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Sample records for hypertonically challenged imcd3

  1. File list: His.Kid.10.AllAg.mIMCD-3 [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  4. File list: His.Kid.20.AllAg.mIMCD-3 [Chip-atlas[Archive

    Lifescience Database Archive (English)

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  5. File list: ALL.Kid.10.AllAg.mIMCD-3 [Chip-atlas[Archive

    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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  7. File list: ALL.Kid.05.AllAg.mIMCD-3 [Chip-atlas[Archive

    Lifescience Database Archive (English)

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    Lifescience Database Archive (English)

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  9. Protective effect of bronchial challenge with hypertonic saline on nocturnal asthma

    Directory of Open Access Journals (Sweden)

    M.C. Borges

    2008-03-01

    Full Text Available Inhalation of hypertonic saline (HS causes bronchoconstriction in asthmatic subjects. Repeated inhalation of HS leads to substantially reduced bronchoconstriction, known as the refractory period. Refractoriness due to different stimuli has also been described (cross-refractoriness. Nocturnal asthma is defined as an increase in symptoms, need for medication, airway responsiveness, and/or worsening of lung function that usually occurs from 4 to 6 am. Our objective was to determine the effect of refractoriness on nocturnal asthma. The challenge test consisted of inhalations of 4.5% saline with increasing durations until a reduction of 20% in forced expiratory volume in 1 s (FEV1 (PD20HS or total time of 15.5 min. Twelve subjects with nocturnal asthma were challenged with HS at 16:00 and 18:00 h and FEV1 was measured at 4:00 h. One to 2 weeks later, FEV1 was determined at 16:00 and 4:00 h. LogPD20HS at 18:00 h was significantly greater than logPD20HS at 16:00 h, 0.51 ± 0.50 and 0.69 ± 0.60 mg, respectively (P = 0.0033. When subjects underwent two HS challenges in the afternoon, mean (± SD FEV1 reduction was 206 ± 414 mL or 9.81 ± 17.42%. On the control day (without challenge in the afternoon FEV1 reduction was 523 ± 308 mL or 22.75 ± 15.40% (P = 0.021. Baseline FEV1 values did not differ significantly between the control and study days, 2.48 ± 0.62 and 2.36 ± 0.46 L, respectively. The refractory period following HS challenges reduces the nocturnal worsening of asthma. This new concept may provide beneficial applications to asthmatic patients.

  10. Hypertonic saline enhances host response to bacterial challenge by augmenting receptor-independent neutrophil intracellular superoxide formation.

    LENUS (Irish Health Repository)

    Shields, Conor J

    2012-02-03

    OBJECTIVE: This study sought to determine whether hypertonic saline (HTS) infusion modulates the host response to bacterial challenge. METHODS: Sepsis was induced in 30 Balb-C mice by intraperitoneal injection of Escherichia coli (5 x 107 organisms per animal). In 10 mice, resuscitation was performed at 0 and 24 hours with a 4 mL\\/kg bolus of HTS (7.5% NaCl), 10 animals received 4 mL\\/kg of normal saline (0.9% NaCl), and the remaining animals received 30 mL\\/kg of normal saline. Samples of blood, spleen, and lung were cultured at 8 and 36 hours. Polymorphonucleocytes were incubated in isotonic or hypertonic medium before culture with E. coli. Phagocytosis was assessed by flow cytometry, whereas intracellular bacterial killing was measured after inhibition of phagocytosis with cytochalasin B. Intracellular formation of free radicals was assessed by the molecular probe CM-H(2)DCFDA. Mitogen-activated protein (MAP) kinase p38 and ERK-1 phosphorylation, and nuclear factor kappa B (NFkappaB) activation were determined. Data are represented as means (SEM), and an analysis of variance test was performed to gauge statistical significance. RESULTS: Significantly reduced bacterial culture was observed in the animals resuscitated with HTS when compared with their NS counterparts, in blood (51.8 +\\/- 4.3 vs. 82.0 +\\/- 3.3 and 78.4 +\\/- 4.8, P = 0.005), lung (40.0 +\\/- 4.1 vs. 93.2 +\\/- 2.1 and 80.9 +\\/- 4.7, P = 0.002), and spleen (56.4 +\\/- 3.8 vs. 85.4 +\\/- 4.2 and 90.1 +\\/- 5.9, P = 0.05). Intracellular killing of bacteria increased markedly (P = 0.026) and superoxide generation was enhanced upon exposure to HTS (775.78 +\\/- 23.6 vs. 696.57 +\\/- 42.2, P = 0.017) despite inhibition of MAP kinase and NFkappaB activation. CONCLUSIONS: HTS significantly enhances intracellular killing of bacteria while attenuating receptor-mediated activation of proinflammatory cascades.

  11. Effects of hypertonic buffer composition on lymph node uptake and bioavailability of rituximab, after subcutaneous administration.

    Science.gov (United States)

    Fathallah, Anas M; Turner, Michael R; Mager, Donald E; Balu-Iyer, Sathy V

    2015-03-01

    The subcutaneous administration of biologics is highly desirable; however, incomplete bioavailability after s.c. administration remains a major challenge. In this work we investigated the effects of excipient dependent hyperosmolarity on lymphatic uptake and plasma exposure of rituximab as a model protein. Using Swiss Webster (SW) mice as the animal model, we compared the effects of NaCl, mannitol and O-phospho-L-serine (OPLS) on the plasma concentration of rituximab over 5 days after s.c. administration. An increase was observed in plasma concentrations in animals administered rituximab in hypertonic buffer solutions, compared with isotonic buffer. Bioavailability, as estimated by our pharmacokinetic model, increased from 29% in isotonic buffer to 54% in hypertonic buffer containing NaCl, to almost complete bioavailability in hypertonic buffers containing high dose OPLS or mannitol. This improvement in plasma exposure is due to the improved lymphatic trafficking as evident from the increase in the fraction of dose trafficked through the lymph nodes in the presence of hypertonic buffers. The fraction of the dose trafficked through the lymphatics, as estimated by the model, increased from 0.05% in isotonic buffer to 13% in hypertonic buffer containing NaCl to about 30% for hypertonic buffers containing high dose OPLS and mannitol. The data suggest that hypertonic solutions may be a viable option for improving s.c. bioavailability. Copyright © 2014 John Wiley & Sons, Ltd.

  12. Hypertonic saline for bronchiolitis in infants

    National Research Council Canada - National Science Library

    Grewal, Simran; Goldman, Ran D

    2015-01-01

    Recently, a 1-year-old patient returned from admission in the hospital for bronchiolitis, and the report I received indicated that he was treated with inhaled hypertonic saline, among other treatments...

  13. Environmental hypertonicity causes induction of gluconeogenesis in the air-breathing singhi catfish, Heteropneustes fossilis.

    Directory of Open Access Journals (Sweden)

    Manas Das

    Full Text Available The air-breathing singhi catfish (Heteropneustes fossilis is frequently being challenged by different environmental insults such as hyper-ammonia, dehydration and osmotic stresses in their natural habitats throughout the year. The present study investigated the effect of hyperosmotic stress, due to exposure to hypertonic environment (300 mM mannitol for 14 days, on gluconeogenesis in this catfish. In situ exposure to hypertonic environment led to significant stimulation of gluconeogenic fluxes from the perfused liver after 7 days of exposure, followed by further increase after 14 days in presence of three different potential gluconeogenic substrates (lactate, pyruvate and glutamate. Environmental hypertonicity also caused a significant increase of activities of key gluconeogenic enzymes, namely phosphoenolpyruvate carboxykinase, fructose 1, 6-bisphosphatase and glucose 6-phosphatase by about 2-6 fold in liver, and 3-6 fold in kidney tissues. This was accompanied by more abundance of enzyme proteins by about 1.8-3.7 fold and mRNAs by about 2.2-5.2 fold in both the tissues with a maximum increase after 14 days of exposure. Hence, the increase in activities of key gluconeogenic enzymes under hypertonic stress appeared to be as a result of transcriptional regulation of genes. Immunocytochemical analysis further confirmed the tissue specific localized expression of these enzymes in both the tissues with the possibility of expressing more in the same localized places. The induction of gluconeogenesis during exposure to environmental hypertonicity possibly occurs as a consequence of changes in hydration status/cell volume of different cell types. Thus, these adaptational strategies related to gluconeogenesis that are observed in this catfish under hypertonic stress probably help in maintaining glucose homeostasis and also for a proper energy supply to support metabolic demands mainly for ion transport and other altered metabolic processes under various

  14. Quantification of nonosmotic sodium storage capacity following acute hypertonic saline infusion in healthy individuals

    NARCIS (Netherlands)

    Olde Engberink, Rik H. G.; Rorije, Nienke M. G.; van den Born, Bert-Jan H.; Vogt, Liffert

    2017-01-01

    The assumption that sodium accumulation in the human body is always accompanied by water retention has been challenged by data showing that sodium can be stored nonosmotically. Here we investigated the contribution of nonosmotic sodium storage to short-term sodium homeostasis after hypertonic saline

  15. Hypertonic saline for bronchiolitis in infants.

    Science.gov (United States)

    Grewal, Simran; Goldman, Ran D

    2015-06-01

    Recently, a 1-year-old patient returned from admission in the hospital for bronchiolitis, and the report I received indicated that he was treated with inhaled hypertonic saline, among other treatments. Is this therapy recommended for children in the acute care setting? Bronchiolitis, caused mostly by respiratory syncytial virus, is very common in the winter. It is the most frequent cause of hospitalization in infancy. Several good studies have been conducted in the past decade on the use of nebulized hypertonic saline for bronchiolitis management; however, they offer conflicting results. While there might be a role for the use of nebulized hypertonic saline in children who are hospitalized with bronchiolitis for more than 3 days, treatment in other settings does not confer enough benefit to recommend its use. Copyright© the College of Family Physicians of Canada.

  16. Hypertonicity: Clinical entities, manifestations and treatment

    Science.gov (United States)

    Rondon-Berrios, Helbert; Argyropoulos, Christos; Ing, Todd S; Raj, Dominic S; Malhotra, Deepak; Agaba, Emmanuel I; Rohrscheib, Mark; Khitan, Zeid J; Murata, Glen H; Shapiro, Joseph I; Tzamaloukas, Antonios H

    2017-01-01

    Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and long-term neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and hyperglycemia. Hypernatremia results from relative excess of body sodium over body water. Loss of water in excess of intake, gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of hypernatremia. Hypernatremia can be hypervolemic, euvolemic or hypovolemic. The management of hypernatremia addresses both a quantitative replacement of water and, if present, sodium deficit, and correction of the underlying pathophysiologic process that led to hypernatremia. Hypertonicity in hyperglycemia has two components, solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the first component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fluid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtained by the corrected sodium concentration, which represents a calculated value of the serum sodium concentration that would result from reduction of the serum glucose concentration to a normal level. PMID:28101446

  17. Poststroke hypertonicity: upper limb assessment and treatment.

    Science.gov (United States)

    Marciniak, Christina

    2011-01-01

    Hypertonicity is common in patients with upper limb dysfunction following hemiplegic stroke and is associated with greater impairment, worse function, and lower health-related quality of life. In addition to increased rest activity, abnormal patterns of muscle activation, such as spastic co-contraction, may contribute to disability. In the upper limb, flexor muscles are more commonly involved distally, and at the shoulder, spasticity of adductors, flexors, and internal rotators is most often observed. Prior to interventions, a history regarding prior interventions, comorbid diagnoses, and limitations imposed by abnormal tone should be elicited. Commonly used scales to assess hypertonicity include the Modified Ashworth, the Modified Tardieu, the Spasm Frequency, the Disability Assessment, the Fugl-Meyer, and the Motor Assessment Scales. Treatment interventions for upper limb hypertonicity include stretching, splinting, strengthening of antagonist muscles, oral medications, and focal injections (phenol or botulinum toxins). Intrathecal baclofen may also impact upper limb tone. For focal injections, correct identification of muscles contributing to problematic tone is evaluated by eliciting resistance to movement at rest and observation of patterns of tightness as the limb is used functionally. The botulinum toxins have been shown to decrease tone in stroke survivors and improve active and passive functioning. Because secondary changes such as contractures and weakness may occur with prolonged hypertonicity, therapy to improve range of motion, strengthen weakened muscles, and incorporate use of the limb should be considered following focal injections, oral medications, or intrathecal pump placement.

  18. Mannitol versus hypertonic saline: Safety and efficacy of mannitol and hypertonic saline in sputum induction and bronchial hyperreactivity assessment.

    Science.gov (United States)

    Alvarez-Puebla, M J; Olaguibel, J M; Almudevar, E; Echegoyen, A A; Vela, C; de Esteban, B

    2015-08-01

    Eosinophilic asthma phenotype predicts good response to corticosteroids and associates to asthmatic exacerbations. Sputum induction by hypertonic saline (HS) inhalation is technically demanding. Bronchial hyperresponsiveness (BHR) to osmotic agents indirectly mirrors active airway inflammation. We compared the safety and ability of HS and mannitol to induce sputum and measure BHR. We evaluated the stability of inflammatory phenotypes. We studied 35 non-smoking asthmatics randomized to undergo HS and mannitol challenges on 2 days 1 week apart. Sputum was sampled for cell analysis and phenotyped as eosinophilic (≥3% eosinophils) and non-eosinophilic (mannitol and nine of them also had BHR to HS. Drops in forced expiratory volume in 1 s were higher from HS challenge than from mannitol challenge. Adequate sputum samples were obtained from 80% subjects (68% mannitol and 71% HS). Eosinophils and macrophages from both challenges correlated. Neutrophils were higher in sputum from HS. Ninety percent samples were equally phenotyped with HS and mannitol. Fractional exhaled nitric oxide, sputum eosinophils and BHR correlated in both challenges. HS and mannitol showed similar capacity to produce valuable sputum samples. BHR to both osmotic stimuli partially resembled airway eosinophilic inflammation but mannitol was more sensitive than HS to assess BHR. Eosinophilic phenotype remained stable in most patients with both stimuli. © The Author(s) 2015.

  19. Operating room use of hypertonic solutions: a clinical review

    Directory of Open Access Journals (Sweden)

    Gustavo Azoubel

    2008-01-01

    Full Text Available Hyperosmotic-hyperoncotic solutions have been widely used during prehospital care of trauma patients and have shown positive hemodynamic effects. Recently, there has been a growing interest in intra-operative use of hypertonic solutions. We reviewed 30 clinical studies on the use of hypertonic saline solutions during surgeries, with the majority being cardiac surgeries. Reduced positive fluid balance, increased cardiac index, and decreased systemic vascular resistance were the main beneficial effects of using hypertonic solutions in this population. Well-designed clinical trials are highly needed, particularly in aortic aneurysm repair surgeries, where hypertonic solutions have shown many beneficial effects. Examining the immunomodulatory effects of hypertonic solutions should also be a priority in future studies.

  20. Hypertonic Saline in Treatment of Pulmonary Disease in Cystic Fibrosis

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    Emer P. Reeves

    2012-01-01

    Full Text Available The pathogenesis of lung disease in cystic fibrosis is characterised by decreased airway surface liquid volume and subsequent failure of normal mucociliary clearance. Mucus within the cystic fibrosis airways is enriched in negatively charged matrices composed of DNA released from colonizing bacteria or inflammatory cells, as well as F-actin and elevated concentrations of anionic glycosaminoglycans. Therapies acting against airway mucus in cystic fibrosis include aerosolized hypertonic saline. It has been shown that hypertonic saline possesses mucolytic properties and aids mucociliary clearance by restoring the liquid layer lining the airways. However, recent clinical and bench-top studies are beginning to broaden our view on the beneficial effects of hypertonic saline, which now extend to include anti-infective as well as anti-inflammatory properties. This review aims to discuss the described therapeutic benefits of hypertonic saline and specifically to identify novel models of hypertonic saline action independent of airway hydration.

  1. Hypertonic saline in treatment of pulmonary disease in cystic fibrosis.

    LENUS (Irish Health Repository)

    Reeves, Emer P

    2012-01-01

    The pathogenesis of lung disease in cystic fibrosis is characterised by decreased airway surface liquid volume and subsequent failure of normal mucociliary clearance. Mucus within the cystic fibrosis airways is enriched in negatively charged matrices composed of DNA released from colonizing bacteria or inflammatory cells, as well as F-actin and elevated concentrations of anionic glycosaminoglycans. Therapies acting against airway mucus in cystic fibrosis include aerosolized hypertonic saline. It has been shown that hypertonic saline possesses mucolytic properties and aids mucociliary clearance by restoring the liquid layer lining the airways. However, recent clinical and bench-top studies are beginning to broaden our view on the beneficial effects of hypertonic saline, which now extend to include anti-infective as well as anti-inflammatory properties. This review aims to discuss the described therapeutic benefits of hypertonic saline and specifically to identify novel models of hypertonic saline action independent of airway hydration.

  2. A randomized, controlled trial of nebulized 5% hypertonic saline and mixed 5% hypertonic saline with epinephrine in bronchiolitis.

    Science.gov (United States)

    Tinsa, Faten; Abdelkafi, Sana; Bel Haj, Imen; Hamouda, Samia; Brini, Ines; Zouari, Bechir; Boussetta, Khadija

    2014-11-01

    Bronchiolitis is a public health problem in the word and in Tunisia. Nebulized hypertonic saline seems to have some benefits in bronchiolitis. The aim of this study is to evaluate the efficacy of nebulized 5% hypertonic saline alone or mixed with epinephrine in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from February 2012 to Mars 2012. A total of 94 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive 5% nebulized hypertonic saline, mixed 5% hypertonic saline with standard epinephrine 0,1% or normal saline (placebo) at admission and every 4 hours during hospitalization. There were no significant difference between nebulized 5% hypertonic saline, mixed 5% hypertonic saline with epinephrine or normal saline at baseline, T30 min, T60 min, and T120 min after start study in Wang severity score, oxygen saturation in room air, rate respiratory and heart rate. There was no difference in duration of hospitalization. Nebulized 5% hypertonic saline or mixed 5% hypertonic saline with epinephrine are safety but does not appear effective in treating moderately ill infants with the first acute bronchiolitis.

  3. Infusion of hypertonic saline before elective hysterectomy: effects on cytokines and stress hormones

    DEFF Research Database (Denmark)

    Kolsen-Petersen, J A; Bendtzen, K; Tonnesen, E

    2008-01-01

    Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery.......Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery....

  4. HYPERTONIC SOLUTIONS EFFICACY IN ACUTE UNCOMPLICATED RHINOSINUSITIS TREATMENT IN CHILDREN

    Directory of Open Access Journals (Sweden)

    М.R. Bogomilskiy

    2011-01-01

    Full Text Available The article is dedicated to the problem of acute rhinosinusitis in children. It contains data from our own research upon hypertonic solution efficacy and suitability in complex therapy of rhinosinusitis. It was shown that inclusion of hypertonic solution of sea water spray into treatment scheme of acute rhinosinusitis allows to reach amelioration of nasal functions and patient’s well being in short term, reduces total duration of the disease, thus decresing the risk of complications development. Key words: rhinosinusitis, treatment, childhood, hypertonic solution, sea water. (Voprosy sovremennoi pediatrii — Current Pediatrics. — 2011; 10 (5: 124–129.

  5. Modeling liver electrical conductivity during hypertonic injection.

    Science.gov (United States)

    Castellví, Quim; Sánchez-Velázquez, Patricia; Moll, Xavier; Berjano, Enrique; Andaluz, Anna; Burdío, Fernando; Bijnens, Bart; Ivorra, Antoni

    2018-01-01

    Metastases in the liver frequently grow as scattered tumor nodules that neither can be removed by surgical resection nor focally ablated. Previously, we have proposed a novel technique based on irreversible electroporation that may be able to simultaneously treat all nodules in the liver while sparing healthy tissue. The proposed technique requires increasing the electrical conductivity of healthy liver by injecting a hypersaline solution through the portal vein. Aiming to assess the capability of increasing the global conductivity of the liver by means of hypersaline fluids, here, it is presented a mathematical model that estimates the NaCl distribution within the liver and the resulting conductivity change. The model fuses well-established compartmental pharmacokinetic models of the organ with saline injection models used for resuscitation treatments, and it considers changes in sinusoidal blood viscosity because of the hypertonicity of the solution. Here, it is also described a pilot experimental study in pigs in which different volumes of NaCl 20% (from 100 to 200 mL) were injected through the portal vein at different flow rates (from 53 to 171 mL/minute). The in vivo conductivity results fit those obtained by the model, both quantitatively and qualitatively, being able to predict the maximum conductivity with a 14.6% average relative error. The maximum conductivity value was 0.44 second/m, which corresponds to increasing 4 times the mean basal conductivity (0.11 second/m). The results suggest that the presented model is well suited for predicting on liver conductivity changes during hypertonic saline injection. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Isotonic and hypertonic sodium loading in supine humans

    DEFF Research Database (Denmark)

    Andersen, L J; Jensen, T U; Bestle, M H

    1999-01-01

    The hypothesis that hypertonic saline infusion induces a greater natriuresis than infusion of the same amount of sodium as isotonic saline was tested in 8 supine subjects on fixed sodium intake of 150 mmol NaCl day(-1). Sodium loads equivalent to the amount of sodium contained in 10% of measured...... extracellular volume were administered intravenously over 90 min either as isotonic saline or as hypertonic saline (850 mmol L(-1)). A third series without saline infusion served as time control. Experiments lasted 8 h. Water balance and sodium loads were maintained by replacing the excreted amounts every hour...... stimulus. Renal sodium excretion increased more than a factor of four with isotonic and hypertonic saline but also increased during time control (factor of three). Cumulated sodium excretions following isotonic (131 +/- 13 mmol) and hypertonic saline (123 +/- 10 mmol) were statistically identical exceeding...

  7. Therapeutic effects of compound hypertonic saline on rats with sepsis

    Directory of Open Access Journals (Sweden)

    Fang Dong

    2014-09-01

    Full Text Available Sepsis is one of the major causes of death and is the biggest obstacle preventing improvement of the success rate in curing critical illnesses. Currently, isotonic solutions are used in fluid resuscitation technique. Several studies have shown that hypertonic saline applied in hemorrhagic shock can rapidly increase the plasma osmotic pressure, facilitate the rapid return of interstitial fluid into the blood vessels, and restore the effective circulating blood volume. Here, we established a rat model of sepsis by using the cecal ligation and puncture approach. We found that intravenous injection of hypertonic saline dextran (7.5% NaCl/6% dextran after cecal ligation and puncture can improve circulatory failure at the onset of sepsis. We found that the levels of tumor necrosis factor-α, interleukin-1β, interleukin-6 and intracellular adhesion molecule 1 levels in the lung tissue of cecal ligation and puncture rats treated with hypertonic saline dextran were significantly lower than the corresponding levels in the control group. We inferred that hypertonic saline dextran has a positive immunoregulatory effect and inhibits the overexpression of the inflammatory response in the treatment of sepsis. The percentage of neutrophils, lung myeloperoxidase activity, wet to dry weight ratio of lung tissues, histopathological changes in lung tissues, and indicators of arterial blood gas analysis was significantly better in the hypertonic saline dextran-treated group than in the other groups in this study. Hypertonic saline dextran-treated rats had significantly improved survival rates at 9 and 18 h compared to the control group. Our results suggest that hypertonic saline dextran plays a protective role in acute lung injury caused after cecal ligation and puncture. In conclusion, hypertonic/hyperoncotic solutions have beneficial therapeutic effects in the treatment of an animal model of sepsis.

  8. Therapeutic effects of compound hypertonic saline on rats with sepsis.

    Science.gov (United States)

    Dong, Fang; Chen, Wei; Xu, Liang; Wang, Huabing; Lu, Huizhi

    2014-01-01

    Sepsis is one of the major causes of death and is the biggest obstacle preventing improvement of the success rate in curing critical illnesses. Currently, isotonic solutions are used in fluid resuscitation technique. Several studies have shown that hypertonic saline applied in hemorrhagic shock can rapidly increase the plasma osmotic pressure, facilitate the rapid return of interstitial fluid into the blood vessels, and restore the effective circulating blood volume. Here, we established a rat model of sepsis by using the cecal ligation and puncture approach. We found that intravenous injection of hypertonic saline dextran (7.5% NaCl/6% dextran) after cecal ligation and puncture can improve circulatory failure at the onset of sepsis. We found that the levels of tumor necrosis factor-α, interleukin-1β, interleukin-6 and intracellular adhesion molecule 1 levels in the lung tissue of cecal ligation and puncture rats treated with hypertonic saline dextran were significantly lower than the corresponding levels in the control group. We inferred that hypertonic saline dextran has a positive immunoregulatory effect and inhibits the overexpression of the inflammatory response in the treatment of sepsis. The percentage of neutrophils, lung myeloperoxidase activity, wet to dry weight ratio of lung tissues, histopathological changes in lung tissues, and indicators of arterial blood gas analysis was significantly better in the hypertonic saline dextran-treated group than in the other groups in this study. Hypertonic saline dextran-treated rats had significantly improved survival rates at 9 and 18 h compared to the control group. Our results suggest that hypertonic saline dextran plays a protective role in acute lung injury caused after cecal ligation and puncture. In conclusion, hypertonic/hyperoncotic solutions have beneficial therapeutic effects in the treatment of an animal model of sepsis. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  9. Therapeutic effects of compound hypertonic saline on rats with sepsis

    Directory of Open Access Journals (Sweden)

    Fang Dong

    Full Text Available Sepsis is one of the major causes of death and is the biggest obstacle preventing improvement of the success rate in curing critical illnesses. Currently, isotonic solutions are used in fluid resuscitation technique. Several studies have shown that hypertonic saline applied in hemorrhagic shock can rapidly increase the plasma osmotic pressure, facilitate the rapid return of interstitial fluid into the blood vessels, and restore the effective circulating blood volume. Here, we established a rat model of sepsis by using the cecal ligation and puncture approach. We found that intravenous injection of hypertonic saline dextran (7.5% NaCl/6% dextran after cecal ligation and puncture can improve circulatory failure at the onset of sepsis. We found that the levels of tumor necrosis factor-α, interleukin-1β, interleukin-6 and intracellular adhesion molecule 1 levels in the lung tissue of cecal ligation and puncture rats treated with hypertonic saline dextran were significantly lower than the corresponding levels in the control group. We inferred that hypertonic saline dextran has a positive immunoregulatory effect and inhibits the overexpression of the inflammatory response in the treatment of sepsis. The percentage of neutrophils, lung myeloperoxidase activity, wet to dry weight ratio of lung tissues, histopathological changes in lung tissues, and indicators of arterial blood gas analysis was significantly better in the hypertonic saline dextran-treated group than in the other groups in this study. Hypertonic saline dextran-treated rats had significantly improved survival rates at 9 and 18 h compared to the control group. Our results suggest that hypertonic saline dextran plays a protective role in acute lung injury caused after cecal ligation and puncture. In conclusion, hypertonic/hyperoncotic solutions have beneficial therapeutic effects in the treatment of an animal model of sepsis.

  10. No increase in small-solute transport in peritoneal dialysis patients treated without hypertonic glucose for fifty-four months.

    Science.gov (United States)

    Pagniez, Dominique; Duhamel, Alain; Boulanger, Eric; Lessore de Sainte Foy, Celia; Beuscart, Jean-Baptiste

    2017-08-31

    Glucose is widely used as an osmotic agent in peritoneal dialysis (PD), but exerts untoward effects on the peritoneum. The potential protective effect of a reduced exposure to hypertonic glucose has never been investigated. The cohort of PD patients attending our center which tackled the challenge of a restricted use of hypertonic glucose solutions has been prospectively followed since 1992. Small-solute transport was assessed using an equivalent of the glucose peritoneal equilibration test after 6 months, and then every year. Study was stopped on July 1st, 2008, before use of biocompatible solutions. Repeated measures in patients treated with PD for 54 months were analyzed by using (1) the slopes of the linear regression for D4/D0 ratios over time computed for each individual, and (2) a linear mixed model. In the study period, 44 patients were treated for a total of 2376 months, 2058 without hypertonic glucose. There was one episode of peritoneal infection every 18 patient-months. The mean of slopes of the linear regression for D4/D0 ratios was found to be significantly positive (Student's test, p solute transport. In this large series, minimizing the use of hypertonic glucose solutions was associated in patients on long term PD with an overall decrease of small-solute transport within 54 months, despite a high rate of peritoneal infection.

  11. New Form of Hypertonic Solution for Nebulization Therapy

    Directory of Open Access Journals (Sweden)

    Olga I. Simonova

    2016-01-01

    Full Text Available Mucolytic, expectorative and antitussive drugs are traditionally used in acute or chronic respiratory episodes affected by acute respiratory infections. Today, preference is given to drugs in a form of solutions for nebulization therapy. The article presents data on the new dosage form of 7% inhalation hypertonic solution in combination with hyaluronic acid used in mucostasis therapy for chronic respiratory diseases. The information on the properties and the favorable effect of hyaluronic acid is provided. We discuss the evidence base of inhalation of the hypertonic solution in combination with hyaluronic acid in cystic fibrosis.

  12. The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis.

    Science.gov (United States)

    Ipek, Ilke Ozahı; Yalcin, Emek Uyur; Sezer, Rabia Gonul; Bozaykut, Abdulkadir

    2011-12-01

    The mainstay of treatment in bronchiolitis includes oxygenation, aspiration of secretions from the respiratory tract and maintenance of hydration. The first choice medical agent in clinical practice is nebulized bronchodilators, although their place in treatment is controversial. We investigated the therapeutic benefit of nebulized hypertonic (3%) saline (HS), by comparing four different nebulized regimens in the treatment of bronchiolitis in the emergency department. A total of 120 infants were included in this randomized, double-blind, prospective study. Infants were grouped according to the nebulized treatment they received: group 1 - salbutamol + normal saline (NS), group 2 - salbutamol + HS, group 3 - HS, group 4 - NS. Heart beat, Clinical Bronchiolitis Severity Score (CBSS) and oxygen saturation of the patients were determined before and after the nebulizations and at 48-72 h after admission by the designated study physician. Post-treatment mean CBSS were significantly lower than pre-treatment scores in all groups (p = 0.0001) with no significant difference within groups. Improvement percentages for CBSSs were significantly higher in infants without a history of atopy treated with HS and NS (p = 0.023, p = 0.0001, respectively). The CBSSs of all the infants improved after three doses of nebulized therapy regardless of the treatment regimens. The combination of salbutamol with hypertonic saline did not lead to an additive effect in the improvement of CBSSs compared to the standard salbutamol + NS combination. Atopic children benefited from salbutamol/NS combination whereas non-atopic children improved with HS and NS nebulizations based on improvement percentages of CBSS. Copyright © 2011 Elsevier Ltd. All rights reserved.

  13. Using hypertonic saline to manage bronchiolitis in infants.

    Science.gov (United States)

    Canty, Wendy B; Colomb-Lippa, Dawn

    2014-07-01

    Bronchiolitis is the most common lower respiratory tract infection in young children and the leading cause of infant hospitalizations. Treatment is centered on supportive measures. Recent studies suggest hypertonic saline is an effective treatment option in admitted infants, demonstrating promising reductions in length of stay and clinical severity scores.

  14. Hot Hypertonic Saline and Compression Device: A Novel Approach ...

    African Journals Online (AJOL)

    Hot Hypertonic Saline and Compression Device: A Novel Approach in Preventing Severe Hemorrhage during Extirpation of Deep Vascular Malformations of the ... The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader).

  15. Transperitoneal transport of sodium during hypertonic peritoneal dialysis

    DEFF Research Database (Denmark)

    Graff, J; Fugleberg, S; Brahm, J

    1996-01-01

    The mechanisms of transperitoneal sodium transport during hypertonic peritoneal dialysis were evaluated by kinetic modelling. A total of six nested mathematical models were designed to elucidate the presence or absence of diffusive, non-lymphatic convective and lymphatic convective solute transport....... Experimental results were obtained from 26 non-diabetic patients undergoing peritoneal dialysis. The model validation procedure demonstrated that only diffusive and non-lymphatic convective transport mechanisms were identifiable in the transperitoneal transport of sodium. Non-lymphatic convective sodium...

  16. Oral hypertonic saline causes transient fall of vasopressin in humans

    Energy Technology Data Exchange (ETDEWEB)

    Seckl, J.R.; Williams, D.M.; Lightman, S.L.

    1986-08-01

    After dehydration, oral rehydration causes a fall in plasma arginine vasopressin (AVP) that precedes changes in plasma osmolality. To investigate further the stimulus for this effect, its specificity, and association with thirst, six volunteers were deprived of water for 24 h and given a salt load on two separate occasions. On each study day they then drank rapidly 10 ml/kg of either tap water or hypertonic saline (360 mosmol/kg). There was a significant fall in plasma AVP from 2.0 +/- 0.3 to 1.2 +/- 0.4 pmol/l 5 min after drinking water and from 1.8 +/- 0.3 to 0.9 +/- 0.2 pmol/l after hypertonic saline. Plasma osmolality fell 30-60 min after water and was unchanged after saline. Plasma renin activity, oxytocin, and total protein all remained unchanged. All subjects reported diminished thirst after hypertonic saline. Gargling with water reduced thirst but did not affect plasma AVP. There appears to be a drinking-mediated neuroendocrine reflex that decreases plasma AVP irrespective of the osmolality of the liquid consumed. The sensation of thirst did not correlate with plasma osmolality and was not always related to plasma AVP concentration. AVP was measured by radioimmunoassay.

  17. Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial

    OpenAIRE

    Carlos Flores-González, J.; Matamala-Morillo, Miguel A; Patricia Rodríguez-Campoy; Juan J Pérez-Guerrero; Belén Serrano-Moyano; Paloma Comino-Vazquez; Encarnación Palma-Zambrano; Rocio Bulo-Concellón; Vanessa Santos-Sánchez; Lechuga-Sancho, Alfonso M.

    2015-01-01

    Background and Aims There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline. Patients and Methods We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hy...

  18. Nebulised hypertonic saline solution for acute bronchiolitis in infants.

    Science.gov (United States)

    Zhang, Linjie; Mendoza-Sassi, Raúl A; Wainwright, Claire; Klassen, Terry P

    2013-07-31

    Airway oedema and mucus plugging are the predominant pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution may reduce these pathological changes and decrease airway obstruction. To assess the effects of nebulised hypertonic (≥ 3%) saline solution in infants with acute viral bronchiolitis. We searched CENTRAL 2013, Issue 4, OLDMEDLINE (1951 to 1965), MEDLINE (1966 to April week 4, 2013), EMBASE (1974 to May 2013), LILACS (1985 to May 2013) and Web of Science (1955 to May 2013). Randomised controlled trials (RCTs) and quasi-RCTs using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline as a comparator in infants up to 24 months of age with acute bronchiolitis. Two review authors independently performed study selection, data extraction and assessment of risk of bias in included studies. We conducted meta-analyses using the Cochrane statistical package RevMan 5.2. We used the random-effects model for meta-analyses. We used mean difference (MD) and risk ratio (RR) as effect size metrics. We included 11 trials involving 1090 infants with mild to moderate acute viral bronchiolitis (500 inpatients, five trials; 65 outpatients, one trial; and 525 emergency department patients, four trials). All but one of the included trials were of high quality with a low risk of bias. A total of 560 patients received hypertonic saline (3% saline n = 503; 5% saline n = 57). Patients treated with nebulised 3% saline had a significantly shorter mean length of hospital stay compared to those treated with nebulised 0.9% saline (MD -1.15 days, 95% confidence interval (CI) -1.49 to -0.82, P saline group also had a significantly lower post-inhalation clinical score than the 0.9% saline group in the first three days of treatment (day 1: MD -0.88, 95% CI -1.36 to -0.39, P = 0.0004; day 2: MD -1.32, 95% CI -2.00 to -0.64, P = 0.001; day 3: MD -1.51, 95% CI -1.88 to -1.14, P

  19. Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial

    Science.gov (United States)

    Comino-Vazquez, Paloma; Palma-Zambrano, Encarnación; Bulo-Concellón, Rocio; Santos-Sánchez, Vanessa

    2015-01-01

    Background and Aims There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline. Patients and Methods We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay. Results A total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively). Conclusions In our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before. Trial Registration EudraCT 2009-016042-57 PMID:26575036

  20. Nebulized hypertonic saline decreases IL-8 in sputum of patients with cystic fibrosis.

    LENUS (Irish Health Repository)

    Reeves, Emer P

    2011-06-01

    Inflammation within the cystic fibrosis (CF) lung is mediated by inflammatory chemokines, such as IL-8. IL-8 is protected from proteolytic degradation in the airways by binding to glycosaminoglycans, while remaining active. Evidence that increased hypertonicity of airway secretions induced by hypertonic saline treatment alters levels of IL-8 is lacking.

  1. Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial.

    Science.gov (United States)

    Flores-González, J Carlos; Matamala-Morillo, Miguel A; Rodríguez-Campoy, Patricia; Pérez-Guerrero, Juan J; Serrano-Moyano, Belén; Comino-Vazquez, Paloma; Palma-Zambrano, Encarnación; Bulo-Concellón, Rocio; Santos-Sánchez, Vanessa; Lechuga-Sancho, Alfonso M

    2015-01-01

    There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline. We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay. A total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011). Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively). In our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before. EudraCT 2009-016042-57.

  2. Epinephrine Improves the Efficacy of Nebulized Hypertonic Saline in Moderate Bronchiolitis: A Randomised Clinical Trial.

    Directory of Open Access Journals (Sweden)

    J Carlos Flores-González

    Full Text Available There is no evidence that the epinephrine-3% hypertonic saline combination is more effective than 3% hypertonic saline alone for treating infants hospitalized with acute bronchiolitis. We evaluated the efficacy of nebulized epinephrine in 3% hypertonic saline.We performed a randomized, double-blind, placebo-controlled clinical trial in 208 infants hospitalized with acute moderate bronchiolitis. Infants were randomly assigned to receive nebulized 3% hypertonic saline with either 3 mL of epinephrine or 3 mL of placebo, administered every four hours. The primary outcome measure was the length of hospital stay.A total of 185 infants were analyzed: 94 in the epinephrine plus 3% hypertonic saline group and 91 in the placebo plus 3% hypertonic saline group. Baseline demographic and clinical characteristics were similar in both groups. Length of hospital stay was significantly reduced in the epinephrine group as compared with the placebo group (3.94 ±1.88 days vs. 4.82 ±2.30 days, P = 0.011. Disease severity also decreased significantly earlier in the epinephrine group (P = 0.029 and P = 0.036 on days 3 and 5, respectively.In our setting, nebulized epinephrine in 3% hypertonic saline significantly shortens hospital stay in hospitalized infants with acute moderate bronchiolitis compared to 3% hypertonic saline alone, and improves the clinical scores of severity from the third day of treatment, but not before.EudraCT 2009-016042-57.

  3. Infusion of hypertonic saline (7.5% NaCl) causes minor immunological changes in normovolaemic women

    DEFF Research Database (Denmark)

    Petersen, Jens Aage Kølsen; Nielsen, J O D; Bendtzen, K

    2004-01-01

    Haemorrhagic shock is treated effectively by infusion of hypertonic saline/colloid solutions. Furthermore, previous studies found hypertonicity to affect immune responses in animals and in human blood cell cultures. It is unknown, however, whether hypertonic saline infusion affects immune responses...

  4. Nebulized hypertonic saline solution for acute bronchiolitis in infants.

    Science.gov (United States)

    Zhang, Linjie; Mendoza-Sassi, Raúl A; Wainwright, Claire; Klassen, Terry P

    2008-10-08

    Airway edema and mucus plugging are the predominant pathological features in infants with acute viral bronchiolitis. Nebulized hypertonic saline solution may reduce these pathological changes and decrease airway obstruction. To assess the effects of nebulized hypertonic saline solution in infants with acute viral bronchiolitis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, issue 4), which contains the Cochrane Acute Respiratory Infections Group Specialized Register; OLDMEDLINE (1951 to 1965); MEDLINE (1966 to November 2007); EMBASE (1974 to November 2007); and LILACS (November 2007). Randomised controlled trials (RCTs) and quasi-RCTs using nebulized hypertonic saline alone or in conjunction with bronchodilators as an active intervention in infants up to 24 months of age with acute bronchiolitis. Two review authors (ZL, MRA) independently performed data extraction and study quality assessment. We pooled the data from individual trials using the Cochrane statistical package Review Manager (RevMan). We included four trials involving 254 infants with acute viral bronchiolitis (189 inpatients and 65 outpatients) in this review. Patients treated with nebulized 3% saline had a significantly shorter mean length of hospital stay compared to those treated with nebulized 0.9% saline (mean difference (MD) -0.94 days, 95% CI -1.48 to -0.40, P = 0.0006). The 3% saline group also had a significantly lower post-inhalation clinical score than the 0.9% saline group in the first three days of treatment (day 1: MD -0.75, 95% CI -1.38 to -0.12, P = 0.02; day 2: MD -1.18, 95% CI -1.97 to -0.39, P = 0.003; day 3: MD -1.28, 95% CI -2.57 to 0.00, P = 0.05). The effect of nebulized hypertonic saline in improving clinical score was greater among outpatients than inpatients. No adverse events related to 3% saline inhalation were reported. Current evidence suggests nebulized 3% saline may significantly reduce the length of hospital stay

  5. Objective evaluation of a splint designed to reduce hypertonicity.

    Science.gov (United States)

    McPherson, J J

    1981-03-01

    Snook's spasticity reduction splint was evaluated objectively with five severely and profoundly handicapped subjects. The force of spastic wrist flexors in pounds of pull was measured on a spring-weighted scale. Findings demonstrated that the device designed for this study was useful in measuring hypertonus; splint wearing resulted in a reduction of the passive component of muscle tone and that this reduction was related to the length of time the subjects wore splints; the effects of splint wearing were not necessarily permanent. Components that contribute to the condition of hypertonicity are discussed, as well as the implications of the study findings for occupational therapists.

  6. Maternal plasma hypertonicity is accentuated in the postterm rat.

    Science.gov (United States)

    Ladella, Subhashini J; Desai, Mina; Cho, Yong; Ross, Michael G

    2003-11-01

    In humans and rats, pregnancy-associated maternal plasma volume expansion and plasma hypotonicity may facilitate maternal-to-fetal water transfer. Although reduced amniotic fluid volume occurs commonly in postterm pregnancy, the mechanisms are unknown. We previously demonstrated a reversal of pregnancy-induced maternal plasma hypotonicity that occurs in the near term (20 days) pregnant rats. We sought to determine whether the relative maternal plasma hypertonicity continues in the postterm period. Rat gestation (normal, 21 days) was prolonged with subcutaneous progesterone injection. Pregnant rats at gestation, 18 days, 21 days, and 24 days and nonpregnant rats were studied. Maternal and fetal hematocrit levels, plasma osmolality, electrolyte levels, and amniotic fluid volume were determined. In addition, maternal and fetal tissues were analyzed for water and electrolyte content. Compared with term (21days), postterm pregnant rats (24 days) had a significant increase in maternal and fetal plasma osmolality (293.7+/-1.4 mOsm/kg vs 302.8+/-3.7 mOsm/kg and 301.0+/-2.0 mOsm/kg vs 310.3+/-3.2 mOsm/kg, respectively; Ppostterm period. Postterm rats demonstrated an increased fetal mortality rate (24%) and a significantly reduced amniotic fluid volume (4.2+/-0.6 mL vs 6.6+/-0.6 mL, Ppostterm pregnancy. This continued hypertonicity may induce a fetal-to-maternal water flow and contribute to postterm oligohydramnios and increased fetal morbidity and mortality rates.

  7. Nebulized hypertonic saline for bronchiolitis: a randomized clinical trial.

    Science.gov (United States)

    Wu, Susan; Baker, Chris; Lang, Michael E; Schrager, Sheree M; Liley, Fasha F; Papa, Carmel; Mira, Valerie; Balkian, Ara; Mason, Wilbert H

    2014-07-01

    Bronchiolitis is one of the most common and costly respiratory diseases in infants and young children. Previous studies have shown a potential benefit of nebulized hypertonic saline; however, its effect in the emergency department (ED) setting is unclear. To compare the effect of nebulized 3% hypertonic saline vs 0.9% normal saline on admission rate and length of stay in infants with bronchiolitis. We conducted a double-blind, randomized clinical trial during 3 consecutive bronchiolitis seasons from March 1, 2008, through April 30, 2011. We recruited a convenience sample of patients younger than 24 months with a primary diagnosis of viral bronchiolitis presenting to the ED of 2 urban free-standing tertiary children's hospitals. We excluded patients who were premature (gestational age, saline [HS group]) or 0.9% sodium chloride (normal saline [NS group]) inhaled as many as 3 times in the ED. Those admitted received the assigned medication every 8 hours until discharge. All treatment solutions were premedicated with albuterol sulfate. Hospital admission rate, length of stay for admitted patients, and Respiratory Distress Assessment Instrument score. A total of 197 patients were enrolled in the NS group and 211 in the HS group. Admission rate in the 3% HS group was 28.9% compared with 42.6% in the NS group (adjusted odds ratio from logistic regression, 0.49 [95% CI, 0.28-0.86]). Mean (SD) length of stay for hospitalized patients was 3.92 (5.24) days for the NS group and 3.16 (2.11) days for the HS group (P = .24). The Respiratory Distress Assessment Instrument score decreased after treatment in both groups; however, we found no significant difference between groups (P = .35). Hypertonic saline given to children with bronchiolitis in the ED decreases hospital admissions. We can detect no significant difference in Respiratory Distress Assessment Instrument score or length of stay between the HS and NS groups. clinicaltrials.gov Identifier: NCT00619918.

  8. Effect of hypertonic medium on human cell growth: III. Changes in cell kinetics of EUE cells.

    Science.gov (United States)

    Pellicciari, C; Mazzini, G; Fuhrman Conti, A M; De Grada, L; Manfredi Romanini, M G

    1989-04-01

    The effects of hypertonicity on cell kinetics of EUE cells in culture have been investigated. After 4 days of growth in a hypertonic medium, the plating efficiency of EUE cells was reduced and cell growth was significantly slowed. Flow cytometric measurements of DNA content in synchronized cells, as well as flow cytometric determinations of DNA content and bromodeoxyuridine incorporation in asynchronous cells, also showed that the cell cycle is slowed in a hypertonic medium. In addition, the fraction of cycling cells is smaller and their progression through the S phase slower than in an isotonic medium.

  9. Upper Limb Hypertonicity in Children with Cerebral Palsy: A Review Study on Medical and Rehabilitative Management

    Directory of Open Access Journals (Sweden)

    Mehdi Rassafiani

    2013-10-01

    Full Text Available Hypertonicity is the most common type of cerebral palsy consists of 85% of the affected children. It has a very complex nature making intervention and management very difficult. This article tries to make reader familiar with various types of intervention and introduce a new intervention process to help clinicians decide better. Literature was reviewed with two criteria including: identifying various interventions and their effects on upper limb hypertonicity and level ofinvasiveness of each intervention. This paper suggested a new way of looking at hypertonicitybased on its two components (i.e., neural and biomechanical and effectiveness of each intervention on these components. In the treatment and management of hypertonicity, clinicians are required tolook at all aspects of hypertonicity and then based on the provided decision tree, decide which kind of treatment to be used for the child.

  10. SABRE: a multicentre randomised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis

    OpenAIRE

    Everard, M.L.; Hind, D.; Ugonna, K.; Freeman, J.; Bradburn, M.; Cooper, C L; Cross, E; Maguire, C.; Cantrill, H.; Alexander, J.; McNamara, P.S.

    2014-01-01

    Aim Acute bronchiolitis is the commonest cause for hospitalisation in infancy. Supportive care remains the cornerstone of current management and no other therapy has been shown to influence the course of the disease. It has been suggested that adding nebulised hypertonic saline to usual care may shorten the duration of hospitalisation. To determine whether hypertonic saline does have beneficial effects we undertook an open, multi-centre parallel-group, pragmatic RCT in ten UK hospitals.\\ud \\u...

  11. Infusion of hypertonic saline before elective hysterectomy: effects on cytokines and stress hormones

    DEFF Research Database (Denmark)

    Kølsen-Petersen, Jens Aage; Bendtzen, Klaus; Tønnesen, Else Kirstine

    2008-01-01

    with the other groups (Psaline before hysterectomy appears to have limited effect on the postoperative concentration of selected plasma cytokines and the hormonal stress......BACKGROUND: Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery. METHODS: Sixty-two women undergoing abdominal hysterectomy were randomized...

  12. The effect of 3% and 6% hypertonic saline in viral bronchiolitis: a randomised controlled trial.

    Science.gov (United States)

    Teunissen, Jasmijn; Hochs, Anne H J; Vaessen-Verberne, Anja; Boehmer, Annemie L M; Smeets, Carien C J M; Brackel, Hein; van Gent, René; Wesseling, Judith; Logtens-Stevens, Danielle; de Moor, Ronald; Rosias, Philippe P R; Potgieter, Steph; Faber, Marianne R; Hendriks, Han J E; Janssen-Heijnen, Maryska L G; Loza, Bettina F

    2014-10-01

    Bronchiolitis is a common disorder in young children that often results in hospitalisation. Except for a possible effect of nebulised hypertonic saline (sodium chloride), no evidence-based therapy is available. This study investigated the efficacy of nebulised 3% and 6% hypertonic saline compared with 0.9% hypertonic saline in children hospitalised with viral bronchiolitis. In this multicentre, double-blind, randomised, controlled trial, children hospitalised with acute viral bronchiolitis were randomised to receive either nebulised 3%, 6% hypertonic saline or 0.9% normal saline during their entire hospital stay. Salbutamol was added to counteract possible bronchial constriction. The primary endpoint was the length of hospital stay. Secondary outcomes were need for supplemental oxygen and tube feeding. From the 292 children included in the study (median age 3.4 months), 247 completed the study. The median length of hospital stay did not differ between the groups: 69 h (interquartile range 57), 70 h (IQR 69) and 53 h (IQR 52), for 3% (n=84) and 6% (n=83) hypertonic saline and 0.9% (n=80) normal saline, respectively, (p=0.29). The need for supplemental oxygen or tube feeding did not differ significantly. Adverse effects were similar in the three groups. Nebulisation with hypertonic saline (3% or 6% sodium chloride) although safe, did not reduce the length of stay in hospital, duration of supplemental oxygen or tube feeding in children hospitalised with moderate-to-severe viral bronchiolitis. ©ERS 2014.

  13. Comparison of the in vitro effects of saline, hypertonic hydroxyethyl starch, hypertonic saline, and two forms of hydroxyethyl starch on whole blood coagulation and platelet function in dogs.

    Science.gov (United States)

    Wurlod, Virginie A; Howard, Judith; Francey, Thierry; Schweighauser, Ariane; Adamik, Katja N

    2015-01-01

    To compare the in vitro effects of hypertonic solutions and colloids to saline on coagulation in dogs. In vitro experimental study. Veterinary teaching hospital. Twenty-one adult dogs. Blood samples were diluted with saline, 7.2% hypertonic saline solution with 6% hydroxyethylstarch with an average molecular weight of 200 kDa and a molar substitution of 0.4 (HH), 7.2% hypertonic saline (HTS), hydroxyethyl starch (HES) 130/0.4 or hydroxyethyl starch 600/0.75 at ratios of 1:22 and 1:9, and with saline and HES at a ratio of 1:3. Whole blood coagulation was analyzed using rotational thromboelastometry (extrinsic thromboelastometry-cloting time (ExTEM-CT), maximal clot firmness (MCF) and clot formation time (CFT) and fibrinogen function TEM-CT (FibTEM-CT) and MCF) and platelet function was analyzed using a platelet function analyzer (closure time, CTPFA ). All parameters measured were impaired by saline dilution. The CTPFA was prolonged by 7.2% hypertonic saline solution with 6% hydroxyethylstarch with an average molecular weight of 200 kDa and a molar substitution of 0.4 (HH) and HTS but not by HES solutions. At clinical dilutions equivalent to those generally administered for shock (saline 1:3, HES 1:9, and hypertonic solutions 1:22), CTPFA was more prolonged by HH and HTS than other solutions but more by saline than HES. No difference was found between the HES solutions or the hypertonic solutions. ExTEM-CFT and MCF were impaired by HH and HTS but only mildly by HES solutions. At clinically relevant dilutions, no difference was found in ExTEM-CFT between HTS and saline or in ExTEM-MCF between HH and saline. No consistent difference was found between the 2 HES solutions but HH impaired ExTEM-CFT and MCF more than HTS. At high dilutions, FibTEM-CT and -MCF and ExTEM-CT were impaired by HES. Hypertonic solutions affect platelet function and whole blood coagulation to a greater extent than saline and HES. At clinically relevant dilutions, only CTPFA was markedly more

  14. Abstracts of the International Conference on Hypertonic Resuscitation (5th) Held in Galveston, Texas on 3-5 June 1992

    Science.gov (United States)

    1992-08-01

    fluids to hypertonic "’small volume" fluids through the I/O route. Hypertonic saline (HTS) is effective in small volumes, but hypernatremia limits the...34small volume" hypertonic fluids is effective. Hypernatremia seen with HTS is not a significant problem with Isosal - a new "isonatremic" hypertonic...significant rise of plasma C1-, from 122 to 141 mEq/l, but no rise was observed in the three isochloremic groups. HAD and NLD induced hypernatremia (174 mEq/1

  15. A clinical trial of hypertonic saline nasal spray in subjects with the common cold or rhinosinusitis.

    Science.gov (United States)

    Adam, P; Stiffman, M; Blake, R L

    1998-01-01

    To determine whether hypertonic saline nasal spray relieves nasal symptoms and shortens illness duration in patients with the common cold or acute rhinosinusitis. Randomized trial with 2 control groups. Two family practice clinics. One hundred forty-three adult patients with a cold or sinus infection. Patients with allergic rhinitis, symptoms for more than 3 weeks, or other respiratory diagnoses were excluded, as were those who had used topical decongestants. Hypertonic saline or normal saline spray 3 times a day or observation. Subjects completed a 7-day symptom checklist that included a well-being question ("Do you feel back to normal?"). Nasal symptom score (sum of scores for nasal congestion, rhinorrhea, and headache) on day 3 and day of well-being (day of symptom resolution). Data were collected for 119 subjects. No difference was found in either primary outcome when hypertonic saline was compared with either normal saline or observation. Mean day of well-being was 8.3 (95% confidence interval [CI], 6.9-9.7), 9.2 (95% CI, 6.9-11.43), and 8.0 (95% CI, 6.7-9.3) days in the hypertonic saline, normal saline, and observation groups, respectively. Day 3 mean nasal symptom score was 3.8 (95% CI, 3.0-4.5) for hypertonic saline, 3.7 (95% CI, 2.9-4.5) for normal saline, and 4.1 (95% CI, 3.5-4.7) for observation. Only 44% of the patients would use the hypertonic saline spray again. Thirty-two percent noted burning, compared with 13% of the normal saline group (P = .05). Hypertonic saline does not improve nasal symptoms or illness duration in patients with the common cold or rhinosinusitis.

  16. Nebulized hypertonic saline without adjunctive bronchodilators for children with bronchiolitis.

    Science.gov (United States)

    Ralston, Shawn; Hill, Vanessa; Martinez, Marissa

    2010-09-01

    The goal was to determine an adverse event rate for nebulized hypertonic saline solution administered without adjunctive bronchodilators for infants with bronchiolitis. This was a retrospective cohort study of the use of nebulized 3% saline for childrenbronchiolitis at a single academic medical center. The medical records of study participants were analyzed for the use of nebulized 3% saline solution and any documented adverse events related to this therapy. Other clinical outcomes evaluated included respiratory distress scores, timing of the use of bronchodilators in relation to 3% saline solution, transfer to a higher level of care, and readmission within 72 hours after discharge. A total of 444 total doses of 3% saline solution were administered, with 377 doses (85%) being administered without adjunctive bronchodilators. Four adverse events occurred with these 377 doses, for a 1.0% adverse event rate (95% confidence interval: 0.3%-2.8%). Adverse events were generally mild. One episode of bronchospasm was documented, for a rate of 0.3% (95% confidence interval: saline solution without adjunctive bronchodilators for inpatients with bronchiolitis had a low rate of adverse events in our center. Additional clinical trials of 3% saline solution in bronchiolitis should evaluate its effectiveness in the absence of adjunctive bronchodilators.

  17. 7% Hypertonic saline in acute bronchiolitis: a randomized controlled trial.

    Science.gov (United States)

    Jacobs, Jonathan D; Foster, Megan; Wan, Jim; Pershad, Jay

    2014-01-01

    Research suggests that hypertonic saline (HS) may improve mucous flow in infants with acute bronchiolitis. Data suggest a trend favoring reduced length of hospital stay and improved pulmonary scores with increasing concentration of nebulized solution to 3% and 5% saline as compared with 0.9% saline mixed with epinephrine. To our knowledge, 7% HS has not been previously investigated. We conducted a prospective, double-blind, randomized controlled trial in 101 infants presenting with moderate to severe acute bronchiolitis. Subjects received either 7% saline or 0.9% saline, both with epinephrine. Our primary outcome was a change in bronchiolitis severity score (BSS), obtained before and after treatment, and at the time of disposition from the emergency department (ED). Secondary outcomes measured were hospitalization rate, proportion of admitted patients discharged at 23 hours, and ED and inpatient length of stay. At baseline, study groups were similar in demographic and clinical characteristics. The decrease in mean BSS was not statistically significant between groups (2.6 vs 2.4 for HS and control groups, respectively). The difference between the groups in proportion of admitted patients (42% in HS versus 49% in normal saline), ED or inpatient length of stay, and proportion of admitted patients discharged at 23 hours was not statistically significant. In moderate to severe acute bronchiolitis, inhalation of 7% HS with epinephrine does not appear to confer any clinically significant decrease in BSS when compared with 0.9% saline with epinephrine.

  18. Use of Mannitol Inhalation Challenge in Assessment of Cough

    Science.gov (United States)

    2009-01-01

    Bronchial provocation testing uses a variety of direct and indirect inhalational challenges to evaluate airway hyperreactivity. Mannitol, a simple, easy-to-administer hypertonic stimulus available in many countries, is currently under review by the FDA in the US. Healthy subjects show no airway response to inhaled mannitol; asthmatic patients respond with airway narrowing similar to challenges with hypertonic saline and exercise. Mannitol challenge also has a tussive effect that is independent of bronchoconstriction, suggesting different physiologic pathways. Patients with chronic cough show increased sensitivity to mannitol, and mannitol testing may be useful for evaluating heterogeneity in the cough response. PMID:19756864

  19. Hypertonic saline impedes tumor cell-endothelial cell interaction by reducing adhesion molecule and laminin expression.

    LENUS (Irish Health Repository)

    Shields, Conor J

    2012-02-03

    BACKGROUND: Hypertonic saline infusion dampens inflammatory responses and suppresses neutrophil-endothelial interaction by reducing adhesion molecule expression. This study tested the hypothesis that hypertonic saline attenuates tumor cell adhesion to the endothelium through a similar mechanism. METHODS: Human colon cancer cells (LS174T) were transfected with green fluorescent protein and exposed to lipopolysaccharide, tumor necrosis factor-alpha, and interleukin-6 under hypertonic and isotonic conditions for 1 and 4 hours. Confluent human umbilical vein endothelial cells were similarly exposed. Cellular apoptosis and expression of adhesion molecules and laminin were measured by flow cytometry. Tumor cell adhesion to endothelium and laminin was assessed with fluorescence microscopy. Data are represented as mean +\\/- standard error of mean, and an ANOVA test was performed to gauge statistical significance, with P <.05 considered significant. RESULTS: Hypertonic exposure significantly reduced tumor cell adhesion despite the presence of the perioperative cell stressors (42 +\\/- 2.9 vs 172.5 +\\/- 12.4, P <.05), attenuated tumor cell beta-1 integrin (14.43 vs 23.84, P <.05), and endothelial cell laminin expression (22.78 +\\/- 2.2 vs 33.74 +\\/- 2.4, P <.05), but did not significantly alter cell viability. CONCLUSION: Hypertonic saline significantly attenuates tumor cell adhesion to endothelium by inhibiting adhesion molecule and laminin expression. This may halt the metastatic behavior of tumor cells shed at surgery.

  20. Normal Saline Versus Hypertonic 3% Saline: It’s Efficacy in Non-Acute Rhinosinusitis

    Directory of Open Access Journals (Sweden)

    Nezamoddin Berjis

    2011-01-01

    Full Text Available Introduction: Sinusitis is one of the most common diseases in general and in otolaryngology practice, but the optimal therapeutic options have not yet been fully developed. This manuscript will try to compare normal saline nasal douching with hypertonic saline in reducing symptoms and improving its signs. Materials and Methods: One hundred and fourteen patients suffering from non acute rhinosinusitis, documented by history, physical examination and radiologic studies were divided into normal saline and hypertonic saline groups, each consisting of 57 patients. data were obtained by physical examination and a questionnaire.. Results:  Type of treatment had no significant effect on headache, morning dryness of mouth and pharynx and fatigue. Nontheless, nasal congestion, purulent discharge and postnasal discharge were reported to have improved in the group treated with hypertonic saline versus the normal saline group. Patient satisfaction also showed better scores in the hypertonic saline group. Conclusion: Hypertonic saline (3% is more effective for nasal irrigation  than normal saline in chronic rhinosinusitis.

  1. [Effectiveness of inhaled hypertonic saline in children with bronchiolitis].

    Science.gov (United States)

    Li, Guangpu; Zhao, Jing

    2014-08-01

    To assess the efficacy and safety of inhaled nebulized hypertonic saline (HS) solution in infants with acute bronchiolitis. Totally 129 patients with acute bronchiolitis (clinical severity score ≥ 4, aged 2-18 months) admitted to the Capital Institute of Pediatrics from November 2012 to January 2013 were enrolled. All the subjects were assigned to receive 1.5 ml compound ipratropium bromide solution for inhalation and 1 ml budesonide firstly, twice a day. Then, the subjects were randomized to receive 2 ml doses of nebulized 5% HS (Group A), 3% HS (Group B) or 0.9% NS (Group C), twice a day. The treatment lasted for 3 days. Clinical severity scores before treatment and 24, 48, 72 h after treatment were documented. Bronchospasm, nausea and emesis were recorded to assess safety. A total of 124 patients completed this research.Group A included 40 cases, Group B included 42 cases, Group C included 42 cases. Demographic characteristics, pre-treatment duration and clinical severity score before treatment were similar among the 3 group.Seventy-two hours after treatment, the clinical severity score of Group A, B, and C were 3.5 (1.0) , 4.0 (1.0) and 5.0 (0) . At 24, 48, and 72 h after treatment, the clinical severity score were significantly different among the three groups (χ(2) = 36.000, 51.200, 50.800, P saline could decrease clinical symptoms of patient with acute bronchiolitis; 5% HS was superior to 3% HS. But 2 ml dose of 5% HS may induce paroxysmal cough.

  2. Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review.

    Science.gov (United States)

    Zhang, Linjie; Mendoza-Sassi, Raúl A; Klassen, Terry P; Wainwright, Claire

    2015-10-01

    The mainstay of treatment for acute bronchiolitis remains supportive care. The objective of this study was to assess the efficacy and safety of nebulized hypertonic saline (HS) in infants with acute bronchiolitis. Data sources included PubMed and the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information up to May 2015. Studies selected were randomized or quasi-randomized controlled trials comparing nebulized HS with 0.9% saline or standard treatment. We included 24 trials involving 3209 patients, 1706 of whom received HS. Hospitalized patients treated with nebulized HS had a significantly shorter length of stay compared with those receiving 0.9% saline or standard care (15 trials involving 1956 patients; mean difference [MD] -0.45 days, 95% confidence interval [CI] -0.82 to -0.08). The HS group also had a significantly lower posttreatment clinical score in the first 3 days of admission (5 trials involving 404 inpatients; day 1: MD -0.99, 95% CI -1.48 to -0.50; day 2: MD -1.45, 95% CI -2.06 to -0.85; day 3: MD -1.44, 95% CI -1.78 to -1.11). Nebulized HS reduced the risk of hospitalization by 20% compared with 0.9% saline among outpatients (7 trials involving 951 patients; risk ratio 0.80, 95% CI 0.67-0.96). No significant adverse events related to HS inhalation were reported. The quality of evidence is moderate due to inconsistency in results between trials and study limitations (risk of bias). Nebulized HS is a safe and potentially effective treatment of infants with acute bronchiolitis. Copyright © 2015 by the American Academy of Pediatrics.

  3. Nebulized hypertonic saline via positive expiratory pressure versus via jet nebulizer in patients with severe cystic fibrosis.

    LENUS (Irish Health Repository)

    O'Connell, Oisin J

    2011-06-01

    Nebulized hypertonic saline is a highly effective therapy for patients with cystic fibrosis (CF), yet 10% of patients are intolerant of hypertonic saline administered via jet nebulizer. Positive expiratory pressure (PEP) nebulizers splint open the airways and offers a more controlled rate of nebulization.

  4. Challenge.

    Directory of Open Access Journals (Sweden)

    René-Éric Dagorn

    2004-04-01

    Full Text Available Sous le titre « The Hispanic Challenge », Samuel P. Huntington propose dans le numéro de Foreign Policy de mars-avril 2004 une nouvelle démonstration du danger de sa pseudo-théorie du « choc des civilisations ». Quel est donc ce «  challenge  » auquel, d'après Huntington, la société américaine serait aujourd'hui confrontée ? C'est celui de l'immigration « hispanique » qui « menace l'identité américaine, ses valeurs et son mode de vie » ...

  5. Prehospital guidelines for use of hypertonic saline are not followed systematically

    DEFF Research Database (Denmark)

    Hejselbaek, Julie; Steinmetz, Jacob; Rasmussen, Lars Simon

    2012-01-01

    Hypertonic saline (HS) was introduced in our physician-based mobile emergency care unit (MECU) in September 2006 for patients with severe traumatic brain injury and hypotension. HS has, however, rarely been used and we sought to identify barriers to its implementation.......Hypertonic saline (HS) was introduced in our physician-based mobile emergency care unit (MECU) in September 2006 for patients with severe traumatic brain injury and hypotension. HS has, however, rarely been used and we sought to identify barriers to its implementation....

  6. Hypertonic-hyperoncotic solutions improve cardiac function in children after open-heart surgery.

    Science.gov (United States)

    Schroth, Michael; Plank, Christian; Meissner, Udo; Eberle, Klaus-Peter; Weyand, Michael; Cesnjevar, Robert; Dötsch, Jörg; Rascher, Wolfgang

    2006-07-01

    Hypertonic-hyperoncotic solutions are used for the improvement of micro- and macrocirculation in various types of shock. In pediatric intensive care medicine, controlled, randomized studies with hypertonic-hyperoncotic solutions are lacking. Hypertonic-hyperoncotic solutions may improve cardiac function in children. The primary objective of this controlled, randomized, blinded study was to evaluate the hemodynamic effects and safety of hypertonic-hyperoncotic solution infusions in children shortly after open-heart surgery for congenital cardiac disease. The secondary objective was to determine whether the administration of hypertonic-hyperoncotic solutions could be a potential and effective therapeutic option for preventing a probable capillary leakage syndrome that frequently occurs in children after open-heart surgery. The children were randomly assigned to 2 groups of 25. The hypertonic-hyperoncotic solution group received Poly-(O-2)-hydroxyethyl-starch 60.0 g, with molecular weight of 200 kDa, Na+ 1232 mmol/L and osmolality of 2464 mOsmol/L (7.2% sodium chloride with 6% hydroxyethyl-starch 200 kDa). The isotonic saline solution group received isotonic saline solution (0.9% sodium chloride). Atrial and ventricular septal defects were corrected using a homograft patch. Monitoring consisted of an arterial, a central venous, and a thermodilution catheter (PULSIOCATH). Cardiac index, extravascular lung water index, stroke volume index, mean arterial blood pressure, and systemic vascular resistance index were measured (Pulse Contour Cardiac Output technique). Immediately after surgery, patients were loaded either with hypertonic-hyperoncotic solution or with isotonic saline solution (4 mL/kg). Blood samples (sodium concentration, osmolality, thrombocyte count, fibrinogen, and arterial blood gases) were drawn directly before; immediately after; 15 minutes after; and, 1, 4, 12, and 24 hours after the end of volume loading. Hemodynamic parameters were registered at the

  7. Hypertonic Saline Dextran Ameliorates Organ Damage in Beagle Hemorrhagic Shock.

    Directory of Open Access Journals (Sweden)

    Jing-xiang Zhao

    Full Text Available The goal of this study was to investigate the effect of hypertonic saline with 6% Dextran-70 (HSD resuscitation on organ damage and the resuscitation efficiency of the combination of HSD and lactated ringers (LR in a model of hemorrhage shock in dogs.Beagles were bled to hold their mean arterial pressure (MAP at 50 ± 5 mmHg for 1 h. After hemorrhage, beagles were divided into three groups (n = 7 to receive pre-hospital resuscitation for 1 h (R1: HSD (4 ml/kg, LR (40 ml/kg, and HSD+LR (a combination of 4 ml/kg HSD and 40 ml/kg LR. Next, LR was transfused into all groups as in-hospital resuscitation (R2. After two hours of observation (R3, autologous blood was transfused. Hemodynamic responses and systemic oxygenation were measured at predetermined phases. Three days after resuscitation, the animals were sacrificed and tissues including kidney, lung, liver and intestinal were obtained for pathological analysis.Although the initial resuscitation with HSD was shown to be faster than LR with regard to an ascending MAP, the HSD group showed a similar hemodynamic performance compared to the LR group throughout the experiment. Compared with the LR group, the systemic oxygenation performance in the HSD group was similar but showed a lower venous-to-arterial CO2 gradient (Pv-aCO2 at R3 (p < 0.05. Additionally, the histology score of the kidneys, lungs and liver were significantly lower in the HSD group than in the LR group (p < 0.05. The HSD+LR group showed a superior hemodynamic response but higher extravascular lung water (EVLW and lower arterial oxygen tension (PaO2 than the other groups (p < 0.05. The HSD+LR group showed a marginally improved systemic oxygenation performance and lower histology score than other groups.Resuscitation after hemorrhagic shock with a bolus of HSD showed a similar hemodynamic response compared with LR at ten times the volume of HSD, but HSD showed superior efficacy in organ protection. Our findings suggest that

  8. Oxytocin and prolactin release after hypertonic saline administration in melatonin-treated male Syrian hamsters

    Energy Technology Data Exchange (ETDEWEB)

    Juszczak, M.; Steger, R.W.; Fadden, C.; Bartke, A. [Southern Illinois Univ., Carbondale, IL (United States)

    1996-12-31

    The aim of the present investigations was to examine the effects of melatonin (Mel) on oxytocin (OT) release under conditions of osmotic stimulation, brought about by hypertonic saline administration, as well as to determine whether osmotically stimulated OT release in Mel-treated Syrian hamster is associated with alterations in the release of prolactin (PRL) and in norepinephrine (NE) and dopamine (DA) content in the hypothalamus. In both Mel- and vehicle-treated hamsters, injection of hypertonic saline was followed by a significant decrease in OT content in the pituitary neurointermediate lobe (NIL) and elevation of plasma OT and PRL levels. Melatonin injections had no significant affect on NIL OT content in either isotonic- or hypertonic-saline treated animals. Pretreatment with Mel did not alter plasma OT or PRL levels in isotonic saline-injected animals. However, Mel facilitated the release of OT, but prevented the release of PRL after hypertonic saline administration. Melatonin treatment reduced hypothalamic NE content (but not that of DA) in isotonic-saline treated animals. After osmotic stimulation, hypothalamic content of NE and DA was significantly lower in Mel-treated than in vehicle-treated animals. Data from the present study suggest that the osmotically-stimulated release of OT and PRL seems to be related to the activation of noradrenergic rather than dopaminergic transmission. Both dopaminergic and noradrenergic transmission may be, however, involved in mediating the effects of Mel on the osmotically-activated OT and PRL release. (author). 48 refs, 3 figs.

  9. Nebulized hypertonic saline decreases IL-8 in sputum of patients with cystic fibrosis.

    LENUS (Irish Health Repository)

    Reeves, Emer P

    2012-02-01

    RATIONALE: Inflammation within the cystic fibrosis (CF) lung is mediated by inflammatory chemokines, such as IL-8. IL-8 is protected from proteolytic degradation in the airways by binding to glycosaminoglycans, while remaining active. Evidence that increased hypertonicity of airway secretions induced by hypertonic saline treatment alters levels of IL-8 is lacking. OBJECTIVES: To investigate the antiinflammatory effect of hypertonic saline (HTS) treatment within the CF lung by focusing on IL-8. METHODS: Degradation of IL-8 in CF lung secretions after treatment with glycosaminoglycan lyases and HTS was analyzed by Western blot analysis and ELISA. The ex vivo chemotactic activity of purified neutrophils in response to CF airway secretions was evaluated post nebulization of HTS (7% saline). MEASUREMENTS AND MAIN RESULTS: In vivo CF bronchoalveolar lavage fluid (BALF) IL-8 levels were significantly higher than the control group (P < 0.05). Digesting glycosaminoglycans in CF BALF displaced IL-8 from glycosaminoglycan matrices, rendering the chemokine susceptible to proteolytic cleavage. High sodium concentrations also liberate IL-8 in CF BALF in vitro, and in vivo in CF sputum from patients receiving aerosolized HTS, resulting in degradation of IL-8 and decreased neutrophil chemotactic efficiency. CONCLUSIONS: Glycosaminoglycans possess the ability to influence the chemokine profile of the CF lung by binding and stabilizing IL-8, which promotes neutrophil chemotaxis and activation. Nebulized hypertonic saline treatment disrupts the interaction between glycosaminoglycans and IL-8, rendering IL-8 susceptible to proteolytic degradation with subsequent decrease in neutrophil chemotaxis, thereby facilitating resolution of inflammation.

  10. Experimental pain in human temporal muscle induced by hypertonic saline, potassium and acidity

    DEFF Research Database (Denmark)

    Jensen, K; Norup, M

    1992-01-01

    The study was aimed at developing a reference model for experimental pain and tenderness in the human temporal muscle by the local injection of hypertonic saline, potassium chloride and acidic phosphate buffer, using isotonic saline as control. The design was randomized and double-blind. Twenty...

  11. Inducible nucleosome depletion at OREBP-binding-sites by hypertonic stress.

    Directory of Open Access Journals (Sweden)

    Edith H Y Tong

    Full Text Available BACKGROUND: Osmotic Response Element-Binding Protein (OREBP, also known as TonEBP or NFAT5, is a unique transcription factor. It is hitherto the only known mammalian transcription factor that regulates hypertonic stress-induced gene transcription. In addition, unlike other monomeric members of the NFAT family, OREBP exists as a homodimer and it is the only transcription factor known to bind naked DNA targets by complete encirclement in vitro. Nevertheless, how OREBP interacts with target DNA, also known as ORE/TonE, and how it elicits gene transcription in vivo, remains unknown. METHODOLOGY: Using hypertonic induction of the aldose reductase (AR gene activation as a model, we showed that OREs contained dynamic nucleosomes. Hypertonic stress induced a rapid and reversible loss of nucleosome(s around the OREs. The loss of nucleosome(s was found to be initiated by an OREBP-independent mechanism, but was significantly potentiated in the presence of OREBP. Furthermore, hypertonic induction of AR gene was associated with an OREBP-dependent hyperacetylation of histones that spanned the 5' upstream sequences and at least some exons of the gene. Nevertheless, nucleosome loss was not regulated by the acetylation status of histone. SIGNIFICANCE: Our findings offer novel insights into the mechanism of OREBP-dependent transcriptional regulation and provide a basis for understanding how histone eviction and transcription factor recruitment are coupled.

  12. Prehospital guidelines for use of hypertonic saline are not followed systematically

    DEFF Research Database (Denmark)

    Hejselbaek, Julie; Steinmetz, Jacob; Rasmussen, Lars Simon

    2012-01-01

    Hypertonic saline (HS) was introduced in our physician-based mobile emergency care unit (MECU) in September 2006 for patients with severe traumatic brain injury and hypotension. HS has, however, rarely been used and we sought to identify barriers to its implementation....

  13. Electrical stimulation to reduce chronic toe-flexor hypertonicity. A case report.

    Science.gov (United States)

    Fulbright, J S

    1984-04-01

    Electrical stimulation reduces hypertonicity, but the mechanism for the effectiveness is not well understood. In this particular case, electrical stimulation to the toe extensors resulted in inhibition of the toe-flexor hypertonicity. This phenomenon may be explained by Sherrington's theory of reciprocal inhibition. Liberson found that electrical stimulation of an agonist is associated with a concomitant inhibition of the antagonist in the healthy individual. I applied Liberson's findings in my treatment of the patient. By facilitating the toe extensors, and thus inhibiting the toe flexors, toe posturing improved considerably and allowed the patient volitionally to control his toes, which, in turn, improved his foot and toe comfort. Stimulation also allowed the patient to assume a plantigrade and forefoot weight-bearing position to improve his gait. This patient benefitted dramatically from the use of electrical stimulation in inhibiting hypertonicity, and I believe this modality may be helpful in other cases dealing with increased muscle tone. The patient will continue to be observed on a regular basis for reassessment of the long-term effects of electrical stimulation on hypertonicity and on the skin at the electrode sites.

  14. Hyaluronic acid improves "pleasantness" and tolerability of nebulized hypertonic saline in a cohort of patients with cystic fibrosis.

    Science.gov (United States)

    Buonpensiero, Paolo; De Gregorio, Fabiola; Sepe, Angela; Di Pasqua, Antonio; Ferri, Pasqualina; Siano, Maria; Terlizzi, Vito; Raia, Valeria

    2010-11-01

    Inhaled hypertonic saline improves lung function and decreases pulmonary exacerbations in people with cystic fibrosis. However, side effects such as cough, narrowing of airways and saltiness cause intolerance of the therapy in 8% of patients. The aim of our study was to compare the effect of an inhaled solution of hyaluronic acid and hypertonic saline with hypertonic solution alone on safety and tolerability. A total of 20 patients with cystic fibrosis aged 6 years and over received a single treatment regimen of 7% hypertonic saline solution or hypertonic solution with 0.1% hyaluronate for 2 days nonconsecutively after a washout period in an open crossover study. Cough, throat irritation, and salty taste were evaluated by a modified ordinal score for assessing tolerability; "pleasantness" was evaluated by a five-level, Likert-type scale. Forced expiratory volume in 1 second was registered before and after the end of the saline inhalations. All 20 patients (nine males, 11 females, mean age 13 years, range 8.9-17.7) completed the study. The inhaled solution of 0.1% hyaluronic acid and hypertonic saline significantly improved tolerability and pleasantness compared to hypertonic saline alone. No major adverse effects were observed. No difference was documented in pulmonary function tests between the two treatments. Hyaluronic acid combined with hypertonic saline solution may contribute to improved adherence to hypertonic saline therapy. Further clinical trials are needed to confirm our findings. Considering the extraordinary versatility of hyaluronic acid in biological reactions, perspective studies could define its applicability to halting progression of lung disease in cystic fibrosis.

  15. Hypertonic saline reduces inflammation and enhances the resolution of oleic acid induced acute lung injury

    Directory of Open Access Journals (Sweden)

    Costello Joseph F

    2008-07-01

    Full Text Available Abstract Background Hypertonic saline (HTS reduces the severity of lung injury in ischemia-reperfusion, endotoxin-induced and ventilation-induced lung injury. However, the potential for HTS to modulate the resolution of lung injury is not known. We investigated the potential for hypertonic saline to modulate the evolution and resolution of oleic acid induced lung injury. Methods Adult male Sprague Dawley rats were used in all experiments. Series 1 examined the potential for HTS to reduce the severity of evolving oleic acid (OA induced acute lung injury. Following intravenous OA administration, animals were randomized to receive isotonic (Control, n = 12 or hypertonic saline (HTS, n = 12, and the extent of lung injury assessed after 6 hours. Series 2 examined the potential for HTS to enhance the resolution of oleic acid (OA induced acute lung injury. Following intravenous OA administration, animals were randomized to receive isotonic (Control, n = 6 or hypertonic saline (HTS, n = 6, and the extent of lung injury assessed after 6 hours. Results In Series I, HTS significantly reduced bronchoalveolar lavage (BAL neutrophil count compared to Control [61.5 ± 9.08 versus 102.6 ± 11.89 × 103 cells.ml-1]. However, there were no between group differences with regard to: A-a O2 gradient [11.9 ± 0.5 vs. 12.0 ± 0.5 KPa]; arterial PO2; static lung compliance, or histologic injury. In contrast, in Series 2, hypertonic saline significantly reduced histologic injury and reduced BAL neutrophil count [24.5 ± 5.9 versus 46.8 ± 4.4 × 103 cells.ml-1], and interleukin-6 levels [681.9 ± 190.4 versus 1365.7 ± 246.8 pg.ml-1]. Conclusion These findings demonstrate, for the first time, the potential for HTS to reduce pulmonary inflammation and enhance the resolution of oleic acid induced lung injury.

  16. Hypertonic 3% Saline in Comparison with 0.9% (Normal Saline in Treatment of Acute Bronchiolitis

    Directory of Open Access Journals (Sweden)

    Abdul-karem Jasem Mohammed Al-bahadily

    2017-01-01

    Full Text Available BackgroundBronchiolitis is the commonest cause of lower respiratory tract infection in infant. Respiratory syncytial virus is the commonest cause of bronchiolitis. This study aimed to assess the efficacy of nebulized 3% hypertonic saline and salbutamol in the treatment of acute bronchiolitis in comparison with nebulized 0.9% saline and salbutamol.Materials and MethodsA prospective case second multicenter study was done at two pediatric tertiary centers at the period from 1st of December 2014 to 31 of March 2015. A total of 100 previously well infant and children of age 1-24 months with clinical diagnoses of bronchiolitis who were admitted to the hospital were included. They were divided into two groups, the study group received 4 ml of nebulized hypertonic 3% saline (for 14 days, and second group received 4 ml of nebulized normal 0.9% saline (for 14 days, each co-administer with 0.5 ml salbutamol.ResultsAll patients with acute bronchiolitis having similar baseline characteristic, mean age 4.9 + Standard deviation (SD months, male gender constitutes 68% of the patients and the majority (67% of the cases were below 6 months. The mean of clinical severity score at admission was 6.4 for normal saline (NS group and 6.6 for hypertonic 3% saline (HS group. The mean length of hospital stay of normal saline group = 4.3 + Standard deviation (SD day and for hypertonic saline group was = 4.7 + Standard deviation (SD day.ConclusionWe didn’t find any advantage of hypertonic 3% saline over 0.9% normal saline in terms of length of hospital stay and clinical severity score.

  17. EFFICIENCY OF HYPERTONIC SOLUTION INHALATION IN CHILDREN WITH BRONCHITIS AND BRONCHIOLITIS

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    O. I. Simonova

    2014-01-01

    Full Text Available Background: Chronic bronchitis and bronchiolitis in children with congenital malformation are often characterized by the severe course of disease. The efficiency of treatment of those conditions can be increased through addition of sodium chloride (NaCl, hypertonic saline which takes a hydrostatic and osmotic effect on mucous membrane of the bronchial tree in broncholytic therapy. Aim: To evaluate the efficiency of 3% NaCl hypertonic solution inhalation in children with chronic bronchitis/bronchiolitis in the setting of bronchi congenital malformation (Kartagener's syndrome and primary ciliary dyskinesia. Patients and methods: The participantsof this study were 28 children in the age of 4–17.5 years with chronic bronchitis/bronchiolitis in the setting of Kartagener's syndrome and primary ciliary dyskinesia in the first days o facute exacerbation of the disease (15 patients in treatment group and 13 patients in control group. In the therapy scheme of treatment group the 3 NaCl hypertonic solution in administered dose of 2 ml was applied 2 times/day during 14 days besides other treatment methods. Results: In patients with chronic bronchiolitis 3% NaCl hypertonic saline inhalation in administered dose of 2 ml twice a day had improved the clinical presentation of disease; by the 14th day of studythe FEV-1 value improved from 70.0 ± 2.1 to 82 ± 3.2% (p = 0.024. The side effects in form of cough aggravation were registered in 13% cases. Among additional criteria of efficiency the improvement of MОС-75 from 52.1 ± 5.2 to 71.2 ± 1.4% (p = 0.011 was also marked in patients. The adverse experience, such as shivering, hypoexcitability and sleep disturbance, were registered in 7% of cases. Conclusion: Inhalation of 3% NaCl hypertonic saline allows the fast arresting of wheezing and eliminates the mycostasis in children with chronic bronchitis/bronchiolitis.

  18. Effect of hypertonic saline on hypotension following induction of general anesthesia: A randomized controlled trial

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    Parviz Kashefi

    2014-01-01

    Full Text Available Background: The aim of this study was to examine the effects of preoperatively administered i.v. hypertonic saline on hypotension following induction of general anesthesia. Materials and Methods: Fifty-four patients who scheduled for elective surgery were randomly allocated to two groups of 27 patients who received hypertonic saline 5% (2.3 ml/kg or received normal saline (13 ml/kg. Infusion of hypertonic saline was done half an hour before induction of anesthesia during 30 minutes. Anesthesia was conducted in a standard protocol for all patients. Age, sex, body mass index (BMI, systolic and diastolic blood pressure (SBP, DBP, heart rate (HR and mean arterial pressure (MAP were assessed in all patients. Results: The mean age of patients was 36.68 ± 10.8 years. Forty percent of patients were male. The mean SBP at min 2 and min 5, mean of DBP at min 2, 5, and 15, mean of HR at all time points and mean of MAP at min 2 and 15 between groups were no significantly different (P > 0.05, but mean of SBP at min 10 and 15, mean of DBP at min 10, and mean of MAP at min 5 and 10 in hypertonic saline group was significantly more than the normal group (P 0.05. Conclusions: Infusion of hypertonic saline 5% (2.3 mg/kg before the general anesthesia led to a useful reduction in MAP and reduced heart rate, with no episodes of severe hypotension.

  19. Effect of nebulized 3% hypertonic saline in the treatment of acute viral bronchiolitis in children.

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    Gisoo Hatami

    2015-05-01

    Full Text Available Background: Bronchiolitis is the most common viral respiratory infections in children under 2 years. No effective Short-term or long-term treatment for bronchiolitis has been approved yet. Treatment is still supportive with oxygen, fluid and mechanical ventilation as necessary. Several studies have shown that 3% hypertonic saline improve immediate and longterm cleaning of small airways in these patients. This study aimed to compare the effects of 3% hypertonic saline with 0.9% saline in 2-24 month children with bronchiolitis. Materials and Methods: In a non-randomized clinical trial, 60 children aged 2 to 24 months with diagnosis of acute viral bronchiolitis were enrolled. Thirty children recieved 3% hypertonic saline with nebulizer as the treatment group and 30 children treated with nebulized normal saline 0.9% as the control group. In entrance, oxygen saturation (by pulse oximetry, respiratory rate, pulse rate and severity of disease were measured using a combination score (sum of Clinical Score (YALE Observation Scale and RDAI (Respiratory Distress Assessment Index . The primary outcomes change in clinical score and hospitalization rate, and secondary outcomes were duration of hospitalization, need to oxygen therapy and recovery time from wheezing and cough. Results: Two groups were not different in terms of baseline variables, except age (8.9±4.9 months in the hypertonic saline group and 6.4 ± 4.6 months in normal saline group P=0.046. After the intervention, the difference in clinical severity between the hypertonic saline group (10.9±5.6 and normal saline (10.4±5.7 was not significant (adjusted for age P=0.77. The hospitalization rate was not significantly different in the two groups (60% vs 63.3%. Length of hospital stay, the need for oxygen therapy, number of days requiring intravenous fluid therapy and recovery time from cough and wheezing were not significantly different between two groups. Conclusion: It seems, 3% hypertonic

  20. Effect of hypertonic saline treatment on the inflammatory response after hydrochloric acid-induced lung injury in pigs.

    Science.gov (United States)

    Holms, Carla Augusto; Otsuki, Denise Aya; Kahvegian, Marcia; Massoco, Cristina Oliveira; Fantoni, Denise Tabacchi; Gutierrez, Paulo Sampaio; Auler Junior, Jose Otavio Costa

    2015-08-01

    Hypertonic saline has been proposed to modulate the inflammatory cascade in certain experimental conditions, including pulmonary inflammation caused by inhaled gastric contents. The present study aimed to assess the potential anti-inflammatory effects of administering a single intravenous dose of 7.5% hypertonic saline in an experimental model of acute lung injury induced by hydrochloric acid. Thirty-two pigs were anesthetized and randomly allocated into the following four groups: Sham, which received anesthesia and were observed; HS, which received intravenous 7.5% hypertonic saline solution (4 ml/kg); acute lung injury, which were subjected to acute lung injury with intratracheal hydrochloric acid; and acute lung injury + hypertonic saline, which were subjected to acute lung injury with hydrochloric acid and treated with hypertonic saline. Hemodynamic and ventilatory parameters were recorded over four hours. Subsequently, bronchoalveolar lavage samples were collected at the end of the observation period to measure cytokine levels using an oxidative burst analysis, and lung tissue was collected for a histological analysis. Hydrochloric acid instillation caused marked changes in respiratory mechanics as well as blood gas and lung parenchyma parameters. Despite the absence of a significant difference between the acute lung injury and acute lung injury + hypertonic saline groups, the acute lung injury animals presented higher neutrophil and tumor necrosis factor alpha (TNF-α), interleukin (IL)-6 and IL-8 levels in the bronchoalveolar lavage analysis. The histopathological analysis revealed pulmonary edema, congestion and alveolar collapse in both groups; however, the differences between groups were not significant. Despite the lower cytokine and neutrophil levels observed in the acute lung injury + hypertonic saline group, significant differences were not observed among the treated and non-treated groups. Hypertonic saline infusion after intratracheal hydrochloric

  1. Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

    OpenAIRE

    Baron, Jeffrey; El-Chaar, Gladys

    2016-01-01

    Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic sal...

  2. Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

    Science.gov (United States)

    Baron, Jeffrey

    2016-01-01

    Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic saline. We reviewed all published clinical trials mentioned in the 2014 AAP guidelines, as well as additional trials published since the guidelines, and critically evaluated each trial to determine efficacy, safety, and expectations of hypertonic saline inhalation therapy. A total of 2682 infants were studied over the course of 22 clinical trials. Nine trials were carried out in the outpatient/clinic/emergency department and 13 in the inpatient setting. We agree with the AAP guidelines regarding the recommendation to use nebulized hypertonic saline for infants hospitalized with bronchiolitis, with the expectation of reducing bronchiolitis scores and length of stay when it is expected to last more than 72 hours. However, we also believe there might be an advantage for hypertonic saline in reducing admission rates from the emergency department, based on close examination of the results of recent trials. This review also highlights important gaps in the available literature that need to be addressed in order to define the role of inhaled hypertonic saline therapy. PMID:26997926

  3. Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature.

    Science.gov (United States)

    Baron, Jeffrey; El-Chaar, Gladys

    2016-01-01

    Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic saline. We reviewed all published clinical trials mentioned in the 2014 AAP guidelines, as well as additional trials published since the guidelines, and critically evaluated each trial to determine efficacy, safety, and expectations of hypertonic saline inhalation therapy. A total of 2682 infants were studied over the course of 22 clinical trials. Nine trials were carried out in the outpatient/clinic/emergency department and 13 in the inpatient setting. We agree with the AAP guidelines regarding the recommendation to use nebulized hypertonic saline for infants hospitalized with bronchiolitis, with the expectation of reducing bronchiolitis scores and length of stay when it is expected to last more than 72 hours. However, we also believe there might be an advantage for hypertonic saline in reducing admission rates from the emergency department, based on close examination of the results of recent trials. This review also highlights important gaps in the available literature that need to be addressed in order to define the role of inhaled hypertonic saline therapy.

  4. Approximate Mathematical Modeling of Osmotic Dehydration of Cone-Shaped Fruits and Vegetables in Hypertonic Solutions

    Directory of Open Access Journals (Sweden)

    Mohammad Sirousazar

    2017-07-01

    Full Text Available Water loss kinetics in osmotic dehydration of cone-shaped fruits and vegetables was modeled on the basis of diffusion mechanism, using the Fick’s second law. The model was developed by taking into account the influences of the fruit geometrical characteristics, initial water content of fruit, water diffusion coefficient in fruit, and the water concentration in hypertonic solution. Based on the obtained model, it was shown that the water diffusion coefficient and the initial water concentration of fruit have direct effects on the dehydration rate and also inverse influence on the dehydration duration. The geometrical parameters of fruit and water concentration in hypertonic solution showed direct effect on the dehydration duration as well as inverse effect on the dehydration rate. The presented model seems to be useful tool to predict the dehydration kinetics of cone-shaped fruit during osmotic dehydration process and to optimize the process prior to perform the experiments.

  5. Rubbing salt into wounds: hypertonic saline to assist with volume removal in heart failure.

    Science.gov (United States)

    Liszkowski, Mark; Nohria, Anju

    2010-09-01

    Traditionally accepted management strategies for patients with heart failure include sodium and fluid restriction, neurohormonal blockade, and the use of loop diuretics to achieve and maintain euvolemia. Despite continued advances in medical and device therapy, fluid management remains a significant problem in patients with the cardiorenal syndrome (manifested as diuretic resistance and worsening renal function with more aggressive attempts at volume removal). This article examines the counterintuitive use of hypertonic saline as a potential therapy to facilitate diuresis in patients with decompensated heart failure and diuretic resistance. Low-volume hypertonic saline administration offsets counterproductive neurohormonal upregulation, transiently improves hemodynamics, and promotes renal sodium excretion with accompanied net water loss and preservation of renal function. This "new" therapeutic tool should be explored further as an adjunct to current medical therapies in the management of patients with refractory volume overload.

  6. Nebulized hypertonic saline/salbutamol solution treatment in hospitalized children with mild to moderate bronchiolitis.

    Science.gov (United States)

    Luo, Zhengxiu; Liu, Enmei; Luo, Jian; Li, Subi; Zeng, Fengqiong; Yang, Xiqiang; Fu, Zhou

    2010-04-01

    The objective of this study was to determine the efficacy and safety of nebulized 3% hypertonic saline solution and salbutamol in the treatment of mild to moderate bronchiolitis. In a randomized controlled trial, 93 infants with mild to moderate bronchiolitis were divided into two groups. The infants received inhalation of 2.5 mg (0.5 mL) salbutamol dissolved in either 4.0 mL normal (0.9%) saline (control group, n= 43) or 4.0 mL hypertonic (3%) saline (treatment group, n= 50). The therapy was repeated three times daily until discharge. Cough, wheezing, pulmonary physical signs, and the length of hospital stay were recorded. Wheezing remission time was 3.8 + or - 1.1 days in the control group and 2.7 + or - 0.9 days in the treatment group (P saline solution and salbutamol is a safe and effective therapy for patients with mild to moderate bronchiolitis.

  7. Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients

    DEFF Research Database (Denmark)

    Claudius, Casper; Perner, Anders; Møller, Morten Hylander

    2015-01-01

    BACKGROUND: Nebulised dornase alfa is used off-label in critically ill patients. We aimed to assess the benefits and harms of nebulised dornase alfa versus placebo, no prophylaxis, or hypertonic saline on patient-important outcome measures in adult critically ill patients. METHODS: We performed...... a systematic review with meta-analysis and trial sequential analysis (TSA) using the Cochrane Collaboration methodology. Eligible trials were randomised clinical trials comparing nebulised dornase alfa with placebo, no prophylaxis, or hypertonic saline. The predefined outcome measures were all-cause mortality...... of the primary estimate was assessed by TSA. RESULTS: Two trials (n = 63) were included; both were judged to have high risk of bias. There was no statistically significant difference in mortality (random effects model RR (95 % CI) 0.73 (0.09-5.77); P = 0.24; I (2) = 30 %). TSA could not be conducted because less...

  8. [Tactics of antihypertensive therapy in patients with hypertonic crisis complicated with hemorrhagic stroke].

    Science.gov (United States)

    Storozhakov, G I; Gendlin, G E; Anisimova, A V; Melekhov, A V; Ostrovskaya, Yu I

    2015-01-01

    To determine an optimal tactics of antihypertensive therapy in patients with hypertonic crisis complicated with hemorrhagic stroke. We examined 86 inpatients, 42 men and 44 women, aged 46-87 years, with hypertonic crisis complicated with hemorrhagic stroke. The severity of neurological deficit, parameters of cardiac output and Kaplan-Meier survival curve based on the level of arterial pressure (AP) were assessed. The best survival rate of the patients with systolic blood pressure >162 mm Hg to the 20th min from the beginning of treatment with the greater rate of its increase was established. The efficacy of antihypertensive therapy did not depend on the baseline neurological deficit. The remote survival rate did not depend on such factors as sex, age, baseline AP level, AP, frequency of heart contractions, hematoma's volume.

  9. Hypertonic saline (HS) for acute bronchiolitis: Systematic review and meta-analysis.

    OpenAIRE

    Maguire, C; Cantrill, H.; Hind, D.; Bradburn, M.; Everard, M L

    2015-01-01

    Background Acute bronchiolitis is the commonest cause of hospitalisation in infancy. Currently management consists of supportive care and oxygen. A Cochrane review concluded that, ?nebulised 3?% saline may significantly reduce the length of hospital stay?. We conducted a systematic review of controlled trials of nebulised hypertonic saline (HS) for infants hospitalised with primary acute bronchiolitis. Methods Searches to January 2015 involved: Cochrane Central Register of Controlled Trials; ...

  10. Hypertonic 3% Saline in Comparison with 0.9% (Normal) Saline in Treatment of Acute Bronchiolitis

    OpenAIRE

    Abdul-karem Jasem Mohammed Al-bahadily; Areege Abdul-abass Mohammed Al-Omrani; Asaad A Atiya

    2017-01-01

    BackgroundBronchiolitis is the commonest cause of lower respiratory tract infection in infant. Respiratory syncytial virus is the commonest cause of bronchiolitis. This study aimed to assess the efficacy of nebulized 3% hypertonic saline and salbutamol in the treatment of acute bronchiolitis in comparison with nebulized 0.9% saline and salbutamol.Materials and MethodsA prospective case second multicenter study was done at two pediatric tertiary centers at the period from 1st of December 2014 ...

  11. The association of hypernatremia and hypertonic saline irrigation in hepatic hydatid cysts

    OpenAIRE

    Zeng, Rujun; Wu, Renhua; Lv, Qingguo; Tong, Nanwei; Zhang, Yuwei

    2017-01-01

    Abstract Rationale: Hypernatremia is a rare but fatal complication of hypertonic saline (HS) irrigation in hepatic hydatid disease. It needs careful monitoring and treatment. Patient concerns: A 28-year-old woman with hepatic hydatid cysts who received operation treatment developed electrolyte disturbances. We also conducted a retrospective study about influence of HS application on electrolytes in patients with hepatic hydatid disease receiving surgery. Diagnoses: Hypernatremia, developed af...

  12. Liposomal internal viscosity affects the fate of membrane deformation induced by hypertonic treatment.

    Science.gov (United States)

    Fujiwara, Kei; Yanagisawa, Miho

    2017-12-13

    Artificial lipid membranes have been utilized to understand the physical mechanisms of the deformation patterns of live cells. However, typical artificial membrane systems contain only dilute components compared to those in the cytoplasm of live cells. By using giant unilamellar liposomes containing dense protein solutions similar to those in live cells, we here reveal that viscosity derived from internal crowding affects the deformation patterns of lipid membranes. After hypertonic treatment, liposome deformation patterns transitioned from budding to tubing when the initial internal macromolecular concentrations were increased. Remarkably, instead of observing different transition concentrations between two species of macromolecules, the viscosity at the transition concentration was found to be similar. Further analyses clearly demonstrated that the internal viscosity affects the deformation patterns of lipid membranes induced by hypertonic treatment. These results indicate that the viscosity of the cytoplasm is a key factor in determining cell deformation, and suggest the association of a process involving dynamic instability, such as a viscous fingering phenomenon, during the determination of deformation patterns by hypertonic treatment.

  13. COMPARATIVE EFFICACY OF HYPERTONIC SALINE AND NORMAL SALINE SOLUTIONS IN EXPERIMENTALLY INDUCED ENDOTOXIC SHOCK IN DOGS

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    M. A. ZAFAR, G. MUHAMMAD, M. H. HUSSAIN, T. AHMAD, A. YOUSAF AND I. SARFARAZ

    2009-07-01

    Full Text Available This study was contemplated to determine the comparative beneficial effects of hypertonic saline solution and sterile saline solution in induced endotoxic shock in dogs. For this purpose, 12 healthy Mongrel dogs were randomly divided into two equal groups (A and B. All the animals were induced endotoxaemia by slow intravenous administration of Escherichia coli endotoxins 0111:B4. Group A was treated with normal saline solution @ 90 ml/kg BW, while group B was given hypertonic saline solution @ 4 ml/kg BW, followed by normal saline solution @ 10 ml/kg BW. Different parameters were observed for evaluation of these fluids including clinical and haematological parameters, serum electrolytes, mean arterial pressure, and blood gases at different time intervals up to 24 hours post treatments. After infusion of respective fluids, all parameters returned to baseline values in both the groups but group B showed better results than group A except bicarbonates, which better recovered in group A. Thus, it was concluded that a small-volume of hypertonic saline solution could be effectively used in reversing the endotoxaemia. Moreover, it provides a rapid and inexpensive resuscitation from endotoxic shock.

  14. Early Implementation of THAM for ICP Control: Therapeutic Hypothermia Avoidance and Reduction in Hypertonics/Hyperosmotics

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    F. A. Zeiler

    2014-01-01

    Full Text Available Background. Tromethamine (THAM has been demonstrated to reduce intracranial pressure (ICP. Early consideration for THAM may reduce the need for other measures for ICP control. Objective. To describe 4 cases of early THAM therapy for ICP control and highlight the potential to avoid TH and paralytics and achieve reduction in sedation and hypertonic/hyperosmotic agent requirements. Methods. We reviewed the charts of 4 patients treated with early THAM for ICP control. Results. We identified 2 patients with aneurysmal subarachnoid hemorrhage (SAH and 2 with traumatic brain injury (TBI receiving early THAM for ICP control. The mean time to initiation of THAM therapy was 1.8 days, with a mean duration of 5.3 days. In all patients, after 6 to 12 hours of THAM administration, ICP stability was achieved, with reduction in requirements for hypertonic saline and hyperosmotic agents. There was a relative reduction in mean hourly hypertonic saline requirements of 89.1%, 96.1%, 82.4%, and 97.0% for cases 1, 2, 3, and 4, respectively, comparing pre- to post-THAM administration. Mannitol, therapeutic hypothermia, and paralytics were avoided in all patients. Conclusions. Early administration of THAM for ICP control could potentially lead to the avoidance of other ICP directed therapies. Prospective studies of early THAM administration are warranted.

  15. Prehospital Resuscitation of Traumatic Hemorrhagic Shock with Hypertonic Solutions Worsens Hypocoagulation and Hyperfibrinolysis

    Science.gov (United States)

    Delano, Matthew J.; Rizoli, Sandro B.; Rhind, Shawn G.; Cuschieri, Joseph; Junger, Wolfgang; Baker, Andrew J.; Dubick, Michael A.; Hoyt, David B.; Bulger, Eileen M.

    2015-01-01

    Impaired hemostasis frequently occurs after traumatic shock and resuscitation. The prehospital fluid administered can exacerbate subsequent bleeding and coagulopathy. Hypertonic solutions are recommended as first-line treatment of traumatic shock; however, their effects on coagulation are unclear. This study explores the impact of resuscitation with various hypertonic solutions on early coagulopathy after trauma. We conducted a prospective observational subgroup analysis of large clinical trial on out-of-hospital single-bolus (250 mL) hypertonic fluid resuscitation of hemorrhagic shock trauma patients (systolic blood pressure, ≤70 mmHg). Patients received 7.5% NaCl (HS), 7.5% NaCl/6% Dextran 70 (HSD), or 0.9% NaCl (normal saline [NS]) in the prehospital setting. Thirty-four patients were included: 9 HS, 8 HSD, 17 NS. Treatment with HS/HSD led to higher admission systolic blood pressure, sodium, chloride, and osmolarity, whereas lactate, base deficit, fluid requirement, and hemoglobin levels were similar in all groups. The HSD-resuscitated patients had higher admission international normalized ratio values and more hypocoagulable patients, 62% (vs. 55% HS, 47% NS; P trauma through imbalances in both procoagulants and anticoagulants and both profibrinolytic and antifibrinolytic activities. PMID:25784523

  16. Efficacy of nebulised L-adrenaline with 3% hypertonic saline versus normal saline in bronchiolitis

    Directory of Open Access Journals (Sweden)

    Shabnam Sharmin

    2016-08-01

    Full Text Available Background: Bronchiolitis is one of the most common respiratory diseases requiring hospitalization. Nebulized epineph­rine and salbutamol therapy has been used in different centres with varying results. Objective: The objective of the study was to compare the efficacy of nebulised adrenaline diluted with 3% hypertonic saline with nebulised adrenaline diluted with normal saline in bronchiolitis. Methods: Fifty three infants and young children with bronchiolitis, age ranging from 2 months to 2 years, presenting in the emergency department of Manikganj Sadar Hospital were enrolled in the study. After initial evaluation, patients were randomized to receive either nebulized adrenaline I .5 ml ( 1.5 mg diluted with 2 ml of3% hypertonic saline (group I ornebulised adrenaline 1.5 ml (1.5 mg diluted with 2 ml of normal saline (group II. Patients were evaluated again 30 minutes after nebulization. Results: Twenty eight patients in the group I (hypertonic saline and twenty five in groupII (normal saline were included in the study. After nebulization, mean respiratory rate decreased from 63.7 to 48.1 (p<.01, mean clinical severity score decreased from 8.5 to 3.5 (p<.01 and mean oxygen satw·ation increased 94.7% to 96.9% (p<.01 in group I. In group II, mean respiratory rate decreased from 62.4 to 47.4 (p<.01, mean clinical severity score decreased from 7.2 to 4.1 (p<.01 and mean oxygen saturation increased from 94. 7% to 96. 7% (p<.01. Mean respiratory rate decreased by 16 in group I versus 14.8 (p>.05 in group 11, mean clinical severity score decreased by 4.6 in group versus 3 (p<.05 in group, and mean oxygen saturation increased by 2.2% and 1.9% in group and group respectively. Difference in reduction in clinical severity score was statistically significant , though the changes in respiratory rate and oxygen saturation were not statistically significant. Conclusion: The study concluded that both nebulised adrenaline diluted with 3% hypertonic saline and

  17. A randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department.

    Science.gov (United States)

    Grewal, Simran; Ali, Samina; McConnell, Don W; Vandermeer, Ben; Klassen, Terry P

    2009-11-01

    To determine whether nebulized 3% hypertonic saline with epinephrine is more effective than nebulized 0.9% saline with epinephrine in the treatment of bronchiolitis in the emergency department. Randomized, double-blind, controlled trial. Single-center urban pediatric emergency department. Infants younger than 12 months with mild to moderate bronchiolitis. Patients were randomized to receive nebulized racemic epinephrine in either hypertonic or normal saline. The primary outcome measure was the change in respiratory distress, as measured by the Respiratory Assessment Change Score (RACS) from baseline to 120 minutes. The change in oxygen saturation was also determined. Secondary outcome measures included the rates of hospital admission and return to the emergency department. Forty-six patients were enrolled and evaluated. The 2 study groups had similar baseline characteristics. The RACS from baseline to 120 minutes demonstrated no improvement in respiratory distress in the hypertonic saline group compared with the normal saline control group. The change in oxygen saturation in the hypertonic saline group was not significant when compared with the control group. Rates of admission and return to the emergency department were not different between the 2 groups. In the treatment of acute bronchiolitis, hypertonic saline and epinephrine did not improve clinical outcome any more than normal saline and epinephrine in the emergency setting. This differs from previously published results of outpatient and inpatient populations and merits further evaluation. isrctn.org Identifier: ISRCTN66632312.

  18. Early Halt of a Randomized Controlled Study with 3% Hypertonic Saline in Acute Bronchiolitis.

    Science.gov (United States)

    Carsin, Ania; Sauvaget, Emilie; Bresson, Violaine; Retornaz, Karine; Cabrera, Maria; Jouve, Elisabeth; Truillet, Romain; Bosdure, Emmanuelle; Dubus, Jean-Christophe

    2017-01-01

    Albeit not recommended because of contradictory results, nebulized 3% hypertonic saline is widely used for treating acute viral bronchiolitis. Whether clinical differences may be attributed to the type of nebulizer used has never been studied. By modifying the amount of salt deposited into the airways, the nebulizer characteristics might influence clinical response. A prospective, randomized, controlled trial included infants hospitalized in a French university hospital for a first episode of bronchiolitis. Each child received 6 nebulizations of 3% hypertonic saline during 48 h delivered with 1 of the 3 following nebulizers: 2 jet nebulizers delivering large or small particles, with a low aerosol output, and 1 mesh nebulizer delivering small particles, with a high aerosol output. The primary endpoint was the difference in the Wang score at 48 h. Only 61 children of 168 were recruited before stopping this study because of severe adverse events (n = 4) or parental requests for discontinuation due to discomfort to their child during nebulization (n = 2). One minor adverse event was noted in 91.8% (n = 56/61) of children. A high aerosol output induced 75% of the severe adverse events; it was significantly associated with the nebulization-induced cough between 24 and 48 h (p = 0.036). Decreases in Wang scores were not significantly different between the groups at 48 h, 9 recoveries out of 10 being obtained with small particles. No beneficial effects and possibly severe adverse events are observed with 3% hypertonic saline in the treatment of bronchiolitis. © 2017 S. Karger AG, Basel.

  19. Complications associated with prolonged hypertonic saline therapy in children with elevated intracranial pressure.

    Science.gov (United States)

    Gonda, David D; Meltzer, Hal S; Crawford, John R; Hilfiker, Mary L; Shellington, David K; Peterson, Bradley M; Levy, Michael L

    2013-07-01

    Safe upper limits for therapeutic hypernatremia in the treatment of intracranial hypertension have not been well established. We investigated complications associated with hypernatremia in children who were treated with prolonged infusions of hypertonic saline. Retrospective chart analysis. PICU in university-affiliated children's hospital. All children from 2004 to 2009 requiring intracranial pressure monitoring (external ventricular drain or fiberoptic intraparenchymal monitor) for at least 4 days who were treated with hypertonic saline infusion for elevated intracranial pressure and did not meet exclusion criteria. Continuous hypertonic saline infusion on a sliding scale was used to achieve target sodium levels that would keep intracranial pressure less than 20 mm Hg once the conventional therapies failed. Eighty-eight children met inclusion criteria. Etiologies of elevated intracranial pressure included trauma (n = 48), ischemic or hemorrhagic stroke (n = 20), infection (n = 8), acute disseminated encephalomyelitis (n = 5), neoplasm (n = 2), and others (n = 5). The mean peak serum sodium was 171.3 mEq/L (range, 150-202). The mean Glasgow Outcome Score was 2.8 (± 1.1) at time of discharge from the hospital. Overall mortality was 15.9%. Children with sustained (> 72 hr) serum sodium levels above 170 mEq/L had a significantly higher occurrence of thrombocytopenia (p syndrome (p = 0.029) after controlling for variables of age, gender, Pediatric Risk of Mortality score, duration of barbiturate-induced coma, duration of intracranial pressure monitoring, vasopressor requirements, and underlying pathology. Children with sustained serum sodium levels greater than 165 mEq/L had a significantly higher prevalence of anemia (p syndrome than those whose sodium level was maintained below these thresholds.

  20. SABRE: a multicentre randomised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis.

    Science.gov (United States)

    Everard, Mark L; Hind, Daniel; Ugonna, Kelechi; Freeman, Jennifer; Bradburn, Mike; Cooper, Cindy L; Cross, Elizabeth; Maguire, Chin; Cantrill, Hannah; Alexander, John; McNamara, Paul S

    2014-12-01

    Acute bronchiolitis is the commonest cause for hospitalisation in infancy. Supportive care remains the cornerstone of current management and no other therapy has been shown to influence the course of the disease. It has been suggested that adding nebulised hypertonic saline to usual care may shorten the duration of hospitalisation. To determine whether hypertonic saline does have beneficial effects we undertook an open, multi-centre parallel-group, pragmatic RCT in ten UK hospitals. Infants admitted to hospital with a clinical diagnosis of acute bronchiolitis and requiring oxygen therapy were randomised to receive usual care alone or nebulised 3% hypertonic saline (HS) administered 6-hourly. Randomisation was within 4 h of admission. The primary outcome was time to being assessed as 'fit' for discharge with secondary outcomes including time to discharge, incidence of adverse events together with follow up to 28 days assessing patient centred health related outcomes. A total of 317 infants were recruited to the study. 158 infants were randomised to HS (141 analysed) and 159 to standard care (149 analysed). There was no difference between the two arms in time to being declared fit for discharge (hazard ratio: 0-95, 95% CI: 0.75-1.20) nor to actual discharge (hazard ratio: 0.97, 95% CI: 0.76-1.23). There was no difference in adverse events. One infant in the HS group developed bradycardia with desaturation. This study does not support the use of nebulised HS in the treatment of acute bronchiolitis over usual care with minimal handlings. NCT01469845. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. In Vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch

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    Görlinger Klaus

    2011-02-01

    Full Text Available Abstract Background Hypertonic saline hydroxyethyl starch (HH has been recommended for first line treatment of hemorrhagic shock. Its effects on coagulation are unclear. We studied in vitro effects of HH dilution on whole blood coagulation and platelet function. Furthermore 7.2% hypertonic saline, 6% hydroxyethylstarch (as ingredients of HH, and 0.9% saline solution (as control were tested in comparable dilutions to estimate specific component effects of HH on coagulation. Methods The study was designed as experimental non-randomized comparative in vitro study. Following institutional review board approval and informed consent blood samples were taken from 10 healthy volunteers and diluted in vitro with either HH (HyperHaes®, Fresenius Kabi, Germany, hypertonic saline (HT, 7.2% NaCl, hydroxyethylstarch (HS, HAES6%, Fresenius Kabi, Germany or NaCl 0.9% (ISO in a proportion of 5%, 10%, 20% and 40%. Coagulation was studied in whole blood by rotation thrombelastometry (ROTEM after thromboplastin activation without (ExTEM and with inhibition of thrombocyte function by cytochalasin D (FibTEM, the latter was performed to determine fibrin polymerisation alone. Values are expressed as maximal clot firmness (MCF, [mm] and clotting time (CT, [s]. Platelet aggregation was determined by impedance aggregrometry (Multiplate after activation with thrombin receptor-activating peptide 6 (TRAP and quantified by the area under the aggregation curve (AUC [aggregation units (AU/min]. Scanning electron microscopy was performed to evaluate HyperHaes induced cell shape changes of thrombocytes. Statistics: 2-way ANOVA for repeated measurements, Bonferroni post hoc test, p Results Dilution impaired whole blood coagulation and thrombocyte aggregation in all dilutions in a dose dependent fashion. In contrast to dilution with ISO and HS, respectively, dilution with HH as well as HT almost abolished coagulation (MCFExTEM from 57.3 ± 4.9 mm (native to 1.7 ± 2.2 mm (HH 40

  2. In vitro impairment of whole blood coagulation and platelet function by hypertonic saline hydroxyethyl starch.

    Science.gov (United States)

    Hanke, Alexander A; Maschler, Stephanie; Schöchl, Herbert; Flöricke, Felix; Görlinger, Klaus; Zanger, Klaus; Kienbaum, Peter

    2011-02-10

    Hypertonic saline hydroxyethyl starch (HH) has been recommended for first line treatment of hemorrhagic shock. Its effects on coagulation are unclear. We studied in vitro effects of HH dilution on whole blood coagulation and platelet function. Furthermore 7.2% hypertonic saline, 6% hydroxyethylstarch (as ingredients of HH), and 0.9% saline solution (as control) were tested in comparable dilutions to estimate specific component effects of HH on coagulation. The study was designed as experimental non-randomized comparative in vitro study. Following institutional review board approval and informed consent blood samples were taken from 10 healthy volunteers and diluted in vitro with either HH (HyperHaes, Fresenius Kabi, Germany), hypertonic saline (HT, 7.2% NaCl), hydroxyethylstarch (HS, HAES6%, Fresenius Kabi, Germany) or NaCl 0.9% (ISO) in a proportion of 5%, 10%, 20% and 40%. Coagulation was studied in whole blood by rotation thrombelastometry (ROTEM) after thromboplastin activation without (ExTEM) and with inhibition of thrombocyte function by cytochalasin D (FibTEM), the latter was performed to determine fibrin polymerisation alone. Values are expressed as maximal clot firmness (MCF, [mm]) and clotting time (CT, [s]). Platelet aggregation was determined by impedance aggregrometry (Multiplate) after activation with thrombin receptor-activating peptide 6 (TRAP) and quantified by the area under the aggregation curve (AUC [aggregation units (AU)/min]). Scanning electron microscopy was performed to evaluate HyperHaes induced cell shape changes of thrombocytes. 2-way ANOVA for repeated measurements, Bonferroni post hoc test, p coagulation and thrombocyte aggregation in all dilutions in a dose dependent fashion. In contrast to dilution with ISO and HS, respectively, dilution with HH as well as HT almost abolished coagulation (MCFExTEM from 57.3 ± 4.9 mm (native) to 1.7 ± 2.2 mm (HH 40% dilution; p coagulation is significant after 10% dilution or more. This effect can

  3. Nebulized hypertonic-saline vs epinephrine for bronchiolitis; proof of concept study of cumulative sum (CUSUM) analysis.

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    Gupta, Neeraj; Puliyel, Ashish; Manchanda, Ayush; Puliyel, Jacob

    2012-07-01

    To apply cumulative sum (CUSUM) to monitor a drug trial of nebulized hypertonic-saline in bronchiolitis. To test if monitoring with CUSUM control lines is practical and useful as a prompt to stop the drug trial early, if the study drug performs significantly worse than the comparator drug. Prospective, open label, controlled trial using standard therapy (epinephrine) and study drug (hypertonic-saline) sequentially in two groups of patients. Hospital offering tertiary-level pediatric care. Children, 2 months to 2 years, with first episode of bronchiolitis, excluding those with cardiac disease, immunodeficiency and critical illness at presentation. Nebulized epinephrine in first half of the bronchiolitis season (n = 35) and hypertonic saline subsequently (n = 29). Continuous monitoring of response to hypertonic-saline using CUSUM control charts developed with epinephrine-response data. Clinical score, tachycardia and total duration of hospital stay. In the epinephrine group, the maximum CUSUM was +2.25 (SD 1.34) and minimum CUSUM was -2.26 (SD 1.34). CUSUM score with hypertonic saline group stayed above the zero line throughout the study. There was no statistical difference in the post-treatment clinical score at 24 hours between the treatment groups {Mean (SD) 3.516 (2.816): 3.552 (2.686); 95% CI: -1.416 to 1.356}, heart rate {Mean (SD) 136 (44): 137(12); 95% CI: -17.849 to 15.849) or duration of hospital stay (Mean (SD) 96.029 (111.41): 82.914 (65.940); 95% CI: -33.888 to 60.128}. The software we developed allows for drawing of control lines to monitor study drug performance. Hypertonic saline performed as well or better than nebulized epinephrine in bronchiolitis.

  4. Evaluation of the Maintained Effect of 3% Hypertonic Saline Solution in an Animal Model of Intracranial Hypertension.

    Science.gov (United States)

    Sousa, Leonardo M; de Andrade, Almir F; Belon, Alessandro R; Soares, Matheus S; Amorim, Robson Luis; Otochi, Jose Pinhata; Teixeira, Manoel J; Paiva, Wellingson S

    2016-10-25

    BACKGROUND Current clinical treatment methods for refractory intracranial hypertension include elevation of the decubitus, ventilation adjustment, and use of hypertonic solutions such as hypertonic saline and mannitol solutions. Previous studies have shown that hypertonic solutions are particularly effective. Although several concentrations of saline solution have been proposed, a 3% solution is the most widely used. The aim of this study was to evaluate the maintained efficacy of a 3% hypertonic saline solution in an experimental model of intracranial hypertension. MATERIAL AND METHODS A porcine model of reversible intracranial hypertension was created by inserting a balloon catheter into the brain parenchyma, which was inflated and deflated to simulate intracranial hypertension and its surgical correction. The experiment included 3 groups of animals (A, B, and C) with different balloon inflation volumes. In group B, balloons were inflated 2 times to simulate reexpansion. A 20 mL/kg bolus of 3% saline solution was infused using a pump 90 minutes after the start of balloon inflation, and the effects of intracranial pressure were evaluated 60 minutes after infusion. RESULTS No increases outside of the normal range were observed in mean serum sodium concentrations (p=0.09). In addition, we identified no differences within each group in serum sodium levels measured during hypertonic saline infusion (p=0.21). No significant reductions in intracranial pressure were observed in any of the 3 groups. CONCLUSIONS Bolus infusion of 3% hypertonic saline solution with the aid of a pump does not significantly reduce intracranial pressure in an animal model of intracranial hypertension.

  5. Hypertonic conditions trigger transient plasmolysis, growth arrest and blockage of transporter endocytosis in Aspergillus nidulans and Saccharomyces cerevisiae.

    Science.gov (United States)

    Bitsikas, Vassilis; Karachaliou, Mayia; Gournas, Christos; Diallinas, George

    2011-01-01

    By using Aspergillus nidulans strains expressing functional GFP-tagged transporters under hypertonic conditions, we noticed the rapid appearance of cortical, relatively static, fluorescent patches (0.5-2.3 μm). These patches do not correspond to transporter microdomains as they co-localize with other plasma membrane-associated molecules, such as the pleckstrin homology (PH) domain and the SsoA t-Snare, or the lipophilic markers FM4-64 and filipin. In addition, they do not show characteristics of lipid rafts, MCCs or other membrane microdomains. Deconvoluted microscopic images showed that fluorescent patches correspond to plasma membrane invaginations. Transporters remain fully active during this phenomenon of localized plasmolysis. Plasmolysis was however associated with reduced growth rate and a dramatic blockage in transporter and FM4-64 endocytosis. These phenomena are transient and rapidly reversible upon wash-out of hypertonic media. Based on the observation that block in endocytosis by hypertonic treatment altered dramatically the cellular localization of tropomyosin (GFP-TpmA), although it did not affect the cortical appearance of upstream (SlaB-GFP) or downstream (AbpA-mRFP) endocytic components, we conclude that hypertonicity modifies actin dynamics and thus acts indirectly on endocytosis. This was further supported by the effect of latrunculin B, an actin depolymerization agent, on endocytosis. We show that the phenomena observed in A. nidulans also occur in Saccharomyces cerevisiae, suggesting that they constitute basic homeostatic responses of ascomycetes to hypertonic shock. Finally, our work shows that hypertonic treatments can be used as physiological tools to study the endocytic down-regulation of transporters in A. nidulans, as non-conditional genetic blocks affecting endocytic internalization are lethal or severely debilitating.

  6. Hypertonic stress induces c-fos but not c-jun expression in the human embryonal EUE epithelial cell line.

    Science.gov (United States)

    Rossi, D; Fuhrman Conti, A M; De Grada, L; Larizza, L

    1995-12-01

    Recent evidence has indicated a role for the two early response genes c-fos and c-jun in transcriptional regulation of genes acting in osmoregulation. On this basis we investigated their expression in response to hypertonic stress in the human embryonal EUE epithelial cell line. EUE cells have proven to be a useful tool for studying long-term in vitro adaptation to hypertonic stress. After culturing EUE cells in hypertonic medium a marked c-fos induction was observed, both at the mRNA and the protein level. Northern analysis of fos-mRNA showed a peak expression at 4 h, followed by a progressive decline till complete extinction at 8 h. Immunofluorescence analysis of FOS protein evidenced a similar, although slightly delayed kinetics of expression. Conversely, neither c-jun nor c-myc up-regulation could be detected. The treatment of EUE cells with cycloheximide led to superinduction of c-fos expression, (with high levels up to 12 h), and to a c-jun expression that was just detectable. Hypertonic stimulation of the transformed cell lines A549, MCF7 and JR induced both c-fos and c-jun only in JR cells. Hypertonic shock was also effective in inducing c-fos expression in fetal human diploid fibroblasts, although the response was earlier and more transient than in EUE cells. These findings indicate that c-fos is a primary response gene in hypertonic stress-activated cells, although the pattern and kinetics of its induction may differ according to the type of cell.

  7. [Animal experimentation of reimplantation of hypertonic saline-induced devitalized bone].

    Science.gov (United States)

    Peng, Chang-liang; Yang, Yi; Sun, Xin; Guo, Wei

    2012-12-18

    To observe the healing process and the change of biomechanical properties of hypertonic saline-induced devitalized bone segment, so as to provide fundamental theory for clinical treatment. A model of New Zealand rabbit ulnar segments devitalized by hypertonic saline was established and then reimplanted in situ. The ulnar specimens were taken for examination of X-rays, light microscope and three-point-bend test at the end of 3, 6, 12, and 24 weeks postoperatively. The devitalized bone healed at the end of 12 weeks in the X-ray film. The histological examination showed that osteoblast multiplied and secreted osteoid gradually. The maximal breaking load of the devitalized bone continuously increased and reached the top at the end of 24 weeks [control group (206.25±16.64) N vs. devitalized group (196.88±8.24) N, P>0.05]. The devitalized bone healed through intramembranous and endochondral ossification, and the endochondral ossification predominated; the biomechanical strength of devitalized bone continually increased as time lasted.

  8. Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms.

    Science.gov (United States)

    Sarrell, E Michael; Tal, Guy; Witzling, Michaela; Someck, Eli; Houri, Sion; Cohen, Herman A; Mandelberg, Avigdor

    2002-12-01

    To determine the utility of inhaled hypertonic saline solution to treat ambulatory infants with viral bronchiolitis. Randomized, double-blind, controlled trial. Sixty-five ambulatory infants (mean +/- SD age, 12.5 +/- 6 months) with viral bronchiolitis received either of the following: inhalation of 0.5 mL (5 mg) terbutaline added to 2 mL of 0.9% saline solution as a wet nebulized aerosol (control; group 1; n = 32) or 0.5 mL (5 mg) terbutaline added to 2 mL of 3% saline solution administered in the same manner as above (treatment; group 2; n = 33). This therapy was repeated three times every day for 5 days. The clinical severity (CS) scores at baseline on the first day of treatment were 6.4 +/- 1.8 in group 1 and 6.6 +/- 1.5 in group 2 (not significant). After the first day, the CS score was significantly lower (better) in group 2 as compared to group 1 on each of the treatment days (p hypertonic saline solution-treated patients (group 2) as compared to the 0.9% saline solution-treated patients (group 1) [p = 0.01; Fig 1 ]. We conclude that in nonasthmatic, nonseverely ill ambulatory infants with viral bronchiolitis, aerosolized 3% saline solution plus 5 mg terbutaline is effective in decreasing symptoms as compared to 0.9% saline solution plus 5 mg terbutaline.

  9. Cell kinetics of PHA-activated lymphocytes are slowed by prolonged hypertonic stress.

    Science.gov (United States)

    Fuhrman Conti, A M; Tori, R; Ronchetti, E; De Grada, L; Pellicciari, C; Manfredi Romanini, M G

    1990-01-01

    The effect of prolonged exposure to a hypertonic medium on human lymphocytes during mitogenic stimulation with phytohemagglutinin was investigated. The process of chromatin decondensation during the first 24 hrs stimulation (G0 to G1 transition) and the changes in kinetic parameters and the occurrence of chromosome aberrations from 48 hrs to 72 hrs of stimulation were studied. In HT medium, lymphocyte transition from G0 to G1 was slowed; there were fewer S-phase cells, after 48 hrs PHA stimulation, whereas after 72 hrs the resistant cells showed the same frequency of S-phase cells as the controls. The mitotic index was always smaller, and the frequency of G0/G1 cells larger. No significant increase in the frequencies of chromosome aberrations were found. These findings suggest that human peripheral lymphocytes can survive and grow in a hypertonic medium; chromosome damages, if not repaired, may be lethal, and only lymphocytes with normal karyotypes can survive for long times in the HT medium, although with modified kinetic characteristics.

  10. Ghrelin reduces hypertonic saline intake under a variety of natriorexigenic conditions

    Science.gov (United States)

    Mietlicki, Elizabeth G.; Daniels, Derek

    2011-01-01

    Ghrelin is a gut peptide that has been studied extensively for its role in food intake and energy balance. More recent studies show that ghrelin reduces water intake in rats and some non-mammalian species. Despite the importance of the regulation of NaCl intake in body fluid homeostasis, the effects of ghrelin on saline intake have not been investigated. Accordingly, we tested the effect of ghrelin on water and 1.8% NaCl intake in two-bottle test conditions under five stimuli that increase hypertonic saline intake: central angiotensin II administration, 24 h fluid deprivation, water deprivation followed by partial rehydration, dietary sodium deficiency, and polyethylene glycol administration combined with dietary sodium deficiency. We found that ghrelin attenuated saline intake stimulated by angiotensin II, by water deprivation followed by partial rehydration, and by dietary sodium deficiency. We did not detect an effect of ghrelin on saline intake after 24 h fluid deprivation without partial rehydration or after the combination of polyethylene glycol and dietary sodium deficiency. The finding that ghrelin reduced hypertonic saline intake under some, but not all, natriorexigenic conditions mirrors the previously published findings that in one-bottle tests of drinking, ghrelin reduces water intake under only some conditions. The results provide evidence for a new role for ghrelin in the regulation of body fluid homeostasis. PMID:21784787

  11. Ghrelin reduces hypertonic saline intake in a variety of natriorexigenic conditions.

    Science.gov (United States)

    Mietlicki, Elizabeth G; Daniels, Derek

    2011-10-01

    Ghrelin is a gut peptide that has been studied extensively for its role in food intake and energy balance. More recent studies show that ghrelin reduces water intake in rats and some non-mammalian species. Despite the importance of the regulation of NaCl intake in body fluid homeostasis, the effects of ghrelin on saline intake have not been investigated. Accordingly, we tested the effect of ghrelin on water and 1.8% NaCl intake in two-bottle test conditions with the following five stimuli that increase hypertonic saline intake: central angiotensin II administration; 24 h fluid deprivation; water deprivation followed by partial rehydration; dietary sodium deficiency; and polyethylene glycol administration combined with dietary sodium deficiency. We found that ghrelin attenuated saline intake stimulated by angiotensin II, by water deprivation followed by partial rehydration and by dietary sodium deficiency. We did not detect an effect of ghrelin on saline intake after 24 h fluid deprivation without partial rehydration or after the combination of polyethylene glycol and dietary sodium deficiency. The finding that ghrelin reduced hypertonic saline intake in some, but not all, natriorexigenic conditions mirrors the previously published findings that in one-bottle tests of drinking, ghrelin reduces water intake in only some conditions. The results provide evidence for a new role for ghrelin in the regulation of body fluid homeostasis.

  12. Differentiation between Candida albicans and Candida dubliniensis using hypertonic Sabouraud broth and tobacco agar

    Directory of Open Access Journals (Sweden)

    Fabíola Silveira-Gomes

    2011-08-01

    Full Text Available INTRODUCTION: Opportunistic fungal infections in immunocompromised hosts are caused by Candida species, and the majority of such infections are due to Candida albicans. However, the emerging pathogen Candida dubliniensis demonstrates several phenotypic characteristics in common with C. albicans, such as production of germ tubes and chlamydospores, calling attention to the development of stable resistance to fluconazole in vitro. The aim of this study was to evaluate the performance of biochemistry identification in the differentiating between C. albicans and C. dubliniensis, by phenotyping of yeast identified as C. albicans. METHODS: Seventy-nine isolates identified as C. albicans by the API system ID 32C were grown on Sabouraud dextrose agar at 30°C for 24-48h and then inoculated on hypertonic Sabouraud broth and tobacco agar. RESULTS: Our results showed that 17 (21.5% isolates were growth-inhibited on hypertonic Sabouraud broth, a phenotypic trait inconsistent with C. albicans in this medium. However, the results observed on tobacco agar showed that only 9 (11.4% of the growth-inhibited isolates produced characteristic colonies of C. dubliniensis (rough colonies, yellowish-brown with abundant fragments of hyphae and chlamydospores. CONCLUSIONS: The results suggest that this method is a simple tool for screening C. albicans and non-albicans yeast and for verification of automated identification.

  13. Differentiation between Candida albicans and Candida dubliniensis using hypertonic Sabouraud broth and tobacco agar.

    Science.gov (United States)

    Silveira-Gomes, Fabíola; Sarmento, Dayse Nogueira; Espírito-Santo, Elaine Patrícia Tavares do; Souza, Nádia de Oliveira; Pinto, Thifany Mendes; Marques-da-Silva, Silvia Helena

    2011-01-01

    Opportunistic fungal infections in immunocompromised hosts are caused by Candida species, and the majority of such infections are due to Candida albicans. However, the emerging pathogen Candida dubliniensis demonstrates several phenotypic characteristics in common with C. albicans, such as production of germ tubes and chlamydospores, calling attention to the development of stable resistance to fluconazole in vitro. The aim of this study was to evaluate the performance of biochemistry identification in the differentiating between C. albicans and C. dubliniensis, by phenotyping of yeast identified as C. albicans. Seventy-nine isolates identified as C. albicans by the API system ID 32C were grown on Sabouraud dextrose agar at 30°C for 24-48h and then inoculated on hypertonic Sabouraud broth and tobacco agar. Our results showed that 17 (21.5%) isolates were growth-inhibited on hypertonic Sabouraud broth, a phenotypic trait inconsistent with C. albicans in this medium. However, the results observed on tobacco agar showed that only 9 (11.4%) of the growth-inhibited isolates produced characteristic colonies of C. dubliniensis (rough colonies, yellowish-brown with abundant fragments of hyphae and chlamydospores). The results suggest that this method is a simple tool for screening C. albicans and non-albicans yeast and for verification of automated identification.

  14. [Effect of 3% hypertonic saline as early fluid resuscitation in pediatric septic shock].

    Science.gov (United States)

    Liu, Shuang; Ren, Xiaoxu; Gun, Linying; Zhang, Qi; Zhang, Jin; Zhu, Yiming

    2015-08-01

    The mainstay of therapy in patients with septic shock is early and aggressive intravenous fluid resuscitation. However the type of intravenous fluid that would be ideal for managing septic shock has been intensely debated. In this study, the authors observed the effects of 3% hypertonic saline solution compared with normal saline solution as early fluid resuscitation in children with septic shock. In this prospective study, 44 septic shock children seen in the intensive care unit (ICU) of the Children's Hospital Affiliated to Capital Institute of Pediatrics were enrolled from January 2012 to January 2014, of whom 33 were male and 11 were female. Patients were randomly divided into two groups: normal saline group (NS group, 24 patients) and 3% hypertonic saline group (HS group,20 patients). There were no significant differences between the 2 groups of patients in age, gender, pediatric critical illness score (PCIS), oxygenation index (OI = PaO2/FiO2), arterial lactate, initial hemodynamic parameters, serum sodium and treatment at time of admission. Patients in NS group received normal saline guided by standard therapy. Those in HS group received 6 ml/kg 3% hypertonic saline as a single bolus over 10 min to 15 min with a maximum of 2 boluses and other standard therapy. Heart rate (HR), mean arterial blood pressure (MAP), arterial lactate, oxygenation index, urine output, serum sodium, lactate clearance rate, PCIS, fluid infusion volume, vasoactive - inotropic score, mechanical ventilation time , as well as incidence of multiple organ dysfunction syndrome (MODS), and 28 days in - hospital mortality were recorded for all patients. (1) HR, MAP in both groups were significantly higher after infusion than those on admission. There were no significant difference in HR and MAP at 1h, 3h, 6h and 24h after infusion between NS group and HS group. (2) OI in HS group was significantly higher than that on admission at 3 hours after infusion [(321. 8 ± 50. 7) vs. (296. 5 ± 58. 2

  15. Computerized Assessment of Wheezing in Children With Respiratory Syncytial Virus Bronchiolitis Before and After Hypertonic Saline Nebulization.

    Science.gov (United States)

    Faber, Tina E; Kamps, Arvid Wa; Sjoerdsma, Machtelt H; Vermeulen, Stephanie; Veeger, Nic Jgm; Bont, Louis J

    2015-09-01

    Studies suggest an effect of nebulized hypertonic saline solution on air-flow limitation in subjects with respiratory syncytial virus (RSV) bronchiolitis, but results are based on subjective scores of clinical severity and are not clear. In this observational study, we used a noninvasive computerized tool to quantify wheezing before and after nebulization with hypertonic saline in children admitted for RSV infection. Twenty-seven children (≤ 24 months old) admitted to the pediatric ward of the Medical Center Leeuwarden with polymerase chain reaction-confirmed RSV bronchiolitis were included. Subjects were simultaneously assessed both clinically and by computerized acoustic monitoring before and 15 min after treatment with nebulized hypertonic saline solution. Clinical assessment, defined by the Respiratory Distress Assessment Instrument score, did not change after nebulization (n = 27, 5.0 vs 4.7, P = .17). Computerized acoustic monitoring showed no improvement in wheezing (n = 27, 3.4% vs 2.0%, P = .05) or inspiration/expiration ratio (0.85 vs 0.85, P = .93) after nebulization. Hypertonic saline nebulization does not improve air flow, as assessed by both clinical and computerized acoustic scores, in children admitted for RSV. Copyright © 2015 by Daedalus Enterprises.

  16. Use of Hypertonic Continuous Venovenous Hemodiafiltration to Control Intracranial Hypertension in an End-Stage Renal Disease Patient

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    Stephen I. Rifkin

    2010-01-01

    Full Text Available Continuous venovenous hemodiafiltration (CVVHDF using solutions designed to maintain hypernatremia is described in an end-stage renal disease (ESRD patient with cerebral edema (CE due to an intracerebral hemorrhage (ICH. Hypernatremia was readily achieved and maintained without complication. CVVHDF should be considered as an alternative treatment option in ESRD patients with cerebral edema who require hypertonic saline therapy.

  17. Assessment Impact of Foot Sensory Modulation on Inhibition of Hypertonicity of the Lower Limb in Children with Diplegia Spastic

    Directory of Open Access Journals (Sweden)

    Saeed Fatoureh-Chi

    2005-01-01

    Full Text Available Objective: The purpose of this study was to assess impact of foot sensory modulation on inhibition of hypertonicity of the lower limb in children with diplegia spastic cerebral palsy. Materials & Methods: 24 selected children (aged 2.5 to 4.5 years were randomly assigned to a control and experimental groups. Muscle tone was assessed using modified Ashworth scale, passive Range of motion by goniameter (Pedretti, neurodevelopmental level by Bobath scale. All children were pre-post tested in an interval of ten weeks. Results: Significant reduction was observed in hypertonicity of hip extensor (p<0/1 and ankle planter flexor (P<0/05. Significant increase was observed in passive Range of motion of hip flexion (P<0/1, knee extension (P<0/05 and ankle dorsi flexion (P<0/05. There was found no significant difference of reduction in hypertonicity of knee flexor and improvement neurodevelopmental level. Meaningful relationship was observed between reduction hypertonicity of the hip extensor (P<0/05 and improvement of neurodevelopmental level (P<0/05. Conclusion: Impact of sensory modulation on children with diplegia spastic cerebral palsy reduces spasticity of lower limb and also extends joints domain of motion.

  18. Effects of hypertonic saline solution associated to remote ischemic perconditioning in kidney ischemia/reperfusion injury in rats.

    Science.gov (United States)

    Brito, Marcus Vinicius Henriques; Yasojima, Edson Yuzur; Percário, Sandro; Ribeiro, Rubens Fernando Gonçalves; Cavalcante, Lainy Carollyne da Costa; Monteiro, Andrew Moraes; Couteiro, Rodrigo Paracampo; Rodrigues, Ivone Aline da Silva; Santos, Hellen Aparecida Geyer Dos

    2017-03-01

    To evaluate the effects of hypertonic saline solution associated to remote ischemic perconditioning in renal ischemia/reperfusion injury in rats. Twenty five male rats (Wistar) underwent right nephrectomy and were distributed into five groups: Sham group (S); Ischemia/Reperfusion group (I/R) with 30 minutes of renal ischemia; Remote ischemic perconditioning group (Per) with three cycles of 10 minutes of I/R performed during kidney ischemia; Hypertonic saline solution group (HSS) treated with hypertonic saline solution (4ml/kg); remote ischemic perconditioning + Hypertonic saline solution group (Per+HSS) with both treatments. After reperfusion, blood samples were collected for BUN and creatinine serum levels analyzes. TBARS were evaluated in plasma and renal tissue to assess oxidative stress. Kidney histopathological examination were performed. Per+HSS group showed a lower degree of renal dysfunction in relation to I/R group, whereas the technique of remote ischemic perconditioning isolated or associated with saline solution significantly reduced oxidative stress and histological damage. Remote ischemic perconditioning associated or not to saline solution promoted reduction of acute renal injury induced by ischemia/reperfusion.

  19. Correction of Hemodynamics with Hypertonic Sodium Chloride Solution in Critical Conditions

    Directory of Open Access Journals (Sweden)

    P. S. Zhbannikov

    2007-01-01

    Full Text Available Objective: to assess the capabilities of small-volume hypertonic infusion in the context of early goal-directed therapy for critical conditions in surgical patients.Subjects and methods. Twenty-nine patients (SAPS II 47.5±6.81 scores operated on for generalized peritonitis (n=24 or severe concomitant injury with damages to chest and/or abdominal organs (n=5 who had the clinical and laboratory signs of a systemic inflammatory reaction were intravenously injected 4 ml/kg of 7.5% of hypertonic sodium chloride solution (HS and colloidal solution, followed by infusion and, if indicated, inotropic maintenance of hemodynamics for 6 hours in order to achieve the goal vales of mean blood pressure (BP, central venous pressure (CVP, central venous blood oxygen saturation (ScvO2, and diuresis. Plasma concentrations of sodium, chlorine, and lactate, acid-base balance, and osmotic blood pressure were monitored.Results. The patients were found to have infusion therapy-refractory critical arterial hypotension, low ScvO2, and oliguria before small-volume circulation maintenance. In all the patients, HS infusion originally caused a rapid rise in BP up to the goal value, with its further colloid infusion maintenance requiring additional dopamine infusion in 12 patients and red blood cell transfusion in 3. This could stabilize over 6 hours BP at the required level in 25 patients, in 9 of whom CVP only approximated the goal value. All the patients were found to have a significant increase in ScvO2 up to an average of 68% in response to HP infusion after 30—60 minutes; in 14 out of them ScvO2 exceeded 70%. By hour 6, ScvO2 stabilized at its goal level in 23 (79% examinees. Administration of HS caused a significantly increased diuresis. In patients with recovered renal function, the observed hypernatremia, hyperchloremia with hyperchloremic acidosis were transient.Conclusion. The results of the study show it possible to include small-volume hypertonic infusion at

  20. [Nebulized hypertonic saline and acute viral bronchiolitis in infants: current aspects].

    Science.gov (United States)

    Sauvaget, E; David, M; Bresson, V; Retornaz, K; Bosdure, E; Dubus, J-C

    2012-06-01

    Acute viral bronchiolitis affects infants, is frequent, and can be severe. Its treatment is only based on symptoms. Hypertonic saline (HS) may act favorably in this situation by fighting virus-induced dehydration of the airway liquid surface. Because of an osmotic action, HS attracts the water from the epithelial cells and improves mucociliary clearance. Five double-blind placebo-controlled studies concerning hospitalized infants with acute viral bronchiolitis showed that repeated nebulizations of 3% HS induce a 20% improvement in the clinical severity score and reduced the hospital length of stay by 24h. Tolerance is excellent. On the other hand, a few questions remain unresolved: what is the optimal salt concentration? What is the recommended nebulizer? What is the best frequency for nebulizer use? Can nebulized HS be used at home? What are the results with systematic physiotherapy when HS is used? Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  1. Correlation of bladder base elevation with pelvic floor hypertonicity in women with lower urinary tract symptoms.

    Science.gov (United States)

    Chuang, Fei-Chi; Kuo, Hann-Chorng

    2007-01-01

    To determine whether the bladder base elevation as revealed by cystogram under fluoroscopy is associated with pelvic floor hypertonicity or bladder outlet obstruction (BOO) in women. Sixty-two women who were referred to our videourodynamic laboratory for assessment of lower urinary tract symptoms (LUTS) were included in this retrospective analysis. Thirty-one of these women with bladder base elevation-revealed by cystogram under fluoroscopy during videourodynamic study-served as the experimental group, and another group of 31 women without bladder base elevation served as control. None of the patients had neuropathy, previous pelvic surgery or chronic urinary retention. The clinical symptoms, urodynamic diagnosis, and parameters were compared between the two groups. The mean voiding pressure (Pdet.Qmax) and postvoid residual (PVR) were significantly greater, and maximum flow rate (Qmax) and voided volume were significantly lower in the bladder base elevation group. When a Pdet.Qmax of >or=35 cmH2O combined with a Qmax of elevation group had BOO than controls (51.6% vs. 9.7%, P=0.0003). Pelvic floor muscle electromyogram (EMG) was dyscoordinated during the voiding phase in 18 (58.1%) and 9 (29%) of the patients with and without bladder base elevation, respectively (P=0.0212). Women with LUTS and bladder base elevation revealed in the filling phase of videourodynamic study had significantly higher voiding pressure and incidence of dyscoordinated pelvic floor EMG activities during voiding, suggesting a higher incidence of BOO and pelvic floor hypertonicity. Copyright (c) 2007 Wiley-Liss, Inc.

  2. Cell cycle effects of hypertonic stress on various human cells in culture.

    Science.gov (United States)

    Pellicciari, C; Filippini, C; De Grada, L; Fuhrman Conti, A M; Manfredi Romanini, M G

    1995-03-01

    Long-term exposure to hypertonic (HT) culture media has been found to perturb the cell cycle and change gene expression in various animal cell types. A lower growth rate, with exit of cells from the cycling compartment has been observed previously in human transformed EUE cells. The aim of this study was to investigate if the kinetic changes after long-term HT stress, were typical of transformed cells or could be also found in primary cultures of normal cells. Human transformed cells from normal and neoplastic tissues, and normal human cells of epithelial and connective origin have been studied. After the incorporation of bromodeoxyuridine (BrdUrd), the frequency of S-phase cells was estimated by dual-parameter flow cytometry of DNA content versus BrdUrd immunolabelling; the total growth fraction was also estimated, after immunolabelling with an anti-PCNA antibody. We also investigated, by polyacrylamide gel electrophoresis, changes in the amount of a 35 kDa protein band, which increased in EUE cells grown in an HT medium, and which may be directly involved in cell resistance to hypertonicity. Lower BrdUrd labelling indices and higher frequencies of cells in the G0/1 range of DNA content were common features of all the cells in HT media, irrespective of their tissue of origin; other cycle phases may also be involved, depending on the cell type considered. The mechanisms by which cells cope with the HT environment could however differ, since only some cell types showed an increase of the 35 kDa stress protein found originally in HT EUE cells.

  3. Hypertonic saline reduces vascular leakage in a mouse model of severe dengue.

    Science.gov (United States)

    Tan, Grace Kai Xin; Ng, Jowin Kai Wei; Tan, Kar Wai; Angeli, Veronique; Moochhala, Shabbir; Ooi, Eng Eong; Alonso, Sylvie

    2013-01-01

    Dengue (DEN) is a mosquito-borne viral disease and represents a serious public health threat and an economical burden throughout the tropics. Dengue clinical manifestations range from mild acute febrile illness to severe DEN hemorrhagic fever/DEN shock syndrome (DHF/DSS). Currently, resuscitation with large volumes of isotonic fluid remains the gold standard of care for DEN patients who develop vascular leakage and shock. Here, we investigated the ability of small volume of hypertonic saline (HTS) suspensions to control vascular permeability in a mouse model of severe DEN associated with vascular leakage. Several HTS treatment regimens were considered and our results indicated that a single bolus of 7.5% NaCl at 4 mL per kg of body weight administered at the onset of detectable vascular leakage rapidly and significantly reduced vascular leak for several days after injection. This transient reduction of vascular leakage correlated with reduced intestine and liver damage with restoration of the hepatic functions, and resulted in delayed death of the infected animals. Mechanistically, we showed that HTS did not directly impact on the viral titers but resulted in lower immune cells counts and decreased systemic levels of soluble mediators involved in vascular permeability. In addition, we demonstrated that neutrophils do not play a critical role in DEN-associated vascular leakage and that the therapeutic effect of HTS is not mediated by its impact on the neutrophil counts. Together our data indicate that HTS treatment can transiently but rapidly reduce dengue-associated vascular leakage, and support the findings of a recent clinical trial which evaluated the efficacy of a hypertonic suspension to impact on vascular permeability in DSS children.

  4. [The peritoneal kinetic study performed with hypertonic glucose permits better evaluation of UF capacity and determination of sieving of sodium].

    Science.gov (United States)

    Fernández-Reyes, M J; Bajo Rubio, M A; del Peso Gilzanz, G; Estrada, P; Sousa, S; Sánchez-Villanueva, R; Heras, M; Ossorio, M; Sánchez-Vega, C; Selgas, R

    2010-01-01

    The use of solutions containing hypertonic glucose (3.86%/4.25%) has been postulated as the method of choice for study the peritoneal function, and permits a better evaluation of the ultrafiltration (UF) capacity. The aim of our study was to analyze the UF capacity and its relation with the peritoneal permeability and sieving of sodium, performing the peritoneal kinetic study with hypertonic glucose solutions. We performed 184 peritoneal kinetic studies with hypertonic glucose solutions in stable patients on peritoneal dialysis (PD), with a mean time on PD of 16 +/- 22 months. We measured the mass transfer coefficient of creatinine (CrMTC), dialysate to plasma ratio of creatinine (D/PCr), UF capacity and sieving of sodium at 60 minutes (difNa60). The mean values were: CrMTC: 9.1 +/- 4.5 ml/min, D/PCr: 0.71 +/- 0.09, UF 759 +/- 233 ml/4 h and difNa60: 4.7 +/- 2.3. The best multivariate model that predicts the UF capacity included: difNa60, CrMTC, age and time on PD (r = 0.57; p > 0.0001). In patients with UF lower than 600 ml/4 h (Percentil 25) the correlation between UF and CrMTC was lost, but remains the correlation with difNa60 (r = 0.48). The patients with previous peritonitis (n = 38) showed no differences in UF, CrMTC or D/Pcr, but the had lower difNa60 (3.7 +/- 2.8 vs. 4.9 +/- 2.1; p = 0.002) than the remaining patients. The peritoneal kinetic study performed with hypertonic glucose allows to standardize the UF capacity and by determination of sieving of sodium, the early detection of water transport alterations, before the UF capacity and small solutes permeability alteration develops.

  5. Saline in Acute Bronchiolitis RCT and Economic evaluation: hypertonic saline in acute bronchiolitis - randomised controlled trial and systematic review

    OpenAIRE

    Everard, M.L.; Hind, D.; Ugonna, K.; Freeman, J.; Bradburn, M.; Dixon, S.; Maguire, C.; Cantrill, H.; Alexander, J; Lenney, W; McNamara, P; Elphick, H; Chetcuti, P.A.J.; Moya, E.F.; Powell, C.

    2015-01-01

    BACKGROUND: Acute bronchiolitis is the most common cause of hospitalisation in infancy. Supportive care and oxygen are the cornerstones of management. A Cochrane review concluded that the use of nebulised 3% hypertonic saline (HS) may significantly reduce the duration of hospitalisation. \\ud \\ud OBJECTIVE: To test the hypothesis that HS reduces the time to when infants were assessed as being fit for discharge, defined as in air with saturations of > 92% for 6 hours, by 25%. \\ud \\ud DESIGN: Pa...

  6. Sensory findings after stimulation of the thoracolumbar fascia with hypertonic saline suggest its contribution to low back pain.

    Science.gov (United States)

    Schilder, Andreas; Hoheisel, Ulrich; Magerl, Walter; Benrath, Justus; Klein, Thomas; Treede, Rolf-Detlef

    2014-02-01

    Injection of hypertonic saline into deep tissues of the back (subcutis, muscle, or the surrounding fascia) can induce acute low back pain (LBP). So far, no study has analyzed differences in temporal, qualitative, and spatial pain characteristics originating from these tissues. The current study aimed to investigate the role of the thoracolumbar fascia as a potential source of LBP. In separate sessions, 12 healthy subjects received ultrasound-guided bolus injections of isotonic saline (0.9%) or hypertonic saline (5.8%) into the erector spinae muscle, the thoracolumbar fascia (posterior layer), and the overlying subcutis. Subjects were asked to rate pain intensity, duration, quality, and spatial extent. Pressure pain thresholds were determined pre and post injection. Injections of hypertonic saline into the fascia resulted in significantly larger area under the curve of pain intensity over time than injections into subcutis (Ppain durations and, to a lesser extent, on higher peak pain ratings. Pressure hyperalgesia was only induced by injection of hypertonic saline into muscle, but not fascia or subcutis. Pain radiation and pain affect evoked by fascia injection exceeded those of the muscle (PPain descriptors after fascia injection (burning, throbbing, and stinging) suggested innervation by both A- and C-fiber nociceptors. These findings show that the thoracolumbar fascia is the deep tissue of the back that is most sensitive to chemical stimulation, making it a prime candidate to contribute to nonspecific LBP but not to localized pressure hyperalgesia. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  7. Effects of hypertonic sodium chloride solution on the electrophysiologic alterations caused by bupivacaine in the dog heart

    Directory of Open Access Journals (Sweden)

    Scalabrini A.

    2003-01-01

    Full Text Available The effects of various hypertonic solutions on the intraventricular conduction, ventricular repolarization and the arrhythmias caused by the intravenous (iv injection of bupivacaine (6.5 mg/kg were studied in sodium pentobarbital-anesthetized mongrel dogs. Hypertonic solutions, given iv 5 min before bupivacaine, were 7.5% (w/v NaCl, 5.4% (w/v LiCl, 50% (w/v glucose (2,400 mOsm/l, 5 ml/kg, or 20% (w/v mannitol (1,200 mOsm/l, 10 ml/kg. Bupivacaine induced severe arrhythmias and ventricular conduction and repolarization disturbances, as reflected by significant increases in QRS complex duration, HV interval, IV interval and monophasic action potential duration, as well as severe hemodynamic impairment. Significant prevention against ventricular electrophysiologic and hemodynamic disturbances and ventricular arrhythmias was observed with 7.5% NaCl (percent increase in QRS complex duration: 164.4 ± 21.8% in the non-pretreated group vs 74.7 ± 14.1% in the pretreated group, P<0.05; percent increase in HV interval: 131.4 ± 16.1% in the non-pretreated group vs 58.2 ± 7.5% in the pretreated group, P<0.05; percent increase in monophasic action potential duration: 22.7 ± 6.8% in the non-pretreated group vs 9.8 ± 6.3% in the pretreated group, P<0.05; percent decrease in cardiac index: -46 ± 6% in the non-pretreated group vs -28 ± 5% in the pretreated group, P<0.05. The other three hypertonic solutions were ineffective. These findings suggest an involvement of sodium ions in the mechanism of hypertonic protection.

  8. Hypertonic Glucose Combined with Negative Pressure Wound Therapy to Prepare Wounds with Pseudomonas aeruginosa Infection for Skin Grafting: A Report of 3 Cases.

    Science.gov (United States)

    Zhao, Jing-Chun; Xian, Chun-Jing; Yu, Jia-Ao; Shi, Kai; Hong, Lei

    2015-06-01

    Soft tissue losses from acute or chronic trauma are a challenge for surgeons. To explore a method to expedite granulation tissue formation in preparation for a split-thickness skin graft (STSG), the medical records of 3 patients - 2 adult men with wounds related to trauma injury and 1 infant with necrotizing fasciitis, all infected with Pseudomonas aeruginosa - were reviewed. All wounds were surgically debrided and managed by applying gauze soaked in 50% glucose followed by continuous negative pressure wound therapy (NPWT) before definitive skin grafting. NPWT pressure was applied at -80 mm Hg for the 2 adult males (ages 39 and 25 years) and -50 mm Hg for the 7-month-old male infant. The dressings were changed every 2 to 3 days. No adverse events occurred, and wounds were successfully closed with a STSG after an average of 7 days. In 1 case, NPWT was able to help affix dressings in a difficult-to-dress area (genital region). The combination of hypertonic glucose and hand-made, gauze-based NPWT was found to be safe, well-tolerated, and effective in preparing the wound bed for grafting. Prospective, randomized, controlled clinical studies are needed to compare the safety, effectiveness, and efficacy of this method to other treatment approaches for P. aeruginosa-infected wounds.

  9. Agreement of measured and calculated serum osmolality during the infusion of mannitol or hypertonic saline in patients after craniotomy: a prospective, double-blinded, randomised controlled trial.

    Science.gov (United States)

    Li, Qian; Chen, Han; Hao, Jing-Jing; Yin, Ning-Ning; Xu, Ming; Zhou, Jian-Xin

    2015-10-07

    Mannitol and hypertonic saline are used to ameliorate brain edema and intracranial hypertension during and after craniotomy. We hypothesized that the agreement of measured and calculated serum osmolality during the infusion of hypertonic saline would be better than mannitol. The objective was to determine the accuracy of serum osmolality estimation by different formulas during the administration of hyperosmolar agent. A prospective, randomized, double-blinded, controlled trial was conducted in a 30-bed neurosurgical intensive care unit at a university hospital. Thirty-five adult patients requiring the use of hyperosmolar agents for prevention or treatment of brain edema after elective craniotomy were enrolled, and randomly assigned 1:1 to receive 125 mL of either 20 % mannitol (mannitol group) or 3.1 % sodium chloride solution (hypertonic saline group) in 15 min. Serum osmolality, serum sodium and potassium concentration, blood urea nitrogen and blood glucose concentration were measured during the study period. The primary outcome was the agreement of measured and estimated serum osmolality during the infusion of the two experimental agents. We used Bland and Altman's limits of agreement analysis to clarify the accuracy of estimated serum osmolality. Bias and upper and lower limits of agreement of bias were calculated. For each formula, the bias was statistically lower in hypertonic saline group than mannitol group (p mannitol group and hypertonic saline group, respectively) was derived from the formula '2 × ([serum sodium] + [serum potassium]) + [blood urea nitrogen] + [blood glucose]'. Compared to mannitol, a better agreement between measured and estimated serum osmolality was found during the infusion of hypertonic saline. This result indicates that, if hypertonic saline is chosen to prevent or treat brain edema, calculated serum osmolality can be used as a reliable surrogate for osmolality measurement. ClinicalTrials.gov identifier: NCT02037815.

  10. The effect of a knee brace on gait parameters of hypertonic hemiplegic patients

    Directory of Open Access Journals (Sweden)

    M.R. Modisane

    2008-02-01

    Full Text Available The aim of this study was to investigate the effects of the useof a knee brace on 15 subjects with hypertonic hemiparesis. The middlecerebral artery was involved in all subjects. The Ashworth scale was usedto screen for the presence of spasticity in the quadriceps muscles.Measurements of gait speed, step and stride length were taken in the middle 10 metres of a 15 metre paper walkway. A comparison of these gait parameters without and with the use of a knee brace was made. A ques-tionnaire was also used to evaluate how subjects responded to the use of aknee brace.The results showed that the mean speed for all 15 subjects increased withthe use of a brace, (p = 0.05. Step and stride length without and with the use of a brace showed no statistical differences.It was therefore concluded that the FECK brace appears to have an effect on the walking speed of subjects withhypertonic  hemiparesis

  11. Comparison of 3% and 7.5% Hypertonic Saline in Resuscitation After Traumatic Hypovolemic Shock.

    Science.gov (United States)

    Han, Juan; Ren, Hui-Qin; Zhao, Qing-Bo; Wu, You-Liang; Qiao, Zhuo-Yi

    2015-03-01

    Hypertonic saline solutions (HSSs) (7.5%) are useful in the resuscitation of patients with hypovolemic shock because they provide immediate intravascular volume expansion via the delivery of a small volume of fluid, improving cardiac function. However, the effects of using 3% HSS in hypovolemic shock resuscitation are not well known. This study was designed to compare the effects of and complications associated with 3% HSS, 7.5% HSS, and standard fluid in resuscitation. In total, 294 severe trauma patients were enrolled from December 2008 to February 2012 and subjected to a double-blind randomized clinical trial. Individual patients were treated with 3% HSS (250 mL), 7.5% HSS (250 mL), or lactated Ringer's solution (LRS) (250 mL). Mean arterial pressure, blood pressure, and heart rate were monitored and recorded before fluid infusion and at 10, 30, 45, and 60 min after infusion, and the incidence of complications and survival rate were analyzed. The results indicate that 3% and 7.5% HSSs rapidly restored mean arterial pressure and led to the requirement of an approximately 50% lower total fluid volume compared with the LRS group (P shock.

  12. Hypertonic saline for the management of raised intracranial pressure after severe traumatic brain injury.

    Science.gov (United States)

    Mangat, Halinder S; Härtl, Roger

    2015-05-01

    Hyperosmolar agents are commonly used as an initial treatment for the management of raised intracranial pressure (ICP) after severe traumatic brain injury (TBI). They have an excellent adverse-effect profile compared to other therapies, such as hyperventilation and barbiturates, which carry the risk of reducing cerebral perfusion. The hyperosmolar agent mannitol has been used for several decades to reduce raised ICP, and there is accumulating evidence from pilot studies suggesting beneficial effects of hypertonic saline (HTS) for similar purposes. An ideal therapeutic agent for ICP reduction should reduce ICP while maintaining cerebral perfusion (pressure). While mannitol can cause dehydration over time, HTS helps maintain normovolemia and cerebral perfusion, a finding that has led to a large amount of pilot data being published on the benefits of HTS, albeit in small cohorts. Prophylactic therapy is not recommended with mannitol, although it may be beneficial with HTS. To date, no large clinical trial has been performed to directly compare the two agents. The best current evidence suggests that mannitol is effective in reducing ICP in the management of traumatic intracranial hypertension and carries mortality benefit compared to barbiturates. Current evidence regarding the use of HTS in severe TBI is limited to smaller studies, which illustrate a benefit in ICP reduction and perhaps mortality. © 2015 New York Academy of Sciences.

  13. Nebulized 3% hypertonic saline solution treatment in hospitalized infants with viral bronchiolitis.

    Science.gov (United States)

    Mandelberg, Avigdor; Tal, Guy; Witzling, Michaela; Someck, Eli; Houri, Sion; Balin, Ami; Priel, Israel E

    2003-02-01

    To determine the utility of inhaled hypertonic saline solution to treat infants hospitalized with viral bronchiolitis. Randomized, double-blind, controlled trial. Fifty-two hospitalized infants (mean +/- SD age, 2.9 +/- 2.1 months) with viral bronchiolitis received either inhalation of epinephrine, 1.5 mg, in 4 mL of 0.9% saline solution (group 1; n = 25) or inhalation of epinephrine, 1.5 mg, in 4 mL of 3% saline solution (group 2; n = 27). This therapy was repeated three times every hospitalization day until discharge. The percentage improvement in the clinical severity scores after inhalation therapy was not significant in group 1 on the first, second, and third days after hospital admission (3.5%, 2%, and 4%, respectively). In group 2, significant improvement was observed on these days (7.3%, 8.9%, and 10%, respectively; p saline solution decreased the hospitalization stay by 25%: from 4 +/- 1.9 days in group 1 to 3 +/- 1.2 days in group 2 (p infants hospitalized with viral bronchiolitis, aerosolized 3% saline solution/1.5 mg epinephrine decreases symptoms and length of hospitalization as compared to 0.9% saline solution/1.5 mg epinephrine.

  14. Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in infants.

    Science.gov (United States)

    Al-Ansari, Khalid; Sakran, Mahmoud; Davidson, Bruce L; El Sayyed, Rafah; Mahjoub, Hella; Ibrahim, Khalid

    2010-10-01

    To compare the efficacy and safety of 5%, 3%, and 0.9% saline solution for treating acute bronchiolitis in the prehospital setting. This was a double-blind trial including consecutive infants aged saline with epinephrine every 4 hours. The primary efficacy outcome was bronchiolitis severity score improvement at 48 hours (chi2 analysis). Scores and oxygen saturation immediately before and after each treatment were recorded to assess safety. A total of 187 previously healthy infants (median age, 3.1 months) diagnosed with bronchiolitis were enrolled. Positivity for respiratory syncytial virus was similar in the 3 treatment groups (mean, 56%). At 48 hours, the mean severity score for the 5% saline group was 3.69+/-1.09, and that for the 0.9% saline group was 4.12+/-1.11 (P=.04; difference, 0.43, 95% confidence interval for the difference, 0.02-0.88). The mean severity score for the 3% saline group was intermediate at 4.00+/-1.22. Revisit rates after discharge were similar in the 3 treatment groups. No adverse reactions or other safety concerns were identified. Nebulization with 5% hypertonic saline is safe, can be widely generalizable, and may be superior to current treatment for early outpatient treatment of bronchiolitis. Copyright (c) 2010 Mosby, Inc. All rights reserved.

  15. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants.

    Science.gov (United States)

    Kuzik, Brian A; Al-Qadhi, Samim A; Kent, Steven; Flavin, Michael P; Hopman, Wilma; Hotte, Simon; Gander, Sarah

    2007-09-01

    To investigate the use of nebulized 3% hypertonic saline (HS) for treating viral bronchiolitis in moderately ill hospitalized infants by a prospective, randomized, double-blinded, controlled, multicenter trial. A total of 96 infants (mean age, 4.7 months; range, 0.3 to 18 months) admitted to the hospital for treatment of viral bronchiolitis were recruited from 3 regional pediatric centers over 3 bronchiolitis seasons (December 2003 to May 2006). Patients were randomized to receive, in a double-blind fashion, repeated doses of nebulized 3% HS (treatment group) or 0.9% normal saline (NS; control group), in addition to routine therapy ordered by the attending physician. The principal outcome measure was hospital length of stay (LOS). On an intention-to-treat basis, the infants in the HS group had a clinically relevant 26% reduction in LOS to 2.6 +/- 1.9 days, compared with 3.5 +/- 2.9 days in the NS group (P = .05). The treatment was well tolerated, with no adverse effects attributable to the use of HS. The use of nebulized 3% HS is a safe, inexpensive, and effective treatment for infants hospitalized with moderately severe viral bronchiolitis.

  16. Method of Hypertonic Saline Administration: Effects on Osmolality in Traumatic Brain Injury Patients.

    Science.gov (United States)

    Maguigan, Kelly L; Dennis, Bradley M; Hamblin, Susan E; Guillamondegui, Oscar D

    2017-05-01

    Hypertonic saline (HTS) is an effective therapy for reducing intracranial pressure (ICP). The ideal method of administration is unknown. The purpose of this study was to evaluate the method of HTS infusion and time to goal osmolality. A retrospective cohort analysis was conducted in severe TBI patients with ICP monitoring in place who received 2 doses of HTS. Patients were divided into bolus versus continuous infusion HTS cohorts. The primary outcome was median time to goal osmolality. Secondary outcomes included percentage of patients reaching goal osmolality, percent time at goal osmolality, mean cerebral perfusion pressure (CPP) and ICP, ICU length of stay, and mortality. Safety outcomes included rates of hyperchloremia, hypernatremia, and acute kidney injury (AKI). 162 patients were included with similar baseline characteristics. Time to goal osmolality was similar between cohorts (bolus 9.78h vs. continuous 11.4h, p=0.817). A significant difference in the percentage of patients reaching goal osmolality favoring the continuous group was found (93.9% vs 73.3%, p=0.003). The continuous group was maintained at goal osmolality for a higher percentage of osmolality values after reaching goal (80% vs. 50%, p=0.032). No difference was seen in CPP, ICP, length of stay and mortality. Rates of hypernatremia were similar, but significant higher rates of hyperchloremia (0.77vs 1.58 events per HTS days, p<0.001) and AKI (0% vs 12.9%, p=0.025) were observed in the continuous cohort. Although no difference in time to goal osmolality was observed, continuous HTS was associated with a higher percentage of patients achieving goal osmolality. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Attenuation of pancreatitis-induced pulmonary injury by aerosolized hypertonic saline.

    LENUS (Irish Health Repository)

    Shields, C J

    2012-02-03

    BACKGROUND: The immunomodulatory effects of hypertonic saline (HTS) provide potential strategies to attenuate inappropriate inflammatory reactions. This study tested the hypothesis that administration of intratracheal aerosolized HTS modulates the development of lung injury in pancreatitis. METHODS: Pancreatitis was induced in 24 male Sprague-Dawley rats by intraperitoneal injection of 20% L-arginine (500 mg\\/100 g body weight). At 24 and 48 h, intratracheal aerosolized HTS (7.5% NaCl, 0.5 mL) was administered to 8 rats, while a further 8 received 0.5 mL of aerosolized normal saline (NS). At 72 hours, pulmonary neutrophil infiltration (myeloperoxidase activity) and endothelial permeability (bronchoalveolar lavage and wet:dry weight ratios) were assessed. In addition, histological assessment of representative lung tissue was performed by a blinded assessor. In a separate experiment, polymorphonucleocytes (PMN) were isolated from human donors, and exposed to increments of HTS. Neutrophil transmigration across an endothelial cell layer, VEGF release, and apoptosis at 1, 6, 12, 18, and 24 h were assessed. RESULTS: Histopathological lung injury scores were significantly reduced in the HTS group (4.78 +\\/- 1.43 vs. 8.64 +\\/- 0.86); p < 0.001). Pulmonary neutrophil sequestration (1.40 +\\/- 0.2) and increased endothelial permeability (6.77 +\\/- 1.14) were evident in the animals resuscitated with normal saline when compared with HTS (0.70 +\\/- 0.1 and 3.57 +\\/- 1.32), respectively; p < 0.04). HTS significantly reduced PMN transmigration (by 97.1, p = 0.002, and induced PMN apoptosis (p < 0.03). HTS did not impact significantly upon neutrophil VEGF release (p > 0.05). CONCLUSIONS: Intratracheal aerosolized HTS attenuates the neutrophil-mediated pulmonary insult subsequent to pancreatitis. This may represent a novel therapeutic strategy.

  18. Effects of hypertonic saline vs normal saline in lactate depuration after cardiovascular surgery.

    Science.gov (United States)

    Atehortúa-López, Luis Horacio; Mendoza-Franco, Ray; Escobar-Serna, José Fernando; Urrego, Luis Alejandro; Alzate, Fernando; Jaimes, Fabian

    2017-03-11

    The postoperative care of patients exposed to cardiac surgery frequently require a thorough reanimation with intravenous fluids but crystalloid solutions like normal saline may increase the interstitial edema, and also it is well known that fluid overload increases mortality. To compare the effect of 7.5% hypertonic saline (HS) with 0.9% normal saline (NS) in the lactate depuration and the hemodynamic response of patients during the first day after on-pump cardiovascular surgery. Patients who were 18 years of age and older with coronary artery disease and/or heart valve disease, and who went to bypass surgery and/or cardiac valve replacement were included and randomly allocated to receive 4mL/kg of HS or NS intravenously for 30min once were admitted to the ICU. We measured lactate, arterial blood gases, HR, CVP and PWP on 0, 6, 12 and 24h after being admitted to the ICU. The analysis was carried out with an intention-to-treat principle. A total of 494 patients were evaluated and 102 were included and assigned to the HS groups (51 patients) or NS (51 patients). Participants' average age was 59±14 years and 59.8% were men. We did not observe any statistically significant difference between two groups in the lactate depuration or in any of the secondary outcomes. Our study failed to show better lactate depuration using a dose of HS, and did not evidence a higher incidence of adverse effects in the HS group. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  19. Hypertonic saline (HTS versus standard (isotonic fluid therapy for traumatic brain injuries: a systematic review

    Directory of Open Access Journals (Sweden)

    Andrit Lourens

    2014-12-01

    Full Text Available Traumatic Brain Injury (TBI is one of the foremost causes of mortality secondary to trauma. Poorer outcomes are associated with secondary insults, after the initial brain injury occurred. The management goal of TBI is to prevent or minimise the effects of secondary brain injuries. The primary objective of this systematic review/meta-analysis was to assess the effects of Hypertonic Saline (HTS compared to Standard Fluid Therapy (SFT in the treatment and resuscitation of TBI patients. We searched CENTRAL, MEDLINE (from 1966, EBSCOhost, Scopus, ScienceDirect, Proquest Medical Library and EMBASE (from 1980 in May 2010 and updated searches in February 2011. Data were assessed and extracted by two independent authors. Risk ratios (RR with a 95% confidence interval (CI were used as the effect measure. The review included three RCTs (1184 participants of which two were of high to moderate quality (1005 participants. HTS was not found to be associated with a reduction in mortality (3 RCTs, 1184 participants, RR 0.91, 95%CI 0.76 to 1.09 and morbidity in TBI patients. No significant improvement in haemodynamical stability was found whereas insufficient data were available to indicate a reduction in the intracranial pressure (ICP. In the HTS group, cerebral perfusion pressure (CPP (MD 3.83 mmHg, 95%CI 1.08 to 6.57 and serum sodium level (MD 8 mEq/L, 95%CI 7.47 to 8.53 were higher. Existing studies show no indication that HTS, in comparison to SFT, reduces mortality or morbidity after the occurrence of TBI. Against this backdrop, some uncertainties still exist in terms of the use of different concentrations and volumes of HTS, the timing of administration as well as the benefit in specific injury profiles. As a result, formulating conclusive recommendations is complex.

  20. Hypertonic saline solution and high-dose furosemide infusion in cardiorenal syndrome: our experience

    Directory of Open Access Journals (Sweden)

    Francesco Ventrella

    2013-03-01

    Full Text Available Introduction Heart failure is frequently complicated by renal failure, and this association is a negative prognostic factor. These patients sometimes present oligo-/anuria and resistance to high-dose furosemide, a condition referred to as the cardiorenal syndrome (CRS. Acute or chronic reductions in left ventricular function result in decreased blood flow, with reduction of renal perfusion and activation of several neurohormonal systems, which cause resistance to diuretic therapy. This condition often requires ultrafiltration, which is an effective, but invasive and expensive procedure. Infusions of hypertonic saline solution (HSS and high-dose furosemide can be an effective alternative. Materials and methods From November 2009 through May 2010, our team treated 20 patients with CRS and resistance to iv boluses of high-dose furosemide. These patients were treated with small-volume (150-250 mL infusions of HSS (NaCl 1.57 – 4.5%, depending on serum Na values and high-dose furosemide twice a day. The aim of this treatment is to modify renal hemodynamics and the water-saline balance in the kidney by counteracting the extracellular fluid accumulation and eliminating symptoms of congestion. Results In 18 patients (90%, urine output was restored and renal function improved during the first hours of treatment. Clinical improvement was evident from the first day of therapy, and there were no adverse events. Two patients (10% did not respond to the treatment: one (who had been in critical condition since admission died; the other required regular sessions of ultrafiltration. Conclusions HSS combined with high-dose furosemide is a safe, effective, low-cost approach to the treatment of CRS that is resistant to diuretic therapy.

  1. Predictors of Acute Kidney Injury in Neurocritical Care Patients Receiving Continuous Hypertonic Saline.

    Science.gov (United States)

    Erdman, Michael J; Riha, Heidi; Bode, Lauren; Chang, Jason J; Jones, G Morgan

    2017-01-01

    Continuous intravenous 3% hypertonic saline (HTS) infusions are commonly used for the management of cerebral edema following severe neurologic injuries. Despite widespread use, data regarding the incidence and predictors of nephrotoxicity are lacking. The purpose of this study was to describe the incidence and identify predictors of acute kidney injury (AKI) in neurocritical care patients administered continuous infusion HTS. This was an institutional review board-approved, multicenter, retrospective cohort study of patients receiving HTS infusions at 2 academic medical centers. A univariate analysis and multivariable logistic regression were used to identify predictors of AKI. Data regarding AKI were evaluated during treatment with HTS and up to 24 hours after discontinuation. A total of 329 patients were included in our analysis, with 54 (16%) developing AKI. Those who developed AKI experienced significantly longer stays in the intensive care unit (14.8 vs 11.5 days; P = .006) and higher mortality (48.1% vs 21.9%; P < .001). We identified past medical history of chronic kidney disease (odds ratio [OR]: 9.7, 95% confidence interval [CI]: 1.9-50.6; P = .007), serum sodium greater than 155 mmol/L (OR: 4.1, 95% CI: 2.1-8.0; P < .001), concomitant administration of piperacillin/tazobactam (OR: 3.9, 95% CI: 1.7-9.3; P = .002), male gender (OR: 3.2, 95% CI: 1.5-6.6; P = .002), and African American race (OR: 2.6, 95% CI: 1.3-5.2; P = .007) as independent predictors of AKI. Acute kidney injury is relatively common in patients receiving continuous HTS and may significantly impact clinical outcomes.

  2. 3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial.

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    Silver, Alyssa H; Esteban-Cruciani, Nora; Azzarone, Gabriella; Douglas, Lindsey C; Lee, Diana S; Liewehr, Sheila; Nazif, Joanne M; Agalliu, Ilir; Villegas, Susan; Rhim, Hai Jung H; Rinke, Michael L; O'Connor, Katherine

    2015-12-01

    Bronchiolitis, the most common reason for hospitalization in children younger than 1 year in the United States, has no proven therapies effective beyond supportive care. We aimed to investigate the effect of nebulized 3% hypertonic saline (HS) compared with nebulized normal saline (NS) on length of stay (LOS) in infants hospitalized with bronchiolitis. We conducted a prospective, randomized, double-blind, controlled trial in an urban tertiary care children's hospital in 227 infants younger than 12 months old admitted with a diagnosis of bronchiolitis (190 completed the study); 113 infants were randomized to HS (93 completed the study), and 114 to NS (97 completed the study). Subjects received 4 mL nebulized 3% HS or 4 mL 0.9% NS every 4 hours from enrollment until hospital discharge. The primary outcome was median LOS. Secondary outcomes were total adverse events, subdivided as clinical worsening and readmissions. Patient characteristics were similar in groups. In intention-to-treat analysis, median LOS (interquartile range) of HS and NS groups was 2.1 (1.2-4.6) vs 2.1 days (1.2-3.8), respectively, P = .73. We confirmed findings with per-protocol analysis, HS and NS groups with 2.0 (1.3-3.3) and 2.0 days (1.2-3.0), respectively, P = .96. Seven-day readmission rate for HS and NS groups were 4.3% and 3.1%, respectively, P = .77. Clinical worsening events were similar between groups (9% vs 8%, P = .97). Among infants admitted to the hospital with bronchiolitis, treatment with nebulized 3% HS compared with NS had no difference in LOS or 7-day readmission rates. Copyright © 2015 by the American Academy of Pediatrics.

  3. Nebulized hypertonic saline for bronchiolitis in the emergency department: a randomized clinical trial.

    Science.gov (United States)

    Florin, Todd A; Shaw, Kathy N; Kittick, Marlena; Yakscoe, Stephen; Zorc, Joseph J

    2014-07-01

    Acute bronchiolitis is the most frequent lower respiratory tract infection in infants, yet there are no effective therapies available. Current evidence is unclear about the role of hypertonic saline (HS) for the acute treatment of bronchiolitis. To determine whether nebulized 3% HS compared with normal saline (NS) improves respiratory distress in infants with bronchiolitis not responding to standard treatments in the emergency department. A randomized clinical trial with blinding of investigators, health care providers, and parents was conducted at a single urban pediatric ED. The participants included children aged 2 to less than 24 months with their first episode of bronchiolitis and a Respiratory Distress Assessment Instrument score of 4 to 15 after nasal suctioning and a trial of nebulized albuterol. Patients were randomized to receive either nebulized 3% HS (HS group) or NS (NS group). The primary outcome was change in respiratory distress at 1 hour after the intervention, as measured by the Respiratory Assessment Change Score (a decrease indicates improvement). Secondary outcomes included vital signs, oxygen saturation, hospitalization, physician clinical impression, parental assessment, and adverse events. The 31 patients enrolled in each treatment arm had similar baseline demographic and clinical characteristics. At 1 hour after the intervention, the HS group demonstrated significantly less improvement in the median Respiratory Assessment Change Score compared with the NS group (HS, -1 [interquartile range, -5 to 1] vs. NS, -5 [interquartile range, -6 to -2]; P = .01). There were no significant differences in heart rate, oxygen saturation, hospitalization rate, or other outcomes. There were no adverse events. Infants with bronchiolitis and persistent respiratory distress after standard treatment in the emergency department had less improvement after receiving 3% HS compared with those who received NS. Based on these results and the existing evidence

  4. Salt Appetite Is Reduced by a Single Experience of Drinking Hypertonic Saline in the Adult Rat

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    Greenwood, Michael P.; Greenwood, Mingkwan; Paton, Julian F. R.; Murphy, David

    2014-01-01

    Salt appetite, the primordial instinct to favorably ingest salty substances, represents a vital evolutionary important drive to successfully maintain body fluid and electrolyte homeostasis. This innate instinct was shown here in Sprague-Dawley rats by increased ingestion of isotonic saline (IS) over water in fluid intake tests. However, this appetitive stimulus was fundamentally transformed into a powerfully aversive one by increasing the salt content of drinking fluid from IS to hypertonic saline (2% w/v NaCl, HS) in intake tests. Rats ingested HS similar to IS when given no choice in one-bottle tests and previous studies have indicated that this may modify salt appetite. We thus investigated if a single 24 h experience of ingesting IS or HS, dehydration (DH) or 4% high salt food (HSD) altered salt preference. Here we show that 24 h of ingesting IS and HS solutions, but not DH or HSD, robustly transformed salt appetite in rats when tested 7 days and 35 days later. Using two-bottle tests rats previously exposed to IS preferred neither IS or water, whereas rats exposed to HS showed aversion to IS. Responses to sweet solutions (1% sucrose) were not different in two-bottle tests with water, suggesting that salt was the primary aversive taste pathway recruited in this model. Inducing thirst by subcutaneous administration of angiotensin II did not overcome this salt aversion. We hypothesised that this behavior results from altered gene expression in brain structures important in thirst and salt appetite. Thus we also report here lasting changes in mRNAs for markers of neuronal activity, peptide hormones and neuronal plasticity in supraoptic and paraventricular nuclei of the hypothalamus following rehydration after both DH and HS. These results indicate that a single experience of drinking HS is a memorable one, with long-term changes in gene expression accompanying this aversion to salty solutions. PMID:25111786

  5. Salt appetite is reduced by a single experience of drinking hypertonic saline in the adult rat.

    Directory of Open Access Journals (Sweden)

    Michael P Greenwood

    Full Text Available Salt appetite, the primordial instinct to favorably ingest salty substances, represents a vital evolutionary important drive to successfully maintain body fluid and electrolyte homeostasis. This innate instinct was shown here in Sprague-Dawley rats by increased ingestion of isotonic saline (IS over water in fluid intake tests. However, this appetitive stimulus was fundamentally transformed into a powerfully aversive one by increasing the salt content of drinking fluid from IS to hypertonic saline (2% w/v NaCl, HS in intake tests. Rats ingested HS similar to IS when given no choice in one-bottle tests and previous studies have indicated that this may modify salt appetite. We thus investigated if a single 24 h experience of ingesting IS or HS, dehydration (DH or 4% high salt food (HSD altered salt preference. Here we show that 24 h of ingesting IS and HS solutions, but not DH or HSD, robustly transformed salt appetite in rats when tested 7 days and 35 days later. Using two-bottle tests rats previously exposed to IS preferred neither IS or water, whereas rats exposed to HS showed aversion to IS. Responses to sweet solutions (1% sucrose were not different in two-bottle tests with water, suggesting that salt was the primary aversive taste pathway recruited in this model. Inducing thirst by subcutaneous administration of angiotensin II did not overcome this salt aversion. We hypothesised that this behavior results from altered gene expression in brain structures important in thirst and salt appetite. Thus we also report here lasting changes in mRNAs for markers of neuronal activity, peptide hormones and neuronal plasticity in supraoptic and paraventricular nuclei of the hypothalamus following rehydration after both DH and HS. These results indicate that a single experience of drinking HS is a memorable one, with long-term changes in gene expression accompanying this aversion to salty solutions.

  6. Towards evidence based emergency medicine: Best BETs from the Manchester Royal Infirmary. Bet 1. Nebulised hypertonic saline significantly decreases length of hospital stay and reduces symptoms in children with bronchiolitis.

    Science.gov (United States)

    Horner, Daniel

    2009-07-01

    A short-cut review was carried out to establish whether nebulised hypertonic saline reduces length of stay and symptoms in children with bronchiolitis. One Cochrane review was found, which addressed this question. This review is summarised. The clinical bottom line is that nebulised hypertonic saline does reduce length of stay and symptoms in children with bronchiolitis.

  7. Furosemide continuous rate infusion diluted with 5% dextrose in water or hypertonic saline in normal adult dogs: a pilot study.

    Science.gov (United States)

    Adin, D; Atkins, C; Papich, M; DeFrancesco, T; Griffiths, E; Penteado, M; Kurtz, K; Klein, A

    2017-02-01

    The goal of this study was to investigate the short-term safety and diuretic efficacy of furosemide constant rate infusion (CRI) diluted with 5% dextrose in water (D5W) compared to dilution with 2.4% hypertonic saline in healthy dogs. Six healthy dogs. Dogs were studied in a randomized, blinded, crossover manner. Furosemide 3.3mg/kg was diluted to 2.2mg/mL with either 1.5mL/kg D5W for the DEX method or with 1.0mL/kg D5W and 0.5mL/kg of 7.2% hypertonic saline for the H-SAL method. After a 0.66mg/kg furosemide IV bolus, the infusion rate was 0.3 mL/kg/hr for 5 h such that both methods delivered 0.66 mg/kg/hr (total 3.3mg/kg) furosemide in equal volume for the study duration. Urine output, water intake, central venous pressure (CVP), physical parameters, furosemide concentrations, blood and urine electrolytes, and urine aldosterone to creatinine ratio (UAldo:C) were evaluated. Measured variables were not different between methods but showed changes over time consistent with diuresis. Mean CVP decreased over time similarly for both methods. Plasma furosemide and urine concentrations were stable and not different between methods. Both furosemide CRI methods showed an increase in the UAldo:C, however, the rise was greater for DEX than for H-SAL. Diuresis was similar for both furosemide CRI methods; however, the H-SAL method induced less renin-angiotensin-aldosterone system activation than the DEX method. The absence of intravascular volume expansion based on CVP suggests that dilution of a furosemide CRI with 2.4% hypertonic saline may be well tolerated in heart failure. Copyright © 2016 Elsevier B.V. All rights reserved.

  8. Hypertonic saline/epinephrine treatment in hospitalized infants with viral bronchiolitis reduces hospitalization stay: 2 years experience.

    Science.gov (United States)

    Tal, Guy; Cesar, Karine; Oron, Anat; Houri, Sion; Ballin, Ami; Mandelberg, Avigdor

    2006-03-01

    We recently published preliminary evidence on the effectiveness of hypertonic saline in infants with viral bronchiolitis. To further establish the efficacy of nebulized hypertonic saline in these infants. In a continuing, second-year randomized, doubleblind controlled trial, an additional 41 infants (age 2.6 +/- 1 months) hospitalized with viral bronchiolitis were recruited during the winter of 2001-2002. The infants received inhalation of 1.5 mg epinephrine dissolved either in 4 ml normal (0.9%) saline (Group I, n=20) or 4 ml hypertonic (3%) saline (Group II, n=22). The therapy was repeated three times daily until discharge. Pooling our 2 years of experience (2000-2002), a total of 93 hospitalized infants with viral bronchiolitis were recruited; 45 were assigned to Group I and 48 to Group II. The clinical scores at baseline were 7.6 +/- 0.7 for Group I vs. 7.4 +/- 1.3 for Group II (P = NS). However, the clinical scores at days 1 and 2 after inhalation differed significantly between the two groups, invariably favoring Group II: 7 +/- 1 vs. 6.25 +/- 1.1 (Psaline to 1.5 mg epinephrine reduced the hospitalization stay from 3.5 +/- 1.7 days in Group I to 2.6 +/- 1.4 in Group II (Psaline to the inhalation mixture decreased hospitalization stay from 3.6 +/- 1.6 to 2.8 +/- 1.3 days (Psaline/1.5 mg epinephrine benefits hospitalized infants with viral bronchiolitis.

  9. The influence of bumetanide on the membrane potential of mouse skeletal muscle cells in isotonic and hypertonic media

    Science.gov (United States)

    van Mil, H G J; Geukes Foppen, R J; Siegenbeek van Heukelom, J

    1996-01-01

    Increasing the medium osmolality, with a non-ionic osmoticant, from control (289 mOsm) to 319 mOsm or 344 mOsm in the lumbrical muscle cell of the mouse, resulted in a depolarization of the membrane potential (Vm) of 5.9 mV and 10.9 mV, respectively.In control medium, the blockers of chloride related cotransport bumetanide and furosemide, induced a hyperpolarization of −3.6 and −3.0 mV and prevented the depolarization due to hypertonicity. When bumetanide was added in hypertonic media Vm fully repolarized to control values.In a medium of 266 mOsm, the hyperpolarization by bumetanide was absent.At 344 mOsm the half-maximal effective concentration (IC50) was 0.5 μM for bumetanide and 21 μM for furosemide.In solutions containing 1.25 mM sodium the depolarization by hypertonicity was reduced to 2.3 mV.Reducing chloride permeability, by anthracene 9 carboxylic acid (9-AC) in 289 mOsm, induced a small but significant hyperpolarization of −2.6 mV. Increasing medium osmolality to 344 mOsm enlarged this hyperpolarization significantly to −7.6 mV.In a solution of 344 mOsm containing 100 μM ouabain, the bumetanide-induced hyperpolarization of Vm was absent.The results indicate that a Na-K-2Cl cotransporter is present in mouse lumbrical muscle fibre and that its contribution to Vm is dependent on medium osmolality. PMID:9117096

  10. Comparison of equimolar doses of mannitol and hypertonic saline for the treatment of elevated intracranial pressure after traumatic brain injury: a systematic review and meta-analysis.

    Science.gov (United States)

    Li, Min; Chen, Tao; Chen, Shu-da; Cai, Jing; Hu, Ying-Hong

    2015-05-01

    The purpose of this meta-analysis was to compare the effectiveness of mannitol and hypertonic saline for reducing intracranial pressure (ICP) after traumatic brain injury (TBI).PubMed, Cochrane, Embase, and ISI Web of Knowledge databases were searched until July 3, 2014 using the terms intracranial hypertension, mannitol, and hypertonic saline. Randomized controlled trials and 2-arm prospective studies in which elevated ICP was present after TBI treated with mannitol or hypertonic saline were included. The primary outcome was the change of ICP from baseline to termination of the infusion, while the secondary outcomes were change from baseline to 30, 60, and 120 minutes after terminating the infusion and change of osmolarity from baseline to termination.A total 7 studies with 169 patients were included. The mean age of patients receiving mannitol ranged from 30.8 to 47 years, and for patients receiving hypertonic saline ranged from 35 to 47 years. A pooled difference in means = -1.69 (95% confidence interval [CI]: -2.95 to -0.44, P = 0.008) indicated that hypertonic saline reduced ICP more effectively than mannitol when compared from the baseline value to the last measurement after treatment. At 30 minutes after intervention, there was no difference in the mean ICP change between the groups, whereas at 60 minutes after intervention (pooled difference in means = -2.58, 95% CI: -4.37 to -0.80, P = .005) and 120 min after intervention (pooled difference in means = -4.04, 95% CI: -6.75 to -1.32, P = .004) hypertonic saline resulted in a significantly greater decrease in ICP. The pooled difference in means = 1.84 (95% CI: -1.64 to 5.31, P = .301) indicated no difference in serum osmolarity between patients treated with hypertonic saline or mannitol.Hypertonic saline is more effective than mannitol for reducing ICP in cases of TBI.

  11. Hypertonic (3%) saline vs 0.93% saline nebulization for acute viral bronchiolitis: a randomized controlled trial.

    Science.gov (United States)

    Sharma, Bhagwan S; Gupta, Mukesh K; Rafik, Shaikh P

    2013-08-01

    To compare the length of hospital stay (primary) and improvement in clinical severity scores (secondary) among children with bronchiolitis nebulized with 3 % hypertonic saline or 0.9% saline. Randomized double blind controlled trial. Tertiary care teaching hospital. Hospitalized children (1-24 months) with acute bronchiolitis of moderate severity. Nebulization of 4 ml of 3% hypertonic saline or 4 mL of 0.9% saline, along with 2.5 mg salbutamol, at 4-hourly intervals till the patient was ready for discharge. Baseline characteristics were similar in two groups. Median clinical severity score at admission was 6 (IQR-1) in both the groups. Clinical severity scores monitored afterwards 12-hourly till discharge (132 h) did not show statistically significant differences in 3% and 0.9% saline groups. Mean length of hospital stay (time to reach predefined clinical severity scoresaline group and 63.51 ± 21.27 h in 0.9% saline group (P=0.878). No adverse events were reported by the parents, caregivers or treating medical attendants in both groups. Nebulized 3 % saline is not superior to 0.9% saline in infants with clinically diagnosed acute bronchiolitis.

  12. Pretreatment with hypertonic NaCl protects MDCK cells against high urea concentrations.

    Science.gov (United States)

    Neuhofer, W; Müller, E; Burger-Kentischer, A; Fraek, M L; Thurau, K; Beck, F

    1998-02-01

    In antidiuresis, the cells of the renal medulla are exposed to high extracellular concentrations of NaCl and urea. Since urea equilibrates with the intracellular compartment and is known to perturb intracellular macromolecules, high urea concentrations may well disturb the structure and function of cell proteins. Two types of organic substances are believed to counteract the adverse effects of high intracellular urea concentrations: specific organic osmolytes of the trimethylamine family [betaine and glycerophosphorylcholine (GPC)], which accumulate in renal medullary cells during prolonged periods of antidiuresis and cytoprotective heat shock proteins (HSPs), the tissue content of two of which (HSPs 27 and 72) is much higher in the inner medulla than in the iso-osmotic renal cortex. To evaluate the contribution of trimethylamines and HSPs to cytoprotection in the presence of high urea concentrations, the effect of HSP induction and osmolyte accumulation prior to exposure to high urea concentrations was examined in Madin-Darby canine kidney (MDCK) cells. Accumulation of organic osmolytes and synthesis of HSP27 and HSP72 was initiated by hypertonic stress (increasing the osmolality of the medium from 290 to 600 mosmol/kg H2O by NaCl addition). Control, non-conditioned cells remained in the isotonic medium for the same period. Upon subsequent exposure to an additional 600 mM urea in the medium for 24 h, 90% of the osmotically conditioned cells but only 15% of non-conditioned cells survived. The HSP72 and trimethylamine contents of the NaCl-conditioned MDCK cells, but not HSP27 content, correlated positively with cell survival. To separate the effects of organic osmolytes and HSP72, chronically NaCl-adapted MDCK cells were returned to isotonic medium for 1 or 2 days, so depleting them of trimethylamine osmolytes. HSP72, with its longer half life, remained elevated. Subsequent exposure of these cells to 600 mM urea in the medium resulted in about 80% survival. These

  13. Investigating effects of hypertonic saline solutions on lipid monolayers at the air-water interface

    KAUST Repository

    Nava Ocampo, Maria F.

    2017-05-01

    More than 70,000 people worldwide suffer from cystic fibrosis, a genetic disease characterized by chronic accumulation of mucus in patients’ lungs provoking bacterial infections, and leading to respiratory failure. An employed age-old treatment to prevent the symptoms of the disease is inhalation of hypertonic saline solution, NaCl at concentrations higher than in the human body (~150 mM). This procedure clears the mucus in the lungs, bringing relief to the patient. However, the biophysical mechanisms underlying this process are not entirely clear. We undertook a new experimental approach to understand the effects of sprayed saline solutions on model lung surfactants towards understanding the mechanisms of the treatment. The surface of lungs contains mainly 1,2-Dipalmitol-sn-glycero-3-phosphocoline (DPPC). As previously assumed by others, we considered that monolayer of DPPC at the air-water interface serves as model system for the lungs surface; we employed a Langmuir-Blodgett (LB) trough and PM-IRRAS to measure surface-specific infrared spectra of the surfactant monolayers and effects on the interfacial tensions. We investigated spraying hyper-saline solutions onto surfactant monolayers at the airwater interface in two parts: (i) validation of our methodology and techniques with stearic acid and (ii) experiments with DPPC monolayers at the air-water interface. Remarkably, when micro-droplets of NaCl were sprayed to the monolayer of stearic acid, we observed enhanced organization of the surfactant, interpreted from the intensities of the CH2 peaks in the surface-specific IR spectra. However, our results with DPPC monolayers didn’t show an effect with the salt added as aerosol, possibly indicating that the experimental methodology proposed is not adequate for the phenomena studied. In parallel, we mimicked respiratory mucous by preparing salt solutions containing 1% (wt%) agar and measured effects on their viscosities. Interestingly, we found that NaCl was much

  14. Abnormal increase in urinary aquaporin-2 excretion in response to hypertonic saline in essential hypertension

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    Graffe Carolina

    2012-03-01

    Full Text Available Abstract Background Dysregulation of the expression/shuttling of the aquaporin-2 water channel (AQP2 and the epithelial sodium channel (ENaC in renal collecting duct principal cells has been found in animal models of hypertension. We tested whether a similar dysregulation exists in essential hypertension. Methods We measured urinary excretion of AQP2 and ENaC β-subunit corrected for creatinine (u-AQP2CR, u-ENaCβ-CR, prostaglandin E2 (u-PGE2 and cyclic AMP (u-cAMP, fractional sodium excretion (FENa, free water clearance (CH2O, as well as plasma concentrations of vasopressin (AVP, renin (PRC, angiotensin II (Ang II, aldosterone (Aldo, and atrial and brain natriuretic peptide (ANP, BNP in 21 patients with essential hypertension and 20 normotensive controls during 24-h urine collection (baseline, and after hypertonic saline infusion on a 4-day high sodium (HS diet (300 mmol sodium/day and a 4-day low sodium (LS diet (30 mmol sodium/day. Results At baseline, no differences in u-AQP2CR or u-ENaCβ-CR were measured between patients and controls. U-AQP2CR increased significantly more after saline in patients than controls, whereas u-ENaCβ-CR increased similarly. The saline caused exaggerated natriuretic increases in patients during HS intake. Neither baseline levels of u-PGE2, u-cAMP, AVP, PRC, Ang II, Aldo, ANP, and BNP nor changes after saline could explain the abnormal u-AQP2CR response. Conclusions No differences were found in u-AQP2CR and u-ENaCβ-CR between patients and controls at baseline. However, in response to saline, u-AQP2CR was abnormally increased in patients, whereas the u-ENaCβ-CR response was normal. The mechanism behind the abnormal AQP2 regulation is not clarified, but it does not seem to be AVP-dependent. Clinicaltrial.gov identifier NCT00345124.

  15. Hypertonic saline (HS) for acute bronchiolitis: Systematic review and meta-analysis.

    Science.gov (United States)

    Maguire, Chin; Cantrill, Hannah; Hind, Daniel; Bradburn, Mike; Everard, Mark L

    2015-11-23

    Acute bronchiolitis is the commonest cause of hospitalisation in infancy. Currently management consists of supportive care and oxygen. A Cochrane review concluded that, "nebulised 3 % saline may significantly reduce the length of hospital stay". We conducted a systematic review of controlled trials of nebulised hypertonic saline (HS) for infants hospitalised with primary acute bronchiolitis. Searches to January 2015 involved: Cochrane Central Register of Controlled Trials; Ovid MEDLINE; Embase; Google Scholar; Web of Science; and, a variety of trials registers. We hand searched Chest, Paediatrics and Journal of Paediatrics on 14 January 2015. Reference lists of eligible trial publications were checked. Randomised or quasi-randomised trials which compared HS versus either normal saline (+/- adjunct treatment) or no treatment were included. Eligible studies involved children less than 2 years old hospitalised due to the first episode of acute bronchiolitis. Two reviewers extracted data to calculate mean differences (MD) and 95 % Confidence Intervals (CIs) for length of hospital stay (LoS-primary outcome), Clinical Severity Score (CSS) and Serious Adverse Events (SAEs). Meta-analysis was undertaken using a fixed effect model, supplemented with additional sensitivity analyses. We investigated statistical heterogeneity using I(2). Risk of bias, within and between studies, was assessed using the Cochrane tool, an outcome reporting bias checklist and a funnel plot. Fifteen trials were included in the systematic review (n = 1922), HS reduced mean LoS by 0.36, (95 % CI 0.50 to 0.22) days, but with considerable heterogeneity (I(2) = 78 %) and sensitivity to alternative analysis methods. A reduction in CSS was observed where assessed [n = 516; MD -1.36, CI -1.52, -1.20]. One trial reported one possible intervention related SAE, no other studies described intervention related SAEs. There is disparity between the overall combined effect on LoS as compared with the

  16. The Impact of Cranios acral Therapy on Inhibition of Hypertonicity of the Lower Limb in Children with Dipelgia Spastic Cerebral Palsy of 3-8 Years Old

    Directory of Open Access Journals (Sweden)

    Ebrahim Pishyareh

    2001-01-01

    Full Text Available Objective: The purpose of this study was to assess the facilitating impact of craniosacral therapy on inhibition of hypertonicity of the lower limb in children with spastic dipelgic cerebral palsy. Materials & Methods: 100 children with cerebral palsy were studied and 36 children selected, aged 3 to 8 years, were randomly assigned to a control and an experimental group. Muscle tone was assessed using modified Ashworth scale, passive range of motion by goniometer, neurodevelopment level by Bobath scale. All children were Pre-Post-tested with in an interval of three months. Results: A further finding of the analyses revealed that significant reduction was observed in hypertonicity of the hip adductors and the ankle plantar flexors. Significant increase was observed in passive range of motion of the hip abduction and the ankle dorsiflexion. There was found no significant difference of reduction in hypertonicity of the knee flexors, of increase in passive range of motion of the knee extensor, of improvement neurodevelopmental level. Meaningful relationship was observed between reduction hypertonicity of the hip adductors and improvement of the neurodevelopmental level. Conclusion: It should be mentioned that in all above cases the was set at 5%. Implications for clinical O.T. are mentioned.

  17. Effects of Hypertonic Saline Solution on Clinical Parameters, Serum Electrolytes and Plasma Volume in the Treatment of Haemorrhagic Septicaemia in Buffaloes

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    M. Arif Zafar*, G. Muhammad, Zafar Iqbal1 and M. Riaz2

    2010-04-01

    Full Text Available This study was conducted to determine the efficacy of hypertonic saline solution (HSS along with antibiotic (ceftiofur HCl and non-steroidal anti-inflammatory drug (ketoprofen in the treatment of haemorrhagic septicaemia in buffaloes. For this purpose, 50 buffaloes suffering from haemorrhagic septicaemia were randomly divided in two equal groups A and B. Group A served as control and was treated with ceftiofur HCl (IM and ketoprofen (IV @ 6 and 2 mg/Kg BW, respectively, for five days. Buffaloes of group B were administered with rapid intravenous infusion of hypertonic saline solution (7.5% NaCl @ 4 ml/Kg BW once in combination with ceftiofur HCl and ketoprofen. Animals were monitored for 24 hours after initiation of treatment. Clinical parameters, serum electrolytes, plasma volume and survival index were recorded at different intervals after treatment. Survival rate (80% in group B was significantly higher (P<0.05 than 48% in group A. The heart rate and respiration rate recovered more effectively in the buffaloes administered with treatment protocol B. Plasma volume was 98% which was almost normal within 24 hours after the infusion of hypertonic saline solution to the animals of group B. It was concluded from the study that hypertonic saline solution as an adjunct to antibiotic and a non-steroidal anti-inflammatory drug more efficiently improved respiration and heart rates and effectively restored plasma volume in resuscitating the buffaloes from haemorrhagic septicaemia than the conventional treatment.

  18. Renal response to graded intravenous hypertonic NaCl infusion in healthy and hypertensive subjects:dose-related impairment in distal NaCl reabsorption

    NARCIS (Netherlands)

    Radó, J.P.; Juhos, E.; Dorhout Mees, E.J.

    The effects of graded acute intravenous hypertonic NaCl loads on the baseline relationship between osmolal clearance and free water reabsorption established during high NaCl dietary intake and on the fractional excretion of various ions were investigated in 15 healthy subjects and in 12 “normal

  19. Effect of equiosmolar solutions of hypertonic sodium lactate versus mannitol in craniectomy patients with moderate traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Muhammad R. Ahmad

    2014-03-01

    Full Text Available Background: Brain relaxation and prevention from cerebral edema are essential in craniectomy. Osmotherapy with 20% mannitol are generally used to withdraw fluid from the brain parenchyma, however may cause hemodynamic fluctuation, due to increase diuresis. On the other hand 0.5 M hypertonic sodium lactate (HSL appeared as an alternative of osmotherapy. This study  aimed to observe the effect of hypertonic sodium lactate (HSL on brain relaxation, blood glucose level and hemodynamic variables in craniectomy due to moderate brain injury.Methods: A randomized controlled study of 42 cases with moderate brain injury, aged 18 - 65 years, ASA 1 - 3, between September-November 2012, was carried out. The patients were divided into group M (n = 21 that received 2.5 mL/kg 20% mannitol and group HSL that received 2.5 mL/kg 0.5M HSL. Mean arterial pressures (MAP, central venous pressures (CVP and urine output were measured after induction, and at 15, 30, 45, 60 min after infusion. Brain relaxation was assessed at a four-point scale after opening the duramater. Blood glucose levels were measured before induction and at 60 min after the infusion. Appropriate statistical tests were used for comparison. Unpaired t-test was used to compare hemodynamic and blood glucose level, and chi-square was used to compare brain relaxation.Results: MAP at 60 minute was significantly higher in HSL group than M group (81.66 ± 7.85 vs 74.33 ± 6.18 mmHg; p = 0.002. There was no difference in brain relaxation (p = 0.988. A significant increase in blood glucose level was observed in group HSL (17.95 ± 11.46 mg/dL; p = 0.001.Conclusion: Half-molar HSL was as effective as 20% mannitol in producing brain relaxation, with better hemodynamic stability and gave significant increase in blood glucose level.Keywords: brain relaxation, hemodynamic, hypertonic sodium lactate, mannitol, traumatic brain injury

  20. The association of hypernatremia and hypertonic saline irrigation in hepatic hydatid cysts: A case report and retrospective study.

    Science.gov (United States)

    Zeng, Rujun; Wu, Renhua; Lv, Qingguo; Tong, Nanwei; Zhang, Yuwei

    2017-09-01

    Hypernatremia is a rare but fatal complication of hypertonic saline (HS) irrigation in hepatic hydatid disease. It needs careful monitoring and treatment. A 28-year-old woman with hepatic hydatid cysts who received operation treatment developed electrolyte disturbances. We also conducted a retrospective study about influence of HS application on electrolytes in patients with hepatic hydatid disease receiving surgery. Hypernatremia, developed after HS irrigation. Normal saline, 5% dextrose and other supportive treatment were administered. In the retrospective study, a comparison of electrolyte and glucose fluctuation was made among different HS application groups. The patient developed hypernatremia after irrigation with HS and died from severe complications. Although some cases of complications are found, no significant relationship between HS irrigation and hypernatremia was reported according to the retrospective study. Hypernatremia after HS irrigation remains rare but might cause severe complications. Monitoring and appropriate treatment are needed to improve prognosis.

  1. A randomized trial of nebulized 3% hypertonic saline with salbutamol in the treatment of acute bronchiolitis in hospitalized infants.

    Science.gov (United States)

    Flores, Pedro; Mendes, Ana Luisa; Neto, Ana S

    2016-04-01

    Acute bronchiolitis is a common disorder of infants that often results in hospitalization. Apart from supportive care, no therapy has been shown to influence the course of the disease, except for a possible effect of nebulized hypertonic saline (HS). To determine whether this does have beneficial effects on length of stay in hospital or on severity scores, we undertook a double-blind, randomized, controlled trial in a pediatric department of a Portuguese hospital. Previously healthy infants, younger than 12 months, hospitalized with mild-to-moderate acute viral bronchiolitis were randomized to receive either nebulized 3% (hypertonic, HS) or 0.9% (normal, NS) saline during their entire hospital stay. Primary endpoints were: length of hospital stay and severity scores on each day of hospitalization. Need for supplemental oxygen, further add-on medications and adverse effects were also analyzed. Sixty-eight patients completed the study (HS: 33; NS: 35). The median length of hospital stay did not differ between groups: HS: 5.6 ± 2.3 days; NS: 5.4 ± 2.1 days (P = 0.747). We found no difference between groups in severity scores from day 1 to day 4. There were no differences in need for supplemental oxygen or add-on medications. Patients in HS group had significantly more cough (46% vs. 20%, P = 0.025) and rhinorrhoe (58% vs. 31%, P = 0.30). This study does not support the use of nebulized HS over NS in therapy of hospitalized children with mild-to-moderate acute viral bronchiolitis. © 2015 Wiley Periodicals, Inc.

  2. Evaluating the effect of administrating hypertonic and isotonic saline solutions on clinical improvement, serum electrolyte concentrations and renal function of calves affected by diarrhea

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    A Hasanpour

    2009-11-01

    This study was conducted on 40 calves under the age of one mouth with 30 calves affected by diarrhea allocated to 3 treatment groups of 10 calves each and the control group consisting of 10 calves. The control group received neither treatment nor any injections. In the first treatment group, only antibiotics were administered without any fluid therapy. In the second treatment group, apart from antibiotic therapy of diarrhea, hypertonic saline solution (7.5% was administered at a dose of 5 ml/kg as slow intravenous infusion alongside oral ORS solution whereas in the third treatment group isotonic saline solution (0.9% was given intravenously according to the formula (Body weight × %Dehydration alongside oral ORS solution. In all groups, clinical examination and blood sampling was undertaken at times 0, 1, 2, 8 and 24 hours following treatment. At time 0, the diarrhea had resulted in clinical and laboratory signs such as a fever, the dehydration, tachycardia, oligopnea, increased packed sell volume, hypernatremia, hyperchloremia, hyperkalemia, hyperphosphatemia, hypercalcemia, increased serum creatinine and BUN values. Following treatment, fever subsided and the dehydration was corrected and this correction occurred faster in calves which had received hypertonic saline solution. Correction of sodium, potassium, chloride, phosphorus and calsium imbalance occurred faster in patients which were treated by hypertonic solution. Fluid therapy with saline solutions prevented the increase in serum creatinine and BUN values. In conclusion, the administration of hypertonic saline solutions leads to much faster and more reliable clinical improvement and electrolyte imbalance correction in calves affected by diarrhea.

  3. Selective response of human airway epithelia to luminal but not serosal solution hypertonicity. Possible role for proximal airway epithelia as an osmolality transducer

    DEFF Research Database (Denmark)

    Willumsen, Niels J.; Davis, C.W.; Boucher, R.C.

    1994-01-01

    exposure (10 min) to 430 mosM luminal solution elicited no regulation of any parameter. Optical measurements revealed a reduction in the thickness of preparations only in response to luminal hypertonic solutions. We conclude that (a) airway epithelial cells exhibit asymmetric water transport properties......- secretion; and (d) cell volume loss increases the resistance of the paracellular path. We speculate that these properties configure human nasal epithelium to behave as an osmotic sensor, transducing information about luminal solutions to the airway wall....

  4. Hypertonic saline solution reduces mesenteric microcirculatory dysfunctions and bacterial translocation in a rat model of strangulated small bowel obstruction.

    Science.gov (United States)

    Luiz Zanoni, Fernando; Costa Cruz, José Walber Miranda; Martins, Joilson Oliveira; Benabou, Simon; Vicente Greco, Karin; Ramos Moreno, Ana Carolina; Baquerizo Martinez, Marina; Ferraro Calderaro, Franco; Rocha e Silva, Mauricio; Sannomiya, Paulina

    2013-07-01

    We examined the effects of hypertonic saline (HS) on inflammatory, metabolic variables, and bacterial translocation (BT) in rats submitted to intestinal obstruction and ischemia (IO). Male Wistar rats were submitted to IO and treated, 2 h thereafter, with lactated Ringer's (LR) (4 mL/kg per 5 min, i.v.) or HS (7.5% NaCl, 4 mL/kg per 5 min, i.v.). Twenty-four hours after IO, rats were also submitted to enterectomy/enteroanastomosis to resection of necrotized small bowel. Leukocyte-endothelial interactions were investigated by intravital microscopy and the expression of P-selectin and intercellular adhesion molecule 1 by immunohistochemistry. Bacterial cultures of mesenteric lymph nodes, liver, spleen, and blood were used to evaluate BT. Levels of chemokines (cytokine-induced neutrophil chemoattractants 1 and 2), insulin, and corticosterone were determined by enzyme-linked immunosorbent assay. Intestinal histology, serum urea and creatinine levels, and hepatic enzymes activities were performed to evaluate local and remote damage. Relative to IO and LR-treated rats, which exhibited increases in the number of rolling (1.5-fold), adhered (3.5-fold) and migrated (9.0-fold) leukocytes, and increased expression of P-selectin (3-fold) and intercellular adhesion molecule 1 (3-fold) on mesenteric microcirculation, treatment with HS followed by enterectomy reduced leukocyte-endothelial interactions and expression of both adhesion molecules to values attained in sham rats. Serum chemokines were normalized after treatment with both solutions followed by enterectomy. Hypertonic saline-treated rats demonstrated a significant reduction in BT to 50% in liver and spleen samples and bacteremia (14%), compared with 82% of BT in liver and spleen samples of IO and LR-treated rats and bacteremia (57%). Local intestinal damage was attenuated, and renal and hepatic function preserved by treatment with HS followed by enterectomy. Survival rate increased to 86% up to 15 days. Data presented

  5. Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis: A Randomized Clinical Trial.

    Science.gov (United States)

    Angoulvant, François; Bellêttre, Xavier; Milcent, Karen; Teglas, Jean-Paul; Claudet, Isabelle; Le Guen, Christèle Gras; de Pontual, Loïc; Minodier, Philippe; Dubos, François; Brouard, Jacques; Soussan-Banini, Valérie; Degas-Bussiere, Vanessa; Gatin, Amélie; Schweitzer, Cyril; Epaud, Ralph; Ryckewaert, Amélie; Cros, Pierrick; Marot, Yves; Flahaut, Philippe; Saunier, Pascal; Babe, Philippe; Patteau, Géraldine; Delebarre, Mathilde; Titomanlio, Luigi; Vrignaud, Bénédicte; Trieu, Thanh-Van; Tahir, Abdelilah; Regnard, Delphine; Micheau, Pascale; Charara, Oussama; Henry, Simon; Ploin, Dominique; Panjo, Henri; Vabret, Astrid; Bouyer, Jean; Gajdos, Vincent

    2017-08-07

    Acute bronchiolitis is the leading cause of hospitalization among infants. Previous studies, underpowered to examine hospital admission, have found a limited benefit of nebulized hypertonic saline (HS) treatment in the pediatric emergency department (ED). To examine whether HS nebulization treatment would decrease the hospital admission rate among infants with a first episode of acute bronchiolitis. The Efficacy of 3% Hypertonic Saline in Acute Viral Bronchiolitis (GUERANDE) study was a multicenter, double-blind randomized clinical trial on 2 parallel groups conducted during 2 bronchiolitis seasons (October through March) from October 15, 2012, through April 15, 2014, at 24 French pediatric EDs. Among the 2445 infants (6 weeks to 12 months of age) assessed for inclusion, 777 with a first episode of acute bronchiolitis with respiratory distress and no chronic medical condition were included. Two 20-minute nebulization treatments of 4 mL of HS, 3%, or 4 mL of normal saline (NS), 0.9%, given 20 minutes apart. Hospital admission rate in the 24 hours after enrollment. Of the 777 infants included in the study (median age, 3 months; interquartile range, 2-5 months; 468 [60.2%] male), 385 (49.5%) were randomized to the HS group and 387 (49.8%) to the NS group (5 patients did not receive treatment). By 24 hours, 185 of 385 infants (48.1%) in the HS group were admitted compared with 202 of 387 infants (52.2%) in the NS group. The risk difference for hospitalizations was not significant according to the mixed-effects regression model (adjusted risk difference, -3.2%; 95% CI, -8.7% to 2.2%; P = .25). The mean (SD) Respiratory Distress Assessment Instrument score improvement was greater in the HS group (-3.1 [3.2]) than in the NS group (-2.4 [3.3]) (adjusted difference, -0.7; 95% CI, -1.2 to -0.2; P = .006) and similarly for the Respiratory Assessment Change Score. Mild adverse events, such as worsening of cough, occurred more frequently among children in the HS group

  6. Reposição de volume na sepse com solução salina hipertônica Sepsis volume reposition with hypertonic saline solution

    Directory of Open Access Journals (Sweden)

    Gilberto Friedman

    2008-09-01

    Full Text Available Esta revisão discute os efeitos hemodinâmicos e imunomoduladores da solução hipertônica em choque experimental e em pacientes com sepse. Comentamos sobre os mecanismos de ação da solução hipertônica, recorrendo a dados sobre choque hemorrágico e séptico. Atuações específicas da solução salina hipertônica aplicáveis a sepse grave e choque séptico são enfatizadas. Os dados disponíveis corroboram os benefícios em potencial da infusão de solução salina hipertônica em vários aspetos da fisiopatologia da sepse, inclusive hipoperfusão dos tecidos, consumo reduzido de oxigênio, disfunção endotelial, depressão miocárdica e presença de um amplo elenco de citocinas próinflamatórias e várias espécies de oxidantes. Uma terapia que, ao mesmo tempo, bloqueie os componentes prejudiciais da sepse terá um impacto no seu tratamento. Estudos prospectivos adequadamente desenhados poderão no futuro comprovar o papel benéfico da solução salina hipertônica.The present review discusses the hemodynamic and immune-modulatory effects of hypertonic saline in experimental shock and in patients with sepsis. We comment on the mechanisms of action of hypertonic saline, calling upon data in hemorrhagic and septic shock. Specific actions of hypertonic saline applicable to severe sepsis and septic shock are highlighted. Data available support potential benefits of hypertonic saline infusion in various aspects of the pathophysiology of sepsis, including tissue hypoperfusion, decreased oxygen consumption, endothelial dysfunction, cardiac depression, and the presence of a broad array of pro-inflammatory cytokines and various oxidant species. A therapy that simultaneously blocks the damaging components of sepsis will have an impact on the management of sepsis. Proper designed prospective studies may prove a beneficial role for hypertonic saline solution in the future.

  7. The safety and efficacy of inhaled dry powder mannitol as a bronchial provocation test for airway hyperresponsiveness: a phase 3 comparison study with hypertonic (4.5% saline

    Directory of Open Access Journals (Sweden)

    Freed-Martens Ruth

    2005-12-01

    Full Text Available Abstract Background Inhaled mannitol is a new bronchial provocation test (BPT developed to improve portability and standardisation of osmotic challenge testing. Osmotic challenge tests have an advantage over the traditional methods of measuring airway hyperresponsiveness using methacholine as they demonstrate higher specificity to identify asthma and thus the need for treatment with inhaled corticosteroids (ICS. The safety and the efficacy of mannitol (M as a BPT to measure airway hyperresponsiveness were compared to hypertonic (4.5% saline (HS in people both with and without signs and symptoms of asthma. Methods A phase III, multi-centre, open label, operator-blinded, crossover design, randomised trial, with follow-up. Asthmatics and non-asthmatics (6–83 yr were recruited and 592 subjects completed the study. Mannitol was delivered using a low resistance dry powder inhaler and HS was delivered using an ultrasonic nebuliser. The FEV1 was measured 60 seconds after each dose of mannitol (5,10,20,40,80,160,160,160 mg and after each exposure to HS (0.5,1.0,2.0,4.0,8.0 minutes. A 15% fall in FEV1 defined a positive test. Adverse events were monitored and diaries kept for 7 days following the tests. Results Mean pre-test FEV1 (mean ± SD was 95.5 ± 14% predicted. 296 were positive to mannitol (M+ and 322 positive to HS (HS+. A post study physician conducted clinical assessment identified 82.3% asthmatic (44% classified mild and 17.7% non-asthmatic. Of those M+, 70.1% were taking ICS and of those mannitol negative (M-, 81.1 % were taking ICS. The % fall in FEV1 for mannitol in asthmatics was 21.0% ± 5.7 and for the non-asthmatics, 5.5% ± 4.8. The median PD15 M was 148 mg and PD15 HS 6.2 ml. The sensitivity of M to identify HS+ was 80.7% and the specificity 86.7%. The sensitivity of M compared with the clinical assessment was 59.8% and specificity 95.2% and increased to 88.7% and 95.0% respectively when the M- subjects taking ICS were excluded

  8. Increased long-latency reflex activity as a sufficient explanation for childhood hypertonic dystonia: a neuromorphic emulation study

    Science.gov (United States)

    Sohn, Won J.; Niu, Chuanxin M.; Sanger, Terence D.

    2015-06-01

    Objective. Childhood dystonia is a movement disorder that interferes with daily movements and can have a devastating effect on quality of life for children and their families. Although injury to basal ganglia is associated with dystonia, the neurophysiological mechanisms leading to the clinical manifestations of dystonia are not understood. Previous work suggested that long-latency stretch reflex (LLSR) is hyperactive in children with hypertonia due to secondary dystonia. We hypothesize that abnormal activity in motor cortices may cause an increase in the LLSR leading to hypertonia. Approach. We modeled two possibilities of hyperactive LLSR by either creating a tonic involuntary drive to cortex, or increasing the synaptic gain in cortical neurons. Both models are emulated using programmable very-large-scale-integrated-circuit hardware to test their sufficiency for producing dystonic symptoms. The emulation includes a joint with two Hill-type muscles, realistic muscle spindles, and 2,304 Izhikevich-type spiking neurons. The muscles are regulated by a monosynaptic spinal pathway with 32 ms delay and a long-latency pathway with 64 ms loop-delay representing transcortical/supra-spinal connections. Main results. When the limb is passively stretched, both models produce involuntary resistance with increased antagonist EMG responses similar to human data; also the muscle relaxation is delayed similar to human data. Both models predict reduced range of motion in voluntary movements. Significance. Although our model is a highly simplified and limited representation of reflex pathways, it shows that increased activity of the LLSR is by itself sufficient to cause many of the features of hypertonic dystonia.

  9. Unilateral fluid absorption and effects on peak power after ingestion of commercially available hypotonic, isotonic, and hypertonic sports drinks.

    Science.gov (United States)

    Rowlands, David S; Bonetti, Darrell L; Hopkins, Will G

    2011-12-01

    Isotonic sports drinks are often consumed to offset the effects of dehydration and improve endurance performance, but hypotonic drinks may be more advantageous. The purpose of the study was to compare absorption and effects on performance of a commercially available hypotonic sports drink (Mizone Rapid: 3.9% carbohydrate [CHO], 218 mOsmol/kg) with those of an isotonic drink (PowerAde: 7.6% CHO, 281 mOsmol/ kg), a hypertonic drink (Gatorade: 6% CHO, 327 mOsmol/kg), and a noncaloric placebo (8 mOsmol/kg). In a crossover, 11 cyclists consumed each drink on separate days at 250 ml/15 min during a 2-hr preload ride at 55% peak power followed by an incremental test to exhaustion. Small to moderate increases in deuterium oxide enrichment in the preload were observed with Mizone Rapid relative to PowerAde, Gatorade, and placebo (differences of 88, 45, and 42 parts per million, respectively; 90% confidence limits ±28). Serum osmolality was moderately lower with Mizone Rapid than with PowerAde and Gatorade (-1.9, -2.4; mOsmol/L; ±1.2 mOsmol/L) but not clearly different vs. placebo. Plasma volume reduction was small to moderate with Mizone Rapid, PowerAde, and Gatorade relative to placebo (-1.9%, -2.5%, -2.9%; ± 2.5%). Gut comfort was highest with Mizone Rapid but clearly different (8.4% ± 4.8%) only vs PowerAde. Peak power was highest with Mizone Rapid (380 W) vs. placebo and other drinks (1.2-3.0%; 99% confidence limits ±4.7%), but differences were inconclusive with reference to the smallest important effect (~1.2%). The outcomes are consistent with fastest fluid absorption with the hypotonic sports drink. Further research should determine whether the effect has a meaningful impact on performance.

  10. Hypertonic saline as a therapy for pediatric concussive pain: a randomized controlled trial of symptom treatment in the emergency department.

    Science.gov (United States)

    Lumba-Brown, Angela; Harley, Jim; Lucio, Simon; Vaida, Florin; Hilfiker, Mary

    2014-03-01

    Three-percent hypertonic saline (HTS) is a hyperosmotic therapy used in pediatric traumatic brain injury to treat increased intracranial pressure and cerebral edema. It also promotes plasma volume expansion and cerebral perfusion pressure, immunomodulation, and anti-inflammatory response. We hypothesized that HTS will improve concussive symptoms of mild traumatic brain injury. The study was a prospective, double-blind, randomized controlled trial. Children, 4 to 7 years of age with a Glasgow Coma Scale score greater than 13, were enrolled from a pediatric emergency department following closed-head injury upon meeting Acute Concussion Evaluation criteria with head pain. Patients were randomized to receive 10 mL/kg of HTS or normal saline (NS) over 1 hour. Self-reported pain values were obtained using the Wong-Baker FACES Pain Rating Scale initially, immediately following fluids, and at 2 to 3 days of discharge. The primary outcome measure was change in self-reported pain following fluid administration. Secondary outcome measures were a change in pain and postconcussive symptoms within 2 to 3 days of fluid administration. We used an intention-to-treat analysis. Forty-four patients, ranging from 7 to 16 years of age with comparable characteristics, were enrolled in the study; 23 patients (52%) received HTS, and 21 (48%) received NS. There was a significant difference (P pain following fluid administration between the HTS group (mean improvement = 3.5) and the NS group (mean improvement = 1.1). There was a significant difference (P = 0.01) identified in the self-reported improvement of pain at 2 to 3 days after treatment between the HTS group (mean improvement = 4.6) and the NS group (mean improvement = 3.0). We were unable to determine a difference in other postconcussive symptoms following discharge. Three-percent HTS is more effective than NS in acutely reducing concussion pain in children.

  11. Nebulised hypertonic saline (3%) among children with mild to moderately severe bronchiolitis--a double blind randomized controlled trial.

    Science.gov (United States)

    Khanal, Aayush; Sharma, Arun; Basnet, Srijana; Sharma, Pushpa Raj; Gami, Fakir Chandra

    2015-09-10

    To Assess the efficacy of nebulised hypertonic saline (HS) (3%) among children with mild to moderately severe bronchiolitis. Infants aged 6 weeks to 24 months, with a first episode of wheezing and Clinical Severity scores (Arch Dis Child 67:289-93, 1992) between 1 and 8, were enrolled over 4 months duration. Those with severe disease, co-morbidities, prior wheezing, recent bronchodilator and steroid use were excluded. Patients were randomized in a double-blind fashion, to receive two doses of nebulized 3% HS (Group 1) or 0.9% normal saline (Group 2) with 1.5 mg of L-Epineprine, delivered 30 min apart. Parents were contacted at 24 h and 7 days. The principal outcome measure was the mean change in clinical severity score at the end of 2 h of observation. A total of 100 infants (mean age 9.6 months, range 2-23 months; 61 % males) were enrolled. Patients in both groups had mild to moderately severe disease at presentation. On an intention-to-treat basis, the infants in the HS group had a significant reduction (3.57 ± 1.41) in the mean clinical severity score compared to those in the NS group (2.26 ± 1.15); [p saline for outpatient management of infants with mild to moderately severe viral bronchiolitis in improving Clinical Severity Scores, facilitating early Out-Patient Department discharge and preventing hospital re-visits and admissions in the 24 h of presentation. Clinicaltrials.gov NCTID012766821. Registered on January 12, 2011.

  12. Seven percent hypertonic saline--0.1% hyaluronic acid in infants with mild-to-moderate bronchiolitis.

    Science.gov (United States)

    Nenna, Raffaella; Papoff, Paola; Moretti, Corrado; De Angelis, Daniela; Battaglia, Massimo; Papasso, Stefano; Bernabucci, Mariangela; Cangiano, Giulia; Petrarca, Laura; Salvadei, Serena; Nicolai, Ambra; Ferrara, Marianna; Bonci, Enea; Midulla, Fabio

    2014-09-01

    Our study was aimed to evaluate the efficacy of 7% hypertonic saline and 0.1% hyaluronic acid (7% HS-HA) given by inhalation, in infants hospitalized for mild-to-moderate bronchiolitis. In a double-blind controlled study, 39 infants (23 boys) saline (NS) (n:18) at a dose of 2.5 ml twice a day for 3 days. All infants were assigned a clinical severity score at admission and four times daily during hospitalization. Main outcome measures were number of days hospitalization, safety and daily reduction in the severity score. No difference was found between the two groups for clinical severity score at admission. One child in the study group and two in the NS group interrupted the study protocol; 19% of infants in the study group and 11% in the NS group had mild cough after the aerosol. The length of stay in the control group and treatment groups were 4.8 ± 1.5 versus 4.1 ± 1.9 days, respectively (P = 0.09). There was a trend for shortening the hospitalization days in the treatment group by 14.6%. The use of NS in the control group was identified as an independent risk factor for length of hospital stay using the multivariate logistic regression model (P = 0.04). No difference was observed between the two groups for the clinical score reduction during the first 3 days hospitalization. 7% HS-HA is a safe and effective therapy in treating infants hospitalized for mild-to-moderate bronchiolitis. © 2013 Wiley Periodicals, Inc.

  13. Effectiveness of 3% hypertonic saline nebulization in acute bronchiolitis among Indian children: A quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Harsh V Gupta

    2016-01-01

    Full Text Available Objective: To compare the effects of 3% hypertonic saline (HS and 0.9% normal saline with nebulized 0.9% normal saline with salbutamol in patients of acute viral bronchiolitis. Materials and Methods: Participants were divided into three groups, that is, 3% HS group, 0.9% normal saline group and 0.9% saline with salbutamol group. Four doses at interval of 6 h were given daily until discharge. Average CS score and length of hospital stay were compared. One-way analysis of variance paired t-test and Chi-square test were utilized for statistical analysis. Results: The mean ages of the patients in three groups were 6.03 ± 3.71, 5.69 ± 3.34 and 5.48 ± 3.35 respectively. The 3rd day CS scores for all the groups were 1.0 ± 1.1, 1.9 ± 1.1 and 3.3 ± 0.5 respectively (P = 0.000. The average length of hospital stay was 3.4 ± 1.7, 3.7 ± 1.9 and 4.9 ± 1.4 days respectively (P = 0.001. Conclusion: The present study concludes that 3% HS nebulization (without additional bronchodilators is an effective and safe treatment for nonasthmatic, moderately ill patients of acute bronchiolitis. The economic benefit of this comparably priced modality of treatment can be enormous in terms of hospital costs with parents returning to work sooner.

  14. Effect of inhaled hypertonic saline on hospital admission rate in children with viral bronchiolitis: a randomized trial.

    Science.gov (United States)

    Kuzik, Brian A; Flavin, Michael P; Kent, Steven; Zielinski, David; Kwan, Charisse W; Adeleye, Adetayo; Vegsund, Bjorn C; Rossi, Carlo

    2010-11-01

    We sought to determine whether inhaled 3% hypertonic saline (HS) reduces admission to hospital in ambulatory children with moderately severe viral bronchiolitis. Secondary objectives compared changes in respiratory scores before and after treatment and assessed the need for unscheduled medical intervention within 7 days. Children under the age of 2 years presenting with moderately severe viral bronchiolitis to the emergency department of 4 general hospitals from November 2008 to March 2009 were randomly assigned to receive 3 consecutive 4-mL doses of nebulized 3% HS (treatment group) or 0.9% normal saline (NS; control group) in a double blind fashion, each coadministered with 1 mg salbutamol. Outcome measures included the difference in hospital admission rate and changes in respiratory distress scores. A total of 81 children (mean age 8.9 mo, range 0.7-22 mo) were assessed over 88 visits on an intention-to-treat basis. No statistically significant differences were found between treatment groups. Children in the HS group had a nonsignificant trend toward greater improvement compared with NS controls with a same-day admission rate of 18% (95% confidence interval [CI] 9%-32%) versus 27% (95% CI 16%-42%), respectively. Respiratory Assessment Change Scores (RACS) favoured the HS group over NS controls (mean RACS 4.7 [95% CI 3.6-5.8] v. 3.7 [95% CI 2.5-4.9], respectively), although the CIs overlap and these differences were not statistically significant. The short-term use of nebulized 3% HS did not result in any statistically significant benefits, although a nonsignificant trend toward a decrease in admission rate and improvement in respiratory distress was found. A larger study would be required to determine whether these trends arise from a clinically relevant treatment effect.

  15. Effects of simulated weightlessness on intramuscular hypertonic saline induced muscle nociception and spinal Fos expression in rats.

    Science.gov (United States)

    Lei, Jing; Pertovaara, Antti; You, Hao-Jun

    2015-01-12

    We assessed the effects of simulated weightlessness, hindlimb unloading (HU) by 7 days of tail suspension, on noxious mechanically and heat evoked spinal withdrawal reflexes and spinal Fos expression during muscle nociception elicited by intramuscular (i.m.) injection of hypertonic (HT; 5.8%) saline into gastrocnemius muscle in rats. In HU rats, i.m. HT saline-induced secondary mechanical hyperalgesia was enhanced, and secondary heat hypoalgesia was significantly delayed. After 7 days of HU, basal Fos expression in spinal L4-6 segments was bilaterally enhanced only in superficial (I-II) but not middle and deep laminae (III-VI) of the spinal dorsal horn, which finding was not influenced by tail denervation. Unilateral i.m. HT saline injection increased spinal Fos expression bilaterally in both the control rats and 7 days of HU rats. The HT saline-induced bilateral increase of spinal Fos occurred within 0.5h and reached its peak within 1h, after which it gradually returned to the control levels within 8h. Spatial patterns of spinal Fos expression differed between the control group and 7 days of HU group. In superficial laminae, the HT saline-induced increases in Fos expression were higher and in the middle and deep laminae V-VI lower in the 7 days of HU than control rats. It is suggested that supraspinal mechanisms presumably underlie the effects of HU on spinally-organized nociception. Simulated weightlessness may enhance descending facilitation and weaken descending inhibition of nociception. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. Efficacy of oral tolvaptan versus 3% hypertonic saline for correction of hyponatraemia in post-operative patients

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    Pulak Tosh

    2017-01-01

    Full Text Available Background and Aims: Hyponatraemia is frequent in post-operative patients and may be corrected with hypertonic saline (HTS. Oral tolvaptan is used to treat hypervolaemic or euvolaemic hyponatraemia. This study was performed to assess the efficacy of oral tolvaptan in correcting postoperative hyponatraemia compared to HTS. Methods: This prospective, randomised study was conducted in 40 symptomatic patients with serum sodium level ≤130 mEq/L. In Group H (n = 20, 3% HTS was infused at 20–30 mL/h aiming for correction of 6 mEq/L/day. Group T received oral tolvaptan 15 mg on the 1st day. If daily correction was <4 mEq/L, the dose was increased by 15 mg/day to a maximum of 45 mg. The primary outcome was serum sodium concentration 48 hours after starting treatment. Paired t-test was used to compare changes in sodium levels. Results: Baseline sodium and values at 12, 24 and 48 h were comparable in both groups. At 72 h, Group T had significantly higher sodium levels as compared to Group H (133.4 ± 1.9 vs. 131.3 ± 2.4 mEq/L. Intragroup analysis had shown a significant increase in sodium levels from baseline values in both groups at 12, 24, 48 and 72 h. Group H had a significantly lower potassium level and lower negative fluid balance on day 3. Conclusion: Oral tolvaptan and 3% HTS were equally effective in correcting hyponatraemia at 48 hours, but serum sodium levels were higher at 72 hours after oral tolvaptan.

  17. LL-37 complexation with glycosaminoglycans in cystic fibrosis lungs inhibits antimicrobial activity, which can be restored by hypertonic saline.

    LENUS (Irish Health Repository)

    Bergsson, Gudmundur

    2009-07-01

    There is an abundance of antimicrobial peptides in cystic fibrosis (CF) lungs. Despite this, individuals with CF are susceptible to microbial colonization and infection. In this study, we investigated the antimicrobial response within the CF lung, focusing on the human cathelicidin LL-37. We demonstrate the presence of the LL-37 precursor, human cathelicidin precursor protein designated 18-kDa cationic antimicrobial protein, in the CF lung along with evidence that it is processed to active LL-37 by proteinase-3. We demonstrate that despite supranormal levels of LL-37, the lung fluid from CF patients exhibits no demonstrable antimicrobial activity. Furthermore Pseudomonas killing by physiological concentrations of exogenous LL-37 is inhibited by CF bronchoalveolar lavage (BAL) fluid due to proteolytic degradation of LL-37 by neutrophil elastase and cathepsin D. The endogenous LL-37 in CF BAL fluid is protected from this proteolysis by interactions with glycosaminoglycans, but while this protects LL-37 from proteolysis it results in inactivation of LL-37 antimicrobial activity. By digesting glycosaminoglycans in CF BAL fluid, endogenous LL-37 is liberated and the antimicrobial properties of CF BAL fluid restored. High sodium concentrations also liberate LL-37 in CF BAL fluid in vitro. This is also seen in vivo in CF sputum where LL-37 is complexed to glycosaminoglycans but is liberated following nebulized hypertonic saline resulting in increased antimicrobial effect. These data suggest glycosaminoglycan-LL-37 complexes to be potential therapeutic targets. Factors that disrupt glycosaminoglycan-LL-37 aggregates promote the antimicrobial effects of LL-37 with the caveat that concomitant administration of antiproteases may be needed to protect the now liberated LL-37 from proteolytic cleavage.

  18. A comparison of equivolume, equiosmolar solutions of hypertonic saline and mannitol for brain relaxation during elective supratentorial craniotomy.

    Science.gov (United States)

    Hernández-Palazón, Joaquín; Fuentes-García, Diego; Doménech-Asensi, Paloma; Piqueras-Pérez, Claudio; Falcón-Araña, Luis; Burguillos-López, Sebastián

    2016-01-01

    Hyperosmolar solutions have been used in neurosurgery to reduce brain volume and facilitate surgical exposure. The purpose of this study was to compare the effects of equivolume, equiosmolar solutions of mannitol and hypertonic saline (HS) on brain relaxation, intensive care unit (ICU) and hospital stay, postoperative outcomes and incidence of side-effects in patients undergoing elective supratentorial craniotomy. In a randomised, prospective, double-blind study, 60 patients undergoing elective supratentorial craniotomy were randomised 1:1 to receive 3 ml/kg of either 20% mannitol or 3% HS. The primary outcome was the surgical condition of the brain assessed by the neurosurgeon using a 4-point scale after opening the dura (1 = relaxed, 2 = satisfactory, 3 = firm and 4 = bulging). Secondary outcomes were electrolytes, blood gases, plasma osmolality and haemodynamic variables measured at 0 min, 30 min, 2 h and 6 h after infusion. Also, predefined postoperative complications, length of ICU and hospital stay were recorded. Appropriate statistical tests were used for comparison; p mannitol, 1(1-3) versus HS, 1(1.4) points; p = 0.55]. Patients with brain midline shift showed a worse response to hyperosmolar solutions than those without midline shift: 37% versus 8%, respectively; OR = 6.6 (95% CI, 1.54-28.83); p = 0.006. Plasma osmolality increased during the study period (6 h) in both the groups (p mannitol and 3% HS are safe and effective for intraoperative brain debulking during elective supratentorial craniotomy, but less effective in patients with pre-existing mass effect and midline shift.

  19. Dual response of human leukemia U937 cells to hypertonic shrinkage: initial regulatory volume increase (RVI) and delayed apoptotic volume decrease (AVD).

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    Yurinskaya, Valentina E; Moshkov, Alexey V; Wibberley, Anna V; Lang, Florian; Model, Michael A; Vereninov, Alexey A

    2012-01-01

    Osmotic cell shrinkage is a powerful trigger of suicidal cell death or apoptosis, which is paralleled and enforced by apoptotic volume decrease (AVD). Cells counteract cell shrinkage by volume regulatory increase (RVI). The present study explored the response of human U937 cells to hypertonic solution thus elucidating the relationship between RVI and AVD. Cell water, concentration of monovalent ions and the appearance of apoptotic markers were followed for 0.5-4 h after the cells were transferred to a hypertonic medium. Intracellular water, K+, Na+, and Cl- content, ouabain-sensitive and -resistant Rb+ influxes were determined by measurement of the cell buoyant density in Percoll density gradient, flame emission analysis and 36Cl- assay, respectively. Fluorescent microscopy of live cells stained by acridine orange and ethidium bromide was used to verify apoptosis. After 2-4 h incubation in hypertonic media the cell population was split into light (L) and heavy (H) fractions. According to microscopy and analysis of monovalent ions the majority of cells in the L population were healthy, while the H fractions were enriched with apoptotic cells. The density of L cells was decreasing with time, while the density of H cells was increasing, thus reflecting the opposite effects of RVI and AVD. At the same time, some of the cells were shifting from L to H fractions, indicating that apoptosis was gradually extending to cells that were previously displaying normal RVI. The findings suggest that apoptosis can develop in cells capable of RVI. Copyright © 2012 S. Karger AG, Basel.

  20. A comparative study on the efficacy of 10% hypertonic saline and equal volume of 20% mannitol in the treatment of experimentally induced cerebral edema in adult rats

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    Fang Ming

    2010-12-01

    Full Text Available Abstract Background Hypertonic saline and mannitol are commonly used in the treatment of cerebral edema and elevated intracranial pressure (ICP at present. In this connection, 10% hypertonic saline (HS alleviates cerebral edema more effectively than the equal volume of 20% mannitol. However, the exact underlying mechanism for this remains obscure. This study aimed to explore the possible mechanism whereby 10% hypertonic saline can ameliorate cerebral edema more effectively than mannitol. Results Adult male Sprague-Dawley (SD rats were subjected to permanent right-sided middle cerebral artery occlusion (MCAO and treated with a continuous intravenous infusion of 10% HS, 20% mannitol or D-[1-3H(N]-mannitol. Brain water content (BWC as analyzed by wet-to-dry ratios in the ischemic hemisphere of SD rats decreased more significantly after 10% HS treatment compared with 20% mannitol. Concentration of serum Na+ and plasma crystal osmotic pressure of the 10% HS group at 2, 6, 12 and 18 h following permanent MCAO increased significantly when compared with 20% mannitol treated group. Moreover, there was negative correlation between the BWC of the ipsilateral ischemic hemisphere and concentration of serum Na+, plasma crystal osmotic pressure and difference value of concentration of serum Na+ and concentration of brain Na+ in ipsilateral ischemic hemisphere in the 10% HS group at the various time points after MCAO. A remarkable finding was the progressive accumulation of mannitol in the ischemic brain tissue. Conclusions We conclude that 10% HS is more effective in alleviating cerebral edema than the equal volume of 20% mannitol. This is because 10% HS contributes to establish a higher osmotic gradient across BBB and, furthermore, the progressive accumulation of mannitol in the ischemic brain tissue counteracts its therapeutic efficacy on cerebral edema.

  1. Effect of a hypertonic balanced ketone solution on plasma, CSF and brain beta-hydroxybutyrate levels and acid-base status.

    Science.gov (United States)

    White, Hayden; Venkatesh, Balasubramanian; Jones, Mark; Worrall, Simon; Chuah, Teong; Ordonez, Jenny

    2013-04-01

    Although glucose is the main source of energy for the human brain, ketones play an important role during starvation or injury. The purpose of our study was to investigate the metabolic effects of a novel hypertonic sodium ketone solution in normal animals. Adult Sprague-Dawley rats (420-570 g) were divided into three groups of five, one control and two study arms. The control group received an intravenous infusion of 3 % NaCl at 5 ml/kg/h. The animals in the two study arms were assigned to receive one of the two formulations of ketone solutions, containing hypertonic saline with 40 and 120 mmol/l beta-hydroxybutyrate, respectively. This was infused for 6 h and then the animal was euthanized and brains removed and frozen. Both blood and cerebrospinal fluid (CSF) levels of beta-hydroxybutyrate (BHB) demonstrated strong evidence of a change over time (p < 0.0001). There was also strong evidence of a difference between groups (p < 0.0001). Multiple comparisons showed all these means were statistically different (p < 0.05). Measurement of BHB levels in brain tissue found strong evidence of a difference between groups (p < 0.0001) with control: 0.15 mmol/l (0.01), BHB 40: 0.19 mmol/l (0.01), and BHB 120: 0.28 mmol/l (0.01). Multiple comparisons showed all these means were statistically different (p < 0.05). There were no differences over time (p = 0.31) or between groups (p = 0.33) or an interaction between groups and time (p = 0.47) for base excess. The IV infusions of hypertonic saline/BHB are feasible and lead to increased plasma, CSF and brain levels of BHB without significant acid/base effects.

  2. Airway inflammation and mannitol challenge test in COPD

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    Smids-Dierdorp Barbara S

    2011-01-01

    Full Text Available Abstract Background Eosinophilic airway inflammation has successfully been used to tailor anti-inflammatory therapy in chronic obstructive pulmonary disease (COPD. Airway hyperresponsiveness (AHR by indirect challenges is associated with airway inflammation. We hypothesized that AHR to inhaled mannitol captures eosinophilia in induced sputum in COPD. Methods Twenty-eight patients (age 58 ± 7.8 yr, packyears 40 ± 15.5, post-bronchodilator FEV1 77 ± 14.0%predicted, no inhaled steroids ≥4 wks with mild-moderate COPD (GOLD I-II completed two randomized visits with hypertonic saline-induced sputum and mannitol challenge (including sputum collection. AHR to mannitol was expressed as response-dose-ratio (RDR and related to cell counts, ECP, MPO and IL-8 levels in sputum. Results There was a positive correlation between RDR to mannitol and eosinophil numbers (r = 0.47, p = 0.03 and level of IL-8 (r = 0.46, p = 0.04 in hypertonic saline-induced sputum. Furthermore, significant correlations were found between RDR and eosinophil numbers (r = 0.71, p = 0.001, level of ECP (r = 0.72, p = 0.001, IL-8 (r = 0.57, p = 0.015 and MPO (r = 0.64, p = 0.007 in sputum collected after mannitol challenge. ROC-curves showed 60% sensitivity and 100% specificity of RDR for >2.5% eosinophils in mannitol-induced sputum. Conclusions In mild-moderate COPD mannitol hyperresponsiveness is associated with biomarkers of airway inflammation. The high specificity of mannitol challenge suggests that the test is particularly suitable to exclude eosinophilic airways inflammation, which may facilitate individualized treatment in COPD. Trial registration Netherlands Trial Register (NTR: NTR1283

  3. Airway inflammation and mannitol challenge test in COPD

    Science.gov (United States)

    2011-01-01

    Background Eosinophilic airway inflammation has successfully been used to tailor anti-inflammatory therapy in chronic obstructive pulmonary disease (COPD). Airway hyperresponsiveness (AHR) by indirect challenges is associated with airway inflammation. We hypothesized that AHR to inhaled mannitol captures eosinophilia in induced sputum in COPD. Methods Twenty-eight patients (age 58 ± 7.8 yr, packyears 40 ± 15.5, post-bronchodilator FEV1 77 ± 14.0%predicted, no inhaled steroids ≥4 wks) with mild-moderate COPD (GOLD I-II) completed two randomized visits with hypertonic saline-induced sputum and mannitol challenge (including sputum collection). AHR to mannitol was expressed as response-dose-ratio (RDR) and related to cell counts, ECP, MPO and IL-8 levels in sputum. Results There was a positive correlation between RDR to mannitol and eosinophil numbers (r = 0.47, p = 0.03) and level of IL-8 (r = 0.46, p = 0.04) in hypertonic saline-induced sputum. Furthermore, significant correlations were found between RDR and eosinophil numbers (r = 0.71, p = 0.001), level of ECP (r = 0.72, p = 0.001), IL-8 (r = 0.57, p = 0.015) and MPO (r = 0.64, p = 0.007) in sputum collected after mannitol challenge. ROC-curves showed 60% sensitivity and 100% specificity of RDR for >2.5% eosinophils in mannitol-induced sputum. Conclusions In mild-moderate COPD mannitol hyperresponsiveness is associated with biomarkers of airway inflammation. The high specificity of mannitol challenge suggests that the test is particularly suitable to exclude eosinophilic airways inflammation, which may facilitate individualized treatment in COPD. Trial registration Netherlands Trial Register (NTR): NTR1283 PMID:21241520

  4. Wheal-and-flare responses to intradermally injected adenosine 5'-monophosphate, hypertonic saline, and histamine: comparison of atopic and nonatopic subjects.

    Science.gov (United States)

    Djukanovic, R; Finnerty, J P; Holgate, S T

    1989-09-01

    Adenosine 5'-monophosphate (AMP) in increasing concentrations, and saline solutions of corresponding tonicity, were injected intradermally in seven atopic and seven normal subjects. Skin wheal-and-flare responses were elicited in a dose-dependent fashion in all subjects, and no difference was found between responses produced by AMP and responses produced by saline of corresponding tonicity. Also, no difference in response to AMP and saline was found between atopic and nonatopic subjects. We further investigated, in seven atopic subjects, whether the skin wheal-and-flare response to the single, highest dose of AMP, saline, and histamine could be inhibited by preadministration of 180 mg of terfenadine, a potent H1 antagonist. A significant inhibition of the wheal-and-flare response to histamine and no significant inhibition to AMP were found. There was a significant inhibition of the flare response caused by hypertonic saline but no inhibition of the wheal response. We interpret these findings as indicating that AMP does not specifically lead to mast cell degranulation in the skin and that there are functional differences between cutaneous and lung mast cells. The observation that terfenadine significantly inhibited the flare response to hypertonic saline suggests that this stimulus produced histamine release.

  5. Hypertonic Saline Solution Drives Neutrophil from Bystander Organ to Infectious Site in Polymicrobial Sepsis: A Cecal Ligation and Puncture Model

    Science.gov (United States)

    Theobaldo, Mariana Cardillo; Llimona, Flavia; Petroni, Ricardo Costa; Rios, Ester Correia Sarmento; Velasco, Irineu Tadeu; Soriano, Francisco Garcia

    2013-01-01

    The effects of hypertonic saline solution (HSS) have been shown in several animal models of ischemia and shock. Literature has shown potential benefits of HSS modulating inflammatory response after sepsis in an animal model. We studied the HSS effects in sepsis through cecal ligation and puncture (CLP) in Balb-C mice. Groups studied: 1- CLP without treatment (CLP-C); 2- CLP treated with normal saline solution NaCl 0.9% – 34 ml/Kg (CLP-S); 3- CLP treated with HSS NaCl 7.5% – 4 ml/Kg (CLP-H); and 4- group (Basal) without no CLP or treatment. Volume infusion was always applied 30 min after CLP. Lung and peritoneal lavage were harvested after 6h and 24h of CLP to analyze cytokines amount, oxide nitric, lipid peroxidation and neutrophil infiltration. Neutrophil infiltration, ICAM-1, CXCR-2, and CXCL-1 in lung were reduced by HSS (CLP-H) compared to CLP-C or CLP-S. Neutrophil in peritoneal lavage was increased in 24h with HSS (CLP-H) compared to CLP and CLP-S. Peritoneal CXCR-2 was increased in CLP-C and CLP-S but presented a lower increase with HSS (CLP-H) after 6 hours. GRK-2 presented difference among the groups at 24 h, showing a profile similar to neutrophil infiltration. Pro-inflammatory cytokines (TNF-α and IL-6) were reduced by HSS treatment; CLP-S increased TNF-α. IL-10 was increased in lung tissue by the HSS treatment. The oxidative stress (TBARS and nitric oxide biochemistry markers) was reduced with HSS. Animal survival was 33.3% in CLP-C group, 46.6% in CLP-S group and 60% in the CLP-H group after the sixth day. The HSS protects the animal against sepsis. Our results suggest that the volume replacement modulate pro and anti-inflammatory mediators of an inflammatory response, but HSS presented a more effective and potent effect. PMID:24069301

  6. Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose-Response Curves in Worsening Refractory Congestive Heart Failure.

    Science.gov (United States)

    Paterna, Salvatore; Di Gaudio, Francesca; La Rocca, Vincenzo; Balistreri, Fabio; Greco, Massimiliano; Torres, Daniele; Lupo, Umberto; Rizzo, Giuseppina; di Pasquale, Pietro; Indelicato, Sergio; Cuttitta, Francesco; Butler, Javed; Parrinello, Gaspare

    2015-10-01

    Diuretic responsiveness in patients with chronic heart failure (CHF) is better assessed by urine production per unit diuretic dose than by the absolute urine output or diuretic dose. Diuretic resistance arises over time when the plateau rate of sodium and water excretion is reached prior to optimal fluid elimination and may be overcome when hypertonic saline solution (HSS) is added to high doses of furosemide. Forty-two consecutively hospitalized patients with refractory CHF were randomized in a 1:1:1 ratio to furosemide doses (125 mg, 250 mg, 500 mg) so that all patients received intravenous furosemide diluted in 150 ml of normal saline (0.9%) in the first step (0-24 h) and the same furosemide dose diluted in 150 ml of HSS (1.4%) in the next step (24-48 h) as to obtain 3 groups as follows: Fourteen patients receiving 125 mg (group 1), fourteen patients receiving 250 mg (group 2), and fourteen patients receiving 500 mg (group 3) of furosemide. Urine samples of all patients were collected at 30, 60, and 90 min, and 3, 4, 5, 6, 8, and 24 h after infusion. Diuresis, sodium excretion, osmolality, and furosemide concentration were evaluated for each urine sample. After randomization, 40 patients completed the study. Two patients, one in group 2 and one in group 3 dropped out. Patients in group 1 (125 mg furosemide) had a mean age of 77 ± 17 years, 43% were male, 6 (43%) had heart failure with a preserved ejection fraction (HFpEF), and 64% were in New York Heart Association (NYHA) class IV; the mean age of patients in group 2 (250 mg furosemide) was 80 ± 8.1 years, 15% were male, 5 (38%) had HFpEF, and 84% were in NYHA class IV; and the mean age of patients in group 3 (500 mg furosemide) was 73 ± 12 years, 54% were male, 6 (46%) had HFpEF, and 69% were in NYHA class IV. HSS added to furosemide increased total urine output, sodium excretion, urinary osmolality, and furosemide urine delivery in all patients and at all time points. The percentage increase was 18,14, and

  7. Association Between Hypertonic Saline and Hospital Length of Stay in Acute Viral Bronchiolitis: A Reanalysis of 2 Meta-analyses.

    Science.gov (United States)

    Brooks, Corinne G; Harrison, Wade N; Ralston, Shawn L

    2016-06-01

    Two previous meta-analyses of nebulized hypertonic saline (HS) on hospital length of stay (LOS) in acute viral bronchiolitis have suggested benefit. Neither study fully addressed the issue of excessive heterogeneity in the cohort of studies, indicating that it may be inappropriate to combine such dissimilar studies to estimate a common treatment effect. To reanalyze the existing data set for sources of heterogeneity to delineate the population most likely to benefit from HS. We used the previously analyzed cohort of randomized trials from 2 published meta-analyses comparing HS with normal saline (or, in 1 case, with standard of care) in infants hospitalized for bronchiolitis. We also repeated the search strategy used by the most recent Cochrane Review in the Medline database through September 2015. Eighteen randomized clinical trials of HS in infants with bronchiolitis reporting LOS as an outcome measure were included. The guidelines used for abstracting data included LOS, study year, setting, sample size, type of control, admission/discharge criteria, adjunct medications, treatment frequency, mean day of illness at study enrollment, mean severity of illness scores, and mean age. Weighted mean difference in LOS and study heterogeneity as measured by the I2 statistic. There were 18 studies included of 2063 infants (63% male), with a mean age of 4.2 months. The mean LOS was 3.6 days. Two main sources of heterogeneity were identified. First, the effect of HS on LOS was entirely sensitive to the removal of one study population, noted to have a widely divergent definition of the primary outcome. Second, there was a baseline imbalance in mean day of illness at presentation between treatment groups. Controlling for either of these factors resolved the heterogeneity (I2 = reduced from 78% to 45% and 0%, respectively) and produced summary estimates in support of the null hypothesis (that HS does not affect LOS). There was a weighted mean difference in LOS of -0.21 days

  8. In vitro effects of 3% hypertonic saline and 20% mannitol on canine whole blood coagulation and platelet function.

    Science.gov (United States)

    Adamik, Katja-Nicole; Butty, Emmanuelle; Howard, Judith

    2015-09-24

    Hyperosmolar therapy, using either mannitol or hypertonic saline (HTS), is considered the treatment of choice for intracranial hypertension. However, hyperosmolar agents may impair coagulation and platelet function, limiting their use in patients at risk for hemorrhage. Despite this, studies evaluating the effects of mannitol compared to other hyperosmolar agents in dogs are largely lacking. The aim of this study was to compare the in vitro effects on global hemostasis and platelet function of 20% mannitol and 3% HTS on canine blood. Citrated whole blood from 15 healthy dogs was diluted with 0.9% saline, 20% mannitol and 3% HTS in ratios of 1:16 and 1:8. Rotational thromboelastometry (ROTEM) was used to assess clotting time (CT), clot formation time (CFT) and maximal clot firmness (MCF) following extrinsic activation (Ex-tem) and after platelet inhibition (Fib-tem). A platelet function analyzer (PFA-100) was used to assess closure time (Ct(PFA)). No significant differences were observed between untreated whole blood and samples diluted with saline. Samples diluted with both mannitol and HTS were hypocoagulable compared to untreated whole blood samples. At a dilution of 1:16, no significant differences were found between any measured parameter in samples diluted with saline compared to mannitol or HTS. At a 1:8 dilution, Ct(PFA) was prolonged in samples diluted with mannitol and HTS compared to saline, and Ct(PFA) was prolonged more with mannitol than HTS. Ex-tem CT was increased at a 1:8 dilution with mannitol compared to HTS. Ex-tem CFT was prolonged at a 1:8 dilution with both agents compared to saline, and was prolonged more with mannitol than HTS. Ex-tem MCF was reduced at a 1:8 dilution with both agents compared to saline. Data in this study indicate that both mannitol and HTS affect canine platelet function and whole blood coagulation in vitro in a dose-dependent fashion. The most pronounced effects were observed after high dilutions with mannitol, which

  9. Combined radiofrequency ablation and acetic acid-hypertonic saline solution instillation: an in vivo study of rabbit liver

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    Lee, Jeong-Min; Han, Joon-Koo; Kim, Se-Hyung; Choi, Byung-Ihn [Seoul National University, Seoul (Korea, Republic of); Kim, Young-Kon; Kim, Sang-Won [Chonbuk National University, Chonju (Korea, Republic of)

    2004-03-15

    We wanted to determine whether combined radiofrequency ablation (RFA) and acetic acid-hypertonic saline solution (AHS) instillation can increase the extent of thermally mediated coagulation in in vivo rabbit liver tissue. We also wished to determine the optimal concentration of the solution in order to maximize its effect on extent of the RFA-induced coagulation. Forty thermal ablation zones were produced in 40 rabbits by using a 17-gauge internally cooled electrode with a 1-cm active tip under ultrasound guidance. The rabbits were assigned to one of four groups: group A: RFA alone (n=10); group B: RFA with 50% AHS instillation (n=10); group C: RFA with 25% AHS instillation (n=10); group D: RFA with 15% AHS instillation (n=10). A range of acetic acid concentrations diluted in 36% NaCl to a total volume of 2 mL were instilled into the liver before RFA. The RF energy (30W) was applied for three minutes. After RFA, in each group, the maximum diameters to the thermal ablation zones in the gross specimens were compared. Technical success and the complication that arose were evaluated by CT and on the basis of autopsy findings. All procedures are technically successful. There were six procedure-related complications (6/40; 15%); two localized perihepatic hematomas and four chemical peritonitis. The incidence of chemical peritonitis was highest for group B with the 50% AHS solution instillation (30%). With instillation of 15% AHS solution, a marked decrease of tissue impedance (24.5 {+-} 15.6 {omega}) and an increase of current (250 mA) occurred as compared to RFA alone. With instillation of the solutions before RFA (group B, C and D). this produced a greater mean diameter of coagulation necrosis than the diameters for rabbits not instilled with the solution (group A) ({rho}<0.05). However, there was no significant difference between group B, C, and D. Combined AHS instillation and RFA can increase the dimension of coagulation necrosis in the liver with a single

  10. Hyperoxia and hypertonic saline in patients with septic shock (HYPERS2S): a two-by-two factorial, multicentre, randomised, clinical trial.

    Science.gov (United States)

    Asfar, Pierre; Schortgen, Frédérique; Boisramé-Helms, Julie; Charpentier, Julien; Guérot, Emmanuel; Megarbane, Bruno; Grimaldi, David; Grelon, Fabien; Anguel, Nadia; Lasocki, Sigismond; Henry-Lagarrigue, Matthieu; Gonzalez, Frédéric; Legay, François; Guitton, Christophe; Schenck, Maleka; Doise, Jean Marc; Devaquet, Jérôme; Van Der Linden, Thierry; Chatellier, Delphine; Rigaud, Jean Philippe; Dellamonica, Jean; Tamion, Fabienne; Meziani, Ferhat; Mercat, Alain; Dreyfuss, Didier; Seegers, Valérie; Radermacher, Peter

    2017-03-01

    There is insufficient research into the use of mechanical ventilation with increased inspiratory oxygen concentration (FiO2) and fluid resuscitation with hypertonic saline solution in patients with septic shock. We tested whether these interventions are associated with reduced mortality. This two-by-two factorial, multicentre, randomised, clinical trial (HYPERS2S) recruited patients aged 18 years and older with septic shock who were on mechanical ventilation from 22 centres in France. Patients were randomly assigned 1:1:1:1 to four groups by a computer generated randomisation list stratified by site and presence or absence of acute respiratory distress syndrome by use of permuted blocks of random sizes. Patients received, in an open-labelled manner, mechanical ventilation either with FiO2 at 1·0 (hyperoxia) or FiO2 set to target an arterial haemoglobin oxygen saturation of 88-95% (normoxia) during the first 24 h; patients also received, in a double-blind manner, either 280 mL boluses of 3·0% (hypertonic) saline or 0·9% (isotonic) saline for fluid resuscitation during the first 72 h. The primary endpoint was mortality at day 28 after randomisation in the intention-to-treat population. This study was registered with ClinicalTrials.gov, number NCT01722422. Between Nov 3, 2012, and June 13, 2014, 442 patients were recruited and assigned to a treatment group (normoxia [n=223] or hyperoxia [n=219]; isotonic [n=224] or hypertonic [n=218]). The trial was stopped prematurely for safety reasons. 28 day mortality was recorded for 434 patients; 93 (43%) of 217 patients had died in the hyperoxia group versus 77 (35%) of 217 patients in the normoxia group (hazard ratio [HR] 1·27, 95% CI 0·94-1·72; p=0·12). 89 (42%) of 214 patients had died in the hypertonic group versus 81 (37%) of 220 patients in the isotonic group (HR 1·19, 0·88-1·61; p=0·25). We found a significant difference in the overall incidence of serious adverse events between the hyperoxia (185 [85%]) and

  11. Changes of hypo- and hypertonic sodium chloride induced by the rat urinary bladder at various filling stages. Evidence for an increased transurothelial access of urine to detrusor nerve and muscle cells with distension.

    Science.gov (United States)

    Hohlbrugger, G

    1987-01-01

    By means of a transaortal injection of a gelatine ink mixture, a manifold mucosa to muscularis blood flow ratio was proved. In addition, the treatment of hypo- and hypertonic NaCl by the rat urinary bladder has been studied at 0.3-, 0.6- and 0.9-ml filling levels in conjunction with continuous bladder pressure recording. With distension an increased permeability to NaCl (efflux) and/or water (influx) was found in hypertonic conditions. In order to demonstrate this, the decreasing surface to volume ratio with distension has to be considered. Final urea concentrations in hypertonic media significantly exceeded those in hypotonic probes. The phenomenon has been hypothetically attributed to the existence of an arteriovenous counter current exchange within mucosal vessels. In comparison to hypotonic bladder contents, hypertonic media increased basic bladder pressures and phasic pressure amplitudes preferably at the 0.9-ml level. Hence, in context with an increased permeability, distension favors access of the bladder content to detrusor nerve and muscle cells thereby facilitating their excitability.

  12. Cognitive Challenges

    Science.gov (United States)

    ... Privacy Policy Sitemap Learn Engage Donate About TSC Cognitive Challenges Approximately 45% to 60% of individuals with TSC develop cognitive challenges (intellectual disabilities), although the degree of intellectual ...

  13. Saline in acute bronchiolitis RCT and economic evaluation: hypertonic saline in acute bronchiolitis - randomised controlled trial and systematic review.

    Science.gov (United States)

    Everard, Mark L; Hind, Daniel; Ugonna, Kelechi; Freeman, Jennifer; Bradburn, Mike; Dixon, Simon; Maguire, Chin; Cantrill, Hannah; Alexander, John; Lenney, Warren; McNamara, Paul; Elphick, Heather; Chetcuti, Philip Aj; Moya, Eduardo F; Powell, Colin; Garside, Jonathan P; Chadha, Lavleen Kumar; Kurian, Matthew; Lehal, Ravinderjit S; MacFarlane, Peter I; Cooper, Cindy L; Cross, Elizabeth

    2015-08-01

    Acute bronchiolitis is the most common cause of hospitalisation in infancy. Supportive care and oxygen are the cornerstones of management. A Cochrane review concluded that the use of nebulised 3% hypertonic saline (HS) may significantly reduce the duration of hospitalisation. To test the hypothesis that HS reduces the time to when infants were assessed as being fit for discharge, defined as in air with saturations of > 92% for 6 hours, by 25%. Parallel-group, pragmatic randomised controlled trial, cost-utility analysis and systematic review. Ten UK hospitals. Infants with acute bronchiolitis requiring oxygen therapy were allocated within 4 hours of admission. Supportive care with oxygen as required, minimal handling and fluid administration as appropriate to the severity of the disease, 3% nebulised HS every ± 6 hours. The trial primary outcome was time until the infant met objective discharge criteria. Secondary end points included time to discharge and adverse events. The costs analysed related to length of stay (LoS), readmissions, nebulised saline and other NHS resource use. Quality-adjusted life-years (QALYs) were estimated using an existing utility decrement derived for hospitalisation in children, together with the time spent in hospital in the trial. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and other databases from inception or from 2010 onwards, searched ClinicalTrials.gov and other registries and hand-searched Chest, Paediatrics and Journal of Paediatrics to January 2015. We included randomised/quasi-randomised trials which compared HS versus saline (± adjunct treatment) or no treatment. We used a fixed-effects model to combine mean differences for LoS and assessed statistical heterogeneity using the I (2) statistic. The trial randomised 158 infants to HS (n = 141 analysed) and 159 to standard care (n = 149 analysed). There was no difference between the two arms in the time to being declared fit for

  14. Waterfront Challenges

    DEFF Research Database (Denmark)

    Kiib, Hans

    2007-01-01

    An overall view on the waterfront transformation and the planning challenges related to this process. It contributes to the specific challenges and potentials related to Aalborg Waterfront.......An overall view on the waterfront transformation and the planning challenges related to this process. It contributes to the specific challenges and potentials related to Aalborg Waterfront....

  15. Small volume hypertonic resuscitation of circulatory shock Soluções hipertônicas para reanimação de pacientes em choque

    Directory of Open Access Journals (Sweden)

    Mauricio Rocha-e-Silva

    2005-04-01

    Full Text Available Small volume hypertonic resuscitation is a relatively new conceptual approach to shock therapy. It was originally based on the idea that a relatively large blood volume expansion could be obtained by administering a relatively small volume of fluid, taking advantage of osmosis. It was soon realized that the physiological vasodilator property of hypertonicity was a useful byproduct of small volume resuscitation in that it induced reperfusion of previously ischemic territories, even though such an effect encroached upon the malefic effects of the ischemia-reperfusion process. Subsequent research disclosed a number of previously unsuspected properties of hypertonic resuscitation, amongst them the correction of endothelial and red cell edema with significant consequences in terms of capillary blood flow. A whole set of actions of hypertonicity upon the immune system are being gradually uncovered, but the full implication of these observations with regard to the clinical scenario are still under study. Small volume resuscitation for shock is in current clinical use in some parts of the world, in spite of objections raised concerning its safety under conditions of uncontrolled bleeding. These objections stem mainly from experimental studies, but there are few signs that they may be of real clinical significance. This review attempts to cover the earlier and the more recent developments in this field.O uso de soluções hipertônicas para reanimação de pacientes em choque é um conceito relativamente novo. Baseou-se originalmente na idéia de que uma expansão volêmica significativa podia ser obtida às custas de um volume relativamente diminuto de infusão, aproveitando a propriedade física de osmose. Logo ficou claro que a capacidade fisiológica de produzir vasodilatação, compartilhada por todas as soluções hipertônicas, seria valiosa para reperfundir territórios tornados isquêmicos pelo choque, embora os malefícios da seq

  16. The effect of continuous hypertonic saline infusion and hypernatremia on mortality in patients with severe traumatic brain injury: a retrospective cohort study.

    Science.gov (United States)

    Tan, Sean K R; Kolmodin, Leif; Sekhon, Mypinder S; Qiao, Lu; Zou, Jie; Henderson, William R; Griesdale, Donald E G

    2016-06-01

    Hypertonic saline (HTS) is used to control intracranial pressure (ICP) in patients with traumatic brain injury (TBI); however, in prior studies, the resultant hypernatremia has been associated with increased mortality. We aimed to study the effect of HTS on ICP and mortality in patients with severe TBI. We performed a retrospective cohort study of 231 patients with severe TBI (Glasgow Coma Scale [GCS] ≤ 8) admitted to two neurotrauma units from 2006-2012. We recorded daily HTS, ICP, and serum sodium (Na) concentration. We used Cox proportional regression modelling for hospital mortality and incorporated the following time-dependent variables: use of HTS, hypernatremia, and desmopressin administration. The mean [standard deviation (SD)] age of patients was 34 (17) and the median (interquartile range [IQR]) GCS was 6 [3-8]. Hypertonic saline was administered as a continuous infusion in 124 of 231 (54%) patients over 788 of 2,968 (27%) patient-days. Hypernatremia (Na > 145 mmol·L(-1)) developed in 151 of 231 (65%) patients over 717 of 2,968 (24%) patients-days. In patients who developed hypernatremia, the median [IQR] Na was 146 [142-147] mmol·L(-1). Overall hospital mortality was 26% (59 of 231 patients). After adjusting for baseline covariates, neither HTS (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.56 to 2.05; P = 0.84) nor hypernatremia (HR, 1.31; 95% CI, 0.68 to 2.55; P = 0.42) was associated with hospital mortality. There was no effect modification by either HTS or hypernatremia on each another. Patients who received HTS observed a significant decrease in ICP during their ICU stay compared with those who did not receive HTS (4 mmHg; 95% CI, 2 to 6; P hypernatremia are not associated with hospital mortality in patients with severe TBI.

  17. Osmolality and respiratory regulation in humans: respiratory compensation for hyperchloremic metabolic acidosis is absent after infusion of hypertonic saline in healthy volunteers.

    Science.gov (United States)

    Moen, Vibeke; Brudin, Lars; Rundgren, Mats; Irestedt, Lars

    2014-10-01

    Several animal studies show that changes in plasma osmolality may influence ventilation. Respiratory depression caused by increased plasma osmolality is interpreted as inhibition of water-dependent thermoregulation because conservation of body fluid predominates at the cost of increased core temperature. Respiratory alkalosis, on the other hand, is associated with a decrease in plasma osmolality and strong ion difference (SID) during human pregnancy. We investigated the hypothesis that osmolality would influence ventilation, so that increased osmolality will decrease ventilation and decreased osmolality will stimulate ventilation in both men and women. Our study participants were healthy volunteers of both sexes (ASA physical status I). Ten men (mean 28 years; range 20-40) and 9 women (mean 33 years; range 22-43) were included. All women participated in both the follicular and luteal phases of the menstrual cycle. Hyperosmolality was induced by IV infusion of hypertonic saline 3%, and hypoosmolality by drinking tap water. Arterial blood samples were collected for analysis of electrolytes, osmolality, and blood gases. Sensitivity to CO2 was determined by rebreathing tests performed before and after the fluid-loading procedures. Infusion of hypertonic saline caused hyperchloremic metabolic acidosis with decreased SID in all subjects. Analysis of pooled data showed absence of respiratory compensation. Baseline arterial PCO2 (PaCO2) mean (SD) 37.8 (2.9) mm Hg remained unaltered, with lowest PaCO2 37.8 (2.9) mm Hg after 100 minutes, P = 0.70, causing a decrease in pH from mean (SD) 7.42 (0.02) to 7.38 (0.02), P Metabolic acidosis was also observed during water loading. Pooled results show that PaCO2 decreased from 38.2 (3.3) mm Hg at baseline to 35.7 (2.8) mm Hg after 80 minutes of drinking water, P = 0.002, and pH remained unaltered: pH 7.43 (0.02) at baseline to pH 7.42 (0.02), P = 0.14, mean difference (confidence interval) = pH -0.007 (-0.017 to 0.003). Our results

  18. The dynamics of vascular volume and fluid shifts of lactated Ringer's solution and hypertonic-saline-dextran solutions infused in normovolemic sheep.

    Science.gov (United States)

    Tølløfsrud, S; Elgjo, G I; Prough, D S; Williams, C A; Traber, D L; Kramer, G C

    2001-10-01

    Infusions of hyperosmotic-hyperoncotic solutions such as hypertonic saline dextran (HSD) are used in Europe for resuscitation of traumatic shock and perioperative volume support as an adjunct to conventional isotonic crystalloids. Whereas plasma volume expansion of HSD has been measured at single time points after the intravascular volume expansion, the detailed time course of fluid shifts during and after infusions have not been reported. We compared the time course of volume expansion during and after 30-min infusions of 4 mL/kg HSD and 25 mL/kg lactated Ringer's solution (LR) in normovolemic conscious splenectomized sheep. Peak plasma volume (Evans blue and hemoglobin dilution) expansion was similar for HSD (7.8 +/- 0.9 mL/kg) and the larger sixfold volume of LR (7.2 +/- 0.5 mL/kg). However, 30 min after the 30-min infusion (T60), plasma expansion remained larger after HSD (5.1 +/- 0.9 mL/kg) than after LR (1.7 +/- 0.6 mL/kg). Both solutions caused an equivalent diuresis. Intravascular volume expansion efficiency (VEE), defined as milliliter plasma expansion/milliliter fluid infused at 0 (T30), 30 (T60), and 60 (T90) min after infusion ended was 1.8, 1.3, and 0.8, respectively for HSD, whereas LR provided a VEE of only 0.27, 0.07, and 0.07. The relative expansion efficiency of HSD versus LR, calculated as the ratio (VEE(HSD)/VEE(LR)), was 7-fold that of LR at the end of infusion T30, and 20-fold at T60, but decreased to 9-fold by T120. Intravascular volume dynamic studies of different volume expanders in animals and patients may provide anesthesiologists with a new tool for monitoring the effectiveness of fluid therapy. Hypertonic saline dextran (HSD) is a new plasma expander recently approved for clinical use in Europe. We compared the plasma volume expansion of HSD versus lactated Ringers (LR) in normovolemic sheep. After a 30 min infusion, HSD was 7 times as effective at expanding volume as an equal volume of LR, but for the next 90 minutes the relative

  19. Minimally invasive assessment of the effect of mannitol and hypertonic saline therapy on traumatic brain edema using measurements of reduced scattering coefficient (μs').

    Science.gov (United States)

    Xie, Jieru; Qian, Zhiyu; Yang, Tianming; Li, Weitao; Hu, Guangxia

    2010-10-01

    Minimally invasive functional near infrared spectroscopy (fNIRs) technology was utilized to assess the effects of mannitol and hypertonic saline (HS) in treating traumatic brain edema (TBE). Rats with TBE models were given mannitol or HS in different dosages for different groups. The reduced scattering coefficient (μ(s)') of the local cortex of rats was simultaneously monitored and recorded in vivo and real time by the minimally invasive fNIRs system. Brain water content (BWC) was measured by the wet and dry weight method at 1, 6, 24, 72, and 120 h after injury and treatment. Effects of treating TBE with different dehydration agents were then assessed by recording μ(s)' and BWC before and after administration of dehydration. In this study, the dynamic changes of brain edema and the effects of dehydration therapy were continuously monitored. Results implied that μ(s)' of the local cortex in rats is a good indicator for assessing effects of treatment of TBE. By recording changes in the value of μ(s)', the following conclusions were obtained: HS is more effective than mannitol in reducing cerebral edema. The effect of dehydration of HS is only related to osmotic gradient and has no correlation with concentration.

  20. Effect of hypertonic sodium chloride hydroxyethyl starch 40 on ET, TXB2, 6-keto-PGF1α, and ANP of preeclampsia in caesarean section.

    Science.gov (United States)

    Wang, T; Jiang, l H; Zhu, J B; Wei, X Y; Li, L; Liu, B

    2015-01-01

    Preeclampsia is a unique disease of pregnancy. Delivery via caesarean section is the most important way of terminating the pregnancy and treating preeclampsia. Perioperative fluid therapy is performed to maintain the circulatory volume and reduce tissue edema. This study evaluated the effects of hypertonic sodium chloride hydroxyethyl starch 40 (HSH40) as perioperative fluid therapy for preeclampsia patients. Forty preeclamptic women were randomly divided into two groups: the Ringer's solution group and the HSH40 group. Their ECG, HR, MAP, and SPO2 were monitored. Their MVP and HR were recorded at five, eight, and ten minutes after anesthesia induction and at the end of the caesarean section. The corresponding volume of infusion, blood loss, and urine output during the operation were also recorded. Venous samples were collected before HSH40 infusion and 30 min after infusion to measure the plasma concentrations of ET, TXB2, 6-keto-PGF1α, and ANP via a radioimmunoassay. HSH40 infusion significantly decreased the plasma ET levels (p ANP and TXB2 levels (p ANP, TXB2, and 6-keto-PGF1α did not significantly change in the control group. Compared with T1, MAP decreased significantly at T2, T3, T4, and T5 within groups (p ANP) during preeclampsia. It effectively maintains and stabilizes the circulating blood volume, increasing renal blood flow, which improves renal function and increases urine output.

  1. Novel hypertonic saline-sodium hydroxide (HS-SH) method for decontamination and concentration of sputum samples for Mycobacterium tuberculosis microscopy and culture.

    Science.gov (United States)

    Ganoza, Christian A; Ricaldi, Jessica N; Chauca, José; Rojas, Gabriel; Munayco, César; Agapito, Juan; Palomino, Juan Carlos; Guerra, Humberto

    2008-09-01

    This study evaluated a new decontamination and concentration (DC) method for sputum microscopy and culture. Sputum samples from patients with suspected pulmonary tuberculosis (TB) (n=106) were tested using the proposed hypertonic saline-sodium hydroxide (HS-SH) DC method, the recommended N-acetyl-L-cysteine-sodium citrate-sodium hydroxide (NALC-NaOH) DC method and unconcentrated direct smear (Ziehl-Neelsen) techniques for the presence of mycobacteria using Löwenstein-Jensen culture and light microscopy. Of 94 valid specimens, 21 (22.3%) were positive in culture and were further characterized as Mycobacterium tuberculosis. The sensitivity for acid-fast bacilli (AFB) smears was increased from 28.6% using the direct method to 71.4% (HS-SH) and 66.7% (NALC-NaOH) using DC methods. Both concentration techniques were highly comparable for culture (kappa=0.794) and smear (kappa=0.631) for AFB. Thus the proposed HS-SH DC method improved the sensitivity of AFB microscopy compared with a routine unconcentrated direct smear; its performance was comparable to that of the NALC-NaOH DC method for AFB smears and culture, but it was methodologically simpler and less expensive, making it a promising candidate for evaluation by national TB control programmes in developing countries.

  2. Nebulized hypertonic saline treatment reduces both rate and duration of hospitalization for acute bronchiolitis in infants: an updated meta-analysis.

    Science.gov (United States)

    Chen, Yen-Ju; Lee, Wen-Li; Wang, Chuang-Ming; Chou, Hsin-Hsu

    2014-12-01

    Nebulized hypertonic saline (HS) treatment reduced the length of hospitalization in infants with acute bronchiolitis in a previous meta-analysis. However, there was no reduction in the admission rate. We hypothesized that nebulized HS treatment might significantly decrease both the duration and the rate of hospitalization if more randomized controlled trials (RCTs) were included. We searched MEDLINE, PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) without a language restriction. A meta-analysis was performed based on the efficacy of nebulized HS treatment in infants with acute bronchiolitis. We used weighted mean difference (WMD) and risk ratio as effect size metrics. Eleven studies were identified that enrolled 1070 infants. Nebulized HS treatment significantly decreased the duration and rate of hospitalization compared with nebulized normal saline (NS) [duration of hospitalization: WMD = -0.96, 95% confidence interval (CI) = -1.38 to -0.54, p bronchiolitis infants post-treatment (Day 1: WMD = -0.77, 95% CI = -1.30 to -0.24, p = 0.005; Day 2: WMD = -0.85, 95% CI = -1.30 to -0.39, p bronchiolitis in infants. Copyright © 2014. Published by Elsevier B.V.

  3. Hypertonic saline resuscitation of hemorrhagic shock does not decrease in vivo neutrophil interactions with endothelium in the blood-brain microcirculation.

    Science.gov (United States)

    Gong, Wanfeng; Marks, Joshua A; Sanati, Paymon; Sims, Carrie; Sarani, Babak; Smith, Douglas H; Pascual, Jose L

    2011-08-01

    Resuscitation of hemorrhagic shock with isotonic crystalloids has been shown to activate polymorphonuclear neutrophils (PMNs). Although hypertonic saline (HTS) can reduce PMN activation and interactions with endothelial cells (EC) in systemic microvascular beds, no data exist demonstrating that the same occurs in the unique blood-brain barrier microcirculation. We hypothesized that resuscitation of hemorrhagic shock with HTS would blunt brain in vivo PMN-EC interactions. Wistar rats (250-350 g) underwent craniotomy and placement of a window for live intravital viewing of pial vessels. Twenty animals were bled to a mean arterial pressure of 30 mm Hg to 35 mm Hg for 1 hour and resuscitated with shed blood and either 5% HTS (6 mL/kg) or Ringer's lactate (RL) (2× shed blood volume). Circulating rhodamine-6G-labeled PMN in pial venules were captured by videomicroscopy at baseline (preshock), end of the shock period, after resuscitation, and every 15 minutes to 30 minutes for 2 hours. Hemodynamics and arterial gases were monitored. Off-line footage analysis allowed comparisons of PMN-EC interactions between groups. Animals in both groups developed significant metabolic acidosis (p nature of the blood-brain interface.

  4. A 33 kDa protein band is enhanced during long-term adaptation of EUE cells to a hypertonic medium.

    Science.gov (United States)

    Giuliani, A; Ferraretto, A; Fuhrman Conti, A M; De Grada, L; Fraschini, A; Pellicciari, C; Manfredi Romanini, M G

    1991-04-01

    A cell line derived from human embryonic epithelium (EUE cells) shows an enhanced expression of a 33 kDa protein when adapted to grow in a hypertonic medium containing 0.246 M NaCl (1.8 x the isotonic concentration). The maximum amount of this protein, followed by SDS-PAGE electrophoresis, was found after 4 days of adaptation; thereafter, the protein band remained fairly constant up to 30 days. When the cells were transferred back to a medium containing 0.137 M NaCl (isotonic medium), the protein pattern reverted to that of control cells. This protein is mainly localized in the cytosol, although a small part is associated with the 150,000 g pellet and needs detergents to be extracted. The molecular weight and the cellular location suggest a possible analogy with the so-called amphitropic proteins, that are known to interact with both the epidermal growth factor receptor and hydrophobic structures, such as the membrane phospholipids and the cytoskeletal components.

  5. Challenging Identities

    DEFF Research Database (Denmark)

    , cultural, and political practices. Notions of national identity and national politics are challenged by European integration, as well as by increasing demographic heterogeneity due to migration, and migrants experience conflicts of identification stemming from clashes between cultural heritage...

  6. Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio

    KAUST Repository

    Quintard, Hervé

    2015-09-30

    Energy dysfunction is associated with worse prognosis after traumatic brain injury (TBI). Recent data suggest that hypertonic sodium lactate infusion (HL) improves energy metabolism after TBI. Here, we specifically examined whether the efficacy of HL (3h infusion, 30-40 μmol/kg/min) in improving brain energetics (using cerebral microdialysis [CMD] glucose as a main therapeutic end-point) was dependent on baseline cerebral metabolic state (assessed by CMD lactate/pyruvate ratio [LPR]) and cerebral blood flow (CBF, measured with perfusion computed tomography [PCT]). Using a prospective cohort of 24 severe TBI patients, we found CMD glucose increase during HL was significant only in the subgroup of patients with elevated CMD LPR >25 (n = 13; +0.13 [95% confidence interval (CI) 0.08-0.19] mmol/L, p < 0.001; vs. +0.04 [-0.05-0.13] in those with normal LPR, p = 0.33, mixed-effects model). In contrast, CMD glucose increase was independent from baseline CBF (coefficient +0.13 [0.04-0.21] mmol/L when global CBF was <32.5 mL/100 g/min vs. +0.09 [0.04-0.14] mmol/L at normal CBF, both p < 0.005) and systemic glucose. Our data suggest that improvement of brain energetics upon HL seems predominantly dependent on baseline cerebral metabolic state and support the concept that CMD LPR - rather than CBF - could be used as a diagnostic indication for systemic lactate supplementation following TBI. Copyright © 2016 Mary Ann Liebert, Inc.

  7. Improvement of Neuroenergetics by Hypertonic Lactate Therapy in Patients with Traumatic Brain Injury Is Dependent on Baseline Cerebral Lactate/Pyruvate Ratio.

    Science.gov (United States)

    Quintard, Hervé; Patet, Camille; Zerlauth, Jean-Baptiste; Suys, Tamarah; Bouzat, Pierre; Pellerin, Luc; Meuli, Reto; Magistretti, Pierre J; Oddo, Mauro

    2016-04-01

    Energy dysfunction is associated with worse prognosis after traumatic brain injury (TBI). Recent data suggest that hypertonic sodium lactate infusion (HL) improves energy metabolism after TBI. Here, we specifically examined whether the efficacy of HL (3h infusion, 30-40 μmol/kg/min) in improving brain energetics (using cerebral microdialysis [CMD] glucose as a main therapeutic end-point) was dependent on baseline cerebral metabolic state (assessed by CMD lactate/pyruvate ratio [LPR]) and cerebral blood flow (CBF, measured with perfusion computed tomography [PCT]). Using a prospective cohort of 24 severe TBI patients, we found CMD glucose increase during HL was significant only in the subgroup of patients with elevated CMD LPR >25 (n = 13; +0.13 [95% confidence interval (CI) 0.08-0.19] mmol/L, p < 0.001; vs. +0.04 [-0.05-0.13] in those with normal LPR, p = 0.33, mixed-effects model). In contrast, CMD glucose increase was independent from baseline CBF (coefficient +0.13 [0.04-0.21] mmol/L when global CBF was <32.5 mL/100 g/min vs. +0.09 [0.04-0.14] mmol/L at normal CBF, both p < 0.005) and systemic glucose. Our data suggest that improvement of brain energetics upon HL seems predominantly dependent on baseline cerebral metabolic state and support the concept that CMD LPR - rather than CBF - could be used as a diagnostic indication for systemic lactate supplementation following TBI.

  8. Hypertonic saline plus i.v. furosemide improve renal safety profile and clinical outcomes in acute decompensated heart failure: A meta-analysis of the literature.

    Science.gov (United States)

    De Vecchis, R; Esposito, C; Ariano, C; Cantatrione, S

    2015-05-01

    In advanced congestive heart failure (CHF), intravenous (i.v.) inotropic agents, i.v. diuretics, ultrafiltration, and hemodialysis have been shown to not yield better clinical outcomes. In this scenario, the simultaneous administration of hypertonic saline solution (HSS) and furosemide may offer a more effective therapeutic option with a good safety profile. Therefore, a meta-analysis was performed to compare combined therapy, consisting of i.v. furosemide plus concomitant administration of HSS, with i.v. furosemide alone for acute decompensated heart failure (ADHF). The outcomes we chose were all-cause mortality, risk of re-hospitalization for ADHF, length of hospital stay, weight loss, and variation of serum creatinine. Based on five randomized controlled trials (RCTs) involving 1,032 patients treated with i.v. HSS plus furosemide vs. 1,032 patients treated with i.v. furosemide alone, a decrease in all-cause mortality in patients treated with HSS plus furosemide was proven [RR = 0.57; 95 % confidence interval (CI) = 0.44-0.74, p = 0.0003]. Likewise, combined therapy with HSS plus furosemide was shown to be associated with a reduced risk of ADHF-related re-hospitalization (RR = 0.51; 95 % CI = 0.35-0.75, p = 0.001). Besides, combined therapy with HSS plus furosemide was found to be associated with a reduced length of hospital stay (p = 0.0002), greater weight loss (p furosemide for diuretic-resistant CHF patients led to a better renal safety profile and improved clinical endpoints such as mortality and heart failure-related hospitalizations.

  9. Immune-Inflammatory and Metabolic Effects of High Dose Furosemide plus Hypertonic Saline Solution (HSS) Treatment in Cirrhotic Subjects with Refractory Ascites

    Science.gov (United States)

    Bellia, Chiara; Clemente, Giuseppe; Pecoraro, Rosaria; Maida, Carlo; Simonetta, Irene; Vassallo, Valerio; Di Bona, Danilo; Gulotta, Eliana; Ciaccio, Marcello; Pinto, Antonio

    2016-01-01

    Introduction Patients with chronic liver diseases are usually thin as a result of hypermetabolism and malnutrition expressed by reduced levels of leptin and impairment of other adyponectins such as visfatin. Aims We evaluated the metabolic and inflammatory effects of intravenous high-dose furosemide plus hypertonic saline solutions (HSS) compared with repeated paracentesis and a standard oral diuretic schedule, in patients with cirrhosis and refractory ascites. Methods 59 consecutive cirrhotic patients with refractory ascites unresponsive to outpatient treatment. Enrolled subjects were randomized to treatment with intravenous infusion of furosemide (125–250mg⁄bid) plus small volumes of HSS from the first day after admission until 3 days before discharge (Group A, n:38), or repeated paracentesis from the first day after admission until 3 days before discharge (Group B, n: 21). Plasma levels of ANP, BNP, Leptin, visfatin, IL-1β, TNF-a, IL-6 were measured before and after the two type of treatment. Results Subjects in group A were observed to have a significant reduction of serum levels of TNF-α, IL-1β, IL-6, ANP, BNP, and visfatin, thus regarding primary efficacy endpoints, in Group A vs. Group B we observed higher Δ-TNF-α, Δ-IL-1β, Δ-IL-6, Δ-ANP, Δ-BNP, Δ-visfatin, Δ-Leptin at discharge. Discussion Our findings underline the possible inflammatory and metabolic effect of saline overload correction in treatment of cirrhosis complications such as refractory ascites, suggesting a possible role of inflammatory and metabolic-nutritional variables as severity markers in these patients. PMID:27941973

  10. Immune-Inflammatory and Metabolic Effects of High Dose Furosemide plus Hypertonic Saline Solution (HSS Treatment in Cirrhotic Subjects with Refractory Ascites.

    Directory of Open Access Journals (Sweden)

    Antonino Tuttolomondo

    Full Text Available Patients with chronic liver diseases are usually thin as a result of hypermetabolism and malnutrition expressed by reduced levels of leptin and impairment of other adyponectins such as visfatin.We evaluated the metabolic and inflammatory effects of intravenous high-dose furosemide plus hypertonic saline solutions (HSS compared with repeated paracentesis and a standard oral diuretic schedule, in patients with cirrhosis and refractory ascites.59 consecutive cirrhotic patients with refractory ascites unresponsive to outpatient treatment. Enrolled subjects were randomized to treatment with intravenous infusion of furosemide (125-250mg⁄bid plus small volumes of HSS from the first day after admission until 3 days before discharge (Group A, n:38, or repeated paracentesis from the first day after admission until 3 days before discharge (Group B, n: 21. Plasma levels of ANP, BNP, Leptin, visfatin, IL-1β, TNF-a, IL-6 were measured before and after the two type of treatment.Subjects in group A were observed to have a significant reduction of serum levels of TNF-α, IL-1β, IL-6, ANP, BNP, and visfatin, thus regarding primary efficacy endpoints, in Group A vs. Group B we observed higher Δ-TNF-α, Δ-IL-1β, Δ-IL-6, Δ-ANP, Δ-BNP, Δ-visfatin, Δ-Leptin at discharge.Our findings underline the possible inflammatory and metabolic effect of saline overload correction in treatment of cirrhosis complications such as refractory ascites, suggesting a possible role of inflammatory and metabolic-nutritional variables as severity markers in these patients.

  11. Troponin I release after intravenous treatment with high furosemide doses plus hypertonic saline solution in decompensated heart failure trial (Tra-HSS-Fur).

    Science.gov (United States)

    Parrinello, Gaspare; Di Pasquale, Pietro; Torres, Daniele; Cardillo, Mauro; Schimmenti, Caterina; Lupo, Umberto; Iatrino, Rossella; Petrantoni, Rossella; Montaina, Carla; Giambanco, Salvatore; Paterna, Salvatore

    2012-09-01

    High values of cardiac troponin in acute decompensated congestive heart failure (ADHF) identify patients at higher risk and worsened prognosis. A cardiac troponin increase during therapy indicates the need for more appropriate intervention, aimed at compensating cardiac disease and effectively minimizing myocardial wall stress and subsequent cytolysis. This study evaluated the effects of an intravenous high dose of furosemide with (group A) or without small volume hypertonic saline solution (HSS) (group B) on myocardial cytolysis in patients with ADHF. A total of 248 consecutive patients with ADHF (148 men, mean age 74.9 ± 10.9 years) were randomly assigned to group A or B. Plasma levels of cardiac troponin-I, brain natriuretic peptide, glomerular filtration rate by Modification of Diet in Renal Disease formula, bioelectrical impedance analysis measurements, and delta pressure/delta time (dP/dt) rate were observed on admission and discharge for all patients. We observed a significant reduction of cardiac troponin in both groups and a significant improvement in renal function, hydration state, pulmonary capillary wedge pressure (P < .0001), end diastolic volume (P < .01), ejection fraction (P < .01), and dP/dt (P < .004) in group A. We also observed a significant reduction in body weight (64.4 vs 75.8 kg) (P < .001), cardiac troponin I (0.02 vs 0.31 ng/mL) (P < .0001) and brain natriuretic peptide (542 vs 1,284 pg/mL) (P < .0001), and hospitalization time (6.25 vs 10.2 days) (P < .0001) in the HSS group. These data demonstrate that intravenous high doses of furosemide do not increase myocardial injury and, in addition, when associated to HSS, significantly reduce cardiac troponin I release. This behavior is mirrored by the achievement of improved hemodynamic compensation at echocardiography and body hydration normalization. Copyright © 2012 Mosby, Inc. All rights reserved.

  12. Does nebulized epinephrine improve the efficacy of hypertonic saline solution in the treatment of hospitalized moderate acute bronchiolitis? A double blind, randomized clinical trial.

    Science.gov (United States)

    Flores-González, Jose Carlos; Dominguez-Coronel, Maria Teresa; Matamala Morillo, Miguel Angel; Aragón Ramírez, Miriam; García Ortega, Rosa María; Dávila Corrales, Francisco Javier; García Palacios, Maria Victoria; Perez Guerrero, Juan Jesus; García García, Laura; Lechuga Sancho, Alfonso María

    2016-04-01

    Nebulized 3% hypertonic saline solution (HSS 3%) has proven to reduce hospital stay in infants with acute bronchiolitis, as compared with nebulized physiological saline solutions. There are no studies assessing the effectiveness of nebulized epinephrine in patients treated with HSS 3%. The aim of this study was to compare the length of stay (LOS) in hospitalized patients treated with HSS 3% with placebo vs. HSS 3% with epinephrine. Secondarily we aimed to assess the effectiveness and safety of both treatments. We performed a prospective, randomized, double-blind, parallel-group study, including infants hospitalized for moderate acute bronchiolitis. Both groups received standard life support and were randomly treated with nebulized HSS 3% (7 mL) with either placebo 3 mL or epinephrine 3 mL. Nebulizations were initially administered every four hours and this interval was modified according to the patient's response. Sixty-four infants were included, 32 patients in each group. No statistically significant differences were found between the two groups (P=0.948) in length of stay, disease severity, SatO2, respiratory rate or heart rate. On the third day of hospitalization, severity and respiratory rate in the HSS 3%+E presented a non statistically significant trend to an earlier improvement, (P=0.063 and P=0.096 repectively). No adverse events occurred. Four patients (two from each group) required transfer to the pediatric intensive care unit. With a third of the final estimated sample, we find a trend to an earlier clinical recovery in the epinephrine group, even though no statistical significant differences in LOS were found. The study needs to be continued until the total sample is recruited.

  13. Enhanced detection of Candida in blood cultures with the BACTEC 460 system by use of the aerobic-hypertonic (8B) medium.

    Science.gov (United States)

    Yagupsky, P; Nolte, F S; Menegus, M A

    1990-12-01

    The blood culture records during the 6-year period 1984-9 were reviewed to compare the performance of the BACTEC aerobic (6B) and aerobic-hypertonic (8B) media for the recovery of Candida spp. and Torulopsis glabrata from blood. There were 137 positive blood culture sets that contained both a 6B and an 8B bottle. Sixty-eight different yeasts were recovered from 65 patients including 35 Candida albicans, 19 C. tropicalis, 6 C. parapsilosis, 4 C. krusei, 1 C. pseudotropicalis and 3 Torulopsis glabrata. The 8B medium detected 120 of the positive cultures (87.6%) and was the only positive medium in 35 (25.6%) sets, while the 6B medium detected 102 positive cultures (74.4%) and was the only positive medium in 17 (12.4%) sets (P less than 0.04). For those sets in which both bottles were positive, radiometric detection occurred first in the 8B bottle in 39 sets and first in the 6B bottle in 11 sets (P less than 0.001). The superior performance of the 8B bottle was not related to the administration of amphotericin B. Cultures of stock strains of C. albicans, C. tropicalis, and C. parapsilosis in 6B and 8B media with and without added blood confirmed the finding that 8B was substantially superior to 6B for the detection of candidaemia. It is concluded that an 8B bottle should be included in the blood culture set whenever candidaemia is suspected.

  14. CHALLENGES IN BRONCHIAL CHALLENGE TESTING

    NARCIS (Netherlands)

    Lexmond, A. J.; Hagedoorn, P.; Frijlink, H. W.; de Boer, A. H.

    2013-01-01

    Background: In the adenosine 5'-monophosphate (AMP) bronchial challenge test, AMP is usually administered according to dosing protocols developed for histamine/methacholine. It has never been thoroughly investigated whether these protocols are suitable for AMP as well. Methods: The setup of the

  15. Mobility Challenges

    DEFF Research Database (Denmark)

    Jensen, Ole B.; Lassen, Claus

    2011-01-01

    This article takes point of departure in the challenges to understand the importance of contemporary mobility. The approach advocated is a cross-disciplinary one drawing on sociology, geography, urban planning and design, and cultural studies. As such the perspective is to be seen as a part...... mobilities. In particular the article discusses 1) the physical city, its infrastructures and technological hardware/software, 2) policies and planning strategies for urban mobility and 3) the lived everyday life in the city and the region....... of the so-called ‘mobility turn’ within social science. The perspective is illustrative for the research efforts at the Centre for Mobility and Urban Studies (C-MUS), Aalborg University. The article presents the contours of a theoretical perspective meeting the challenges to research into contemporary urban...

  16. Challenging Identities

    DEFF Research Database (Denmark)

    Identity is a keyword in a number of academic fields as well as in public debate and in politics. During the last decades, references to identity have proliferated, yet there is no simple definition available that corresponds to the use of the notion in all contexts. The significance of the notion...... depends on the conceptual or ideological constellation in which it takes part. This volume on one hand demonstrates the role of notions of identity in a variety of European contexts, and on the other hand highlights how there may be reasons to challenge the use of the term and corresponding social......, cultural, and political practices. Notions of national identity and national politics are challenged by European integration, as well as by increasing demographic heterogeneity due to migration, and migrants experience conflicts of identification stemming from clashes between cultural heritage...

  17. Challenging Identities

    DEFF Research Database (Denmark)

    , cultural, and political practices. Notions of national identity and national politics are challenged by European integration, as well as by increasing demographic heterogeneity due to migration, and migrants experience conflicts of identification stemming from clashes between cultural heritage...... Rask Madsen, JUR Center for International CourtsOrganisation ; Henning Koch, JUR Center for retskulturelle studierOrganisation ; Peter E. Nielsen ; Catharina Raudvere, Institut for Tværkulturelle og Regionale StudierOrganisation: Institut ; Barbara Törnqvist-Plewa, University of Lund, Sweden ; Karl...

  18. Challenging Identities

    DEFF Research Database (Denmark)

    , cultural, and political practices. Notions of national identity and national politics are challenged by European integration, as well as by increasing demographic heterogeneity due to migration, and migrants experience conflicts of identification stemming from clashes between cultural heritage...... and the cultures of the new habitat. European horizons—frames of mind, historical memories, and expectations at the level of groups or communities, at the national level, and at the general European level—are at odds. Analyzing a series of issues in European countries from Turkey to Spain and from Scandinavia...

  19. The challenge

    Science.gov (United States)

    Freeman, Roger L.

    1988-01-01

    Radio systems in space are on the brink of achieving throughout data rates in the hundred of megabits. At present, radio systems operate below 60 GHz and are the traditional workhorses of satellite communications. Legal constraints and the laws of physics limit data rates on the systems. It is maintained that the challenge to provide high technology tools to develop viable high-data-rate space transmission systems can be met before the next century if three optical system and technology issues are overcome. In declining order of importance, the issues are: precise optical pointing, acquisition, and tracking; efficient laser diode optical sources producing sufficient output power; and advanced optical detector technology.

  20. Challenged Pragmatism

    DEFF Research Database (Denmark)

    Christoffersen, Lisbet; Vinding, Niels Valdemar

    2013-01-01

    Against the backdrop of a well-regulated and pragmatic Danish labour market, the question of reasonable accommodation is discussed on the basis of current legislation, recent legal cases and substantial interview material drawn from the RELIGARE sociolegal research done in Denmark. Employees...... of religious faith have made religious claims and thereby challenged a secular understanding of the Danish labour market. This raises the question of the extent to which the religion of the individual can be accepted in the general public sphere. At the same time, religious ethos organisations have argued...

  1. Hypertonic/hyperoncotic solution in hypovolemic patients: experience in the emergency room Solução hipertônica hiperoncótica em pacientes com hipovolemia: experiência na sala de admissão

    Directory of Open Access Journals (Sweden)

    Riad N. Younes

    2002-06-01

    Full Text Available Hypertonic solutions have been studied extensively in the treatment of hypovolemic shock, both in experimental and clinical models. Safety, efficacy, and long-term effects on animals and patients have been evaluated. The present article reviews indications, safety, mortality rates, and outcome in patients with hemorrhagic hypovolemic shock who were treated after admission with a hypertonic/hyperoncotic solution under strict observation in the emergency room.As soluções hipertônicas têm sido estudadas no tratamento de choque hipovolêmico, tanto em protocolos experimentais quanto clínicos. A eficácia, a segurança e os efeitos a longo prazo em animais e pacientes foram avaliados. O presente estudo apresenta uma revisão da literatura sobre as indicações, as taxas de morbidade e de mortalidade e a evolução de pacientes com choque hipovolêmico, admitidos e tratados com soluções hipertônicas/hiperoncóticas, admitidos e tratados sob observação contínua na sala de emergência do pronto socorro.

  2. Data Challenges

    CERN Multimedia

    McCubbin, N A

    Some two years ago we planned a series of Data Challenges starting at the end of 2001. At the time, that seemed to be comfortingly far in the future... Well, as the saying goes, doesn't time fly when you are having fun! ATLAS Computing is now deep in the throes of getting the first Data Challenge (DC0) up and running. One of the main aims of DC0 is to have a software 'release' in which we can generate full physics events, track all particles through the detector, simulate the detector response, reconstruct the event, and study it, with appropriate data storage en route. As all software is "always 95% ready" (!), we have been able to do most of this, more or less, for some time. But DC0 forces us to have everything working, together, at the same time: a reality check. DC0 should finish early next year, and it will be followed almost immediately afterwards by DC1 (DC0 was foreseen as the 'check' for DC1). DC1 will last into the middle of 2002, and has two major goals. The first is generation, simulation, and r...

  3. Nebulized Hypertonic Saline Treatment Reduces Both Rate and Duration of Hospitalization for Acute Bronchiolitis in Infants: An Updated Meta-analysis

    Directory of Open Access Journals (Sweden)

    Yen-Ju Chen

    2014-12-01

    Full Text Available Nebulized hypertonic saline (HS treatment reduced the length of hospitalization in infants with acute bronchiolitis in a previous meta-analysis. However, there was no reduction in the admission rate. We hypothesized that nebulized HS treatment might significantly decrease both the duration and the rate of hospitalization if more randomized controlled trials (RCTs were included. We searched MEDLINE, PubMed, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL without a language restriction. A meta-analysis was performed based on the efficacy of nebulized HS treatment in infants with acute bronchiolitis. We used weighted mean difference (WMD and risk ratio as effect size metrics. Eleven studies were identified that enrolled 1070 infants. Nebulized HS treatment significantly decreased the duration and rate of hospitalization compared with nebulized normal saline (NS [duration of hospitalization: WMD = −0.96, 95% confidence interval (CI = −1.38 to −0.54, p < 0.001; rate of hospitalization: risk ratio = 0.59, 95% CI = 0.37–0.93, p = 0.02]. Furthermore, nebulized HS treatment had a beneficial effect in reducing the clinical severity (CS score of acute bronchiolitis infants post-treatment (Day 1: WMD = −0.77, 95% CI = −1.30 to −0.24, p = 0.005; Day 2: WMD = −0.85, 95% CI = −1.30 to −0.39, p < 0.001; Day 3: WMD = −1.14, 95% CI = −1.69 to −0.58, p < 0.001. There was no decrease in the rate of readmission (risk ratio = 1.08, 95% CI = 0.68–1.73, p = 0.74. Nebulized HS treatment significantly decreased both the rate and the duration of hospitalization. Due to the efficacy and cost-effectiveness, HS should be considered for the treatment of acute bronchiolitis in infants.

  4. Hyaluronic acid improves the tolerability of hypertonic saline in the chronic treatment of cystic fibrosis patients: a multicenter, randomized, controlled clinical trial.

    Science.gov (United States)

    Ros, Mirco; Casciaro, Rosaria; Lucca, Francesca; Troiani, Patrizia; Salonini, Elena; Favilli, Federica; Quattrucci, Serena; Sher, Daniel; Assael, Baroukh Maurice

    2014-04-01

    TRIAL DESIGN AND METHODS: Between December 2009 and July 2011, four cystic fibrosis (CF) centers in Italy participated in a randomized, double-blind, controlled clinical trial to test whether 7% hypertonic saline (HS) administered together with 0.1% hyaluronic acid (HA) was better tolerated by patients who previously did not tolerate HS well on its own. Participants were CF patients at least 8 years old, in clinically stable conditions, with forced expiratory volume in 1 sec (FEV1) at least 50% predicted. Forty patients were recruited and randomized to receive either HS or HS plus HA (5 mL to be inhaled over 15 min, twice daily for 28 days). Primary endpoints were cough, throat irritation, salty taste, and overall acceptability, as assessed by each patient on a semiquantitative scale on a diary card. Secondary endpoint was FEV1 change at the end of treatment. Patients were randomized into randomly permuted blocks. The first and last doses were administered in hospital. In between, patients were treated at home. Patients, all caregivers, and the statistician who conducted the analysis (different from the one who generated the random list) were blinded to group assignment. Severity of cough, throat irritation, and saltiness were more severe in patients treated with HS alone, both after the first inhalation and over the entire treatment period. Overall pleasantness was rated higher by patients treated with the combination product. All differences were highly significant. There were no changes in FEV1 between the first and last administrations. Five patients did not complete the study. Four patients (two from each group) withdrew because of cough or throat irritation. One more patient from the HS group withdrew because of a respiratory exacerbation at week 3. HS is currently a cornerstone in the treatment of CF patients. The addition of HA to HS reduces the prevalence and severity of cough, throat irritation, and saltiness and may improve compliance in patients

  5. Challenging makerspaces

    DEFF Research Database (Denmark)

    Sandvik, Kjetil; Thestrup, Klaus

    . The Danish part of the project will be undertaken by a small network of partners: DOKK1, a public library and open urban space in Aarhus, that is experimenting with different kind of makerspaces, spaces and encounters between people, The LEGO-LAB situated at Computer Science, Aarhus University, that has......-8 will be developed through participation in creative activities in specially-designed spaces termed ‘makerspaces’. This paper discusses, develops and challenges this term in relation to Danish pedagogical traditions, to expanding makerspaces onto the internet and on how to combine narratives and construction...... developed a number of work space activities on children and technology and finally Katrinebjergskolen, a public school that has built a new multi-functional room, that among other things are meant for makerspaces and new combinations of media and materials. This group will work with the notion of Next...

  6. Scrapheap Challenge

    CERN Document Server

    2004-01-01

    Three British guys at CERN recently took a break from work to try their hand at Scrapheap Challenge. Shown on Channel 4 in the UK, it is a show where two teams must construct a machine for a specific task using only the junk they can scavenge from the scrap yard around them. And they have just 10 hours to build their contraption before it is put to the test. The first round, aired 19 September, pitted a team of three women, from the British Army's Royal Electrical and Mechanical Engineers, against the CERN guys - the Up 'n Atoms: Ali Day, David McFarlane and James Ridewood. Each team, with the help of an appointed expert, had the task of making a giant, 3-metre self-propelled "bowling ball", to roll down a 50 metre bowling alley at skittles 4 metres high. The Up 'n Atoms' contraption featured a small car with a huge wheel on its back. Once up to speed, slamming on the brakes caused the wheel to roll over and take the car with it. On their very last run they managed to take out seven pins. Luckily, though, ...

  7. Two Sulfur Glycoside Compounds Isolated from Lepidium apetalum Willd Protect NRK52e Cells against Hypertonic-Induced Adhesion and Inflammation by Suppressing the MAPK Signaling Pathway and RAAS

    Directory of Open Access Journals (Sweden)

    Peipei Yuan

    2017-11-01

    Full Text Available Lepidium apetalum Willd has been used to reduce edema and promote urination. Cis-desulfoglucotropaeolin (cis-DG and trans-desulfoglucotropaeolin (trans-DG were isolated from Lepidium apetalum Willd, and caused a significant increase in cell viability in a hypertonic model in NRK52e cells. In the hypertonic model, cis-DG and trans-DG significantly promoted the cell viability of NRK52e cells and inhibited the elevation of Na+ in the supernatant, inhibited the renin-angiotensin-aldosterone (RAAS system, significantly reduced the levels of angiotensin II (Ang II and aldosterone (ALD, and lowered aquaporin-2 (AQP2 and Na+–K+ ATP content in renal medulla. After treatment with cis-DG and trans-DG, expression of calcineurin (CAN and Ca/calmodulin-dependent protein kinase II (CaMK II was decreased in renal tissue and Ca2+ influx was inhibited, thereby reducing the secretion of transforming growth factor-β (TGFβ, reversing the increase in adhesion and inflammatory factor E-selectin and monocyte chemotactic protein 1 (MCP-1 induced by high NaCl, while reducing oxidative stress status and decreasing the expression of cyclooxygenase-2 (COX2. Furthermore, inhibition of protein kinase C (PKC expression also contributed to these improvements. The cis-DG and trans-DG reduced the expression of p-p44/42 MAPK, p-JNK and p-p38, inhibited the phosphorylation of the MAPK signaling pathway in NRN52e cells induced by high salt, decreased the overexpression of p-p38 and p-HSP27, and inhibited the overactivation of the p38-MAPK signaling pathway, suggesting that the p38-MAPK pathway may play a vital role in the hypertonic-induced adhesion and inflammatory response. From the results of this study, it can be concluded that the mechanism of cis-DG and trans-DG may mainly be through inhibiting the p38-MAPK signaling pathway, inhibiting the excessive activation of the RAAS system, and thereby reducing adhesion and inflammatory factors.

  8. The relationship between serum sodium and intracranial pressure when using hypertonic saline to target mild hypernatremia in patients with head trauma.

    Science.gov (United States)

    Wells, Diana L; Swanson, Joseph M; Wood, G Christopher; Magnotti, Louis J; Boucher, Bradley A; Croce, Martin A; Harrison, Charles G; Muhlbauer, Michael S; Fabian, Timothy C

    2012-10-15

    Limited data suggest mild hypernatremia may be related to lower intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The practice at the study center has been to use hypertonic saline (HTS) to generate a targeted serum sodium of 145 to 155 mEq/l in patients with TBI. The purpose of this study was to determine the relationship between serum sodium values and ICP, and to evaluate the acute effect of HTS on ICP. A retrospective review of patients who were admitted to the trauma ICU for TBI, had an ICP monitor placed, and received at least one dose of HTS between January 2006 and March 2011 was performed. Data were collected for up to 120 hours after ICP monitor placement. The primary outcome was the relationship between serum sodium and maximum ICP. Secondary outcomes were the relationship between serum sodium and the mean number of daily interventions for ICP control, and the acute effect of HTS on ICP during the 6 hours after each dose. Linear regression was used to analyze the primary outcome. Analysis of variance on ranks and repeated measures analysis of variance were used to evaluate the number of interventions and the acute effect of HTS on ICP, respectively. Eighty-one patients were enrolled with mean ± standard deviation age of 36 ± 15 years and median Glasgow Coma Scale score of 7 (interquartile range, 4 to 7). A total of 1,230 serum sodium values (range, 118 to 174 mEq/l) and 7,483 ICP values (range, 0 to 159 mmHg) were collected. There was no correlation between serum sodium and maximum ICP (R(2) = 0.0052). The overall mean ± standard deviation number of interventions for elevated ICP per day was 4.2 ± 2.9, 2.9 ± 2.0, and 2.6 ± 2.3 for patients with a mean serum sodium of 155 mEq/l, respectively (P < 0.001). Regarding the acute effect of HTS on ICP, there was no statistical difference in mean ICP compared with baseline during hours 1 through 6 following HTS doses (baseline, 13.7 ± 8.4 mmHg; hour 1, 13.6 ± 8.3 mmHg; hour 2, 13

  9. Overcoming Breastfeeding Challenges

    Medline Plus

    Full Text Available ... Only Natural email updates. Enter email address Submit Home > It's Only Natural > Overcoming challenges Overcoming breastfeeding challenges YouTube embed video: YouTube embed video: https:// ...

  10. National Drug IQ Challenge

    Science.gov (United States)

    ... Reto nacional del coeficiente intelectual (CI) sobre las drogas y el alcohol 2016 National Drug IQ Challenge ... Reto nacional del coeficiente intelectual (CI) sobre las drogas y el alcohol 2015 National Drug IQ Challenge ...

  11. Millennium Challenge Account

    National Research Council Canada - National Science Library

    Tarnoff, Curt

    2008-01-01

    .... foreign aid initiative. The Millennium Challenge Account (MCA) provides assistance through a competitive selection process to developing nations that are pursing political and economic reforms in three areas...

  12. College and University Challenge

    Science.gov (United States)

    This EPA's Green Power Partnership Challenge tracks and recognizes U.S. colleges and universities recognizes the largest single green power users within each participating collegiate athletic conferences.

  13. First Aid Challenge

    Science.gov (United States)

    Roman, Harry T.

    2011-01-01

    This article describes a challenge wherein students will be asked to design a portable first aid kit that is normally carried in a recreational vehicle (RV), but can also be hand-carried or backpacked off road for distances of approximately 1-2 miles. This can be a very practical challenge for the students because it touches everyone. Everybody…

  14. Overcoming Breastfeeding Challenges

    Medline Plus

    Full Text Available ... size | Print | Skip left navigation It's Only Natural Planning ahead Overcoming challenges Overcoming breastfeeding challenges Dealing with ... it into your life My breastfeeding story Partner resources ... U.S. Department of Health and Human Services 200 Independence Avenue, S.W. • Washington, DC ...

  15. Bilingual Education: Current Challenges.

    Science.gov (United States)

    Krashen, Stephen

    2000-01-01

    Examines current controversies and challenges in bilingual education, reviewing the case for bilingual education and the research supporting it. Makes suggestions for improving bilingual education, which include enriching the print environment and using heritage language development. Discusses research findings on challenges to bilingual…

  16. Hydrodynamics challenge problem

    Energy Technology Data Exchange (ETDEWEB)

    Hornung, R. D. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Keasler, J. A. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Gokhale, M. B. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2011-06-09

    The hydrodynamics challenge problem represents a classical HPC physics problem, namely high deformation event modeling via Lagrangian shock hydrodynamics. This challenge problem solves the Sedov blast wave problem for one material in three dimensions. The problem has an analytic solution, and can be scaled to arbitrarily large problem sizes. The reference code is drawn from a production LLNL hydrodynamics code.

  17. Dewey's Challenge to Teachers

    Science.gov (United States)

    Fishman, Stephen M.; McCarthy, Lucille

    2010-01-01

    Given the serious social problems confronting Americans and others worldwide, the authors propose that Dewey's 1932 challenge to teachers is worthy of reconsideration by educators at all levels. In times similar to our own, Dewey challenged teachers to cultivate students' capacities to identify their happiness with what they can do to improve the…

  18. Virtual Bridge Design Challenge

    Science.gov (United States)

    Mitts, Charles R.

    2013-01-01

    This design/problem-solving activity challenges students to design a replacement bridge for one that has been designated as either structurally deficient or functionally obsolete. The Aycock MS Technology/STEM Magnet Program Virtual Bridge Design Challenge is an authentic introduction to the engineering design process. It is a socially relevant…

  19. Overcoming Breastfeeding Challenges

    Medline Plus

    Full Text Available ... Health Skip Navigation En Español Skip top navigation Home A-Z Health Topics Printables and Shareables Blog ... Only Natural email updates. Enter email address Submit Home > It's Only Natural > Overcoming challenges Overcoming breastfeeding challenges ...

  20. Science Challenge Day

    Science.gov (United States)

    Siegel, Deborah

    2013-01-01

    Science fairs can be good motivators, but as extracurricular activities, they leave some students behind. However, by staging a Science Challenge Day at school, educators can involve all students in doing everything from choosing activities to judging projects. This article presents a model for running a successful Science Challenge Day. The…

  1. Employment challenges in the future

    DEFF Research Database (Denmark)

    Rimmer, Nina Roehr

    2011-01-01

    Discussion of challenges in employment challenges in Europe and a brief discription of the Danish flexicurity system......Discussion of challenges in employment challenges in Europe and a brief discription of the Danish flexicurity system...

  2. Infusion of hypertonic saline before elective hysterectomy: effects on cytokines and stress hormonesTumor necrosis factor-alpha binding capacity and anti-infliximab antibodies measured by fluid-phase radioimmunoassays as predictors of clinical efficacy of infliximab in Crohn's disease

    DEFF Research Database (Denmark)

    Kolsen-Petersen, J.A.; Bendtzen, K.; Tonnesen, E.

    2008-01-01

    BACKGROUND: Infusion of hypertonic saline provides early haemodynamic benefits and may affect the immune system. It is unknown if infusion of hypertonic saline affects plasma cytokines and stress hormones after surgery. METHODS: Sixty-two women undergoing abdominal hysterectomy were randomized...... in a double-blind study to infusion of NaCl 7.5% (HS), NaCl 0.9% (NS4), both 4 ml kg(-1), or NaCl 0.9% 32 ml kg(-1) (NS32) over 20 min. Blood was collected at baseline, 1, 4, and 24 h after surgery (n=34) for the determination of interleukin (IL)-1beta, IL-6, IL-8, IL-10, IL-12, IL-1ra, and tumour necrosis...... factor-alpha. Serum cortisol and vasopressin were measured at these time points and 48 h after operation. Epinephrine and norepinephrine (n=26) were quantified at baseline, after infusion, 25 min after incision, 1, and 4 h after surgery. Finally, C-reactive protein was measured at baseline, 24, and 48 h...

  3. Challenges of serious games

    Directory of Open Access Journals (Sweden)

    B. Fernández-Manjón

    2015-11-01

    Full Text Available Although educational games have revealed to be a very effective focus in diverse situations, their use in education is still very limited. In this paper we analyse the main challenges concerning educational games that, from our perspective, have to be approached so that the use of this kind of games can be widespread. These challenges are classified in three main dimensions: socio-cultural, educational and technological. Once the challenges are identified, some possible measures are suggested to address or reduce these problems so that the use of educational games may be widespread.

  4. Big Data Challenges

    Directory of Open Access Journals (Sweden)

    Alexandru Adrian TOLE

    2013-10-01

    Full Text Available The amount of data that is traveling across the internet today, not only that is large, but is complex as well. Companies, institutions, healthcare system etc., all of them use piles of data which are further used for creating reports in order to ensure continuity regarding the services that they have to offer. The process behind the results that these entities requests represents a challenge for software developers and companies that provide IT infrastructure. The challenge is how to manipulate an impressive volume of data that has to be securely delivered through the internet and reach its destination intact. This paper treats the challenges that Big Data creates.

  5. A two-center, assessor-blinded, prospective trial evaluating the efficacy of a novel hypertonic draining cream for cellulite reduction: A Clinical and instrumental (Antera 3D CS) assessment.

    Science.gov (United States)

    Puviani, Mario; Tovecci, Federica; Milani, Massimo

    2017-12-04

    Gynoid lipodystrophy, also known as cellulite, is a very common skin alteration representing mainly a cosmetic problem rather than a real disease. An effective treatment of cellulite has not been well established. The initial phase of cellulite is characterized by subdermal tissue edema with interstitial fluids retention. A new hypertonic topical product with draining action (HTC) containing NaCl 13%, escine, caffeine, and beta-sitosterol has been recently developed. A 28-day double-blind placebo-controlled study has shown that this cream is able to reduce thigh circumference and the thickness of adipose tissue. No data so far are available regarding an objective evaluation of skin appearance for a longer application period. To evaluate the clinical efficacy of 2-month HCT treatment with clinical and instrumental assessments. In a prospective, 2-center, assessor-blinded trial 20 women (mean age 34 years) with cellulite of Grade I-III in severity were enrolled after their informed consent. HTC was applied once daily for 60 days. Primary outcomes of the trial were the evolution of thigh circumference measurements (assessed at baseline, after 1 and 2 months) and the computer-analysis of skin profilometry (ie, skin volumes) of a prespecified target area evaluated by means of Antera 3D CS digitalized images (assessed at baseline and at the end of the trial). Secondary outcome was the orange peel severity score (from 0 to 5) before and after pitch test. All subjects concluded the study period. Thigh circumference was reduced by -0.88 (right)/-1.2 cm (left) and by -1.8(right)/-2.1 (left) cm, after 30 and 60 days of treatment, respectively (P = .001, Wilcoxon test vs baseline). Antera 3D profilometry of the target zone showed a significant reduction in skin depression expressed in mm 3 of -56% (from 59.7 to 26.73 mm 3 ) after HTC application. Orange peel (no pitch test) mean (SD) score was 2.3 (1) at baseline, 2.0 (1) and 1.8 (0.8) after 1 and 2 months (P = .0031

  6. Comparison of the effects of 7.2% hypertonic saline and 20% mannitol on whole blood coagulation and platelet function in dogs with suspected intracranial hypertension - a pilot study.

    Science.gov (United States)

    Yozova, Ivayla D; Howard, Judith; Henke, Diana; Dirkmann, Daniel; Adamik, Katja N

    2017-06-19

    Hyperosmolar therapy with either mannitol or hypertonic saline (HTS) is commonly used in the treatment of intracranial hypertension (ICH). In vitro data indicate that both mannitol and HTS affect coagulation and platelet function in dogs. The aim of this study was to compare the effects of 20% mannitol and 7.2% HTS on whole blood coagulation using rotational thromboelastometry (ROTEM®) and platelet function using a platelet function analyzer (PFA®) in dogs with suspected ICH. Thirty client-owned dogs with suspected ICH needing osmotherapy were randomized to receive either 20% mannitol (5 ml/kg IV over 15 min) or 7.2% HTS (4 ml/kg IV over 5 min). ROTEM® (EXTEM® and FIBTEM® assays) and PFA® analyses (collagen/ADP cartridges) were performed before (T0), as well as 5 (T5), 60 (T60) and 120 (T120) minutes after administration of HTS or mannitol. Data at T5, T60 and T120 were analyzed as a percentage of values at T0 for comparison between groups, and as absolute values for comparison between time points, respectively. No significant difference was found between the groups for the percentage change of any parameter at any time point except for FIBTEM® clotting time. Within each group, no significant difference was found between time points for any parameter except for FIBTEM® clotting time in the HTS group, and EXTEM® and FIBTEM® maximum clot firmness in the mannitol group. Median ROTEM® values lay within institutional reference intervals in both groups at all time points, whereas median PFA® values were above the reference intervals at T5 (both groups) and T60 (HTS group). Using currently recommended doses, mannitol and HTS do not differ in their effects on whole blood coagulation and platelet function in dogs with suspected ICH. Moreover, no relevant impairment of whole blood coagulation was found following treatment with either solution, whereas a short-lived impairment of platelet function was found after both solutions.

  7. Better Buildings Challenge Overview

    Energy Technology Data Exchange (ETDEWEB)

    None

    2011-06-01

    The Better Buildings Challenge is a national leadership initiative calling on corporate chief executive officers, university presidents, and state and local leaders to make a significant commitment to building energy efficiency.

  8. Overcoming Breastfeeding Challenges

    Medline Plus

    Full Text Available ... project of the U.S. Department of Health and Human Services Office on Women's Health Skip Navigation En ... breastfeeding challenges Dealing with lack of family support Is my baby getting enough milk? Breastfeeding ...

  9. 2017 TRI University Challenge

    Science.gov (United States)

    Details about the 2017 TRI University Challenge, in which EPA is looking to academic institutions to help build a diverse portfolio of practical and replicable projects that benefit communities, the environment, academic institutions, and the TRI Program.

  10. Brazil World Cup Challenges

    Directory of Open Access Journals (Sweden)

    MANSUR, R.

    2012-12-01

    Full Text Available Overcoming the productivity challenge is the main benefit of the 2014 World Cup for Brazilian people. The sustainable development of our cultural tourism industry will catapult the new middle class growing up rate.

  11. Overcoming Breastfeeding Challenges

    Medline Plus

    Full Text Available ... Overcoming breastfeeding challenges Dealing with lack of family support Is my baby getting enough milk? Breastfeeding in ... get a good latch Addressing breastfeeding myths Finding support Fitting it into your life My breastfeeding story ...

  12. The Electric Car Challenge.

    Science.gov (United States)

    Diehl, Brian E.

    1997-01-01

    Describes the Electric Car Challenge during which students applied methods of construction to build lightweight, strong vehicles that were powered by electricity. The activity required problem solving, sheet metal work, electricity, design, and construction skills. (JOW)

  13. Community Challenge Grantees

    Data.gov (United States)

    Department of Housing and Urban Development — HUD's Community Challenge Grants aim to reform and reduce barriers to achieving affordable, economically vital and sustainable communities. The funds are awarded to...

  14. Big data challenges

    DEFF Research Database (Denmark)

    Bachlechner, Daniel; Leimbach, Timo

    2016-01-01

    Although reports on big data success stories have been accumulating in the media, most organizations dealing with high-volume, high-velocity and high-variety information assets still face challenges. Only a thorough understanding of these challenges puts organizations into a position in which...... they can make an informed decision for or against big data, and, if the decision is positive, overcome the challenges smoothly. The combination of a series of interviews with leading experts from enterprises, associations and research institutions, and focused literature reviews allowed not only...... framework are also relevant. For large enterprises and startups specialized in big data, it is typically easier to overcome the challenges than it is for other enterprises and public administration bodies....

  15. The new productivity challenge.

    Science.gov (United States)

    Drucker, P F

    1991-01-01

    "The single greatest challenge facing managers in the developed countries of the world is to raise the productivity of knowledge and service workers," writes Peter F. Drucker in "The New Productivity Challenge." Productivity, says Drucker, ultimately defeated Karl Marx; it gave common laborers the chance to earn the wages of skilled workers. Now five distinct steps will raise the productivity of knowledge and service workers--and not only stimulate new economic growth but also defuse rising social tensions.

  16. 78 FR 49296 - Centennial Challenges 2014 Sample Return Robot Challenge

    Science.gov (United States)

    2013-08-13

    ... SPACE ADMINISTRATION Centennial Challenges 2014 Sample Return Robot Challenge AGENCY: National Aeronautics and Space Administration (NASA). ACTION: Notice of Centennial Challenges 2014 Sample Return Robot... Robot Challenge is scheduled and teams that wish to compete may register. Centennial Challenges is a...

  17. Centennial Challenges Program

    Science.gov (United States)

    Ortega, Sam; Eberly, Eric

    2015-01-01

    NASA's Centennial Challenges Program was initiated in 2005 to directly engage the public in the process of advanced technology development. The program offers incentive prizes to generate revolutionary solutions to problems of interest to NASA and the nation. The program seeks innovations from diverse and nontraditional sources. Competitors are not supported by government funding and awards are only made to successful teams when the challenges are met. In keeping with the spirit of the Wright Brothers and other American innovators, the Centennial Challenge prizes are offered to independent inventors including small businesses, student groups, and individuals. These independent inventors are sought to generate innovative solutions for technical problems of interest to NASA and the nation and to provide them with the opportunity to stimulate or create new business ventures.

  18. Meeting the Challenge

    Directory of Open Access Journals (Sweden)

    T. Reg Bott

    2009-01-01

    Full Text Available The first Chempor Conference held in Lisbon in 1975 under the auspices of the Calouste Gulbenkian Foundation, heralded a regular wide-ranging review of research and development in Portugal and the UK Progressively in later years the Conferences have attracted contributions from other European countries and indeed further afield. There is an increasing awareness of the problems for the environment, notably global warming, brought about by human activities. Recent predictions about the future are dire, particularly regarding food and water for a rapidly growing world population. They represent a substantial challenge to the scientific and technical fraternity. In response to that challenge it is important to keep up to date with technical developments, to meet and keep in touch with coworkers in associated fields, and to cooperate wherever possible. The papers presented at the Chempor and other conferences have made and continue to make a significant contribution to that objective of meeting the challenge.

  19. Challenges facing production grids

    Energy Technology Data Exchange (ETDEWEB)

    Pordes, Ruth; /Fermilab

    2007-06-01

    Today's global communities of users expect quality of service from distributed Grid systems equivalent to that their local data centers. This must be coupled to ubiquitous access to the ensemble of processing and storage resources across multiple Grid infrastructures. We are still facing significant challenges in meeting these expectations, especially in the underlying security, a sustainable and successful economic model, and smoothing the boundaries between administrative and technical domains. Using the Open Science Grid as an example, I examine the status and challenges of Grids operating in production today.

  20. Anthropocene Age Wicked Challenges

    DEFF Research Database (Denmark)

    Edgeman, Rick; Wu, Zhaohui

    2015-01-01

    weather events, drought, and desertification; threatened food supplies; water pollution, air pollution, and soil contamination; and the connection of these to disease, violence, and terrorism. Wicked challenges are discussed in relation to enterprise excellence, sustainability, resilience and robustness...... (SEER2) where these are in part enabled by supply chain proficiency.......Grand global challenges, including wicked human caused or influenced ones key to sustainability, characterize the Anthropocene Age. Among these are climate change driven by increased methane and CO2 in the atmosphere; consequent global warming and increasing intensity and incidence of extreme...

  1. British Muslims: A Challenge

    OpenAIRE

    Abdel-Hady, Zakaryya Mohamed [زكريا محمد عبد الهادي

    2007-01-01

    The Muslim community in Britain today face multiple challenges covering a wide range of spectrum from the basic right to exists, fighting the increasing trends of Islamophobia, having equal opportunities, to participate in public life, fully integrate within the society and be a positive member of the community. The recent events of September 11th in the US, July 7th in UK and the more recent row over the ban of the headscarf in UK and other European countries have placed tremendous challenge...

  2. Electric Vehicle Battery Challenge

    Science.gov (United States)

    Roman, Harry T.

    2014-01-01

    A serious drawback to electric vehicles [batteries only] is the idle time needed to recharge their batteries. In this challenge, students can develop ideas and concepts for battery change-out at automotive service stations. Such a capability would extend the range of electric vehicles.

  3. MALL: The Pedagogical Challenges

    Science.gov (United States)

    Burston, Jack

    2014-01-01

    In this paper the development of mobile-assisted language learning (MALL) over the past 20 years is reviewed with a particular focus on the pedagogical challenges facing its exploitation. Following a consideration of the definition of mobile learning, the paper describes the dominant mobile technologies upon which MALL applications have been…

  4. Employment Challenges in Kenya

    African Journals Online (AJOL)

    Dr Kazungu

    To reverse the trend in slow employment growth, Kenya must focus on ensuring high and sustained economic growth. .... (KYEP), Youth. Employment Scheme Abroad (YESA) and Women Enterprise Fund (WEF). ..... This study undertakes a simple extrapolation exercise to examine Kenya's employment challenge over the ...

  5. The Challenge of Thor

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 15; Issue 3. The Challenge of Thor. Anil Kakodkar Sujata Varadarajan. Face to Face Volume 15 Issue 3 March 2010 pp 277-293. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/015/03/0277-0293 ...

  6. A Cool Challenge

    Science.gov (United States)

    Roman, Harry T.

    2012-01-01

    The world of man-made design is all around, in everyday objects and appliances people use without a second thought. In this exercise, students have an opportunity to challenge the common refrigerator's design--and improve it. This approach can be used with many other appliances.

  7. India's Higher Education Challenges

    Science.gov (United States)

    Altbach, Philip G.

    2014-01-01

    India, with the world's second largest higher education system and a rapidly growing economy as one of the BRIC nations, faces significant challenges in building both capacity and excellence in higher education. India's higher education system is characterized by "islands of excellence in a sea of mediocrity." The mainstream universities…

  8. The Store Challenge

    Science.gov (United States)

    Roman, Harry T.

    2014-01-01

    Biomedical and robotic technologies are merging to present a wonderful opportunity to develop artificial limbs and prosthetic devices for humans injured on the job, in the military, or due to disease. In this challenge, students will have the opportunity to design a store or online service that specifically dedicates itself to amputees. Described…

  9. The Better Boat Challenge

    Science.gov (United States)

    Schomburg, Aaron

    2008-01-01

    "On your mark, get set, go!" Elementary students love to hear these words as they participate in the annual Third Grade Better Boat Challenge. This highly motivational project started a few years ago as the author was developing the third-grade science curriculum to include a study that revolved around models, design, and problem solving. It has…

  10. A Challenge to Watson

    Science.gov (United States)

    Detterman, Douglas K.

    2011-01-01

    Watson's Jeopardy victory raises the question of the similarity of artificial intelligence and human intelligence. Those of us who study human intelligence issue a challenge to the artificial intelligence community. We will construct a unique battery of tests for any computer that would provide an actual IQ score for the computer. This is the same…

  11. US Cyber Challenge Research

    Science.gov (United States)

    2012-02-01

    FORCE RESEARCH LABORATORY INFORMATION DIRECTORATE US CYBER CHALLENGE RESEARCH CENTER FOR INTERNET SECURITY , INC FEBRUARY 2012...CY 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Center for Internet Security , Inc. CIS 31 Tech Valley Dr East Greenbush, NY 12061-4134 8...detect and defeat cyber threats. 15. SUBJECT TERMS Cyber Security, Information Assurance, Internet Security , Cyber Education and Training 16

  12. Microarray challenges in ecology

    NARCIS (Netherlands)

    Kammenga, Jan E.; Herman, Michael A.; Ouborg, N. Joop; Johnson, Loretta; Breitling, Rainer

    Microarrays are used to measure simultaneously the amount of mRNAs transcribed from many genes. They were originally designed for gene expression profiling in relatively simple biological systems, such as cell lines and model systems under constant laboratory conditions. This poses a challenge to

  13. University Engineering Design Challenge

    Science.gov (United States)

    2015-01-02

    shoulder strain or sprain 18 University Design Challenge 2012 –2013 Introduction Arizona State University (ASU) was contracted by the Air Force Research... causing issues with regards to lateral instability. Testing Parameters:  Amsteel purple rope, fed normally (horizontals and verticals), but then looped

  14. Kayak Design Challenge

    Science.gov (United States)

    Wood, Anson

    2011-01-01

    Living in the Adirondack Park and being an avid outdoorsman has often resulted in the author's love of the outdoors working its way into class projects. In 2010, the author gave a group of 25 students in grades 9-12 a challenge that required them to design and construct a prototype inexpensive, lightweight kayak for backpackers and fisherman. In…

  15. Challenges in data science

    DEFF Research Database (Denmark)

    Carbone, Anna; Jensen, M.; Sato, Aki-Hiro

    2016-01-01

    The ability to process and manage large data volumes has been proven to be not enough to tackle the current challenges presented by "Big Data". Deep insight is required for understanding interactions among connected systems, space- and time-dependent heterogeneous data structures. Emergence...

  16. 77 FR 70835 - Centennial Challenges 2013 Sample Return Robot Challenge

    Science.gov (United States)

    2012-11-27

    ... SPACE ADMINISTRATION Centennial Challenges 2013 Sample Return Robot Challenge AGENCY: National... in accordance with 51 U.S.C. 20144(c). The 2013 Sample Return Robot Challenge is scheduled and teams... Robot Challenge is a prize competition designed to encourage development of new technologies or...

  17. 76 FR 56819 - Centennial Challenges 2012 Sample Return Robot Challenge

    Science.gov (United States)

    2011-09-14

    ... SPACE ADMINISTRATION Centennial Challenges 2012 Sample Return Robot Challenge AGENCY: National... 42 U.S.C. 2451(314)(d). The 2012 Sample Return Robot Challenge is scheduled and teams that wish to... technologies of interest and value to NASA and the nation. The 2012 Sample Return Robot Challenge is a prize...

  18. Challenges to Resistance Welding

    DEFF Research Database (Denmark)

    Song, Quanfeng

    This report originates from the compulsory defense during my Ph.D. study at the Technical University of Denmark. Resistance welding is an old and well-proven technology. Yet the emergence of more and more new materials, new designs, invention off new joining techniques, and more stringent...... requirement in quality have imposed challenges to the resistance welding. More some research and development have to be done to adapt the old technology to the manufacturing industry of the 21st century. In the 1st part of the report, the challenging factors to the resistance welding are reviewed. Numerical...... simulation of resistance welding has been under development for many years. Yet it is no easy to make simulation results reliable and accurate because of the complexity of resistance welding process. In the 2nd part of the report numerical modeling of resistance welding is reviewed, some critical factors...

  19. Challenges in sexual medicine

    DEFF Research Database (Denmark)

    Cellek, Selim; Giraldi, Annamaria

    2012-01-01

    The sexual medicine field has been in mode of revolution until recently. Like all other fields of biomedical research, the economic situation around the world has had a negative impact on the field's momentum-research funding bodies, regulatory bodies and pharmaceutical companies seem to have...... placed sexual medicine in their low-priority list. But this is not the only challenge the field is facing. The successful development of phosphodiesterase type 5 (PDE5) inhibitors for treatment of erectile dysfunction (ED) means that research in this area seems to have slowed. However, there remain...... several unmet medical needs within sexual medicine such as premature ejaculation, severe ED and hypoactive sexual desire disorder, which await novel therapeutic approaches. Despite these challenges, research into finding and developing such therapies is likely to continue in the sexual medicine field...

  20. Diagnostic Challenges at SNS

    CERN Document Server

    Plum, M A

    2003-01-01

    The Spallation Neutron Source now being built in Oak Ridge, Tennessee, USA, accelerates an H- ion beam to 1000 MeV with an average power of 1.4 MW. The H- beam is then stripped to H+, compressed in a storage ring to a pulse length of 695 ns, and then directed onto a mercury neutron spallation target. Most of the acceleration is accomplished with superconducting rf cavities. The presence of these cavities, the high average beam power, and the large range of beam intensity in the storage ring, provide unique challenges to the beam diagnostics systems. In this talk we will discuss these challenges and some of our solutions, including the laser profile monitor system, the residual gas ionization profile monitors, and network attached devices. Measurements performed using prototype instrumentation will also be presented.

  1. Mathematical olympiad challenges

    CERN Document Server

    Andreescu, Titu

    2000-01-01

    Mathematical Olympiad Challenges is a rich collection of problems put together by two experienced and well-known professors and coaches of the U.S. International Mathematical Olympiad Team. Hundreds of beautiful, challenging, and instructive problems from algebra, geometry, trigonometry, combinatorics, and number theory were selected from numerous mathematical competitions and journals. An important feature of the work is the comprehensive background material provided with each grouping of problems. The problems are clustered by topic into self-contained sections with solutions provided separately. All sections start with an essay discussing basic facts and one or two representative examples. A list of carefully chosen problems follows and the reader is invited to take them on. Additionally, historical insights and asides are presented to stimulate further inquiry. The emphasis throughout is on encouraging readers to move away from routine exercises and memorized algorithms toward creative solutions to open-e...

  2. Challenges in Request Management

    DEFF Research Database (Denmark)

    Sommer, Anita Friis

    2014-01-01

    and its customers. The study provides an insight into a new area of supply chain management, including the process activity flow and challenges involved across the process. Furthermore, the method is dyadic including the customer in the case study, which is rare in related research....... profitability. This research study seeks to investigate the challenges of RQM in practice. Existing demand chain management literature is used as a basis for developing a RQM framework. RQM is investigated through an explorative research design in a dyadic B2B case study including a global industrial company......Request management (RQM) is a new term used for managing customer requests for new products. It is the counterpart to typical product development processes, which has no direct customer involvement. It is essential to manage customer requests in a structured and efficient way to obtain...

  3. Asia's new challenges

    DEFF Research Database (Denmark)

    Brach, Juliana; Vang, Jan

    2012-01-01

    Asian countries are currently undergoing significant changes with respect to their role in and interaction with the international economy. Despite their heterogeneity, Asian countries share the common aim to upgrade capacities, skills and capabilities. This paper aims at unpacking the challenges ...... and consequences of Asian countries' four decades of internationalisation. Special attention is granted to the current redesign of the interface with focus on the upgrading towards becoming knowledge and technology intensive nations; nations that are also exporters of FDI....

  4. Terabit Wireless Communication Challenges

    Science.gov (United States)

    Hwu, Shian U.

    2012-01-01

    This presentation briefly discusses a research effort on Terabit Wireless communication systems for possible space applications. Recently, terahertz (THz) technology (300-3000 GHz frequency) has attracted a great deal of interest from academia and industry. This is due to a number of interesting features of THz waves, including the nearly unlimited bandwidths available, and the non-ionizing radiation nature which does not damage human tissues and DNA with minimum health threat. Also, as millimeter-wave communication systems mature, the focus of research is, naturally, moving to the THz range. Many scientists regard THz as the last great frontier of the electromagnetic spectrum, but finding new applications outside the traditional niches of radio astronomy, Earth and planetary remote sensing, and molecular spectroscopy particularly in biomedical imaging and wireless communications has been relatively slow. Radiologists find this area of study so attractive because t-rays are non-ionizing, which suggests no harm is done to tissue or DNA. They also offer the possibility of performing spectroscopic measurements over a very wide frequency range, and can even capture signatures from liquids and solids. According to Shannon theory, the broad bandwidth of the THz frequency bands can be used for terabit-per-second (Tb/s) wireless communication systems. This enables several new applications, such as cell phones with 360 degrees autostereoscopic displays, optic-fiber replacement, and wireless Tb/s file transferring. Although THz technology could satisfy the demand for an extremely high data rate, a number of technical challenges need to be overcome before its development. This presentation provides an overview the state-of-the- art in THz wireless communication and the technical challenges for an emerging application in Terabit wireless systems. The main issue for THz wave propagation is the high atmospheric attenuation, which is dominated by water vapor absorption in the THz

  5. The Terawatt Challenge

    Science.gov (United States)

    Haegel, Nancy

    In response to concerns about accelerating climate change, the world is uniting to both envision and enable a global energy system that supports a sustainable environment and broad economic prosperity. Growth in the technology and the deployment of renewable energy has been dramatic. Evidence can be seen in the growth of photovoltaics (PV) and wind as contributors to worldwide electricity production over the last decade. PV and wind provided 1.2% and 3.7% of global electricity production in 2015, compared to 0.1% and 1.3% respectively in 2005. These numbers indicate both the rapid increase in the rate of deployment, as well as the remaining work to be done to extend this trend to transform a massive energy system and provide a significant fraction of the world's future energy demand with renewable energy. Based on recent trends, it is highly likely that global cumulative PV installation will reach terawatt scale in the next few decades. The challenges, as well as the resulting impact, vary greatly depending on whether we envision 1 TW ( 15% of 2015 global electricity capacity), 3 TW ( 50% of 2015 global electricity capacity) or 10 TW, a level that could drive electrification of transportation and industrial sectors and production of solar fuels. This presentation will draw upon the work of the 2016 GA-SERI (Global Alliance of Solar Energy Research Institutes) Terawatt Workshop to assess the feasibility and summarize the challenges for PV as a primary energy source. These challenges include the continuing demand for improved efficiency and reliability, the required magnitude of capital expenditure, the need for a sustainable industry (both financially and environmentally), as well as needs for grid modernization and consistent policies that support global climate goals. Physicists can play important roles in addressing this full range of challenges, from materials science to public policy, as well as in education of the public and its future leaders.

  6. Challenges in Danish VET

    DEFF Research Database (Denmark)

    Aarkrog, Vibe

    2011-01-01

    In Denmark the 95 percent target, meaning that in 2015 95 percent of a youth cohort should complete a youth education programme, is particularly challenging for the vocational educational and training (VET) system. In the article is given a short outline of the significant characteristics...... of the Danish dual VET system as well as of the current central initiatives aimed at reaching the 95 percent target....

  7. Rare cancers: Challenges & issues

    Directory of Open Access Journals (Sweden)

    Raveendran K Pillai

    2017-01-01

    Full Text Available Rare cancers account for about 22 per cent of all cancers diagnosed worldwide, disproportionately affecting some demographic groups, with an occurrence of less than 6 per 100,000 individuals annually. Many rare cancers in adults, adolescents and children are not curable, and patients and care providers have little option to take therapeutic decisions. The epidemiology of rare cancers is a challenging area of study but is inadequately addressed. Despite efforts mainly in some European nations, a few improvements have been observed in the management of rare cancers. Reasons for this obvious stagnation are multifactorial and are mainly inherent to logistical difficulties in carrying out clinical trials in very small patient populations, hesitation of the pharmaceutical industry to spend in small markets and complexity in creating adequate information for the development of cost-effective drugs. Rare cancers also face specific challenges that include late and incorrect diagnosis, lack of clinical expertise and lack of research interest and development of new therapies. The utilization of nationally representative study findings for the patients' evaluation may possibly offer chances to find out pathogenesis and prevalence, and this will eventually lead to control and prevention. Currently, advancing targeted therapies offer a great opportunity for the better management of rare cancers. Conducting clinical trials with small patient population, innovative clinical trial approach, prevailing controlling obstacles for international cooperation and financial support for research are the present challenges for rare cancers. The International Rare Cancers Initiative functions as a main platform for achieving new international clinical trials in rare tumours. This review delineates the current challenges and issues in the interpretation, management and research scenarios of rare cancers.

  8. Ireland's Competitiveness Challenge 2011

    OpenAIRE

    2012-01-01

    The NCC publishes two annual competitiveness reports. Ireland's Competitiveness Challenge focuses on the national competitiveness issues of most importance to the enterprise sector and identifies policy recommendations required to address these issues. The report focuses on pursuing policies to improve competitiveness, particularly those to reduce the cost base for enterprise, to enhance the performance of the entire education system, and to deliver meaningful public sector reform. Ireland's ...

  9. EDMS implementation challenge.

    Science.gov (United States)

    De La Torre, Marta

    2002-08-01

    The challenges faced by facilities wishing to implement an electronic medical record system are complex and overwhelming. Issues such as customer acceptance, basic computer skills, and a thorough understanding of how the new system will impact work processes must be considered and acted upon. Acceptance and active support are necessary from Senior Administration and key departments to enable this project to achieve measurable success. This article details one hospital's "journey" through design and successful implementation of an electronic medical record system.

  10. Challenges in plastics recycling

    OpenAIRE

    Pivnenko, Kostyantyn; Jakobsen, L. G.; Eriksen, Marie Kampmann; Damgaard, Anders; Astrup, Thomas Fruergaard

    2015-01-01

    Recycling of waste plastics still remains a challenging area in the waste management sector. The current and potential goals proposed on EU or regional levels are difficult to achieve, and even to partially fullfil them the improvements in collection and sorting should be considerable. A study was undertaken to investigate the factors affecting quality in plastics recycling. The preliminary results showed factors primarily influencing quality of plastics recycling to be polymer cross contamin...

  11. Rare cancers: Challenges & issues

    Science.gov (United States)

    Pillai, Raveendran K.; Jayasree, K.

    2017-01-01

    Rare cancers account for about 22 per cent of all cancers diagnosed worldwide, disproportionately affecting some demographic groups, with an occurrence of less than 6 per 100,000 individuals annually. Many rare cancers in adults, adolescents and children are not curable, and patients and care providers have little option to take therapeutic decisions. The epidemiology of rare cancers is a challenging area of study but is inadequately addressed. Despite efforts mainly in some European nations, a few improvements have been observed in the management of rare cancers. Reasons for this obvious stagnation are multifactorial and are mainly inherent to logistical difficulties in carrying out clinical trials in very small patient populations, hesitation of the pharmaceutical industry to spend in small markets and complexity in creating adequate information for the development of cost-effective drugs. Rare cancers also face specific challenges that include late and incorrect diagnosis, lack of clinical expertise and lack of research interest and development of new therapies. The utilization of nationally representative study findings for the patients’ evaluation may possibly offer chances to find out pathogenesis and prevalence, and this will eventually lead to control and prevention. Currently, advancing targeted therapies offer a great opportunity for the better management of rare cancers. Conducting clinical trials with small patient population, innovative clinical trial approach, prevailing controlling obstacles for international cooperation and financial support for research are the present challenges for rare cancers. The International Rare Cancers Initiative functions as a main platform for achieving new international clinical trials in rare tumours. This review delineates the current challenges and issues in the interpretation, management and research scenarios of rare cancers. PMID:28574010

  12. IDEOLOGICALLY CHALLENGING ENTERTAINMENT (ICE

    Directory of Open Access Journals (Sweden)

    Dana Lori Chalmers

    2015-09-01

    Full Text Available Ideologically Challenging Entertainment (ICE is entertainment that challenges ‘us vs. them’ ideologies associated with radicalization, violent conflict and terrorism. ICE presents multiple perspectives on a conflict through mainstream entertainment. This article introduces the theoretical underpinnings of ICE, the first ICE production and the audience responses to it. The first ICE production was Two Merchants: The Merchant of Venice adapted to challenge ideologies of the Arab-Israeli Conflict. A mixed-methods study of audience responses explored whether this production inspired audiences to shift their ideological views. Each performance included two versions of the adaptation: a Jewish dominated society with an Arab Muslim minority, contrasted with an Arab Muslim dominated society and a Jewish minority. A mixed-methods study of audience responses explored whether this production inspired audiences to shift their ideological views to become more tolerant of differences away from ideological radicalization. Of audience members who did not initially agree with the premise of the production, 40% reconsidered their ideological views, indicating increased tolerance, greater awareness of and desire to change their own prejudices. In addition, 86% of the audience expressed their intention to discuss the production with others, thereby encouraging critical engagement with, and broader dissemination of the message. These outcomes suggest that high quality entertainment – as defined by audience responses to it - can become a powerful tool in the struggle against radicalised ideologies.

  13. Grand Challenge Problem 10

    DEFF Research Database (Denmark)

    Dirckinck-Holmfeld, Lone; Balacheff, Nicolas; Bottino, Rosa Maria

    2016-01-01

    Small and medium sized research labs (SMLs) are dominating European TEL research. This is justified by the great numbers of countries and regions in Europe needing to develop a research and innovation competence to facilitate the diverse educational systems contextualized in various institutional...... settings across Europe. However, to strengthen the various research practices and to develop a common scientific language on TEL research the Grand Challenge Problem is to establish a vivid network and a community of practice among the research labs. TELEARC (Technology Enhanced Learning European Advanced...

  14. Semantic Web Evaluation Challenge

    CERN Document Server

    2014-01-01

    This book constitutes the thoroughly refereed post conference proceedings of the first edition of the Semantic Web Evaluation Challenge, SemWebEval 2014, co-located with the 11th Extended Semantic Web conference, held in Anissaras, Crete, Greece, in May 2014. This book includes the descriptions of all methods and tools that competed at SemWebEval 2014, together with a detailed description of the tasks, evaluation procedures and datasets. The contributions are grouped in three areas: semantic publishing (sempub), concept-level sentiment analysis (ssa), and linked-data enabled recommender systems (recsys).

  15. Challenging the Innovation Paradigm

    CERN Document Server

    Sveiby, Karl Erik; Segercrantz, Beata

    2012-01-01

    Innovation is almost always seen as a "good thing". Challenging the Innovation Paradigm is a critical analysis of the innovation frenzy and contemporary innovation research. The one-sided focus on desirable effects of innovation misses many opportunities to reduce the undesirable consequences. Authors in this book show how systemic effects outside the innovating firms reduce the net benefits of innovation for individual employees, customers, as well as for society as a whole - also the innovators' own organizations. This book analyzes the dominant discourses that construct and recons

  16. Media Challenging Status Quo

    DEFF Research Database (Denmark)

    Sandvik, Kjetil

    ). Skeptical internet sociologists such as Morozov (2011) point out that the same media which was used e.g. to mobilize the ‘Twitter revolution’ in Iran in 2009 also was used by the regime to infiltrate and strike down the democratic movement. Following such position statements, international media...... and communication research is currently engaging in a longer and deeper process of examining and assessing the cultural consequences of networked communication. One present challenge is to understand digital media and networked communication at the intersection of established and countercultural, utopian...

  17. Media challenging capitalism

    DEFF Research Database (Denmark)

    Sandvik, Kjetil

    ). Skeptical internet sociologists such as Morozov (2011) point out that the same media which was used e.g. to mobilize the ‘Twitter revolution’ in Iran in 2009 also was used by the regime to infiltrate and strike down the democratic movement. Following such position statements, international media...... and communication research is currently engaging in a longer and deeper process of examining and assessing the cultural consequences of networked communication. One present challenge is to understand digital media and networked communication at the intersection of established and countercultural, utopian...

  18. New challenges? Well, certainly!

    DEFF Research Database (Denmark)

    Lauridsen, Karen M.

    New challenges? Well, certainly! With the internationalization of European higher education, teaching and learning through the medium of a foreign language has become more and more widespread in recent years. This requires, of course, that lecturers as well as students have the necessary language......, different cultural backgrounds, different educational backgrounds and be used to a diverse set of didactic traditions and norms. Given this diversity, higher education institutions (HEIs) need to have measures in place to deal with this. Policies and practices must go hand in hand and, more often than not...

  19. Perishable Inventory Challenges

    DEFF Research Database (Denmark)

    Damgaard, Cecilie Maria; Nguyen, Vivi Thuy; Hvolby, Hans-Henrik

    2012-01-01

    The paper investigates how inventory control of perishable items is managed and line up some possible options of improvement. This includes a review of relevant literature dealing with the challenges of determining ordering policies for perishable products and a study of how the current procedures...... in the retail supply chains. The goal is to find and evaluate the parameters which affect the decision making process, when finding the optimal order quantity and order time. The paper takes a starting point in the retail industry but links to other industries....

  20. Rising to the Challenge

    Directory of Open Access Journals (Sweden)

    Xiaoping Li

    2015-06-01

    Full Text Available Writing is recognized as a vital skill in education and the workplace; students in the United States finishing K-12 schooling are expected to be competent writers. Yet, the Nation’s Report Card found that U.S. high school graduates coming into the workforce are particularly deficient in writing skills. Teachers serve as a crucial link in the move to improve literacy skills of K-12 students; however, teachers themselves are underprepared to be writers and writing teachers. Therefore, there is an urgent need to improve teachers’ writing skills and skills of teaching writing to improve K-12 students’ writing skills in the United States. This qualitative study examined the process-based writing project experienced by 22 practicing teachers through their reflective practices in a graduate capstone class. In particular, this study explored the challenges the teachers faced and the lessons they learned through the recursive phases of writing: planning, drafting, revising, editing, conferring, and publishing. The triangulation of the researchers’ field notes, teachers’ daily reflections, and informal interviews between the instructor and the teachers indicated that the challenges the teachers faced and the lesson they learned through the process-based writing project were phase specific. On the completion of the writing project, the participating teachers (a developed a deep understanding of process-based writing; (b learned new skills of planning, drafting, revising, editing, and sharing; and (c were more confident as writers themselves and as writing teachers for their students.

  1. Safeguards by Design Challenge

    Energy Technology Data Exchange (ETDEWEB)

    Alwin, Jennifer Louise [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-09-13

    The International Atomic Energy Agency (IAEA) defines Safeguards as a system of inspection and verification of the peaceful uses of nuclear materials as part of the Nuclear Nonproliferation Treaty. IAEA oversees safeguards worldwide. Safeguards by Design (SBD) involves incorporation of safeguards technologies, techniques, and instrumentation during the design phase of a facility, rather that after the fact. Design challenge goals are the following: Design a system of safeguards technologies, techniques, and instrumentation for inspection and verification of the peaceful uses of nuclear materials. Cost should be minimized to work with the IAEA’s limited budget. Dose to workers should always be as low are reasonably achievable (ALARA). Time is of the essence in operating facilities and flow of material should not be interrupted significantly. Proprietary process information in facilities may need to be protected, thus the amount of information obtained by inspectors should be the minimum required to achieve the measurement goal. Then three different design challenges are detailed: Plutonium Waste Item Measurement System, Marine-based Modular Reactor, and Floating Nuclear Power Plant (FNPP).

  2. Challenge Based Innovation gala

    CERN Multimedia

    CERN. Geneva; Utriainen, Tuuli Maria; Toivonen, Harri; Nordberg, Markus

    2014-01-01

    Challenge Based Innovation gala   There’s a new experiment starting in CERN called IdeaLab where we work together with detector R&D researchers to help them to bridge their knowledge into a more human, societally oriented context. Currently we are located in B153, but will move our activities to a new facility next to the Globe in May 2014. One of our first pilot projects is a 5 month course CBI (Challenge Based Innovation) where two multidisciplinary student teams join forces with Edusafe & TALENT projects at CERN. Their goal is to discover what kind of tools for learning could be created in collaboration with the two groups. After months of user interviews and low resolution prototyping they are ready to share the results with us in the form of an afternoon gala. We warmly welcome you to join us to see the students' results and experience the prototypes they have conceived. The event is in three parts, you are welcome to visit all of them,...

  3. Résultats challenge

    CERN Document Server

    Club de pétanque

    2015-01-01

    C'est avec un temps magnifique que se disputait pour la deuxième année le Challenge de notre cher ami Patrick DURAND le jeudi 30 juillet 2015. Vingt-six personnes formées en doublettes s'affrontaient pour trois parties .Après des parties très serrées le juge arbitre Claude JOUVE épaulé par Alain PHILIPONA déclarait  vainqueur l'imbattable Claude MACARI suivi de très près par Eric DARMEDRU et à la troisième place Christian JOUVE. La première féminine était Mireille ROCHE. La soirée se clôturait par une succulente paëlla préparée par Jennifer et sa maman Sylvie JOUVE. Rendez-vous à tous pour le jeudi 27 août 2015 pour le challenge Jean-Claude FROT Nos concours sont ouverts à tous les amateurs de pétanque.

  4. 75 FR 47316 - Centennial Challenges 2010 Strong Tether Challenge

    Science.gov (United States)

    2010-08-05

    ... Challenge will be conducted at the 2010 Space Elevator Conference held at the Microsoft Conference Center... SPACE ADMINISTRATION Centennial Challenges 2010 Strong Tether Challenge AGENCY: National Aeronautics and Space Administration (NASA). ACTION: Notice. SUMMARY: This notice is issued in accordance with 42 U.S.C...

  5. 76 FR 41526 - Centennial Challenges 2011 Strong Tether Challenge

    Science.gov (United States)

    2011-07-14

    ... Challenge will be conducted at the 2011 Space Elevator Conference held at the Microsoft Conference Center... SPACE ADMINISTRATION Centennial Challenges 2011 Strong Tether Challenge AGENCY: National Aeronautics and Space Administration (NASA). ACTION: Notice. SUMMARY: This notice is issued in accordance with 42 U.S.C...

  6. A brief overview of our energy challenge(s)

    Science.gov (United States)

    Rosner, Robert

    2018-01-01

    I provide an overview of the current world-wide energy generation and use, and discuss the challenge of meeting the expectations of rising standards of living in the developing world, as well as the challenge posed by ongoing climate change. I focus in particular on the possible evolution of energy systems in response to these challenges.

  7. 78 FR 19742 - Centennial Challenges: 2014 Night Rover Challenge

    Science.gov (United States)

    2013-04-02

    ... addressed to Dr. Larry Cooper, Centennial Challenges Program, NASA Headquarters, 300 E Street SW., Washington, DC 20546-0001. Email address: larry.p.cooper@nasa.gov . SUPPLEMENTARY INFORMATION: Summary Solar... Challenge will be conducted in an ambient Earth environment in a NASA test chamber. The Phase I Challenge...

  8. The challenge of conceiving

    DEFF Research Database (Denmark)

    Hansen, Claus Thorp; Jørgensen, Ulrik

    2011-01-01

    solving and optimization methods. Going back to the earlier days of engineering education problems were defined through the repertoire of existing technologies and solutions taken up and handled as given cases in the education. With the growing emphasis on scientific methods leading to a continued change...... in engineering disciplines throughout the mid 20th century the focus changed and problems were defined in more theoretical terms. Engineering education remained dominated by its introduction of a more and more dense repertoire of methods and theoretical models. In this paper we will approach this problem from...... the perspective of engineering design challenges where the need for problem identification is obvious to avoid the pitfall to reproduce and piecemeal engineer already existing product or service concepts. Problem identification is not a simple desk research task as it often involves a multitude of actors having...

  9. Hydropower Modeling Challenges

    Energy Technology Data Exchange (ETDEWEB)

    Stoll, Brady [National Renewable Energy Lab. (NREL), Golden, CO (United States); Andrade, Juan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cohen, Stuart [National Renewable Energy Lab. (NREL), Golden, CO (United States); Brinkman, Greg [National Renewable Energy Lab. (NREL), Golden, CO (United States); Brancucci Martinez-Anido, Carlo [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2017-04-19

    Hydropower facilities are important assets for the electric power sector and represent a key source of flexibility for electric grids with large amounts of variable generation. As variable renewable generation sources expand, understanding the capabilities and limitations of the flexibility from hydropower resources is important for grid planning. Appropriately modeling these resources, however, is difficult because of the wide variety of constraints these plants face that other generators do not. These constraints can be broadly categorized as environmental, operational, and regulatory. This report highlights several key issues involving incorporating these constraints when modeling hydropower operations in terms of production cost and capacity expansion. Many of these challenges involve a lack of data to adequately represent the constraints or issues of model complexity and run time. We present several potential methods for improving the accuracy of hydropower representation in these models to allow for a better understanding of hydropower's capabilities.

  10. Challenges of ecological restoration

    DEFF Research Database (Denmark)

    Halme, Panu; Allen, Katherine A.; Aunins, Ainars

    2013-01-01

    The alarming rate of ecosystem degradation has raised the need for ecological restoration throughout different biomes and continents. North European forests may appear as one of the least vulnerable ecosystems from a global perspective, since forest cover is not rapidly decreasing and many...... ecosystem services remain at high level. However, extensive areas of northern forests are heavily exploited and have lost a major part of their biodiversity value. There is a strong requirement to restore these areas towards a more natural condition in order to meet the targets of the Convention...... on Biological Diversity. Several northern countries are now taking up this challenge by restoring forest biodiversity with increasing intensity. The ecology and biodiversity of boreal forests are relatively well understood making them a good model for restoration activities in many other forest ecosystems. Here...

  11. Some Challenges to Sustainability

    Directory of Open Access Journals (Sweden)

    Bruce R. Conard

    2013-08-01

    Full Text Available The word “sustainability” is often used in business in the belief that the current ways of doing things will be able to be continued with only minor changes to balance economic development with related environmental and social issues. There are, however, immense challenges that threaten the very sustainability of our global society, let alone individual businesses or developments. A few of the most important of these challenges—population growth, clean energy supply, fresh water availability, and global climate change—are discussed. As humanity forms its collective response to these threats, it is concluded that all intelligent people, but especially scientists, have important roles to play, not only in technical innovation, but also in catalyzing political action.

  12. Challenging the CSCW matrix

    DEFF Research Database (Denmark)

    Jørnø, Rasmus Leth Vergmann; Gynther, Karsten; Christensen, Ove

    2014-01-01

    of a different approach to learning situations based on the idea that tools, technology and learning environments are media through which participants simultaneously acquire proficiency to articulate and gain a perspective in order to decode what is going on. To effectively interact online, we contend that both...... teachers and students are required to modify and adapt their “perception abilities” and “enacting strategies” to appropriate a technology-mediated environment for learning purposes. The analysis illustrates the claim that particular collaborative or cooperative work practices attempt to appropriate tools......This paper challenges traditional dichotomies that identify temporal and spatial restrains as relevant defining properties of learning environments. We present a critique of the current dominant Computer Supported Cooperative Work (CSCW) taxonomy. Although we believe that the taxonomy does provide...

  13. Technology Empowerment: Security Challenges.

    Energy Technology Data Exchange (ETDEWEB)

    Warren, Drake Edward [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Backus, George A. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Jones, Wendell [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Nelson, Thomas R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Skocypec, Russell D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2017-03-01

    “Technology empowerment” means that innovation is increasingly accessible to ordinary people of limited means. As powerful technologies become more affordable and accessible, and as people are increasingly connected around the world, ordinary people are empowered to participate in the process of innovation and share the fruits of collaborative innovation. This annotated briefing describes technology empowerment and focuses on how empowerment may create challenges to U.S. national security. U.S. defense research as a share of global innovation has dwindled in recent years. With technology empowerment, the role of U.S. defense research is likely to shrink even further while technology empowerment will continue to increase the speed of innovation. To avoid falling too far behind potential technology threats to U.S. national security, U.S. national security institutions will need to adopt many of the tools of technology empowerment.

  14. USCT data challenge

    Science.gov (United States)

    Ruiter, Nicole V.; Zapf, Michael; Hopp, Torsten; Gemmeke, Hartmut; van Dongen, Koen W. A.

    2017-03-01

    In the past years we have perceived within the USCT research community a demand for freely available USCT data sets. Inspired by the idea of Open Science, this collection of data sets could stimulate the collaboration and the exchange of ideas and experiences between USCT researchers. In addition, it may lead to comprehensive comparison of different reconstruction algorithms and their results. Finally, by collecting feedback from the users about data and system architecture, valuable information is gathered for further development of measurement setups. For the above reasons, we have initiated a digital portal with several reference data sets and access scripts under free licenses. To kick off this initiative, we organized a USCT data challenge event at SPIE Medical Imaging 2017.

  15. The Biofilm Challenge

    DEFF Research Database (Denmark)

    Alhede, Maria; Alhede, Morten

    2014-01-01

    The concept of biofilms has emerged in the clinical setting during the last decade. Infections involving biofilms have been documented in all parts of the human body, and it is currently believed that the presence of biofilm-forming bacteria is equivalent to chronic infection. A quick Pubmed search...... reveals the significance of biofilms, as evidenced by a dramatic increase in scientific publications on the topic, as well as in publications concerning wounds with biofilms, which reached 600 publications in 2013. Judged from the number of publications, it appears that biofilms play a significant role...... in wounds. However, the impact of biofilms is often debated, because infected wounds were also treated before the concept of biofilms was coined. In this short review, we will address the significance of biofilms and their role in wounds, and discuss the future tasks of the biofilm challenge....

  16. Ayurveda research: Ontological challenges

    Directory of Open Access Journals (Sweden)

    Jayakrishna Nayak

    2012-01-01

    Full Text Available Collaborative research involving Ayurveda and the current sciences is undoubtedly an imperative and is emerging as an exciting horizon, particularly in basic sciences. Some work in this direction is already going on and outcomes are awaited with bated breath. For instance the ′ASIIA (A Science Initiative In Ayurveda′ projects of Dept of Science and Technology, Govt of India, which include studies such as Ayurvedic Prakriti and Genetics. Further intense and sustained collaborative research needs to overcome a subtle and fundamental challenge-the ontologic divide between Ayurveda and all the current sciences. Ontology, fundamentally, means existence; elaborated, ontology is a particular perspective of an object of existence and the vocabulary developed to share that perspective. The same object of existence is susceptible to several ontologies. Ayurveda and modern biomedical as well as other sciences belong to different ontologies, and as such, collaborative research cannot be carried out at required levels until a mutually acceptable vocabulary is developed.

  17. Challenges of Antibacterial Discovery

    Science.gov (United States)

    Silver, Lynn L.

    2011-01-01

    Summary: The discovery of novel small-molecule antibacterial drugs has been stalled for many years. The purpose of this review is to underscore and illustrate those scientific problems unique to the discovery and optimization of novel antibacterial agents that have adversely affected the output of the effort. The major challenges fall into two areas: (i) proper target selection, particularly the necessity of pursuing molecular targets that are not prone to rapid resistance development, and (ii) improvement of chemical libraries to overcome limitations of diversity, especially that which is necessary to overcome barriers to bacterial entry and proclivity to be effluxed, especially in Gram-negative organisms. Failure to address these problems has led to a great deal of misdirected effort. PMID:21233508

  18. Challenges in plastics recycling

    DEFF Research Database (Denmark)

    Pivnenko, Kostyantyn; Jakobsen, L. G.; Eriksen, Marie Kampmann

    2015-01-01

    Recycling of waste plastics still remains a challenging area in the waste management sector. The current and potential goals proposed on EU or regional levels are difficult to achieve, and even to partially fullfil them the improvements in collection and sorting should be considerable. A study...... was undertaken to investigate the factors affecting quality in plastics recycling. The preliminary results showed factors primarily influencing quality of plastics recycling to be polymer cross contamination, presence of additives, non-polymer impurities, and polymer degradation. Deprivation of plastics quality......, with respect to recycling, has been shown to happen throughout the plastics value chain, but steps where improvements may happen have been preliminary identified. Example of Cr in plastic samples analysed showed potential spreading and accumulation of chemicals ending up in the waste plastics. In order...

  19. The Global Energy Challenge

    DEFF Research Database (Denmark)

    Connolly, David

    2011-01-01

    . Afterwards, the security of the world’s energy supply is investigated and it becomes clear that there is both an inevitable shortage of fossil fuels and a dangerous separation of supply and demand. The final topic discussed is renewable energy, since it is one sustainable solution to the global energy......This report gives a brief overview of the global energy challenge and subsequently outlines how and where renewable energy could be developed to solve these issues. The report does not go into a lot of detail on these issues and hence, it is meant as an overview only. The report begins by outlining...... the causes of global climate change, concluding that energy-related emissions are the primary contributors to the problem. As a result, global energy production is analysed in more detail, discussing how it has evolved over the last 30 years and also, how it is expected to evolve in the coming 30 years...

  20. Challenges of protection

    Directory of Open Access Journals (Sweden)

    Emma Fanning

    2010-11-01

    Full Text Available Local protection committees in North and South Kivu are tackling – with some success – a range of protection challenges.Since June 2010, Mukungu1 village in Kalehe, South Kivu, has welcomed 1,150 displaced households fleeing FDLR2 attacks during military operations in the area. A battalion of the national army arrived recently; they have set up checkpoints demanding a fee, do not speak any local language and have moved in with local families unasked. Forced labour and arbitrary arrests are widespread. Meanwhile, locals cannot farm fields near the forest as FDLR soldiers rape women who try – and have killed men who accompany them. The local community takes in IDPs but they warn that resources are limited.

  1. Huijgens' Synchronization: A Challenge

    Science.gov (United States)

    Nijmeijer, H.; Pogromsky, A. Y.

    Oscillations are common almost everywhere, be it in biology, in economics, in physics and many other fields. Everyone is familiar with the day-night rhythm, or the regular or less regular heart-beat of a human, the pig cycle in economy or the flashing of fire-flies and so on. All the above examples have in common that the oscillations seem to happen naturally, but there are also other more or less forced type of oscillations like for instance in chemistry, electrical circuits and acoustics. Probably the most basic example of an oscillator is a pendulum clock that runs at a fixed frequency and such that the exact time is given by the clock. Design and construction of a fully accurate mechanical clock is - even today - a very challenging task; the reader is referred to [Rawlings, 1994; Penman, 1998] for some background on this…

  2. Ten Challenges in Contraception.

    Science.gov (United States)

    Binette, Audrey; Howatt, Kerry; Waddington, Ashley; Reid, Robert L

    2017-01-01

    Despite the introduction of promising products into the contraceptive market, the rate of unintended pregnancies remains high. Women with underlying medical conditions should have access to safe and effective contraceptive methods for various reasons, including the potential deleterious effect of the disease on the pregnancy or the effect of the pregnancy on the disease process. Healthcare providers are often confronted with cases in which contraception counseling is problematic due to controversial evidence and persistent myths. This review will examine a number of medical conditions that often create contraception counseling challenges. It should in no way be considered as an extensive review of all contraceptive options for a given medical condition. The following topics will be explored: depression, immunosuppression, inflammatory bowel diseases, past bariatric surgery, liver diseases, family history of breast cancer, migraines, polycystic ovarian syndrome, perimenopausal state, and sickle cell disease. We advocate for improved information and accessibility to contraception as a means of decreasing the rate of unintended pregnancies.

  3. Challenging the Boundaries

    DEFF Research Database (Denmark)

    Nørgaard, Nina

    2004-01-01

    to explore in the study and teaching of foreign languages. Not only may linguistics and literature be employed to shed light on each other, the insights gained may furthermore prove useful in a broader context in our foreign language studies. The article begins with a brief introduction to literary...... linguistics in general and to Hallidayan linguistics in particular. The theoretical framework thus laid out, it is exemplified how Halliday's theory of language may be employed in the analysis of literature. The article concludes by considering the possible status of literary linguistics in a broader......To many people, challenging the boundaries between the traditional disciplines in foreign language studies means doing cultural studies. The aim of this article is to pull in a different direction by suggesting how the interface between linguistics and literature may be another fertile field...

  4. Coalition Warfare: the Leadership Challenges

    Science.gov (United States)

    2011-05-19

    multinational operations, leadership challenges, leadership attributes, unity of command. 16. SECURITY CLASSIFICATION OF: UNCLASSIFIED 17. LIMITATION OF...Approved for Public Release; Distribution is Unlimited Coalition Warfare: The leadership challenges A Monograph by Colonel Mark J Thornhill...The leadership challenges. 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Colonel Mark J. Thornhill

  5. New challenges in gas

    Energy Technology Data Exchange (ETDEWEB)

    Mandil, C. [Institut Francais du Petrole (IFP), 92 - Rueil-Malmaison (France); Chabrelie, M.F. [Cedigaz, 92 - Rueil Malmaison (France); Streicher, C. [Prosernat, 92 - Paris la Defense (France)] [and others

    2003-07-01

    New developments in the area of gas treatment will be to a large extent driven by the need to find appropriate solutions to the fundamental need of sustainable development. New gas treatment processes are developed with the aim to minimise contaminant emissions and meet most stringent environmental specifications. A new major challenge for the industry will be to implement new cost effective technologies for reducing CO{sub 2} emissions. Industry has also to minimise its costs, and therefore, in order to ensure at the same time a better protection of the environment and a better safety, it is necessary to innovate. The purpose of this seminar is precisely to identify better the innovations which are required in the area of gas treatment. These proceedings comprise 8 papers and a summary of the contributions to a round-table discussion dealing with the options for CO{sub 2} capture and sequestration. The presentations treat of: the future prospects for the gas industry (M.F. Chabrelie, Cedigaz); the solutions for offshore gas treatment (C. Streicher, Prosernat); gas treatment with membranes (H. Meyer, GTI); the Axens Multibed{sub TM} technology for natural gas treatment (G. Jochem, Axens); the potentials and applications for the Propure co-current contactors (F.P. Nilsen, ProPure); the production of very-sour and super-sour large gas reserves: the new challenges (F. Lallemand, TotalFinaElf); Hybrisol, a new gas treatment process for sour natural gases (F. Lecomte, IFP); and the conception and building of large acid-gas removal units (J. Castel, Technip-Coflexip). (J.S.)

  6. Challenges in Piaget's legacy.

    Science.gov (United States)

    Bibace, Roger

    2013-03-01

    The publication of After Piaget (Martí and Rodríguez 2012) hopefully triggers a new effort to understand the richness of the efforts of that major psychologist of the 20th century. Piaget was consistently concerned with part/whole relationships throughout his life. He addressed this issue philosophically, epistemologically, and psychologically. Conceptually Piaget struggled with the issue of continuity/discontinuity in development and changed his mind about how to reconcile the discontinuities of stages with his concept of development. I also attribute his variability to the implications of his important work on perception, and to his willingness to get involved in widespread concrete applications of his approach to education including the education of children with special needs; his center for genetic epistemology, and his interest in psychoanalysis. Benefiting from all the authors of After Piaget, I want to point out that Piaget has identified many major issues that will continue to constitute challenges to psychology in this century. These include specifying terms such as 'development;' methodological issues such as sampling both quantitatively in one culture and across cultures; comprehensive inclusion of the psychological processes covered by introductory textbooks in psychology; and conceptual issues such as the relationships among all these parts within a whole. I make a distinction between an 'issue' and a 'problem'--problems have solutions; while issues refer to controversies in science generally as well as in psychology that have persisted for centuries.

  7. Challenges in Astronomy Education

    Science.gov (United States)

    De Greve, Jean-Pierre

    2010-11-01

    Astronomy is an attractive subject for education. It deals with fascination of the unknown and the unreachable, yet is uses tools, concepts and insights from various fundamental sciences such as mathematics, physics, chemistry, biology. Because of this it can be well used for introducing sciences to young people and to raise their interest in further studies in that direction. It is also an interesting subject for teaching as its different aspects (observation techniques, theory, data sampling and analysis, modelling,?) offer various didactical approaches towards different levels of pupils, students and different backgrounds. And it gives great opportunities to teach and demonstrate the essence of scientific research, through tutorials and projects. In this paper we discuss some of the challenges education in general, and astronomy in particular, faces in the coming decades, given the major geophysical and technological changes that can be deducted from our present knowledge. This defines a general, but very important background in terms of educational needs at various levels, and in geographical distribution of future efforts of the astronomical community. Special emphasis will be given to creative approaches to teaching, to strategies that are successful (such as the use of tutorials with element from computer games), and to initiatives complementary to the regular educational system. The programs developed by the IAU will be briefly highlighted.

  8. Ribosomal Antibiotics: Contemporary Challenges

    Directory of Open Access Journals (Sweden)

    Tamar Auerbach-Nevo

    2016-06-01

    Full Text Available Most ribosomal antibiotics obstruct distinct ribosomal functions. In selected cases, in addition to paralyzing vital ribosomal tasks, some ribosomal antibiotics are involved in cellular regulation. Owing to the global rapid increase in the appearance of multi-drug resistance in pathogenic bacterial strains, and to the extremely slow progress in developing new antibiotics worldwide, it seems that, in addition to the traditional attempts at improving current antibiotics and the intensive screening for additional natural compounds, this field should undergo substantial conceptual revision. Here, we highlight several contemporary issues, including challenging the common preference of broad-range antibiotics; the marginal attention to alterations in the microbiome population resulting from antibiotics usage, and the insufficient awareness of ecological and environmental aspects of antibiotics usage. We also highlight recent advances in the identification of species-specific structural motifs that may be exploited for the design and the creation of novel, environmental friendly, degradable, antibiotic types, with a better distinction between pathogens and useful bacterial species in the microbiome. Thus, these studies are leading towards the design of “pathogen-specific antibiotics,” in contrast to the current preference of broad range antibiotics, partially because it requires significant efforts in speeding up the discovery of the unique species motifs as well as the clinical pathogen identification.

  9. Constitutionality of CEPA challenged

    Energy Technology Data Exchange (ETDEWEB)

    Attaran, A.

    1997-02-24

    The Canadian Environmental Protection Act (CEPA) was challenged by Hydro-Quebec in the Supreme Court of Canada. Hydro-Quebec argued that in the absence of any explicit jurisdiction, federal environmental law must be rooted in either the Constitution`s criminal law power, or in its power to legislate for the peace, order and good government of Canada. When accused under CEPA of dumping PCBs into the the St. Maurice River in 1990, Hydro-Quebec, joined in its case by the Attorney Generals of Quebec and Saskatchewan, and IPSCO Inc., argued that the law failed to meet these criteria, and is, therefore unconstitutional and invalid. The Supreme Court case focused primarily on the validity of the Federal Government`s right to declare substances toxic in its pursuit of protecting the environment from immediate or long-term harm, in as much as the criminal law power is understood to protect human life and health, but heretofore, not the environment. Although the Justices were anxious to circumscribe the limits of federal environmental jurisdiction, they also appeared disinclined to explode all of Canada`s toxic waste laws. The most likely outcome is that the CEPA will be allowed to stand, but will be severed of the environmental protection purpose, while preserving the Federal Government`s jurisdiction over toxic substances under the protection of human life and health provisions of the Constitution.

  10. Whiplash Continues Its Challenge.

    Science.gov (United States)

    Jull, Gwendolen

    2016-10-01

    There have been many advances in the management of neck pain disorders, but a personal frustration as a clinician and researcher in the field is that the incidence of full recovery following a whiplash injury as a result of a motor vehicle crash has not increased and, subsequently, the rate of transition to chronic neck pain has not lessened. The commentaries in this special issue reflect the multifaceted nature of whiplash-associated disorders and the wide-ranging research in the field. While management of whiplash, especially the challenge of lessening the rate of transition to chronicity, has yet to be achieved, the picture is becoming clearer. This should give great confidence and some hope to individuals with whiplash-associated disorders who have long-term pain and functional disability that after the next decade of research and clinical development, the outcomes following whiplash are likely to be vastly improved. J Orthop Sports Phys Ther 2016;46(10):815-817. doi:10.2519/jospt.2016.0112.

  11. Osteomyelitis: a current challenge

    Directory of Open Access Journals (Sweden)

    Luciana Souza Jorge

    Full Text Available Over the last 30 years, the pathogenesis of osteomyelitis has almost been totally elucidated, and many factors responsible for the persistence of this infection have been identified. Numerous antimicrobial agents with distinct spectrums of action, pharmacokinetics, and pharmacodynamics have been used in its treatment. Surgical techniques, including muscle grafts, the Ilizarov technique, and antibiotic bone cements, have been applied. However, bone infections are still a challenge. Despite the importance of isolation and identification of microorganisms to determine the antimicrobial treatment of bone infections, there are few systematic national studies about the etiological profile of these diseases. This article describes the current knowledge of osteomyelitis and summarizes published national data based on the experience of different Orthopedic and Traumatology Services. In general, S. aureus was described as an important etiological agent; however, the difference in design of national studies makes a comparison between the prevalence of bone infection, the associated risk factors, and the different therapeutic approaches difficult. In conclusion, effort is necessary in order to stimulate systematic national studies in different Orthopedics and Traumatology Services to obtain a better consensus on preventive measures and therapies of bone infections.

  12. Challenges of climate change

    Science.gov (United States)

    Husaini, Amjad M

    2014-01-01

    Kashmir valley is a major saffron (Crocus sativus Kashmirianus) growing area of the world, second only to Iran in terms of production. In Kashmir, saffron is grown on uplands (termed in the local language as “Karewas”), which are lacustrine deposits located at an altitude of 1585 to 1677 m above mean sea level (amsl), under temperate climatic conditions. Kashmir, despite being one of the oldest historical saffron-producing areas faces a rapid decline of saffron industry. Among many other factors responsible for decline of saffron industry the preponderance of erratic rainfalls and drought-like situation have become major challenges imposed by climate change. Saffron has a limited coverage area as it is grown as a ‘niche crop’ and is a recognized “geographical indication,” growing under a narrow microclimatic condition. As such it has become a victim of climate change effects, which has the potential of jeopardizing the livelihood of thousands of farmers and traders associated with it. The paper discusses the potential and actual impact of climate change process on saffron cultivation in Kashmir; and the biotechnological measures to address these issues. PMID:25072266

  13. Hermes: the engineering challenges

    Science.gov (United States)

    Brzeski, Jurek; Gers, Luke; Smith, Greg; Staszak, Nicholas

    2012-09-01

    The Australian Astronomical Observatory is building a 4-channel VPH-grating High Efficiency and Resolution Multi Element Spectrograph (HERMES) for the 3.9 meter Anglo-Australian Telescope (AAT). HERMES will provide a nominal spectral resolving power of 28,000 for Galactic Archaeology with an optional high-resolution mode of 45,000 with the use of a slit mask. HERMES is fed by a fibre positioning robot called 2dF at the telescope prime focus. There are a total of 784 science fibres, which interface with the spectrograph via two separate slit body assemblies, each comprising of 392 science fibers. The slit defines the spectral lines of 392 fibres on the detector. The width of the detector determines the spectral bandwidth and the detector height determines the fibre to fibre spacing or cross talk. Tolerances that follow from this are all in the 10 micrometer range. The slit relay optics must contribute negligibly to the overall image quality budget and uniformly illuminate the spectrograph exit pupil. The latter requirement effectively requires that the relay optics provide a telecentric input at the collimator entrance slit. As a result it is critical to align the optical components to extreme precision required by the optical design. This paper discusses the engineering challenges of designing, optimising, tolerancing and manufacturing of very precise mechanical components for housing optics and the design of low cost of jigs and fixtures for alignment and assembly of the optics.

  14. DIGITAL PAKISTAN: OPPORTUNITIES & CHALLENGES

    Directory of Open Access Journals (Sweden)

    Ghulam Muhammad Kundi

    2008-10-01

    Full Text Available IT has revolutionized the social and organizational life around the globe. Given the newness of IT as a technology, there is a lot of potential that needs to be explored. It is however, argued that as IT can revolutionize the economic development, by the same coin, although its mismanagement in adoption process can end up in problems or even straight failure of the technology at the business-end. This study was conducted with reference to opportunities and challenges in the IT adoption process in Pakistan. The aim of the study was to point out the barriers that are impeding the country’s computerization process in order to provide facts to the policy makers for smooth computerization. The primary data collected through structured questionnaires was analyzed and tested through correlation, regressions analysis and t-test. Out of 10 hypotheses, 3 were accepted while in the rest null hypotheses were not substantiated. Based on primary and secondary data analysis this study has found that all independent bureaucratic, political, education and social and cultural variables are mutually correlated and have significant impact on shaping and reshaping of IT in Pakistan, while the Pakistan IT policy is inconsistent, administrative machinery attitude is negative and non cooperative, procedures are cumbersome and implementation is weak and ineffective, not to mention the lack of IT knowledge on the bureaucratic side. The political environment is instable and law and order is worse which is discouraging the investment. Moreover, physical and legal infrastructure is insufficient and the country is lacking good quality IT professionals. IT organization alignment is another serious issue in Pakistan. However, government incentives and growing interest from the private sector indicate positive attitude towards computerization of the country.

  15. The Repack Challenge

    Science.gov (United States)

    Kruse, Daniele Francesco

    2014-06-01

    Physics data stored in CERN tapes is quickly reaching the 100 PB milestone. Tape is an ever-changing technology that is still following Moore's law in terms of capacity. This means we can store every year more and more data in the same amount of tapes. However this doesn't come for free: the first obvious cost is the new higher capacity media. The second less known cost is related to moving the data from the old tapes to the new ones. This activity is what we call repack. Repack is vital for any large tape user: without it, one would have to buy more tape libraries and more floor space and, eventually, data on old non supported tapes would become unreadable and be lost forever. In this paper we describe the challenge of repacking 115 PB before LHC data taking starts in the beginning of 2015. This process will have to run concurrently with the existing experiment tape activities, and therefore needs to be as transparent as possible for users. Making sure that this works out seamlessly implies careful planning of the resources and the various policies for sharing them fairly and conveniently. To tackle this problem we need to fully exploit the speed and throughput of our modern tape drives. This involves proper dimensioning and configuration of the disk arrays and all the links between them and the tape servers, i.e the machines responsible for managing the tape drives. It is also equally important to provide tools to improve the efficiency with which we use our tape libraries. The new repack setup we deployed has on average increased tape drive throughput by 80%, allowing them to perform closer to their design specifications. This improvement in turn means a 48% decrease in the number of drives needed to achieve the required throughput to complete the full repack on time.

  16. IT Challenges for Space Medicine

    Science.gov (United States)

    Johnson-Throop, Kathy

    2010-01-01

    This viewgraph presentation reviews the various Information Technology challenges for aerospace medicine. The contents include: 1) Space Medicine Activities; 2) Private Medical Information; 3) Lifetime Surveillance of Astronaut Health; 4) Mission Medical Support; 5) Data Repositories for Research; 6) Data Input and Output; 7) Finding Data/Information; 8) Summary of Challenges; and 9) Solutions and questions.

  17. Challenges Facing Group Work Online

    Science.gov (United States)

    Chang, Bo; Kang, Haijun

    2016-01-01

    Online group work can be complicated because of its asynchronous characteristics and lack of physical presence, and its requirements for skills in handling technology, human relationships, and content-related tasks. This study focuses on the administrative, logistical and relationship-related challenges in online group work. Challenges in areas…

  18. Challenges in Delivering Distance Education

    Science.gov (United States)

    Chawdhry, Adnan A.

    2010-01-01

    Despite the challenges that exist with DE (Distance Education), university and faculty can provide a strong learning environment for their students if they understand and mitigate the challenges of the DE program. This paper describes a case study of a DE program that offers classroom instruction for multiple sites that are connected using a…

  19. Challenges in Computational Commutative Algebra

    OpenAIRE

    Abbott, John

    2006-01-01

    In this paper we consider a number of challenges from the point of view of the CoCoA project one of whose tasks is to develop software specialized for computations in commutative algebra. Some of the challenges extend considerably beyond the boundary of commutative algebra, and are addressed to the computer algebra community as a whole.

  20. Challenges When Introducing Electronic Exam

    Science.gov (United States)

    Kuikka, Matti; Kitola, Markus; Laakso, Mikko-Jussi

    2014-01-01

    Time pressures often necessitate the use of more efficient exam tools, such as electronic exams (e-exams), instead of traditional paper exams. However, teachers may face challenges when introducing e-exams in a higher education context. This paper describes what kinds of challenges teachers may face when introducing e-exams, based on experiences…

  1. Organizational leadership: meeting the challenge.

    Science.gov (United States)

    Hart, A L

    1994-06-01

    Leadership can be learned. Knowledge of leadership theories can serve as basis for developing skills and techniques. Style, trait, and transformational leadership can be applied in both health care institutions and professional associations. Organizational leadership is challenging, but those challenges can help individual nurses grow in the leadership skills that will continue to be demanded in the ever changing healthcare arena.

  2. Statistics Poster Challenge for Schools

    Science.gov (United States)

    Payne, Brad; Freeman, Jenny; Stillman, Eleanor

    2013-01-01

    The analysis and interpretation of data are important life skills. A poster challenge for schoolchildren provides an innovative outlet for these skills and demonstrates their relevance to daily life. We discuss our Statistics Poster Challenge and the lessons we have learned.

  3. Team Building through Physical Challenges.

    Science.gov (United States)

    Gibbons, Sandra L.

    The enhancement of positive self-concept has been identified as a key benefit of participation in team-building programs. This paper reviews research on the impact of team-building activities that include demanding physical challenges on the self-concept of physical education students. Team Building through Physical Challenges (TBPC) is a program…

  4. Interior Design: Challenges and Solutions.

    Science.gov (United States)

    School Planning and Management, 1999

    1999-01-01

    Presents solutions to architectural challenges in school interior design; these solutions made the indoor environments more conducive and attractive for learning. Addresses four challenges: making a long corridor look less like a tunnel; maintaining tradition and minimizing cost in a new athletic facility; designing a kindergarten that is secure…

  5. Grand Challenges facing Storage Systems

    CERN Multimedia

    CERN. Geneva

    2004-01-01

    In this talk, we will discuss the future of storage systems. In particular, we will focus on several big challenges which we are facing in storage, such as being able to build, manage and backup really massive storage systems, being able to find information of interest, being able to do long-term archival of data, and so on. We also present ideas and research being done to address these challenges, and provide a perspective on how we expect these challenges to be resolved as we go forward.

  6. Challenges in aerospace medicine education.

    Science.gov (United States)

    Grenon, S Marlene; Saary, Joan

    2011-11-01

    Aerospace medicine training and research represents a dream for many and a challenge for most. In Canada, although some opportunities exist for the pursuit of education and research in the aerospace medicine field, they are limited despite the importance of this field for enabling safe human space exploration. In this commentary, we aim to identify some of the challenges facing individuals wishing to get involved in the field as well as the causal factors for these challenges. We also explore strategies to mitigate against these.

  7. Eight challenges in phylodynamic inference

    Directory of Open Access Journals (Sweden)

    Simon D.W. Frost

    2015-03-01

    Full Text Available The field of phylodynamics, which attempts to enhance our understanding of infectious disease dynamics using pathogen phylogenies, has made great strides in the past decade. Basic epidemiological and evolutionary models are now well characterized with inferential frameworks in place. However, significant challenges remain in extending phylodynamic inference to more complex systems. These challenges include accounting for evolutionary complexities such as changing mutation rates, selection, reassortment, and recombination, as well as epidemiological complexities such as stochastic population dynamics, host population structure, and different patterns at the within-host and between-host scales. An additional challenge exists in making efficient inferences from an ever increasing corpus of sequence data.

  8. Presidential Transition. Challenges and Opportunities

    National Research Council Canada - National Science Library

    Walker, David

    2000-01-01

    .... Attention to these themes will help the new administration successfully implement its agenda and address both long-standing and newly emerging management, fiscal, and other challenges that confront...

  9. Challenging environmental mythology: wrestling Zeus

    National Research Council Canada - National Science Library

    Dini, J. W; Lehr, Jay H

    2003-01-01

    .... At a time when the public can be thoroughly confused between fact and fiction regarding our environmental concerns, this book proposes to challenge our concerns in clear, jargon free language that we can...

  10. CMS Distributed Data Analysis Challenges

    CERN Document Server

    Grandi, C

    2004-01-01

    In Spring 2004 CMS will undertake a 100 TeraByte-scale Data Challenge (DC04) as part of a series of challenges in preparation for running at CERN's Large Hadron Collider. During 1 month, DC04 must demonstrate the ability of the computing and software to cope with a sustained event data-taking rate of 25 Hz, for a total of 50 million events. The emphasis of DC04 is on the validation of the first pass reconstruction and storage systems at CERN and the streaming of events to a distributed system of Tier-1, and Tier-2 sites worldwide where typical analysis tasks will be performed. It is expected that the LHC Computing Grid project will provide a set of grid services suitable for use in a real production environment, as part of this data challenge. The results of this challenge will be used to define the CMS software and computing systems in their Technical Design Report.

  11. CHALLENGES OF PERMANENT TEACHER TRAINING

    National Research Council Canada - National Science Library

    María Manuela Valles-Ornelas; Efrén Viramontes-Anaya; Alma Delia Campos-Arroyo

    2015-01-01

    The new challenges for teachers and managers require to assume permanent formation as a tool for responding effectively and efficiently to them, different perspective to strengthen from the initial...

  12. Challenge of COPD: Getting Tested

    Science.gov (United States)

    ... please turn JavaScript on. Feature: The Challenge of COPD Getting Tested Past Issues / Fall 2014 Table of Contents Getting Tested Everyone at risk for COPD who has cough, sputum production, or shortness of ...

  13. Challenges in Designing Mechatronic Systems

    DEFF Research Database (Denmark)

    Torry-Smith, Jonas; Qamar, Ahsan; Achiche, Sofiane

    2013-01-01

    Development of mechatronic products is traditionally carried out by several design experts from different design domains. Performing development of mechatronic products is thus greatly challenging. In order to tackle this, the critical challenges in mechatronics have to be well understood and well...... supported through applicable methods and tools. This paper aims at identifying the major challenges, by conducting a systematic and thorough survey of the most relevant research work in mechatronic design. Solutions proposed in literature are assessed and illustrated through a case study in order...... to investigate if the challenges can be handled appropriately by the methods, tools, and mindsets suggested by the mechatronic community. Using a real world mechatronics case, the paper identifies the areas where further research is required, by showing a clear connection between the actual problems faced during...

  14. Refugee status determination: three challenges

    Directory of Open Access Journals (Sweden)

    Martin Jones

    2009-04-01

    Full Text Available Refugee status determination (RSD, which is vital to the protection of so many asylum seekers worldwide, is at best an imperfect, haphazard and challenging process. It merits greater attention and appropriate reform.

  15. The Cybersecurity Challenge in Acquisition

    Science.gov (United States)

    2016-04-30

    modern supply chain will add vulnerabilities to these linked supplier systems. Introduction Cyber Threat Challenges The accelerated growth in cyber...cyber challenges of their systems at the right level of detail is the only viable solution to this problem in the long run. Securing Supply Chains ...in turn introduce new vulnerabilities in the organization and must be managed by those acquisition specialists focused most on the supply chain

  16. Challenges to Nordic Police Research

    DEFF Research Database (Denmark)

    Holmberg, Lars

    2015-01-01

    The paper will cover three main points: A short description of published police research in the Nordic countries; a somewhat longer discussion of the nature of, and challenges to, Nordic police research and, finally, a critique of the homeliness of research.......The paper will cover three main points: A short description of published police research in the Nordic countries; a somewhat longer discussion of the nature of, and challenges to, Nordic police research and, finally, a critique of the homeliness of research....

  17. Stable isotope views on ecosystem function: challenging or challenged?

    Science.gov (United States)

    Resco, Víctor; Querejeta, José I.; Ogle, Kiona; Voltas, Jordi; Sebastià, Maria-Teresa; Serrano-Ortiz, Penélope; Linares, Juan C.; Moreno-Gutiérrez, Cristina; Herrero, Asier; Carreira, José A.; Torres-Cañabate, Patricia; Valladares, Fernando

    2010-01-01

    Stable isotopes and their potential for detecting various and complex ecosystem processes are attracting an increasing number of scientists. Progress is challenging, particularly under global change scenarios, but some established views have been challenged. The IX meeting of the Spanish Association of Terrestrial Ecology (AAET, Úbeda, 18–22 October 2009) hosted a symposium on the ecology of stable isotopes where the linear mixing model approach of partitioning sinks and sources of carbon and water fluxes within an ecosystem was challenged, and new applications of stable isotopes for the study of plant interactions were evaluated. Discussion was also centred on the need for networks that monitor ecological processes using stable isotopes and key ideas for fostering future research with isotopes. PMID:20015858

  18. Novel strategies: challenge loop diuretics and sodium management in heart failure--part II.

    Science.gov (United States)

    Di Pasquale, Pietro; Sarullo, Filippo M; Paterna, Salvatorew

    2007-01-01

    The conflicting results of diuretic treatments in heart failure (HF) and the importance of Na management in the context of the cardiorenal syndrome and neurohormonal activation in HF have suggested novel and counterintuitive strategies, focused primarily on the use of vasopressin antagonists and hypertonic saline solution with high doses of loop diuretics and their neurohormonal interference. The emerging novel therapies involving direct inhibition of vasopressin receptors appear to show promising results. The use of hypertonic saline solution mixed with a high dose of loop diuretics produces, probably by indirect mechanisms, a reduction or inhibition of the activated neurohormonal systems in HF patients. This treatment opens a new window on the role of sodium management in these patients and on the relation between sodium and the kidney's role and function in heart failure. The authors review the current evidence for these therapies and suggest hypothetical bases for their efficacy.

  19. Ecological Challenges for Closed Systems

    Science.gov (United States)

    Nelson, Mark; Dempster, William; Allen, John P.

    2012-07-01

    Closed ecological systems are desirable for a number of purposes. In space life support systems, material closure allows precious life-supporting resources to be kept inside and recycled. Closure in small biospheric systems facilitates detailed measurement of global ecological processes and biogeochemical cycles. Closed testbeds facilitate research topics which require isolation from the outside (e.g. genetically modified organisms; radioisotopes) so their ecological interactions and fluxes can be studied separate from interactions with the outside environment. But to achieve and maintain closure entails solving complex ecological challenges. These challenges include being able to handle faster cycling rates and accentuated daily and seasonal fluxes of critical life elements such as carbon dioxide, oxygen, water, macro- and mico-nutrients. The problems of achieving sustainability in closed systems for life support include how to handle atmospheric dynamics including trace gases, producing a complete human diet and recycling nutrients and maintaining soil fertility, the sustaining of healthy air and water and preventing the loss of crucial elements from active circulation. In biospheric facilities the challenge is also to produce analogues to natural biomes and ecosystems, studying processes of self-organization and adaptation in systems that allow specification or determination of state variables and cycles which may be followed through all interactions from atmosphere to soils. Other challenges include the dynamics and genetics of small populations, the psychological challenges for small isolated human groups and measures and options which may be necessary to ensure long-term operation of closed ecological systems.

  20. Challenged

    Science.gov (United States)

    Manzo, Kathleen Kennedy

    2006-01-01

    The work of librarians can be a lifeline to youths dealing with difficult personal issues, such as family strife, growing up, and sexuality. This paper presents an issue where school library books at Fayetteville High School are questioned because their books are too sexually explicit or mature for teenagers. In the midst of intense media coverage…

  1. Data challenges in ATLAS computing

    CERN Document Server

    Vaniachine, A

    2003-01-01

    ATLAS computing is steadily progressing towards a highly functional software suite, plus a World Wide computing model which gives all ATLAS equal and equal quality of access to ATLAS data. A key component in the period before the LHC is a series of Data Challenges of increasing scope and complexity. The goals of the ATLAS Data Challenges are the validation of the computing model, of the complete software suite, of the data model, and to ensure the correctness of the technical choices to be made. We are committed to 'common solutions' and look forward to the LHC Computing Grid being the vehicle for providing these in an effective way. In close collaboration between the Grid and Data Challenge communities ATLAS is testing large-scale testbed prototypes around the world, deploying prototype components to integrate and test Grid software in a production environment, and running DC1 production at 39 'tier' centers in 18 countries on four continents.

  2. Higgs Machine Learning Challenge 2014

    CERN Multimedia

    Olivier, A-P; Bourdarios, C ; LAL / Orsay; Goldfarb, S ; University of Michigan

    2014-01-01

    High Energy Physics (HEP) has been using Machine Learning (ML) techniques such as boosted decision trees (paper) and neural nets since the 90s. These techniques are now routinely used for difficult tasks such as the Higgs boson search. Nevertheless, formal connections between the two research fields are rather scarce, with some exceptions such as the AppStat group at LAL, founded in 2006. In collaboration with INRIA, AppStat promotes interdisciplinary research on machine learning, computational statistics, and high-energy particle and astroparticle physics. We are now exploring new ways to improve the cross-fertilization of the two fields by setting up a data challenge, following the footsteps of, among others, the astrophysics community (dark matter and galaxy zoo challenges) and neurobiology (connectomics and decoding the human brain). The organization committee consists of ATLAS physicists and machine learning researchers. The Challenge will run from Monday 12th to September 2014.

  3. LHC luminosity upgrade detector challenges

    CERN Multimedia

    CERN. Geneva; de Roeck, Albert; Bortoletto, Daniela; Wigmans, Richard; Riegler, Werner; Smith, Wesley H

    2006-01-01

    LHC luminosity upgrade: detector challenges The upgrade of the LHC machine towards higher luminosity (1035 cm -2s-1) has been studied over the last few years. These studies have investigated scenarios to achieve the increase in peak luminosity by an order of magnitude, as well as the physics potential of such an upgrade and the impact of a machine upgrade on the LHC DETECTORS. This series of lectures will cover the following topics: • Physics motivation and machine scenarios for an order of magnitude increase in the LHC peak luminosity (lecture 1) • Detector challenges including overview of ideas for R&D programs by the LHC experiments: tracking and calorimetry, other new detector developments (lectures 2-4) • Electronics, trigger and data acquisition challenges (lecture 5) Note: the much more ambitious LHC energy upgrade will not be covered

  4. Polymer Informatics: Opportunities and Challenges.

    Science.gov (United States)

    Audus, Debra J; de Pablo, Juan J

    2017-10-01

    We are entering an era where large volumes of scientific data, coupled with algorithmic and computational advances, can reduce both the time and cost of developing new materials. This emerging field known as materials informatics has gained acceptance for a number of classes of materials, including metals and oxides. In the particular case of polymer science, however, there are important challenges that must be addressed before one can start to deploy advanced machine learning approaches for designing new materials. These challenges are primarily related to the manner in which polymeric systems and their properties are reported. In this viewpoint, we discuss the opportunities and challenges for making materials informatics as applied to polymers, or equivalently polymer informatics, a reality.

  5. The medical leadership challenge in healthcare is an identity challenge.

    Science.gov (United States)

    Andersson, Thomas

    2015-01-01

    The purpose of this article is to describe and analyse the identity challenges that physicians with medical leadership positions face. Four qualitative case studies were performed to address the fact that identity is processual, relational and situational. Physicians with managerial roles were interviewed, as well as their peers, supervisors and subordinates. Furthermore, observations were made to understand how different identities are displayed in action. This study illustrates that medical leadership implies identity struggles when physicians have manager positions, because of the different characteristics of the social identities of managers and physicians. Major differences are related between physicians as autonomous individuals in a system and managers as subordinates to the organizational system. There are psychological mechanisms that evoke the physician identity more often than the managerial identity among physicians who are managers, which explains why physicians who are managers tend to remain foremost physicians. The implications of the findings, that there are major identity challenges by being both a physician and manager, suggest that managerial physicians might not be the best prerequisite for medical leadership, but instead, cooperative relationships between physicians and non-physician managers might be a less difficult way to support medical leadership. Acknowledging and addressing identity challenges can be important both in creating structures in organizations and designing the training for managers in healthcare (both physicians and non-physicians) to support medical leadership. Medical leadership is most often related to organizational structure and/or leadership skills, but this paper discusses identity requirements and challenges related to medical leadership.

  6. Success of Breast Cancer Startup Challenge Inspires Second Challenge | Poster

    Science.gov (United States)

    By Thomas Stackhouse, Joseph Conrad, and Michele Newton, Contributing Writers, and Rosemarie Truman, Guest Writer Sixty-one teams have been accepted into, and are now competing in, the Neuro Startup Challenge, a new collaboration established by the National Institutes of Health (NIH) with The Center for Advancing Innovation (CAI) and Heritage Provider Network, Inc.

  7. New Challenges in Model Checking

    Science.gov (United States)

    Holzmann, Gerard J.; Joshi, Rajeev; Groce, Alex

    2006-01-01

    In the last 25 years, the notion of performing software verification with logic model checking techniques has evolved from intellectual curiosity to accepted technology with significant potential for broad practical application. In this paper we look back at the main steps in this evolution and illustrate how the challenges have changed over the years, as we sharpened our theories and tools. Next we discuss a typical challenge in software verification that we face today - and that perhaps we can look back on in another 25 years as having inspired the next logical step towards a broader integration of model checking into the software development process.

  8. Grand Challenges of Enterprise Integration

    Energy Technology Data Exchange (ETDEWEB)

    Brosey, W.D; Neal, R.E.; Marks, D.

    2001-04-01

    Enterprise Integration connects and combines people, processes, systems, and technologies to ensure that the right people and the right processes have the right information and the right resources at the right time. A consensus roadmap for Technologies for Enterprise Integration was created as part of an industry/government/academia partnership in the Integrated Manufacturing Technology Initiative (IMTI). Two of the grand challenges identified by the roadmapping effort will be addressed here--Customer Responsive Enterprises and Totally Connected Enterprises. Each of these challenges is briefly discussed as to the current state of industry and the future vision as developed in the roadmap.

  9. Respiratory challenge MRI: Practical aspects

    OpenAIRE

    Moreton, Fiona C.; Dani, Krishna A.; Goutcher, Colin; O'Hare, Kevin; Muir, Keith W.

    2016-01-01

    Respiratory challenge MRI is the modification of arterial oxygen (PaO2) and/or carbon dioxide (PaCO2) concentration to induce a change in cerebral function or metabolism which is then measured by MRI. Alterations in arterial gas concentrations can lead to profound changes in cerebral haemodynamics which can be studied using a variety of MRI sequences. Whilst such experiments may provide a wealth of information, conducting them can be complex and challenging. In this paper we review the ration...

  10. Zero Energy Schools: The Challenges

    Energy Technology Data Exchange (ETDEWEB)

    Torcellini, Paul A [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-29

    School buildings have a lot of potential to achieve zero energy (ZE) in new construction as well as in retrofits. There are many examples of schools operating at ZE, and many technical resources available to guide school districts and their design and construction teams through the process. When school districts embark on the path to ZE, however, they often confront challenges related to processes and a perception that ZE buildings require 'new,' unconventional, and expensive technologies, materials, or equipment. Here are some of the challenges school districts and their design and construction teams commonly encounter, and the solutions they use to overcome them.

  11. Vitreous substitutes: challenges and directions.

    Science.gov (United States)

    Gao, Qian-Ying; Fu, Yue; Hui, Yan-Nian

    2015-01-01

    The natural vitreous body has a fine structure and complex functions. The imitation of the natural vitreous body by vitreous substitutes is a challenging work for both researchers and ophthalmologists. Gases, silicone oil, heavy silicone oil and hydrogels, particularly the former two vitreous substitutes are clinically widely used with certain complications. Those, however, are not real artificial vitreous due to lack of structure and function like the natural vitreous body. This article reviews the situations, challenges, and future directions in the development of vitreous substitutes, particularly the experimental and clinical use of a new artificial foldable capsular vitreous body.

  12. CHALLENGES FACING THE ESP PRACTITIONER

    OpenAIRE

    SIMION MINODORA OTILIA

    2015-01-01

    The ESP teacher has to face certain challenges in his profession: One of the biggest challenges of the ESP teacher is the fact that he/she lacks the necessary knowledge of the subject to teach Business English, for instance, some researchers believing that such courses should be taught by subject teachers. The task of teaching ESP by ESL teachers is not an easy one. Dudley- Evans and St. John pointed out its complexity, identifying five key roles of the ESP practitioner: teacher, cou...

  13. Understanding the LHC Controls Challenges

    CERN Document Server

    Van den Eynden, M

    2000-01-01

    The analysis, design and construction of the LHC control system is a complex problem which will challenge CERN's capability to provide a modern controls infrastructure fulfilling the stringent operational requirements of this machine. The first part of this talk will review the present LHC project context in which several controls initiatives have already been taken. The second part will try to highlight the important technical aspects and engineering steps involved in the process of defining a control system architecture. The importance of understanding the major LHC operational challenges will be stressed along with some practical proposals and examples on how to conduct such activity with all stakeholders.

  14. Challenges in legal translation - revisited

    Directory of Open Access Journals (Sweden)

    Ingrid Simonnæs

    2013-12-01

    Full Text Available The aim of this paper is to discuss challenges in legal translation from the view of a teacher who evaluates the work of semi-professional translators in a special setting. Recurrent translation errors may subsequently be used as a pedagogical resource in specialised translator training. The observation of recurrent challenges confronting the candidates in legal translation and the absence of formal translator training programs are the reasons why NHH now offers an on-line course in legal translation, JurDist, focusing i.a. on useful translation strategies.

  15. Challenges and opportunities for REDD+

    DEFF Research Database (Denmark)

    Pasgaard, Maya; Sun, Zhanli; Müller, Daniel

    2016-01-01

    Reducing Emissions from Deforestation and forest Degradation (REDD+) is a promising mechanism of payments for ecosystem services with the aim to effectively reduce emissions in an efficient and equitable manner. REDD+ is part of the Paris-agreement reached at the UNFCCC COP21 in December 2015...... the opportunities and challenges of REDD+ for achieving effective, efficient and equitable outcomes and co-benefits (3E+). We substantiate our survey results with a literature review. Results suggest that the challenges in achieving the 3E+ relate to the disproportionality between deforestation drivers...

  16. Short-term effects of hypertonic saline solution in acute heart failure and long-term effects of a moderate sodium restriction in patients with compensated heart failure with New York Heart Association class III (Class C) (SMAC-HF Study).

    Science.gov (United States)

    Paterna, Salvatore; Fasullo, Sergio; Parrinello, Gaspare; Cannizzaro, Sergio; Basile, Ivana; Vitrano, Gabriella; Terrazzino, Gabriella; Maringhini, Giorgio; Ganci, Filippo; Scalzo, Sebastiano; Sarullo, Filippo M; Cice, Gennaro; Di Pasquale, Pietro

    2011-07-01

    Hypertonic saline solution (HSS) and a moderate Na restriction plus high furosemide dose showed beneficial effects in compensated heart failure (HF), in short and long terms. The study was aimed to verify the effects of this combination on hospitalization time, readmissions and mortality in patients in New York Heart Association (NYHA) class III. Chronic ischemic or nonischemic cardiomyopathy uncompensated patients with HF in NYHA III functional class with ejection fraction <40%, serum creatinine <2.5 mg/dL, blood urea nitrogen <60 mg/dL and reduced urinary volume were single-blind randomized in 2 groups: the first group received a 30-minute intravenous infusion of furosemide (250 mg) plus HSS (150 mL) twice daily and a moderate Na restriction (120 mmol); the second group received furosemide intravenous bolus (250 mg) twice a day, without HSS and a low Na diet (80 mmol); both groups received a fluid intake of 1000 mL/d. After discharge, the HSS group continued with 120 mmol Na/d; the second group continued with 80 mmol Na/d. A total of 1771 patients (881 HSS group and 890 without HSS group) met inclusion criteria: the first group (881 patients), compared with the second (890 patients), showed an increase in diuresis and serum Na levels, a reduction in hospitalization time (3.5 + 1 versus 5.5 + 1 days, P < 0.0001) and, during follow-up (57 + 15 months), a lower rate in readmissions (18.5% versus 34.2%, P < 0.0001) and mortality (12.9% versus 23.8%, P < 0.0001); the second group also showed a significant increase in blood urea nitrogen and serum creatinine. This study suggests that in-hospital HSS administration, combined with moderate Na restriction, reduces hospitalization time and that a moderate sodium diet restriction determines long-term benefit in patients with NYHA class III HF.

  17. Solução salina hipertônica para prevenção de insuficiência renal em pacientes com insuficiência cardíaca descompensada e hiponatremia Hypertonic saline solution for renal failure prevention in patients with decompensated heart failure

    Directory of Open Access Journals (Sweden)

    Victor Sarli Issa

    2007-10-01

    insuficiência renal.BACKGROUND: Hyponatremia and congestive phenomena indicate a bad prognosis in decompensated heart failure. The occurrence of renal failure is associated to an increased death risk. OBJECTIVE: To evaluate the safety and efficacy of the hypertonic saline solution in patients with decompensated heart failure for renal failure prevention. METHODS: Patients with decompensated heart failure, congestion and hyponatremia participated in the study. In addition to the standard treatment, the patients received hypertonic saline solution and were submitted to clinical as well as laboratory assessment. RESULTS: Nine patients were enrolled in the study. Mean age was 55 + 14.2 years, being 5 male (55.5% and 4 (44.5% female patients. All of them presented functional class III-IV of the New York Heart Association (NYHA, and 5 (55.5% received dobutamine. All of them presented initial creatinine > 1.4 mg/dl. The mean tonicity of the solution was 4.39% + 0.018% (2.5% to 7.5% and the duration of treatment was 4.9 days + 4.1 days (1-15 days. There were no severe adverse effects; none of the patients presented clinical worsening or neurologic disorders; hypokalemia occurred in 4 cases (44.5%. The comparison of the variables before and after treatment showed a decrease in urea (105 mg/dl + 74.8 mg/dl vs. 88 mg/dl + 79.4 mg/dl; p = 0.03 and increase in the urinary volume (1,183 ml/day vs. 1,778 ml/day; p = 0.03; there was no tendency to creatinine decrease (2.0 mg/dl + 0.8 mg/dl vs. 1.7 mg/dl + 1.0 mg/dl; p = 0.08. Despite the elevation in sodium levels (131 mEq/l + 2.8 mEq/l vs. 134 mEq/l + 4.9 mEq/l and weight decrease (69.5 kg + 18.6 kg vs. 68.2 kg + 17.1 kg, there was no statistically significant difference. CONCLUSION: The use of hypertonic saline solution in patients with decompensated heart failure can be a safe therapeutic method and potentially related to clinical improvement and renal failure prevention.

  18. Broncoprovocação com solução salina hipertônica em crianças asmáticas Brocoprovocación con solución salina hipertónica en niños asmáticos Bronchoprovocation with hypertonic saline solution in asthmatic children

    Directory of Open Access Journals (Sweden)

    Cínthia Maria X. Costa

    2012-09-01

    ,5%, considerándose el resultado positivo como la reducción del volumen espiratorio forzado en el primer segundo (VEF1 ≥20%. RESULTADOS: Sesenta individuos eran atópicos. La frecuencia de positividad de la prueba de broncoprovocación fue mayor en el Grupo MG que en el IL (93 versus 65%. El tiempo necesario para la reducción de 20% del VEF1 para el grupo de atópicos fue menor en el MG cuando comparado al IL, 90 (30 a 330 versus 210 (30 a 690 segundos, con pOBJECTIVE: To verify if the bronchoprovocation test with 4.5% hypertonic saline solution allows to detect the gradient of response in asthmatic children and adolescents, according to asthma severity. METHODS: 75 asthmatic patients aged six to 18 years-old were evaluated in this cross-sectional study. They were classified according to asthma severity in: intermittent or mild persistent (IM and moderate or severe persistent (MS. They were also classified according to sensitization to inhaled allergens in atopics: positive skin prick test to Dermatophagoides pteronyssinus, D. farinae and Blomia tropicalis; or non- atopic with negative skin prick tests. All patients underwent a bronchoprovocation test with 4.5% hypertonic saline solution. The result of the bronchoprovocation test was considerd positive if at least a reduction of 20% in the forced expiratory volume in one second (FEV1 was noted. RESULTS: 60 individuals were atopic. The bronchoprovocation test was positive more frequently in the MS group than in the IM one (93 versus 65%. Less time was needed for a 20% fall of FEV1 in the MG compared to the IL group [90 (30 - 330 versus 210 (30 - 690 seconds; p<0.05]. The percentage of FEV1 fall was higher in the MG group than in the IL one [26,4% (14 - 63 versus 20% (0 - 60; p<0.05]. CONCLUSIONS: The 4.5% hypertonic saline solution bronchoprovocation test is safe and easy to perform. It detects a gradient of response in asthmatic children and adolescents regarding asthma severity. Higher frequency of positive tests, shorter

  19. Hypertonic saline solution increases cerebral perfusion pressure during clinical orthotopic liver transplantation for fulminant hepatic failure: preliminary results Solução salina hipertônica aumenta a pressão de perfusão cerebral no transplante do fígado para hepatite fulminante: resultados preliminares

    Directory of Open Access Journals (Sweden)

    Joel Avancini Rocha Filho

    2006-06-01

    Full Text Available During orthotopic liver transplantation for fulminant hepatic failure, some patients may develop sudden deterioration of cerebral perfusion and oxygenation, mainly due to increased intracranial pressure and hypotension, which are likely responsible for postoperative neurological morbidity and mortality. In the present study, we hypothesized that the favorable effects of hypertonic saline solution (NaCl 7.5%, 4 mL/kg infusion on both systemic and cerebral hemodynamics, demonstrated in laboratory and clinical settings of intracranial hypertension and hemorrhagic shock resuscitation, may attenuate the decrease in cerebral perfusion pressure that often occurs during orthotopic liver transplantation for fulminant hepatic failure. METHODS: 10 patients with fulminant hepatic failure in grade IV encephalopathy undergoing orthotopic liver transplantation with intracranial pressure monitoring were included in this study. The effect on cerebral and systemic hemodynamics in 3 patients who received hypertonic saline solution during anhepatic phase (HSS group was examined, comparing their data with historical controls obtained from surgical procedure recordings in 7 patients (Control group. The maximal intracranial pressure and the corresponding mean arterial pressure values were collected in 4 time periods: (T1 the last 10 min of the dissection phase, (T2 the first 10 minutes at the beginning of anhepatic phase, (T3 at the end of the anhepatic phase, and (T4 the first 5 minutes after graft reperfusion. RESULTS: Immediately after hypertonic saline solution infusion, intracranial pressure decreased 50.4%. During the first 5 min of reperfusion, the intracranial pressure remained stable in the HSS group, and all these patients presented an intracranial pressure lower than 20 mm Hg, while in the Control group, the intracranial pressure increased 46.5% (P Neste estudo testamos a hipótese de que os efeitos benéficos decorrentes da administração da solu

  20. The Mock LISA Data Challenges: from challenge 3 to challenge 4

    Energy Technology Data Exchange (ETDEWEB)

    Babak, Stanislav; Petiteau, Antoine; Robinson, Emma L [Max-Planck-Institut fuer Gravitationsphysik (Albert-Einstein-Institut), Am Muehlenberg 1, D-14476 Golm bei Potsdam (Germany); Baker, John G; McWilliams, Sean T; Arnaud, Keith A [Gravitational Astrophysics Laboratory, NASA Goddard Space Flight Center, 8800 Greenbelt Rd, Greenbelt, MD 20771 (United States); Benacquista, Matthew J [Center for Gravitational Wave Astronomy, University of Texas at Brownsville, Brownsville, TX 78520 (United States); Cornish, Neil J; Adams, Matt [Department of Physics, Montana State University, Bozeman, MT 59717 (United States); Larson, Shane L [Department of Physics, Utah State University, Logan, UT 84322 (United States); Mandel, Ilya [Department of Physics and Astronomy, Northwestern University, Evanston, IL (United States); Porter, Edward K [APC, UMR 7164, University Paris 7 Denis Diderot, 10, rue Alice Domon et Leonie Duquet, 75025 Paris Cedex 13 (France); Vallisneri, Michele; Cutler, Curt [Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 (United States); Vecchio, Alberto [School of Physics and Astronomy, University of Birmingham, Edgbaston, Birmingham B152TT (United Kingdom); Blaut, Arkadiusz [Institute of Theoretical Physics, University of Wroclaw, Wroclaw (Poland); Bridges, Michael; Feroz, Farhan [Astrophysics Group, Cavendish Laboratory, University of Cambridge, Cambridge CB30HE (United Kingdom); Cohen, Michael [Theoretical Astrophysics, California Institute of Technology, Pasadena, CA 91125 (United States); Gair, Jonathan R., E-mail: Michele.Vallisneri@jpl.nasa.go [Institute of Astronomy, University of Cambridge, Cambridge CB30HA (United Kingdom)

    2010-04-21

    The Mock LISA Data Challenges are a program to demonstrate LISA data-analysis capabilities and to encourage their development. Each round of challenges consists of one or more datasets containing simulated instrument noise and gravitational waves from sources of undisclosed parameters. Participants analyze the datasets and report best-fit solutions for the source parameters. Here we present the results of the third challenge, issued in April 2008, which demonstrated the positive recovery of signals from chirping galactic binaries, from spinning supermassive-black-hole binaries (with optimal SNRs between approx10 and 2000), from simultaneous extreme-mass-ratio inspirals (SNRs of 10-50), from cosmic-string-cusp bursts (SNRs of 10-100), and from a relatively loud isotropic background with OMEGA{sub gw}(f) approx 10{sup -11}, slightly below the LISA instrument noise.

  1. IPTV: Challenges and Future Directions

    NARCIS (Netherlands)

    O.M. Bonastre; M.J. Montpetit; P.S. Cesar Garcia (Pablo Santiago)

    2011-01-01

    htmlabstractThe move to IP Protocol Television (IPTV) has challenged the traditional television industry by opening the Internet to high quality real time television content delivery. Thus it has provided an enabling set of key technologies to understand and foster further innovations in the

  2. Challenging Sexual Harassment on Campus

    Science.gov (United States)

    Baker, Nancy V.

    2010-01-01

    More than thirty years ago, an administrative assistant at Cornell University first challenged her university's indifference to her boss's sexually predatory behavior. While she did not prevail, her case sparked a movement. Litigation, news stories, and government guidelines defining sexual harassment followed. And universities responded: policies…

  3. School Psychologists and Ethical Challenges

    Science.gov (United States)

    Kapoulitsas, Maryanne; Corcoran, Tim

    2017-01-01

    This research explored how psychologists working in the Victorian secondary state school system construct meaning around ethical practice. The specific aims of the research were to examine psychologists understanding of ethics in practice within schools and to explore challenges they faced regarding professional ethics when working in the…

  4. Accountability: new challenges, new forms

    NARCIS (Netherlands)

    van Woerkum, C.; Aarts, N.

    2012-01-01

    The general call for more accountability, affecting all western institutions, has reached the communication professionals as well. How can they cope with this new challenge? The danger is that they focus mainly on outcomes, so on performative accountability, whereas decisional accountability,

  5. NASA Space Rocket Logistics Challenges

    Science.gov (United States)

    Neeley, James R.; Jones, James V.; Watson, Michael D.; Bramon, Christopher J.; Inman, Sharon K.; Tuttle, Loraine

    2014-01-01

    The Space Launch System (SLS) is the new NASA heavy lift launch vehicle and is scheduled for its first mission in 2017. The goal of the first mission, which will be uncrewed, is to demonstrate the integrated system performance of the SLS rocket and spacecraft before a crewed flight in 2021. SLS has many of the same logistics challenges as any other large scale program. Common logistics concerns for SLS include integration of discreet programs geographically separated, multiple prime contractors with distinct and different goals, schedule pressures and funding constraints. However, SLS also faces unique challenges. The new program is a confluence of new hardware and heritage, with heritage hardware constituting seventy-five percent of the program. This unique approach to design makes logistics concerns such as commonality especially problematic. Additionally, a very low manifest rate of one flight every four years makes logistics comparatively expensive. That, along with the SLS architecture being developed using a block upgrade evolutionary approach, exacerbates long-range planning for supportability considerations. These common and unique logistics challenges must be clearly identified and tackled to allow SLS to have a successful program. This paper will address the common and unique challenges facing the SLS programs, along with the analysis and decisions the NASA Logistics engineers are making to mitigate the threats posed by each.

  6. They rose to the challenge!

    CERN Multimedia

    Anaïs Schaeffer

    2015-01-01

    The Challenge-Based Innovation programme is a Masters-level initiative developed at CERN in collaboration with many universities around the world. The first programme saw 45 students take part, and their final results were presented at an official "gala" held on 26 February.   On 26 February, after their official presentations, the six CBI teams presented their prototypes to the public in the IdeaSquare building.   As part of the IdeaSquare project, the Challenge-Based Innovation (CBI) programme is based on a very pragmatic question: can the tools and results produced by basic research (like that being carried out at CERN) be used to solve societal problems? If so, how? To answer this question, 45 students from very different professional and cultural backgrounds formed six teams, each with a specific societal challenge to solve (see here). Over a six-month period – from September 2014 to February 2015 – the six teams worked on the challenge in o...

  7. The Real Challenge of ESD

    Science.gov (United States)

    Jackson, M. G.

    2011-01-01

    Between the Inter-governmental Conference on Environmental Education at Tbilisi in 1977 and the Fourth International Conference on Environmental Education at Ahmedabad in 2007, our conception of the challenge posed by the global crises of climate change, environmental destruction, social disintegration, poverty, natural resources exhaustion and…

  8. Coordinated Exploration for Grand Challenges

    DEFF Research Database (Denmark)

    Ørding Olsen, Anders; Sofka, Wolfgang; Grimpe, Christoph

    2016-01-01

    Grand challenges are among the most complex problems for modern societies. Many governments and foundations provide substantial resources to encourage the search for solutions. Due to the significance of these problems, organizations often form partnerships in what we call search consortia to eng...... that advocacy groups benefit search consortia, particularly when consortia exhibit a high dispersion of technological knowledge and when they are inexperienced....

  9. Focusing on key development challenges

    International Development Research Centre (IDRC) Digital Library (Canada)

    Strategic Framework to guide our work during 2010–2015. This framework builds on the Centre's strengths ... Focusing on key development challenges. Building on strengths. Meeting tomorrow's ... durable peace, and the inclusion of marginalized groups, particularly women and girls. • Globalization, Growth and Poverty.

  10. Modernizing emergency alerts poses challenges

    OpenAIRE

    Center for Homeland Defense and Security

    2010-01-01

    Center for Homeland Defense and Security, OUT OF THE CLASSROOM Download the paper: Paper: IPAWS (Integrated Public Alert and Warning System)” Modernizing emergency alerts poses challenges Anthony Cox is interested in the next generation of emergency alert systems.Any television viewer...

  11. The Challenge of Weather Prediction

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 2; Issue 1. The Challenge of Weather Prediction Difficulties in Predicting the Weather. B N Goswami. Series Article Volume 2 Issue 1 January 1997 pp 8-15. Fulltext. Click here to view fulltext PDF. Permanent link:

  12. The Challenge of Weather Prediction

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 2; Issue 3. The Challenge of Weather Prediction Old and Modern Ways of Weather Forecasting. B N Goswami. Series Article Volume 2 Issue 3 March 1997 pp 8-15. Fulltext. Click here to view fulltext PDF. Permanent link:

  13. Monitoring challenges and innovative ideas

    Energy Technology Data Exchange (ETDEWEB)

    O' Neill, R.V.; Hunsaker, C.T.; Levine, D.A.

    1990-01-01

    Monitoring programs are difficult to design even when they focus on specific problems. Ecosystems are complex, and it is often impossible to predetermine what aspects of system structure or dynamics will respond to a specific insult. It is equally difficult to interpret whether a response is a stabilizing compensatory mechanism or a real loss of capacity to maintain the ecosystem. The problems are compounded in a broad monitoring program designed to assess ecosystem health'' at regional and continental scales. It is challenging in the extreme to monitor ecosystem response, at any scale, to past insults as well as an unknown future array of impacts. The present paper will examine some of the fundamental issues and challenges raised by large-scale monitoring efforts. The challenges will serve as a framework and as an excuse to discuss several important topics in more detail. Following the discussion of challenges, we suggest some basic innovations that could be important across a range of monitoring programs. The innovations include integrative measures, innovative methodology, and creative interpretation. 59 refs., 1 tab.

  14. Efficient audio power amplification - challenges

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Michael A.E.

    2005-07-01

    For more than a decade efficient audio power amplification has evolved and today switch-mode audio power amplification in various forms are the state-of-the-art. The technical steps that lead to this evolution are described and in addition many of the challenges still to be faced and where extensive research and development are needed is covered. (au)

  15. Research and challenges of CPS

    Science.gov (United States)

    Huang, Jintao; Zhang, Lichen

    2017-08-01

    This paper mainly introduces the basic concept of CPS and the research process of domestic and foreign development. The logic architecture and operation principle of CPS are elaborated, and the application of CPS in electric power, agriculture and medical field is discussed. Finally concluding the challenges of CPS and research emphasis of CPS.

  16. Challenges for Relational Reinforcement Learning

    NARCIS (Netherlands)

    van Otterlo, M.; Kersting, Kristian; Tadepalli, P.; Givan, R; Driessens, K.

    2004-01-01

    We present a perspective and challenges for Relational Reinforcement Learning (RRL). We first survey existing work and distinguish a number of main directions. We then highlight some research problems that are intrinsically involved in abstracting over relational Markov Decision Processes. These are

  17. Neuroscience challenges to philosophical anthropology

    Directory of Open Access Journals (Sweden)

    Antonio Sánchez Orantos

    2016-02-01

    Full Text Available This article aims to provide a possible framework to critically define the concept of human nature and person in dialogue with Neuroscience. He tries to help meet the challenge of the naturalism in the current thought.

  18. Efficient Audio Power Amplification - Challenges

    DEFF Research Database (Denmark)

    Andersen, Michael Andreas E.

    2005-01-01

    For more than a decade efficient audio power amplification has evolved and today switch-mode audio power amplification in various forms are the state-of-the-art. The technical steps that lead to this evolution are described and in addition many of the challenges still to be faced and where...... extensive research and development are needed is covered....

  19. Climate Change: Meeting the Challenge

    Science.gov (United States)

    Chance, Paul; Heward, William L.

    2010-01-01

    In "Climate Change: Meeting the Challenge," we conclude the special section by assuming that you have been persuaded by Thompson's paper or other evidence that global warming is real and poses a threat that must be dealt with, and that for now the only way to deal with it is by changing behavior. Then we ask what you, as behavior analysts, can do…

  20. The Leaking-Toilet Challenge

    Science.gov (United States)

    Roman, Harry T.

    2008-01-01

    Leaking toilets can cost homeowners big dollars--often before it is even realized. Homeowners do not necessarily hear it leaking. It just does, and when the water bill comes due, it can be a most unpleasant surprise. This article presents a classroom challenge to try to develop leak-detection ideas that would be inexpensive and easily added to…

  1. The Challenges of Digital Leadership

    Science.gov (United States)

    McLeod, Scott

    2015-01-01

    Because digital devices and online environments can simultaneously be transformatively empowering and maddeningly disruptive, the work of integrating digital learning tools into schools is usually difficult and complex. Common challenges arise, however, and can be thoughtfully addressed by proactive leadership. In the end, technology change in…

  2. Research Award: IDRC Challenge Fund

    International Development Research Centre (IDRC) Digital Library (Canada)

    Corey Piccioni

    2013-08-07

    Deadline: August 7, 2013. Please note that all applicafions must be sent electronically. IDRC is one of the world's leaders in generang new knowledge to meet global challenges. We offer a number of research awards providing a unique opportunity to enhance research skills and gain a fresh perspecve on crucial.

  3. Meeting the Challenges of Inclusion

    Science.gov (United States)

    Hills, Joanne

    2011-01-01

    Managing practical science activities effectively is demanding for any teacher and especially so for inexperienced practitioners. Add the problems posed by integrating children with learning and behavioural difficulties and one has the sort of challenge that makes working in education rewarding--but not easy! As a newly qualified teacher, the…

  4. Student Leadership: Challenges and Possibilities

    Science.gov (United States)

    Nel, Willy

    2016-01-01

    In my attempt to adhere to the request that I provide an interpretation of the theme for the session, "Critical Engagement, Innovation and Inclusivity", and cognisant of the primary audience, I weave student leadership responsibilities, challenges and possibilities into the address. Events since the plenary address have however…

  5. Climate change challenges for SEA

    DEFF Research Database (Denmark)

    Larsen, Sanne Vammen

    This paper takes a theoretical perspective on the challenges that climate changes pose for SEA. The theoretical framework used is the sociologist Ulrich Beck’s theory of risk society and the aspects that characterise this society. Climate change is viewed as a risk, and the theory is used to derive...

  6. Challenges in Business System Integration

    NARCIS (Netherlands)

    Hvolby, H.H.; Trienekens, J.H.

    2010-01-01

    Four main frameworks for intercompany relationships (SCOR, CPFR, ISA95 and OAG) are discussed and compared. The link between the frameworks and different supply chain integration applications such as ERP, CRM and VMI are pictured. Finally the state-of-the-art, future state and challenges of the

  7. Challenges of Participatory Plant Breeding

    OpenAIRE

    Messmer, Monika

    2012-01-01

    FiBL Plant breeding strategies - Why participatory plant breeding ? - Level of participation - Principles of participatory research - Challenges of participatory plant breeding - Who to get started - Communication / Common language - Definition of common goals - Long term engagement & Gender aspect - Implementation of PPB & Struggle with on farm trials - Data assessment & sample handling - Legal aspects and financing - Impact of participative plant breeding

  8. Challenges in commercializing biomimetic membranes

    DEFF Research Database (Denmark)

    Perry, Mark; Madsen, Steen Ulrik; Jørgensen, Tine Elkjær

    2015-01-01

    of these barriers and challenges associated with introducing biomimetic aquaporin membranes. These include technical issues in membrane production and product testing. Then we discuss possible business models for introducing new technologies in general, followed by a presentation of beach-head market segments...... relevant for biomimetic aquaporin membranes....

  9. Research Award: IDRC Challenge Fund

    International Development Research Centre (IDRC) Digital Library (Canada)

    Corey Piccioni

    2014-08-06

    Aug 6, 2014 ... IDRC is one of the world's leaders in generating new knowledge to meet global challenges. We offer a number of research awards providing a unique opportunity to enhance research skills and gain a fresh perspective on crucial development issues. These one‐year, paid, in‐house programs of training ...

  10. Cystic hygroma: A surgical challenge

    Directory of Open Access Journals (Sweden)

    Mohit Bhatia

    2016-01-01

    Full Text Available Cystic hygroma (CH is a congenital malformation of lymphatic system. The incidence of CH is approximately 1 in 6000 live births. In most of the cases, it presents as a painless, fluctuant swelling. Due to its variable presentation its optimum treatment often poses a potential challenge.

  11. Self Efficacy: Operationalizing Challenge Education.

    Science.gov (United States)

    McGowan, Michael L.

    1986-01-01

    Examines self-efficacy theory and how it can be utilized in describing participant change in adventure/challenge programs. Explores connection between personal experience and how people view ability to function in world around them. Discusses Bandura's theory and interaction of sources of information: performance accomplishment, vicarious…

  12. The Concrete and Pavement Challenge

    Science.gov (United States)

    Roman, Harry T.

    2012-01-01

    The modern world is characterized by the extensive use of concrete and asphalt pavement. Periodically, these materials are replaced and the old materials disposed of. In this challenge, students will be asked to develop ways to reuse the old materials. It is important for students to understand how concrete and asphalt are made and applied, as…

  13. Digital Libraries: The Grand Challenges.

    Science.gov (United States)

    Garrett, John R.

    1993-01-01

    Describes the technical, economic, social, and cultural challenges to building a national digital library system. Selecting and filtering information, building and scaling distributed digital library networks, invoicing, payment, authorizing access, the locus of planning leadership, and the information poor are discussed. (Contains three…

  14. The Challenges of Becoming Agile

    DEFF Research Database (Denmark)

    Ovesen, Nis; Dowlen, Chris

    2012-01-01

    During the last decade agile methods have been a vast success in the domain of software development. This paper investigates whether these methods can be successfully transferred to the domain of physical product development in order to address the fundamental challenges of increased marked speed...

  15. A Water-Service Challenge

    Science.gov (United States)

    Roman, Harry T.

    2011-01-01

    It is important to let students see the value of mathematics in design--and how mathematics lends perspective to problem solving. In this article, the author describes a water-service challenge which enables students to design a water utility system that uses surface runoff into an open reservoir as the potable water source. This challenge…

  16. Plain language and organisational challenges

    DEFF Research Database (Denmark)

    Pedersen, Karsten

    2014-01-01

    Changing the language in an organization is a major organizational change. In this article, I discuss some of the organizational challenges for one specific language change implementation, taking the stance that language change must be treated as any other organizational change for it to have an ...

  17. Challenges to 5G standardization

    DEFF Research Database (Denmark)

    Mihovska, Albena D.; Prasad, Ramjee

    2013-01-01

    Interoperable, ubiquitous and dynamic are key objectives for fifth-generation (5G) communication systems and applications. These characteristics are also at the core of the main challenges that researchers, manufacturers, regulators and standardization bodies face when designing targeted strategies...... for the successful deployment of 5G enabling technologies....

  18. President's Report: Choices and Challenges.

    Science.gov (United States)

    Burrill, Gail

    1997-01-01

    Presents remarks from the Presidential Address at the 75th Annual Meeting of the National Council of Teachers of Mathematics held in Minneapolis in April, 1997. Two major challenges addressed were the need to change classroom practice and the need to rethink the definition of "basic". (AIM)

  19. Challenges in a Physics Course

    DEFF Research Database (Denmark)

    Hernández, Carola Hernández; Ravn, Ole; Forero Shelton, Antonio Manu

    2014-01-01

    This article identifies and analyses some of the challenges that arose in a development process of changing from a content-based teaching environment to a student-centred environment in an undergraduate physics course for medicine and biology students at Universidad de los Andes. Through the use...

  20. The WCET Tool Challenge 2011

    DEFF Research Database (Denmark)

    Hanxleden, Reinhard von; Holsti, Niklas; Lisper, Björn

    of problems to be solved by the Challenge participants with their tools, WCET problems, which ask for bounds on the execution time, and ow-analysis problems, which ask for bounds on the number of times certain parts of the code can be executed. The benchmarks to be used in WCC'11 were debie1, Papa...

  1. Challenges from the Niger Delta

    African Journals Online (AJOL)

    User

    2012-01-24

    Jan 24, 2012 ... leadership that we are going to consider the state of security in the Niger. Delta region. Vol. ... what Bolade and Adelemo. National Security and Sustainable Development in Nigeria: Challenges from the Niger Delta .... development theory adopts a holistic approach that is mindful of the future implications of ...

  2. Leadership in Meeting Ethical Challenges.

    Science.gov (United States)

    Jonsen, Albert R.

    1987-01-01

    The ethical challenge to academic medical centers is to find a balance between education and research, addressing such issues as serving the unsponsored patient, the cost of new technology, and balancing acute and primary care as well as educating future physicians. (MSE)

  3. Nonlinear dynamics: Challenges and perspectives

    Indian Academy of Sciences (India)

    In spite of these developments, several challenges, some of them fundamental and others on the efficacy of these methods in developing cutting edge technologies, remain to be tackled. In this article, a brief ... Department of Physics, Centre for Nonlinear Dynamics, Bharathidasan University, Tiruchirapalli 620 024, India ...

  4. Accountability: New challenges, new forms

    NARCIS (Netherlands)

    Woerkum, van C.; Aarts, N.

    2012-01-01

    The general call for more accountability, affecting all western institutions, has reached the communication professionals as well. How can they cope with this new challenge? The danger is that they focus mainly on outcomes, so on performative accountability, whereas decisional accountability,

  5. Terahertz applications: trends and challenges

    Science.gov (United States)

    Robin, Thierry; Bouye, Clementine; Cochard, Jacques

    2014-03-01

    The objective of our work [1] was to determine the opportunities and challenges for Terahertz application development for the next years with a focus on systems: for homeland security and for Non Destructive Testing (NDT). Terahertz radiation has unique abilities and has been the subject of extensive research for many years. Proven concepts have emerged for numerous applications including Industrial NDT, Security, Health, Telecommunications, etc. Nevertheless, there has been no widely deployed application and Businesses based on THz technologies are still in their infancy. Some technological, market and industrial barriers are still to be broken. We summarize the final analysis and data: study of the technology trends and major bottlenecks per application segment, main challenges to be addressed in the next years, key opportunities for THz technologies based on market needs and requirements.

  6. Challenges for Research on Intelligence

    Directory of Open Access Journals (Sweden)

    Earl Hunt

    2013-10-01

    Full Text Available After 100 years of research, the definition of the field is still inadequate. The biggest challenge we see is moving away from a de-factor definition of intelligence in terms of test scores, but at the same time making clear what the boundaries of the field are. We then present four challenges for the field, two within a biological and two within a social context. These revolve around the issues of the malleability of intelligence and its display in everyday life, outside of a formal testing context. We conclude that developments in cognitive neuroscience and increases in the feasibility of monitoring behavior outside of the context of a testing session offer considerable hope for expansion of our both the biological and social aspects of individual differences in cognition.

  7. Challenges of Space Mission Interoperability

    Science.gov (United States)

    Martin, Warren L.; Hooke, Adrian J.

    2007-01-01

    This viewgraph presentation reviews some of the international challenges to space mission interoperability. Interoperability is the technical capability of two or more systems or components to exchange information and to use the information that has been exchanged. One of the challenges that is addressed is the problem of spectrum bandwidth, and interference. The key to interoperability is the standardization of space communications services and protocols. Various levels of international cross support are reviewed: harmony, cooperation cross support and confederation cross support. The various international bodies charged with implementing cross support are reviewed. The goal of the Interagency Operations Advisory Group (IOAG) is to achieve plug-and-play operations where all that is required is for each of the systems to use an agreed communications medium, after which the systems configure each other for the purpose of exchanging information and subsequently effect such exchange automatically.

  8. Smart textiles: Challenges and opportunities

    Science.gov (United States)

    Cherenack, Kunigunde; van Pieterson, Liesbeth

    2012-11-01

    Smart textiles research represents a new model for generating creative and novel solutions for integrating electronics into unusual environments and will result in new discoveries that push the boundaries of science forward. A key driver for smart textiles research is the fact that both textile and electronics fabrication processes are capable of functionalizing large-area surfaces at very high speeds. In this article we review the history of smart textiles development, introducing the main trends and technological challenges faced in this field. Then, we identify key challenges that are the focus of ongoing research. We then proceed to discuss fundamentals of smart textiles: textile fabrication methods and textile interconnect lines, textile sensor, and output device components and integration of commercial components into textile architectures. Next we discuss representative smart textile systems and finally provide our outlook over the field and a prediction for the future.

  9. Challenges in pediatric endothelial keratoplasty

    Directory of Open Access Journals (Sweden)

    Vikas Mittal

    2014-01-01

    Full Text Available We performed endothelial keratoplasty (EK in three eyes of two siblings (2.5 years, male and 3.5 years, female with congenital hereditary endothelial dystrophy (CHED and report the intraoperative and postoperative difficulties. Repeated iris prolapse, apprehension of crystalline lens touch due to positive vitreous pressure, and need for frequent air injections to attach the graft were intraoperative challenges in all three eyes. These were addressed by use of Sheet′s glide instead of Busin′s glide during graft insertion and suturing of main and side ports before air injection. One eye had graft dislocation on second postoperative day due to eye rubbing by the child. Graft was repositioned with air and a venting incision was created. Postoperative examination required repeated general anesthesia. Corneal edema resolved completely in all three eyes. Present case series highlights the possible intraoperative and postoperative challenges and their solutions in pediatric EK for CHED.

  10. Health Smart Homes: New Challenges.

    Science.gov (United States)

    Maeder, Anthony J; Williams, Patricia A H

    2017-01-01

    Health Smart Homes provide various forms of assisted living support, by monitoring the activities and health status of their occupants to generate flows of information and sometimes interventions involving the occupants and their careers. Technologies of varying complexity must be combined to produce the underlying Health Smart Home system, and processing of the resulting data may require methods of varying sophistication. These aspects have been well studied, but no widely-adopted approaches for practical implementation of systems or systematic processing of data have been developed. Also, the integration of Health Smart Home services with the overall health care system has not been regularized. This paper identifies and categorizes the emerging high-level challenges beyond those in the basic technical and algorithmic spaces. These challenges will influence future directions for Health Smart Homes and their wider adoption and integration with health systems.

  11. Hypersonic propulsion: Status and challenge

    Science.gov (United States)

    Guy, R. Wayne

    1990-01-01

    Scientists in the U.S. are again focusing on the challenge of hypersonic flight with the proposed National Aerospace Plane (NASP). This renewed interest has led to an expansion of research related to high speed airbreathing propulsion, in particular, the supersonic combustion ramjet, or scramjet. The history is briefly traced of scramjet research in the U.S., with emphasis on NASA sponsored efforts, from the Hypersonic Research Engine (HRE) to the current status of today's airframe integrated scramjets. The challenges of scramjet technology development from takeover to orbital speeds are outlined. Existing scramjet test facilities such as NASA Langley's Scramjet Test Complex as well as new high Mach number pulse facilities are discussed. The important partnership role of experimental methods and computational fluid dynamics is emphasized for the successful design of single stage to orbit vehicles.

  12. Conceptual challenges for internalising externalities

    DEFF Research Database (Denmark)

    Miguel, Brandão; Weidema, Bo Pedersen

    2013-01-01

    We analyse a number of different externalities to identify conceptual challenges for the practical implementation of their internalisation. Three issues were identified: i) The balance between compensation and technology change and the respective effects on the nominal and real GDP; ii) The relev......We analyse a number of different externalities to identify conceptual challenges for the practical implementation of their internalisation. Three issues were identified: i) The balance between compensation and technology change and the respective effects on the nominal and real GDP; ii...... geographical and especially temporal distance between the benefitting actor and the victim of the external cost, the involvement of a non-governmental intermediate actor becomes increasingly necessary to provide the short-term capital required to ensure a successful implementation....

  13. Challenges for Contextualizing Language Learning

    DEFF Research Database (Denmark)

    Eskildsen, Søren; Rehm, Matthias

    2013-01-01

    to ensure a better experience-based learning. We present methods used to collect information about everyday activities collected by immigrants or foreigners. This information will help structuring language learning assignments presented through the context-aware mobile application.......To help facilitate language learning for immigrants or foreigners arriving to another culture and language, we propose a context-aware mobile application. To expand on the known elements like location, activity, time and identity, we investigate the challenges on including cultural awareness...

  14. The ambiguous challenge of intranets

    DEFF Research Database (Denmark)

    Thommesen, Jacob

    2003-01-01

    media, email and the web, partly in the perspective of media richness theory, partly compared with philosophical discussions of classical media. The fourth chapter presents an intranet in a global company, in which problems and challenges related to ambiguity have proven significant.......In this thesis I shall present the argument that intranets increase the role of ambiguity – confrontation between contradicting frames of interpretation – in organisational communication by encouraging processes across organisational borders. In the first chapter I discuss philosophical aspects...

  15. The Challenge of the bespoke

    DEFF Research Database (Denmark)

    Tamke, Martin; Quinn, Gregory; Evers, Henrik Leander

    2014-01-01

    The Dermoid project, a series of three plywood grid shells, navigates at the interface between parametrically designed architectural spaces and the efficiency and resourcefulness of the simulations that are necessary in order to build them. It highlights the increasingly common challenges...... and conflicts which occur in building practice ranging from design to fabrication and highlights approaches that facilitate implementation in multiple scales of material, element and structure....

  16. Management Challenges Fiscal Year 2016

    Science.gov (United States)

    2017-01-01

    housing on military installations and found that DoD officials did not ensure that tenants were properly screened before granting unescorted access to...Management Challenges that cyberspace operations by a range of state and non-state actors have intensified against the DoD. The Commander cited individual...include improved lighting; high-efficiency heating, ventilation, and air conditioning systems; double -pane windows, solar and wind electricity, and new

  17. The ATLAS Student Event Challenge

    CERN Document Server

    Fassouliotis, D; Roupas, Z; Vudragovic, D

    2007-01-01

    The ASEC (ATLAS Student Event Challenge) is an educational project which allows the students to learn about the elementary particles by studying "events", the products of beam collisions at the LHC. The events are collected by the ATLAS detector and displayed graphically using the ATLANTIS package. The students are given the means to select and analyse the events on-line, and subsequently present the results and draw conclusions.

  18. Rural Entrepreneurship: Challenges and Opportunities

    OpenAIRE

    Imedashvili, Sopiko; Kekua, Ani; Ivchenko, Polina

    2013-01-01

    According to World Bank Report published in 2012, the rural population in Sweden is 15.3 %. Rural population is calculated as difference between total populations minus urban population. 15.3 % clearly shows how important rural areas are for Sweden’s future development. Entrepreneurship plays the integral role in rural area development. However, earlier research has shown only economic perspective of rural development. On the other hand, the new ways to discover the challenges and opportuniti...

  19. The challenges of managing migration

    Energy Technology Data Exchange (ETDEWEB)

    Tacoli, Cecilia

    2005-10-15

    Migration and urbanisation are driven by economic growth and social change, but also by deepening inequalities. Managing migration should not be equated with curbing it, as this inevitably reduces migrants' rights. But managing population movement whilst respecting the rights of migrants and nonmigrants, supporting the contribution of migration to poverty reduction and economic growth in sending and receiving areas and reducing the human and material costs of movement means that fundamental challenges need to be addressed.

  20. Challenges of Big Data Analysis.

    Science.gov (United States)

    Fan, Jianqing; Han, Fang; Liu, Han

    2014-06-01

    Big Data bring new opportunities to modern society and challenges to data scientists. On one hand, Big Data hold great promises for discovering subtle population patterns and heterogeneities that are not possible with small-scale data. On the other hand, the massive sample size and high dimensionality of Big Data introduce unique computational and statistical challenges, including scalability and storage bottleneck, noise accumulation, spurious correlation, incidental endogeneity, and measurement errors. These challenges are distinguished and require new computational and statistical paradigm. This article gives overviews on the salient features of Big Data and how these features impact on paradigm change on statistical and computational methods as well as computing architectures. We also provide various new perspectives on the Big Data analysis and computation. In particular, we emphasize on the viability of the sparsest solution in high-confidence set and point out that exogeneous assumptions in most statistical methods for Big Data can not be validated due to incidental endogeneity. They can lead to wrong statistical inferences and consequently wrong scientific conclusions.

  1. Challenge to unique researches; Unique na kenkyu eno challenge

    Energy Technology Data Exchange (ETDEWEB)

    Kato, M. [Central Research Inst. of Electric Power Industry, Tokyo (Japan)

    2000-05-10

    Mr. Takashi Tachibana, a critic, enumerates two reasons for why the U.S.A. is maintaining the high research level. One is the U.S. research institution in which foreigners can perform their actions freely. Another is the American frontier spirit that evaluates highly the challenge to new things. In the fields where the Central Research Institute of Electric Power Industry of Japan has achieved world-wide excellent accomplishments, many are the cases in which foreign researchers participate and work actively as the visiting researchers or the Science and Technology Agency (STA) fellows. In the latter case, the Central Research Institute of Electric Power Industry has introduced since a few years ago a system in which challenges can be made on unique researches that the researchers can draw their inspirations by themselves. Results are beginning to appear in several subjects, including the environmental hormone measuring method utilizing biotechnology. The 21st century requires solution of different problems in the electric power business, such as energy and environment issues. It would become increasingly important to work positively on creative and advanced researches and further strengthen the research power as the base for problem solution under the internationally opened research institution where first-class researchers inside and outside the country will get together. (NEDO)

  2. Fossil Energy: Drivers and Challenges.

    Science.gov (United States)

    Friedmann, Julio

    2007-04-01

    Concerns about rapid economic growth, energy security, and global climate change have created a new landscape for fossil energy exploration, production, and utilization. Since 85% of primary energy supply comes from fossil fuels, and 85% of greenhouse gas emissions come from fossil fuel consumption, new and difficult technical and political challenges confront commercial, governmental, and public stakeholders. As such, concerns over climate change are explicitly weighed against security of international and domestic energy supplies, with economic premiums paid for either or both. Efficiency improvements, fuel conservation, and deployment of nuclear and renewable supplies will help both concerns, but are unlikely to offset growth in the coming decades. As such, new technologies and undertakings must both provide high quality fossil energy with minimal environmental impacts. The largest and most difficult of these undertakings is carbon management, wherein CO2 emissions are sequestered indefinitely at substantial incremental cost. Geological formations provide both high confidence and high capacity for CO2 storage, but present scientific and technical challenges. Oil and gas supply can be partially sustained and replaced through exploitation of unconventional fossil fuels such as tar-sands, methane hydrates, coal-to-liquids, and oil shales. These fuels provide enormous reserves that can be exploited at current costs, but generally require substantial energy to process. In most cases, the energy return on investment (EROI) is dropping, and unconventional fuels are generally more carbon intensive than conventional, presenting additional carbon management challenges. Ultimately, a large and sustained science and technology program akin to the Apollo project will be needed to address these concerns. Unfortunately, real funding in energy research has dropped dramatically (75%) in the past three decades, and novel designs in fission and fusion are not likely to provide any

  3. Cooperative Projects - Challenges and Opportunities

    Science.gov (United States)

    Schubotz, Wiebke; Brücher, Tim; Vamborg, Freja

    2017-04-01

    Today's research in Germany is often organized in large projects and collaborations, so-called cooperative projects ("Verbundprojekte" in German). These projects are defined by a large number of members (more than 50) and participating institutes, e.g. institutes of research organizations such as the Max-Planck society and the Leibniz association, Helmholtz centres, and universities. For coordination purposes these projects usually have a general project manager or project coordinator close to the speaker of the project. Despite this overarching position, it is often challenging for the project manager to really overview the entire project as he is, for example, not involved in the individual institute's recruitment processes or research connections to other institutes via other projects. Additionally, there is neither a formal obligation for the principal investigators and project scientists to report changes within their sub-projects, nor any formal dependency between these sub-projects and the coordination office to ensure a contemporary update of changes and progress in their specific tasks of the project. Therefore, the idea of a coordinating position to oversee the entire cooperative project is sometimes difficult to reach. Furthermore, project managers usually have no formal connection to other project managers. This means that recurrent tasks, for which cooperation between project managers would be helpful, need to be reinvented for each project anew. Due to the lack of this more formalized cooperation between project managers, acquired expertise is often lost. We will illustrate the challenges of this kind of project management based on projects at the Max Planck Institute for Meteorology (Hamburg) and the Helmholtz Centre for Ocean Research (GEOMAR, Kiel), but also point out opportunities that arise within a large collaboration of partners. Moreover, we present an approach to coordinate management processes in order to overcome some of the aforementioned

  4. Challenges in Regulating Pesticide Mixtures

    Directory of Open Access Journals (Sweden)

    Michael Lydy

    2004-12-01

    Full Text Available This paper introduces the field of mixture toxicity and the challenges in regulating pesticide mixtures. Even though pesticides are unique chemical stressors designed to have biological activity that can affect a number of nontarget species, they are intentionally placed into the environment in large quantities. Currently, methods and terminology for evaluating mixture toxicity are poorly established. The most common approach used is the assumption of additive concentration, with the concentrations adjusted for potency to a reference toxicant. Using this approach, the joint action of pesticides that have similar chemical structures and modes of toxic action can be predicted. However, this approach and other modeling techniques often provide little insight into the observed toxicity produced by mixtures of pesticides from different classes. Particularly difficult to model are mixtures that involve a secondary toxicant that changes the toxicokinetics of a primary toxicant. This may result in increased activation or a change in the persistence of the primary toxicant within the organism and may be responsible for a several-fold increase or decrease in toxicity. At present, the ecological effects caused by mixtures of pesticides are given little consideration in the regulatory process. However, mixtures are being considered in relation to human health in the pesticide registration process, setting a precedent that could be followed for ecological protection. Additionally, pesticide mixtures may be regulated through toxicity testing of surface water under the Clean Water Act. The limits of our basic knowledge of how mixtures interact are compromising both these avenues for regulating mixtures. We face many challenges to adequately protecting the environment from mixture toxicity; these challenges include understanding the interactions of toxicants within an organism, identifying the mixtures that most commonly occur and cause adverse effects, and

  5. Challenges for current University management

    Directory of Open Access Journals (Sweden)

    Pedro Rodríguez Vargas

    2016-03-01

    Full Text Available The Ecuadorian university through a change of era, this complex pathway mediated by globalization imposes imminently. The aim of this paper is to present a review of literature on the main aspects of management that are generated for the interaction University - context. This scan was performed on secondary sources, and grounded in scienti?c data abstraction. College education is an information and training process that allows the scientific, technological, economic, political, social and cultural development of a region or country; however, some phenomena such as globalization, technological revolution or multiculturalism are key to this, same that can be considered as a problem or a challenge.

  6. Plain Language and Organizational Challenges

    Directory of Open Access Journals (Sweden)

    Karsten Pedersen

    2014-06-01

    Full Text Available Changing the language in an organization is a major organizational change. In this article, I discuss some of the organizational challenges for one specific language change implementation, taking the stance that language change must be treated as any other organizational change for it to have an effect. I work with the case of the Danish tax authorities’ language project aimed at producing more readable letters. The empirical data that I work with are two qualitative informant interviews. One recorded at the language project’s headquarters where they lay out the general lines for the project, and the other at the payment center where they use the revised letters.

  7. Challenges in describing ribosome dynamics

    Science.gov (United States)

    Nguyen, Kien; Whitford, Paul Charles

    2017-04-01

    For decades, protein folding and functional dynamics have been described in terms of diffusive motion across an underlying energy landscape. With continued advances in structural biology and high-performance computing, the field is positioned to extend these approaches to large biomolecular assemblies. Through the application of energy landscape techniques to the ribosome, one may work towards establishing a comprehensive description of the dynamics, which will bridge theoretical concepts and experimental observations. In this perspective, we discuss a few of the challenges that will need to be addressed as we extend the application of landscape principles to the ribosome.

  8. The Euclid Data Processing Challenges

    Science.gov (United States)

    Dubath, Pierre; Apostolakos, Nikolaos; Bonchi, Andrea; Belikov, Andrey; Brescia, Massimo; Cavuoti, Stefano; Capak, Peter; Coupon, Jean; Dabin, Christophe; Degaudenzi, Hubert; Desai, Shantanu; Dubath, Florian; Fontana, Adriano; Fotopoulou, Sotiria; Frailis, Marco; Galametz, Audrey; Hoar, John; Holliman, Mark; Hoyle, Ben; Hudelot, Patrick; Ilbert, Olivier; Kuemmel, Martin; Melchior, Martin; Mellier, Yannick; Mohr, Joe; Morisset, Nicolas; Paltani, Stéphane; Pello, Roser; Pilo, Stefano; Polenta, Gianluca; Poncet, Maurice; Saglia, Roberto; Salvato, Mara; Sauvage, Marc; Schefer, Marc; Serrano, Santiago; Soldati, Marco; Tramacere, Andrea; Williams, Rees; Zacchei, Andrea

    2017-06-01

    Euclid is a Europe-led cosmology space mission dedicated to a visible and near infrared survey of the entire extra-galactic sky. Its purpose is to deepen our knowledge of the dark content of our Universe. After an overview of the Euclid mission and science, this contribution describes how the community is getting organized to face the data analysis challenges, both in software development and in operational data processing matters. It ends with a more specific account of some of the main contributions of the Swiss Science Data Center (SDC-CH).

  9. Tuberous breast: a surgical challenge.

    Science.gov (United States)

    Choupina, Miguel; Malheiro, Edgardo; Pinho, Carlos; Ferreira, António; Pinto, Armindo; Cardoso, Augusta; Reis, Jorge; Amarante, José

    2002-01-01

    Since the presentation of the tuberous breast deformity by Rees and Aston in 1976, many surgical procedures have been developed, but the correction of such a deformity still remains a surgical challenge. The authors report the last cases treated in the Department of Plastic and Reconstructive Surgery of São João Hospital-Porto and discuss about the ideal procedure which should be used according to the type of deformity. They emphasize the periareolar approach and the good results obtained by the Liacyr Ribeiro technique.

  10. Nanometrology - challenges for health regulation

    Directory of Open Access Journals (Sweden)

    Jailton Carreteiro Damasceno

    2013-11-01

    Full Text Available The relationship between metrology, nanotechnology and nanoscience and sanitary regulation is discussed from the point of view of its importance and the interrelationship between the themes for the development of products and services involving nanotech-nology. The discussion involves the main techniques for measuring dimensional, chemical and biological properties of materials, and presents some of the challenges for the future. Issues such as processes of standardization and regulation in Europe, U.S. and Brazil are also addressed, providing an overview of how these processes are related to sanitary regulation.

  11. Distributed analysis challenges in ATLAS

    Energy Technology Data Exchange (ETDEWEB)

    Duckeck, Guenter; Legger, Federica; Mitterer, Christoph Anton; Walker, Rodney [Ludwig-Maximilians-Universitaet Muenchen (Germany)

    2016-07-01

    The ATLAS computing model has undergone massive changes to meet the high luminosity challenge of the second run of the Large Hadron Collider (LHC) at CERN. The production system and distributed data management have been redesigned, a new data format and event model for analysis have been introduced, and common reduction and derivation frameworks have been developed. We report on the impact these changes have on the distributed analysis system, study the various patterns of grid usage for user analysis, focusing on the differences between the first and th e second LHC runs, and measure performances of user jobs.

  12. University education: Demands and challenges

    Directory of Open Access Journals (Sweden)

    Eduardo Pinos Vélez

    2013-06-01

    Full Text Available This paper presents a study on the current situation prevailing in the Universities from the point of view of a teacher whose academic since its inception has been Salesian, which allows for a “best approach” to young students and where the passion for teaching is clearly influenced by the teachings of one of the greatest teachers, Don Bosco. Also, these teachings are still of great relevance in our time, seek to adopt these methodologies in our workspaces teaching is challenging, where you can suggest new strategies for communication and integration with students and in this way to service the needy, such as programs aid Persons with Disabilities.

  13. The Kiki-Bouba Challenge

    DEFF Research Database (Denmark)

    Sturm, Bob L.; Collins, Nick

    2014-01-01

    We propose the “Kiki-Bouba Challenge” (KBC) for the re- search and development of content-based music informa- tion retrieval (MIR) systems. This challenge is unencum- bered by several problems typically encountered in MIR research: insufficient data, restrictive copyrights, imper- fect ground...... truth, a lack of specific criteria for classes (e.g., genre), a lack of explicit problem definition, and irrepro- ducibility. KBC provides a limitless amount of free data, a perfect ground truth, and well-specifiable and meaningful characteristics defining each class. These ideal conditions are made...

  14. Addressing the workforce pipeline challenge

    Energy Technology Data Exchange (ETDEWEB)

    Leonard Bond; Kevin Kostelnik; Richard Holman

    2006-11-01

    A secure and affordable energy supply is essential for achieving U.S. national security, in continuing U.S. prosperity and in laying the foundations to enable future economic growth. To meet this goal the next generation energy workforce in the U.S., in particular those needed to support instrumentation, controls and advanced operations and maintenance, is a critical element. The workforce is aging and a new workforce pipeline, to support both current generation and new build has yet to be established. The paper reviews the challenges and some actions being taken to address this need.

  15. Embedded Systems Design: Optimization Challenges

    DEFF Research Database (Denmark)

    Pop, Paul

    2005-01-01

    -to-market, and reduce development and manufacturing costs. In this paper, the author introduces several embedded systems design problems, and shows how they can be formulated as optimization problems. Solving such challenging design optimization problems are the key to the success of the embedded systems design...... of designing such systems is becoming increasingly important and difficult at the same time. New automated design optimization techniques are needed, which are able to: successfully manage the complexity of embedded systems, meet the constraints imposed by the application domain, shorten the time...

  16. Distribution challenges and workable solutions

    Directory of Open Access Journals (Sweden)

    Avinash G. Mulky

    2013-09-01

    Full Text Available An effective distribution channel can be a source of strategic advantage for companies. However, little research exists about the distribution channel structure in India, which is largely traditional and quite unique. The first part of this round table article provides an overview of distribution channels, particularly their constituents and structure, with a special focus on distribution channels in India. The second part of the article reports on a panel discussion with eminent academic and industry experts on the challenges that companies in India face in designing, constructing, and managing distribution channels on the ground.

  17. Asymmetry a challenge for orthodontists

    DEFF Research Database (Denmark)

    Melsen, Birte

    2007-01-01

    the required tooth displacements can be generated. In order to control the interaction between the force systems developed in the three planes of space, the appliances should commonly be segmented. Anchorage problems can occasionally only be solved by means of skeletal anchorage.......  Asymmetry is considered a challenge and often the reason for which the optimal result cannot be obtained. The explanations are many. Only rarely, the cause of the asymmetry is localized and camouflage is frequently resulting in the development a different type of asymmetry occurring in all three...

  18. CHALLENGES FOR DIGITAL LITERATURE TEACHING

    Directory of Open Access Journals (Sweden)

    Edgar Roberto Kirchof

    2013-12-01

    Full Text Available This paper addresses some challenges faced by researchers and teachers interested in teaching digital literature in formal educational institutions. Initially, a brief history of digital literature is presented, with emphasis on the first literary experiments with computational language that were carried out still in the 50s, under the mentorship of Max Bense in Germany. In addition, the paper brings forward two movements of digital literature arising after the 50s: thedigital poetry and its relation with avant-garde poetry movements; and the hypertext literature. Finally, the paper presents the results of some educational projects on teaching digital literature conducted in different European universities

  19. Challenging Regeneration to Transform Medicine.

    Science.gov (United States)

    Tsukamoto, Ann; Abbot, Stewart E; Kadyk, Lisa C; DeWitt, Natalie D; Schaffer, David V; Wertheim, Jason A; Whittlesey, Kevin J; Werner, Michael J

    2016-01-01

    The aging population in the U.S. and other developed countries has led to a large increase in the number of patients suffering from degenerative diseases. Transplantation surgery has been a successful therapeutic option for certain patients; however, the availability of suitable donor organs and tissues significantly limits the number of patients who can benefit from this approach. Regenerative medicine has witnessed numerous recent and spectacular advances, making the repair or replacement of dysfunctional organs and tissues an achievable goal. Public-private partnerships and government policies and incentives would further catalyze the development of universally available donor tissues, resulting in broad medical and economic benefits. This article describes a Regenerative Medicine Grand Challenge that the Alliance for Regenerative Medicine recently shared with the White House's Office of Science and Technology Policy in response to a White House call to action in scientific disciplines suggesting that the development of "universal donor tissues" should be designated as a Regenerative Medicine Grand Challenge. Such a designation would raise national awareness of the potential of regenerative medicine to address the unmet needs of many diseases and would stimulate the scientific partnerships and investments in technology needed to expedite this goal. Here we outline key policy changes and technological challenges that must be addressed to achieve the promise of a major breakthrough in the treatment of degenerative disease. A nationalized effort and commitment to develop universal donor tissues could realize this goal within 10 years and along the way result in significant innovation in manufacturing technologies. Regenerative therapies, in which dysfunctional or degenerating cells, tissues, or organs are repaired or replaced, have the potential to cure chronic degenerative diseases. Such treatments are limited by a shortage of donor organs and tissues and the need

  20. Efeitos da solução salina hipertônica a 7,5% em glicose a 5% nas concentrações séricas de sódio, cloreto e potássio de eqüinos com hipovolemia induzida Effects of 7,5% hypertonic saline in 5% glucose on serum levels of sodium, chloride and potassium in induced hypovolemic horses

    Directory of Open Access Journals (Sweden)

    A.I. Bordin

    2007-06-01

    Full Text Available Estudaram-se os efeitos de soluções salinas isotônica e hipertônica em eqüinos hipovolêmicos sobre as concentrações séricas de sódio, cloreto e potássio e freqüências cardíaca (FC e respiratória (FR. Quinze eqüinos machos com peso entre 390 e 475kg e idades entre quatro e 18 anos foram submetidos à retirada de sangue correspondente a 2% do peso corporal e distribuídos em três grupos de igual número: o grupo GSH recebeu solução hipertônica de NaCl a 7,5% em glicose a 5%; o GSI, solução isotônica de NaCl a 0,9%; e o GC não foi tratado. Os eletrólitos séricos foram avaliados antes (T0, após a retirada de sangue (T1 e após a infusão das soluções, entre 20 e 30 minutos (T2, entre 60 e 70 minutos (T3 e entre 120 e 130 minutos (T4. Após T0, houve elevação da FC e da FR, e as concentrações séricas de Na, Cl, K permaneceram inalteradas. Após a infusão, houve melhora das variáveis clínicas em GSI e GSH, em relação ao GC. Quanto a T3 e T4, os valores de Na em T2 do GSH foram maiores, e os de Cl e de K não se alteraram. As soluções hipertônica e isotônica são seguras na correção da hipovolemia induzida e não produzem alteração eletrolítica significativa.The effect of isotonic and hypertonic solutions on serum levels of sodium, chloride and potassium and cardiac (CR and respiratory rates (RR of hypovolemic horses were studied. Fifteen horses weighting from 390 to 475kg, aging from four to 18-years-old were submitted to bleeding of 2% of body weight and divided in three groups: 7.5% NaCl hypertonic saline in 5% glucose (GSH, 0.9% NaCl isotonic saline and control group (GC. Serum electrolytes were evaluated before (T0 and after bleeding (T1 and after the administration of the solutions between 20 and 30 minutes (T2, 60 and 70 minutes (T3 and 120 and 130 minutes (T4. After T0, CR and RR increased while serum sodium, chloride, potassium were not affected. After the treatment, the clinical variables

  1. Engineering ethics challenges and opportunities

    CERN Document Server

    Bowen, W Richard

    2014-01-01

    Engineering Ethics: Challenges and Opportunities aims to set a new agenda for the engineering profession by developing a key challenge: can the great technical innovation of engineering be matched by a corresponding innovation in the acceptance and expression of ethical responsibility?  Central features of this stimulating text include:   ·         An analysis of engineering as a technical and ethical practice providing great opportunities for promoting the wellbeing and agency of individuals and communities. ·         Elucidation of the ethical opportunities of engineering in three key areas:             - Engineering for Peace, emphasising practical amelioration of the root causes of    conflict rather than military solutions.             - Engineering for Health, focusing on close collaboration with healthcare professionals      for both the promotion and restoration of health.             - Engineering for Development, providing effective solution...

  2. Managing neurocysticercosis: challenges and solutions

    Science.gov (United States)

    Fogang, Yannick Fogoum; Savadogo, Abdoul Aziz; Camara, Massaman; Toffa, Dènahin Hinnoutondji; Basse, Anna; Sow, Adjaratou Djeynabou; Ndiaye, Mouhamadou Mansour

    2015-01-01

    Taenia solium neurocysticercosis (NCC) is a major cause of neurological morbidity in the world. Variability in the neuropathology and clinical presentation of NCC often make it difficult to diagnose and manage. Diagnosis of NCC can be challenging especially in endemic and resource-limited countries where laboratory and imaging techniques are often lacking. NCC management can also be challenging as current treatment options are limited and involve symptomatic agents, antiparasitic agents, or surgery. Although antiparasitic treatment probably reduces the number of active lesions and long-term seizure frequency, its efficacy is limited and strategies to improve treatment regimens are warranted. Treatment decisions should be individualized in relation to the type of NCC. Initial measures should focus on symptomatic management, with antiparasitic therapy only to be considered later on, when appropriate. Symptomatic treatment remains the cornerstone in NCC management which should not only focuses on epilepsy, but also on other manifestations that cause considerable burden (recurrent headaches, cognitive decline). Accurate patients’ categorization, better antiparasitic regimens, and definition of new clinical outcomes for trials on NCC could improve management quality and prognosis of NCC. Prevention strategies targeting tapeworm carriers and infected pigs are yielding good results in local models. If local elimination of transmission is confirmed and replicated, this will open the door to cysticercosis eradication efforts worldwide. PMID:26527895

  3. The challenges of amblyopia treatment.

    Science.gov (United States)

    Maconachie, Gail D E; Gottlob, Irene

    2015-12-01

    The treatment of amblyopia, particularly anisometropic (difference in refractive correction) and/or strabismic (turn of one eye) amblyopia has long been a challenge for many clinicians. Achieving optimum outcomes, where the amblyopic eye reaches a visual acuity similar to the fellow eye, is often impossible in many patients. Part of this challenge has resulted from a previous lack of scientific evidence for amblyopia treatment that was highlight by a systematic review by Snowdon et al. in 1998. Since this review, a number of publications have revealed new findings in the treatment of amblyopia. This includes the finding that less intensive occlusion treatments can be successful in treating amblyopia. A relationship between adherence to treatment and visual acuity has also been established and has been shown to be influenced by the use of intervention material. In addition, there is growing evidence of that a period of glasses wearing only can significantly improve visual acuity alone without any other modes of treatment. This review article reports findings since the Snowdon's report. Copyright © 2016 Chang Gung University. Published by Elsevier B.V. All rights reserved.

  4. The challenges of amblyopia treatment

    Directory of Open Access Journals (Sweden)

    Gail D.E. Maconachie

    2015-12-01

    Full Text Available The treatment of amblyopia, particularly anisometropic (difference in refractive correction and/or strabismic (turn of one eye amblyopia has long been a challenge for many clinicians. Achieving optimum outcomes, where the amblyopic eye reaches a visual acuity similar to the fellow eye, is often impossible in many patients. Part of this challenge has resulted from a previous lack of scientific evidence for amblyopia treatment that was highlight by a systematic review by Snowdon et al. in 1998. Since this review, a number of publications have revealed new findings in the treatment of amblyopia. This includes the finding that less intensive occlusion treatments can be successful in treating amblyopia. A relationship between adherence to treatment and visual acuity has also been established and has been shown to be influenced by the use of intervention material. In addition, there is growing evidence of that a period of glasses wearing only can significantly improve visual acuity alone without any other modes of treatment. This review article reports findings since the Snowdon's report.

  5. Space Shuttle Star Tracker Challenges

    Science.gov (United States)

    Herrera, Linda M.

    2010-01-01

    The space shuttle fleet of avionics was originally designed in the 1970's. Many of the subsystems have been upgraded and replaced, however some original hardware continues to fly. Not only fly, but has proven to be the best design available to perform its designated task. The shuttle star tracker system is currently flying as a mixture of old and new designs, each with a unique purpose to fill for the mission. Orbiter missions have tackled many varied missions in space over the years. As the orbiters began flying to the International Space Station (ISS), new challenges were discovered and overcome as new trusses and modules were added. For the star tracker subsystem, the growing ISS posed an unusual problem, bright light. With two star trackers on board, the 1970's vintage image dissector tube (IDT) star trackers track the ISS, while the new solid state design is used for dim star tracking. This presentation focuses on the challenges and solutions used to ensure star trackers can complete the shuttle missions successfully. Topics include KSC team and industry partner methods used to correct pressurized case failures and track system performance.

  6. Challenges in Double Beta Decay

    Directory of Open Access Journals (Sweden)

    Oliviero Cremonesi

    2014-01-01

    Full Text Available In the past ten years, neutrino oscillation experiments have provided the incontrovertible evidence that neutrinos mix and have finite masses. These results represent the strongest demonstration that the electroweak Standard Model is incomplete and that new Physics beyond it must exist. In this scenario, a unique role is played by the Neutrinoless Double Beta Decay searches which can probe lepton number conservation and investigate the Dirac/Majorana nature of the neutrinos and their absolute mass scale (hierarchy problem with unprecedented sensitivity. Today Neutrinoless Double Beta Decay faces a new era where large-scale experiments with a sensitivity approaching the so-called degenerate-hierarchy region are nearly ready to start and where the challenge for the next future is the construction of detectors characterized by a tonne-scale size and an incredibly low background. A number of new proposed projects took up this challenge. These are based either on large expansions of the present experiments or on new ideas to improve the technical performance and/or reduce the background contributions. In this paper, a review of the most relevant ongoing experiments is given. The most relevant parameters contributing to the experimental sensitivity are discussed and a critical comparison of the future projects is proposed.

  7. Multiphysics simulations: challenges and opportunities.

    Energy Technology Data Exchange (ETDEWEB)

    Keyes, D.; McInnes, L. C.; Woodward, C.; Gropp, W.; Myra, E.; Pernice, M. (Mathematics and Computer Science); (KAUST and Columbia Univ.); (Lawrence Livermore National Laboratory); (Univ. of Illinois at Urbana-Champaign); (Univ. of Mich.); (Idaho National Lab.)

    2012-11-29

    This report is an outcome of the workshop Multiphysics Simulations: Challenges and Opportunities, sponsored by the Institute of Computing in Science (ICiS). Additional information about the workshop, including relevant reading and presentations on multiphysics issues in applications, algorithms, and software, is available via https://sites.google.com/site/icismultiphysics2011/. We consider multiphysics applications from algorithmic and architectural perspectives, where 'algorithmic' includes both mathematical analysis and computational complexity and 'architectural' includes both software and hardware environments. Many diverse multiphysics applications can be reduced, en route to their computational simulation, to a common algebraic coupling paradigm. Mathematical analysis of multiphysics coupling in this form is not always practical for realistic applications, but model problems representative of applications discussed herein can provide insight. A variety of software frameworks for multiphysics applications have been constructed and refined within disciplinary communities and executed on leading-edge computer systems. We examine several of these, expose some commonalities among them, and attempt to extrapolate best practices to future systems. From our study, we summarize challenges and forecast opportunities. We also initiate a modest suite of test problems encompassing features present in many applications.

  8. Medical humanities' challenge to medicine.

    Science.gov (United States)

    Macnaughton, Jane

    2011-10-01

    Medicine is predicated on a view of human nature that is highly positivist and atomistic. This is apparent in the way in which its students are taught, clinical consultations are structured and medical evidence is generated. The field of medical humanities originally emerged as a challenge to this overly narrow view, but it has rarely progressed beyond tinkering around the edges of medical education. This is partly because its practitioners have largely been working from within a pervasive medical culture from which it is difficult to break free, and partly because the field has been insufficiently armed with scholarly thinking from the humanities. This is beginning to change and there is a sign that research in medical humanities has the potential to mount a persuasive challenge to medicine's ways of teaching, working and finding out. This article problematizes medicine's narrow viewpoint, grounding its critique in philosophical ideas from phenomenology and pragmatism. I will reflect upon the historical context within which medical humanities has emerged and briefly examine specific examples of how its interdisciplinary approach, involving humanities scholars with clinicians and medical scientists, may develop new research directions in medicine. © 2011 Blackwell Publishing Ltd.

  9. Medical humanities’ challenge to medicine

    Science.gov (United States)

    Macnaughton, Jane

    2015-01-01

    Medicine is predicated on a view of human nature that is highly positivist and atomistic. This is apparent in the way in which its students are taught, clinical consultations are structured and medical evidence is generated. The field of medical humanities originally emerged as a challenge to this overly narrow view, but it has rarely progressed beyond tinkering around the edges of medical education. This is partly because its practitioners have largely been working from within a pervasive medical culture from which it is difficult to break free, and partly because the field has been insufficiently armed with scholarly thinking from the humanities. This is beginning to change and there is a sign that research in medical humanities has the potential to mount a persuasive challenge to medicine’s ways of teaching, working and finding out. This article problematizes medicine’s narrow viewpoint, grounding its critique in philosophical ideas from phenomenology and pragmatism. I will reflect upon the historical context within which medical humanities has emerged and briefly examine specific examples of how its interdisciplinary approach, involving humanities scholars with clinicians and medical scientists, may develop new research directions in medicine. PMID:21851510

  10. Ageing world: Health care challenges

    Directory of Open Access Journals (Sweden)

    Vinay Mahishale

    2015-01-01

    Full Text Available The world population reached 7 billion in 2012, which is 6 billion more than in 1800. This remarkable population growth is the result of several factors like advances in the medical, technological and public health systems resulting in the control and treatment of communicable diseases, the control of pandemics, the end of large-scale wars, improvements in living conditions and the revolutions in the field of agriculture. Because of all these factors, there has been a considerable improvement in the life expectancy of human beings. There is also an alarming reduction in fertility rates. The combination of declining fertility rate and augmented life expectancies has led to a change in the demographics of the population with the strata of older individuals growing faster than the younger individuals. The aging of populations is poised to become the next global public health challenge. Advances in medicine and socioeconomic development have substantially reduced mortality and morbidity rates due to infectious conditions and, to some extent, non-communicable diseases. These demographic and epidemiological changes, coupled with rapid urbanization, modernization, globalization, and accompanying changes in risk factors and lifestyles, have increased the prominence of chronic non-infective conditions. Health systems need to find effective strategies to extend health care and to respond to the needs of older adults. This review highlights the pathophysiology of aging, biological and physiological changes, impact of aging on health, epidemiological transitions, multi-morbidity in elderly and challenges for health care system.

  11. Green ergonomics: challenges and opportunities.

    Science.gov (United States)

    Hanson, Margaret A

    2013-01-01

    Addressing the causes and consequences of environmental degradation presents significant challenges for humankind. This paper considers what ergonomics/human factors (E/HF) professionals can contribute to understanding and tackling some of the issues that arise through the movement towards a more environmentally sustainable economy. These issues are considered in relation to work in green industries (specifically, sustainable energy production, recycling and organic food production), and there is a need to ensure that these jobs are safe and healthy; the design of products and systems that are 'environmentally friendly' to facilitate their acceptability and use and how E/HF professionals can contribute to understanding and promoting behavioural change relating to environmental choices. The activities of some international organisations in this area are identified and the potential for E/HF involvement is considered. The implications for the E/HF profession are discussed. This paper considers how ergonomics/human factors professionals can contribute to the movement towards more sustainable and 'environmentally friendly' design and work. Potential challenges and opportunities are discussed in relation to jobs in green industries, products and systems and behaviour change.

  12. The coffee-time challenge

    CERN Multimedia

    CERN Bulletin

    2010-01-01

    The challenge to identify the LEP events displayed on coffee tables in Restaurant 1 (Bulletin 02-03/2010) sparked interest among readers who do not have the opportunity to see them . Table 1, Table 2, Table 3, Table 4, Table 5, Table 6, Table 7, Table 8, Table 9, Table 10, Table 11, Table 12 Table 13, Table 14, Table 15, Table 16       We have therefore decided to open the challenge to these readers by displaying the events on the web. We are also extending the deadline accordingly to 2 March. There are 16 events in total (in two areas), four from each of the four LEP experiments, and they include examples of different particle decays observed at LEP during its 11 years of operation. The list below indicates the decay channels represented. We are offering a prize of the ATLAS pop-up book, Voyage to the Heart of Matter, for the correct identification of all 16 events.  Entries should indicate the table number corresponding to each of the decays listed. There wi...

  13. Challenges in diagnosing mesenteric ischemia.

    Science.gov (United States)

    van den Heijkant, Teun C; Aerts, Bart A C; Teijink, Joep A; Buurman, Wim A; Luyer, Misha D P

    2013-03-07

    Early identification of acute mesenteric ischemia (AMI) is challenging. The wide variability in clinical presentation challenges providers to make an early accurate diagnosis. Despite major diagnostic and treatment advances over the past decades, mortality remains high. Arterial embolus and superior mesenteric artery thrombosis are common causes of AMI. Non-occlusive causes are less common, but vasculitis may be important, especially in younger people. Because of the unclear clinical presentation and non-specific laboratory findings, low clinical suspicion may lead to loss of valuable time. During this diagnostic delay, progression of ischemia to transmural bowel infarction with peritonitis and septicemia may further worsen patient outcomes. Several diagnostic modalities are used to assess possible AMI. Multi-detector row computed tomographic angiography is the current gold standard. Although computed tomographic angiography leads to an accurate diagnosis in many cases, early detection is a persistent problem. Because early diagnosis is vital to commence treatment, new diagnostic strategies are needed. A non-invasive simple biochemical test would be ideal to increase clinical suspicion of AMI and would improve patient selection for radiographic evaluation. Thus, AMI could be diagnosed earlier with follow-up computed tomographic angiography or high spatial magnetic resonance imaging. Experimental in vitro and in vivo studies show promise for alpha glutathione S transferase and intestinal fatty acid binding protein as markers for AMI. Future research must confirm the clinical utility of these biochemical markers in the diagnosis of mesenteric ischemia.

  14. Meeting the Challenges for Agriculture

    Directory of Open Access Journals (Sweden)

    Les Copeland

    2011-06-01

    Full Text Available Ensuring food security is an ongoing global challenge. Many forecasts point to a need to increase food production by at least 70% if we are to feed the world’s projected population of nine billion in 2050. Recent volatility in commodity prices and the general upward trend in the cost of food are indicators that global food systems are now driven by demand rather than supply. There are various reasons for this: greater demand for animal protein with economic growth in developing countries; the continuing increase in world population; competition between food and bioenergy crops for land and water; low inventories of world grain stocks; reduced investment in agricultural R&D; and unfavorable weather resulting in a succession of poor harvests around the world. Increasing production of grains, which are the foundation of the human food supply, will have to be achieved through higher crop yields without boosting inputs of land, water and energy. Meeting community expectations for environmental stewardship and sustainability, and adapting food production to increasingly variable climate, add greatly to the challenge.

  15. The sleepy teenager - diagnostic challenges.

    Science.gov (United States)

    Landtblom, Anne-Marie; Engström, Maria

    2014-01-01

    The sleepy teenager puts the doctor in a, often tricky, situation where it must be decided if we deal with normal physiology or if we should suspect pathological conditions. What medical investigations are proper to consider? What differential diagnoses should be considered in the first place? And what tools do we actually have? The symptoms and problems that usually are presented at the clinical visit can be both of medical and psychosocial character - and actually they are often a mixture of both. Subsequently, the challenge to investigate the sleepy teenager often includes the examination of a complex behavioral pattern. It is important to train and develop diagnostic skills and to realize that the physiological or pathological conditions that can cause the symptoms may have different explanations. Research in sleep disorders has shown different pathological mechanisms congruent with the variations in the clinical picture. There are probably also different patterns of involved neuronal circuits although common pathways may exist. The whole picture remains to be drawn in this interesting and challenging area.

  16. Antibiotic resistance: An ethical challenge.

    Science.gov (United States)

    Littmann, Jasper; Buyx, Alena; Cars, Otto

    2015-10-01

    In this paper, we argue that antibiotic resistance (ABR) raises a number of ethical problems that have not yet been sufficiently addressed. We outline four areas in which ethical issues that arise in relation to ABR are particularly pressing. First, the emergence of multidrug-resistant and extensively drug-resistant infections exacerbates traditional ethical challenges of infectious disease control, such as the restriction of individual liberty for the protection of the public's health. Second, ABR raises issues of global distributive justice, both with regard to the overuse and lack of access to antibiotics. Third, the use of antibiotics in veterinary medicine raises serious concerns for animal welfare and sustainable farming practices. Finally, the diminishing effectiveness of antibiotics leads to questions about intergenerational justice and our responsibility for the wellbeing of future generations. We suggest that current policy discussions should take ethical conflicts into account and engage openly with the challenges that we outline in this paper. Copyright © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  17. Gaudi Evolution for Future Challenges

    Science.gov (United States)

    Clemencic, M.; Hegner, B.; Leggett, C.

    2017-10-01

    The LHCb Software Framework Gaudi was initially designed and developed almost twenty years ago, when computing was very different from today. It has also been used by a variety of other experiments, including ATLAS, Daya Bay, GLAST, HARP, LZ, and MINERVA. Although it has been always actively developed all these years, stability and backward compatibility have been favoured, reducing the possibilities of adopting new techniques, like multithreaded processing. R&D efforts like GaudiHive have however shown its potential to cope with the new challenges. In view of the LHC second Long Shutdown approaching and to prepare for the computing challenges for the Upgrade of the collider and the detectors, now is a perfect moment to review the design of Gaudi and plan future developments of the project. To do this LHCb, ATLAS and the Future Circular Collider community joined efforts to bring Gaudi forward and prepare it for the upcoming needs of the experiments. We present here how Gaudi will evolve in the next years and the long term development plans.

  18. Managing voluntary turnover through challenging assignments

    NARCIS (Netherlands)

    Preenen, P.T.Y.; de Pater, I.E.; van Vianen, A.E.M.; Keijzer, L.

    2011-01-01

    This study examines employees’ challenging assignments as manageable means to reduce turnover intentions, job search behaviors, and voluntary turnover. Results indicate that challenging assignments are negatively related to turnover intentions and job search behaviors and that these relationships

  19. Managing voluntary turnover through challenging assignments

    NARCIS (Netherlands)

    Preenen, P.T.Y.; Pater, I.E. de; Vianen, A.E.M. van; Keijzer, L.

    2011-01-01

    This study examines employees' challenging assignments as manageable means to reduce turnover intentions, job search behaviors, and voluntary turnover. Results indicate that challenging assignments are negatively related to turnover intentions and job search behaviors and that these relationships

  20. Managing Challenges in a Multi Contractor Project

    Science.gov (United States)

    King, Ron

    2011-01-01

    The presentation provides a project description, describes the integrated product team, and review project challenges. The challenges include programmatic, technical, basic drop tests, heavy drop tests, C-17 envelope expansion, and Ares I-X.

  1. Statistical Challenges in Modeling Big Brain Signals

    KAUST Repository

    Yu, Zhaoxia

    2017-11-01

    Brain signal data are inherently big: massive in amount, complex in structure, and high in dimensions. These characteristics impose great challenges for statistical inference and learning. Here we review several key challenges, discuss possible solutions, and highlight future research directions.

  2. Statistical Challenges in Modeling Big Brain Signals

    OpenAIRE

    Yu, Zhaoxia; Pluta, Dustin; Shen, Tong; Chen, Chuansheng; Xue, Gui; Ombao, Hernando

    2017-01-01

    Brain signal data are inherently big: massive in amount, complex in structure, and high in dimensions. These characteristics impose great challenges for statistical inference and learning. Here we review several key challenges, discuss possible solutions, and highlight future research directions.

  3. EU employment challenges in the future

    DEFF Research Database (Denmark)

    Rimmer, Nina Roehr

    2010-01-01

    Comparison and discussion of the Danish and Spanish employment situation and challenges in the future......Comparison and discussion of the Danish and Spanish employment situation and challenges in the future...

  4. Sustainable Materials Management (SMM) Electronics Challenge Data

    Data.gov (United States)

    U.S. Environmental Protection Agency — On September 22, 2012, EPA launched the SMM Electronics Challenge. The Challenge encourages electronics manufacturers, brand owners and retailers to strive to send...

  5. Engineering: issues, challenges and opportunities for development

    CSIR Research Space (South Africa)

    Wall, K

    2010-10-01

    Full Text Available The critical roles of engineering in addressing the large-scale pressing challenges facing our societies worldwide are widely recognized. Such large-scale challenges include access to affordable health care; tackling the coupled issues of energy...

  6. Typhoid Fever: The Challenges of Medical Management

    African Journals Online (AJOL)

    Typhoid Fever: The Challenges of Medical Management. Dr J A Otegbayo. Gastrointeslinal/ Liver Unit, Department of Medicine,. University oflbaa'an/ University College Hospital, Ibadan, Nigeria. Keywords: Typhoid, medical management, challenges. INTRODUCTION. Salmonella enterica serotype typhi is the aetiological.

  7. Challenges in diagnosing tuberculosis in children

    DEFF Research Database (Denmark)

    Rahman, Nadia; Pedersen, Karin Kæreby; Nielsen, Vibeke Rosenfeldt

    2012-01-01

    Clinical investigations of childhood tuberculosis (TB) are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. We investigated the challenges in diagnosing TB in children in a low-incidence country.......Clinical investigations of childhood tuberculosis (TB) are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. We investigated the challenges in diagnosing TB in children in a low-incidence country....

  8. CAp 2017 challenge: Twitter Named Entity Recognition

    OpenAIRE

    Lopez, Cédric; Partalas, Ioannis; Balikas, Georgios; Derbas, Nadia; Martin, Amélie; Reutenauer, Coralie; Segond, Frédérique; Amini, Massih-Reza

    2017-01-01

    The paper describes the CAp 2017 challenge. The challenge concerns the problem of Named Entity Recognition (NER) for tweets written in French. We first present the data preparation steps we followed for constructing the dataset released in the framework of the challenge. We begin by demonstrating why NER for tweets is a challenging problem especially when the number of entities increases. We detail the annotation process and the necessary decisions we made. We provide statistics on the inter-...

  9. HCI challenges in Dance Education

    Directory of Open Access Journals (Sweden)

    K.El Raheb

    2016-08-01

    Full Text Available Dance learning is by nature multimodal, while dance practice presents a wide diversity across genres and contexts. Choreography and artistic contemporary dance performances have been using interactive technologies to support their creative process for several decades. Nevertheless the use of interactive technologies to support dance learning and education is still relatively immature and raises many challenges and interesting questions when it comes to choosing the appropriate human computer interaction methods. In this paper, we present the characteristics of dance teaching and learning in relation to interactive technology and we highlight the points/feedback that dance, as a field of mastering expressive movement, can bring to the design of whole-body interaction experiences.

  10. Multiphysics simulations: Challenges and opportunities

    KAUST Repository

    Keyes, David E.

    2013-02-01

    We consider multiphysics applications from algorithmic and architectural perspectives, where "algorithmic" includes both mathematical analysis and computational complexity, and "architectural" includes both software and hardware environments. Many diverse multiphysics applications can be reduced, en route to their computational simulation, to a common algebraic coupling paradigm. Mathematical analysis of multiphysics coupling in this form is not always practical for realistic applications, but model problems representative of applications discussed herein can provide insight. A variety of software frameworks for multiphysics applications have been constructed and refined within disciplinary communities and executed on leading-edge computer systems. We examine several of these, expose some commonalities among them, and attempt to extrapolate best practices to future systems. From our study, we summarize challenges and forecast opportunities. © The Author(s) 2012.

  11. Challenges for Better thesis supervision.

    Science.gov (United States)

    Ghadirian, Laleh; Sayarifard, Azadeh; Majdzadeh, Reza; Rajabi, Fatemeh; Yunesian, Masoud

    2014-01-01

    Conduction of thesis by the students is one of their major academic activities. Thesis quality and acquired experiences are highly dependent on the supervision. Our study is aimed at identifing the challenges in thesis supervision from both students and faculty members point of view. This study was conducted using individual in-depth interviews and Focus Group Discussions (FGD). The participants were 43 students and faculty members selected by purposive sampling. It was carried out in Tehran University of Medical Sciences in 2012. Data analysis was done concurrently with data gathering using content analysis method. Our data analysis resulted in 162 codes, 17 subcategories and 4 major categories, "supervisory knowledge and skills", "atmosphere", "bylaws and regulations relating to supervision" and "monitoring and evaluation". This study showed that more attention and planning in needed for modifying related rules and regulations, qualitative and quantitative improvement in mentorship training, research atmosphere improvement and effective monitoring and evaluation in supervisory area.

  12. Challenges in wind farm optimization

    DEFF Research Database (Denmark)

    Larsen, Gunner Chr.

    To achieve the optimal economic output from a wind farm over its lifetime, an optimal balance between capital costs, operation and maintenance costs, fatigue lifetime consumption of turbine components and power production is to be determined on a rational basis. This has implications both...... for the wind turbine modeling, where aeroelastic models are required, and for the wind farm flow field description, where in-stationary flow field modeling is needed to capture the complicated mixture of atmospheric boundary layer (ABL) flows and upstream emitted meandering wind turbine wakes, which together...... dictates the fatigue loading of the individual wind turbines. Within an optimization context, the basic challenge in describing the in-stationary wind farm flow field is computational speed. The Dynamic Wake Meandering (DWM) model includes the basic features of a CFD Large Eddy Simulation approach...

  13. CHALLENGES OF PERMANENT TEACHER TRAINING

    Directory of Open Access Journals (Sweden)

    María Manuela Valles-Ornelas

    2015-07-01

    Full Text Available The new challenges for teachers and managers require to assume permanent formation as a tool for responding effectively and efficiently to them, different perspective to strengthen from the initial teacher education programs. The research was done in a primary school in the state of Chihuahua. The method used was research action, the question was: How can we encourage the lifelong learning and training of the staff of this school, with the purpose to assist them in these processes to improve the service that the school provides to students. The school group is the center of the process, the cooperative and collaborative work accompanied by educational leadership and persuasive provide better results, and all accompanied by the professional selfinvitation.

  14. Challenges in uncomplicated acute appendicitis

    Directory of Open Access Journals (Sweden)

    Fernando Resende

    2016-03-01

    Full Text Available Acute appendicitis is one of the most common abdominal emergencies requiring surgery. It still represents, however, a challenging diagnosis. In order to facilitate this process, several scoring systems were developed, namely, the Alvarado score, acute inflammatory response and Raja Isteri Pengiran Anak Saleha Appendicitis scores, which are the most used in clinical practice. This clinical condition encompasses a wide spectrum of clinical presentations, from the uncomplicated form to the one with diffuse peritonitis. Treatment of uncomplicated acute appendicitis remains a matter of discussion. Although appendectomy has been regarded as the gold-standard, conservative management with antibiotics is gaining more and more acceptance. The approach to appendectomy constitutes another controversial issue, namely, its performance through an open or a laparoscopic approach, which seems to be establishing itself, in some centers, as the standard of care. With this paper, we intend to give some insight on the aforementioned topics, through a review of the available literature on uncomplicated appendicitis.

  15. The ITER project technological challenges

    CERN Document Server

    CERN. Geneva; Lister, Joseph; Marquina, Miguel A; Todesco, Ezio

    2005-01-01

    The first lecture reminds us of the ITER challenges, presents hard engineering problems, typically due to mechanical forces and thermal loads and identifies where the physics uncertainties play a significant role in the engineering requirements. The second lecture presents soft engineering problems of measuring the plasma parameters, feedback control of the plasma and handling the physics data flow and slow controls data flow from a large experiment like ITER. The last three lectures focus on superconductors for fusion. The third lecture reviews the design criteria and manufacturing methods for 6 milestone-conductors of large fusion devices (T-7, T-15, Tore Supra, LHD, W-7X, ITER). The evolution of the designer approach and the available technologies are critically discussed. The fourth lecture is devoted to the issue of performance prediction, from a superconducting wire to a large size conductor. The role of scaling laws, self-field, current distribution, voltage-current characteristic and transposition are...

  16. Challenging institutional logics in Gourmet

    DEFF Research Database (Denmark)

    Nickelsen, Niels Christian Mossfeldt; Scheuer, John Damm

    2015-01-01

    This paper focuses on the initial phase of an organizational transformation. More precisely the paper analyses the moment where an institutional entrepreneur produces ideas, which have the capacity to break with existing logics and thus produces the potential for change by challenging existing fi...... field logics. The empirical case is the gastronomic field in Denmark and in the Nordic countries - more specifically the paper discusses the cook and entrepreneur Claus Meyers ambitions to realize a food-political vision; The New Nordic Kitchen. The theoretical contribution of the paper......, Ferran Adria initiates field level change by focusing on technical development of haute cuisine through research and development and a systematic and almost scientific approach to gastronomic development. The study of the introduction of the NNK and Claus Meyer shows in contrast that an institutional...... entrepreneur may initiate field level institutional change by focusing on mobilizing important actors by introducing a new attractive institutional logic....

  17. ETHICAL CHALLENGES IN AESTHETIC DENTISTRY

    Directory of Open Access Journals (Sweden)

    Marius NEAGU

    2015-12-01

    Full Text Available Aesthetic dentistry is a branch of dentistry which aims primarily at improving patient’s physical appearance and, to a lesser extent, the functionality of teeth. This field raises particular ethical dilemmas and requires a careful evaluation of patient’s needs and wishes versus his/her clinical best interests. In this article, the authors discuss the main ethical challenges in the field of aesthetic dentistry in the light of the four “classical” principles of bioethics: autonomy, beneficence, non-maleficence and justice. The authors conclude that the principles of medical ethics should be at the very foundation of the field of aesthetic dentistry, for establishing a patient-physician relationship which could lead to optimum clinical outcomes, while respecting the wishes of the patient and promoting his/her best interests.

  18. Nuclear energy safety - new challenges

    Energy Technology Data Exchange (ETDEWEB)

    Rausch, Julio Cezar; Fonseca, Renato Alves da, E-mail: jrausch@cnen.gov.b, E-mail: rfonseca@cnen.gov.b [Comissao Nacional de Energia Nuclear (CNEN), Rio de Janeiro, RJ (Brazil)

    2011-07-01

    Fukushima accident in March this year, the second most serious nuclear accident in the world, put in evidence a discussion that in recent years with the advent of the 'nuclear renaissance' has been relegated in the background: what factors influence the use safe nuclear energy? Organizational precursor, latent errors, reduction in specific areas of competence and maintenance of nuclear programs is a scenario where the guarantee of a sustainable development of nuclear energy becomes a major challenge for society. A deep discussion of factors that influenced the major accidents despite the nuclear industry use of the so-called 'lessons learned' is needed. Major accidents continue to happen if a radical change is not implemented in the focus of safety culture. (author)

  19. Multiphysics Simulations: Challenges and Opportunities

    Energy Technology Data Exchange (ETDEWEB)

    Keyes, David; McInnes, Lois C.; Woodward, Carol; Gropp, William; Myra, Eric; Pernice, Michael; Bell, John; Brown, Jed; Clo, Alain; Connors, Jeffrey; Constantinescu, Emil; Estep, Don; Evans, Kate; Farhat, Charbel; Hakim, Ammar; Hammond, Glenn E.; Hansen, Glen; Hill, Judith; Isaac, Tobin; Jiao, Xiangmin; Jordan, Kirk; Kaushik, Dinesh; Kaxiras, Efthimios; Koniges, Alice; Lee, Ki Hwan; Lott, Aaron; Lu, Qiming; Magerlein, John; Maxwell, Reed M.; McCourt, Michael; Mehl, Miriam; Pawlowski, Roger; Randles, Amanda; Reynolds, Daniel; Riviere, Beatrice; Rude, Ulrich; Scheibe, Timothy D.; Shadid, John; Sheehan, Brendan; Shephard, Mark; Siegel, Andrew; Smith, Barry; Tang, Xianzhu; Wilson, Cian; Wohlmuth, Barbara

    2013-02-12

    We consider multiphysics applications from algorithmic and architectural perspectives, where ‘‘algorithmic’’ includes both mathematical analysis and computational complexity, and ‘‘architectural’’ includes both software and hardware environments. Many diverse multiphysics applications can be reduced, en route to their computational simulation, to a common algebraic coupling paradigm. Mathematical analysis of multiphysics coupling in this form is not always practical for realistic applications, but model problems representative of applications discussed herein can provide insight. A variety of software frameworks for multiphysics applications have been constructed and refined within disciplinary communities and executed on leading-edge computer systems. We examine several of these, expose some commonalities among them, and attempt to extrapolate best practices to future systems. From our study, we summarize challenges and forecast opportunities.

  20. The Shigella human challenge model.

    Science.gov (United States)

    Porter, C K; Thura, N; Ranallo, R T; Riddle, M S

    2013-02-01

    Shigella is an important bacterial cause of infectious diarrhoea globally. The Shigella human challenge model has been used since 1946 for a variety of objectives including understanding disease pathogenesis, human immune responses and allowing for an early assessment of vaccine efficacy. A systematic review of the literature regarding experimental shigellosis in human subjects was conducted. Summative estimates were calculated by strain and dose. While a total of 19 studies evaluating nine strains at doses ranging from 10 to 1 × 1010 colony-forming units were identified, most studies utilized the S. sonnei strain 53G and the S. flexneri strain 2457T. Inoculum solution and pre-inoculation buffering has varied over time although diarrhoea attack rates do not appear to increase above 75-80%, and dysentery rates remain fairly constant, highlighting the need for additional dose-ranging studies. Expansion of the model to include additional strains from different serotypes will elucidate serotype and strain-specific outcome variability.