004-03-01

    Discontinuities may remain in the weld region of copper canisters following the final closure welding and inspection procedures. Although the shell of the copper canister is expected to exhibit excellent corrosion properties in the repository environment, the question remains what impact these discontinuities might have on the long-term performance and service life of the canister. A review of the relevant corrosion literature has been carried out and an expert opinion of the impact of these discontinuities on the canister lifetime has been developed. Since the amount of oxidant in the repository is limited and the maximum wall penetration is expected to be 2 O/Cu(OH) 2 film at a critical electrochemical potential determines where and when pits initiate, not the presence of pit-shaped surface discontinuities. The factors controlling pit growth and death are well understood. There is evidence for a maximum pit radius for copper in chloride solutions, above which the small anodic: cathodic surface area ratio required for the formation of deep pits cannot be sustained. This maximum pit radius is of the order of 0.1-0.5 mm. Surface discontinuities larger than this size are unlikely to propagate as pits, and pits generated from smaller discontinuities will die once they reach this maximum size. Death of propagating pits will be compounded by the decrease in oxygen flux to the canister as the repository environment becomes anoxic. Surface discontinuities could impact the SCC behaviour either through their effect on the local environment or via stress concentration or intensification. There is no evidence that surface discontinuities will affect the initiation of SCC by ennoblement of the corrosion potential or the formation of locally aggressive conditions. Stress concentration at pits could lead to crack initiation under some circumstances, but the stress intensity factor for the resultant cracks, or for pre-existing crack-like discontinuities, will be smaller than the

  4. Automatic extraction of discontinuity orientation from rock mass surface 3D point cloud

    Science.gov (United States)

    Chen, Jianqin; Zhu, Hehua; Li, Xiaojun

    2016-10-01

    This paper presents a new method for extracting discontinuity orientation automatically from rock mass surface 3D point cloud. The proposed method consists of four steps: (1) automatic grouping of discontinuity sets using an improved K-means clustering method, (2) discontinuity segmentation and optimization, (3) discontinuity plane fitting using Random Sample Consensus (RANSAC) method, and (4) coordinate transformation of discontinuity plane. The method is first validated by the point cloud of a small piece of a rock slope acquired by photogrammetry. The extracted discontinuity orientations are compared with measured ones in the field. Then it is applied to a publicly available LiDAR data of a road cut rock slope at Rockbench repository. The extracted discontinuity orientations are compared with the method proposed by Riquelme et al. (2014). The results show that the presented method is reliable and of high accuracy, and can meet the engineering needs.

  5. A gradient estimate for solutions to parabolic equations with discontinuous coefficients

    Directory of Open Access Journals (Sweden)

    Jishan Fan

    2013-04-01

    Full Text Available Li-Vogelius and Li-Nirenberg gave a gradient estimate for solutions of strongly elliptic equations and systems of divergence forms with piecewise smooth coefficients, respectively. The discontinuities of the coefficients are assumed to be given by manifolds of codimension 1, which we called them emph{manifolds of discontinuities}. Their gradient estimate is independent of the distances between manifolds of discontinuities. In this paper, we gave a parabolic version of their results. That is, we gave a gradient estimate for parabolic equations of divergence forms with piecewise smooth coefficients. The coefficients are assumed to be independent of time and their discontinuities are likewise the previous elliptic equations. As an application of this estimate, we also gave a pointwise gradient estimate for the fundamental solution of a parabolic operator with piecewise smooth coefficients. Both gradient estimates are independent of the distances between manifolds of discontinuities.

  6. Seismological evidence of the Hales discontinuity in northeast India

    Science.gov (United States)

    Anand, Aakash; Bora, Dipok K.; Borah, Kajaljyoti; Madhab Borgohain, Jayanta

    2018-04-01

    The crust and upper mantle shear wave velocity structure beneath the northeast India is estimated by joint inversion of Rayleigh wave group velocity and receiver function, calculated from teleseismic earthquakes data recorded at nine broadband seismic stations. The Assam valley and the Shillong-Mikir plateau are the two important tectonic blocks in the northeast India, which are surrounded by the Himalayan collision zone in the north, Indo-Burma subduction zone in the east and by the Bengal basin in the south. The joint inversion followed by forward modeling reveal crustal thicknesses of 30-34 km beneath the Shillong plateau, 36 km beneath the Mikir hills and 38-40 km beneath the Assam valley with an average shear wave velocity (Vs) of 3.4-3.5 km/s. The estimated low upper mantle shear wave velocity (Vsn) 4.2-4.3 km/s may be due to the rock composition or grain size or increased temperature and partial melt (<1%) in the upper mantle, or an effect of all. Also, we report for the first time, the existence of the Hales discontinuity at depths 56-74 km with Vs ∼4.4-4.6 km/s. Variable depth of the Hales discontinuity may be explained by the geotherm and/or addition of Cr3+ and Fe2+ in the spinel-garnet system.

  7. Temperature Discontinuity Caused by Relocation of Meteorological Stations in Taiwan

    Directory of Open Access Journals (Sweden)

    Chih-wen Hung

    2009-01-01

    Full Text Available With global warming upon us, it has be come increasingly important to identify the extent of this warming trend and in doing so be able to rank mean temperature changes in particular seasons and years. This requires a need for homogeneous climate data, which do not reflect individual anomalies in instruments, station locations or local environments (urbanization. Ac curate homogeneous long-term meteorological data helps show how temperature variations have truly occurred in the climate. Many possible factors contribute to artificial abrupt changes or sharp discontinuities in long time series data, such as the impact of station relocation, changes in observational schedules and instrumentation. Homogeneity adjustments of in situ climate data are very important processes for preparing observational data to be used in further analysis and research. Users require a well-documented history of stations to make appropriate homogeneity adjustments because precise historical back ground records of stations can provide researchers with knowledge of when artificial discontinuity has occurred and its causes. With out such de tailed historical data for each meteorological station, abrupt changes are difficult to interpret. Unfortunately, no homogeneity adjustments for temperature records have been con ducted previously in Tai wan, and present available sources of the history of Taiwan's meteorological stations exhibit in consistencies. In this study, information pertaining to station history, especially relocation records, is pro vided. This information is essential for anal y sis of continuous time series data for temperature and climate warming studies. Temperature data from several stations is given in this study to show how artificial discontinuity occurs due to station relocation. Al though there is no homogeneous adjusted climate data provided in this preliminary work, the summarizing of information regarding station relocations should be of assistance

  8. A simple model of discontinuous firm’s growth

    OpenAIRE

    D'Elia, Enrico

    2011-01-01

    Typically, firms change their size through a row of discrete leaps over time. Sunk costs, regulatory, financial and organizational constraints, talent distribution and other factors may explain this fact. However, firms tend to grow or fall discontinuously even if those inertial factors were removed. For instance, a very essential model of discontinuous growth can be based on a couple of assumptions concerning only technology and entrepreneurs’ strategy, that is: (a) in the short run, the...

  9. Reciprocity principle for scattered fields from discontinuities in waveguides.

    Science.gov (United States)

    Pau, Annamaria; Capecchi, Danilo; Vestroni, Fabrizio

    2015-01-01

    This study investigates the scattering of guided waves from a discontinuity exploiting the principle of reciprocity in elastodynamics, written in a form that applies to waveguides. The coefficients of reflection and transmission for an arbitrary mode can be derived as long as the principle of reciprocity is satisfied at the discontinuity. Two elastodynamic states are related by the reciprocity. One is the response of the waveguide in the presence of the discontinuity, with the scattered fields expressed as a superposition of wave modes. The other state is the response of the waveguide in the absence of the discontinuity oscillating according to an arbitrary mode. The semi-analytical finite element method is applied to derive the needed dispersion relation and wave mode shapes. An application to a solid cylinder with a symmetric double change of cross-section is presented. This model is assumed to be representative of a damaged rod. The coefficients of reflection and transmission of longitudinal waves are investigated for selected values of notch length and varying depth. Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Discontinuities Characteristics of the Upper Jurassic Arab-D Reservoir Equivalent Tight Carbonates Outcrops, Central Saudi Arabia

    Science.gov (United States)

    Abdlmutalib, Ammar; Abdullatif, Osman

    2017-04-01

    Jurassic carbonates represent an important part of the Mesozoic petroleum system in the Arabian Peninsula in terms of source rocks, reservoirs, and seals. Jurassic Outcrop equivalents are well exposed in central Saudi Arabia and which allow examining and measuring different scales of geological heterogeneities that are difficult to collect from the subsurface due to limitations of data and techniques. Identifying carbonates Discontinuities characteristics at outcrops might help to understand and predict their properties and behavior in the subsurface. The main objective of this study is to identify the lithofacies and the discontinuities properties of the upper Jurassic carbonates of the Arab D member and the Jubaila Formation (Arab-D reservoir) based on their outcrop equivalent strata in central Saudi Arabia. The sedimentologic analysis revealed several lithofacies types that vary in their thickness, abundances, cyclicity and vertical and lateral stacking patterns. The carbonates lithofacies included mudstone, wackestone, packstone, and grainstone. These lithofacies indicate deposition within tidal flat, skeletal banks and shallow to deep lagoonal paleoenvironmental settings. Field investigations of the outcrops revealed two types of discontinuities within Arab D Member and Upper Jubaila. These are depositional discontinuities and tectonic fractures and which all vary in their orientation, intensity, spacing, aperture and displacements. It seems that both regional and local controls have affected the fracture development within these carbonate rocks. On the regional scale, the fractures seem to be structurally controlled by the Central Arabian Graben System, which affected central Saudi Arabia. While, locally, at the outcrop scale, stratigraphic, depositional and diagenetic controls appear to have influenced the fracture development and intensity. The fracture sets and orientations identified on outcrops show similarity to those fracture sets revealed in the upper

  11. Epstein-Barr virus DNA monitoring in serum and whole blood in pediatric liver transplant recipients who do or do not discontinue immunosuppressive therapy.

    Science.gov (United States)

    Kullberg-Lindh, C; Saalman, R; Olausson, M; Herlenius, G; Lindh, M

    2017-08-01

    The rate of PTLD can be reduced by weaned IS guided by monitoring of EBV DNA. In this single-center retrospective case series study, we analyzed how reduction in IS influenced EBV DNA levels in whole blood and serum in 30 children during the first year after liver transplantation, and how these levels were related to symptoms putatively due to EBV. Primary and reactivated EBV infection was seen in 18 (60%) and eight patients (27%), respectively. Thirteen patients (42%) developed chronic high load the first year post-transplant. IS was successfully discontinued in six patients the first year post-transplant and in another two patients within 3 years. EBV DNA levels were reduced, but persisted long term in all the eight patients who had IS completely withdrawn. There was no case of PTLD. In summary, EBV DNAemia and chronic high load were very common after pediatric liver transplantation. Liver graft tolerance facilitates radical reduction in IS treatment, which may prevent PTLD, but EBV DNAemia may persist long term after discontinued IS. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Economic comparison of common treatment protocols and J5 vaccination for clinical mastitis in dairy herds using optimized culling decisions.

    Science.gov (United States)

    Kessels, J A; Cha, E; Johnson, S K; Welcome, F L; Kristensen, A R; Gröhn, Y T

    2016-05-01

    This study used an existing dynamic optimization model to compare costs of common treatment protocols and J5 vaccination for clinical mastitis in US dairy herds. Clinical mastitis is an infection of the mammary gland causing major economic losses in dairy herds due to reduced milk production, reduced conception, and increased risk of mortality and culling for infected cows. Treatment protocols were developed to reflect common practices in dairy herds. These included targeted therapy following pathogen identification, and therapy without pathogen identification using a broad-spectrum antimicrobial or treating with the cheapest treatment option. The cost-benefit of J5 vaccination was also estimated. Effects of treatment were accounted for as changes in treatment costs, milk loss due to mastitis, milk discarded due to treatment, and mortality. Following ineffective treatments, secondary decisions included extending the current treatment, alternative treatment, discontinuing treatment, and pathogen identification followed by recommended treatment. Average net returns for treatment protocols and vaccination were generated using an existing dynamic programming model. This model incorporates cow and pathogen characteristics to optimize management decisions to treat, inseminate, or cull cows. Of the treatment protocols where 100% of cows received recommended treatment, pathogen-specific identification followed by recommended therapy yielded the highest average net returns per cow per year. Out of all treatment scenarios, the highest net returns were achieved with selecting the cheapest treatment option and discontinuing treatment, or alternate treatment with a similar spectrum therapy; however, this may not account for the full consequences of giving nonrecommended therapies to cows with clinical mastitis. Vaccination increased average net returns in all scenarios. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  13. Discontinuous precipitation and ordering in Ni2V-Cu alloys

    International Nuclear Information System (INIS)

    Sukhanov, V.D; Boyarshinova, T.S.; Shashkov, O.D.

    1986-01-01

    Ni-V-Cu system alloys were used to investigate the effect of ordering on over-saturated solid solution decomposition. It was discovered that ordering in the process of grain boundary migration (discontinuous disordering), stimulated changing of continuous precipitation mechanism for discontinuous one

  14. A gradient estimate for solutions to parabolic equations with discontinuous coefficients

    OpenAIRE

    Fan, Jishan; Kim, Kyoungsun; Nagayasu, Sei; Nakamura, Gen

    2011-01-01

    Li-Vogelius and Li-Nirenberg gave a gradient estimate for solutions of strongly elliptic equations and systems of divergence forms with piecewise smooth coefficients, respectively. The discontinuities of the coefficients are assumed to be given by manifolds of codimension 1, which we called them emph{manifolds of discontinuities}. Their gradient estimate is independent of the distances between manifolds of discontinuities. In this paper, we gave a parabolic version of their results. T...

  15. Factors Influencing Contraceptive Choice and Discontinuation ...

    African Journals Online (AJOL)

    Erah

    2010-03-30

    women indicated that their HIV status dictated contraceptive decisions, particularly with ... Women reported method discontinuation because of side effects, having met desired parity, ...... Washington, D.C., 2009. ... Accessed March 30, 2010.

  16. 41 CFR 101-39.105 - Discontinuance or curtailment of service.

    Science.gov (United States)

    2010-07-01

    ..., AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet Management Systems § 101-39.105 Discontinuance or curtailment of service. (a... efficiencies are realized from the operation of any fleet management system, the Administrator, GSA, will...

  17. How do horizontal, frictional discontinuities affect reverse fault-propagation folding?

    Science.gov (United States)

    Bonanno, Emanuele; Bonini, Lorenzo; Basili, Roberto; Toscani, Giovanni; Seno, Silvio

    2017-09-01

    The development of new reverse faults and related folds is strongly controlled by the mechanical characteristics of the host rocks. In this study we analyze the impact of a specific kind of anisotropy, i.e. thin mechanical and frictional discontinuities, in affecting the development of reverse faults and of the associated folds using physical scaled models. We perform analog modeling introducing one or two initially horizontal, thin discontinuities above an initially blind fault dipping at 30° in one case, and 45° in another, and then compare the results with those obtained from a fully isotropic model. The experimental results show that the occurrence of thin discontinuities affects both the development and the propagation of new faults and the shape of the associated folds. New faults 1) accelerate or decelerate their propagation depending on the location of the tips with respect to the discontinuities, 2) cross the discontinuities at a characteristic angle (∼90°), and 3) produce folds with different shapes, resulting not only from the dip of the new faults but also from their non-linear propagation history. Our results may have direct impact on future kinematic models, especially those aimed to reconstruct the tectonic history of faults that developed in layered rocks or in regions affected by pre-existing faults.

  18. Discontinuity of mode transition and hysteresis in hydrogen inductively coupled plasma via a fluid model

    International Nuclear Information System (INIS)

    Xu Hui-Jing; Shu-Xia Zhao; Gao Fei; Zhang Yu-Ru; Li Xue-Chun; Wang You-Nian

    2015-01-01

    A new type of two-dimensional self-consistent fluid model that couples an equivalent circuit module is used to investigate the mode transition characteristics and hysteresis in hydrogen inductively coupled plasmas at different pressures, by varying the series capacitance of the matching box. The variations of the electron density, temperature, and the circuit electrical properties are presented. As cycling the matching capacitance, at high pressure both the discontinuity and hysteresis appear for the plasma parameters and the transferred impedances of both the inductive and capacitive discharge components, while at low pressure only the discontinuity is seen. The simulations predict that the sheath plays a determinative role on the presence of discontinuity and hysteresis at high pressure, by influencing the inductive coupling efficiency of applied power. Moreover, the values of the plasma transferred impedances at different pressures are compared, and the larger plasma inductance at low pressure due to less collision frequency, as analyzed, is the reason why the hysteresis is not seen at low pressure, even with a wider sheath. Besides, the behaviors of the coil voltage and current parameters during the mode transitions are investigated. They both increase (decrease) at the E to H (H to E) mode transition, indicating an improved (worsened) inductive power coupling efficiency. (paper)

  19. Father's Labour Migration and Children's School Discontinuation in Rural Mozambique.

    Science.gov (United States)

    Yabiku, Scott T; Agadjanian, Victor

    2017-08-01

    We examine how the discontinuation of schooling among left-behind children is related to multiple dimensions of male labor migration: the accumulation of migration experience, the timing of these migration experiences in the child's life course, and the economic success of the migration. Our setting is rural southern Mozambique, an impoverished area with massive male labor out-migration. Results show that fathers' economically successful labor migration is more beneficial for children's schooling than unsuccessful migration or non-migration. There are large differences, however, by gender: compared to sons of non-migrants, sons of migrant fathers (regardless of migration success) have lower rates of school discontinuation, while daughters of migrant fathers have rates of school discontinuation no different than daughters of non-migrants. Furthermore, accumulated labor migration across the child's life course is beneficial for boys' schooling, but not girls'. Remittances sent in the past year reduce the rate of discontinuation for sons, but not daughters.

  20. 21 CFR 1301.52 - Termination of registration; transfer of registration; distribution upon discontinuance of business.

    Science.gov (United States)

    2010-04-01

    ... discontinues business or professional practice. Any registrant who ceases legal existence or discontinues... registration; distribution upon discontinuance of business. 1301.52 Section 1301.52 Food and Drugs DRUG... of registration; transfer of registration; distribution upon discontinuance of business. (a) Except...

  1. Apical root resorption due to orthodontic treatment detected by cone beam computed tomography.

    Science.gov (United States)

    Castro, Iury O; Alencar, Ana H G; Valladares-Neto, José; Estrela, Carlos

    2013-03-01

    To determine the frequency of apical root resorption (ARR) due to orthodontic treatment using cone beam computed tomography (CBCT) in a sample of 1256 roots from 30 patients. All patients had Class I malocclusion with crowding. Of the 30 patients evaluated, 11 were boys and 19 were girls; their mean age was 13 years (11 to 16 years). Orthodontic treatment followed the nonextraction treatment. CBCT images were obtained before and after orthodontic treatment, and ARR was determined using Axial Guided Navigation of CBCT images. All patients had ARR. No statistically significant association was found between resorption frequency, gender, and age. ARR was detected using CBCT in 46% of all roots that underwent orthodontic treatment. CBCT was effective for detecting in vivo even minimal degrees of ARR due to orthodontic treatment and allowed three-dimensional evaluation of dental roots and visualization of palatine roots of maxillary molars. The highest frequencies and the most significant ARR occurred in incisors and distal roots of first maxillary and mandibular molars.

  2. The Effect of Levothyroxine Discontinuation Timing on Postoperative Hypothyroidism after Hemithyroidectomy for Papillary Thyroid Microcarcinoma

    Directory of Open Access Journals (Sweden)

    Tae Kwun Ha

    2016-01-01

    Full Text Available Objective. No previous studies regarding the appropriate timing of thyroid hormone discontinuation after hemithyroidectomy have been published. This study aimed to identify the appropriate timing for levothyroxine discontinuation after hemithyroidectomy among patients with papillary thyroid microcarcinoma (PTMC. Methods. This study retrospectively evaluated 304 patients who underwent ≥1 attempt to discontinue levothyroxine after hemithyroidectomy for treating PTMC between January 2008 and December 2013. Fifty-three patients were excluded because of preoperative hypothyroidism or hyperthyroidism, a history of thyroid hormone or antithyroid therapy, no available serological data, or a postoperative follow-up of <24 months. We evaluated the associations of successful levothyroxine discontinuation with patient age, sex, preoperative serological data, underlying thyroid gland histopathology, anteroposterior diameter of the residual thyroid gland, number of discontinuation attempts, and initial discontinuation timing. Results. Among the 251 included patients, 125 patients (49.8% achieved successful levothyroxine discontinuation during the follow-up period after hemithyroidectomy. There was a significant difference in the outcomes for patients who underwent an initial discontinuation attempt at ≤3 months and ≥4 months after hemithyroidectomy (p < 0.001. There were significant differences in the discontinuation outcomes according to underlying thyroid histopathology (p = 0.001, preoperative thyroid-stimulating hormone levels (p < 0.001, and number of discontinuation attempts (p < 0.001. Conclusions. Among patients with PTMC, the initial levothyroxine discontinuation attempt is recommended at ≥4 months after hemithyroidectomy.

  3. Quantum field theory near surfaces of discontinuity

    International Nuclear Information System (INIS)

    Onishi, H.T.

    1981-01-01

    This work deals with the problem of a quantized scalar field propagating near a surface of discontinuity. The proper time formalism is employed to express the Green's function and stress tensor as proper time integrals of a transformation function. The transformation function is calculated by a WKB approximation which exhibits the essential singularities generated by the high frequency behavior of waves propagating near the surface. Two singularities are present, the usual direct singularity and an additional reflected singularity generated by the high frequency behavior of waves reflected by the discontinuity. The stress tensor is calculated by dimensional continuation. The results are employed to analyze energy generated by the surface

  4. Corticosteroid-induced asthma: a manifestation of limited hyperinfection syndrome due to Strongyloides stercoralis.

    Science.gov (United States)

    Sen, P; Gil, C; Estrellas, B; Middleton, J R

    1995-09-01

    Inadequate therapeutic response to parenteral corticosteroids in patients with acute bronchial asthma is infrequent. We report four patients whose bronchial asthma symptoms worsened after treatment with parenteral corticosteroids. All had larvae of Strongyloides stercoralis in the stool. The new attack or the exacerbation of asthma appeared to be precipitated by systemic corticosteroid administration. The paradoxic therapeutic response of asthma to glucocorticoides was the major pulmonary manifestation of Strongyloides superinfection; there was no evidence of other organ involvement. Individuals with new onset of bronchial asthma or worsening of asthmatic episodes concurrent with the use of systemic corticosteroids should have thorough investigation for possible superinfection due to Strongyloides stercoralis. This is particularly important for patients who have resided in areas where intestinal helminthic infections are endemic. Discontinuance of steroid therapy or reduction in dosage of parenteral steroids appears necessary. Treatment with thiabendazole appears to be effective in patients with limited hyperinfection syndrome.

  5. Strong discontinuity with cam clay under large deformations

    DEFF Research Database (Denmark)

    Katic, Natasa; Hededal, Ole

    2008-01-01

    The work shows simultaneous implementation of Strong discontinuity approach (SDA) by means of Enhanced Assumed Strain (EAS) and Critical State Soil Mechanics CSSM) in large strain regime. The numerical model is based on an additive decomposition of the displacement gradient into a conforming and ...... and an enhanced part. The localized deformations are approximated by means of a discontinuous displacement field. The applied algorithm leads to a predictor/corrector procedure which is formally identical to the returnmapping algorithm of classical (local and continuous) Cam clay model....

  6. Stacking by electroinjection with discontinuous buffers in capillary zone electrophoresis.

    Science.gov (United States)

    Shihabi, Zak K

    2002-08-01

    The work presented here demonstrates that electroinjection can be performed using discontinuous buffers, which can result in better stacking than that obtained by hydrodynamic injection. The sample can be concentrated at the tip of the capillary leaving practically the whole capillary for sample separation. This results in several advantages, such as better sample concentration, higher plate number and shorter time of stacking. However, sample introduction by electromigration is suited for samples free or low in salt content. Samples, which are high in salt content, are better introduced by the hydrodynamic injection for stacking by the discontinuous buffers. Different simple methods to introduce the discontinuity in the buffer for electroinjection are discussed.

  7. [Surgical Treatment of Bronchial Stricture due to Endobronchial Tuberculosis: 
Results in 36 Consecutive Cases].

    Science.gov (United States)

    Ruan, Junzhong; Zhang, Tianhui; Li, Fugen; Duan, Yong; Han, Ming; Wang, Zitong

    2018-04-20

    Bronchial tuberculosis is a common complication of pulmonary tuberculosis. The present report is to investigate and analyze the indication and efficacy of surgical treatment of bronchial stricture due to severe endobronchial tuberculosis, when the drug and endoscopic treatment were no effect. Reviewed the clinical-pathological records documenting the surgical outcomes in 36 bronchial stricture due to severe endobronchial tuberculosis who underwent lobectomy or pneumonectomy enrolled in our hospital between January 2000 and February 2016. Pneumonectomy in 8 cases, lobectomy in 23 cases, sleeve resection in 5 cases. No intraoperative or early postoperative death occurred. Six patients developed complications. All 6 cases recovered well after treatment. Surgical treatment is still the recommended treatment modatity for bronchial stricture caused by endobronchial tuberculosis due to its good results. It should be performed in time when the drug and intraluninal treatment were no effect for avoiding of being progeressed.

  8. Treatment of Adults with Idiopathic Recurrent Pericarditis: Novel Use of Immunotherapy.

    Science.gov (United States)

    Schwier, Nicholas C; Hale, Genevieve M; Davies, Marie L

    2017-03-01

    Idiopathic recurrent pericarditis (IRP) can be challenging to treat. Even after guideline-directed first-line treatment consisting of aspirin (ASA) or a nonsteroidal antiinflammatory drug (NSAID) in combination with colchicine therapy, recurrences still occur in greater than 20% of patients. Many patients then require treatment with long-term corticosteroids, which is not a favorable option due to their short- and long-term adverse effects. Because it is theorized that the pathophysiology of IRP may possess autoimmune sequelae, the use of immunotherapy for the treatment of IRP has emerged. In this review, we describe the literature associated with immunotherapy used to treat IRP in an adult population as well as provide an overview of the safety and monitoring parameters for each agent. The most common immunotherapies used after patients have had multiple recurrences of IRP are anakinra, intravenous immunoglobulin (IVIG), and azathioprine. In most cases, these immunotherapies are adjunctive therapy, with the goal of tapering and discontinuing immunosuppressive corticosteroids. After reviewing the data, anakinra resulted in more patients discontinuing corticosteroids and prevented further recurrences of pericarditis. IVIG resulted in symptom resolution and no further recurrences in most of the patients. Azathioprine was associated with more than half of patients becoming recurrence free; however, many patients required a restart of corticosteroids due to recurrence. Clinicians should be aware of the adverse effects of immunotherapy, ranging from mild gastrointestinal events to risk of infection and serious blood dyscrasias that may require diligent monitoring. The use of immunotherapy for the treatment of adults with IRP should be restricted to patients who have multiple recurrences. Ideally, immunotherapy would be adjunctive to first-line combination therapy with ASA/NSAID plus colchicine, with the goal of tapering and discontinuing immunosuppressive

  9. A note on iterated function systems with discontinuous probabilities

    International Nuclear Information System (INIS)

    Jaroszewska, Joanna

    2013-01-01

    Highlights: ► Certain iterated function system with discontinuous probabilities is discussed. ► Existence of an invariant measure via the Schauder–Tychonov theorem is established. ► Asymptotic stability of the system under examination is proved. -- Abstract: We consider an example of an iterated function system with discontinuous probabilities. We prove that it posses an invariant probability measure. We also prove that it is asymptotically stable provided probabilities are positive

  10. Discontinuities in Early Development of the Understanding of Physical Causality

    Science.gov (United States)

    Aschersleben, Gisa; Henning, Anne; Daum, Moritz M.

    2013-01-01

    Research on early physical reasoning has shown surprising discontinuities in developmental trajectories. Infants possess some skills that seem to disappear and then re-emerge in childhood. It has been suggested that prediction skills required in search tasks might cause these discontinuities (Keen, 2003). We tested 3.5- to 5-year-olds'…

  11. Discontinuation of penicillamine in the absence of alternative orphan drugs (trientine-zinc): a case of decompensated liver cirrhosis in Wilson's disease.

    Science.gov (United States)

    Ping, C C; Hassan, Y; Aziz, N A; Ghazali, R; Awaisu, A

    2007-02-01

    To report a case of early-decompensated liver cirrhosis secondary to discontinuation of penicillamine therapy in a patient with Wilson's disease. A 33-year-old Chinese female patient was diagnosed with Wilson's disease, for which penicillamine 250 mg p.o. once daily was prescribed. However, the patient developed intolerance and penicillamine was discontinued without alternative treatment. Five months later, she developed decompensated liver cirrhosis with hepatic encephalopathy. Eventually, the patient died because of the complications of sepsis and decompensated liver failure. Chelating agent is the mainstay of treatment in Wilson's disease, which is an inherited disorder of hepatic copper metabolism. Therapy must be instituted and continued for life once diagnosis is confirmed. Interruption of therapy can be fatal or cause irreversible relapse. Penicillamine given orally is the chelating agent of first choice. However, its unfavourable side-effects profile leads to discontinuation of therapy in 20-30% of patients. In most case reports, cessation of penicillamine without replacement treatment causes rapid progression to fulminant hepatitis, which is fatal unless liver transplantation is performed. In this, we highlight a case of discontinuation of penicillamine in a patient with Wilson's disease without substitution with alternative regimen. This was caused by unavailability of the alternative agents such as trientine in our country. Consequently, the patient progressed to decompensated liver cirrhosis with encephalopathy and eventually passed-away within 5 months. One recent study supports a combination of trientine and zinc in treating patient with decompensated liver cirrhosis. This combination is capable of reversing liver failure and prevents the need of liver transplantation. Both trientine and zinc are not registered in Malaysia. Therefore, liver transplantation was probably the only treatment option for this patient. Hence, non-availability of orphan drugs

  12. Work related determinants of breastfeeding discontinuation among employed mothers in Malaysia

    Directory of Open Access Journals (Sweden)

    Darus Azlan

    2011-02-01

    Full Text Available Abstract Background This cross-sectional study assesses factors that contribute to discontinuing breastfeeding among employed mothers in Malaysia. Methods A structured questionnaire was used in conducting this study involving all government health clinics in Petaling district between July and September 2006. Respondents were Malaysian women with children between the ages of six to twelve months who were formally employed. Factors studied were selected socio-demographic and work-related characteristics. Results From a total of 290 respondents, 51% discontinued breastfeeding. The majority (54% of mothers who discontinued breastfeeding had breastfed their babies for less than three months. Compared to Malay mothers, the risk of breastfeeding discontinuation were higher among Chinese (AOR 3.7, 95% CI: 1.7, 7.8 and Indian mothers (AOR 7.3, 95% CI 1.9, 27.4. Not having adequate breastfeeding facilities at the workplace was also a risk factor for breastfeeding discontinuation (AOR 1.8, 95% CI: 1.05, 3.1. Conclusion It is important that workplaces provide adequate breastfeeding facilities such as a room in which to express breast milk and a refrigerator, and allow mothers flexible time to express breast milk.

  13. Reasons given by mothers for discontinuing breastfeeding in Iran

    Directory of Open Access Journals (Sweden)

    Olang Beheshteh

    2012-05-01

    Full Text Available Abstract Background We have previously shown that in Iran, only 28% of infants were exclusively breastfed at six months, despite a high prevalence of breastfeeding at two years of age. The primary aim of this study was to investigate the reasons women discontinued exclusive breastfeeding. Method This retrospective study was based on questionnaires and interviews with 63,071 mothers of infants up to 24 months of age, divided into two populations: infants younger than six months and six months or older. The data were collected in 2005–2006 from all 30 provinces of Iran. Results Only 5.3% of infants less than six months of age stopped breastfeeding (mean age of 3.2 months; more commonly in urban than rural areas. The most frequently cited reasons mothers gave for discontinuing exclusive breastfeeding were physicians’ recommendation (54% and insufficient breast milk (self-perceived or true, 28%. Breastfeeding was common after six months of age: only 11% of infants discontinued breastfeeding, at a mean of 13.8 months. The most common reason for discontinuation at this age was insufficient breast milk (self-perceived or true, 45%. Maternal illness or medication (10%, infant illness (6%, and return to work (3% were uncommon causes. Use of a pacifier was correlated with breastfeeding discontinuation. Maternal age and education was not associated with duration of breastfeeding. Multivariate analysis showed that using a pacifier and formula or other bottle feeding increased the risk of early cessation of breastfeeding. Conclusions Physicians and other health professionals have an important role to play in encouraging and supporting mothers to maintain breastfeeding.

  14. Multi-slicing strategy for the three-dimensional discontinuity layout optimization (3D DLO).

    Science.gov (United States)

    Zhang, Yiming

    2017-03-01

    Discontinuity layout optimization (DLO) is a recently presented topology optimization method for determining the critical layout of discontinuities and the associated upper bound limit load for plane two-dimensional and three-dimensional (3D) problems. The modelling process (pre-processing) for DLO includes defining the discontinuities inside a specified domain and building the target function and the global constraint matrix for the optimization solver, which has great influence on the the efficiency of the computation processes and the reliability of the final results. This paper focuses on efficient and reliable pre-processing of the discontinuities within the 3D DLO and presents a multi-slicing strategy, which naturally avoids the overlapping and crossing of different discontinuities. Furthermore, the formulation of the 3D discontinuity considering a shape of an arbitrary convex polygon is introduced, permitting the efficient assembly of the global constraint matrix. The proposed method eliminates unnecessary discontinuities in 3D DLO, making it possible to apply 3D DLO for solving large-scale engineering problems such as those involving landslides. Numerical examples including a footing test, a 3D landslide and a punch indentation are considered, illustrating the effectiveness of the presented method. © 2016 The Authors. International Journal for Numerical and Analytical Methods in Geomechanics published by John Wiley & Sons Ltd.

  15. Tofacitinib versus Biologic Treatments in Moderate-to-Severe Rheumatoid Arthritis Patients Who Have Had an Inadequate Response to Nonbiologic DMARDs: Systematic Literature Review and Network Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Evelien Bergrath

    2017-01-01

    Full Text Available Objective. To compare the efficacy and tolerability of tofacitinib, an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA, as monotherapy and combined with disease-modifying antirheumatic drugs (DMARDs versus biological DMARDs (bDMARDs and other novel DMARDs for second-line moderate-to-severe rheumatoid arthritis (RA patients by means of a systematic literature review (SLR and network meta-analysis (NMA. Methods. MEDLINE®, EMBASE®, and Cochrane Central Register of Controlled Trials were searched to identify randomized clinical trials (RCTs published between 1990 and March 2015. Efficacy data based on American College of Rheumatology (ACR response criteria, improvements in the Health Assessment Questionnaire Disability Index (HAQ-DI at 6 months, and discontinuation rates due to adverse events were analyzed by means of Bayesian NMAs. Results. 45 RCTs were identified, the majority of which demonstrated a low risk of bias. Tofacitinib 5 mg twice daily (BID and 10 mg BID monotherapy exhibited comparable efficacy and discontinuation rates due to adverse events versus other monotherapies. Tofacitinib 5 mg BID and 10 mg BID + DMARDs or methotrexate (MTX were mostly comparable to other combination therapies in terms of efficacy and discontinuation due to adverse events. Conclusion. In most cases, tofacitinib had similar efficacy and discontinuation rates due to adverse events compared to biologic DMARDs.

  16. Fitness in animals correlates with proximity to discontinuities in body mass distributions.

    Science.gov (United States)

    Angeler, David G.; Allen, Craig R.; Vila-Gispert, Anna; Almeida, David

    2014-01-01

    Discontinuous structure in landscapes may cause discontinuous, aggregated species body-mass patterns, reflecting the scales of structure available to animal communities within a landscape. Empirical analyses have shown that the location of species within body mass aggregations, which reflect this scale-specific organization, is non-random with regard to several ecological phenomena, including species extinctions. The propensity of declining species to have body masses proximate to discontinuities suggests that transition zones between scaling regimes ultimately decreases the ecological fitness for some species. We test this proposition using vulnerable and unthreatened fish species in Mediterranean streams with differing levels of human impact. We show that the proximity to discontinuities in body mass aggregations (“distance-to-edge”) of more vs. less fit individuals within vulnerable and unthreatened populations differs. Specifically, regression analysis between the scaled mass index, a proxy of animal fitness, and distance-to-edge reveals negative and positive relationships for vulnerable and unthreatened species, respectively. That is, fitness is higher close to discontinuities in vulnerable populations and toward the center of body mass aggregation groups in unthreatened populations. Our results demonstrate the suitability of the discontinuity framework for scrutinizing non-random patterns of environmental impact in populations. Further exploration of the usefulness of this method across other ecosystems and organism groups is warranted.

  17. A structural behavior study of rock caverns considering the effects of discontinuities

    International Nuclear Information System (INIS)

    Kim, Jhin Wung; Kim, Sun Hoon; Seo, Jeong Moon; Choi, Kyu Seop; Kim, Dae Hong; Lee, Kyung Jin; Choi, In Gil; Lee, Dong Yong

    1990-06-01

    The objective of this study is to understand the effects of discontinuities within rock masses on the structural behavior of underground rock caverns for radioactive waste disposal, and then develop a computer program for the structural analysis of rock caverns considering these effect of discontinuities. The behavior of rock masses, such as strength, deformation modes, ect., is very difficult to predict because discontinuities in the form of microcracks or joints are randomly distributed within rock masses. Discontinuties existing around the rock cavern for underground radioactive waste disposal may become the main transport pathways of radionuclides, and reduce the strength of rock masses eventually causing the rock cavern structure unstable. Therefore, a comprehensive understanding of the mechanical properties and behavior of discontinuous rock masses and an improvement of structural analysis methods are essential in order to understand the behavior of underground rock cavern structures properly in order to design safe and economic understanding the behavior of discontinuous rock masses is essential. Therfore, this study includes literature review on mechanical properties of and computational models for discontinuous rock masses, and on structures. Then, bases on the engineering judgement a suitable selection and slight modifications on computational models and analysis methods have been made before developing the structural analysis computer program for underground radioactive waste disposal structures. (author)

  18. Successful careers and cognitive style: a follow-up study of childhood family discontinuity.

    Science.gov (United States)

    Gordon, V Z

    1991-12-01

    It was predicted that those participants who experienced discontinuity (death, divorce, and separations) from their parent(s) in childhood and who had successful careers in adulthood would manifest more innovative than adaptive cognitive styles on the Kirton Adaption-Innovation Inventory. The original research showed 61% of the sample members (n = 41) experienced family discontinuity. Ninety percent (n = 37) of the previous participants responded and showed 59% family discontinuity. Fifty-four percent in the follow-up study chose an alternative career path (counterstriving), the same percentage as in the original sample. When both family discontinuity and counterstriving were present, statistically significant innovation scores occurred. Family discontinuity in childhood and a successful career in adulthood are likely to be associated with high striving-motivation and an innovative (paradigm-breaking) problem-solving style.

  19. The Influence of F0 Discontinuity on Intonational Cues to Word Segmentation

    DEFF Research Database (Denmark)

    Welby, Pauline; Niebuhr, Oliver

    2016-01-01

    The paper presents the results of a 2AFC offline wordidentification experiment by [1], reanalyzed to investigate how F0 discontinuities due to voiceless fricatives and voiceless stops affect cues to word segmentation in accentual phraseinitial rises (APRs) of French relative to a reference...... condition with liquid and nasal consonants. Although preliminary due to the small sample size, we found initial evidence that voiceless consonants degrade F0 cues to word segmentation relative to liquids and nasals. In addition, this degradation seems to be stronger for voiceless stops than for voiceless...... pitch impressions created by the fricative noise. Our results call for follow-up studies that use French APRs as a testing ground for this intonational model and also examine the precise nature of intonational cues to word segmentation....

  20. Occupy the Financial Niche – Saturation and Crisis (discontinuous decisions

    Directory of Open Access Journals (Sweden)

    Ionut PURICA

    2014-09-01

    Full Text Available The model presented is proposing an approach that could verify the nonlinear behaviour during a crisis, such that to quantify and predict potential discontinuous behaviour. In this case, the crisis behaviour associated with financial funds reallocation among various credit instruments, described as memes with the sense of Dawkins, is shown to be of discontinuous nature stemming from a logistic penetration in the financial behaviour niche. Actually the logistic penetration is typical in creating cyclic behaviour of economic structures as shown by Marchetti and others from IIASA. A Fokker-Planck equation description results in a stationary solution having a bifurcation like solution with evolution trajectories on a ‘cusp’ type catastrophe that may describe discontinuous decision behaviour

  1. Identification of small-scale discontinuities based on dip-oriented gradient energy entropy coherence estimation

    Science.gov (United States)

    Peng, Da; Yin, Cheng

    2017-09-01

    Locating small-scale discontinuities is one of the most challenging geophysical tasks; these subtle geological features are significant since they are often associated with subsurface petroleum traps. Subtle faults, fractures, unconformities, reef textures, channel boundaries, thin-bed boundaries and other structural and stratigraphic discontinuities have subtle geological edges which may provide lateral variation in seismic expression. Among the different geophysical techniques available, 3D seismic discontinuity attributes are particularly useful for highlighting discontinuities in the seismic data. Traditional seismic discontinuity attributes are sensitive to noise and are not very appropriate for detecting small-scale discontinuities. Thus, we present a dip-oriented gradient energy entropy (DOGEE) coherence estimation method to detect subtle faults and structural features. The DOGEE coherence estimation method uses the gradient structure tensor (GST) algorithm to obtain local dip information and construct a gradient correlation matrix to calculate gradient energy entropy. The proposed DOGEE coherence estimation method is robust to noise, and also improves the clarity of fault edges. It is effective for small-scale discontinuity characterisation and interpretation.

  2. Comparative Benefits and Harms of Complementary and Alternative Medicine Therapies for Initial Treatment of Major Depressive Disorder: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Asher, Gary N; Gartlehner, Gerald; Gaynes, Bradley N; Amick, Halle R; Forneris, Catherine; Morgan, Laura C; Coker-Schwimmer, Emmanuel; Boland, Erin; Lux, Linda J; Gaylord, Susan; Bann, Carla; Pierl, Christiane Barbara; Lohr, Kathleen N

    2017-12-01

    To report the comparative benefits and harms of exercise and complementary and alternative medicine (CAM) treatments with second-generation antidepressants (SGA) for major depressive disorder (MDD). Systematic review and meta-analysis. Outpatient clinics. Adults, aged 18 years and older, with MDD receiving an initial treatment attempt with SGA. Any CAM or exercise intervention compared with an SGA. Treatment response, remission, change in depression rating, adverse events, treatment discontinuation, and treatment discontinuation due to adverse events. We found 22 randomized controlled trials for direct comparisons and 127 trials for network meta-analyses, including trials of acupuncture, omega-3 fatty acids, S-adenosyl methionine, St. John's wort, and exercise. For most treatment comparisons, we found no differences between treatment groups for response and remission. However, the risk of bias of these studies led us to conclude that the strength of evidence for these findings was either low or insufficient. The risk of treatment harms and treatment discontinuation attributed to adverse events was higher for selective serotonin receptor inhibitors than for St. John's wort. Although we found little difference in the comparative efficacy of most CAM therapies or exercise and SGAs, the overall poor quality of the available evidence base tempers any conclusions that we might draw from those trials. Future trials should incorporate patient-oriented outcomes, treatment expectancy, depressive severity, and harms assessments into their designs; antidepressants should be administered over their full dosage ranges; and larger trials using methods to reduce sampling bias are needed.

  3. Bivirkninger som årsag til seponering af donepezil ved Alzheimers demens

    DEFF Research Database (Denmark)

    Carøe, Tanja Korfitsen; Moe, Claus

    2009-01-01

    INTRODUCTION: The objective was to investigate the frequency of adverse events (AE) as a cause for discontinuation of donepezil treatment for Alzheimer's dementia (DAT) in a geriatric memory unit. MATERIAL AND METHODS: Five-year retrospective study of 123 donepezil-treated patients diagnosed...... mixed dementia. A total of 100 (81%) were female while 23 (19%) were male. The median age was 84 years. In all, 26 (21%) patients discontinued treatment due to AE. The most frequent AE were nausea/vomiting, diarrhoea and loss of appetite. CONCLUSION: In 21% of the cases treatment was discontinued within...... 12 months due to AE. The most frequent AEs were nausea/vomiting, diarrhoea and loss of appetite. For the most part discontinuation took place within the initial three months. However, some treatments were not discontinued until after six months; consequently, treatment should be supervised...

  4. Reflection and transmission of ion acoustic waves from a plasma discontinuity

    International Nuclear Information System (INIS)

    Gary, S.P.; Alexeff, I.; Bloomberg, H.W.

    1975-01-01

    Transmission and reflection coefficients are calculated for an ion acoustic wave incident from the upstream direction upon a plasma discontinuity of width much less than the wavelength. In the limit of an infinitely strong discontinuity there is complete in phase reflection. (U.S.)

  5. Discontinuous precipitation and ordering in Ni/sub 2/V-Cu alloys

    Energy Technology Data Exchange (ETDEWEB)

    Sukhanov, V D; Boyarshinova, T S; Shashkov, O D

    1986-12-01

    Ni-V-Cu system alloys were used to investigate the effect of ordering on over-saturated solid solution decomposition. It was discovered that ordering in the process of grain boundary migration (discontinuous disordering), stimulated changing of continuous precipitation mechanism for discontinuous one.

  6. Evaluation of distant results after lamivudine discontinuation in children with chronic hepatitis B.

    Directory of Open Access Journals (Sweden)

    Lech Chyczewski

    2010-08-01

    Full Text Available The aim of this study was to estimate distant results after discontinuation of long term lamivudine treatment in children with chronic hepatitis B. Furthermore, the emergence of HBV polymerase gene variants in YMDD motif during therapy was examined. Additionally, the most commonly occurring type of mutation in the polymerase YMDD region were investigated. The study involved 27 HBeAg positive children with chronic hepatitis B. Children included to lamivudine therapy were previously treated without effects with interferon alpha.

  7. Prolonged-release melatonin versus placebo for benzodiazepine discontinuation in patients with schizophrenia: a randomized clinical trial - the SMART trial protocol

    DEFF Research Database (Denmark)

    Baandrup, Lone; Fagerlund, Birgitte; Jennum, Poul

    2011-01-01

    Treatment of schizophrenia frequently includes prolonged benzodiazepine administration despite a lack of evidence of its use. It is often difficult to discontinue benzodiazepines because of the development of dependence. We aim to assess if melatonin can facilitate the withdrawal of prolonged...

  8. Regression Discontinuity in Prospective Evaluations: The Case of the FFVP Evaluation

    Science.gov (United States)

    Klerman, Jacob Alex; Olsho, Lauren E. W.; Bartlett, Susan

    2015-01-01

    While regression discontinuity has usually been applied retrospectively to secondary data, it is even more attractive when applied prospectively. In a prospective design, data collection can be focused on cases near the discontinuity, thereby improving internal validity and substantially increasing precision. Furthermore, such prospective…

  9. hpGEM -- A software framework for discontinuous Galerkin finite element methods

    NARCIS (Netherlands)

    Pesch, L.; Bell, A.; Sollie, W.E.H.; Ambati, V.R.; Bokhove, Onno; van der Vegt, Jacobus J.W.

    2006-01-01

    hpGEM, a novel framework for the implementation of discontinuous Galerkin finite element methods, is described. We present structures and methods that are common for many (discontinuous) finite element methods and show how we have implemented the components as an object-oriented framework. This

  10. Longitudinal coupling impedance of step discontinuities in a circular beam tube

    International Nuclear Information System (INIS)

    Hahn, H.; Zatz, S.

    1979-01-01

    The longitudinal coupling impedance presented by a single wall discontinuity to the circulating beam in a circular accelerator or storage ring is usually analyzed by considering a developed periodic structure. However, the typical parameters are often such that it becomes adequate to treat the discontinuity as a nonperiodic problem. Using modal field matching methods, solutions were derived for the cases of a single as well as a double-step discontinuity in a circular beam tube. Numerical results are presented in this paper and the typical behavior at low frequency, at reasonance, and above cut-off is discussed

  11. Modeling shallow water flows using the discontinuous Galerkin method

    CERN Document Server

    Khan, Abdul A

    2014-01-01

    Replacing the Traditional Physical Model Approach Computational models offer promise in improving the modeling of shallow water flows. As new techniques are considered, the process continues to change and evolve. Modeling Shallow Water Flows Using the Discontinuous Galerkin Method examines a technique that focuses on hyperbolic conservation laws and includes one-dimensional and two-dimensional shallow water flows and pollutant transports. Combines the Advantages of Finite Volume and Finite Element Methods This book explores the discontinuous Galerkin (DG) method, also known as the discontinuous finite element method, in depth. It introduces the DG method and its application to shallow water flows, as well as background information for implementing and applying this method for natural rivers. It considers dam-break problems, shock wave problems, and flows in different regimes (subcritical, supercritical, and transcritical). Readily Adaptable to the Real World While the DG method has been widely used in the fie...

  12. Evaluation of energy absorption performance of steel square profiles with circular discontinuities

    Directory of Open Access Journals (Sweden)

    Dariusz Szwedowicz

    Full Text Available This article details the experimental and numerical results on the energy absorption performance of square tubular profile with circular discontinuities drilled at lengthwise in the structure. A straight profile pattern was utilized to compare the absorption of energy between the ones with discontinuities under quasi-static loads. The collapse mode and energy absorption conditions were modified by circular holes. The holes were drilled symmetrically in two walls and located in three different positions along of profile length. The results showed a better performance on energy absorption for the circular discontinuities located in middle height. With respect to a profile without holes, a maximum increase of 7% in energy absorption capacity was obtained experimentally. Also, the numerical simulation confirmed that the implementation of circular discontinuities can reduce the peak load (Pmax by 10%. A present analysis has been conducted to compare numerical results obtained by means of the finite element method with the experimental data captured by using the testing machine. Finally the discrete model of the tube with and without geometrical discontinuities presents very good agreements with the experimental results.

  13. Discontinuous jamming transitions in soft materials: coexistence of flowing and jammed states

    International Nuclear Information System (INIS)

    Dennin, Michael

    2008-01-01

    Many systems in nature exhibit transitions between fluid-like states and solid-like states, or 'jamming transitions'. There is a strong theoretical foundation for understanding equilibrium phase transitions that involve solidification, or jamming. Other jamming transitions, such as the glass transition, are less well understood. The jamming phase diagram has been proposed to unify the description of equilibrium phase transitions, the glass transitions, and other nonequilibrium jamming transitions. As with equilibrium phase transitions, which can either be first order (discontinuous in a relevant order parameter) or second order (continuous), one would expect that generalized jamming transitions can be continuous or discontinuous. In studies of flow in complex fluids, there is a wide range of evidence for discontinuous transitions, mostly in the context of shear localization, or shear banding. In this paper, I review the experimental evidence for discontinuous transitions. I focus on systems in which there is a discontinuity in the rate of strain between two, coexisting states: one in which the material is flowing and the other in which it is solid-like. (topical review)

  14. Speedup of minimum discontinuity phase unwrapping algorithm with a reference phase distribution

    Science.gov (United States)

    Liu, Yihang; Han, Yu; Li, Fengjiao; Zhang, Qican

    2018-06-01

    In three-dimensional (3D) shape measurement based on phase analysis, the phase analysis process usually produces a wrapped phase map ranging from - π to π with some 2 π discontinuities, and thus a phase unwrapping algorithm is necessary to recover the continuous and nature phase map from which 3D height distribution can be restored. Usually, the minimum discontinuity phase unwrapping algorithm can be used to solve many different kinds of phase unwrapping problems, but its main drawback is that it requires a large amount of computations and has low efficiency in searching for the improving loop within the phase's discontinuity area. To overcome this drawback, an improvement to speedup of the minimum discontinuity phase unwrapping algorithm by using the phase distribution on reference plane is proposed. In this improved algorithm, before the minimum discontinuity phase unwrapping algorithm is carried out to unwrap phase, an integer number K was calculated from the ratio of the wrapped phase to the nature phase on a reference plane. And then the jump counts of the unwrapped phase can be reduced by adding 2K π, so the efficiency of the minimum discontinuity phase unwrapping algorithm is significantly improved. Both simulated and experimental data results verify the feasibility of the proposed improved algorithm, and both of them clearly show that the algorithm works very well and has high efficiency.

  15. THE FORMATION OF ROTATIONAL DISCONTINUITIES IN COMPRESSIVE THREE-DIMENSIONAL MHD TURBULENCE

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Liping; Feng, Xueshang [SIGMA Weather Group, State Key Laboratory for Space Weather, Center for Space Science and Applied Research, Chinese Academy of Sciences, 100190, Beijing (China); Zhang, Lei; He, Jiansen; Tu, Chuanyi; Wang, Linghua; Wang, Xin [School of Earth and Space Sciences, Peking University, 100871 Beijing (China); Marsch, Eckart [Institute for Experimental and Applied Physics, Christian Albrechts University at Kiel, D-24118 Kiel (Germany); Zhang, Shaohua, E-mail: jshept@gmail.com [Center of Spacecraft Assembly Integration and Test, China Academy of Space Technology, Beijing 100094 (China)

    2015-08-20

    Measurements of solar wind turbulence reveal the ubiquity of discontinuities. In this study we investigate how the discontinuities, especially rotational discontinuities (RDs), are formed in MHD turbulence. In a simulation of the decaying compressive three-dimensional (3D) MHD turbulence with an imposed uniform background magnetic field, we detect RDs with sharp field rotations and little variations of magnetic field intensity, as well as mass density. At the same time, in the de Hoffman–Teller frame, the plasma velocity is nearly in agreement with the Alfvén speed, and is field-aligned on both sides of the discontinuity. We take one of the identified RDs to analyze its 3D structure and temporal evolution in detail. By checking the magnetic field and plasma parameters, we find that the identified RD evolves from the steepening of the Alfvén wave with moderate amplitude, and that steepening is caused by the nonuniformity of the Alfvén speed in the ambient turbulence.

  16. Discontinuous Galerkin finite element methods for radiative transfer in spherical symmetry

    Science.gov (United States)

    Kitzmann, D.; Bolte, J.; Patzer, A. B. C.

    2016-11-01

    The discontinuous Galerkin finite element method (DG-FEM) is successfully applied to treat a broad variety of transport problems numerically. In this work, we use the full capacity of the DG-FEM to solve the radiative transfer equation in spherical symmetry. We present a discontinuous Galerkin method to directly solve the spherically symmetric radiative transfer equation as a two-dimensional problem. The transport equation in spherical atmospheres is more complicated than in the plane-parallel case owing to the appearance of an additional derivative with respect to the polar angle. The DG-FEM formalism allows for the exact integration of arbitrarily complex scattering phase functions, independent of the angular mesh resolution. We show that the discontinuous Galerkin method is able to describe accurately the radiative transfer in extended atmospheres and to capture discontinuities or complex scattering behaviour which might be present in the solution of certain radiative transfer tasks and can, therefore, cause severe numerical problems for other radiative transfer solution methods.

  17. A Floating Node Method for the Modelling of Discontinuities Within a Finite Element

    Science.gov (United States)

    Pinho, Silvestre T.; Chen, B. Y.; DeCarvalho, Nelson V.; Baiz, P. M.; Tay, T. E.

    2013-01-01

    This paper focuses on the accurate numerical representation of complex networks of evolving discontinuities in solids, with particular emphasis on cracks. The limitation of the standard finite element method (FEM) in approximating discontinuous solutions has motivated the development of re-meshing, smeared crack models, the eXtended Finite Element Method (XFEM) and the Phantom Node Method (PNM). We propose a new method which has some similarities to the PNM, but crucially: (i) does not introduce an error on the crack geometry when mapping to natural coordinates; (ii) does not require numerical integration over only part of a domain; (iii) can incorporate weak discontinuities and cohesive cracks more readily; (iv) is ideally suited for the representation of multiple and complex networks of (weak, strong and cohesive) discontinuities; (v) leads to the same solution as a finite element mesh where the discontinuity is represented explicitly; and (vi) is conceptually simpler than the PNM.

  18. Time-dependent behavior of rough discontinuities under shearing conditions

    Science.gov (United States)

    Wang, Zhen; Shen, Mingrong; Ding, Wenqi; Jang, Boan; Zhang, Qingzhao

    2018-02-01

    The mechanical properties of rocks are generally controlled by their discontinuities. In this study, the time-dependent behavior of rough artificial joints under shearing conditions was investigated. Based on Barton’s standard profile lines, samples with artificial joint surfaces were prepared and used to conduct the shear and creep tests. The test results showed that the shear strength of discontinuity was linearly related to roughness, and subsequently an empirical equation was established. The long-term strength of discontinuity can be identified using the inflection point of the isocreep-rate curve, and it was linearly related to roughness. Furthermore, the ratio of long-term and instantaneous strength decreased with the increase of roughness. The shear-stiffness coefficient increased with the increase of shear rate, and the influence of shear rate on the shear stiffness coefficient decreased with the decrease of roughness. Further study of the mechanism revealed that these results could be attributed to the different time-dependent behavior of intact and joint rocks.

  19. Treatment for amphetamine withdrawal.

    Science.gov (United States)

    Shoptaw, Steven J; Kao, Uyen; Heinzerling, Keith; Ling, Walter

    2009-04-15

    withdrawal. Amineptine showed reduction in discontinuation rates and improvement in clinical presentation compared to placebo, but had no effect on reducing withdrawal symptoms or craving. In spite of these limited benefits, amineptine is not available for use due to concerns over abuse liability when using the drug. The benefits of mirtazapine as a withdrawal agent are less clear based on findings from two randomised controlled trials: one report showed improvements in amphetamine withdrawal symptoms over placebo; a second report showed no differences in withdrawal symptoms compared to placebo. Further potential treatment studies should examine medications that increase central nervous system activity involving dopamine, norepinephrine and/or serotonin neurotransmitters, including mirtazapine.

  20. Mechanics of interfaces and evolving discontinuities

    NARCIS (Netherlands)

    De Borst, René; Remmers, Joris J C; Verhoosel, Clemens V.; Needleman, Alan; Zingoni, A.

    2013-01-01

    The two main approaches to the modelling of discontinuities are reviewed concisely, followed by a discussion of cohesive models for fracture. Emphasis is put on a novel approach to incorporate triaxiality into cohesive-zone models, and on the representation of cohesive crack models by phase-field

  1. 77 FR 26185 - POSTNET Barcode Discontinuation

    Science.gov (United States)

    2012-05-03

    ... discontinue POSTNET barcodes for automation letter and flat price eligibility. There were six comments... on each piece, to facilitate processing by presort companies. We added language to specifically allow..., with or without prepayment of postage, for return to the address on the reply piece. If postage is...

  2. Schrödinger propagation of initial discontinuities leads to divergence of moments

    Science.gov (United States)

    Marchewka, A.; Schuss, Z.

    2009-09-01

    We show that the large phase expansion of the Schrödinger propagation of an initially discontinuous wave function leads to the divergence of average energy, momentum, and displacement, rendering them unphysical states. If initially discontinuous wave functions are considered to be approximations to continuous ones, the determinant of the spreading rate of these averages is the maximal gradient of the initial wave function. Therefore a dilemma arises between the inclusion of discontinuous wave functions in quantum mechanics and the requirement of finite moments.

  3. Rotational discontinuities in anisotropic plasmas

    International Nuclear Information System (INIS)

    Omidi, N.

    1992-01-01

    The kinetic structure of rotational discontinuities (RDs) in anisotropic plasmas with T perpendicular /T parallel > 1 is investigated by using a one-dimensional electromagnetic hybrid code. To form the RD, a new approach is used where the plasma is injected from one boundary and reflected from the other, resulting in the generation of a traveling fast shock and an RD. Unlike the previously used methods, no a priori assumptions are made regarding the initial structure (i.e. width or sense of rotation) of the rotational discontinuity. The results show that across the RD both the magnetic field strength and direction, as well as the plasma density change. Given that such a change can also be associated with an intermediate shock, the Rankine-Hugoniot relations are used to confirm that the observed structures are indeed RDs. It is found that the thickness of RDs is a few ion inertial lengths and is independent of the rotation angle. Also, the preferred sense of rotation is in the electron sense; however, RDs with a rotation angle larger than 180 degree are found to be unstable, changing their rotation to a stable ion sense

  4. Treatment of premenstrual dysphoric disorder with luteal phase dosing of sertraline.

    Science.gov (United States)

    Halbreich, Uriel; Kahn, Linda S

    2003-11-01

    Sertraline (Zoloft, Pfizer Inc.) is a selective serotonin re-uptake inhibitor (SSRI) which has been approved by the US FDA for the treatment of premenstrual dysphoric disorder (PMDD). PMDD is a severe form of premenstrual syndrome (PMS) which affects at least 5 - 8% of women of reproductive age. It is characterised by cyclic appearance at the late luteal phase of the menstrual cycle, and disappearance following the beginning of menses, with no symptoms during at least 1 week of the cycle - usually during the mid-follicular phase. Due to the cyclic luteal occurrence of PMDD, luteal phase dosing of SSRIs has been suggested and proven effective for sertraline as well as several other SSRIs. The clinical response of sertraline is reported to be within several days following initiation of treatment. Despite repeated cyclic discontinuation, no significant discontinuation adverse effects have been reported. In addition to its proven clinical efficacy, luteal-phase dosing may offer the advantages of minimising adverse effects of SSRIs while reducing the personal and economic burden of taking a prescription medication continuously for long periods and thus increasing compliance.

  5. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study.

    Science.gov (United States)

    Toyos, Rolando; McGill, William; Briscoe, Dustin

    2015-01-01

    The purpose of this study was to determine the clinical benefits of intense-pulsed-light therapy for the treatment of dry-eye disease caused by meibomian gland dysfunction (MGD). MGD is the leading cause of evaporative dry eye disease. It is currently treated with a range of methods that have been shown to be only somewhat effective, leading to the need for advanced treatment options. A retrospective noncomparative interventional case series was conducted with 91 patients presenting with severe dry eye syndrome. Treatment included intense-pulsed-light therapy and gland expression at a single outpatient clinic over a 30-month study. Pre/post tear breakup time data were available for a subset of 78 patients. For all patients, a specially developed technique for the treatment of dry eye syndrome was applied as a series of monthly treatments until there was adequate improvement in dry eye syndrome symptoms by physician judgment, or until patient discontinuation. Primary outcomes included change in tear breakup time, self-reported patient satisfaction, and adverse events. Physician-judged improvement in dry eye tear breakup time was found for 68 of 78 patients (87%) with seven treatment visits and four maintenance visits on average (medians), and 93% of patients reported post-treatment satisfaction with degree of dry eye syndrome symptoms. Adverse events, most typically redness or swelling, were found for 13% of patients. No serious adverse events were found. Although preliminary, study results of intense-pulsed-light therapy treatment for dry eye syndrome caused by meibomian gland dysfunction are promising. A multisite clinical trial with a larger sample, treatment comparison groups, and randomized controlled trials is currently underway.

  6. An Analysis of Contraceptive Discontinuation among Female, Reversible Method Users in Urban Honduras

    Science.gov (United States)

    Barden-O’Fallon, Janine; Speizer, Ilene S.; Cálix, Javier; Rodriguez, Francisco

    2013-01-01

    A panel study examining the effects of individual characteristics, side effects experienced, and service quality on contraceptive discontinuation was undertaken in four urban areas of Honduras. Data were collected from October 2006 to December 2007. The baseline population included 800 women aged 15–44 who were new or continuing users of the injectable, IUD, or oral contraceptive pill. A total of 671 women (84%) were re-interviewed after one year. Life tables and Cox proportional hazards models are used to present discontinuation rates and factors associated with contraceptive discontinuation. Among new users, discontinuation of the baseline method at 12 months was high (45%); especially for users of the injectable (50%). In the hazards model, service quality had little effect on discontinuation, while individual characteristics and the experience of specific side effects showed significant effects. The results suggest that programs should emphasize continuous contraceptive coverage rather than continuous use of a particular method. PMID:21500697

  7. Variation formulae for the solutions of delay differential equations with discontinuous initial conditions

    International Nuclear Information System (INIS)

    Kharatishvili, G L; Tadumadze, T A

    2005-01-01

    Variation formulae are proved for solutions of non-linear differential equations with variable delays and discontinuous initial conditions. The discontinuity of the initial condition means that at the initial moment of time the values of the initial function and the trajectory, generally speaking, do not coincide. The formulae obtained contain a new summand connected with the discontinuity of the initial condition and the variation of the initial moment.

  8. Reevaluating response and failure of medical treatment of endometriosis: a systematic review.

    Science.gov (United States)

    Becker, Christian M; Gattrell, William T; Gude, Kerstin; Singh, Sukhbir S

    2017-07-01

    To assess patient response rates to medical therapies used to treat endometriosis-associated pain. A systematic review with the use of Medline and Embase. Not applicable. Women receiving medical therapy to treat endometriosis. None. The proportions of patients who: experienced no reduction in endometriosis-associated pain symptoms; had pain symptoms remaining at the end of the treatment period; had pain recurrence after treatment cessation; experienced an increase or no change in disease score during the study; were satisfied with treatment; and discontinued therapy owing to adverse events or lack of efficacy. The change in pain symptom severity experienced during and after treatment, as measured on the visual analog scale, was also assessed. In total, 58 articles describing 125 treatment arms met the inclusion criteria. Data for the response of endometriosis-associated pain symptoms to treatment were presented in only 29 articles. The median proportions of women with no reduction in pain were 11%-19%; at the end of treatment, 5%-59% had pain remaining; and after follow-up, 17%-34% had experienced recurrence of pain symptoms after treatment cessation. After median study durations of 2-24 months, the median discontinuation rates due to adverse events or lack of efficacy were 5%-16%. Few studies of medical therapies for endometriosis report outcomes that are relevant to patients, and many women gain only limited or intermittent benefit from treatment. Copyright © 2017. Published by Elsevier Inc.

  9. Discrete modeling of multiple discontinuities in rock mass using XFEM

    OpenAIRE

    Das, Kamal C.; Ausas, Roberto Federico; Carol, Ignacio; Rodrigues, Eduardo; Sandeep, Sandra; Vargas, P. E.; Gonzalez, Nubia Aurora; Segura, Josep María; Lakshmikantha, Ramasesha Mookanahallipatna; Mello,, U.

    2017-01-01

    Modeling of discontinuities (fractures and fault surfaces) is of major importance to assess the geomechanical behavior of oil and gas reservoirs, especially for tight and unconventional reservoirs. Numerical analysis of discrete discontinuities traditionally has been studied using interface element concepts, however more recently there are attempts to use extended finite element method (XFEM). The development of an XFEM tool for geo-mechanical fractures/faults modeling has significant industr...

  10. [Treatment of hyperthyroidism due to Graves' disease: what is the recommended antithyroid drug during pregnancy?].

    Science.gov (United States)

    Caron, P

    2013-05-01

    Clinical hyperthyroidism during the first trimester of pregnancy due to Graves' disease can be associated with maternal, obstetrical and fetal complications, indicating an active treatment to restore normal thyroid function. Antithyroid drugs are the first line treatment in pregnant women with hyperthyroidism. Due to the increased congenital malformations reported in neonates after first-trimester carbimazole/methimazole treatment and propylthiouracil associated hepatotoxicity, the recommended treatment for pregnant women with hyperthyroid Graves' disease is propylthiouracil during the first trimester of pregnancy and following the first trimester, consideration should be given switching to carbimazole/methimazole during the second part of gestation. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  11. Quantity and economic value of unused oral anti-cancer and biological disease-modifying anti-rheumatic drugs among outpatient pharmacy patients who discontinue therapy.

    Science.gov (United States)

    Bekker, C L; Melis, E J; Egberts, A C G; Bouvy, M L; Gardarsdottir, H; van den Bemt, B J F

    2018-03-24

    Patients sometimes discontinue the use of expensive oral anti-cancer drug (OACD) or biological disease-modifying anti-rheumatic drug (bDMARD) therapies early, leading to medication waste if the patient has not used all dispensed medication. To determine the proportion of patients who have unused OACDs or bDMARDs after therapy discontinuation, and the quantity and economic value of these unused medications. Furthermore, patients' reasons for therapy discontinuation and their disposal method for unused medications were determined. In a retrospective follow-up study using a Dutch outpatient pharmacy database, patients (≥18 years) who did not refill an OACD or bDMARD prescription, dispensed between November 2015 and February 2016, within two weeks of the prescription end date were contacted by phone and asked about their unused medication and reasons thereof. The economic value was calculated using Dutch medication prices. Data were descriptively analyzed in STATA13. The database included 1173 patients, of whom 159 likely had discontinued therapy and were contacted. Of these, 88 patients were excluded (39 refilled, 47 missing, and 2 other). Of the 71 patients who had discontinued therapy, 39 (54.9%) had unused medications, comprising 22 OACD users (mean age 63.0 (SD ± 15.9) years, 50.0% female) and 17 bDMARD users (mean age 50.7 (SD ± 13.5) years, 47.1% female). A total of 59 packages were unused, with a total value of €60,341. Unused OACD packages and bDMARD packages had median values of €179 (IQR €24-2487) and €992 (IQR €681-1093), respectively. Patients primarily discontinued therapy due to adverse or insufficient effects. This study illustrates that more than half of patients discontinuing OACD or bDMARD therapies have unused medication. This emphasizes the need for waste-reducing interventions. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Static deformation of an orthotropic elastic layered medium due to a ...

    African Journals Online (AJOL)

    Closed-form analytic expressions for the deformation field at any point of a homogeneous, orthotropic, homogeneous elastic layer interfacing differently to a base due to non-uniform discontinuity (slip) along a very long strike-slip fault situated in the orthotropic elastic layer have been obtained. Four non-uniform slip profiles: ...

  13. Angioedema due to Systemic Isotretinoin Therapy

    Directory of Open Access Journals (Sweden)

    Pelin Üstüner

    2014-01-01

    Full Text Available Angioedema is the swelling of the mucosal membranes as a variant of urticaria induced by hereditary C1 esterase inhibitor enzyme deficiency, certain foods, or drugs. Herein, we report the case of a 23-year-old woman, with mild-moderate acne presenting with widespread facial angioedema on the 2nd day of systemic isotretinoin treatment. The patient had taken no drugs other than isotretinoin in the preceding days and had no known food allergy. Her angioedema was resolved after the isotretinoin was discontinued. We want to draw the attention of dermatologists to this rare adverse allergic effect of isotretinoin which is frequently used in the treatment of acne vulgaris.

  14. Predictors of discontinuation of antipsychotic medication and subsequent outcomes in the European First Episode Schizophrenia Trial (EUFEST).

    Science.gov (United States)

    Landolt, Karin; Rössler, Wulf; Ajdacic-Gross, Vladeta; Derks, Eske M; Libiger, Jan; Kahn, René S; Fleischhacker, W Wolfgang

    2016-04-01

    This study had two aims: to describe patients suffering from first-episode schizophrenia who had stopped taking any antipsychotic medication, and to gain information on the predictors of successful discontinuation. We investigated data from the European First Episode Schizophrenia Trial (EUFEST). From the 325 patients included, 15.7% discontinued all antipsychotic medication. In a first analysis, clinical and sociodemographical predictors of discontinuing any antipsychotic medication were identified, using Cox regression. In the second analysis, logistic regression was used to determine variables associated with those patients who had stopped taking antipsychotic medication and had a favourable outcome, i.e., successful discontinuation. A good outcome was defined as a) having had no relapse within the whole observation period (80.6%), and b) having had no relapse and symptomatic remission at 12-month-follow-up (37.2%). Cox regression revealed that a higher proportion of patients from Western European countries and Israel stopped antipsychotic medication than from Central and Eastern European countries, that relapse was associated with discontinuation, and that discontinuers had lower compliance and higher quality of life. Predictors of successful discontinuation differed with the outcome definition used. Using definition b), successful discontinuers had a better baseline prognosis and better baseline social integration. Using definition a), successful discontinuers more often were from Western European countries. Region and clinical factors were associated with discontinuation. Prognosis and social integration played an important role in predicting successful discontinuation. As this study had several limitations, for example the observational design regarding discontinuation, further studies are needed to identify predictors of successful discontinuation. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. Introduction to the special issue on discontinuity of fluvial systems

    Science.gov (United States)

    Burchsted, Denise; Daniels, Melinda; Wohl, Ellen E.

    2014-01-01

    Fluvial systems include natural and human-created barriers that modify local base level; as such, these discontinuities alter the longitudinal flux of water and sediment by storing, releasing, or changing the flow path of those materials. Even in the absence of distinct barriers, fluvial systems are typically discontinuous and patchy. The size of fluvial discontinuities ranges across scales from 100 m, such as riffles, to 104 m, such as lava dams or major landslides. The frequency of occurrence appears to be inversely related to size, with creation and failure of the small features, such as beaver dams, occurring on a time scale of 100 to 101 years and a frequency of occurrence at scales as low as 101 m. In contrast, larger scale discontinuities, such as lava dams, can last for time scales up to 105 years and have a frequency of occurrence of approximately 104 m. The heterogeneity generated by features is an essential part of river networks and should be considered as part of river management. Therefore, we suggest that "natural" dams are a useful analog for human dams when evaluating options for river restoration. This collection of papers on the studies of natural dams includes bedrock barriers, log jams and beaver dams. The collection also addresses the discontinuity generated by a floodplain — in the absence of an obvious barrier in the channel — and tools for evaluation of riverbed heterogeneity. It is completed with a study of impact of human dams on floodplain sedimentation. These papers will help geomorphologists and river managers understand the factors that control river heterogeneity across scales and around the world.

  16. The effect of oral immunomodulatory therapy on treatment uptake and persistence in multiple sclerosis.

    Science.gov (United States)

    Warrender-Sparkes, Matthew; Spelman, Tim; Izquierdo, Guillermo; Trojano, Maria; Lugaresi, Alessandra; Grand'Maison, François; Havrdova, Eva; Horakova, Dana; Boz, Cavit; Oreja-Guevara, Celia; Alroughani, Raed; Iuliano, Gerardo; Duquette, Pierre; Girard, Marc; Terzi, Murat; Hupperts, Raymond; Grammond, Pierre; Petersen, Thor; Fernandez-Bolaños, Ricardo; Fiol, Marcela; Pucci, Eugenio; Lechner-Scott, Jeannette; Verheul, Freek; Cristiano, Edgardo; Van Pesch, Vincent; Petkovska-Boskova, Tatjana; Moore, Fraser; Kister, Ilya; Bergamaschi, Roberto; Saladino, Maria Laura; Slee, Mark; Barnett, Michael; Amato, Maria Pia; Shaw, Cameron; Shuey, Neil; Young, Carolyn; Gray, Orla; Kappos, Ludwig; Butzkueven, Helmut; Kalincik, Tomas; Jokubaitis, Vilija

    2016-04-01

    We aimed to analyse the effect of the introduction of fingolimod, the first oral disease-modifying therapy, on treatment utilisation and persistence in an international cohort of patients with multiple sclerosis (MS). MSBASIS, a prospective, observational sub-study of the MSBase registry, collects demographic, clinical and paraclinical data on patients followed from MS onset (n=4718). We conducted a multivariable conditional risk set survival analysis to identify predictors of treatment discontinuation, and to assess if the introduction of fingolimod has altered treatment persistence. A total of 2640 patients commenced immunomodulatory therapy. Following the introduction of fingolimod, patients were more likely to discontinue all other treatments (hazard ratio 1.64, ptreatment compared with other therapies (ptreatment discontinuation. Following the availability of fingolimod, patients were more likely to discontinue injectable treatments. Those who switched to fingolimod were more likely to do so for convenience. Persistence was improved on fingolimod compared to other medications. © The Author(s), 2015.

  17. Reasons for Discontinuing Hashish Use in a Group of Central European Athletes.

    Science.gov (United States)

    Duncan, David F.

    1988-01-01

    Examined self-reported reasons for discontinuing marijuana use among 61 former marijuana using students at central European sports training facility. Most common reasons given for discontinuing marijuana use were dislike of effects, athletic training regimen, health reasons, and mental/emotional problems. (Author/NB)

  18. Interior penalty discontinuous Galerkin method for coupled elasto-acoustic media

    OpenAIRE

    Dudouit , Yohann; Giraud , Luc; Millot , Florence; Pernet , Sébastien

    2016-01-01

    We introduce a high order interior penalty discontinuous Galerkin scheme for the nu- merical solution of wave propagation in coupled elasto-acoustic media. A displacement formulation is used, which allows for the solution of the acoustic and elastic wave equations within the same framework. Weakly imposing the correct transmission condition is achieved by the derivation of adapted numerical fluxes. This generalization does not weaken the discontinuous Galerkin method, thus hp-non-conforming m...

  19. Reactive oxygen species production and discontinuous gas exchange in insects

    OpenAIRE

    Boardman, Leigh; Terblanche, John S.; Hetz, Stefan K.; Marais, Elrike; Chown, Steven L.

    2011-01-01

    While biochemical mechanisms are typically used by animals to reduce oxidative damage, insects are suspected to employ a higher organizational level, discontinuous gas exchange mechanism to do so. Using a combination of real-time, flow-through respirometry and live-cell fluorescence microscopy, we show that spiracular control associated with the discontinuous gas exchange cycle (DGC) in Samia cynthia pupae is related to reactive oxygen species (ROS). Hyperoxia fails to increase mean ROS produ...

  20. A systematic review of randomized controlled trials of bupropion versus methylphenidate in the treatment of attention-deficit/hyperactivity disorder

    Directory of Open Access Journals (Sweden)

    Maneeton N

    2014-08-01

    Full Text Available Narong Maneeton,1 Benchalak Maneeton,1 Suthi Intaprasert,1 Pakapan Woottiluk2 1Department of Psychiatry, Faculty of Medicine, 2Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, ThailandBackground: Some trials have suggested that bupropion, as well as methylphenidate, is bene­ficial in the treatment of attention-deficit/hyperactivity disorder (ADHD.Objectives: The purpose of this systematic review was to summarize the efficacy, acceptability, and tolerability of bupropion in comparison with methylphenidate for ADHD treatment. Included studies were randomized controlled trials (RCTs that compared bupropion and methylphenidate. Clinical studies conducted between January 1991 and January 2014 were reviewed.Data sources: MEDLINE®, EMBASE™, CINAHL, PsycINFO®, and the Cochrane Controlled Trials Register were searched in January 2014. Additionally, clinical trials were identified from the databases of ClinicalTrials.gov and the EU Clinical Trials Register.Study eligible criteria, participants, and interventions: All RCTs of bupropion and methylphenidate reporting final outcomes relevant to 1 ADHD severity, 2 response or remission rates, 3 overall discontinuation rate, or 4 discontinuation rate due to adverse events. Language restriction was not applied.Study appraisal and synthesis methods: The relevant clinical trials were examined and the data of interest were extracted. Additionally, the risks of bias were also inspected. The efficacy outcomes were the mean changed scores of ADHD rating scales, the overall response rate, and the overall remission rates. The overall discontinuation rate and the discontinuation rate due to adverse events were determined. Relative risks and weighted mean differences or standardized mean differences with 95% confidence intervals were estimated using a random effect model.Results: A total of 146 subjects in four RCTs comparing bupropion with methylphenidate in the treatment of

  1. A novel scheme for Liouville's equation with a discontinuous Hamiltonian and applications to geometrical optics

    NARCIS (Netherlands)

    Lith, van B.S.; Thije Boonkkamp, ten J.H.M.; IJzerman, W.L.; Tukker, T.W.

    2015-01-01

    We compute numerical solutions of Liouville's equation with a discontinuous Hamiltonian. We assume that the underlying Hamiltonian system has a well-defined behaviour even when the Hamiltonian is discontinuous. In the case of geometrical optics such a discontinuity yields the familiar Snell's law or

  2. A novel scheme for Liouville's equation with a discontinuous Hamiltonian and applications to geometrical optics

    NARCIS (Netherlands)

    van Lith, B.S.; ten Thije Boonkkamp, J.H.M.; IJzerman, W.L.; Tukker, T.W.

    A novel scheme is developed that computes numerical solutions of Liouville’s equation with a discontinuous Hamiltonian. It is assumed that the underlying Hamiltonian system has well-defined behaviour even when the Hamiltonian is discontinuous. In the case of geometrical optics such a discontinuity

  3. Global Discontinuity Structure of the Mantle Transition Zone from Finite-Frequency Tomography of SS Precursors

    Science.gov (United States)

    Guo, Z.; Zhou, Y.

    2017-12-01

    We report global structure of the 410-km and 660-km discontinuities from finite-frequency tomography using frequency-dependent traveltime measurements of SS precursors recorded at the Global Seismological Network (GSN). Finite-frequency sensitivity kernels for discontinuity depth perturbations are calculated in the framework of traveling-wave mode coupling. We parametrize the global discontinuities using a set of spherical triangular grid points and solve the tomographic inverse problem based on singular value decomposition. Our global 410-km and 660-km discontinuity models reveal distinctly different characteristics beneath the oceans and subduction zones. In general, oceanic regions are associated with a thinner mantle transition zone and depth perturbations of the 410-km and 660-km discontinuities are anti-correlated, in agreement with a thermal origin and an overall warm and dry mantle beneath the oceans. The perturbations are not uniform throughout the oceans but show strong small-scale variations, indicating complex processes in the mantle transition zone. In major subduction zones (except for South America where data coverage is sparse), depth perturbations of the 410-km and 660-km discontinuities are correlated, with both the 410-km and the 660-km discontinuities occurring at greater depths. The distributions of the anomalies are consistent with cold stagnant slabs just above the 660-km discontinuity and ascending return flows in a superadiabatic upper mantle.

  4. Seismic imaging of lithospheric discontinuities and continental evolution

    Science.gov (United States)

    Bostock, M. G.

    1999-09-01

    Discontinuities in physical properties within the continental lithosphere reflect a range of processes that have contributed to craton stabilization and evolution. A survey of recent seismological studies concerning lithospheric discontinuities is made in an attempt to document their essential characteristics. Results from long-period seismology are inconsistent with the presence of continuous, laterally invariant, isotropic boundaries within the upper mantle at the global scale. At regional scales, two well-defined interfaces termed H (˜60 km depth) and L (˜200 km depth) of continental affinity are identified, with the latter boundary generally exhibiting an anisotropic character. Long-range refraction profiles are frequently characterized by subcontinental mantle that exhibits a complex stratification within the top 200 km. The shallow layering of this package can behave as an imperfect waveguide giving rise to the so-called teleseismic Pn phase, while the L-discontinuity may define its lower base as the culmination of a low velocity zone. High-resolution, seismic reflection profiling provides sufficient detail in a number of cases to document the merging of mantle interfaces into lower continental crust below former collisional sutures and magmatic arcs, thus unambiguously identifying some lithospheric discontinuities with thrust faults and subducted oceanic lithosphere. Collectively, these and other seismic observations point to a continental lithosphere whose internal structure is dominated by a laterally variable, subhorizontal layering. This stratigraphy appears to be more pronounced at shallower lithospheric levels, includes dense, anisotropic layers of order 10 km in thickness, and exhibits horizontal correlation lengths comparable to the lateral dimensions of overlying crustal blocks. A model of craton evolution which relies on shallow subduction as a principal agent of craton stabilization is shown to be broadly compatible with these characteristics.

  5. 76 FR 41413 - Post Office Organization and Administration: Establishment, Classification, and Discontinuance

    Science.gov (United States)

    2011-07-14

    ... Handbook PO-101, Post Office Discontinuance Guide, have provided only that community meetings are one... contract where sound business judgment and effective oversight would require otherwise. CPO operators would... that the emergency suspension form in Handbook PO-101, Post Office Discontinuance Guide, currently does...

  6. A second order discontinuous Galerkin method for advection on unstructured triangular meshes

    NARCIS (Netherlands)

    Geijselaers, Hubertus J.M.; Huetink, Han

    2003-01-01

    In this paper the advection of element data which are linearly distributed inside the elements is addressed. Across element boundaries the data are assumed discontinuous. The equations are discretized by the Discontinuous Galerkin method. For stability and accuracy at large step sizes (large values

  7. Controlling chaos in discontinuous dynamical systems

    International Nuclear Information System (INIS)

    Danca, Marius-F.

    2004-01-01

    In this paper we consider the possibility to implement the technique of changes in the system variables to control the chaos introduced by Gueemez and Matias for continuous dynamical systems to a class of discontinuous dynamical systems. The approach is realized via differential inclusions following the Filippov theory. Three practical examples are considered

  8. Early safety and efficacy of fingolimod treatment in Denmark

    DEFF Research Database (Denmark)

    Voldsgaard, A; Koch-Henriksen, N; Magyari, M

    2017-01-01

    BACKGROUND: Initiation of fingolimod treatment is associated with a transient decrease of heart rate, and atrioventricular (AV) conduction block may occur. OBJECTIVE: To evaluate the therapeutic effect and safety of fingolimod treatment in MS patients in Denmark with focus on cardiac and pulmonary...... to bradycardia and/or second-degree AV block type I. All patients recovered spontaneously. Two patients discontinued fingolimod. Eleven (5.4%) patients reported respiratory complaints and two of these patients discontinued treatment. CONCLUSIONS: Fingolimod appears to be safe and effective in MS patients...

  9. Prospective randomized trial of sclerotherapy vs standard treatment for epistaxis due to hereditary hemorrhagic telangiectasia.

    Science.gov (United States)

    Boyer, Holly; Fernandes, Patricia; Le, Chap; Yueh, Bevan

    2015-05-01

    Our previous studies have demonstrated the tolerability and low side-effect profile of office-based sclerotherapy with sodium tetradecyl sulfate (STS) for treating recurrent epistaxis due to hereditary hemorrhagic telangiectasia (HHT). The objective of this study was to use a prospective randomized trial to determine the effectiveness of sclerotherapy with STS vs standard treatment. This prospective randomized trial (conducted from November 1, 2011, through January 31, 2014) involved 17 patients with recurrent epistaxis due to HHT. We defined standard treatment as continuation of any treatment that the patient had previously undergone, such as moisturization, packing, and cautery. We used a crossover design, so study participants were randomized to either sclerotherapy or standard treatment during the first time period, and then to the other during the second period. The primary outcome measure was frequency and severity of epistaxis, as measured by the epistaxis severity score (ESS). The ESS is a 10-point scale, with higher scores corresponding to more bleeding. After controlling for treatment order, bleeding was substantially better controlled after sclerotherapy; the ESS after sclerotherapy was nearly one point lower than after standard treatment (-0.95, 1-sided p = 0.027). Treatment order, baseline ESS, the number of lesions, moisturization practices, and a history of previous blood transfusions did not significantly affect the results. This trial demonstrated that sclerotherapy with STS (vs standard treatment) significantly reduced epistaxis due to HHT. © 2015 ARS-AAOA, LLC.

  10. Use of compression garments by women with lymphoedema secondary to breast cancer treatment.

    Science.gov (United States)

    Longhurst, E; Dylke, E S; Kilbreath, S L

    2018-02-19

    This aim of this study was to determine the use of compression garments by women with lymphoedema secondary to breast cancer treatment and factors which underpin use. An online survey was distributed to the Survey and Review group of the Breast Cancer Network Australia. The survey included questions related to the participants' demographics, breast cancer and lymphoedema medical history, prescription and use of compression garments and their beliefs about compression and lymphoedema. Data were analysed using principal component analysis and multivariable logistic regression. Compression garments had been prescribed to 83% of 201 women with lymphoedema within the last 5 years, although 37 women had discontinued their use. Even when accounting for severity of swelling, type of garment(s) and advice given for use varied across participants. Use of compression garments was driven by women's beliefs that they were vulnerable to progression of their disease and that compression would prevent its worsening. Common reasons given as to why women had discontinued their use included discomfort, and their lymphoedema was stable. Participant characteristics associated with discontinuance of compression garments included their belief that (i) the garments were not effective in managing their condition, (ii) experienced mild-moderate swelling and/or (iii) had experienced swelling for greater than 5 years. The prescription of compression garments for lymphoedema is highly varied and may be due to lack of underpinning evidence to inform treatment.

  11. Supply risk under the condition of discontinuous demand in the field of nuclear power industry

    International Nuclear Information System (INIS)

    Wei Qiyan; Tian Zhilong

    2006-01-01

    Demands can be divided into two kinds: continuous and discontinuous demands. Based on the analysis of the results on common supply risk studies, discontinuous demand is studied concerning its definition, characteristics, and the more obvious and severe risks and consequences induced by its characteristics. Furthermore, the discontinuous characteristics and relevant precautions of demand of nuclear power industry are analyzed. Analysis and research on supply risks under the condition of discontinuous demand would be helpful to enterprises to take this issue serious and prevent the risks. (authors)

  12. Predictors of statin adherence, switching, and discontinuation in the USAGE survey: understanding the use of statins in America and gaps in patient education.

    Science.gov (United States)

    Wei, Melissa Y; Ito, Matthew K; Cohen, Jerome D; Brinton, Eliot A; Jacobson, Terry A

    2013-01-01

    Although statins have been shown to reduce cardiovascular disease mortality, less than half of U.S. adults achieve their low-density lipoprotein cholesterol goal. In many patients initiated on a statin, adherence rates decrease over time. To characterize current and former statin users, identify reasons for the discontinuation or switching of statins, and identify factors associated with adherence. The USAGE survey is a cross-sectional, self-administered Internet-based survey of 10,138 U.S. adults fielded September to October 2011. The following statin users were identified and compared: adherent nonswitchers, adherent switchers, non-adherent switchers, and discontinuers. Univariate and multivariate models using a priori covariates for adherence and discontinuation were examined. Most participants were current statin users who adhered with their prescribed statin (82.5%, n = 8371). Former statin users or discontinuers (12%, n = 1220) cited muscle pain, a side effect, as the primary reason for discontinuation (60%), followed by cost (16%), and then perceived lack of efficacy (13%). Discontinuers were less satisfied with their physicians' explanation of cholesterol treatment, more likely to use the Internet to research statins, and less likely to undergo frequent cholesterol monitoring. Among adherent statin users, the primary reasons for switching were muscle side effects (33%) and cost (32%). Individuals at risk for non-adherence included those with low household income, those who experienced muscle pain as a side effect while on statin therapy, and those taking medication for cardiovascular disease. Statin-related muscle side effects are common and contribute significantly to rates of discontinuation, switching, and non-adherence. Improved physician patient communication about side effects and benefits of statins are necessary to improve both adherence and outcomes. Copyright © 2013 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  13. Treatment of erectile dysfunction with sildenafil citrate (Viagra) in parkinsonism due to Parkinson's disease or multiple system atrophy with observations on orthostatic hypotension

    Science.gov (United States)

    Hussain, I; Brady, C; Swinn, M; Mathias, C; Fowler, C

    2001-01-01

    multiple system atrophy reported a good erectile response and were reluctant to discontinue the medication.
CONCLUSIONS—Sidenafil citrate (50 mg) is efficacious in the treatment of erectile dysfunction in parkinsonism due to Parkinson's disease or multiple system atrophy; however, it may unmask or exacerbate hypotension in multiple system atrophy. As Parkinson's disease may be diagnostically difficult to distinguish from multiple system atrophy, especially in the early stages, we recommend measurement of lying and standing blood pressure before prescribing sildenafil to men with parkinsonism. Furthermore, such patients should be made aware of seeking medical advice if they develop symptoms on treatment suggestive of orthostatic hypotension.

 PMID:11511713

  14. Application of discontinuity factors in C-PORCA 7 code

    International Nuclear Information System (INIS)

    Pos, I.; Parko, T.; Szabo, S. P.

    2010-01-01

    During last years there were up-rated the reactor power up to 1485 MW and new fuel types have been utilised at the Paks NPP. To fulfil the demand of the accuracy and correctness of on-line core monitoring and off-line core analysis the HELIOS/C-PORCA models have been modernised as well. The main step of this developing process was to change the mathematics of the 3D two group diffusion model on the basis of hybrid finite element method. The upgraded mathematics gave very good results comparing the C-PORCA calculations against mathematical benchmarks and measurements of different units and cycles of NPP Paks and Mochovce. As a final step of the modernisation process the application of flux discontinuity factors has been made. In the frame of VVER community the usage of this parameter in core analyses codes is very unusual in contrast with codes for the same purpose in western countries. In this paper both the reason of the introduction of discontinuity factors into HELIOS/C-PORCA models and its effect on the accuracy of calculation are also presented. We tried to emphasise which kind of codes and which kind of reactor-physical parameters can be influenced mainly by discontinuity factors. The method of the calculation of flux discontinuity factors in fuel and non-fuel regions of the core is also described. As the most important effect of the utilisation of this parameter was that almost all fittings in C-PORCA code based on in-core measurements have became needless. (Authors)

  15. A transient, Hex-Z nodal code corrected by discontinuity factors

    International Nuclear Information System (INIS)

    Shatilla, Y.A.M.; Henry, A.F.

    1993-01-01

    This document constitutes Volume 1 of the Final Report of a three-year study supported by the special Research Grant Program for Nuclear Energy Research set up by the US Department of Energy. The original motivation for the work was to provide a fast and accurate computer program for the analysis of transients in heavy water or graphite-moderated reactors being considered as candidates for the New Production Reactor. Thus, part of the funding was by way of pass-through money from the Savannah River Laboratory. With this intent in mind, a three-dimensional (Hex-Z), general-energy-group transient, nodal code was created, programmed, and tested. In order to improve accuracy, correction terms, called open-quotes discontinuity factors,close quotes were incorporated into the nodal equations. Ideal values of these factors force the nodal equations to provide node-integrated reaction rates and leakage rates across nodal surfaces that match exactly those edited from a more exact reference calculation. Since the exact reference solution is needed to compute the ideal discontinuity factors, the fact that they result in exact nodal equations would be of little practical interest were it not that approximate discontinuity factors, found at a greatly reduced cost, often yield very accurate results. For example, for light-water reactors, discontinuity factors found from two-dimensional, fine-mesh, multigroup transport solutions for two-dimensional cuts of a fuel assembly provide very accurate predictions of three-dimensional, full-core power distributions. The present document (volume 1) deals primarily with the specification, programming and testing of the three-dimensional, Hex-Z computer program. The program solves both the static (eigenvalue) and transient, general-energy-group, nodal equations corrected by user-supplied discontinuity factors

  16. Discontinuous precipitation in copper base alloys

    Indian Academy of Sciences (India)

    Discontinuous precipitation (DP) is associated with grain boundary migration in the wake of which alternate plates of the precipitate and the depleted matrix form. Some copper base alloys show DP while others do not. In this paper the misfit strain parameter, , has been calculated and predicted that if 100 > ± 0.1, DP is ...

  17. Discontinuous Galerkin for the Radiative Transport Equation

    KAUST Repository

    Guermond, Jean-Luc

    2013-10-11

    This note presents some recent results regarding the approximation of the linear radiative transfer equation using discontinuous Galerkin methods. The locking effect occurring in the diffusion limit with the upwind numerical flux is investigated and a correction technique is proposed.

  18. Regression Discontinuity Designs Based on Population Thresholds

    DEFF Research Database (Denmark)

    Eggers, Andrew C.; Freier, Ronny; Grembi, Veronica

    In many countries, important features of municipal government (such as the electoral system, mayors' salaries, and the number of councillors) depend on whether the municipality is above or below arbitrary population thresholds. Several papers have used a regression discontinuity design (RDD...

  19. Discontinuous Galerkin for the Radiative Transport Equation

    KAUST Repository

    Guermond, Jean-Luc; Kanschat, Guido; Ragusa, Jean C.

    2013-01-01

    This note presents some recent results regarding the approximation of the linear radiative transfer equation using discontinuous Galerkin methods. The locking effect occurring in the diffusion limit with the upwind numerical flux is investigated and a correction technique is proposed.

  20. Hybridized Multiscale Discontinuous Galerkin Methods for Multiphysics

    Science.gov (United States)

    2015-09-14

    local approximation spaces of the hybridizable discontinuous Galerkin methods with precomputed phases which are solutions of the eikonal equation in...geometrical optics. Second, we propose a systematic procedure for computing multiple solutions of the eikonal equation. Third, we utilize the eigenvalue

  1. Early Discontinuation of Metformin in Individuals Treated with Inhibitors of Transporters of Metformin

    DEFF Research Database (Denmark)

    Stage, Tore Bjerregaard; Lee, Moa P; Hallas, Jesper

    2016-01-01

    The aim of this study was to examine the risk of early discontinuation of metformin as a proxy for intolerance, associated with use of drugs known to inhibit transporters involved in metformin distribution. We analysed all incident users of metformin in Denmark between 2000 and 2012 (n = 132......,221) and in a cohort of US patients (n = 296,903). Risk of early discontinuation of metformin was assessed using adjusted logistic regression for 28 drugs putatively inhibiting metformin transporters and four negative controls. Increased odds ratio of early discontinuation of metformin was only associated with codeine...... drugs were associated with a decreased risk. These findings indicate that codeine use may be associated with risk of early discontinuation of metformin and could be used as a basis for further investigation....

  2. Sustainability of first-line antiretroviral regimens: findings from a large HIV treatment program in western Kenya.

    Science.gov (United States)

    Braitstein, Paula; Ayuo, Paul; Mwangi, Ann; Wools-Kaloustian, Kara; Musick, Beverly; Siika, Abraham; Kimaiyo, Sylvester

    2010-02-01

    To describe first change or discontinuation in combination antiretroviral treatment (cART) among previously treatment naive, HIV-infected adults in a resource-constrained setting. The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership has enrolled >90,000 HIV-infected patients at 18 clinics throughout western Kenya. Patients in this analysis were aged > or =18 years, previously antiretroviral treatment naive, and initiated to cART between January 2006 and November 2007, with at least 1 follow-up visit. A treatment change or discontinuation was defined as change of regimen including single drug substitutions or a complete halting of cART. There were 14,162 patients eligible for analysis and 10,313 person-years of follow-up, of whom 1376 changed or stopped their cART. Among these, 859 (62%) changed their regimen (including 514 patients who had a single drug substitution) and 517 (38%) completely discontinued cART. The overall incidence rate (IR) of cART changes or stops per 100 person-years was 13.3 [95% confidence interval (CI): 12.7-14.1]. The incidence was much higher in the first year of post-cART initiation (IR: 25.0, 95% CI: 23.6-26.3) compared with the second year (IR: 2.4, 95% CI: 2.0-2.8). The most commonly cited reason was toxicity (46%). In multivariate regression, individuals were more likely to discontinue cART if they were World Health Organization stage III/IV [adjusted hazard ratio (AHR): 1.37, 95% CI: 1.11-1.69] or were receiving a zidovudine-containing regimen (AHR: 4.44, 95% CI: 3.35-5.88). Individuals were more likely to change their regimen if they were aged > or =38 years (AHR: 1.44, 95% CI: 1.23-1.69), had to travel more than 1 hour to clinic (AHR: 1.34, 95% CI: 1.15-1.57), had a CD4 at cART initiation < or =111 cells/mm3 (AHR: 1.51, 95% CI: 1.29-1.77), or had been receiving a zidovudine-containing regimen (AHR: 3.73, 95% CI: 2.81-4.95). Those attending urban clinics and those receiving

  3. Recovery of Pavlovian sign-tracking (autoshaping) following the discontinuation of inter-trial interval food in rats.

    Science.gov (United States)

    Kearns, David N; Weiss, Stanley J

    2007-07-01

    In pigeons, Pavlovian autoshaped keypecking produced by keylight-food pairings has been eliminated by introducing food during periods between CS presentations (i.e., during the inter-trial intervals). Keypecking eliminated in this manner reappears when the inter-trial USs are discontinued even though the CS is no longer paired with US. The present experiment investigated whether this recovery of responding produced by discontinuing unpaired inter-trial US presentations could be extended to another species, rats, within a Pavlovian sign-tracking paradigm. Rats were initially trained on a procedure where insertion of one retractable lever (CS(+)) was followed, response independently, with food, while insertion of another lever (CS(-)) was not paired with food. Rats quickly came to contact the CS(+) lever at high rates, but contacted the CS(-) lever infrequently. In the next phase, CS(+) was no longer followed by food. Explicitly unpaired food was presented only during the inter-trial intervals when both levers were absent. This treatment essentially eliminated the sign-tracking response. In the final phase, the unpaired inter-trial food presentations were discontinued while both CSs continued to be presented without food. This produced a significant recovery of the sign-tracking elicited by the CS(+) lever, extending the species generality of the Pavlovian resurgence phenomenon that has previously only been reported in pigeons, to rats.

  4. Improving Treatment Adherence in Bipolar Disorder: A Review of Current Psychosocial Treatment Efficacy and Recommendations for Future Treatment Development

    Science.gov (United States)

    Gaudiano, Brandon A.; Weinstock, Lauren M.; Miller, Ivan W.

    2008-01-01

    Treatment adherence is a frequent problem in bipolar disorder, with research showing that more than 60% of bipolar patients are at least partially nonadherent to medications. Treatment nonadherence is consistently predictive of a number of negative outcomes in bipolar samples, and the discontinuation of mood stabilizers places these patients at…

  5. Discontinuation of continuous renal replacement therapy: A post hoc analysis of a prospective multicenter observational study

    NARCIS (Netherlands)

    Uchino, Shigehiko; Bellomo, Rinaldo; Morimatsu, Hiroshi; Morgera, Stanislao; Schetz, Miet; Tan, Ian; Bouman, Catherine; Macedo, Ettiene; Gibney, Noel; Tolwani, Ashita; Oudemans-van Straaten, Heleen; Ronco, Claudio; Kellum, John A.

    2009-01-01

    Objectives: To describe current practice for the discontinuation of continuous renal replacement therapy in a multinational setting and to identify variables associated with successful discontinuation. The approach to discontinue continuous renal replacement therapy may affect patient outcomes.

  6. ELECTRON TEMPERATURES OF PLANETARY NEBULAE DETERMINED FROM THE He I DISCONTINUITIES

    International Nuclear Information System (INIS)

    Zhang, Y.; Nakashima, J.; Kwok, S.; Yuan, H.-B.; Liu, X.-W.; Hua, C.-T.

    2009-01-01

    We have used the He I discontinuities at 3421 A to determine the electron temperatures, designated T e (He I), for a sample of five Galactic planetary nebulae (PNe). We compared T e (He I) with the electron temperatures derived from the hydrogen Balmer jump at 3646 A, designated T e (H I), and found that T e (He I) are generally lower than T e (H I). There are two possible interpretations, (1) the presence of substantial He 2+ zone, or (2) the presence of hydrogen-deficient cold clumps within diffuse nebulae. A series of photoionization models were constructed to test the two scenarios. We found that the observed T e (He I)/T e (H I) discrepancies are beyond the predictions of chemically homogeneous models. Our modeling shows that the presence of a small amount of hydrogen-deficient inclusions seems to be able to reproduce the observed intensities of He I discontinuities. We stress the value of He I discontinuities in investigating nebular physical conditions. Albeit with some observational and technical limitations, He I discontinuities should be considered in future modeling work.

  7. Einstein’s “true” discontinuity.With an application to Zeno

    Directory of Open Access Journals (Sweden)

    Constantin Antonopoulos

    2009-11-01

    Full Text Available The question whether quantum discontinuity can or cannot provide an answer to Zeno’s Paradoxes is reopened. It is observed that what is usually understood by the term “discontinuity”, namely, Einstein’s conception of the photon as described by himself and all others, is unsuitable to the task because, essentially,it reduces to the trivial ‘discontinuity’ of objects scattered in space. By contrast, quantization of energy levels, which are not in space but can only alternate in time, provide the right sort of discontinuity required. Discrete quantized orbits, corresponding to eigen-frequencies, are irreducible, and nothing is allowed to stand in-between them in satisfaction of the quantum postulate, furnishing the requisite, and so far missing, immediate nextness of a point to a certain other. In this way, Zeno’s Runner need not postpone his first step indefinitely, always waiting upon an infinity of preceding steps, before it can be taken. There is now a point that is next to a point and so a step on that point, which is the first step. It follows that, if one kind of discontinuity, Einstein’s, is incapable of offerring an answer to Zeno, while another kind can, the two are discrepant. One of them, the former, is not a kind of discontinuity properly so called at all, though evidently the consequence of one.

  8. Increased incidence of antiretroviral drug discontinuation among patients with viremic hepatitis C virus coinfection and high hyaluronic acid, a marker of liver fibrosis

    DEFF Research Database (Denmark)

    Grint, D.; Peters, L.; Rockstroh, J. K.

    2014-01-01

    HCV/HIV coinfected patients. Methods: EuroSIDA patients taking combination antiretroviral therapy were included. Poisson regression identified factors associated with antiretroviral treatment discontinuation. Results: A total of 9535 HIV-positive patients with known HCV status were included (6939...

  9. Impedance Discontinuity Reduction Between High-Speed Differential Connectors and PCB Interfaces

    Science.gov (United States)

    Navidi, Sal; Agdinaoay, Rodell; Walter, Keith

    2013-01-01

    High-speed serial communication (i.e., Gigabit Ethernet) requires differential transmission and controlled impedances. Impedance control is essential throughout cabling, connector, and circuit board construction. An impedance discontinuity arises at the interface of a high-speed quadrax and twinax connectors and the attached printed circuit board (PCB). This discontinuity usually is lower impedance since the relative dielectric constant of the board is higher (i.e., polyimide approx. = 4) than the connector (Teflon approx. = 2.25). The discontinuity can be observed in transmit or receive eye diagrams, and can reduce the effective link margin of serial data networks. High-speed serial data network transmission improvements can be made at the connector-to-board interfaces as well as improving differential via hole impedances. The impedance discontinuity was improved by 10 percent by drilling a 20-mil (approx. = 0.5-mm) hole in between the pin of a differential connector spaced 55 mils (approx. = 1.4 mm) apart as it is attached to the PCB. The effective dielectric constant of the board can be lowered by drilling holes into the board material between the differential lines in a quadrax or twinax connector attachment points. The differential impedance is inversely proportional to the square root of the relative dielectric constant. This increases the differential impedance and thus reduces the above described impedance discontinuity. The differential via hole impedance can also be increased in the same manner. This technique can be extended to multiple smaller drilled holes as well as tapered holes (i.e., big in the middle followed by smaller ones diagonally).

  10. Discontinuities of Plastic Deformation in Metallic Glasses with Different Glass Forming Ability

    Science.gov (United States)

    Hurakova, Maria; Csach, Kornel; Miskuf, Jozef; Jurikova, Alena; Demcak, Stefan; Ocelik, Vaclav; Hosson, Jeff Th. M. De

    The metallic ribbons Fe40Ni40B20, Cu47Ti35Zr11Ni6Si1 and Zr65Cu17.5Ni10Al7.5 with different microhardness and glass forming ability were studied at different loading rates from 0.05 to 100 mN/s. We describe in details the differences in elemental discontinuities on the loading curves for the studied alloys. It was found that the discontinuities began at a certain local deformation independently on the macroscopic mechanical properties of a ribbon. More developed discontinuities at higher deformations are created for the materials with lower microhardness and so lower strength.

  11. Trial discontinuation: lessons for future trial design?

    NARCIS (Netherlands)

    V.J.A.A. Nuij (Veerle); C.J. de Haar (Colin); C.J. van der Woude (Janneke)

    2012-01-01

    textabstractBackground: The current therapeutic arsenal still does not fulfill the therapeutic needs of inflammatory bowel disease patients. Although new drugs are constantly being developed, many will never reach the market. In this review we will search for reasons for discontinuing promising

  12. Determining the Locations and Discontinuities in the Derivatives of Functions

    International Nuclear Information System (INIS)

    Archibald, Richard K.; Gelb, Anne; Yoon, Jungho

    2007-01-01

    We introduce a method for detecting discontinuities in piecewise smooth functions and in their derivatives. The method is constructed from a local stencil of grid point values and is based on a polynomial annihilation technique. By varying the order of the method and the arrangement of the corresponding stencils, the jump discontinuities of a function and its derivatives can be identified with high order accuracy. The method is efficient and robust and can be applied to non-uniform distributions in one dimension

  13. On cell entropy inequality for discontinuous Galerkin methods

    Science.gov (United States)

    Jiang, Guangshan; Shu, Chi-Wang

    1993-01-01

    We prove a cell entropy inequality for a class of high order discontinuous Galerkin finite element methods approximating conservation laws, which implies convergence for the one dimensional scalar convex case.

  14. Pin cell discontinuity factors in the transient 3-D discrete ordinates code TORT-TD - 237

    International Nuclear Information System (INIS)

    Seubert, A.

    2010-01-01

    This paper describes the application of generalized equivalence theory to the time-dependent 3-D discrete ordinates neutron transport code TORT-TD. The introduction of pin cell discontinuity factors into the discrete ordinates transport equation is described by assuming a linear dependence of the homogenized neutron angular flux within a pin cell which may be discontinuous at the interfaces to adjacent cells. The homogenized flux discontinuity at cell interfaces is expressed by pin cell discontinuity factors which in turn are determined from fuel assembly lattice calculations using HELIOS. Application of TORT-TD to the all rods in state of the PWR MOX/UO 2 Core Transient Benchmark with pin cell homogenized nuclear cross sections demonstrate the potential of pin cell discontinuity factors to reduce pin cell homogenization errors. (authors)

  15. Determination of Mantle Discontinuity Depths beneath the South Pacific Superswell As Inferred Using Data From Broadband OBS Array

    Science.gov (United States)

    Suetsugu, D.; Shiobara, H.; Sugioka, H.; Kanazawa, T.; Fukao, Y.

    2005-12-01

    We determined depths of the mantle discontinuities (the 410-km and 660-km discontinuities) beneath the South Pacific Superswell using waveform data from broadband ocean bottom seismograph (BBOBS) array to image presumed mantle plumes and their temperature anomalies. Seismic structure beneath this region had not previously been well explored in spite of its significance for mantle dynamics. The region is characterized by a topographic high of more than 680 m (Adam and Bonneville, 2005), a concentration of hotspot chains (e.g., Society, Cook-Austral, Marquesas, and Pitcairn) whose volcanic rocks have isotopic characteristics suggesting deep mantle origin, and a broad low velocity anomaly in the lower mantle revealed by seismic tomography. These observations suggest the presence of a whole-mantle scale upwelling beneath the region, which is called a 'superplume' (McNutt, 1998). However, the seismic structure has been only poorly resolved so far and the maximum depth of anomalous material beneath the hotspots has not yet been determined, mainly due to the sparseness of seismic stations in the region. To improve the seismic coverage, we deployed an array of 10 BBOBS over the French Polynesia area from 2003 to 2005. The BBOBS has been developed by Earthquake Research Institute of University of Tokyo and are equipped with the broadband CMG-3T/EBB sensor. The observation was conducted as a Japan-France cooperative project (Suetsugu et al., 2005, submitted to EOS). We computed receiver functions from the BBOBS data to detect Ps waves from the mantle discontinuities. The Velocity Spectrum Stacking method (Gurrola et al., 1994) were employed to enhance the Ps waves for determination of the discontinuity depths, in which receiver functions were stacked in a depth-velocity space. The Ps-waves from the mantle discontinuities were successfully detected at the most of the BBOBS stations, from which the discontinuity depths were determined with the Iasp91 velocity model. The 410-km

  16. Predictors of premature clopidogrel discontinuation within 30 days of successful coronary artery stenting

    Directory of Open Access Journals (Sweden)

    Çayan Cakir

    2018-01-01

    Full Text Available Objective: We aimed to determine the prevalence, predictors, and mortality rate of premature clopidogrel discontinuation within 30 days of successful coronary stenting. Methods: All consecutive patients who underwent successful coronary stent implantation at our hospital between December 2006 and December 2007 were prospectively included in this study. Patients were interviewed by telephone 30 days after stent implantation. Premature clopidogrel discontinuation was defined as follows: patients who did not continue clopidogrel after discharge were defined as “never used” and patients who received clopidogrel for <20 days or interrupted therapy for at least 5 successive days within the first 30 days were defined as “partially used.” Results: Follow-up data were available for 381 patients and 58 (15.2% patients reported premature clopidogrel discontinuation. No mortality and only 1 (0.3% stent thrombosis occurred in adherent patients, whereas there were 2 (3.4% mortalities and 6 (10.3% stent thrombosis in the patients who prematurely discontinued clopidogrel. Those who discontinued clopidogrel therapy were older (P = 0.02, more likely to be female (P = 0.02, single (P = 0.03, of lower economic (P < 0.05 and educational status (P < 0.01, more likely to have chronic disease (P = 0.04, less likely to have undergone previous stenting (P = 0.01, and were more likely to be receiving a larger number of drugs (P < 0.05. In multivariate analysis, low- or intermediate-economic status, no history of previous stent implantation, and total number of prescribed drugs using were factors independently associated with premature clopidogrel discontinuation. Conclusion: This study demonstrates several predictors of premature clopidogrel discontinuation. This data may help clinicians pay particular attention to these patients in an attempt to improve the outcomes of coronary stenting.

  17. Estimation of the Continuous and Discontinuous Leverage Effects.

    Science.gov (United States)

    Aït-Sahalia, Yacine; Fan, Jianqing; Laeven, Roger J A; Wang, Christina Dan; Yang, Xiye

    2017-01-01

    This paper examines the leverage effect, or the generally negative covariation between asset returns and their changes in volatility, under a general setup that allows the log-price and volatility processes to be Itô semimartingales. We decompose the leverage effect into continuous and discontinuous parts and develop statistical methods to estimate them. We establish the asymptotic properties of these estimators. We also extend our methods and results (for the continuous leverage) to the situation where there is market microstructure noise in the observed returns. We show in Monte Carlo simulations that our estimators have good finite sample performance. When applying our methods to real data, our empirical results provide convincing evidence of the presence of the two leverage effects, especially the discontinuous one.

  18. Continuation versus discontinuation of oxytocin in the active phase of labour

    DEFF Research Database (Denmark)

    Bor, Isil Pinar; Ledertoug, Susanne; Boie, Sidsel

    2016-01-01

    . POPULATION: Women with singleton pregnancy in the vertex position undergoing labour induction or augmentation. METHODS: Two hundred women were randomised when cervical dilation was ≤4 cm to either continue or discontinue oxytocin infusion when cervical dilation reached 5 cm. MAIN OUTCOME MEASURES......, and neonatal outcomes. RESULTS: The active phase of labour was longer by 41 minutes (95% confidence interval 11-75 minutes) in the discontinued group (median 125 minutes in 85 women who had reached the active phase and delivered vaginally) versus the continued group (median 88 minutes in 78 women......OBJECTIVE: To investigate whether discontinuation of oxytocin infusion increases the duration of the active phase of labour and reduces maternal and neonatal complications. DESIGN: Randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, Regional Hospital of Randers, Denmark...

  19. Discontinuity Preserving Image Registration through Motion Segmentation: A Primal-Dual Approach

    Directory of Open Access Journals (Sweden)

    Silja Kiriyanthan

    2016-01-01

    Full Text Available Image registration is a powerful tool in medical image analysis and facilitates the clinical routine in several aspects. There are many well established elastic registration methods, but none of them can so far preserve discontinuities in the displacement field. These discontinuities appear in particular at organ boundaries during the breathing induced organ motion. In this paper, we exploit the fact that motion segmentation could play a guiding role during discontinuity preserving registration. The motion segmentation is embedded in a continuous cut framework guaranteeing convexity for motion segmentation. Furthermore we show that a primal-dual method can be used to estimate a solution to this challenging variational problem. Experimental results are presented for MR images with apparent breathing induced sliding motion of the liver along the abdominal wall.

  20. Life Threatening Severe QTc Prolongation in Patient with Systemic Lupus Erythematosus due to Hydroxychloroquine

    Directory of Open Access Journals (Sweden)

    John P. O’Laughlin

    2016-01-01

    Full Text Available We present a case of a syncopal episode resulting from significant QT interval prolongation in a patient on hydroxychloroquine for the treatment of systemic lupus erythematosus and end stage renal disease. The patient had been treated with hydroxychloroquine for two years prior to presentation. After thorough workup for secondary causes of QT interval prolongation hydroxychloroquine was discontinued and the patient’s QT interval shortened. The patient was treated with mexiletine to prevent sudden ventricular arrhythmias, which was unique compared to other documented cases in which lidocaine was used. The patient was noted to have mild prolongation of the QT interval on electrocardiogram prior to initiation of hydroxychloroquine therapy which was exacerbated by its use and may have been caused due to toxicity from underlying renal failure.

  1. Forecasting Technological Discontinuities in the ICT Industry

    DEFF Research Database (Denmark)

    Hoisl, Karin; Stelzer, Tobias; Biala, Stefanie

    2015-01-01

    in the ICT industry. The conjoint approach allows for a simulation of the forecasting process and considers utility trade-offs. The results show that for both types of experts the perceived benefit of users most highly contributes to predicting technological discontinuities. Internal experts assign more...

  2. Determinants of Method Switching among Social Franchise Clients Who Discontinued the Use of Intrauterine Contraceptive Device.

    Science.gov (United States)

    Hameed, Waqas; Azmat, Syed Khurram; Ali, Moazzam; Hussain, Wajahat; Mustafa, Ghulam; Ishaque, Muhammad; Ali, Safdar; Ahmed, Aftab; Temmerman, Marleen

    2015-01-01

    Introduction. Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD) to other methods instead of terminating contraceptive usage altogether. Methods. The data used for this study comes from a larger cross-sectional survey conducted in nine (9) randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who reported the removal of IUCDs due to reasons other than the desire to get pregnant. Results. We found that 39.9% of the women do not switch to another method of contraception within one month after IUCD discontinuation. Use of contraception before IUCD insertion increases the odds for method switching by 2.26 times after removal. Similarly, postremoval follow-up by community health worker doubles (OR = 2.0) the chances of method switching. Compared with women who received free IUCD service (via voucher scheme), the method switching is 2.01 times higher among women who had paid for IUCD insertion. Conclusion. To increase the likelihood of method switching among IUCD discontinuers this study emphasizes the need for postremoval client counseling, follow-up by healthcare provider, improved choices to a wider range of contraceptives for poor clients, and user satisfaction.

  3. Determinants of Method Switching among Social Franchise Clients Who Discontinued the Use of Intrauterine Contraceptive Device

    Directory of Open Access Journals (Sweden)

    Waqas Hameed

    2015-01-01

    Full Text Available Introduction. Women who do not switch to alternate methods after contraceptive discontinuation, for reasons other than the desire to get pregnant or not needing it, are at obvious risk for unplanned pregnancies or unwanted births. This paper examines the factors that influence women to switch from Intrauterine Contraceptive Device (IUCD to other methods instead of terminating contraceptive usage altogether. Methods. The data used for this study comes from a larger cross-sectional survey conducted in nine (9 randomly selected districts of Sindh and Punjab provinces of Pakistan, during January 2011. Using Stata 11.2, we analyzed data on 333 women, who reported the removal of IUCDs due to reasons other than the desire to get pregnant. Results. We found that 39.9% of the women do not switch to another method of contraception within one month after IUCD discontinuation. Use of contraception before IUCD insertion increases the odds for method switching by 2.26 times after removal. Similarly, postremoval follow-up by community health worker doubles (OR = 2.0 the chances of method switching. Compared with women who received free IUCD service (via voucher scheme, the method switching is 2.01 times higher among women who had paid for IUCD insertion. Conclusion. To increase the likelihood of method switching among IUCD discontinuers this study emphasizes the need for postremoval client counseling, follow-up by healthcare provider, improved choices to a wider range of contraceptives for poor clients, and user satisfaction.

  4. Anti-parathyroid treatment effectiveness and persistence in incident haemodialysis patients with secondary hyperparathyroidism.

    Science.gov (United States)

    de Francisco, Angel Luis Martín; Gillespie, Iain Andrew; Gioni, Ioanna; Floege, Jürgen; Kronenberg, Florian; Marcelli, Daniele; Wheeler, David Collins; Froissart, Marc; Drueke, Tilman Bernhard

    2016-01-01

    Anti-parathyroid treatment initiation and discontinuation are important decisions in chronic haemodialysis (HD) patients, where pill burden is often excessive. The present study aimed to describe secondary hyperparathyroidism (sHPT) drug therapy changes in HD patients. Retrospective observational cohort study of incident European HD patients with sHPT who were prescribed calcitriol or alfacalcidol (alpha calcitriol), paricalcitol or cinacalcet. Treatment-naïve patients prescribed alpha calcitriol (N=2259), paricalcitol (N=1689) and cinacalcet (N=1245) were considered for analysis. Serum intact parathyroid hormone (iPTH) levels decreased post-initiation with all treatment modalities; serum calcium and phosphate levels increased in response to activated vitamin D derivatives but decreased with cinacalcet. Approximately one-third of alpha calcitriol and paricalcitol patients but less than one-quarter of cinacalcet patients discontinued treatment. Although the three groups had comparable serum iPTH control at the time of treatment discontinuation, they differed in terms of calcium and phosphate levels. Following discontinuation, the evolution of laboratory parameters differed by treatment modality: whilst iPTH increased for all three treatment groups, calcium and phosphate decreased in patients who were being treated with alpha calcitriol and paricalcitol at the time of discontinuation, and increased in those who had been treated with cinacalcet. In conditions of daily clinical practice, attaining and maintaining recommended biochemical control of sHPT appears to be more frequently achievable with cinacalcet than with activated vitamin D compounds. Copyright © 2015 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  5. ADER discontinuous Galerkin schemes for general-relativistic ideal magnetohydrodynamics

    Science.gov (United States)

    Fambri, F.; Dumbser, M.; Köppel, S.; Rezzolla, L.; Zanotti, O.

    2018-03-01

    We present a new class of high-order accurate numerical algorithms for solving the equations of general-relativistic ideal magnetohydrodynamics in curved spacetimes. In this paper we assume the background spacetime to be given and static, i.e. we make use of the Cowling approximation. The governing partial differential equations are solved via a new family of fully-discrete and arbitrary high-order accurate path-conservative discontinuous Galerkin (DG) finite-element methods combined with adaptive mesh refinement and time accurate local timestepping. In order to deal with shock waves and other discontinuities, the high-order DG schemes are supplemented with a novel a-posteriori subcell finite-volume limiter, which makes the new algorithms as robust as classical second-order total-variation diminishing finite-volume methods at shocks and discontinuities, but also as accurate as unlimited high-order DG schemes in smooth regions of the flow. We show the advantages of this new approach by means of various classical two- and three-dimensional benchmark problems on fixed spacetimes. Finally, we present a performance and accuracy comparisons between Runge-Kutta DG schemes and ADER high-order finite-volume schemes, showing the higher efficiency of DG schemes.

  6. Upper Mantle Discontinuities Underneath Central and Southern Mexico

    Science.gov (United States)

    Perez-Campos, X.; Clayton, R. W.

    2011-12-01

    Central and southern Mexico are affected by the subduction of Cocos plate beneath North American plate. The MesoAmerican Subduction Experiment (MASE) and the Veracruz-Oaxaca (VEOX) project have mapped the geometry of the Cocos slab. It is characterized in central Mexico by a shallow horizontal geometry up to ~300 km from the trench, then it dives steeply (70°) into the mantle, to its apparent end at 500 km depth. In contrast, some 400 km to the south, the slab subducts smoothly, with a dip angle of ~26° to a depth of 150 km. We use receiver functions from teleseismic events, recorded at stations from MASE, VEOX, and the Servicio Sismológico Nacional (SSN, Mexican National Seismological Service) to map the upper mantle discontinuities and properties of the transition zone in central and southern Mexico. We also use data from the Mapping the Rivera Subduction Zone (MARS) Experiment to get a complete picture of the subduction regime in central Mexico and compare the mantle transition zone in a slab tear regime. The 410 discontinuity shows significant variation in topography in central Mexico, particularly where the slab is expected to reach such depth. The 660 discontinuity shows a smoother topography, indicating that the slab does not penetrate this far down. The results will be compared with a ridge regime in the Gulf of California.

  7. Interface discontinuity factors in the modal Eigenspace of the multigroup diffusion matrix

    International Nuclear Information System (INIS)

    Garcia-Herranz, N.; Herrero, J.J.; Cuervo, D.; Ahnert, C.

    2011-01-01

    Interface discontinuity factors based on the Generalized Equivalence Theory are commonly used in nodal homogenized diffusion calculations so that diffusion average values approximate heterogeneous higher order solutions. In this paper, an additional form of interface correction factors is presented in the frame of the Analytic Coarse Mesh Finite Difference Method (ACMFD), based on a correction of the modal fluxes instead of the physical fluxes. In the ACMFD formulation, implemented in COBAYA3 code, the coupled multigroup diffusion equations inside a homogenized region are reduced to a set of uncoupled modal equations through diagonalization of the multigroup diffusion matrix. Then, physical fluxes are transformed into modal fluxes in the Eigenspace of the diffusion matrix. It is possible to introduce interface flux discontinuity jumps as the difference of heterogeneous and homogeneous modal fluxes instead of introducing interface discontinuity factors as the ratio of heterogeneous and homogeneous physical fluxes. The formulation in the modal space has been implemented in COBAYA3 code and assessed by comparison with solutions using classical interface discontinuity factors in the physical space. (author)

  8. 14 CFR 170.25 - LORAN-C discontinuance criteria.

    Science.gov (United States)

    2010-01-01

    ... nonprecision approach may be subject to discontinuance when the present value of the continued maintenance costs (PVCM) of the LORAN-C approach exceed the present value of its remaining life-cycle benefits (PVB...

  9. Innovation at the end of the life cycle : discontinuous innovation strategies by incumbents

    NARCIS (Netherlands)

    Kishna, M.; Negro, S.O.; Alkemade, F.; Hekkert, M.

    2017-01-01

    This paper focuses on the strategies of incumbents that seek to develop discontinuous innovations within the boundaries of a mature innovation system. Mature innovation systems do not provide support for these discontinuous innovations. This article focuses on exploring why incumbents in these

  10. Baseline predictors of persistence to first disease-modifying treatment in multiple sclerosis.

    Science.gov (United States)

    Zettl, U K; Schreiber, H; Bauer-Steinhusen, U; Glaser, T; Hechenbichler, K; Hecker, M

    2017-08-01

    Patients with multiple sclerosis (MS) require lifelong therapy. However, success of disease-modifying therapies is dependent on patients' persistence and adherence to treatment schedules. In the setting of a large multicenter observational study, we aimed at assessing multiple parameters for their predictive power with respect to discontinuation of therapy. We analyzed 13 parameters to predict discontinuation of interferon beta-1b treatment during a 2-year follow-up period based on data from 395 patients with MS who were treatment-naïve at study onset. Besides clinical characteristics, patient-related psychosocial outcomes were assessed as well. Among patients without clinically relevant fatigue, males showed a higher persistence rate than females (80.3% vs 64.7%). Clinically relevant fatigue scores decreased the persistence rate in men and especially in women (71.4% and 51.2%). Besides gender and fatigue, univariable and multivariable analyses revealed further factors associated with interferon beta-1b therapy discontinuation, namely lower quality of life, depressiveness, and higher relapse rate before therapy initiation, while higher education, living without a partner, and higher age improved persistence. Patients with higher grades of fatigue and depressiveness are at higher risk to prematurely discontinue MS treatment; especially, women suffering from fatigue have an increased discontinuation rate. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  11. Measurement of a discontinuous object based on a dual-frequency grating

    Institute of Scientific and Technical Information of China (English)

    Qiao Nao-Sheng; Cai Xin-Hua; Yao Chun-Mei

    2009-01-01

    The dual-frequency grating measurement theory is proposed in order to carry out the measurement of a discontinuous object. Firstly, the reason why frequency spectra are produced by low frequency gratings and high frequency gratings in the field of frequency is analysed, and the relationship between the wrapped-phase and the unwrappingphase is discussed. Secondly, a method to combine the advantages of the two kinds of gratings is proposed: one stripe is produced in the mutation part of the object measured by a suitable low frequency grating designed by MATLAB, then the phase produced by the low frequency grating need not be unfolded. The integer series of stripes is produced by a high frequency grating designed by MATLAB based on the frequency ratio of the two kinds of gratings and the high frequency wrapped-phase, and the high frequency unwrapping-phase is then obtained. In order to verify the correctness of the theoretical analysis, a steep discontinuous object of 600×600 pixels and 10.00 mm in height is simulated and a discontinuous object of ladder shape which is 32.00 mm in height is used in experiment. Both the simulation and the experiment can restore the discontinuous object height accurately by using the dual-frequency grating measurement theory.

  12. Discontinuous conduction mode analysis of phase-modulated series ...

    Indian Academy of Sciences (India)

    modulated dc–dc series resonant converter (SRC) operating in discontinuous conduction mode (DCM). The conventional fundamental harmonic approximation technique is extended for a non-ideal series resonant tank to clarify the limitations of ...

  13. Fatigue analysis of a structure with welds considering metallurgical discontinuities

    International Nuclear Information System (INIS)

    Cabrillat, M.T.; Lejeail, Y.

    1995-01-01

    Within the frameworks of a creep-fatigue experimental program, called EVASION, thermo-mechanical tests were conducted on two mock-ups, the first one was fully machined and the second one welded and then machined (in order to eliminate geometrical discontinuities, thus only leaving metallurgical discontinuities). These two mock-ups were submitted to exactly the same loading history. Plastic analyses with a correct description of mechanical properties and fatigue strength of materials are conducted and compared with experimental results in order to highlight the influence of the weld. (author). 3 refs., 4 figs., 3 tabs

  14. HIV Prevention After Discontinuing Pre-Exposure Prophylaxis: Conclusions From a Case Study

    Directory of Open Access Journals (Sweden)

    Kai J. Jonas

    2018-05-01

    Full Text Available Pre-exposure prophylaxis (PrEP with tenofovir disoproxil fumarate in combination with emtricitabine (FTC is a highly effective form of HIV prevention. Endeavors of health-care providers and activists in many countries over the world are directed at making access to PrEP possible, or increasing PrEP use among men-who-have-sex-with-men (MSM. We argue while this effort is necessary, we also need to consider modes of HIV prevention after a period of PrEP use. PrEP uptake is not a one-way street, meaning that individuals may discontinue PrEP use, either voluntarily and involuntarily. Voluntary discontinued PrEP use in conjunction with decreased or no HIV risk exposure is unproblematic, but involuntary discontinuations with continuous high level of HIV risk exposure calls for tailored post-PrEP use HIV prevention. We present a case study of an MSM individual who discontinued PrEP for medical reasons (renal function and seroconverted soon afterward, to illustrate the need for tailored HIV prevention post-PrEP. Furthermore, we provide additional contexts of PrEP discontinuation leading to populations that are in need for post-PrEP types of HIV prevention. Subsequently, we present suggestions for modes of post-PrEP HIV prevention based on knowledge–communication–choice model. Community organization and health-care providers should consider and prepare their HIV prevention consulting protocols for such types of clients and add post-PrEP HIV prevention measures to their consulting offer.

  15. Discontinuous precipitation in cobalt-tungsten alloys

    International Nuclear Information System (INIS)

    Zieba, P.; Cliff, G.; Lorimer, G.W.

    1997-01-01

    Discontinuous precipitation in a Co32 wt% W alloy aged in the temperature range from 875 K to 1025 K has been investigated. Philips EM 430 STEM has been used to characterize the microstructure and to measure the composition profiles across individual lamellae of ε Co and Co 3 W phases in partially transformed specimens. Two kinds of cellular precipitates have been found in the alloy. The initial transformation product, identified as primary lamellae with spacing of a few nanometers is replaced during prolonged ageing by secondary lamellae with a much larger interlamellar spacing, typically a few tens of nm. Line scans across cell boundaries of the primary lamellae revealed that, just behind the advancing cell boundary, the solute content is far from the equilibrium state. This solute excess within the cells is quickly removed at the ageing temperature. Calculations show that the diffusion process was too rapid to be identified as ordinary volume diffusion. Investigation of the kinetics showed that discontinuous precipitation is controlled by diffusion processes at the advancing cell boundary. This proposal has been confirmed by STEM analysis of tungsten profiles in the depleted ε Co lamellae

  16. Clinical features of HBV-associated acute-on-chronic liver failure induced by discontinuation of nucleoside analogues

    Directory of Open Access Journals (Sweden)

    LIU Xiaoyan

    2016-09-01

    Full Text Available Objective To investigate the clinical features of patients with HBV-associated acute-on-chronic liver failure (HBV-ACLF induced by the discontinuation of necleos(tide analogues. Methods A retrospective analysis was performed for 698 patients with a definite diagnosis of HBV-ACLF in The 302 Hospital of PLA from January 2014 to April 2016, and among these patients, 150 (discontinuation group had acute-on-chronic liver failure (ACLF induced by discontinuation, 396 (previously untreated group had not received antiviral therapy when they developed this disease for the first time, and the other 152 patients with ACLF caused by other reasons were enrolled as controls. The causative factors, underlying diseases, family history, serum hepatitis B markers, prognosis, and initial onset were summarized, and the drugs used and discontinuation time were recorded for patients who stopped taking necleos(tide analogues. The chi-square test was used for the comparison of categorical data between groups. Results Among the 698 patients, 355(50.86% had a family history of chronic hepatitis B (CHB, and 93 patients (62.00% in the discontinuation group had a family history of CHB. Among the 150 patients in the discontinuation group, 27 (18.00% had an underlying disease of chronic hepatitis, among whom 12 (44.44% had a family history of CHB, which was significantly lower than the overall level (χ2=2.57, P=0.07; 123 (82.00% had an underlying disease of liver cirrhosis (compensated, among whom 81 (65.85% had a family history of CHB, which was significantly higher than the overall level (χ2=48.77, P<0.001. Of all the patients in the discontinuation group, 77.33% (116/150 developed the disease within 1 year after discontinuation, and 21.33% (32/150developed the disease during the second year after discontinuation. The HBeAg-negative patients accounted for 47.33% (71/150. In the discontinuation group and previously untreated group, the patients with an underlying disease

  17. High Resolution Seismic Images of Transition Zone Discontinuities beneath the Hawaii-Emperor Seamount Chain

    Science.gov (United States)

    Cao, Q.; Wang, P.; van der Hilst, R. D.; Shim, S.

    2009-12-01

    Taking advantage of the abundance of natural sources (earthquakes) in western Pacific subduction zones and the many seismograph stations in the Americas, we use inverse scattering - a generalized Radon transform - of SS precursors to image the transition zone discontinuities underneath Hawaii and the Hawaii-Emperor seamount chain. The GRT makes use of scattering theory and extracts structural information from broad band data windows that include precursors to SS (which are the specular reflections at the discontinuities that form the main arrivals) as well as non-specular scattered energy (which is often discarded as noise). More than 150,000 seismograms (from the IRIS Data Management Center) are used to form a 3-D image of the transition zone discontinuities beneath the central Pacific. In addition to clear signals near 410, 520, and 660 km depth, the data also reveal scatter interfaces near 370 km dept and between 800-1000 km depth, which may be regional, laterally intermittent scatter horizons. Our images reveal a conspicuous uplift of the 660 discontinuity in a region of 800km in diameter to the west of the active volcanoes of Hawaii. No correspondent localized depression of the 410 discontinuity is found. Instead, we find a smaller scale anomaly suggesting that the 410 discontinuity is locally elevated in the same region. This may indicate the presence of melt or minor chemical constitutes. The lack of correlation between and differences in lateral length scale of the topographies of the 410 and 660 km discontinuities are also consistent with a deep-mantle plume impinging on the transition zone, creating a pond of hot material underneath 660 discontinuity, and with secondary plumes connecting to the present-day hotspot at Earth’s surface. Our observations suggest that more complicated plume morphology and plume dynamics within the Earth's mantle should be taken into account to describe the plumes and, in particular, mass transport across the transition zone

  18. Roughness-dependent tribology effects on discontinuous shear thickening.

    Science.gov (United States)

    Hsu, Chiao-Peng; Ramakrishna, Shivaprakash N; Zanini, Michele; Spencer, Nicholas D; Isa, Lucio

    2018-05-15

    Surface roughness affects many properties of colloids, from depletion and capillary interactions to their dispersibility and use as emulsion stabilizers. It also impacts particle-particle frictional contacts, which have recently emerged as being responsible for the discontinuous shear thickening (DST) of dense suspensions. Tribological properties of these contacts have been rarely experimentally accessed, especially for nonspherical particles. Here, we systematically tackle the effect of nanoscale surface roughness by producing a library of all-silica, raspberry-like colloids and linking their rheology to their tribology. Rougher surfaces lead to a significant anticipation of DST onset, in terms of both shear rate and solid loading. Strikingly, they also eliminate continuous thickening. DST is here due to the interlocking of asperities, which we have identified as "stick-slip" frictional contacts by measuring the sliding of the same particles via lateral force microscopy (LFM). Direct measurements of particle-particle friction therefore highlight the value of an engineering-tribology approach to tuning the thickening of suspensions. Copyright © 2018 the Author(s). Published by PNAS.

  19. Super-convergence of Discontinuous Galerkin Method Applied to the Navier-Stokes Equations

    Science.gov (United States)

    Atkins, Harold L.

    2009-01-01

    The practical benefits of the hyper-accuracy properties of the discontinuous Galerkin method are examined. In particular, we demonstrate that some flow attributes exhibit super-convergence even in the absence of any post-processing technique. Theoretical analysis suggest that flow features that are dominated by global propagation speeds and decay or growth rates should be super-convergent. Several discrete forms of the discontinuous Galerkin method are applied to the simulation of unsteady viscous flow over a two-dimensional cylinder. Convergence of the period of the naturally occurring oscillation is examined and shown to converge at 2p+1, where p is the polynomial degree of the discontinuous Galerkin basis. Comparisons are made between the different discretizations and with theoretical analysis.

  20. Modelling discontinuous well log signal to identify lithological ...

    Indian Academy of Sciences (India)

    1Indian School of Mines (ISM), Dhanbad 826 004, India. ... new wavelet transform-based algorithm to model the abrupt discontinuous changes from well log data by taking care of ...... the 11th ACM International Conference on Multimedia,.

  1. Effects of discontinuities of the derivatives of the inflaton potential

    Energy Technology Data Exchange (ETDEWEB)

    Cadavid, Alexander Gallego [Instituto de Fisica, Universidad de Antioquia, A.A.1226, Medellin (Colombia); Yukawa Institute for Theoretical Physics, Kyoto University, Kyoto (Japan); Romano, Antonio Enea, E-mail: aer@physics.uoc.gr [Instituto de Fisica, Universidad de Antioquia, A.A.1226, Medellin (Colombia); Yukawa Institute for Theoretical Physics, Kyoto University, Kyoto (Japan); Department of Physics, University of Crete, 71003, Heraklion (Greece)

    2015-12-12

    We study the effects of a class of features of the inflaton potential, corresponding to discontinuities in its derivatives. We perform fully numerical calculations and derive analytical approximations for the curvature perturbations spectrum and the bispectrum which are in good agreement with the numerical results. The spectrum of primordial perturbations has oscillations around the scale k{sub 0} which leaves the horizon at the time τ{sub 0} when the feature occurs, with the amplitude and phase of the oscillations determined by the size and the order of the discontinuity. The large scale bispectrum in the squeezed and equilateral limits have a very similar form and are linearly suppressed. Both in the squeezed and the equilateral small scale limit the bispectrum has an oscillatory behavior whose phase depends on the parameters determining the discontinuity, and whose amplitude is inversely proportional to the scale. Given the generality of this class of features they could be used to model or classify phenomenologically different types of non-Gaussian features encountered in observational data such as the cosmic microwave background radiation or large scale structure.

  2. Effects of discontinuities of the derivatives of the inflaton potential

    Energy Technology Data Exchange (ETDEWEB)

    Gallego Cadavid, Alexander [Universidad de Antioquia, Instituto de Fisica, Medellin (Colombia); Kyoto University, Yukawa Institute for Theoretical Physics, Kyoto (Japan); Enea Romano, Antonio [Universidad de Antioquia, Instituto de Fisica, Medellin (Colombia); Kyoto University, Yukawa Institute for Theoretical Physics, Kyoto (Japan); University of Crete, Department of Physics, Heraklion (Greece)

    2015-12-15

    We study the effects of a class of features of the inflaton potential, corresponding to discontinuities in its derivatives. We perform fully numerical calculations and derive analytical approximations for the curvature perturbations spectrum and the bispectrum which are in good agreement with the numerical results. The spectrum of primordial perturbations has oscillations around the scale k{sub 0} which leaves the horizon at the time τ{sub 0} when the feature occurs, with the amplitude and phase of the oscillations determined by the size and the order of the discontinuity. The large scale bispectrum in the squeezed and equilateral limits have a very similar form and are linearly suppressed. Both in the squeezed and the equilateral small scale limit the bispectrum has an oscillatory behavior whose phase depends on the parameters determining the discontinuity, and whose amplitude is inversely proportional to the scale. Given the generality of this class of features they could be used to model or classify phenomenologically different types of non-Gaussian features encountered in observational data such as the cosmic microwave background radiation or large scale structure. (orig.)

  3. Mechanical Properties of Discontinuous Precipitated Al-Zn Alloys after Drawing at Room and Cryogenic Temperatures

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Soo; Lee, Jehyun [Changwon National University, Changwon (Korea, Republic of); Han, Seung Zeon; Ahn, Jee Hyuk [Korea Institute of Materials Science, Changwon (Korea, Republic of); Lim, Sung Hwan [Kangwon National University, Chuncheon (Korea, Republic of); Kim, Kwang Ho [Pusan National University, Pusan (Korea, Republic of); Kim, Sang sik [Gyeongsang National University, Jinju (Korea, Republic of)

    2017-02-15

    In order to study the effect of microstructural change on the tensile properties of discontinuous precipitated Al-Zn binary alloy, four different Al-Zn alloys(25, 30, 35, 45 wt%Zn) were aged at 160 ℃ for different aging times(0, 5, 15, 30, 60, 120, 360 min) after being solution treated at 400 ℃, and successively drawn at room and cryogenic temperatures(-197 ℃). Discontinuous precipitation was formed during aging in the Al matrix(which contained more than 30 wt%Zn) in Al alloys containing more than 30 wt%Zn. The tensile strength of continuous precipitated Al-35Zn alloy decreased with increasing drawing ratio, however, the tensile strength of discontinuous precipitated Al-35Zn alloy increased with further drawing. The strength and ductility combination, 350 MPa-36%was achieved by drawning discontinuous precipitated Al-Zn alloy at room temperature. The discontinuous precipitated Al-Zn alloy drawn at cryogenic temperature showed a higher value of tensile strength, over 500 MPa, although ductility decreased.

  4. Mechanical Properties of Discontinuous Precipitated Al-Zn Alloys after Drawing at Room and Cryogenic Temperatures

    International Nuclear Information System (INIS)

    Kim, Min Soo; Lee, Jehyun; Han, Seung Zeon; Ahn, Jee Hyuk; Lim, Sung Hwan; Kim, Kwang Ho; Kim, Sang sik

    2017-01-01

    In order to study the effect of microstructural change on the tensile properties of discontinuous precipitated Al-Zn binary alloy, four different Al-Zn alloys(25, 30, 35, 45 wt%Zn) were aged at 160 ℃ for different aging times(0, 5, 15, 30, 60, 120, 360 min) after being solution treated at 400 ℃, and successively drawn at room and cryogenic temperatures(-197 ℃). Discontinuous precipitation was formed during aging in the Al matrix(which contained more than 30 wt%Zn) in Al alloys containing more than 30 wt%Zn. The tensile strength of continuous precipitated Al-35Zn alloy decreased with increasing drawing ratio, however, the tensile strength of discontinuous precipitated Al-35Zn alloy increased with further drawing. The strength and ductility combination, 350 MPa-36%was achieved by drawning discontinuous precipitated Al-Zn alloy at room temperature. The discontinuous precipitated Al-Zn alloy drawn at cryogenic temperature showed a higher value of tensile strength, over 500 MPa, although ductility decreased.

  5. Continuous versus discontinuous albedo representations in a simple diffusive climate model

    Science.gov (United States)

    Simmons, P. A.; Griffel, D. H.

    1988-07-01

    A one-dimensional annually and zonally averaged energy-balance model, with diffusive meridional heat transport and including icealbedo feedback, is considered. This type of model is found to be very sensitive to the form of albedo used. The solutions for a discontinuous step-function albedo are compared to those for a more realistic smoothly varying albedo. The smooth albedo gives a closer fit to present conditions, but the discontinuous form gives a better representation of climates in earlier epochs.

  6. Propagation of Boundary-Induced Discontinuity in Stationary Radiative Transfer

    Science.gov (United States)

    Kawagoe, Daisuke; Chen, I.-Kun

    2018-01-01

    We consider the boundary value problem of the stationary transport equation in the slab domain of general dimensions. In this paper, we discuss the relation between discontinuity of the incoming boundary data and that of the solution to the stationary transport equation. We introduce two conditions posed on the boundary data so that discontinuity of the boundary data propagates along positive characteristic lines as that of the solution to the stationary transport equation. Our analysis does not depend on the celebrated velocity averaging lemma, which is different from previous works. We also introduce an example in two dimensional case which shows that piecewise continuity of the boundary data is not a sufficient condition for the main result.

  7. Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin-angiotensin system blockade: a UK general practice-based cohort study.

    Science.gov (United States)

    Schmidt, Morten; Mansfield, Kathryn E; Bhaskaran, Krishnan; Nitsch, Dorothea; Sørensen, Henrik Toft; Smeeth, Liam; Tomlinson, Laurie A

    2017-01-09

    To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored. A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. UK primary care, 2004-2014. 223 814 new ACEI/ARB users. Proportion of patients with renal function monitoring before and after ACEI/ARB initiation; creatinine increase ≥30% or potassium levels >6 mmol/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2 weeks after treatment initiation. 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months after initiation of an ACEI/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12-125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored. Only one-tenth of patients initiating ACEI/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation discontinuation criteria for creatinine and potassium increases continue on treatment

  8. Adherence to guidelines for creatinine and potassium monitoring and discontinuation following renin–angiotensin system blockade: a UK general practice-based cohort study

    Science.gov (United States)

    Schmidt, Morten; Bhaskaran, Krishnan; Nitsch, Dorothea; Sørensen, Henrik Toft; Smeeth, Liam; Tomlinson, Laurie A

    2017-01-01

    Objectives To examine adherence to serum creatinine and potassium monitoring and discontinuation guidelines following initiation of treatment with ACE inhibitors (ACEI) or angiotensin receptor blockers (ARBs); and whether high-risk patients are monitored. Design A general practice-based cohort study using electronic health records from the UK Clinical Practice Research Datalink and Hospital Episode Statistics. Setting UK primary care, 2004–2014. Subjects 223 814 new ACEI/ARB users. Main outcome measures Proportion of patients with renal function monitoring before and after ACEI/ARB initiation; creatinine increase ≥30% or potassium levels >6 mmol/L at first follow-up monitoring; and treatment discontinuation after such changes. Using logistic regression models, we also examined patient characteristics associated with these biochemical changes, and with follow-up monitoring within the guideline recommendation of 2 weeks after treatment initiation. Results 10% of patients had neither baseline nor follow-up monitoring of creatinine within 12 months before and 2 months after initiation of an ACEI/ARB, 28% had monitoring only at baseline, 15% only at follow-up, and 47% both at baseline and follow-up. The median period between the most recent baseline monitoring and drug initiation was 40 days (IQR 12–125 days). 34% of patients had baseline creatinine monitoring within 1 month before initiating therapy, but creatinine increase ≥30% (n=567, 1.2%) or potassium level >6 mmol/L (n=191, 0.4%), 80% continued treatment. Although patients with prior myocardial infarction, hypertension or baseline potassium >5 mmol/L were at high risk of ≥30% increase in creatinine after ACEI/ARB initiation, there was no evidence that they were more frequently monitored. Conclusions Only one-tenth of patients initiating ACEI/ARB therapy receive the guideline-recommended creatinine monitoring. Moreover, the vast majority of the patients fulfilling postinitiation

  9. Antipsychotic discontinuation syndromes: a narrative review of the evidence and its integration into Australian mental health nursing textbooks.

    Science.gov (United States)

    Salomon, Carmela; Hamilton, Bridget

    2014-02-01

    In light of the high number of people discontinuing antipsychotics each year, it is essential that nurses develop a robust understanding of all aspects of the discontinuation experience. While there is a large body of published work documenting post-discontinuation relapse rates, less is known about other aspects of the discontinuation experience. This paper presents the results of a narrative review of international studies of antipsychotic discontinuation syndromes and their relevance to nursing practice. Four key mental health nursing textbooks used in student nurse education in Australia are examined to assess how this evidence has been incorporated into clinical recommendations. This review finds that the evidence for discontinuation syndromes could be more widely disseminated and applied than it is at present. Strikingly, this evidence has not been incorporated into key mental health nursing textbooks in Australia at all. Slow integration into nursing published work may be influenced by a number of clinical and research uncertainties. We consider the impact of this silence on key nursing roles of psycho-education and adverse event monitoring during antipsychotic discontinuation periods. Further robust research should be conducted into discontinuation syndromes as a matter of urgency. Given the high number of consumers potentially impacted upon by discontinuation syndromes, nurse authors and educators should consider revising key nursing textbooks to include the currently available information about discontinuation syndromes. © 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

  10. High rates of regimen change due to drug toxicity among a cohort of South Indian adults with HIV infection initiated on generic, first-line antiretroviral treatment.

    Science.gov (United States)

    Sivadasan, Ajith; Abraham, O C; Rupali, Priscilla; Pulimood, Susanne A; Rajan, Joyce; Rajkumar, S; Zachariah, Anand; Kannangai, Rajesh; Kandathil, Abraham Joseph; Sridharan, G; Mathai, Dilip

    2009-05-01

    To determine the rates, reasons and predictors of treatment change of the initial antiretroviral treatment (ART) regimen in HIV-infected south Indian adults. In this prospective cohort study, ART-naive adults initiated on generic, fixed dose combination ART as per the National AIDS Control Organization guidelines were followed up at an academic medical center. Treatment change was defined as any event which necessitated a change in or discontinuation of the initial ART regimen. Two hundred and thirty persons with HIV infection (males 74.8% and median age 37 years) were followed up for median duration of 48 weeks. The majority (98.7%) had acquired HIV infection through the heterosexual route. Most (70.4%) had advanced IV infection (WHO clinical stage 3 or 4) and 78% had CD4+ T-lymphocyte counts below 200 cells/microL. The initial ART regimens used were: Lamivudine (3TC) with Stavudine (d4T) (in 76%) or Azidothymidine (AZT) and Nevirapine (NVP) (in 86%) or Efavirenz (EFV). The cumulative incidence of treatment change was 39.6% (91 patients). Drug toxicity (WHO grade 3 or 4) was the reason for treatment change among 62 (27%) (incidence rate 35.9/100 person-years). The most common toxicities were attributable to the thymidine analogue nucleoside reverse transcriptase inhibitors (NRTIs), d4T and AZT [lactic acidosis (8.7%), anemia (7%) and peripheral neuropathy (5.2%)]. The other toxicities were rash (3.9%) and hepatitis (1.3%) due to NVP. The mortality (4.6/100 person-years) and disease progression rates (4.1/100 person-years) were low. The ART regimens used in this study were effective in decreasing disease progression and death. However, they were associated with high rates of drug toxicities, particularly those attributable to thymidine analogue NRTI. As efforts are made to improve access to ART, treatment regimens chosen should not only be potent, but also safe.

  11. SSRI treatment suppresses dream recall frequency but increases subjective dream intensity in normal subjects.

    Science.gov (United States)

    Pace-Schott, E F; Gersh, T; Silvestri, R; Stickgold, R; Salzman, C; Hobson, J A

    2001-06-01

    Clinical lore and a small number of published studies report that the selective serotonin reuptake inhibitors (SSRIs) intensify dreaming. This study examines the dream effects of paroxetine and fluvoxamine in order to both increase clinical knowledge of these agents and to test an important potential method for probing the relationship between REM sleep neurobiology and dreaming in humans. Fourteen normal, paid volunteers (4 males, 10 females; mean age 27.4 year, range 22--39) free of medical or neuropsychiatric symptoms as well as of psychotropic or sleep affecting drugs completed a 31-day home-based study consisting of: 7 days drug-free baseline; 19 days on either 100 mg fluvoxamine (7 Ss) or 20 mg paroxetine (7 Ss) in divided morning and evening doses; and 5 days acute discontinuation. Upon awakening, subjects wrote dream reports, self-scored specific emotions in their reports and rated seven general dream characteristics using 5-point Likert scales. Dream reports were independently scored for bizarreness, movement and number of visual nouns by three judges. REM sleep-related measures were obtained using the Nightcap ambulatory sleep monitor. Mean dream recall frequency decreased during treatment compared with baseline. Dream report length and judge-rated bizarreness were greater during acute discontinuation compared with both baseline and treatment and this effect was a result of the fluvoxamine-treated subjects. The subjective intensity of dreaming increased during both treatment and acute discontinuation compared with baseline. Propensity to enter REM sleep was decreased during treatment compared with baseline and acute discontinuation and the intensity of REM sleep increased during acute discontinuation compared with baseline and treatment. The decrease in dream frequency during SSRI treatment may reflect serotonergic REM suppression while the augmented report length and bizarreness during acute SSRI discontinuation may reflect cholinergic rebound from

  12. Factors associated with β-blocker initiation and discontinuation in a population-based cohort of seniors newly diagnosed with heart failure

    Directory of Open Access Journals (Sweden)

    Girouard C

    2016-09-01

    Full Text Available Catherine Girouard,1–3 Jean-Pierre Grégoire,1–3 Paul Poirier,2,4 Jocelyne Moisan1–3 1Chair on Adherence to Treatments, Université Laval, 2Faculty of Pharmacy, Université Laval, 3Population Health and Optimal Health Practices Research Unit, CHU de Québec Research Center, 4Quebec Heart and Lung Institute-Université Laval, Quebec City, QC, Canada Purpose: β-Blockers (bisoprolol, carvedilol, and metoprolol are the cornerstone of heart failure (HF management. The incidence rate of β-blocker initiation and discontinuation and their associated factors among seniors with a first HF diagnosis were assessed.Methods: A population-based inception cohort study that included all individuals aged ≥65 years with a first HF diagnosis in Quebec was conducted. β-Blockers initiation among 91,131 patients who were not using β-blockers at the time of HF diagnosis and discontinuation among those who initiated a β-blocker after HF diagnosis were assessed. Stepwise Cox regression analyses were used to calculate hazard ratios (HR and to identify factors associated with β-blocker initiation and discontinuation.Results: After HF diagnosis, 32,989 (36.2% individuals initiated a β-blocker. Of these, 15,408 (46.7% discontinued their β-blocker during the follow-up. Individuals more likely to initiate a β-blocker were those diagnosed in a recent calendar year (2009: HR, 2.11; 95% confidence interval [CI], 2.00–2.23 and diagnosed by a cardiologist (HR, 1.38; 95% CI, 1.34–1.42. Individuals less likely to initiate were those aged ≥90 years (HR, 0.65; 95% CI, 0.61–0.68 and those with chronic obstructive pulmonary disease (HR, 0.66; 95% CI, 0.64–0.68. Individuals more likely to discontinue were those with more than nine medical consultations (HR, 1.14; 95% CI, 1.10–1.18 and those with dementia (HR, 1.13; 95% CI, 1.01–1.27. Individuals less likely to discontinue were those diagnosed in a recent calendar year (2009: HR 0.74; 95% CI, 0.65–0.82 and

  13. Contraceptive discontinuation and switching among Ghanaian women: evidence from the Ghana Demographic and Health Survey, 2008.

    Science.gov (United States)

    Modey, Emefa J; Aryeetey, Richmond; Adanu, Richard

    2014-03-01

    This study identifies factors associated with contraceptive discontinuation and switching among Ghanaian women of reproductive age, using data from 1,378 female respondents of the 2008 Ghana Demographic and Health Survey. Logistic regression models were used to determine relationships between key socio-demographic factors and user status. Discontinued use occurred among 56% of ever users and switching among 55% of current users. The IUD was most abandoned (70%) and its use was associated with almost twice the odds of discontinuation (OR = 1.97; 95% CI (1.04, 3.75)). Having a history of terminated pregnancy significantly predicted both discontinuation (OR = 1.36; 95% CI (1.03, 1.79) and switching (OR = 1.78; 95% CI (1.16, 2.73)) and intention to limit births significantly predicted lower discontinuation (OR = 0.71; 95% CI (0.52, 0.96)). Counseling services emphasizing contraceptive options and reinforcing switching are critically needed to reduce unwanted pregnancies that may result from poor method use and discontinuation especially among post-abortion clients and IUD users.

  14. Combination antibiotic therapy for the treatment of infective endocarditis due to enterococci.

    Science.gov (United States)

    Leone, Sebastiano; Noviello, Silvana; Esposito, Silvano

    2016-06-01

    Enterococci are common causes of infective endocarditis (IE) in both health care and community-based setting. Enterococcal IE requires bactericidal therapy for an optimal outcome. For decades, cell-wall-active antimicrobial agents (penicillins or vancomycin) in combination with aminoglycosides were the cornerstone of the treatment; however, the emergence of antibiotic resistance has significantly reduced the efficacy of these regimens. Data for this review were identified by searches of MEDLINE and references from relevant articles on antibiotic combination regimens for the treatment of enterococcal IE. Abstracts presented in scientific conferences were not searched for. New effective and safe combination treatments, including double-β-lactam and daptomycin/β-lactam combination, are proving useful for the management of IE due to enterococci.

  15. Periodic synchronization control of discontinuous delayed networks by using extended Filippov-framework.

    Science.gov (United States)

    Cai, Zuowei; Huang, Lihong; Guo, Zhenyuan; Zhang, Lingling; Wan, Xuting

    2015-08-01

    This paper is concerned with the periodic synchronization problem for a general class of delayed neural networks (DNNs) with discontinuous neuron activation. One of the purposes is to analyze the problem of periodic orbits. To do so, we introduce new tools including inequality techniques and Kakutani's fixed point theorem of set-valued maps to derive the existence of periodic solution. Another purpose is to design a switching state-feedback control for realizing global exponential synchronization of the drive-response network system with periodic coefficients. Unlike the previous works on periodic synchronization of neural network, both the neuron activations and controllers in this paper are allowed to be discontinuous. Moreover, owing to the occurrence of delays in neuron signal, the neural network model is described by the functional differential equation. So we introduce extended Filippov-framework to deal with the basic issues of solutions for discontinuous DNNs. Finally, two examples and simulation experiments are given to illustrate the proposed method and main results which have an important instructional significance in the design of periodic synchronized DNNs circuits involving discontinuous or switching factors. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. A discontinuous Galerkin method for solving transient Maxwell equations with nonlinear material properties

    KAUST Repository

    Sirenko, Kostyantyn

    2014-07-01

    Discontinuous Galerkin time-domain method (DGTD) has been used extensively in computational electromagnetics for analyzing transient electromagnetic wave interactions on structures described with linear constitutive relations. DGTD expands unknown fields independently on disconnected mesh elements and uses numerical flux to realize information exchange between fields on different elements (J. S. Hesthaven and T. Warburton, Nodal Discontinuous Galerkin Method, 2008). The numerical flux of choice for \\'linear\\' Maxwell equations is the upwind flux, which mimics accurately the physical behavior of electromagnetic waves on discontinuous boundaries. It is obtained from the analytical solution of the Riemann problem defined on the boundary of two neighboring mesh elements.

  17. A discontinuous Galerkin method for solving transient Maxwell equations with nonlinear material properties

    KAUST Repository

    Sirenko, Kostyantyn; Asirim, Ozum Emre; Bagci, Hakan

    2014-01-01

    Discontinuous Galerkin time-domain method (DGTD) has been used extensively in computational electromagnetics for analyzing transient electromagnetic wave interactions on structures described with linear constitutive relations. DGTD expands unknown fields independently on disconnected mesh elements and uses numerical flux to realize information exchange between fields on different elements (J. S. Hesthaven and T. Warburton, Nodal Discontinuous Galerkin Method, 2008). The numerical flux of choice for 'linear' Maxwell equations is the upwind flux, which mimics accurately the physical behavior of electromagnetic waves on discontinuous boundaries. It is obtained from the analytical solution of the Riemann problem defined on the boundary of two neighboring mesh elements.

  18. A Rare Side Effect due to TNF-Alpha Blocking Agent: Acute Pleuropericarditis with Adalimumab

    Directory of Open Access Journals (Sweden)

    Hakan Ozkan

    2013-01-01

    Full Text Available Tumor necrosis factor-alpha antagonism is an important treatment strategy in patients with rheumatoid arthritis, psoriatic arthritis, vasculitis, and ankylosing spondylitis. Adalimumab is one of the well-known tumor necrosis factor-alpha blocking agents. There are several side effects reported in patients with adalimumab therapy. Cardiac side effects of adalimumab are rare. Only a few cardiac side effects were reported. A 61-year-old man treated with adalimumab for the last 6 months due to psoriatic arthritis presented with typically acute pleuropericarditis. Chest X-ray and echocardiography demonstrated marked pericardial effusion. Patient was successfully evaluated for the etiology of acute pleuro-pericarditis. Every etiology was excluded except the usage of adalimumab. Adalimumab was discontinued, and patient was treated with 1200 mg of ibuprofen daily. Control chest X-ray and echocardiography after three weeks demonstrated complete resolution of both pleural and pericardial effusions. This case clearly demonstrated the acute onset of pericarditis with adalimumab usage. Acute pericarditis and pericardial effusion should be kept in mind in patients with adalimumab treatment.

  19. Discontinuous gas exchange, water loss, and metabolism in Protaetia cretica (Cetoniinae, Scarabaeidae).

    Science.gov (United States)

    Matthews, Philip G D; White, Craig R

    2012-01-01

    Insects are at high risk of desiccation because of their small size, high surface-area-to-volume ratio, and air-filled tracheal system that ramifies throughout their bodies to transport O(2) and CO(2) to and from respiring cells. Although the tracheal system offers a high-conductance pathway for the movement of respiratory gases, it has the unintended consequence of allowing respiratory transpiration to the atmosphere. When resting, many species exchange respiratory gases discontinuously, and an early hypothesis for the origin of these discontinuous gas exchange cycles (DGCs) is that they serve to reduce respiratory water loss. In this study, we test this "hygric" hypothesis by comparing rates of CO(2) exchange and water loss among flower beetles Protaetia cretica (Cetoniinae, Scarabaeidae) breathing either continuously or discontinuously. We show that, consistent with the expectations of the hygric hypothesis, rates of total water loss are higher during continuous gas exchange than during discontinuous gas exchange and that the ratio of respiratory water loss to CO(2) exchange is lower during discontinuous gas exchange. This conclusion is in agreement with other studies of beetles and cockroaches that also support the hygric hypothesis. However, this result does not exclude other adaptive hypotheses supported by work on ants and moth pupae. This ambiguity may arise because there are multiple independent evolutionary origins of DGCs and no single adaptive function underlying their genesis. Alternatively, the observed reduction in water loss during DGCs may be a side effect of a nonadaptive gas exchange pattern that is elicited during periods of inactivity.

  20. Discontinuities concentrate mobile predators: Quantifying organism-environment interactions at a seascape scale

    Science.gov (United States)

    Kennedy, Christina G.; Mather, Martha E.; Smith, Joseph M.; Finn, John T.; Deegan, Linda A.

    2016-01-01

    Understanding environmental drivers of spatial patterns is an enduring ecological problem that is critical for effective biological conservation. Discontinuities (ecologically meaningful habitat breaks), both naturally occurring (e.g., river confluence, forest edge, drop-off) and anthropogenic (e.g., dams, roads), can influence the distribution of highly mobile organisms that have land- or seascape scale ranges. A geomorphic discontinuity framework, expanded to include ecological patterns, provides a way to incorporate important but irregularly distributed physical features into organism–environment relationships. Here, we test if migratory striped bass (Morone saxatilis) are consistently concentrated by spatial discontinuities and why. We quantified the distribution of 50 acoustically tagged striped bass at 40 sites within Plum Island Estuary, Massachusetts during four-monthly surveys relative to four physical discontinuities (sandbar, confluence, channel network, drop-off), one continuous physical feature (depth variation), and a geographic location variable (region). Despite moving throughout the estuary, striped bass were consistently clustered in the middle geographic region at sites with high sandbar area, close to channel networks, adjacent to complex confluences, with intermediate levels of bottom unevenness, and medium sized drop-offs. In addition, the highest striped bass concentrations occurred at sites with the greatest additive physical heterogeneity (i.e., where multiple discontinuities co-occurred). The need to incorporate irregularly distributed features in organism–environment relationships will increase as high-quality telemetry and GIS data accumulate for mobile organisms. The spatially explicit approach we used to address this challenge can aid both researchers who seek to understand the impact of predators on ecosystems and resource managers who require new approaches for biological conservation.

  1. Relativistic transport equation for a multiple discontinuity wave

    Energy Technology Data Exchange (ETDEWEB)

    Giambo, S [Istituto di Matematica, Universita degli Studi, Messina (Italy)

    1980-09-29

    The theory of singular hypersurfaces is combined with the ray theory to study propagation of weak discontinuities of solutions of a quasi-linear hyperbolic system in the context of special relativity. The case of a multiple wave is considered.

  2. Factorization of products of discontinuous functions applied to Fourier-Bessel basis.

    Science.gov (United States)

    Popov, Evgeny; Nevière, Michel; Bonod, Nicolas

    2004-01-01

    The factorization rules of Li [J. Opt. Soc. Am. A 13, 1870 (1996)] are generalized to a cylindrical geometry requiring the use of a Bessel function basis. A theoretical study confirms the validity of the Laurent rule when a product of two continuous functions or of one continuous and one discontinuous function is factorized. The necessity of applying the so-called inverse rule in factorizing a continuous product of two discontinuous functions in a truncated basis is demonstrated theoretically and numerically.

  3. Determinants for drug survival of methotrexate in patients with psoriasis, split according to different reasons for discontinuation: results of the prospective MTX-CAPTURE

    NARCIS (Netherlands)

    Otero, M.E.; Reek, J.M.P.A. van den; Seyger, M.M.B.; Kerkhof, P.C.M. van de; Kievit, W.; Jong, E.M.G.J. de

    2017-01-01

    BACKGROUND: As methotrexate (MTX) is a widely used treatment for psoriasis, it is important to gain insight into the reasons for the discontinuation of MTX and to understand the determinants for drug survival. OBJECTIVES: To describe 5-year drug survival for MTX in patients with psoriasis, split

  4. hp-version discontinuous Galerkin methods on polygonal and polyhedral meshes

    CERN Document Server

    Cangiani, Andrea; Georgoulis, Emmanuil H; Houston, Paul

    2017-01-01

    Over the last few decades discontinuous Galerkin finite element methods (DGFEMs) have been witnessed tremendous interest as a computational framework for the numerical solution of partial differential equations. Their success is due to their extreme versatility in the design of the underlying meshes and local basis functions, while retaining key features of both (classical) finite element and finite volume methods. Somewhat surprisingly, DGFEMs on general tessellations consisting of polygonal (in 2D) or polyhedral (in 3D) element shapes have received little attention within the literature, despite the potential computational advantages. This volume introduces the basic principles of hp-version (i.e., locally varying mesh-size and polynomial order) DGFEMs over meshes consisting of polygonal or polyhedral element shapes, presents their error analysis, and includes an extensive collection of numerical experiments. The extreme flexibility provided by the locally variable elemen t-shapes, element-sizes, and elemen...

  5. Characterization of discontinuities in high-dimensional stochastic problems on adaptive sparse grids

    International Nuclear Information System (INIS)

    Jakeman, John D.; Archibald, Richard; Xiu Dongbin

    2011-01-01

    In this paper we present a set of efficient algorithms for detection and identification of discontinuities in high dimensional space. The method is based on extension of polynomial annihilation for discontinuity detection in low dimensions. Compared to the earlier work, the present method poses significant improvements for high dimensional problems. The core of the algorithms relies on adaptive refinement of sparse grids. It is demonstrated that in the commonly encountered cases where a discontinuity resides on a small subset of the dimensions, the present method becomes 'optimal', in the sense that the total number of points required for function evaluations depends linearly on the dimensionality of the space. The details of the algorithms will be presented and various numerical examples are utilized to demonstrate the efficacy of the method.

  6. Discontinuous Galerkin Approaches for Stokes Flow and Flow in Porous Media

    Science.gov (United States)

    Lehmann, Ragnar; Kaus, Boris; Lukacova, Maria

    2014-05-01

    Firstly, we present results of a study comparing two different numerical approaches for solving the Stokes equations with strongly varying viscosity: the continuous Galerkin (i.e., FEM) and the discontinuous Galerkin (DG) method. Secondly, we show how the latter method can be extended and applied to flow in porous media governed by Darcy's law. Nonlinearities in the viscosity or other material parameters can lead to discontinuities in the velocity-pressure solution that may not be approximated well with continuous elements. The DG method allows for discontinuities across interior edges of the underlying mesh. Furthermore, depending on the chosen basis functions, it naturally enforces local mass conservation, i.e., in every mesh cell. Computationally, it provides the capability to locally adapt the polynomial degree and needs communication only between directly adjacent mesh cells making it highly flexible and easy to parallelize. The methods are compared for several geophysically relevant benchmarking setups and discussed with respect to speed, accuracy, computational efficiency.

  7. A case of new onset keratosis pilaris after discontinuation of erlotinib.

    Science.gov (United States)

    Okereke, Uchenna R; Colozza, Sara; Cohen, David E

    2014-11-01

    Keratosis pilaris and keratosis pilaris-like eruptions have been reported in association with RAF inhibitors sorafenib and vemurafenib. We describe herein what is to our knowledge the first reported case of new onset keratosis pilaris after discontinuation of EGFR inhibitor erlotinib. A 60 year-old female with stage IV lung cancer was treated with erlotinib (100 mg/d). The patient elected to discontinue erlotinib after four years secondary to adverse systemic reactions. However, five months later small, monomorphic, rough, folliculocentric papules with surrounding mild erythema characteristic of keratosis pilaris were noted on upper back and arms. This serves as the first documented case of new onset keratosis pilaris in a patient after discontinuation of erlotinib. We report the present case to show the possible association of keratosis pilaris with not only RAF inhibitors, but also the EGFR inhibitor erlotinib. Further investigation will determine whether this is a class effect with other systemic EGFR inhibitors.

  8. Physicochemical properties of discontinuous S2-glass fiber reinforced resin composite.

    Science.gov (United States)

    Huang, Qiting; Qin, Wei; Garoushi, Sufyan; He, Jingwei; Lin, Zhengmei; Liu, Fang; Vallittu, Pekka K; Lassila, Lippo V J

    2018-01-30

    The objective of this study was to investigate several physicochemical properties of an experimental discontinuous S2-glass fiber-reinforced resin composite. The experimental composite was prepared by mixing 10 wt% of discontinuous S2-glass fibers with 27.5 wt% of resin matrix and 62.5 wt% of particulate fillers. Flexural strength (FS) and modulus (FM), fracture toughness (FT), work of fracture (WOF), double bond conversion (DC), Vickers hardness, volume shrinkage (VS) and fiber length distribution were determined. These were compared with two commercial resin composites. The experimental composite showed the highest FS, WOF and FT compared with two control composites. The DC of the experimental composite was comparable with controls. No significant difference was observed in VS between the three tested composites. The use of discontinuous glass fiber fillers with polymer matrix and particulate fillers yielded improved physical properties and substantial improvement was associated with the use of S2-glass fiber.

  9. Recent Developments on Discontinuous Precipitation

    Directory of Open Access Journals (Sweden)

    Zięba P.

    2017-06-01

    Full Text Available The discontinuous precipitation (DP belongs to a group of diffusive solid state phase transformations during which the formation of a new phase is heterogeneous and limited to a migrating reaction front (RF. The use of analytical electron microscopy provided reliable information that there is no differences in the diffusion rate at the stationary grain boundary and moving RF of DP reaction. On the other hand, the use of “in situ” transmission electron microscopy observations indicated the importance of stop-go motion or oscillatory movement of the RF.

  10. Plasmonic response and transformation mechanism upon single laser exposure of metal discontinuous films

    Energy Technology Data Exchange (ETDEWEB)

    Rodríguez, C.E. [Laser Processing Group, Instituto de Óptica, CSIC, Serrano 121, 28006 Madrid (Spain); Peláez, R.J., E-mail: rpelaez@io.cfmac.csic.es [Laser Processing Group, Instituto de Óptica, CSIC, Serrano 121, 28006 Madrid (Spain); Afonso, C.N. [Laser Processing Group, Instituto de Óptica, CSIC, Serrano 121, 28006 Madrid (Spain); Riedel, S.; Leiderer, P. [Faculty of Physics, University of Konstanz, Universitätsstraße 10, 78457 Konstanz (Germany); Jimenez-Rey, D.; Font, A. Climent- [Centro de Micro-Análisis de Materiales (CMAM) and Departamento de Física Aplicada, University Autonoma Madrid, 28049 Madrid (Spain)

    2014-05-01

    Ag and Au discontinuous films were exposed to single nanosecond pulses of a homogenized beam of an excimer laser operating at 193 nm. For low fluences, the films convert into big, almost spherical and isolated nanoparticles (NPs) due to laser-induced dewetting. Their optical response exhibits a sharp surface plasmon resonance (SPR) consistent with that of spherical and non-interacting NPs. For higher fluences, the formation of many small NPs and almost no big NPs is observed instead. The SPR features change and the plasmonic response becomes influenced by multipolar interactions among neighbouring NPs. Low and high fluence regimes are respectively related to melting and boiling threshold of the metal, and additionally, craters appear in the latter regime.

  11. Discontinuities in an axisymmetric generalized thermoelastic problem

    Directory of Open Access Journals (Sweden)

    Moncef Aouadi

    2005-06-01

    Full Text Available This paper deals with discontinuities analysis in the temperature, displacement, and stress fields of a thick plate whose lower and upper surfaces are traction-free and subjected to a given axisymmetric temperature distribution. The analysis is carried out under three thermoelastic theories. Potential functions together with Laplace and Hankel transform techniques are used to derive the solution in the transformed domain. Exact expressions for the magnitude of discontinuities are computed by using an exact method developed by Boley (1962. It is found that there exist two coupled waves, one of which is elastic and the other is thermal, both propagating with finite speeds with exponential attenuation, and a third which is called shear wave, propagating with constant speed but with no exponential attenuation. The Hankel transforms are inverted analytically. The inversion of the Laplace transforms is carried out using the inversion formula of the transform together with Fourier expansion techniques. Numerical results are presented graphically along with a comparison of the three theories of thermoelasticity.

  12. Steady-state creep of discontinuous fibre composites

    International Nuclear Information System (INIS)

    Boecker Pedersen, O.

    1975-07-01

    A review is given of the relevant literature on creep of composites, including a presentation of existing models for the steady-state creep of composites containing aligned discontinuous fibres where creep of the matrix and fibres is assumed to follow a power law. A model is suggested for predicting the composite creep law from a matrix creep law given in a general form, in the case where the fibres do not creep. The composite creep law predicted by this model is compared with those predicted by previous models, when these are extended to comprise a general matrix creep law. Experimentally, pure copper and composites consisting of aligned discontinuous tungsten fibres in a copper matrix were creep tested at a temperature of 500 deg C. The results indicate a relatively low stress sensitivity of the steady-state creep-rate for pure copper and relatively high stress sensitivity for the composites. This may be explained by the creep models based upon a general matrix creep law. A quantitative prediction shows promising agreement with the present experimental results. (author)

  13. A case of osteomalacia due to deranged mineral balance caused by saccharated ferric oxide and short-bowel syndrome

    Science.gov (United States)

    Nomoto, Hiroshi; Miyoshi, Hideaki; Nakamura, Akinobu; Nagai, So; Kitao, Naoyuki; Shimizu, Chikara; Atsumi, Tatsuya

    2017-01-01

    Abstract Rationale: Saccharated ferric oxide has been shown to lead to elevation of fibroblast growth factor 23, hypophosphatemia, and, consequently, osteomalacia. Moreover, mineral imbalance is often observed in patients with short-bowel syndrome to some degree. Patient concerns: A 62-year-old woman with short-bowel syndrome related with multiple resections of small intestines due to Crohn disease received regular intravenous administration of saccharated ferric oxide. Over the course of treatment, she was diagnosed with tetany, which was attributed to hypocalcemia. Additional assessments of the patient revealed not only hypocalcemia, but also hypophosphatemia, hypomagnesemia, osteomalacia, and a high concentration of fibroblast growth factor 23 (314 pg/mL). Diagnoses: We diagnosed her with mineral imbalance-induced osteomalacia due to saccharated ferric oxide and short-bowel syndrome. Interventions: Magnesium replacement therapy and discontinuation of saccharated ferric oxide alone. Outcomes: These treatments were able to normalize her serum mineral levels and increase her bone mineral density. Lessons: This case suggests that adequate evaluation of serum minerals, including phosphate and magnesium, during saccharated ferric oxide administration may be necessary, especially in patients with short-bowel syndrome. PMID:28953654

  14. Discontinuous approximate molecular electronic wave-functions

    International Nuclear Information System (INIS)

    Stuebing, E.W.; Weare, J.H.; Parr, R.G.

    1977-01-01

    Following Kohn, Schlosser and Marcus and Weare and Parr an energy functional is defined for a molecular problem which is stationary in the neighborhood of the exact solution and permits the use of trial functions that are discontinuous. The functional differs from the functional of the standard Rayleigh--Ritz method in the replacement of the usual kinetic energy operators circumflex T(μ) with operators circumflex T'(μ) = circumflex T(μ) + circumflex I(μ) generates contributions from surfaces of nonsmooth behavior. If one uses the nabla PSI . nabla PSI way of writing the usual kinetic energy contributions, one must add surface integrals of the product of the average of nabla PSI and the change of PSI across surfaces of discontinuity. Various calculations are carried out for the hydrogen molecule-ion and the hydrogen molecule. It is shown that ab initio calculations on molecules can be carried out quite generally with a basis of atomic orbitals exactly obeying the zero-differential overlap (ZDO) condition, and a firm basis is thereby provided for theories of molecular electronic structure invoking the ZDO aoproximation. It is demonstrated that a valence bond theory employing orbitals exactly obeying ZDO can provide an adequate account of chemical bonding, and several suggestions are made regarding molecular orbital methods

  15. A case of osteomalacia due to deranged mineral balance caused by saccharated ferric oxide and short-bowel syndrome: A case report.

    Science.gov (United States)

    Nomoto, Hiroshi; Miyoshi, Hideaki; Nakamura, Akinobu; Nagai, So; Kitao, Naoyuki; Shimizu, Chikara; Atsumi, Tatsuya

    2017-09-01

    Saccharated ferric oxide has been shown to lead to elevation of fibroblast growth factor 23, hypophosphatemia, and, consequently, osteomalacia. Moreover, mineral imbalance is often observed in patients with short-bowel syndrome to some degree. A 62-year-old woman with short-bowel syndrome related with multiple resections of small intestines due to Crohn disease received regular intravenous administration of saccharated ferric oxide. Over the course of treatment, she was diagnosed with tetany, which was attributed to hypocalcemia. Additional assessments of the patient revealed not only hypocalcemia, but also hypophosphatemia, hypomagnesemia, osteomalacia, and a high concentration of fibroblast growth factor 23 (314 pg/mL). We diagnosed her with mineral imbalance-induced osteomalacia due to saccharated ferric oxide and short-bowel syndrome. Magnesium replacement therapy and discontinuation of saccharated ferric oxide alone. These treatments were able to normalize her serum mineral levels and increase her bone mineral density. This case suggests that adequate evaluation of serum minerals, including phosphate and magnesium, during saccharated ferric oxide administration may be necessary, especially in patients with short-bowel syndrome.

  16. A new method for automatic discontinuity traces sampling on rock mass 3D model

    Science.gov (United States)

    Umili, G.; Ferrero, A.; Einstein, H. H.

    2013-02-01

    A new automatic method for discontinuity traces mapping and sampling on a rock mass digital model is described in this work. The implemented procedure allows one to automatically identify discontinuity traces on a Digital Surface Model: traces are detected directly as surface breaklines, by means of maximum and minimum principal curvature values of the vertices that constitute the model surface. Color influence and user errors, that usually characterize the trace mapping on images, are eliminated. Also trace sampling procedures based on circular windows and circular scanlines have been implemented: they are used to infer trace data and to calculate values of mean trace length, expected discontinuity diameter and intensity of rock discontinuities. The method is tested on a case study: results obtained applying the automatic procedure on the DSM of a rock face are compared to those obtained performing a manual sampling on the orthophotograph of the same rock face.

  17. Safety of Temporary Discontinuation of Antihypertensive Medication in Patients With Difficult-to-Control Hypertension.

    Science.gov (United States)

    Beeftink, Martine M A; van der Sande, Nicolette G C; Bots, Michiel L; Doevendans, Pieter A; Blankestijn, Peter J; Visseren, Frank L J; Voskuil, Michiel; Spiering, Wilko

    2017-05-01

    Successful control of blood pressure relies on identification of secondary causes and contributing factors of hypertension. As antihypertensive medication can interfere with diagnostic investigations, temporary discontinuation of medication is advised. However, there are concerns about the safety of temporary discontinuation of antihypertensive medication in patients with difficult-to-control hypertension. We assessed the occurrence of adverse cardiovascular and cerebrovascular events potentially attributable to temporary discontinuation of antihypertensive medication between February 2010 and March 2016 (n=604) in our Analysis of Complicated Hypertension screening program. A reference group (n=604) was extracted from the SMART study (Second Manifestations of Arterial Disease) cohort (comprising a similar cohort at our hospital in whom medication was not stopped) and individually matched for blood pressure, age, sex, and history of cardiovascular disease. Discontinuation of medication was well tolerated; 62% reported no complaints, 24% had mild discomfort that could be left untreated, and 14% experienced complaints that required prescription of antihypertensive escape medication. Three major adverse events were observed in the Analysis of Complicated Hypertension group between discontinuation of medication and 30 days after restart of medication (event rate=31.2 events per 1000 patient-year). In the reference cohort, 5 cardiovascular events were observed during a similar follow-up period (event rate=51.2 events per 1000 patient-year). In conclusion, discontinuation of antihypertensive medication for the diagnostic evaluation of hypertension does not increase the acute risk of cardiovascular events when performed in a well-controlled setting in specialized hospitals with appropriate protocols for monitoring safety. © 2017 American Heart Association, Inc.

  18. Treatment adherence and persistence with long-acting somatostatin analog therapy for the treatment of acromegaly: a retrospective analysis.

    Science.gov (United States)

    Gurel, Michelle H; Han, Yi; Stevens, Andrea L; Furtado, Aaron; Cox, David

    2017-04-04

    Many patients with acromegaly require medical treatment that includes somatostatin analogs (SSAs). Long-acting SSA formulations are widely used, due in part to increased patient convenience and increased treatment adherence vs daily medications. Although medication compliance can be poor in patients with chronic conditions, adherence and persistence with these SSAs in patients with acromegaly has not been evaluated. This analysis utilized claims data to estimate treatment adherence and persistence for lanreotide depot and long-acting octreotide in this population. This retrospective analysis used the MarketScan® database (~100 payors, 500 million claims in the US), which was searched between January 2007 and June 2012 to identify patients with acromegaly taking either lanreotide depot or long-acting octreotide. Patients switching treatments were excluded. Treatment adherence was assessed using medication possession ratio (MPR; number of doses dispensed in relation to dispensing period; ≥80% is considered adherent), injection count, and treatment time. Persistence was estimated by Kaplan-Meier analyses and Cox proportional hazards modeling. A washout period, defined as no acromegaly-related prescription activity 180 days prior to the index date, was employed to minimize effects of prior therapy and focus on patients more likely to be treatment-naïve. Altogether 1308 patients with acromegaly receiving a single SSA for treatment (1127 octreotide, 181 lanreotide) who had not switched treatments were identified. Mean MPR in patients with a 180-day washout (n = 663) was 89% for those receiving octreotide (n = 545) and 87% for those receiving lanreotide (n = 118). Median number of days on therapy was 169 (95% CI 135-232) for octreotide patients and 400 (95% CI 232-532) for lanreotide patients. The point estimate of the Cox proportional hazard ratio for stopping treatment was 1.385 for octreotide vs lanreotide (95% CI 1.079-1.777), suggesting a 38

  19. The AFEN Method in Cylindrical (r,θ ,z) Geometry for Pebble Bed Reactors -Incorporation of Acceleration and Discontinuity Factor

    International Nuclear Information System (INIS)

    Lee, Jaejun; Cho, Namzin

    2007-01-01

    Most existing methods of nuclear design analysis for pebble bed reactors (PBRs) are based on old finite difference solvers or on statistical methods. These methods require very long computer times. Therefore, there is strong desire of making available high fidelity coarse-mesh nodal computer codes. Recently, we extended the analytic function expansion nodal (AFEN) method developed quite extensively in Cartesian (x,y,z) geometry and in hexagonal-z geometry to the treatment of the full three dimensional cylindrical (r,θ,z) geometry for pebble bed reactors(PBRs). The AFEN methodology in this geometry as in hexagonal geometry is 'robust', due to the unique feature of the AFEN method that it does not use the transverse integration. This paper presents an acceleration scheme based on the coarse-group rebalance (CGR) concept and provides test results verifying the method and its implementation in the TOPS code. Also, we implemented discontinuity factors in the TOPS code and tested on benchmark problems. The TOPS results are in excellent agreement with those of the VENTURE code, using significantly less computer time

  20. Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation : A meta-analysis of placebo-controlled randomized trials

    NARCIS (Netherlands)

    Kaymaz, Nil; van Os, Jim; Loonen, Anton J. M.; Nolen, Willem A.

    Background: Antidepressants are effective in the prevention of relapse after remission from an acute depressive episode. It is unclear, however, to what degree duration of the continuation phase, level of abruptness of antidepressant discontinuation, or the number of previous episodes moderate the

  1. Discontinuous Galerkin finite element method with anisotropic local grid refinement for inviscid compressible flows

    NARCIS (Netherlands)

    van der Vegt, Jacobus J.W.; van der Ven, H.

    1998-01-01

    A new discretization method for the three-dimensional Euler equations of gas dynamics is presented, which is based on the discontinuous Galerkin finite element method. Special attention is paid to an efficient implementation of the discontinuous Galerkin method that minimizes the number of flux

  2. Discontinuous structural phase transition of liquid metal and alloys (2)

    International Nuclear Information System (INIS)

    Wang, Li; Liu, Jiantong

    2004-01-01

    The diameter (d f ) of diffusion fluid cluster before and after phase transition has been calculated in terms of the paper ''Discontinuous structural phase transition of liquid metal and alloy (1)'' Physics Letters. A 326 (2004) 429-435, to verify quantitatively the discontinuity of structural phase transition; the phenomena of thermal contraction and thermal expansion during the phase transition, together with the evolution model of discontinuous structural phase transition are also discussed in this Letter to explore further the nature of structural transition; In addition, based on the viscosity experimental result mentioned in paper [Y. Waseda, The Structure of Non-Crystalline Materials--Liquids and Amorphous Solids, McGraw-Hill, New York, 1980], we present an approach to draw an embryo of the liquid-liquid (L-L) phase diagram for binary alloys above liquidus in the paper, expecting to guide metallurgy process so as to improve the properties of alloys. The idea that controls amorphous structure and its properties by means of the L-L phase diagram for alloys and by the rapid cooling technique to form the amorphous alloy has been brought forward in the end

  3. Oral contraceptive discontinuation and its aftermath in 19 developing countries.

    Science.gov (United States)

    Ali, Mohamed M; Cleland, John

    2010-01-01

    The purpose of the article was to document oral contraceptive (OC) discontinuation and switching in a large number of low- and middle-income countries, and to assess the effects of women's education and reason for use (spacing vs. limitation). An attempt was made to explain intercountry variations. Calendar data from 19 Demographic and Health Surveys conducted between 1999 and 2005 were used. Data were analyzed by single- and multiple-decrement life tables and by Cox proportional hazard model. The probability of stopping OC use within 12 months for reasons that implied dissatisfaction with the method ranged from 15% in Indonesia to over 40% in Bolivia and Peru with a median value of 28%. On average, 35% switched to a modern method within 3 months and 16% to a less effective 'traditional' method. Both education and reason for use were strongly related to the probability of switching to a modern method. Discontinuation was lower and switching higher in countries judged to have strong family planning programs. Both discontinuation of use and inadequate switching to alternative methods are major but neglected problems in the family planning services of many developing countries.

  4. A detailed map of the 660-kilometer discontinuity beneath the izu-bonin subduction zone.

    Science.gov (United States)

    Wicks, C W; Richards, M A

    1993-09-10

    Dynamical processes in the Earth's mantle, such as cold downwelling at subduction zones, cause deformations of the solid-state phase change that produces a seismic discontinuity near a depth of 660 kilometers. Observations of short-period, shear-to-compressional wave conversions produced at the discontinuity yield a detailed map of deformation beneath the Izu-Bonin subduction zone. The discontinuity is depressed by about 60 kilometers beneath the coldest part of the subducted slab, with a deformation profile consistent with the expected thermal signature of the slab, the experimentally determined Clapeyron slope of the phase transition, and the regional tectonic history.

  5. Higher derivative discontinuous solutions to linear ordinary differential equations: a new route to complexity?

    International Nuclear Information System (INIS)

    Datta, Dhurjati Prasad; Bose, Manoj Kumar

    2004-01-01

    We present a new one parameter family of second derivative discontinuous solutions to the simplest scale invariant linear ordinary differential equation. We also point out how the construction could be extended to generate families of higher derivative discontinuous solutions as well. The discontinuity can occur only for a subset of even order derivatives, viz., 2nd, 4th, 8th, 16th,.... The solutions are shown to break the discrete parity (reflection) symmetry of the underlying equation. These results are expected to gain significance in the contemporary search of a new dynamical principle for understanding complex phenomena in nature

  6. Seismic detection method for small-scale discontinuities based on dictionary learning and sparse representation

    Science.gov (United States)

    Yu, Caixia; Zhao, Jingtao; Wang, Yanfei

    2017-02-01

    Studying small-scale geologic discontinuities, such as faults, cavities and fractures, plays a vital role in analyzing the inner conditions of reservoirs, as these geologic structures and elements can provide storage spaces and migration pathways for petroleum. However, these geologic discontinuities have weak energy and are easily contaminated with noises, and therefore effectively extracting them from seismic data becomes a challenging problem. In this paper, a method for detecting small-scale discontinuities using dictionary learning and sparse representation is proposed that can dig up high-resolution information by sparse coding. A K-SVD (K-means clustering via Singular Value Decomposition) sparse representation model that contains two stage of iteration procedure: sparse coding and dictionary updating, is suggested for mathematically expressing these seismic small-scale discontinuities. Generally, the orthogonal matching pursuit (OMP) algorithm is employed for sparse coding. However, the method can only update one dictionary atom at one time. In order to improve calculation efficiency, a regularized version of OMP algorithm is presented for simultaneously updating a number of atoms at one time. Two numerical experiments demonstrate the validity of the developed method for clarifying and enhancing small-scale discontinuities. The field example of carbonate reservoirs further demonstrates its effectiveness in revealing masked tiny faults and small-scale cavities.

  7. Hybrid piezoresistive-optical tactile sensor for simultaneous measurement of tissue stiffness and detection of tissue discontinuity in robot-assisted minimally invasive surgery

    Science.gov (United States)

    Bandari, Naghmeh M.; Ahmadi, Roozbeh; Hooshiar, Amir; Dargahi, Javad; Packirisamy, Muthukumaran

    2017-07-01

    To compensate for the lack of touch during minimally invasive and robotic surgeries, tactile sensors are integrated with surgical instruments. Surgical tools with tactile sensors have been used mainly for distinguishing among different tissues and detecting malignant tissues or tumors. Studies have revealed that malignant tissue is most likely stiffer than normal. This would lead to the formation of a sharp discontinuity in tissue mechanical properties. A hybrid piezoresistive-optical-fiber sensor is proposed. This sensor is investigated for its capabilities in tissue distinction and detection of a sharp discontinuity. The dynamic interaction of the sensor and tissue is studied using finite element method. The tissue is modeled as a two-term Mooney-Rivlin hyperelastic material. For experimental verification, the sensor was microfabricated and tested under the same conditions as of the simulations. The simulation and experimental results are in a fair agreement. The sensor exhibits an acceptable linearity, repeatability, and sensitivity in characterizing the stiffness of different tissue phantoms. Also, it is capable of locating the position of a sharp discontinuity in the tissue. Due to the simplicity of its sensing principle, the proposed hybrid sensor could also be used for industrial applications.

  8. Exit Site Infection due to Mycobacterium chelonae in an Elderly Patient on Peritoneal Dialysis

    Directory of Open Access Journals (Sweden)

    Arata Hibi

    2018-01-01

    Full Text Available Nontuberculous mycobacteria (NTM are rarely isolated from peritoneal dialysis (PD-associated catheter infections. However, NTM infection is usually difficult to treat and leads to catheter loss. Prompt diagnosis is essential for appropriate treatment. A 70-year-old Japanese man who had been on PD for 2 years and with a medical history of 2 episodes of exit site infections (ESIs due to methicillin-resistant Staphylococcus aureus was admitted to the hospital due to suspected ESI recurrence. However, Gram staining of the pus revealed no gram-positive cocci. Instead, weakly stained gram-positive rods were observed after 7 days of incubation, which were also positive for acid-fast staining. Rapidly growing NTM Mycobacterium chelonae was isolated on day 14. Despite administering a combination antibiotic therapy, ESI could not be controlled, and catheter removal surgery was performed on day 21. Although PD was discontinued temporarily, the patient did not require hemodialysis, without any uremic symptoms. The catheter was reinserted on day 48, and PD was reinitiated on day 61. The patient was discharged on day 65. Antibiotic therapy was continued for 3 months after discharge, with no indications of recurrent infections observed. It is important to consider the risk of NTM infections in patients on PD. Acid-fast staining could be a key test for prompt diagnosis and provision of an appropriate treatment.

  9. Discontinuous Petrov–Galerkin method with optimal test functions for thin-body problems in solid mechanics

    KAUST Repository

    Niemi, Antti H.; Bramwell, Jamie A.; Demkowicz, Leszek F.

    2011-01-01

    We study the applicability of the discontinuous Petrov-Galerkin (DPG) variational framework for thin-body problems in structural mechanics. Our numerical approach is based on discontinuous piecewise polynomial finite element spaces for the trial

  10. Quantitative Estimation of Transmitted and Reflected Lamb Waves at Discontinuity

    International Nuclear Information System (INIS)

    Lim, Hyung Jin; Sohn, Hoon

    2010-01-01

    For the application of Lamb wave to structural health monitoring(SHM), understanding its physical characteristic and interaction between Lamb wave and defect of the host structure is an important issue. In this study, reflected, transmitted and mode converted Lamb waves at discontinuity of a plate structure were simulated and the amplitude ratios are calculated theoretically using Modal decomposition method. The predicted results were verified comparing with finite element method(FEM) and experimental results simulating attached PZTs. The result shows that the theoretical prediction is close to the FEM and the experimental verification. Moreover, quantitative estimation method was suggested using amplitude ratio of Lamb wave at discontinuity

  11. NUMERICAL SIMULATION OF SHOCK WAVE REFRACTION ON INCLINED CONTACT DISCONTINUITY

    Directory of Open Access Journals (Sweden)

    P. V. Bulat

    2016-05-01

    Full Text Available We consider numerical simulation of shock wave refraction on plane contact discontinuity, separating two gases with different density. Discretization of Euler equations is based on finite volume method and WENO finite difference schemes, implemented on unstructured meshes. Integration over time is performed with the use of the third-order Runge–Kutta stepping procedure. The procedure of identification and classification of gas dynamic discontinuities based on conditions of dynamic consistency and image processing methods is applied to visualize and interpret the results of numerical calculations. The flow structure and its quantitative characteristics are defined. The results of numerical and experimental visualization (shadowgraphs, schlieren images, and interferograms are compared.

  12. Efem vs. XFEM: a comparative study for modeling strong discontinuity in geomechanics

    OpenAIRE

    Das, Kamal C.; Ausas, Roberto Federico; Segura Segarra, José María; Narang, Ankur; Rodrigues, Eduardo; Carol, Ignacio; Lakshmikantha, Ramasesha Mookanahallipatna; Mello,, U.

    2015-01-01

    Modeling of big faults or weak planes of strong and weak discontinuities is of major importance to assess the Geomechanical behaviour of mining/civil tunnel, reservoirs etc. For modelling fractures in Geomechanics, prior art has been limited to Interface Elements which suffer from numerical instability and where faults are required to be aligned with element edges. In this paper, we consider comparative study on finite elements for capturing strong discontinuities by means of elemental (EFEM)...

  13. 41 CFR 101-39.105-1 - Transfers from discontinued or curtailed fleet management systems.

    Science.gov (United States)

    2010-07-01

    ... discontinued or curtailed fleet management systems. 101-39.105-1 Section 101-39.105-1 Public Contracts and... AVIATION, TRANSPORTATION, AND MOTOR VEHICLES 39-INTERAGENCY FLEET MANAGEMENT SYSTEMS 39.1-Establishment, Modification, and Discontinuance of Interagency Fleet Management Systems § 101-39.105-1 Transfers from...

  14. Understanding discontinuation of oral adjuvant endocrine therapy by women with hormone receptor-positive invasive breast cancer nearly 4 years from diagnosis.

    Science.gov (United States)

    Bell, Robin J; Fradkin, Pamela; Schwarz, Max; Davis, Susan R

    2013-01-01

    The aim of this study was to investigate the extent of discontinuation of oral adjuvant endocrine therapy (OAET) in women nearly 4 years from the diagnosis of their first episode of invasive breast cancer and the reasons for such discontinuation. We used a large, prospective cohort study of women who had been diagnosed with their first episode of invasive breast cancer between 2004 and 2006, recruited through a state-based cancer registry. All participants completed an enrollment questionnaire (EQ) within 12 months of diagnosis and annual follow-up questionnaires (FQs) thereafter. The data in this report were obtained from the EQ and the first three FQs. A total of 1,370 women with hormone receptor-positive disease completed the EQ. At the completion of the third FQ nearly 4 years from diagnosis, 1,193 women remained in the study. Use of OAET peaked by 2 years postdiagnosis. At nearly 4 years from diagnosis, 18% of the 1,193 women remaining in the study were not taking OAET. Of these women, just more than half had ceased therapy mainly owing to a range of adverse effects, predominantly estrogen deficiency symptoms, but the remainder (8% of women remaining in the study) had never used OAET. Our study confirms that early discontinuation of OAET due to estrogen deficiency symptoms remains an important issue despite calls for strategies to address this problem. The number of women potentially suitable for OAET but not receiving it was almost as great as the number of those who have discontinued therapy.

  15. Successful Discontinuation of Infliximab in a Refractory Case of Vasculo-Behçet Disease

    Directory of Open Access Journals (Sweden)

    Akihiro Nakamura

    2016-01-01

    Full Text Available Reports have shown that antitumor necrosis factor alpha (anti-TNF-α agents including infliximab (IFX can dramatically suppress the disease activity of refractory vasculo-Behçet disease (vasculo-BD. However, it is completely unknown whether we can discontinue anti-TNF-α agents under clinical remission. A 31-year-old patient with vasculo-BD was initially treated with a high dose of steroid and intravenous cyclophosphamide therapy. Six months later, however, the disease recurred. IFX was administered and immediately the disease activity was reduced. Fortunately, we could discontinue IFX after 18-month remission and no recurrence has been observed. Based on previous reports and our patient, all patients who could discontinue IFX sustained clinical remission for at least one year, continued taking immunosuppressive agents such as methotrexate and azathioprine, and had vascular involvements only in non-life-threatening major vessels such as leg or arm arteries/veins. This is a report suggesting the possibility of discontinuation of IFX in vasculo-BD.

  16. High-contrast imaging with an arbitrary aperture: Active compensation of aperture discontinuities

    International Nuclear Information System (INIS)

    Pueyo, Laurent; Norman, Colin

    2013-01-01

    We present a new method to achieve high-contrast images using segmented and/or on-axis telescopes. Our approach relies on using two sequential deformable mirrors (DMs) to compensate for the large amplitude excursions in the telescope aperture due to secondary support structures and/or segment gaps. In this configuration the parameter landscape of DM surfaces that yield high-contrast point-spread functions is not linear, and nonlinear methods are needed to find the true minimum in the optimization topology. We solve the highly nonlinear Monge-Ampere equation that is the fundamental equation describing the physics of phase-induced amplitude modulation. We determine the optimum configuration for our two sequential DM system and show that high-throughput and high-contrast solutions can be achieved using realistic surface deformations that are accessible using existing technologies. We name this process Active Compensation of Aperture Discontinuities (ACAD). We show that for geometries similar to the James Webb Space Telescope, ACAD can attain at least 10 –7 in contrast and an order of magnitude higher for both the future extremely large telescopes and on-axis architectures reminiscent of the Hubble Space Telescope. We show that the converging nonlinear mappings resulting from our DM shapes actually damp near-field diffraction artifacts in the vicinity of the discontinuities. Thus, ACAD actually lowers the chromatic ringing due to diffraction by segment gaps and struts while not amplifying the diffraction at the aperture edges beyond the Fresnel regime. This outer Fresnel ringing can be mitigated by properly designing the optical system. Consequently, ACAD is a true broadband solution to the problem of high-contrast imaging with segmented and/or on-axis apertures. We finally show that once the nonlinear solution is found, fine tuning with linear methods used in wavefront control can be applied to further contrast by another order of magnitude. Generally speaking, the

  17. Investigation of Soil and Vegetation Characteristics in Discontinuous Permafrost Landscapes Near Fairbanks, Alaska

    Science.gov (United States)

    2015-08-01

    ER D C TR -1 5- 7 ERDC Center-Directed Research Investigation of Soil and Vegetation Characteristics in Discontinuous Permafrost ...Characteristics in Discontinuous Permafrost Landscapes Near Fairbanks, Alaska Jacob F. Berkowitz U.S. Army Engineer Research and Development Center (ERDC...Washington, DC 20314-1000 Under ERDC Center-Directed Research project “Integrated Technologies for Delineat- ing Permafrost and Ground-State

  18. Comparison of raloxifene and bisphosphonates based on adherence and treatment satisfaction in postmenopausal Asian women.

    Science.gov (United States)

    Pasion, Ellewellyn G; Sivananthan, Shanmugam K; Kung, Annie Wai-Chee; Chen, Sung-Hsiung; Chen, Yen-Jen; Mirasol, Roberto; Tay, Boon Keng; Shah, Ghazanfar Ali; Khan, Mansoor Ali; Tam, Frances; Hall, Belinda J; Thiebaud, Daniel

    2007-01-01

    We evaluated adherence with raloxifene therapy compared with daily bisphosphonate in Asian postmenopausal women at increased risk of osteoporotic fractures. In this 12-month observational study conducted in Asia (Hong Kong, Malaysia, Pakistan, Philippines, Singapore, Taiwan), 984 postmenopausal women (aged 55 years or older) were treated with raloxifene 60 mg/day (n = 707; 72%) or daily bisphosphonate (alendronate 10 mg/day; n = 206; 21%, or risedronate 5 mg/day; n = 71; 7%) during their normal course of care. Patients were assessed at baseline, 6, and 12 months. Baseline characteristics (including age, race, education, menopausal status, and baseline fractures) were comparable between the raloxifene and bisphosphonate groups. More women on raloxifene completed the study compared with those on bisphosphonate (50.2% versus 37.5%; P < 0.001). Patients also took raloxifene for a longer period than bisphosphonate (median, 356 versus 348 days; P = 0.011). Compared with those taking bisphosphonate, significantly fewer patients taking raloxifene discontinued the study because of stopping treatment (5.7% versus 10.1%, P = 0.017) or changing treatment (2.8% versus 9.7%, P < 0.001). Inconvenient dosing was reported as a primary reason for discontinuation due to stopping or changing treatment in 19 (6.9%) bisphosphonate patients compared with 0 raloxifene patients. The percentage of patients who had consumed 80% or more of their study medication was similar for raloxifene patients (48-56 weeks; 95.2%) and bisphosphonate patients (48-56 weeks; 93.3%). More raloxifene patients responded that they were satisfied with their medication than bisphosphonate patients at 48-56 weeks (P = 0.002). We concluded that Asian postmenopausal women at increased risk of osteoporotic fractures showed a greater propensity to remain on raloxifene compared with bisphosphonate. The women on raloxifene exhibited lower discontinuation rates and higher treatment satisfaction.

  19. When do gamblers help themselves? Self-discontinuity increases self-directed change over time.

    Science.gov (United States)

    Kim, Hyoun S; Wohl, Michael J A; Salmon, Melissa; Santesso, Diane

    2017-01-01

    Most disordered gamblers fail to take the necessary action to change their behavior. When action is taken, it is typically done under self-direction. Yet, little is known about what motivates gamblers to engage in self-directed change as researchers have focused almost exclusively on barriers to treatment seeking. Herein, we tested whether self-discontinuity (i.e., the notion that the self has undergone fundamental changes as a result of one's gambling) predicts self-directed change among gamblers experiencing sub-clinical levels of disordered gambling. Further, we tested whether this relationship would hold when controlling for feelings of shame and guilt about one's gambling as well as self-stigma as a disordered gambler (i.e., known barriers to change). To this end, 195 gamblers from the community completed a questionnaire battery that contained the variables of interest. Six months later, participants were re-contacted to assess whether they engaged in self-directed change. As hypothesized, the likelihood that self-directed change was attempted increased to the extent participants reported feeling self-discontinuous - an effect that remained significant when controlling for shame, guilt, and self-stigma. Results suggest that heightening the awareness that the gambling has fundamentally changed the self increases the likelihood of gamblers taking action to change their disordered gambling behaviors. Copyright © 2016. Published by Elsevier Ltd.

  20. Closed-Form Solutions for Gradient Elastic Beams with Geometric Discontinuities by Laplace Transform

    Directory of Open Access Journals (Sweden)

    Mustafa Özgür Yayli

    2013-01-01

    Full Text Available The static bending solution of a gradient elastic beam with external discontinuities is presented by Laplace transform. Its utility lies in the ability to switch differential equations to algebraic forms that are more easily solved. A Laplace transformation is applied to the governing equation which is then solved for the static deflection of the microbeam. The exact static response of the gradient elastic beam with external discontinuities is obtained by applying known initial conditions when the others are derived from boundary conditions. The results are given in a series of figures and compared with their classical counterparts. The main contribution of this paper is to provide a closed-form solution for the static deflection of microbeams under geometric discontinuities.

  1. Serum Level of Antibodies Against Hepatitis B Core Protein Is Associated With Clinical Relapse After Discontinuation of Nucleos(t)ide Analogue Therapy.

    Science.gov (United States)

    Chi, Heng; Li, Zhandong; Hansen, Bettina E; Yu, Tao; Zhang, Xiaoyong; Sun, Jian; Hou, Jinlin; Janssen, Harry L A; Peng, Jie

    2018-06-11

    Levels of antibodies against the hepatitis B virus (HBV) core protein (anti-HBc) have been associated with response to nucleos(t)ide analogue and (peg)interferon therapy in patients with chronic HBV infection. We performed a prospective study to determine whether the total serum level of anti-HBc level (immunoglobulins M and G) is associated with clinical relapse after discontinuation of nucleos(t)ide analogue-based therapy. We collected data from patients with chronic HBV infection who discontinued nucleos(t)ide analogue therapy according to pre-specified stopping criteria, recruited from November 2012 through July 2016 at an academic hospital in Guangzhou, China. Patients were followed through February 2017. We performed comprehensive biochemical and virologic tests at every visit, and anti-HBc was quantified for 2 years after treatment cessation (at baseline and weeks 4, 8, 12, 24, 48, and 96). The primary endpoint was clinical relapse, defined as level of HBV DNA >2000 IU/mL and level of alanine aminotransferase more than 2-fold the upper limit of normal-these were also the criteria for retreatment. We followed 100 patients (71% positive for HB e antigen [HBeAg] at the start of nucleos(t)ide analogue therapy, 43% treated with entecavir or tenofovir) for a median of 2.5 years after stopping therapy. Clinical relapse occurred in 39 patients (in 46% of patients at year 4 after discontinuation). High level of anti-HBc at the end of treatment (hazard ratio [HR], 0.31 per log IU/mL; P=.002) and low level of HB surface antigen (HBsAg) at the end of treatment (HR, 1.71 per log IU/mL; P=.032) were associated with a reduced risk of clinical relapse after adjusting for age, start of nucleos(t)ide analogue therapy HBeAg-status, and consolidation therapy duration. At year 4, 21% of patients with anti-HBc levels at the end of treatment ≥1000 IU/mL developed a clinical relapse compared to 85% of patients with levels level at the end of treatment ≤100 IU/mL was associated

  2. Discontinuities in ODEs - Systems with change of state

    DEFF Research Database (Denmark)

    Thomsen, Per Grove

    2006-01-01

    The occurrence of discontinuous right hand sides in ODE-systems often appears in technical applications. Such applications may be characterised by the cases where the system changes between several states. Each state is defined by a system of ODEs and the transition between states is defined...

  3. A Research Agenda for Appearance Changes Due to Breast Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Mia K. Markey

    2008-01-01

    Full Text Available Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods. However, maintaining quality of life is a factor often under emphasized for breast cancer survivors. Breast cancer treatments are invasive and can lead to deformation of the breast. Breast reconstruction is important for restoring the survivor’s appearance. However, more work is needed to develop technologies for quantifying surgical outcomes and understanding women’s perceptions of changes in their appearance. A method for objectively measuring breast anatomy is needed in order to help both the breast cancer survivors and their surgeons take expected changes to the survivor’s appearance into account when considering various treatment options. In the future, augmented reality tools could help surgeons reconstruct a survivor’s breasts to match her preferences as much as possible.

  4. Rock discontinuity surface roughness variation with scale

    Science.gov (United States)

    Bitenc, Maja; Kieffer, D. Scott; Khoshelham, Kourosh

    2017-04-01

    ABSTRACT: Rock discontinuity surface roughness refers to local departures of the discontinuity surface from planarity and is an important factor influencing the shear resistance. In practice, the Joint Roughness Coefficient (JRC) roughness parameter is commonly relied upon and input to a shear strength criterion such as developed by Barton and Choubey [1977]. The estimation of roughness by JRC is hindered firstly by the subjective nature of visually comparing the joint profile to the ten standard profiles. Secondly, when correlating the standard JRC values and other objective measures of roughness, the roughness idealization is limited to a 2D profile of 10 cm length. With the advance of measuring technologies that provide accurate and high resolution 3D data of surface topography on different scales, new 3D roughness parameters have been developed. A desirable parameter is one that describes rock surface geometry as well as the direction and scale dependency of roughness. In this research a 3D roughness parameter developed by Grasselli [2001] and adapted by Tatone and Grasselli [2009] is adopted. It characterizes surface topography as the cumulative distribution of local apparent inclination of asperities with respect to the shear strength (analysis) direction. Thus, the 3D roughness parameter describes the roughness amplitude and anisotropy (direction dependency), but does not capture the scale properties. In different studies the roughness scale-dependency has been attributed to data resolution or size of the surface joint (see a summary of researches in [Tatone and Grasselli, 2012]). Clearly, the lower resolution results in lower roughness. On the other hand, have the investigations of surface size effect produced conflicting results. While some studies have shown a decrease in roughness with increasing discontinuity size (negative scale effect), others have shown the existence of positive scale effects, or both positive and negative scale effects. We

  5. An investigation of the structure of rotational discontinuities

    International Nuclear Information System (INIS)

    Goodrich, C.C.; Cargill, P.J.

    1991-01-01

    The structure of rotational discontinuities (RDs) has been studied through hybrid simulations for a range of propagation angle Θ bn between the discontinuity normal and the upstream magnetic field and plasma β. For sufficiently narrow initial states, the simulations produce quasi-steady reverse rotation magnetic field structures for 30 degree ≤ Θ bn ≤ 60 degree and 0 i -1 . This structure is characterized by a right handed field rotation upstream joined smoothly to a left handed field rotation downstream; its width decreases from 60-70 c/ω pi at Θ bn = 30 degree to less than 25 c/ω pi at Θ bn = 60 degree. The magnetic field hodograms of the RD results have a distinctive S-shape which is most pronounced in simulations with small Θ bn and initially right handed rotations. The reverse rotation structure is the net result of the expansion of the initial current layer via the fast and intermediate wave modes

  6. Dynamic response of underground openings in discontinuous rock

    International Nuclear Information System (INIS)

    Asmis, H.W.

    1984-02-01

    This report examines the behaviour of underground openings in discontinuous rock in response to seismic waves associated with either earthquakes or rock bursts. A literature search revealed that well-constructed underground structures, such as would be expected for nuclear fuel waste disposal vaults, underground pumped-storage or nuclear plants, have an extremely high resistance to damage from seismic motion. To complement these qualitative results, it was necessary to examine the basic mechanisms of the entire progression of seismic motion, from wave generation and propagation, to wave interaction with the underground opening. From these investigations, it was found that unless a seismic event occurs very close to the installation, the stresses generated will be low with respect to the excavation stresses, because high stress waves are rapidly attenuated in travelling through rock. As well, an earthquake may generate extremely high accelerations, but is limited in the maximum amount of stress that it can create. The question, however, of the actual specific nature of underground seismic motions still remains essentially unanswered, although it is expected that there is a reduction in peak motions with depth due to the effect of the free surface of the earth

  7. A new method for automated discontinuity trace mapping on rock mass 3D surface model

    Science.gov (United States)

    Li, Xiaojun; Chen, Jianqin; Zhu, Hehua

    2016-04-01

    This paper presents an automated discontinuity trace mapping method on a 3D surface model of rock mass. Feature points of discontinuity traces are first detected using the Normal Tensor Voting Theory, which is robust to noisy point cloud data. Discontinuity traces are then extracted from feature points in four steps: (1) trace feature point grouping, (2) trace segment growth, (3) trace segment connection, and (4) redundant trace segment removal. A sensitivity analysis is conducted to identify optimal values for the parameters used in the proposed method. The optimal triangular mesh element size is between 5 cm and 6 cm; the angle threshold in the trace segment growth step is between 70° and 90°; the angle threshold in the trace segment connection step is between 50° and 70°, and the distance threshold should be at least 15 times the mean triangular mesh element size. The method is applied to the excavation face trace mapping of a drill-and-blast tunnel. The results show that the proposed discontinuity trace mapping method is fast and effective and could be used as a supplement to traditional direct measurement of discontinuity traces.

  8. Reasons for Electronic Cigarette Experimentation and Discontinuation Among Adolescents and Young Adults.

    Science.gov (United States)

    Kong, Grace; Morean, Meghan E; Cavallo, Dana A; Camenga, Deepa R; Krishnan-Sarin, Suchitra

    2015-07-01

    Understanding why young people try and stop electronic cigarette (e-cigarette) use is critical to inform e-cigarette regulatory efforts. We conducted 18 focus groups (N = 127) in 1 middle school (MS), 2 high schools (HSs), and 2 colleges in Connecticut to assess themes related to e-cigarette experimentation and discontinuation. We then conducted surveys to evaluate these identified themes in 2 MSs, 4 HSs, and 1 college (N = 1,175) to explore whether reasons for e-cigarette experimentation and/or discontinuation differed by school level or cigarette smoking status. From the focus groups, we identified experimentation themes (i.e., curiosity, flavors, family/peer influence, easy access, and perceptions of e-cigarettes as "cool" and as a healthier/better alternative to cigarettes) and discontinuation themes (i.e., health concerns, loss of interest, high cost, bad taste, and view of e-cigarettes as less satisfying than cigarettes). The survey data showed that the top reasons for experimentation were curiosity (54.4%), appealing flavors (43.8%), and peer influences (31.6%), and the top reasons for discontinuation were responses related to losing interest (23.6%), perceiving e-cigarettes as "uncool" (16.3%), and health concerns (12.1%). Cigarette smokers tried e-cigarettes because of the perceptions that they can be used anywhere and to quit smoking and discontinued because they were not as satisfying as cigarettes. School level differences were detected. E-cigarette prevention efforts toward youth should include limiting e-cigarette flavors, communicating messages emphasizing the health risks of use, and changing social norms surrounding the use of e-cigarettes. The results should be interpreted in light of the limitations of this study. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Surface electronic properties of discontinuous Pd films during hydrogen exposure

    International Nuclear Information System (INIS)

    Zhao, Ming; Nagata, Shinji; Shikama, Tatsuo; Inouye, Aichi; Yamamoto, Shunya; Yoshikawa, Masahito

    2011-01-01

    This paper explored the change in the surface resistance of the discontinuous palladium (Pd) films during hydrogen exposure. In our experiments, we observed a remarkable rise in the electrical resistance of the discontinuous film which consists of nano-sized particles, when it was exposed to thin hydrogen. By studying the resistance change ratio before and after hydrogen exposure, we have found that it demonstrates an inverse exponential relationship with the ratio of on-film particle radius to the inter island separation. This suggests that the change in the film resistance under hydrogen exposure is primarily associated with the variation of surface work function which is caused by the hydrogen absorption on the Pd surface. (author)

  10. From continuous to discontinuous transitions in social diffusion

    Science.gov (United States)

    Tuzón, Paula; Fernández-Gracia, Juan; Eguíluz, Víctor M.

    2018-03-01

    Models of social diffusion reflect processes of how new products, ideas or behaviors are adopted in a population. These models typically lead to a continuous or a discontinuous phase transition of the number of adopters as a function of a control parameter. We explore a simple model of social adoption where the agents can be in two states, either adopters or non-adopters, and can switch between these two states interacting with other agents through a network. The probability of an agent to switch from non-adopter to adopter depends on the number of adopters in her network neighborhood, the adoption threshold T and the adoption coefficient a, two parameters defining a Hill function. In contrast the transition from adopter to non-adopter is spontaneous at a certain rate μ. In a mean-field approach, we derive the governing ordinary differential equations and show that the nature of the transition between the global non-adoption and global adoption regimes depends mostly on the balance between the probability to adopt with one and two adopters. The transition changes from continuous, via a transcritical bifurcation, to discontinuous, via a combination of a saddle-node and a transcritical bifurcation, through a supercritical pitchfork bifurcation. We characterize the full parameter space. Finally, we compare our analytical results with Montecarlo simulations on annealed and quenched degree regular networks, showing a better agreement for the annealed case. Our results show how a simple model is able to capture two seemingly very different types of transitions, i.e., continuous and discontinuous and thus unifies underlying dynamics for different systems. Furthermore the form of the adoption probability used here is based on empirical measurements.

  11. Diffusion piecewise homogenization via flux discontinuity ratios

    International Nuclear Information System (INIS)

    Sanchez, Richard; Dante, Giorgio; Zmijarevic, Igor

    2013-01-01

    We analyze piecewise homogenization with flux-weighted cross sections and preservation of averaged currents at the boundary of the homogenized domain. Introduction of a set of flux discontinuity ratios (FDR) that preserve reference interface currents leads to preservation of averaged region reaction rates and fluxes. We consider the class of numerical discretizations with one degree of freedom per volume and per surface and prove that when the homogenization and computing meshes are equal there is a unique solution for the FDRs which exactly preserve interface currents. For diffusion sub-meshing we introduce a Jacobian-Free Newton-Krylov method and for all cases considered obtain an 'exact' numerical solution (eight digits for the interface currents). The homogenization is completed by extending the familiar full assembly homogenization via flux discontinuity factors to the sides of regions laying on the boundary of the piecewise homogenized domain. Finally, for the familiar nodal discretization we numerically find that the FDRs obtained with no sub-mesh (nearly at no cost) can be effectively used for whole-core diffusion calculations with sub-mesh. This is not the case, however, for cell-centered finite differences. (authors)

  12. Discontinuity model for internal transport barrier formation in reversed magnetic shear plasmas

    International Nuclear Information System (INIS)

    Kishimoto, Y.; Dettrick, S.A.; Li, J.Q.; Shirai, S.; Kim, J.Y.; Horton, W.; Tajima, T.; LeBrun, M.J.

    2000-01-01

    It is becoming clear that tokamak anomalous transport is dominated by radially extended non-local modes which originate from strong toroidal coupling of rational surfaces in non-uniform plasmas. To aid in understanding the internal transport barrier (ITB) formed in reversed magnetic shear experiments, in addition to the well known shear flow effect, the article points out an important non-local effect and/or finite size effect which comes from the complex behaviour of the mode over a finite radial region around the minimum q (safety factor) surface. The non-local mode, which is characterized by its radial extent and the degree of tilting in the poloidal direction (Δr, θ 0 ), changes its structure depending on the sign of the magnetic shear, and as a result such modes are weakly excited across the q min surface. This leads to a discontinuity or gap which disconnects the phase relation in the global wave structure across the q min surface. Once such a discontinuity (or gap) is formed, transport suppression occurs and therefore a transport barrier can be expected near the q min surface. The existence of this discontinuity is confirmed through use of a toroidal particle simulation. It is also shown that whether such a discontinuity is efficiently established depends on the presence of the radial electric field and the related plasma shear flow. (author)

  13. Prevalence and associated factors of contraceptive discontinuation and switching among Bangladeshi married women of reproductive age

    Directory of Open Access Journals (Sweden)

    Mahumud RA

    2015-01-01

    Full Text Available Rashidul Alam Mahumud,1 Md Golam Hossain,2 Abdur Razzaque Sarkar,1 Md Nurul Islam,2 Md Ripter Hossain,2 Aik Saw,3 Jahangir AM Khan1,4 1Health Economics and Financing Research Group, Center for Equity and Health Systems, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; 2Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh; 3Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; 4Adjunct Faculty, Health Economics Unit, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden Introduction: Contraceptive discontinuation is a worldwide incident that may be connected with low incentive to avoid pregnancy. Contraceptive discontinuation highly contributes to unplanned pregnancy and unwanted births.Objectives: The objective of this study was to observe the prevalence of discontinuation and switching of contraceptive methods among Bangladeshi married women. In addition, the sociodemographic factors associated with contraceptive discontinuation and switching were assessed.Methods: Secondary cross-sectional data was used in this study. A total of 16,273 married Bangladeshi women of reproductive age (15–49 years were considered in the present study, from the Bangladesh Demographic and Health Survey, 2011. Logistic regression models were used to determine the relationships between key sociodemographic factors and user status.Results: The prevalence of discontinuation and switching of contraceptive method among women were 38.4% and 15.4%, respectively. The logistic regression model demonstrated that women in early reproductive years (25–29 years and 30–34 years significantly more often (odds ratio [OR] =0.84 and 0.71, respectively discontinued use of contraceptives. Significantly higher rates of discontinuation were pronounced among women who

  14. Acupuncture Treatment for Dyspnea due to Combined Pulmonary Fibrosis and Emphysema: A Case Report.

    Science.gov (United States)

    Matsumoto-Miyazaki, Jun; Miyazaki, Nagisa; Nishiwaki, Ayuko; Endo, Junki; Ushikoshi, Hiroaki; Ohno, Yasushi; Minatoguchi, Shinya

    2015-12-01

    Combined idiopathic pulmonary fibrosis with pulmonary emphysema (CPFE) is a syndrome with a characteristic presentation of upper lobe emphysema and lower lobe fibrosis. Dyspnea on exertion (DOE) is a major symptom of CPFE. We report a patient with DOE due to CPFE who was successfully treated with acupuncture. Case report. A 72-year-old Japanese man with a 4-year history of DOE was diagnosed with CPFE 2 years previously in another hospital. He received standard Western medicine treatment, which included bronchodilators. However, his DOE did not improve. Consequently, he visited our hospital for acupuncture treatment and received acupuncture treatment once a week for 1 year. After 10 weeks of acupuncture treatment, the results of the 6-minute walk test (6-minute walking distance, 379 m; lowest oxygen saturation, 86%; modified Borg dyspnea scale score: 2 units) were better than those at baseline (352 m, 84%, 4 units, respectively). These values were sustained at both 30 weeks (470 m, 88%, 1 unit) and 60 weeks (473 m, 85%, 2 units). Serum interstitial biomarkers, Krebs von den Lungen and surfactant protein-D, decreased after commencement of acupuncture therapy. A patient with CPFE showed improvements in dyspnea scores, exercise tolerance, and serum biomarkers during a 1-year course of acupuncture treatment. Use of acupuncture might be an effective adjunct therapy in relieving DOE due to CPFE. A large, well-designed cohort study that includes patients with CPFE treated with acupuncture should be conducted.

  15. Treatment of imported malaria in adults: a multicentre study in France.

    Science.gov (United States)

    Ranque, S; Marchou, B; Malvy, D; Adehossi, E; Laganier, R; Tissot-Dupont, H; Lotte, A; Dydymsky, S; Durant, J; Stahl, J-P; Bosseray, A; Gaillat, J; Sotto, A; Cazorla, C; Ragneau, J-M; Brouqui, P; Delmont, J

    2005-10-01

    Data about anti-malarial drugs prescription practices in Europe and the safety of imported malaria treatments are scanty. In 1999, a French consensus development conference published guidelines for the prevention and treatment of imported P. falciparum malaria. The impact of these guidelines has not been evaluated. To investigate the impact of these guidelines on the prescription of anti-malarials, and to evaluate the incidence of acute drug events (ADEs) leading to discontinuation of treatment. Cross-sectional survey. Members of the medical staff in 14 French infectious and tropical disease wards completed a standardized form for each patient treated for imported malaria in 2001. A propensity score matching technique was used to estimate the risk of ADEs leading to discontinuation of the regimen. In the 474 patients studied, quinine was the first-line anti-malarial most often prescribed. Only 3% of patients received halofantrine. Mefloquine was associated with a RR of 4.9 (95%CI 3.2-7.4, p guidelines have been taken into account. Mefloquine was associated with a substantial risk of discontinuing the treatment because of ADEs. This is a serious limitation for the use of mefloquine in the treatment of out-patients with imported malaria.

  16. Cost effectiveness of pegaptanib for the treatment of age-related macular degeneration in the UK.

    Science.gov (United States)

    Wolowacz, Sorrel E; Roskell, Neil; Kelly, Steven; Maciver, Fiona M; Brand, Chris S

    2007-01-01

    Age-related macular degeneration (AMD) is the primary cause of vision loss in the elderly and results in significant economic and humanistic burden. The selective vascular endothelial growth factor inhibitor, pegaptanib (Macugen) is indicated for patients with neovascular AMD. Guidance is needed regarding the cost effectiveness of treatment, any variation between sub-populations of differing clinical characteristics and the optimum duration of treatment. To estimate the cost effectiveness of pegaptanib versus best supportive care (BSC) for AMD from the perspective of the UK government, and to evaluate the impact of patient characteristics and differing treatment discontinuation scenarios. A cohort of 1000 patients aged >45 years with a best-corrected visual acuity (VA) in their better-seeing eye of age, gender, lesion type or lesion size as covariates. Mortality rates were adjusted for the age, gender and VA of the population. Cost effectiveness was expressed as the incremental cost (IC) per vision-year saved and IC/QALY. Uncertainty was explored by probabilistic and univariate sensitivity analysis. Costs (year 2005 values) and outcomes were discounted at 3.5% per anum. In the base-case analysis, treatment was targeted to patients with a VA of 6/12 to 6/95 and discontinued after 2 years, or earlier if VA fell below 6/95 or by > or =6 lines. The IC/QALY was estimated as 8023 pounds(upper 95% CI 20,641 pounds). Cost effectiveness varied by age (age age > or =75 years = 11,657 pounds/QALY) and by pre-treatment VA (6/12-6/95 = 8023 pounds/QALY; 6/12-6/60 = 6664 pounds/QALY; 6/12-6/24 = 1920 pounds/QALY). Gender and lesion type or size had little effect. Cost effectiveness was not sensitive to precise rules for treatment discontinuation, but was maximised if treatment was discontinued in patients no longer likely to benefit. The results suggest that pegaptanib treatment is likely to be cost effective across all groups studied, and marginally more cost effective in

  17. An H1(Ph)-Coercive Discontinuous Galerkin Formulation for the Poisson Problem : 1-D Analysis

    NARCIS (Netherlands)

    Van der Zee, K.G.; Van Brummelen, E.H.

    2005-01-01

    Discontinuous Galerkin (DG) methods are finite element techniques for the solution of partial differential equations. They allow shape functions which are discontinuous across inter-element edges. In principle, DG methods are ideally suited for hp-adaptivity, as they handle nonconforming meshes and

  18. Second order finite volume scheme for Maxwell's equations with discontinuous electromagnetic properties on unstructured meshes

    Energy Technology Data Exchange (ETDEWEB)

    Ismagilov, Timur Z., E-mail: ismagilov@academ.org

    2015-02-01

    This paper presents a second order finite volume scheme for numerical solution of Maxwell's equations with discontinuous dielectric permittivity and magnetic permeability on unstructured meshes. The scheme is based on Godunov scheme and employs approaches of Van Leer and Lax–Wendroff to increase the order of approximation. To keep the second order of approximation near dielectric permittivity and magnetic permeability discontinuities a novel technique for gradient calculation and limitation is applied near discontinuities. Results of test computations for problems with linear and curvilinear discontinuities confirm second order of approximation. The scheme was applied to modelling propagation of electromagnetic waves inside photonic crystal waveguides with a bend.

  19. Pulmonary eosinophilia associated to treatment with natalizumab

    Directory of Open Access Journals (Sweden)

    Elena Curto

    2016-01-01

    Full Text Available Natalizumab (Tysabri® is a leukocytes chemotaxis inhibitor that decreases the leukocytes passage through the hematoencephalic barrier and it is currently used in relapsing-remitting forms of multiple sclerosis (MS. We present a patient with allergic rhinoconjunctivitis diagnosed with MS who started treatment with natalizumab. She began to show mild asthmatic symptoms until she needed admission to the hospital due to respiratory insufficiency. Blood tests showed peripheral eosinophilia and the thoracic computed tomography scan demonstrated pulmonary infiltrates. The bronchoscopy with the bronchoalveolar lavage resulted in eosinophilic alveolitis. No evidence of bacterial, fungal and parasitic infection, connective tissue disease, or vasculitis were observed. After discontinuation of natalizumab, the patient improved without other treatments. As MS is a prevalent disease and the use of natalizumab is increasing, we consider important to point out that this drug can be associated with pulmonary eosinophilia, especially in patients with allergic rhinoconjunctivitis or asthma.

  20. Clinician support and psychosocial risk factors associated with breastfeeding discontinuation.

    Science.gov (United States)

    Taveras, Elsie M; Capra, Angela M; Braveman, Paula A; Jensvold, Nancy G; Escobar, Gabriel J; Lieu, Tracy A

    2003-07-01

    Breastfeeding rates fall short of goals set in Healthy People 2010 and other national recommendations. The current, national breastfeeding continuation rate of 29% at 6 months lags behind the Healthy People 2010 goal of 50%. The objective of this study was to evaluate associations between breastfeeding discontinuation at 2 and 12 weeks postpartum and clinician support, maternal physical and mental health status, workplace issues, and other factors amenable to intervention. A prospective cohort study was conducted of low-risk mothers and infants who were in a health maintenance organization and enrolled in a randomized, controlled trial of home visits. Mothers were interviewed in person at 1 to 2 days postpartum and by telephone at 2 and 12 weeks. Logistic regression modeling was performed to assess the independent effects of the predictors of interest, adjusting for sociodemographic and other confounding variables. Of the 1163 mother-newborn pairs in the cohort, 1007 (87%) initiated breastfeeding, 872 (75%) were breastfeeding at the 2-week interview, and 646 (55%) were breastfeeding at the 12-week interview. In the final multivariate models, breastfeeding discontinuation at 2 weeks was associated with lack of confidence in ability to breastfeed at the 1- to 2-day interview (odds ratio [OR]: 2.8; 95% confidence interval [CI]: 1.02-7.6), early breastfeeding problems (OR: 1.5; 95% CI: 1.1-1.97), Asian race/ethnicity (OR: 2.6; 95% CI: 1.1-5.7), and lower maternal education (OR: 1.5; 95% CI: 1.2-1.9). Mothers were much less likely to discontinue breastfeeding at 12 weeks postpartum if they reported (during the 12-week interview) having received encouragement from their clinician to breastfeed (OR: 0.6; 95% CI: 0.4-0.8). Breastfeeding discontinuation at 12 weeks was also associated with demographic factors and maternal depressive symptoms (OR: 1.18; 95% CI: 1.01-1.37) and returning to work or school by 12 weeks postpartum (OR: 2.4; 95% CI: 1.8-3.3). Our results indicate

  1. Identification of a Discontinuous Parameter in Stochastic Parabolic Systems

    International Nuclear Information System (INIS)

    Aihara, S. I.

    1998-01-01

    The purpose of this paper is to study the identification problem for a spatially varying discontinuous parameter in stochastic diffusion equations. The consistency property of the maximum likelihood estimate (M.L.E.) and a generating algorithm for M.L.E. have been explored under the condition that the unknown parameter is in a sufficiently regular space with respect to spatial variables. In order to prove the consistency property of the M.L.E. for a discontinuous diffusion coefficient, we use the method of sieves, i.e., first the admissible class of unknown parameters is projected into a finite-dimensional space and next the convergence of the derived finite-dimensional M.L.E. to the infinite-dimensional M.L.E. is justified under some conditions. An iterative algorithm for generating the M.L.E. is also proposed with two numerical examples

  2. Magnetic field integral equation analysis of surface plasmon scattering by rectangular dielectric channel discontinuities.

    Science.gov (United States)

    Chremmos, Ioannis

    2010-01-01

    The scattering of a surface plasmon polariton (SPP) by a rectangular dielectric channel discontinuity is analyzed through a rigorous magnetic field integral equation method. The scattering phenomenon is formulated by means of the magnetic-type scalar integral equation, which is subsequently treated through an entire-domain Galerkin method of moments (MoM), based on a Fourier-series plane wave expansion of the magnetic field inside the discontinuity. The use of Green's function Fourier transform allows all integrations over the area and along the boundary of the discontinuity to be performed analytically, resulting in a MoM matrix with entries that are expressed as spectral integrals of closed-form expressions. Complex analysis techniques, such as Cauchy's residue theorem and the saddle-point method, are applied to obtain the amplitudes of the transmitted and reflected SPP modes and the radiated field pattern. Through numerical results, we examine the wavelength selectivity of transmission and reflection against the channel dimensions as well as the sensitivity to changes in the refractive index of the discontinuity, which is useful for sensing applications.

  3. Solution of the Neutron transport equation in hexagonal geometry using strongly discontinuous nodal schemes

    International Nuclear Information System (INIS)

    Mugica R, C.A.; Valle G, E. del

    2005-01-01

    In 2002, E. del Valle and Ernest H. Mund developed a technique to solve numerically the Neutron transport equations in discrete ordinates and hexagonal geometry using two nodal schemes type finite element weakly discontinuous denominated WD 5,3 and WD 12,8 (of their initials in english Weakly Discontinuous). The technique consists on representing each hexagon in the union of three rhombuses each one of which it is transformed in a square in the one that the methods WD 5,3 and WD 12,8 were applied. In this work they are solved the mentioned equations of transport using the same discretization technique by hexagon but using two nodal schemes type finite element strongly discontinuous denominated SD 3 and SD 8 (of their initials in english Strongly Discontinuous). The application in each case as well as a reference problem for those that results are provided for the effective multiplication factor is described. It is carried out a comparison with the obtained results by del Valle and Mund for different discretization meshes so much angular as spatial. (Author)

  4. Bohman-Frieze-Wormald model on the lattice, yielding a discontinuous percolation transition

    Science.gov (United States)

    Schrenk, K. J.; Felder, A.; Deflorin, S.; Araújo, N. A. M.; D'Souza, R. M.; Herrmann, H. J.

    2012-03-01

    The BFW model introduced by Bohman, Frieze, and Wormald [Random Struct. Algorithms1042-983210.1002/rsa.20038, 25, 432 (2004)], and recently investigated in the framework of discontinuous percolation by Chen and D'Souza [Phys. Rev. Lett.PRLTAO0031-900710.1103/PhysRevLett.106.115701 106, 115701 (2011)], is studied on the square and simple-cubic lattices. In two and three dimensions, we find numerical evidence for a strongly discontinuous transition. In two dimensions, the clusters at the threshold are compact with a fractal surface of fractal dimension df=1.49±0.02. On the simple-cubic lattice, distinct jumps in the size of the largest cluster are observed. We proceed to analyze the tree-like version of the model, where only merging bonds are sampled, for dimension two to seven. The transition is again discontinuous in any considered dimension. Finally, the dependence of the cluster-size distribution at the threshold on the spatial dimension is also investigated.

  5. Treatment outcomes of treatment-naïve Hepatitis C patients co-infected with HIV: a systematic review and meta-analysis of observational cohorts.

    Directory of Open Access Journals (Sweden)

    Anna Davies

    Full Text Available INTRODUCTION: Co-infection with Hepatitis C (HCV and HIV is common and HIV accelerates hepatic disease progression due to HCV. However, access to HCV treatment is limited and success rates are generally poor. METHODS: We conducted a systematic review and meta-analysis to assess HCV treatment outcomes in observational cohorts. Two databases (Medline and EMBASE were searched using a compound search strategy for cohort studies reporting HCV treatment outcomes (as determined by a sustained virological response, SVR in HIV-positive patients initiating HCV treatment for the first time. RESULTS: 40 studies were included for review, providing outcomes on 5339 patients from 17 countries. The pooled proportion of patients achieving SVR was 38%. Significantly poorer outcomes were observed for patients infected with HCV genotypes 1 or 4 (pooled SVR 24.5%, compared to genotypes 2 or 3 (pooled SVR 59.8%. The pooled proportion of patients who discontinued treatment due to drug toxicities (reported by 33 studies was low, at 4.3% (3.3-5.3%. Defaulting from treatment, reported by 33 studies, was also low (5.1%, 3.5-6.6%, as was on-treatment mortality (35 studies, 0.1% (0-0.2%. CONCLUSIONS: These results, reported under programmatic conditions, are comparable to those reported in randomised clinical trials, and show that although HCV treatment outcomes are generally poor in HIV co-infected patients, those infected with HCV genotypes 2 or 3 have outcomes comparable to HIV-negative patients.

  6. Treatment eligibility and retention in clinical HIV care: A regression discontinuity study in South Africa.

    Science.gov (United States)

    Bor, Jacob; Fox, Matthew P; Rosen, Sydney; Venkataramani, Atheendar; Tanser, Frank; Pillay, Deenan; Bärnighausen, Till

    2017-11-01

    Loss to follow-up is high among HIV patients not yet receiving antiretroviral therapy (ART). Clinical trials have demonstrated the clinical efficacy of early ART; however, these trials may miss an important real-world consequence of providing ART at diagnosis: its impact on retention in care. We examined the effect of immediate (versus deferred) ART on retention in care using a regression discontinuity design. The analysis included all patients (N = 11,306) entering clinical HIV care with a first CD4 count between 12 August 2011 and 31 December 2012 in a public-sector HIV care and treatment program in rural South Africa. Patients were assigned to immediate versus deferred ART eligibility, as determined by a CD4 count linear regression models with a data-driven bandwidth and with the algorithm for selecting the bandwidth chosen ex ante. Among patients with CD4 counts close to the 350-cells/μl threshold, having an ART-eligible CD4 count (<350 cells/μl) was associated with higher 12-month retention than not having an ART-eligible CD4 count (50% versus 32%), an intention-to-treat risk difference of 18 percentage points (95% CI 11 to 23; p < 0.001). The decision to start ART was determined by CD4 count for one in four patients (25%) presenting close to the eligibility threshold (95% CI 20% to 31%; p < 0.001). In this subpopulation, having an ART-eligible CD4 count was associated with higher 12-month retention than not having an ART-eligible CD4 count (91% versus 21%), a complier causal risk difference of 70 percentage points (95% CI 42 to 98; p < 0.001). The major limitations of the study are the potential for limited generalizability, the potential for outcome misclassification, and the absence of data on longer-term health outcomes. Patients who were eligible for immediate ART had dramatically higher retention in HIV care than patients who just missed the CD4-count eligibility cutoff. The clinical and population health benefits of offering immediate ART regardless

  7. Finite Element Quadrature of Regularized Discontinuous and Singular Level Set Functions in 3D Problems

    Directory of Open Access Journals (Sweden)

    Nicola Ponara

    2012-11-01

    Full Text Available Regularized Heaviside and Dirac delta function are used in several fields of computational physics and mechanics. Hence the issue of the quadrature of integrals of discontinuous and singular functions arises. In order to avoid ad-hoc quadrature procedures, regularization of the discontinuous and the singular fields is often carried out. In particular, weight functions of the signed distance with respect to the discontinuity interface are exploited. Tornberg and Engquist (Journal of Scientific Computing, 2003, 19: 527–552 proved that the use of compact support weight function is not suitable because it leads to errors that do not vanish for decreasing mesh size. They proposed the adoption of non-compact support weight functions. In the present contribution, the relationship between the Fourier transform of the weight functions and the accuracy of the regularization procedure is exploited. The proposed regularized approach was implemented in the eXtended Finite Element Method. As a three-dimensional example, we study a slender solid characterized by an inclined interface across which the displacement is discontinuous. The accuracy is evaluated for varying position of the discontinuity interfaces with respect to the underlying mesh. A procedure for the choice of the regularization parameters is proposed.

  8. Block volume estimation from the discontinuity spacing measurements of mesozoic limestone quarries, Karaburun Peninsula, Turkey.

    Science.gov (United States)

    Elci, Hakan; Turk, Necdet

    2014-01-01

    Block volumes are generally estimated by analyzing the discontinuity spacing measurements obtained either from the scan lines placed over the rock exposures or the borehole cores. Discontinuity spacing measurements made at the Mesozoic limestone quarries in Karaburun Peninsula were used to estimate the average block volumes that could be produced from them using the suggested methods in the literature. The Block Quality Designation (BQD) ratio method proposed by the authors has been found to have given in the same order of the rock block volume to the volumetric joint count (J(v)) method. Moreover, dimensions of the 2378 blocks produced between the years of 2009 and 2011 in the working quarries have been recorded. Assuming, that each block surfaces is a discontinuity, the mean block volume (V(b)), the mean volumetric joint count (J(vb)) and the mean block shape factor of the blocks are determined and compared with the estimated mean in situ block volumes (V(in)) and volumetric joint count (J(vi)) values estimated from the in situ discontinuity measurements. The established relations are presented as a chart to be used in practice for estimating the mean volume of blocks that can be obtained from a quarry site by analyzing the rock mass discontinuity spacing measurements.

  9. Block Volume Estimation from the Discontinuity Spacing Measurements of Mesozoic Limestone Quarries, Karaburun Peninsula, Turkey

    Directory of Open Access Journals (Sweden)

    Hakan Elci

    2014-01-01

    Full Text Available Block volumes are generally estimated by analyzing the discontinuity spacing measurements obtained either from the scan lines placed over the rock exposures or the borehole cores. Discontinuity spacing measurements made at the Mesozoic limestone quarries in Karaburun Peninsula were used to estimate the average block volumes that could be produced from them using the suggested methods in the literature. The Block Quality Designation (BQD ratio method proposed by the authors has been found to have given in the same order of the rock block volume to the volumetric joint count (Jv method. Moreover, dimensions of the 2378 blocks produced between the years of 2009 and 2011 in the working quarries have been recorded. Assuming, that each block surfaces is a discontinuity, the mean block volume (Vb, the mean volumetric joint count (Jvb and the mean block shape factor of the blocks are determined and compared with the estimated mean in situ block volumes (Vin and volumetric joint count (Jvi values estimated from the in situ discontinuity measurements. The established relations are presented as a chart to be used in practice for estimating the mean volume of blocks that can be obtained from a quarry site by analyzing the rock mass discontinuity spacing measurements.

  10. How Can Comparison Groups Strengthen Regression Discontinuity Designs?

    Science.gov (United States)

    Wing, Coady; Cook, Thomas D.

    2011-01-01

    In this paper, the authors examine some of the ways that different types of non-equivalent comparison groups can be used to strengthen causal inferences based on regression discontinuity design (RDD). First, they consider a design that incorporates pre-test data on assignment scores and outcomes that were collected either before the treatment…

  11. Exploration of lateral discontinuities with shallow seismic reflection

    International Nuclear Information System (INIS)

    Kose, K.; Ecevitoglu, B.

    2007-01-01

    Shallow seismic reflection method is used to for research of mine, fault and stratigraphy and these researches have been result successfully. Survey parameters should be determined with detailed pre-research before data collection. In this study, limestone-fly sch discontinuity experienced at surface and its extension was researched with collected reflection data

  12. Adaptive oriented PDEs filtering methods based on new controlling speed function for discontinuous optical fringe patterns

    Science.gov (United States)

    Zhou, Qiuling; Tang, Chen; Li, Biyuan; Wang, Linlin; Lei, Zhenkun; Tang, Shuwei

    2018-01-01

    The filtering of discontinuous optical fringe patterns is a challenging problem faced in this area. This paper is concerned with oriented partial differential equations (OPDEs)-based image filtering methods for discontinuous optical fringe patterns. We redefine a new controlling speed function to depend on the orientation coherence. The orientation coherence can be used to distinguish the continuous regions and the discontinuous regions, and can be calculated by utilizing fringe orientation. We introduce the new controlling speed function to the previous OPDEs and propose adaptive OPDEs filtering models. According to our proposed adaptive OPDEs filtering models, the filtering in the continuous and discontinuous regions can be selectively carried out. We demonstrate the performance of the proposed adaptive OPDEs via application to the simulated and experimental fringe patterns, and compare our methods with the previous OPDEs.

  13. Regularization of discontinuous foliations: Blowing up and sliding conditions via Fenichel theory

    Science.gov (United States)

    Panazzolo, Daniel; da Silva, Paulo R.

    2017-12-01

    We study the regularization of an oriented 1-foliation F on M ∖ Σ where M is a smooth manifold and Σ ⊂ M is a closed subset, which can be interpreted as the discontinuity locus of F. In the spirit of Filippov's work, we define a sliding and sewing dynamics on the discontinuity locus Σ as some sort of limit of the dynamics of a nearby smooth 1-foliation and obtain conditions to identify whether a point belongs to the sliding or sewing regions.

  14. Premature Discontinuation of Prospective Clinical Studies Approved by a Research Ethics Committee - A Comparison of Randomised and Non-Randomised Studies.

    Directory of Open Access Journals (Sweden)

    Anette Blümle

    Full Text Available Premature discontinuation of clinical studies affects about 25% of randomised controlled trials (RCTs which raises concerns about waste of scarce resources for research. The risk of discontinuation of non-randomised prospective studies (NPSs is yet unclear.To compare the proportion of discontinued studies between NPSs and RCTs that received ethical approval.We systematically surveyed prospective longitudinal clinical studies that were approved by a single REC in Freiburg, Germany between 2000 and 2002. We collected study characteristics, identified subsequent publications, and surveyed investigators to elucidate whether a study was discontinued and, if so, why.Of 917 approved studies, 547 were prospective longitudinal studies (306 RCTs and 241 NPSs. NPSs were on average smaller than RCTs, more frequently single centre and pilot studies, and less frequently funded by industry. NPSs were less frequently discontinued than RCTs: 32/221 (14% versus 78/288 (27%, p<0.001, missing data excluded. Poor recruitment was the most frequent reason for discontinuation in both NPSs (36% and RCTs (37%.Compared to RCTs, NPSs were at lower risk for discontinuation. Measures to reliably predict, sustain, and stimulate recruitment could prevent discontinuation of many RCTs but also of some NPSs.

  15. Exponential discontinuous numerical scheme for electron transport in the continuous slowing down approximation

    International Nuclear Information System (INIS)

    Prinja, A.K.

    1997-01-01

    A nonlinear discretization scheme in space and energy, based on the recently developed exponential discontinuous method, is applied to continuous slowing down dominated electron transport (i.e., in the absence of scattering.) Numerical results for dose and charge deposition are obtained and compared against results from the ONELD and ONEBFP codes, and against exact results from an adjoint Monte Carlo code. It is found that although the exponential discontinuous scheme yields strictly positive and monotonic solutions, the dose profile is considerably straggled when compared to results from the linear codes. On the other hand, the linear schemes produce negative results which, furthermore, do not damp effectively in some cases. A general conclusion is that while yielding strictly positive solutions, the exponential discontinuous method does not show the crude cell accuracy for charged particle transport as was apparent for neutral particle transport problems

  16. The 1D Richards' equation in two layered soils: a Filippov approach to treat discontinuities

    Science.gov (United States)

    Berardi, Marco; Difonzo, Fabio; Vurro, Michele; Lopez, Luciano

    2018-05-01

    The infiltration process into the soil is generally modeled by the Richards' partial differential equation (PDE). In this paper a new approach for modeling the infiltration process through the interface of two different soils is proposed, where the interface is seen as a discontinuity surface defined by suitable state variables. Thus, the original 1D Richards' PDE, enriched by a particular choice of the boundary conditions, is first approximated by means of a time semidiscretization, that is by means of the transversal method of lines (TMOL). In such a way a sequence of discontinuous initial value problems, described by a sequence of second order differential systems in the space variable, is derived. Then, Filippov theory on discontinuous dynamical systems may be applied in order to study the relevant dynamics of the problem. The numerical integration of the semidiscretized differential system will be performed by using a one-step method, which employs an event driven procedure to locate the discontinuity surface and to adequately change the vector field.

  17. Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility

    OpenAIRE

    Bruce D. Meyer; Laura R. Wherry

    2012-01-01

    This paper uses a policy discontinuity to identify the immediate and long-term effects of public health insurance coverage during childhood. Our identification strategy exploits a unique feature of several early Medicaid expansions that extended eligibility only to children born after September 30, 1983. This feature resulted in a large discontinuity in the lifetime years of Medicaid eligibility of children at this birthdate cutoff. Those with family incomes at or just below the poverty line ...

  18. Grades, Gender, and Encouragement: A Regression Discontinuity Analysis

    Science.gov (United States)

    Owen, Ann L.

    2010-01-01

    The author employs a regression discontinuity design to provide direct evidence on the effects of grades earned in economics principles classes on the decision to major in economics and finds a differential effect for male and female students. Specifically, for female students, receiving an A for a final grade in the first economics class is…

  19. Effects of discontinuous magnetic permeability on magnetodynamic problems

    KAUST Repository

    Guermond, J.-L.

    2011-07-01

    A novel approximation technique using Lagrange finite elements is proposed to solve magneto-dynamics problems involving discontinuous magnetic permeability and non-smooth interfaces. The algorithm is validated on benchmark problems and is used for kinematic studies of the Cadarache von Kármán Sodium 2 (VKS2) experimental fluid dynamo. © 2011 Elsevier Inc.

  20. Discontinuous Galerkin finite element methods for hyperbolic nonconservative partial differential equations

    International Nuclear Information System (INIS)

    Rhebergen, S.; Bokhove, O.; Vegt, J.J.W. van der

    2008-01-01

    We present space- and space-time discontinuous Galerkin finite element (DGFEM) formulations for systems containing nonconservative products, such as occur in dispersed multiphase flow equations. The main criterium we pose on the weak formulation is that if the system of nonconservative partial differential equations can be transformed into conservative form, then the formulation must reduce to that for conservative systems. Standard DGFEM formulations cannot be applied to nonconservative systems of partial differential equations. We therefore introduce the theory of weak solutions for nonconservative products into the DGFEM formulation leading to the new question how to define the path connecting left and right states across a discontinuity. The effect of different paths on the numerical solution is investigated and found to be small. We also introduce a new numerical flux that is able to deal with nonconservative products. Our scheme is applied to two different systems of partial differential equations. First, we consider the shallow water equations, where topography leads to nonconservative products, in which the known, possibly discontinuous, topography is formally taken as an unknown in the system. Second, we consider a simplification of a depth-averaged two-phase flow model which contains more intrinsic nonconservative products

  1. Application of Discontinuous PWM Modulation in Active Power Filters

    DEFF Research Database (Denmark)

    Blaabjerg, Frede; Asiminoaei, Lucian; Rodriguez, Pedro

    2008-01-01

    Classical discontinuous pulsewidth modulations (DPWMs) may not be efficiently applied in active power filters (APFs), because it is hard to predict the peak values of the inverter current, and consequently it is difficult to calculate the position of the clamped interval, that minimizes...

  2. -Error Estimates of the Extrapolated Crank-Nicolson Discontinuous Galerkin Approximations for Nonlinear Sobolev Equations

    Directory of Open Access Journals (Sweden)

    Lee HyunYoung

    2010-01-01

    Full Text Available We analyze discontinuous Galerkin methods with penalty terms, namely, symmetric interior penalty Galerkin methods, to solve nonlinear Sobolev equations. We construct finite element spaces on which we develop fully discrete approximations using extrapolated Crank-Nicolson method. We adopt an appropriate elliptic-type projection, which leads to optimal error estimates of discontinuous Galerkin approximations in both spatial direction and temporal direction.

  3. A Streaming Language Implementation of the Discontinuous Galerkin Method

    Science.gov (United States)

    Barth, Timothy; Knight, Timothy

    2005-01-01

    We present a Brook streaming language implementation of the 3-D discontinuous Galerkin method for compressible fluid flow on tetrahedral meshes. Efficient implementation of the discontinuous Galerkin method using the streaming model of computation introduces several algorithmic design challenges. Using a cycle-accurate simulator, performance characteristics have been obtained for the Stanford Merrimac stream processor. The current Merrimac design achieves 128 Gflops per chip and the desktop board is populated with 16 chips yielding a peak performance of 2 Teraflops. Total parts cost for the desktop board is less than $20K. Current cycle-accurate simulations for discretizations of the 3-D compressible flow equations yield approximately 40-50% of the peak performance of the Merrimac streaming processor chip. Ongoing work includes the assessment of the performance of the same algorithm on the 2 Teraflop desktop board with a target goal of achieving 1 Teraflop performance.

  4. Constitutive model of discontinuous plastic flow at cryogenic temperatures

    CERN Document Server

    Skoczen, B; Bielski, J; Marcinek, D

    2010-01-01

    FCC metals and alloys are frequently used in cryogenic applications, nearly down to the temperature of absolute zero, because of their excellent physical and mechanical properties including ductility. Some of these materials, often characterized by the low stacking fault energy (LSFE), undergo at low temperatures three distinct phenomena: dynamic strain ageing (DSA), plastic strain induced transformation from the parent phase (gamma) to the secondary phase (alpha) and evolution of micro-damage. The constitutive model presented in the paper is focused on the discontinuous plastic flow (serrated yielding) and takes into account the relevant thermodynamic background. The discontinuous plastic flow reflecting the DSA effect is described by the mechanism of local catastrophic failure of Lomer-Cottrell (LC) locks under the stress fields related to the accumulating edge dislocations (below the transition temperature from the screw dislocations to the edge dislocations mode T-1). The failure of LC locks leads to mass...

  5. Factors associated with use and discontinuation of Implanon ...

    African Journals Online (AJOL)

    Factors associated with use and discontinuation of Implanon contraceptive in ... The low CPR is the direct cause of the high total fertility of 5.7 in Nigeria. ... This is especially more true with the use of long acting reversible contraceptive methods like implanon which ... Their mean age was 31 years with a range of 16 to 53.

  6. An entropy stable nodal discontinuous Galerkin method for the two dimensional shallow water equations on unstructured curvilinear meshes with discontinuous bathymetry

    Energy Technology Data Exchange (ETDEWEB)

    Wintermeyer, Niklas [Mathematisches Institut, Universität zu Köln, Weyertal 86-90, 50931 Köln (Germany); Winters, Andrew R., E-mail: awinters@math.uni-koeln.de [Mathematisches Institut, Universität zu Köln, Weyertal 86-90, 50931 Köln (Germany); Gassner, Gregor J. [Mathematisches Institut, Universität zu Köln, Weyertal 86-90, 50931 Köln (Germany); Kopriva, David A. [Department of Mathematics, The Florida State University, Tallahassee, FL 32306 (United States)

    2017-07-01

    We design an arbitrary high-order accurate nodal discontinuous Galerkin spectral element approximation for the non-linear two dimensional shallow water equations with non-constant, possibly discontinuous, bathymetry on unstructured, possibly curved, quadrilateral meshes. The scheme is derived from an equivalent flux differencing formulation of the split form of the equations. We prove that this discretization exactly preserves the local mass and momentum. Furthermore, combined with a special numerical interface flux function, the method exactly preserves the mathematical entropy, which is the total energy for the shallow water equations. By adding a specific form of interface dissipation to the baseline entropy conserving scheme we create a provably entropy stable scheme. That is, the numerical scheme discretely satisfies the second law of thermodynamics. Finally, with a particular discretization of the bathymetry source term we prove that the numerical approximation is well-balanced. We provide numerical examples that verify the theoretical findings and furthermore provide an application of the scheme for a partial break of a curved dam test problem.

  7. Continuity and discontinuity in the Inuit culture of Greenland

    NARCIS (Netherlands)

    Kylstra, Hans P.

    1977-01-01

    In november 1976 the Arctic Centre of the University of Gronlngen organized its third symposium. The third symposium was a Dutch-Danish one on the Greenlandic Inuit: 'Continuity and Discontinuity In Greenlandic Arctic Culture'. As on the two previous occasions, an exhibition was organized.

  8. Risk of losing remission, low disease activity or radiographic progression in case of bDMARD discontinuation or tapering in rheumatoid arthritis: systematic analysis of the literature and meta-analysis.

    Science.gov (United States)

    Henaux, Sophie; Ruyssen-Witrand, Adeline; Cantagrel, Alain; Barnetche, Thomas; Fautrel, Bruno; Filippi, Nathalie; Lukas, Cédric; Raffeiner, Bernd; Rossini, Maurizio; Degboé, Yannick; Constantin, Arnaud

    2018-04-01

    To assess the risk of losing remission, low disease activity (LDA) or radiographic progression in the case of (1) discontinuing or (2) tapering doses of biological disease-modifying antirheumatic drugs (bDMARDs) compared with continuation of the initial treatment regimen in rheumatoid arthritis (RA) patients with remission or LDA. A systematic literature analysis was carried out through May 2017 on the PubMed, Embase, Cochrane and international congress databases, selecting controlled trials comparing bDMARDs discontinuation/tapering versus continuation in RA patients with remission or LDA. The meta-analysis assessed the risk ratio (RR) and 95% CI of losing remission or LDA and the risk of radiographic progression after (1) discontinuing and (2) tapering doses of bDMARDs versus continuing the initial treatment. The meta-analysis comparing bDMARDs discontinuation versus continuation performed on nine trials showed an increased risk of losing remission (RR (95% CI)=1.97(1.43 to 2.73), P<0.0001) or LDA (RR (95% CI)=2.24(1.52 to 3.30), P<0.0001) and an increased risk of radiographic progression (RR (95% CI)=1.09(1.02 to 1.17), P=0.01) in case of bDMARD discontinuation. The meta-analysis comparing bDMARDs tapering versus continuation performed on 11 trials showed an increased risk of losing remission (RR (95% CI)=1.23(1.06 to 1.42), P=0.006) but no increased risk of losing LDA (RR (95% CI)=1.02 (0.85 to 1.23), P=0.81) nor any increased risk of radiographic progression (RR (95% CI)=1.09(0.94 to 1.26), P=0.26) in case of bDMARD tapering. Discontinuation of bDMARDs leads to an increased risk of losing remission or LDA and radiographic progression, while tapering doses of bDMARDs does not increase the risk of relapse (LDA) or radiographic progression, even though there is an increased risk of losing remission. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted

  9. Ovarian failure due to cancer treatment and fertility preservation options

    Directory of Open Access Journals (Sweden)

    Soheila Aminimoghaddam

    2016-04-01

    Full Text Available Primary ovarian insufficiency (POI, commonly referred to premature ovarian failure, is defined as ovarian failure before the age of 40 years. It is the loss of ovarian function caused by a process directly affecting ovaries. Cancer therapy which includes surgery, radiotherapy, and chemotherapy influence ovarian function, leading to premature menopause and loss of fertility. POI is idiopathic in most cases (74-90%. The known causes, in addition to anticancer treatment, are other processes like chromosomal abnormalities, autoimmunity, and natural aging can result in secondary ovarian failure, which is detected by an increase in serum gonadotropin levels (FSH and LH. There are evident risks of POI in women treated for cancer. Those who receive anticancer treatments have an increased risk of developing POI. There by, anticancer drugs and radiation therapy are considered as the most common toxins of ovaries. Although cancer incidence rates in women less than 50 years old continue to increase during recent years, mortality rates are dramatically decreasing due to modern advances in treatment. Increasing numbers of survivors are now confronted with the long-term consequences of exposure to these treatments. The pool of primordial follicles in the ovary is fixed and any injury to the ovary can potentially reduce this ovarian reserve, effectively advancing the patient’s reproductive age, thus narrowing the window of reproductive opportunity. Ovarian failure occurs in a significant percentage of childhood cancer survivors and many of them will seek care for reproductive dysfunction. Nevertheless, Embryo cryopreservation, oocyte cryopreservation, ovary tissue cryopreservation, ovarian suppression and oophoro-pexy are some options to preserve fertility in these groups. As a result, having foreknowledge of potential treatment related ovarian failure will allow the physician to give a better counsel to patients and their family regarding the importance and

  10. Clostridium Difficile Infection Due to Pneumonia Treatment: Mortality Risk Models.

    Science.gov (United States)

    Chmielewska, M; Zycinska, K; Lenartowicz, B; Hadzik-Błaszczyk, M; Cieplak, M; Kur, Z; Wardyn, K A

    2017-01-01

    One of the most common gastrointestinal infection after the antibiotic treatment of community or nosocomial pneumonia is caused by the anaerobic spore Clostridium difficile (C. difficile). The aim of this study was to retrospectively assess mortality due to C. difficile infection (CDI) in patients treated for pneumonia. We identified 94 cases of post-pneumonia CDI out of the 217 patients with CDI. The mortality issue was addressed by creating a mortality risk models using logistic regression and multivariate fractional polynomial analysis. The patients' demographics, clinical features, and laboratory results were taken into consideration. To estimate the influence of the preceding respiratory infection, a pneumonia severity scale was included in the analysis. The analysis showed two statistically significant and clinically relevant mortality models. The model with the highest prognostic strength entailed age, leukocyte count, serum creatinine and urea concentration, hematocrit, coexisting neoplasia or chronic obstructive pulmonary disease. In conclusion, we report on two prognostic models, based on clinically relevant factors, which can be of help in predicting mortality risk in C. difficile infection, secondary to the antibiotic treatment of pneumonia. These models could be useful in preventive tailoring of individual therapy.

  11. Prolonged-release melatonin versus placebo for benzodiazepine discontinuation in patients with schizophrenia: a randomized clinical trial - the SMART trial protocol

    DEFF Research Database (Denmark)

    Baandrup, Lone; Fagerlund, Birgitte; Jennum, Poul

    2011-01-01

    Treatment of schizophrenia frequently includes prolonged benzodiazepine administration despite a lack of evidence of its use. It is often difficult to discontinue benzodiazepines because of the development of dependence. We aim to assess if melatonin can facilitate the withdrawal of prolonged...... benzodiazepine administration in patients with schizophrenia. Furthermore, we aim to investigate the association of benzodiazepine dose reduction with the following clinically important variables: sleep, psychophysiology, cognition, social function, and quality of life....

  12. Effect of Poultry Litter Treatment (PLT) on death due to ascites in broilers.

    Science.gov (United States)

    Terzich, M; Quarles, C; Goodwin, M A; Brown, J

    1998-01-01

    The purposes of this study were to determine the effect of Poultry Litter Treatment (PLT) on levels of litter moisture, litter nitrogen, atmospheric ammonia, and death due to ascites. Data were collected from chicks raised in containment conditions that resembled commercial settings. The ascites death rate (5.9%) in broiler chicks on PLT-treated litter was significantly (chi 2 = 15.5, df = 1, P = 0.0001) lower than that (31.5%) in broiler chicks raised on untreated litter. Likewise, atmospheric ammonia levels in pens that had been treated with PLT were significantly (P litter moisture and litter nitrogen levels were not different (P > 0.05) among treatments at any sample interval.

  13. Impact of Oral Hygiene Discontinuation on Supragingival and Salivary Microbiomes

    DEFF Research Database (Denmark)

    Belstrøm, D; Sembler-Møller, M L; Grande, M A

    2018-01-01

    of oral hygiene. Supragingival and salivary microbiotas were processed by next-generation sequencing (Human Oral Microbe Identification using Next Generation Sequencing) and microbial community profiles were compared. Microbial composition of supragingival plaque samples collected after 4, 7, and 10 d......The purpose of the present study was to characterize and compare supragingival and salivary microbiotas during a 10-d period of oral hygiene discontinuation. We tested the hypothesis that the composition of the salivary microbiota will reflect local microbial changes associated with accumulated...... biofilm formation and maturation. Pooled supragingival plaque (n = 145) and stimulated saliva (n = 145) samples were collected and plaque and gingival indices were recorded from 29 orally healthy individuals at baseline, during oral hygiene discontinuation (days 4, 7, and 10), and 14 d after resumption...

  14. A 66pW Discontinuous Switch-Capacitor Energy Harvester for Self-Sustaining Sensor Applications.

    Science.gov (United States)

    Wu, Xiao; Shi, Yao; Jeloka, Supreet; Yang, Kaiyuan; Lee, Inhee; Sylvester, Dennis; Blaauw, David

    2016-06-01

    We present a discontinuous harvesting approach for switch capacitor DC-DC converters that enables ultra-low power energy harvesting. By slowly accumulating charge on an input capacitor and then transferring it to a battery in burst-mode, switching and leakage losses in the DC-DC converter can be optimally traded-off with the loss due to non-ideal MPPT operation. The harvester uses a 15pW mode controller, an automatic conversion ratio modulator, and a moving sum charge pump for low startup energy upon a mode switch. In 180nm CMOS, the harvester achieves >40% end-to-end efficiency from 113pW to 1.5μW with 66pW minimum input power, marking a >10× improvement over prior ultra-low power harvesters.

  15. Apnoea of prematurity – discontinuation of methylxanthines in a ...

    African Journals Online (AJOL)

    Background. Methylxanthines such as caffeine have been proven to reduce apnoea of prematurity and are often discontinued at 35 weeks' corrected gestational age (GA). Objective. To ascertain whether a caffeine protocol based on international guidelines is applicable in our setting, where GA is often uncertain. Methods.

  16. Boundary discontinuous Fourier analysis of thick beams with clamped and simply supported edges via CUF

    Directory of Open Access Journals (Sweden)

    F.G. CANALES

    2017-10-01

    Full Text Available This paper presents an analytical solution for static analysis of thick rectangular beams with different boundary conditions. Carrera’s Unified Formulation (CUF is used in order to consider shear deformation theories of arbitrary order. The novelty of the present work is that a boundary discontinuous Fourier approach is used to consider clamped boundary conditions in the analytical solution, unlike Navier-type solutions which are restricted to simply supported beams. Governing equations are obtained by employing the principle of virtual work. The numerical accuracy of results is ascertained by studying the convergence of the solution and comparing the results to those of a 3D finite element solution. Beams subjected to bending due to a uniform pressure load and subjected to torsion due to opposite linear forces are considered. Overall, accurate results close to those of 3D finite element solutions are obtained, which can be used to validate finite element results or other approximate methods.

  17. Defining futile life-prolonging treatments through Neo-Socratic Dialogue.

    Science.gov (United States)

    Aizawa, Kuniko; Asai, Atsushi; Bito, Seiji

    2013-12-09

    In Japan, people are negative towards life-prolonging treatments. Laws that regulate withholding or discontinuing life-prolonging treatments and advance directives do not exist. Physicians, however, view discontinuing life-prolonging treatments negatively due to fears of police investigations. Although ministerial guidelines were announced regarding the decision process for end-of-life care in 2007, a consensus could not be reached on the definition of end-of-life and conditions for withholding treatment. We established a forum for extended discussions and consensus building on this topic. We used the Neo-Socratic Dialogue (NSD) method which promotes philosophical discussion based on a case-study to address a question and formulate a consensus and answer in a group. The question chosen for the dialogue was: "What is a life-prolonging treatment?" A series of dialogues took place over a period of one and a half days. It was carried out by three groups in 2010 and 2011. Seven participants with diverse backgrounds were recruited per group. We analyzed the content of the discussion. Based on three case studies concerning different opinions about treatment options for an older dementia patient, a patient demanding chemotherapy, and a severely ill neonate, conditions for futile life-prolonging treatment were elucidated through NSD. Such treatments are those carried out for the sole purpose of prolonging life and are detrimental to the patient, and should be decided based foremost on the patient's lack of desire for treatment, the consensus of those involved, and through social acceptance. These arguments are essentially consistent with ones on medical futility in the United States. By expressing the objective of healthcare and the requirement of social acceptance, participants were also able to elucidate issues related to the awareness of those involved and the medical environment. Compared to the end-of-life guidelines in Japan, the objective of treatment, its effects

  18. Medication persistence and discontinuation of rivaroxaban versus warfarin among patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Nelson, Winnie W; Song, Xue; Coleman, Craig I; Thomson, Erin; Smith, David M; Damaraju, C V; Schein, Jeffrey R

    2014-12-01

    To compare real-world persistence and discontinuation among non-valvular atrial fibrillation (NVAF) patients on rivaroxaban and warfarin in the US. A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF treated with rivaroxaban or warfarin from 1 July 2010 through 31 March 2013. Index date was the date of the first prescription of rivaroxaban or warfarin. All patients were followed until the earliest of inpatient death, end of continuous enrollment, or end of study period. Rivaroxaban patients were matched 1:1 by propensity scores. Medication persistence was defined as absence of refill gap of ≥ 60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up. Cox proportional hazards models were estimated to examine the adjusted hazard ratios (aHRs) of rivaroxaban vs. warfarin on non-persistence and discontinuation. A total of 32,886 NVAF patients on rivaroxaban or warfarin met the study inclusion criteria. Each of the 7259 rivaroxaban patients identified were matched 1:1 to warfarin patients. Patients on rivaroxaban had a significantly better rate of persistence (aHR: 0.63, 95% CI 0.59-0.68) and lower rate of discontinuation (aHR: 0.54, 95% CI 0.49-0.58) compared to warfarin recipients. Claims data may have contained inaccuracies and miscoding. Confounding may remain even after propensity score matching and additional adjustments in model. Refill data may not fully reflect actual medication use. Longer follow-up may produce more precise estimates of persistence and discontinuation. This matched cohort analysis indicated that rivaroxaban was associated with significantly higher medication persistence and lower discontinuation rates compared to warfarin.

  19. Bifurcation in autonomous and nonautonomous differential equations with discontinuities

    CERN Document Server

    Akhmet, Marat

    2017-01-01

    This book is devoted to bifurcation theory for autonomous and nonautonomous differential equations with discontinuities of different types. That is, those with jumps present either in the right-hand-side or in trajectories or in the arguments of solutions of equations. The results obtained in this book can be applied to various fields such as neural networks, brain dynamics, mechanical systems, weather phenomena, population dynamics, etc. Without any doubt, bifurcation theory should be further developed to different types of differential equations. In this sense, the present book will be a leading one in this field. The reader will benefit from the recent results of the theory and will learn in the very concrete way how to apply this theory to differential equations with various types of discontinuity. Moreover, the reader will learn new ways to analyze nonautonomous bifurcation scenarios in these equations. The book will be of a big interest both for beginners and experts in the field. For the former group o...

  20. Electrical resistivity discontinuity of iron along the melting curve

    Science.gov (United States)

    Wagle, Fabian; Steinle-Neumann, Gerd

    2018-04-01

    Discontinuous changes of electrical resistivity ρel (increase), density ϱ and isothermal compressibility βT (decrease) occur across the melting temperature of metals and can be directly related by Ziman's theory in the long-wavelength approximation. By evaluating experimental data at ambient pressure, we show that Ziman's approximation holds for iron and other simple and transition metals. Using a thermodynamic model to determine βT for γ-, ɛ- and liquid Fe and a previously published model for ρel of liquid Fe, we apply Ziman's approximation to calculate ρel of solid Fe along the melting curve. For pure Fe, we find the discontinuity in ρel to decrease with pressure and to be negligibly small at inner core boundary conditions. However, if we account for light element enrichment in the liquid outer core, the electrical resistivity decrease across the inner core boundary is predicted to be as large as 36 per cent.