WorldWideScience

Sample records for inappropriate identification storage

  1. Independent review of inappropriate identification, storage and treatment methods of polychlorinated biphenyl waste streams

    International Nuclear Information System (INIS)

    1997-07-01

    The purpose of the review was to evaluate incidents involving the inappropriate identification, storage, and treatment methods associated with polychlorinated biphenyl (PCB) waste streams originating from the V-tank system at the Test Area North (TAN). The team was instructed to perform a comprehensive review of Lockheed Martin Idaho Technologies Company (LMITCO's) compliance programs related to these incidents to assess the adequacy and effectiveness of the management program in all respects including: adequacy of the waste management program in meeting all LMITCO requirements and regulations; adequacy of policies, plans, and procedures in addressing and implementing all federal and state requirements and regulations; and compliance status of LMITCO, LMITCO contract team members, and LMITCO contract/team member subcontractor personnel with established PCB management policies, plans, and procedures. The V-Tanks are part of an intermediate waste disposal system and are located at the Technical Support Facility (TSF) at TAN at the Idaho National Engineering and Environmental Laboratory (INEEL). The IRT evaluated how a waste was characterized, managed, and information was documented; however, they did not take control of wastes or ensure followup was performed on all waste streams that may have been generated from the V-Tanks. The team has also subsequently learned that the Environmental Restoration (ER) program is revising the plans for the decontamination and decommissioning of the intermediate waste disposal system based on new information listed and PCB wastes. The team has not reviewed those in-process changes. The source of PCB in the V-Tank is suspected to be a spill of hydraulic fluid in 1968

  2. The Use of WISC-R Subtest Scatter in the Identification of Intellectually Gifted Handicapped Children: An Inappropriate Task?

    Science.gov (United States)

    Brown, Scott W.

    1984-01-01

    The paper discusses issues involved in the identification of gifted handicapped children, reviewing several research studies that attempted to define a specific configuration of Wechsler Intelligence Scale for Children-Revised subtest scores indicative of handicapped children possessing intellectual gifts. The author concludes that profiles and…

  3. Inappropriate Antidiuretic Hormone Secretion

    African Journals Online (AJOL)

    1974-06-08

    Jun 8, 1974 ... with Addison's disease, diarrhoea or salt-losing nephritis. (asymptomatic hyponatraemia).~ Schwartz et al.3 stud;ed two patients with anaplastic bronchus carcinoma and hyponatraemia in 1957, and they suggested that there was an inappropriate secretion of antidiuretic hormone (ADH). It is now well ...

  4. Identification of energy storage rate components. Theoretical and experimental approach

    International Nuclear Information System (INIS)

    Oliferuk, W; Maj, M

    2010-01-01

    The subject of the present paper is decomposition of energy storage rate into terms related to different mode of deformation. The stored energy is the change in internal energy due to plastic deformation after specimen unloading. Hence, this energy describes the state of the cold-worked material. Whereas, the ratio of the stored energy increment to the appropriate increment of plastic work is the measure of energy conversion process. This ratio is called the energy storage rate. Experimental results show that the energy storage rate is dependent on plastic strain. This dependence is influenced by different microscopic deformation mechanisms. It has been shown that the energy storage rate can be presented as a sum of particular components. Each of them is related to the separate internal microscopic mechanism. Two of the components are identified. One of them is the storage rate of statistically stored dislocation energy related to uniform deformation. Another one is connected with non-uniform deformation at the grain level. It is the storage rate of the long range stresses energy and geometrically necessary dislocation energy. The maximum of energy storage rate, that appeared at initial stage of plastic deformation is discussed in terms of internal micro-stresses.

  5. Identifying Non-Volatile Data Storage Areas: Unique Notebook Identification Information as Digital Evidence

    Directory of Open Access Journals (Sweden)

    Nikica Budimir

    2007-03-01

    Full Text Available The research reported in this paper introduces new techniques to aid in the identification of recovered notebook computers so they may be returned to the rightful owner. We identify non-volatile data storage areas as a means of facilitating the safe storing of computer identification information. A forensic proof of concept tool has been designed to test the feasibility of several storage locations identified within this work to hold the data needed to uniquely identify a computer. The tool was used to perform the creation and extraction of created information in order to allow the analysis of the non-volatile storage locations as valid storage areas capable of holding and preserving the data created within them.  While the format of the information used to identify the machine itself is important, this research only discusses the insertion, storage and ability to retain such information.

  6. Inappropriate prescribing in the elderly.

    LENUS (Irish Health Repository)

    Gallagher, P

    2012-02-03

    BACKGROUND AND OBJECTIVE: Drug therapy is necessary to treat acute illness, maintain current health and prevent further decline. However, optimizing drug therapy for older patients is challenging and sometimes, drug therapy can do more harm than good. Drug utilization review tools can highlight instances of potentially inappropriate prescribing to those involved in elderly pharmacotherapy, i.e. doctors, nurses and pharmacists. We aim to provide a review of the literature on potentially inappropriate prescribing in the elderly and also to review the explicit criteria that have been designed to detect potentially inappropriate prescribing in the elderly. METHODS: We performed an electronic search of the PUBMED database for articles published between 1991 and 2006 and a manual search through major journals for articles referenced in those located through PUBMED. Search terms were elderly, inappropriate prescribing, prescriptions, prevalence, Beers criteria, health outcomes and Europe. RESULTS AND DISCUSSION: Prescription of potentially inappropriate medications to older people is highly prevalent in the United States and Europe, ranging from 12% in community-dwelling elderly to 40% in nursing home residents. Inappropriate prescribing is associated with adverse drug events. Limited data exists on health outcomes from use of inappropriate medications. There are no prospective randomized controlled studies that test the tangible clinical benefit to patients of using drug utilization review tools. Existing drug utilization review tools have been designed on the basis of North American and Canadian drug formularies and may not be appropriate for use in European countries because of the differences in national drug formularies and prescribing attitudes. CONCLUSION: Given the high prevalence of inappropriate prescribing despite the widespread use of drug-utilization review tools, prospective randomized controlled trials are necessary to identify useful interventions. Drug

  7. Low temperature storage test phase 2 : identification of problem species

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-12-15

    The use of renewable fuels such as biodiesel, in motor vehicle fuels is expected to grow rapidly in North America as a result of governmental mandates. Biodiesel is a fuel component made from plant and animal feedstocks via a transesterification process. The fatty acid methyl esters (FAME) of biodiesel have cloud points that range from 5 degrees C to -15 degrees C. The poor low temperature performance of blends containing FAME must be understood in order to avoid operability issues. This paper presented the results of several testing programs conducted by researchers to investigate filter plugging in biodiesel fuels caused by high levels of saturated monoglycerides. The low temperature storage stability of 57 biodiesel fuels comprised of B5 and B20 made with canola methyl ester (CME), soybean methyl ester (SME), tallow methyl ester (TME) and palm methyl ester (PME) was investigated. Filter blocking tests were conducted to assess storage stability. Deposits from the blends were analyzed using gas chromatography and mass spectrometry (GC-MS) in order to identify the problem species. Results of the study confirmed the deleterious impact of saturated mono-glycerides in FAME on the low temperature operability of filters in fuel handling systems. 11 refs., 7 tabs., 5 figs. 9 appendices.

  8. Optimization of Experimental Model Parameter Identification for Energy Storage Systems

    Directory of Open Access Journals (Sweden)

    Rosario Morello

    2013-09-01

    Full Text Available The smart grid approach is envisioned to take advantage of all available modern technologies in transforming the current power system to provide benefits to all stakeholders in the fields of efficient energy utilisation and of wide integration of renewable sources. Energy storage systems could help to solve some issues that stem from renewable energy usage in terms of stabilizing the intermittent energy production, power quality and power peak mitigation. With the integration of energy storage systems into the smart grids, their accurate modeling becomes a necessity, in order to gain robust real-time control on the network, in terms of stability and energy supply forecasting. In this framework, this paper proposes a procedure to identify the values of the battery model parameters in order to best fit experimental data and integrate it, along with models of energy sources and electrical loads, in a complete framework which represents a real time smart grid management system. The proposed method is based on a hybrid optimisation technique, which makes combined use of a stochastic and a deterministic algorithm, with low computational burden and can therefore be repeated over time in order to account for parameter variations due to the battery’s age and usage.

  9. Waste encapsulation storage facility (WESF) standards/requirements identification document (S/RIDS)

    Energy Technology Data Exchange (ETDEWEB)

    Maddox, B.S., Westinghouse Hanford

    1996-07-29

    This Standards/Requirements Identification Document (S/RID) sets forth the Environmental Safety and Health (ES{ampersand}H) standards/requirements for the Waste Encapsulation Storage Facility (WESF). This S/RID is applicable to the appropriate life cycle phases of design, construction, operation, and preparation for decommissioning. These standards/requirements are adequate to ensure the protection of the health and safety of workers, the public, and the environment.

  10. Inappropriate prescribing in geriatric patients.

    LENUS (Irish Health Repository)

    Barry, Patrick J

    2012-02-03

    Inappropriate prescribing in older people is a common condition associated with significant morbidity, mortality, and financial costs. Medication use increases with age, and this, in conjunction with an increasing disease burden, is associated with adverse drug reactions. This review outlines why older people are more likely to develop adverse drug reactions and how common the problem is. The use of different tools to identify and measure the problem is reviewed. Common syndromes seen in older adults (eg, falling, cognitive impairment, sleep disturbance) are considered, and recent evidence in relation to medication use for these conditions is reviewed. Finally, we present a brief summary of significant developments in the recent literature for those caring for older people.

  11. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, Lisbeth; Thirstrup, Steffen; Kristensen, Mogens Brandt

    2007-01-01

    to the patients. Topical, dermatological medications and medications not used regularly were excluded. RESULTS: 212 patients were prescribed 1621 medications by their GPs at baseline. In all, 640 (39.5%) of the medications had one or more inappropriate ratings in the 10 criteria making up the MAI. The main part...... is good. However, the majority of patients used one or more medications with inappropriate ratings. The inappropriate prescribing relates to specific therapeutic groups and criteria, which should be targeted in future interventions....

  12. Inappropriate shocks in the subcutaneous ICD

    DEFF Research Database (Denmark)

    Olde Nordkamp, Louise R A; Brouwer, Tom F; Barr, Craig

    2015-01-01

    shocks have been reported. METHODS: We analyzed the incidence, predictors and management of inappropriate shocks in the EFFORTLESS S-ICD Registry, which collects S-ICD implantation information and follow-up data from clinical centers in Europe and New Zealand. RESULTS: During a follow-up of 21 ± 13...... xyphoid to V6) reduced the risk. Reprogramming or optimization of SVT treatment after the first clinical event of inappropriate shock was successful in preventing further inappropriate shocks for cardiac oversensing and SVT events. CONCLUSIONS: Inappropriate shocks, mainly due to cardiac oversensing...

  13. [Inappropriate test methods in allergy].

    Science.gov (United States)

    Kleine-Tebbe, J; Herold, D A

    2010-11-01

    Inappropriate test methods are increasingly utilized to diagnose allergy. They fall into two categories: I. Tests with obscure theoretical basis, missing validity and lacking reproducibility, such as bioresonance, electroacupuncture, applied kinesiology and the ALCAT-test. These methods lack both the technical and clinical validation needed to justify their use. II. Tests with real data, but misleading interpretation: Detection of IgG or IgG4-antibodies or lymphocyte proliferation tests to foods do not allow to separate healthy from diseased subjects, neither in case of food intolerance, allergy or other diagnoses. The absence of diagnostic specificity induces many false positive findings in healthy subjects. As a result unjustified diets might limit quality of life and lead to malnutrition. Proliferation of lymphocytes in response to foods can show elevated rates in patients with allergies. These values do not allow individual diagnosis of hypersensitivity due to their broad variation. Successful internet marketing, infiltration of academic programs and superficial reporting by the media promote the popularity of unqualified diagnostic tests; also in allergy. Therefore, critical observation and quick analysis of and clear comments to unqualified methods by the scientific medical societies are more important than ever.

  14. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 5

    International Nuclear Information System (INIS)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 5) outlines the standards and requirements for the Fire Protection and Packaging and Transportation sections

  15. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 4

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 4) presents the standards and requirements for the following sections: Radiation Protection and Operations.

  16. High level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 6

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 6) outlines the standards and requirements for the sections on: Environmental Restoration and Waste Management, Research and Development and Experimental Activities, and Nuclear Safety.

  17. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID)

    International Nuclear Information System (INIS)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 3) presents the standards and requirements for the following sections: Safeguards and Security, Engineering Design, and Maintenance

  18. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID)

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 3) presents the standards and requirements for the following sections: Safeguards and Security, Engineering Design, and Maintenance.

  19. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 4

    International Nuclear Information System (INIS)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 4) presents the standards and requirements for the following sections: Radiation Protection and Operations

  20. High level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 6

    International Nuclear Information System (INIS)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 6) outlines the standards and requirements for the sections on: Environmental Restoration and Waste Management, Research and Development and Experimental Activities, and Nuclear Safety

  1. Identification of new genes involved in human adipogenesis and fat storage.

    Directory of Open Access Journals (Sweden)

    Jörn Söhle

    Full Text Available Since the worldwide increase in obesity represents a growing challenge for health care systems, new approaches are needed to effectively treat obesity and its associated diseases. One prerequisite for advances in this field is the identification of genes involved in adipogenesis and/or lipid storage. To provide a systematic analysis of genes that regulate adipose tissue biology and to establish a target-oriented compound screening, we performed a high throughput siRNA screen with primary (preadipocytes, using a druggable siRNA library targeting 7,784 human genes. The primary screen showed that 459 genes affected adipogenesis and/or lipid accumulation after knock-down. Out of these hits, 333 could be validated in a secondary screen using independent siRNAs and 110 genes were further regulated on the gene expression level during adipogenesis. Assuming that these genes are involved in neutral lipid storage and/or adipocyte differentiation, we performed InCell-Western analysis for the most striking hits to distinguish between the two phenotypes. Beside well known regulators of adipogenesis and neutral lipid storage (i.e. PPARγ, RXR, Perilipin A the screening revealed a large number of genes which have not been previously described in the context of fatty tissue biology such as axonemal dyneins. Five out of ten axonemal dyneins were identified in our screen and quantitative RT-PCR-analysis revealed that these genes are expressed in preadipocytes and/or maturing adipocytes. Finally, to show that the genes identified in our screen are per se druggable we performed a proof of principle experiment using an antagonist for HTR2B. The results showed a very similar phenotype compared to knock-down experiments proofing the "druggability". Thus, we identified new adipogenesis-associated genes and those involved in neutral lipid storage. Moreover, by using a druggable siRNA library the screen data provides a very attractive starting point to identify anti

  2. Primary Sjogren's syndrome associated with inappropriate ...

    African Journals Online (AJOL)

    A patient in whom primary Sjogren's syndrome and inappropriate antiduretic hormone secretion were associated is reported. This is the first report of such an association. The possible pathophysiological mechanisms are discussed and vasculitis proposed as the underlying pathogenetic mechanism.

  3. Inappropriate prescribing: criteria, detection and prevention.

    LENUS (Irish Health Repository)

    O'Connor, Marie N

    2012-06-01

    Inappropriate prescribing is highly prevalent in older people and is a major healthcare concern because of its association with negative healthcare outcomes including adverse drug events, related morbidity and hospitalization. With changing population demographics resulting in increasing proportions of older people worldwide, improving the quality and safety of prescribing in older people poses a global challenge. To date a number of different strategies have been used to identify potentially inappropriate prescribing in older people. Over the last two decades, a number of criteria have been published to assist prescribers in detecting inappropriate prescribing, the majority of which have been explicit sets of criteria, though some are implicit. The majority of these prescribing indicators pertain to overprescribing and misprescribing, with only a minority focussing on the underprescribing of indicated medicines. Additional interventions to optimize prescribing in older people include comprehensive geriatric assessment, clinical pharmacist review, and education of prescribers as well as computerized prescribing with clinical decision support systems. In this review, we describe the inappropriate prescribing detection tools or criteria most frequently cited in the literature and examine their role in preventing inappropriate prescribing and other related healthcare outcomes. We also discuss other measures commonly used in the detection and prevention of inappropriate prescribing in older people and the evidence supporting their use and their application in everyday clinical practice.

  4. Development of the method of aggregation to determine the current storage area using computer vision and radiofrequency identification

    Science.gov (United States)

    Astafiev, A.; Orlov, A.; Privezencev, D.

    2018-01-01

    The article is devoted to the development of technology and software for the construction of positioning and control systems in industrial plants based on aggregation to determine the current storage area using computer vision and radiofrequency identification. It describes the developed of the project of hardware for industrial products positioning system in the territory of a plant on the basis of radio-frequency grid. It describes the development of the project of hardware for industrial products positioning system in the plant on the basis of computer vision methods. It describes the development of the method of aggregation to determine the current storage area using computer vision and radiofrequency identification. Experimental studies in laboratory and production conditions have been conducted and described in the article.

  5. Comparative analysis of storage conditions and homogenization methods for tick and flea species for identification by MALDI-TOF MS.

    Science.gov (United States)

    Nebbak, A; El Hamzaoui, B; Berenger, J-M; Bitam, I; Raoult, D; Almeras, L; Parola, P

    2017-12-01

    Ticks and fleas are vectors for numerous human and animal pathogens. Controlling them, which is important in combating such diseases, requires accurate identification, to distinguish between vector and non-vector species. Recently, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) was applied to the rapid identification of arthropods. The growth of this promising tool, however, requires guidelines to be established. To this end, standardization protocols were applied to species of Rhipicephalus sanguineus (Ixodida: Ixodidae) Latreille and Ctenocephalides felis felis (Siphonaptera: Pulicidae) Bouché, including the automation of sample homogenization using two homogenizer devices, and varied sample preservation modes for a period of 1-6 months. The MS spectra were then compared with those obtained from manual pestle grinding, the standard homogenization method. Both automated methods generated intense, reproducible MS spectra from fresh specimens. Frozen storage methods appeared to represent the best preservation mode, for up to 6 months, while storage in ethanol is also possible, with some caveats for tick specimens. Carnoy's buffer, however, was shown to be less compatible with MS analysis for the purpose of identifying ticks or fleas. These standard protocols for MALDI-TOF MS arthropod identification should be complemented by additional MS spectrum quality controls, to generalize their use in monitoring arthropods of medical interest. © 2017 The Royal Entomological Society.

  6. Prevalence and Predictors of Inappropriate Medications Prescribing ...

    African Journals Online (AJOL)

    Data analysis involved use of World Health Organization (WHO) prescribing indicators, Updated 2002 Beer's criteria and DRUG-REAX® system software package of MICROMEDEX (R) Healthcare Series to assess the prescribing pattern, identify potentially inappropriate medications and potential drug-drug interactions, ...

  7. Children's Context Inappropriate Anger and Salivary Cortisol

    Science.gov (United States)

    Locke, Robin L.; Davidson, Richard J.; Kalin, Ned H.; Goldsmith, H. Hill

    2009-01-01

    Some children show emotion that is not consistent with normative appraisal of the context and can therefore be defined as context inappropriate (CI). The authors used individual growth curve modeling and hierarchical multiple regression analyses to examine whether CI anger predicts differences in hypothalamic-pituitary-adrenal axis activity, as…

  8. Missed opportunities and inappropriately given vaccines reduce ...

    African Journals Online (AJOL)

    Objectives: To quantify missed opportunities for immunisation, document reasons for their occurrence and evaluate the extent of inappropriately given vaccine doses. Design: A cross sectional study of children under two years of age attending health facilities. Setting: Six health facilities predominantly serving the slums of ...

  9. Functional Analysis and Reduction of Inappropriate Spitting

    Science.gov (United States)

    Carter, Stacy L.; Wheeler, John J.

    2007-01-01

    Functional analysis was used to determine the possible function of inappropriate spitting behavior of an adult woman who had been diagnosed with profound mental retardation. Results of an initial descriptive assessment indicated a possible attention function and led to an attention-based intervention, which was deemed ineffective at reducing the…

  10. Hybrid Swarm Intelligence Optimization Approach for Optimal Data Storage Position Identification in Wireless Sensor Networks

    Science.gov (United States)

    Mohanasundaram, Ranganathan; Periasamy, Pappampalayam Sanmugam

    2015-01-01

    The current high profile debate with regard to data storage and its growth have become strategic task in the world of networking. It mainly depends on the sensor nodes called producers, base stations, and also the consumers (users and sensor nodes) to retrieve and use the data. The main concern dealt here is to find an optimal data storage position in wireless sensor networks. The works that have been carried out earlier did not utilize swarm intelligence based optimization approaches to find the optimal data storage positions. To achieve this goal, an efficient swam intelligence approach is used to choose suitable positions for a storage node. Thus, hybrid particle swarm optimization algorithm has been used to find the suitable positions for storage nodes while the total energy cost of data transmission is minimized. Clustering-based distributed data storage is utilized to solve clustering problem using fuzzy-C-means algorithm. This research work also considers the data rates and locations of multiple producers and consumers to find optimal data storage positions. The algorithm is implemented in a network simulator and the experimental results show that the proposed clustering and swarm intelligence based ODS strategy is more effective than the earlier approaches. PMID:25734182

  11. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 7

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    This Requirements Identification Document (RID) describes an Occupational Health and Safety Program as defined through the Relevant DOE Orders, regulations, industry codes/standards, industry guidance documents and, as appropriate, good industry practice. The definition of an Occupational Health and Safety Program as specified by this document is intended to address Defense Nuclear Facilities Safety Board Recommendations 90-2 and 91-1, which call for the strengthening of DOE complex activities through the identification and application of relevant standards which supplement or exceed requirements mandated by DOE Orders. This RID applies to the activities, personnel, structures, systems, components, and programs involved in maintaining the facility and executing the mission of the High-Level Waste Storage Tank Farms.

  12. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 7

    International Nuclear Information System (INIS)

    1994-04-01

    This Requirements Identification Document (RID) describes an Occupational Health and Safety Program as defined through the Relevant DOE Orders, regulations, industry codes/standards, industry guidance documents and, as appropriate, good industry practice. The definition of an Occupational Health and Safety Program as specified by this document is intended to address Defense Nuclear Facilities Safety Board Recommendations 90-2 and 91-1, which call for the strengthening of DOE complex activities through the identification and application of relevant standards which supplement or exceed requirements mandated by DOE Orders. This RID applies to the activities, personnel, structures, systems, components, and programs involved in maintaining the facility and executing the mission of the High-Level Waste Storage Tank Farms

  13. Identification and capacity quantification of CO{sub 2} storage sites

    Energy Technology Data Exchange (ETDEWEB)

    Bachu, Stefan [Energy Resources Conservation Board (Canada)

    2008-07-15

    In this presentation the subject of scales of evaluation of the sites of CO{sub 2} storage is commented. Also the criteria to identify river basins and sites appropriated for the CO{sub 2} storage are analyzed and finally the matter of the estimation of the capacities of CO{sub 2} storage is analyzed. [Spanish] En esta presentacion se comenta sobre las escalas de evaluacion de los sitios de almacenamiento de CO{sub 2}. Tambien se analizan los criterios para identificar cuencas y lugares adecuados para el almacenamiento de CO{sub 2} y por ultimo se habla sobre la estimacion de las capacidades de almacenamiento de CO{sub 2}.

  14. Preliminary study of acoustic emission (ae) noise signal identification for crude oil storage tank

    International Nuclear Information System (INIS)

    Nurul Ain Ahmad Latif; Shukri Mohd

    2008-08-01

    This preliminary work was carried out to simulate the Acoustic Emission (AE) signal contributed by pitting corrosion, and noise signal from environment during crude oil storage tanks monitoring. The purpose of this study is to prove that acoustic emission (AE) could be used to detect the formation of pitting corrosion in the crude oil storage tank and differentiated it from other sources of noise signal. In this study, the pitting corrosion was simulated by inducing low voltage and low amperage current onto the crude oil storage tank material (ASTM 516 G 70). Water drop, air blow and surface rubbing were applied onto the specimen surface. To simulate the noise signal produce by rain fall, wind blow and other sources of noise during AE crude oil storage tanks monitoring. AE sensor was attached onto the other surface of specimen to acquire all of these AE signals which then has send to AE DiSP 24 data acquisition system for signal conditioning. AE win software has been used to analyse this entire signal. It is found that, simulated pitting corrosion could be detected by AE system and differentiated from other sources of noise by using amplitude analysis. From the amplitude analysis is shown that 20-30 dB is the range amplitude for the blow test, 50-60 dB for surface rubbing test and over than 60 dB for water drop test. (Author)

  15. Second Generation CO2 FEP Analysis: CASSIF - Carbon Storage Scenario Identification Framework

    NARCIS (Netherlands)

    Yavuz, F.; Tilburg, T. van; David, P.; Spruijt, M.; Wildenborg, T.

    2009-01-01

    Carbon dioxide Capture and Storage (CCS) is a promising contribution to reduce further increase of atmospheric CO2 emissions from fossil fuels. The CCS concept anticipates that large amounts of CO2 are going to be stored in the subsurface for the long term. Since CCS is a rather new technology,

  16. Identification and characterisation of seed storage protein transcripts from Lupinus angustifolius

    Directory of Open Access Journals (Sweden)

    Goggin Danica E

    2011-04-01

    Full Text Available Abstract Background In legumes, seed storage proteins are important for the developing seedling and are an important source of protein for humans and animals. Lupinus angustifolius (L., also known as narrow-leaf lupin (NLL is a grain legume crop that is gaining recognition as a potential human health food as the grain is high in protein and dietary fibre, gluten-free and low in fat and starch. Results Genes encoding the seed storage proteins of NLL were characterised by sequencing cDNA clones derived from developing seeds. Four families of seed storage proteins were identified and comprised three unique α, seven β, two γ and four δ conglutins. This study added eleven new expressed storage protein genes for the species. A comparison of the deduced amino acid sequences of NLL conglutins with those available for the storage proteins of Lupinus albus (L., Pisum sativum (L., Medicago truncatula (L., Arachis hypogaea (L. and Glycine max (L. permitted the analysis of a phylogenetic relationships between proteins and demonstrated, in general, that the strongest conservation occurred within species. In the case of 7S globulin (β conglutins and 2S sulphur-rich albumin (δ conglutins, the analysis suggests that gene duplication occurred after legume speciation. This contrasted with 11S globulin (α conglutin and basic 7S (γ conglutin sequences where some of these sequences appear to have diverged prior to speciation. The most abundant NLL conglutin family was β (56%, followed by α (24%, δ (15% and γ (6% and the transcript levels of these genes increased 103 to 106 fold during seed development. We used the 16 NLL conglutin sequences identified here to determine that for individuals specifically allergic to lupin, all seven members of the β conglutin family were potential allergens. Conclusion This study has characterised 16 seed storage protein genes in NLL including 11 newly-identified members. It has helped lay the foundation for efforts to use

  17. Genotypic variability and mutant identification in cicer arietinum L. by seed storage protein profiling

    International Nuclear Information System (INIS)

    Hameed, A.; Iqbal, N.; Shah, T.M.

    2012-01-01

    A collection of thirty-four chickpea genotypes, including five kabuli and twenty-nine desi, were analyzed by SDS-PAGE for seed storage protein profiling. Total soluble seed proteins were resolved on 12% gels. A low level of variability was observed in desi as compared to kabuli genotypes. Dendrogram based on electrophoretic data clustered the thirty-four genotypes in four major groups. As large number of desi genotypes illustrated identical profiles, therefore could not be differentiated on the basis of seed storage protein profiles. One kabuli genotype ILC-195 found to be the most divergent showing 86% similarity with all other genotypes. ILC-195 can be distinguished from its mutant i.e., CM-2000 and other kabuli genotypes on the basis of three peptides i.e. SSP-66, SSP-43 and SSP-39. Some proteins peptides were found to be genotype specific like SSP-26 for ICCV-92311. Uniprot and NCBI protein databases were searched for already reported and characterized seed storage proteins in chickpea. Among 33 observed peptides, only six seed storages proteins from chickpea source were available in databases. On the basis of molecular weight similarity, identified peptides were SSP-64 as Serine/Threonine dehydratase, SSP-56 as Alpha-amylase inhibitor, SSP-50 as Provicillin, SSP-39 as seed imbibition protein, SSP-35 as Isoflavane reductase and SSP-19 as lipid transport protein. Highest variability was observed in vicillin subunits and beta subunits of legumins and its polymorphic forms. In conclusion, seed storage profiling can be economically used to asses the genetic variation, phylogenetic relationship and as markers to differentiate mutants from their parents. (author)

  18. Potentially inappropriate prescribing in older patients admitted to psychiatric hospital

    NARCIS (Netherlands)

    Rongen, S.; Kramers, C.; O'Mahony, D.; Feuth, T.; Olde Rikkert, M.G.M.; Ahmed, A.I.A.

    2016-01-01

    OBJECTIVES: The objectives of this study are to determine the prevalence of potentially inappropriate prescribing including potentially inappropriate medications (PIMs) and potential prescription omissions (PPOs) and to assess related risk factors in older people with major psychiatric illness.

  19. Seed Storage Proteins as a System for Teaching Protein Identification by Mass Spectrometry in Biochemistry Laboratory

    Science.gov (United States)

    Wilson, Karl A.; Tan-Wilson, Anna

    2013-01-01

    Mass spectrometry (MS) has become an important tool in studying biological systems. One application is the identification of proteins and peptides by the matching of peptide and peptide fragment masses to the sequences of proteins in protein sequence databases. Often prior protein separation of complex protein mixtures by 2D-PAGE is needed,…

  20. Corrosion in systems for storage and transportation of petroleum products and biofuels identification, monitoring and solutions

    CERN Document Server

    Groysman, Alec

    2014-01-01

    This book treats corrosion as it occurs and affects processes in real-world situations, and thus points the way to practical solutions. Topics described include the conditions in which petroleum products are corrosive to metals; corrosion mechanisms of petroleum products; which parts of storage tanks containing crude oils and petroleum products undergo corrosion; dependence of corrosion in tanks on type of petroleum products; aggressiveness of petroleum products to polymeric material; how microorganisms take part in corrosion of tanks and pipes containing petroleum products; which corrosion monitoring methods are used in systems for storage and transportation of petroleum products; what corrosion control measures should be chosen; how to choose coatings for inner and outer surfaces of tanks containing petroleum products; and how different additives (oxygenates, aromatic solvents) to petroleum products and biofuels influence metallic and polymeric materials. The book is of interest to corrosion engineers, mat...

  1. High level waste storage tanks 242-A evaporator standards/requirement identification document

    International Nuclear Information System (INIS)

    Biebesheimer, E.

    1996-01-01

    This document, the Standards/Requirements Identification Document (S/RIDS) for the subject facility, represents the necessary and sufficient requirements to provide an adequate level of protection of the worker, public health and safety, and the environment. It lists those source documents from which requirements were extracted, and those requirements documents considered, but from which no requirements where taken. Documents considered as source documents included State and Federal Regulations, DOE Orders, and DOE Standards

  2. Subtle pulmonary nodules: detection and identification with storage phosphor radiographs and conventional chest films

    International Nuclear Information System (INIS)

    Scheck, R.J.; Schaetzl, M.; Kandziora, C.; Panzer, M.; Rienmueller, R.

    1994-01-01

    To determine the value of digital storagephosphor radiography (SR) on the detection and identification of subtle lung nodules, postero-anterior (PA) and lateral (LAT) film-screen (FR) chest radiographs were compared with isodose SR images of 45 patients with metastatic malignancies. The SR postprocessing was done with a particular mode previously optimized for routine chest radiography. Pulmonary metastases were found in 34 patients and were proved or excluded by CT (n=28) or longterm follow-up FR (n=17). Chest images were divided into four regions for evaluation of image quality, number of lung nodules per region and marked pulmonary structures by receiver-operating characteristics (ROC) analysis (45 patients; 125 nodules; 2810 observations; five readers). Of the nodules selected for an ROC study 82% were 0.5-1.0 cm in diameter. Overall image quality was rated better for FR concerning lung fields (PA) and mediastinum/hilum (LAT). More lung-field nodules were detected on FR than on SR chest images. Use of FR was superior to SR in the general identification of nodules (PA chest), especially concerning intermediate and subtle abnormalities, whereas there was no significant difference for LAT chest images. Our results show, that currently FR still has advantages over SR in the detection and identification of subtle lung nodules in routine clinical radiography. (orig.)

  3. Identification of the Rice Wines with Different Marked Ages by Electronic Nose Coupled with Smartphone and Cloud Storage Platform.

    Science.gov (United States)

    Wei, Zhebo; Xiao, Xize; Wang, Jun; Wang, Hui

    2017-10-31

    In this study, a portable electronic nose (E-nose) was self-developed to identify rice wines with different marked ages-all the operations of the E-nose were controlled by a special Smartphone Application. The sensor array of the E-nose was comprised of 12 MOS sensors and the obtained response values were transmitted to the Smartphone thorough a wireless communication module. Then, Aliyun worked as a cloud storage platform for the storage of responses and identification models. The measurement of the E-nose was composed of the taste information obtained phase (TIOP) and the aftertaste information obtained phase (AIOP). The area feature data obtained from the TIOP and the feature data obtained from the TIOP-AIOP were applied to identify rice wines by using pattern recognition methods. Principal component analysis (PCA), locally linear embedding (LLE) and linear discriminant analysis (LDA) were applied for the classification of those wine samples. LDA based on the area feature data obtained from the TIOP-AIOP proved a powerful tool and showed the best classification results. Partial least-squares regression (PLSR) and support vector machine (SVM) were applied for the predictions of marked ages and SVM (R² = 0.9942) worked much better than PLSR.

  4. Identification of the Rice Wines with Different Marked Ages by Electronic Nose Coupled with Smartphone and Cloud Storage Platform

    Directory of Open Access Journals (Sweden)

    Zhebo Wei

    2017-10-01

    Full Text Available In this study, a portable electronic nose (E-nose was self-developed to identify rice wines with different marked ages—all the operations of the E-nose were controlled by a special Smartphone Application. The sensor array of the E-nose was comprised of 12 MOS sensors and the obtained response values were transmitted to the Smartphone thorough a wireless communication module. Then, Aliyun worked as a cloud storage platform for the storage of responses and identification models. The measurement of the E-nose was composed of the taste information obtained phase (TIOP and the aftertaste information obtained phase (AIOP. The area feature data obtained from the TIOP and the feature data obtained from the TIOP-AIOP were applied to identify rice wines by using pattern recognition methods. Principal component analysis (PCA, locally linear embedding (LLE and linear discriminant analysis (LDA were applied for the classification of those wine samples. LDA based on the area feature data obtained from the TIOP-AIOP proved a powerful tool and showed the best classification results. Partial least-squares regression (PLSR and support vector machine (SVM were applied for the predictions of marked ages and SVM (R2 = 0.9942 worked much better than PLSR.

  5. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 7. Revision 1

    International Nuclear Information System (INIS)

    Burt, D.L.

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 7) presents the standards and requirements for the following sections: Occupational Safety and Health, and Environmental Protection

  6. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 7. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Burt, D.L.

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Identification Document (S/RID) is contained in multiple volumes. This document (Volume 7) presents the standards and requirements for the following sections: Occupational Safety and Health, and Environmental Protection.

  7. Inappropriate colonoscopic surveillance of hyperplastic polyps.

    LENUS (Irish Health Repository)

    Keane, R A

    2011-11-15

    Colonoscopic surveillance of hyperplastic polyps alone is controversial and may be inappropriate. The colonoscopy surveillance register at a university teaching hospital was audited to determine the extent of such hyperplastic polyp surveillance. The surveillance endoscopy records were reviewed, those patients with hyperplastic polyps were identified, their clinical records were examined and contact was made with each patient. Of the 483 patients undergoing surveillance for colonic polyps 113 (23%) had hyperplastic polyps alone on last colonoscopy. 104 patients remained after exclusion of those under appropriate surveillance. 87 of the 104 patients (84%) were successfully contacted. 37 patients (8%) were under appropriate colonoscopic surveillance for a significant family history of colorectal carcinoma. 50 (10%) patients with hyperplastic polyps alone and no other clinical indication for colonoscopic surveillance were booked for follow up colonoscopy. This represents not only a budgetary but more importantly a clinical opportunity cost the removal of which could liberate valuable colonoscopy time for more appropriate indications.

  8. Screening and identification of sites for a proposed Monitored Retrievable Storage Facility

    International Nuclear Information System (INIS)

    1985-04-01

    The Director, Office of Civilian Radioactive Waste Management (OCRWM), Department of Energy (DOE), has identified the Clinch River Breeder Reactor site, the DOE Oak Ridge Reservation and the Tennessee Valley Authority (TVA) Hartsville Nuclear Plant site as preferred and alternative sites, respectively, for development of site-specific designs as part of the proposal for construction of an integrated Monitored Retrievable Storage (MRS) Facility. The proposal, developed pursuant to Section 141 (b) of the Nuclear Waste Policy Act of 1982, will be submitted to Congress in January 1986. The Director expects to propose to Congress that an MRS be constructed at the perferred site. His judgment could change based on information to be developed between now and January 1986. The decision to construct an MRS facility and final site selection are reserved by Congress for itself. The Director's judgment is based on the results of a rigorous site screening and evaluation process described in this report. The three sites were selected from among eleven sites evaluated in detail. The Clinch River Breeder Reactor site, owned by the Tennessee Valley Authority, was identified as the preferred site. It has several particularly desirable features including: (1) federal ownership and control by the Department of Energy; (2) particularly good transportation access (five miles to the nearest interstate highway and direct rail access); (3) site characteristics and current data base judged by the NRC in 1983 as sufficient for granting a limited work authorization for the now cancelled breeder reactor; and (4) a technical community in the vicinity of site which can provide experienced nuclear facility support functions. 6 figs., 2 tabs

  9. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 4

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    Radiation protection of personnel and the public is accomplished by establishing a well defined Radiation Protection Organization to ensure that appropriate controls on radioactive materials and radiation sources are implemented and documented. This Requirements Identification Document (RID) applies to the activities, personnel, structures, systems, components, and programs involved in executing the mission of the Tank Farms. The physical boundaries within which the requirements of this RID apply are the Single Shell Tank Farms, Double Shell Tank Farms, 242-A Evaporator-Crystallizer, 242-S, T Evaporators, Liquid Effluent Retention Facility (LERF), Purgewater Storage Facility (PWSF), and all interconnecting piping, valves, instrumentation, and controls. Also included is all piping, valves, instrumentation, and controls up to and including the most remote valve under Tank Farms control at any other Hanford Facility having an interconnection with Tank Farms. The boundary of the structures, systems, components, and programs to which this RID applies, is defined by those that are dedicated to and/or under the control of the Tank Farms Operations Department and are specifically implemented at the Tank Farms.

  10. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 4

    International Nuclear Information System (INIS)

    1994-04-01

    Radiation protection of personnel and the public is accomplished by establishing a well defined Radiation Protection Organization to ensure that appropriate controls on radioactive materials and radiation sources are implemented and documented. This Requirements Identification Document (RID) applies to the activities, personnel, structures, systems, components, and programs involved in executing the mission of the Tank Farms. The physical boundaries within which the requirements of this RID apply are the Single Shell Tank Farms, Double Shell Tank Farms, 242-A Evaporator-Crystallizer, 242-S, T Evaporators, Liquid Effluent Retention Facility (LERF), Purgewater Storage Facility (PWSF), and all interconnecting piping, valves, instrumentation, and controls. Also included is all piping, valves, instrumentation, and controls up to and including the most remote valve under Tank Farms control at any other Hanford Facility having an interconnection with Tank Farms. The boundary of the structures, systems, components, and programs to which this RID applies, is defined by those that are dedicated to and/or under the control of the Tank Farms Operations Department and are specifically implemented at the Tank Farms

  11. Setting Limits: The Child Who Uses Inappropriate Language

    Science.gov (United States)

    Greenberg, Polly

    2004-01-01

    This article discusses how to work with a child who uses inappropriate language. The words inappropriately used by young children are grouped into five categories: (1) names of body parts considered as private, and their nicknames; (2) bathroom words and body products; (3) religion-related words; (4) sexually charged words overheard when adults…

  12. Identification of the Area for Proper Integration of Three Current Storage Objects into One Complex Logistics Point

    Directory of Open Access Journals (Sweden)

    Li Chenguang

    2017-05-01

    Full Text Available The paper presents an option to identify the suitable area for locating the specific storage object in order to integrate three current storage objects into one complex logistics point. Initial chapters of the paper are focused on overview of theoretical terms related to the storage objects, their activities, services, parameters as well as their location and allocation. Other parts of this paper outline specific methods regarding the issue of storage objects location. Its main part describes individual steps for identifying the suitable storage object location in the certain area using the specific method.

  13. Identification and characterisation of factors affecting losses in the large-scale, non-ventilated bulk storage of wood chips and development of best storage practices

    Energy Technology Data Exchange (ETDEWEB)

    Garstang, J.; Weekes, A.; Poulter, R.; Bartlett, D.

    2002-07-01

    The report describes the findings of a study to determine the factors affecting the commercial storage of wood chips for biomass power generation in the UK. The UK's first such plant in North Yorkshire uses a mixture of forestry residues and short rotation coppice (SRC) willow, where problems with the stored fuel highlighted the need to determine best storage practices. Two wood chip piles were built (one with willow chip and the other with wood chips from board leaf forestry residues) and monitored (moisture, temperature, chemical composition, spore numbers and species, heat and air flows, bulk density, etc). Local weather data was also obtained. Recommendations for future storage practices are made.

  14. Inappropriate use of payment weights to risk adjust readmission rates.

    Science.gov (United States)

    Fuller, Richard L; Goldfield, Norbert I; Averill, Richard F; Hughes, John S

    2012-01-01

    In this article, the authors demonstrate that the use of relative weights, as incorporated within the National Quality Forum-endorsed PacifiCare readmission measure, is inappropriate for risk adjusting rates of hospital readmission.

  15. Characteristics of the overflow pollution of storm drains with inappropriate sewage entry.

    Science.gov (United States)

    Yin, Hailong; Lu, Yi; Xu, Zuxin; Li, Huaizheng; Schwegler, Benedict R

    2017-02-01

    To probe the overflow pollution of separate storm drains with inappropriate sewage entries, in terms of the relationship between sewage entries and the corresponding dry-weather and wet-weather overflow, the monitoring activities were conducted in a storm drainage system in the Shanghai downtown area (374 ha). In this study site, samples from inappropriately entered dry-weather sewage and the overflow due to storm pumps operation on dry-weather and wet-weather days were collected and then monitored for six water quality constituents. It was found that overflow concentrations of dry-weather period could be higher than those of wet-weather period; under wet-weather period, the overflow concentrations of storm drains were close to or even higher than that of combined sewers. Relatively strong first flush mostly occurred under heavy rain that satisfied critical rainfall amount, maximum rainfall intensity, and maximum pumping discharge, while almost no first flush effect or only weak first flush effect was found for the other rainfall events. Such phenomenon was attributed to lower in-line pipe storage as compared to that of the combined sewers, and serious sediment accumulation within the storm pipes due to sewage entry. For this kind of system, treating a continuous overflow rate is a better strategy than treating the maximum amount of early part of the overflow. Correcting the key inappropriate sewage entries into storm drains should also be focused.

  16. Discontinuing Inappropriate Medication Use in Nursing Home Residents : A Cluster Randomized Controlled Trial

    NARCIS (Netherlands)

    Wouters, Hans; Scheper, Jessica; Koning, Hedi; Brouwer, Chris; Twisk, Jos W.; van der Meer, Helene; Boersma, Froukje; Zuidema, Sytse U.; Taxis, Katja

    2017-01-01

    Background: Inappropriate prescribing is a well-known clinical problem in nursing home residents, but few interventions have focused on reducing inappropriate medication use. Objective: To examine successful discontinuation of inappropriate medication use and to improve prescribing in nursing home

  17. Discontinuing Inappropriate Medication in Nursing Home Residents (DIM-NHR study): A cluster randomized controlled trial

    NARCIS (Netherlands)

    Wouters, H.; Scheper, J.; Koning, H.; Brouwer, C.; Twisk, J.; Van Der Meer, H.; Boersma, F.; Zuidema, S.; Taxis, K.

    2017-01-01

    Introduction: Inappropriate prescribing is a prevalent problem in nursing home residents that is associated with cognitive and physical impairment. Few interventions have been shown to reduce inappropriate prescribing. The aim was therefore to examine successful discontinuation of inappropriate

  18. Identification of Components or Fractions Associated with Adverse Changes in Freeze Dried Chicken and Pork during Storage

    Science.gov (United States)

    1978-06-01

    objective of which was to further define and correlate the majur physical, chemical. and sensory changes which occur during the storage deterioration of pr...changes in freeze-dried chicken and pork during high temper-ao -r ature, oxygen-free storage. This effort was undertaken as part of the U.S. Air Force ...for 20 minutes, drained for five minutes, and weighed. Water was expressed from the rehydrated samples by a 500-kg Instron activated force acting

  19. Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients.

    LENUS (Irish Health Repository)

    Barry, P J

    2012-02-03

    BACKGROUND: In appropriate prescribing is a significant and persistent problem in elderly people, both in hospital and the community and has been described in several countries in Europe and also the USA. The problem of inappropriate prescribing has not been quantified in the Republic of Ireland. The most commonly used criteria for the identification of inappropriate prescribing are the Beers\\' criteria [both independent of diagnosis (ID) and considering diagnosis (CD) - 2003 version]. The Beers\\' criteria ID includes 48 different categories of either single medications or multiple medications of a similar class identified as inappropriate prescriptions and the Beers\\' criteria CD contains 19 different categories containing possible drug-disease interactions. A second tool, the improved prescribing in the elderly tool (IPET) has also been validated and used in hospital and community studies and has 14 categories of either explicitly contraindicated medications or possible drug-disease interactions. OBJECTIVES: The primary aim of the study is to measure the incidence of inappropriate prescribing among older community-dwelling individuals presenting to an acute hospital in the Republic of Ireland. A secondary aim of this study was also therefore to compare the efficacy of the above two tools in identifying inappropriate prescribing. METHODS: A prospective, consecutive observational cohort study was carried out over a 4-month period. The setting was an urban-based university hospital acute geriatric medicine assessment unit. Subjects in this study (n = 350) were consecutively screened on admission to hospital (mean age = 80.3 +\\/- 6.1 years) and all patients had both Beers\\' criteria ID and CD and IPET applied to their list of prescription drugs on admission, cross-referenced with their list of current active medical diagnosis. RESULTS: The results of the study identified a high rate of inappropriate prescribing among this population of community

  20. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Document (S/RID) is contained in multiple volumes. This document (Volume 2) presents the standards and requirements for the following sections: Quality Assurance, Training and Qualification, Emergency Planning and Preparedness, and Construction.

  1. High-level waste storage tank farms/242-A evaporator Standards/Requirements Identification Document (S/RID), Volume 2

    International Nuclear Information System (INIS)

    1994-04-01

    The High-Level Waste Storage Tank Farms/242-A Evaporator Standards/Requirements Document (S/RID) is contained in multiple volumes. This document (Volume 2) presents the standards and requirements for the following sections: Quality Assurance, Training and Qualification, Emergency Planning and Preparedness, and Construction

  2. Identification of a large intronic transposal insertion in SLC17A5 causing sialic acid storage disease

    NARCIS (Netherlands)

    Tarailo-Graovac, M. (Maja); Drögemöller, B.I. (Britt I.); Wasserman, W.W. (Wyeth W.); C.J. Ross; A.M.W. van den Ouweland (Ans); N. Darin (Niklas); Kollberg, G. (Gittan); Van Karnebeek, C.D.M. (Clara D. M.); Blomqvist, M. (Maria)

    2017-01-01

    textabstractBackground: Sialic acid storage diseases are neurodegenerative disorders characterized by accumulation of sialic acid in the lysosome. These disorders are caused by mutations in SLC17A5, the gene encoding sialin, a sialic acid transporter located in the lysosomal membrane. The most

  3. Identification of QTLs for seed germination capability after various storage periods using two RIL populations in rice.

    Science.gov (United States)

    Jiang, Wenzhu; Lee, Joohyun; Jin, Yong-Mei; Qiao, Yongli; Piao, Rihua; Jang, Sun Mi; Woo, Mi-Ok; Kwon, Soon-Wook; Liu, Xianhu; Pan, Hong-Yu; Du, Xinglin; Koh, Hee-Jong

    2011-04-01

    Seed germination capability of rice is one of the important traits in the production and storage of seeds. Quantitative trait loci (QTL) associated with seed germination capability in various storage periods was identified using two sets of recombinant inbred lines (RILs) which derived from crosses between Milyang 23 and Tong 88-7 (MT-RILs) and between Dasanbyeo and TR22183 (DT-RILs). A total of five and three main additive effects (QTLs) associated with seed germination capability were identified in MT-RILs and DT-RILs, respectively. Among them, six QTLs were identified repeatedly in various seed storage periods designated as qMT-SGC5.1, qMT-SGC7.2, and qMT-SGC9.1 on chromosomes 5, 7, and 9 in MT-RILs, and qDT-SGC2.1, qDT-SGC3.1, and qDT-SGC9.1 on chromosomes 2, 3, and 9 in DT-RILs, respectively. The QTL on chromosome 9 was identified in both RIL populations under all three storage periods, explaining up to 40% of the phenotypic variation. Eight and eighteen pairs additive × additive epistatic effect (epistatic QTL) were identified in MT-RILs and DT-RILs, respectively. In addition, several near isogenic lines (NILs) were developed to confirm six repeatable QTL effects using controlled deterioration test (CDT). The identified QTLs will be further studied to elucidate the mechanisms controlling seed germination capability, which have important implications for long-term seed storage.

  4. Inappropriate shocks in the subcutaneous ICD: Incidence, predictors and management

    NARCIS (Netherlands)

    Olde Nordkamp, Louise R. A.; Brouwer, Tom F.; Barr, Craig; Theuns, Dominic A. M. J.; Boersma, Lucas V. A.; Johansen, Jens B.; Neuzil, Petr; Wilde, Arthur A. M.; Carter, Nathan; Husby, Michael; Lambiase, Pier D.; Knops, Reinoud E.

    2015-01-01

    The entirely subcutaneous implantable cardioverter-defibrillator (S-ICD) eliminates the need for transvenous leads, and therefore has the potential to improve lead-longevity and reduce lead-related complications. The S-ICD has a morphology-based sensing algorithm of which inappropriate shocks have

  5. Polypharmacy and Potentially Inappropriate Medication in People with Dementia

    DEFF Research Database (Denmark)

    Kristensen, Rachel Underlien; Nørgaard, Ane; Jensen-Dahm, Christina

    2018-01-01

    BACKGROUND: Polypharmacy (use of ≥5 different medications) and potentially inappropriate medication (PIM) are well-known risk factors for numerous negative health outcomes. However, the use of polypharmacy and PIM in people with dementia is not well-described. OBJECTIVE: To examine the prevalence...

  6. [Inappropriate prescription in older patients: the STOPP/START criteria].

    LENUS (Irish Health Repository)

    Delgado Silveira, Eva

    2009-09-01

    Older people are a heterogeneous group of patients, often with multiple comorbidities for which they are prescribed a large number of drugs, leading to an increased risk of adverse drug reactions (ADR) and drug interactions. This risk is compounded by physiological age-related changes in physiology, changes in drug pharmacokinetics and pharmacodynamics, as well as by disease-related, functional and social issues. Inappropriate prescription of drugs is common in the older individuals and contributes to the increased risk of ADR. Several tools have been developed to detect potentially inappropriate prescription, the most frequently used in Spain being Beers\\' criteria. However, the value of these criteria is limited, especially as they were developed in a different healthcare system. In this article, the Spanish version of a new tool to detect potentially inappropriate prescriptions-STOPP (Screening Tool of Older Person\\'s Prescriptions) and START (Screening Tool to Alert doctors to Right i.e. appropriate, indicated Treatment) criteria-is presented. The creation, development, reliability, and use of these criteria in routine practice is described and discussed. These criteria have shown better sensitivity than Beers\\' criteria in detecting prescription problems and have the added value of being able to detect not only inappropriate prescription of some drugs, but also the omission of well indicated drugs. The STOPP\\/START criteria could become a useful screening tool to improve prescription in older people.

  7. Inappropriate Practices in Fitness Testing and Reporting: Alternative Strategies

    Science.gov (United States)

    Zhu, Xihe; Davis, Summer; Kirk, T. Nicole; Haegele, Justin A.; Knott, Stephen E.

    2018-01-01

    Fitness education is becoming an integrated component for many physical education programs. As such, many physical educators conduct health-related fitness tests on a regular basis. Some states even mandate certain types of physical fitness tests to be administered and reported annually or by semester. Yet, inappropriate practices have been…

  8. Inappropriate prescribing of proton pump inhibitors among patients ...

    African Journals Online (AJOL)

    By comparing the patients according to their site of care, 52.4 % (43/82) of ICU patients compared to 87.4 % (97/111) of medically hospitalized patient (non-ICU) were inappropriately receiving PPIs (p = 0.000). Conclusion: Adherence to the current practice guidelines for safe prescription of PPIs is poor. Thus, updating ...

  9. Risk factors for inappropriate blood requisition among hospitals in Tanzania.

    Science.gov (United States)

    Mauka, Wilhellmuss I; Mtuy, Tara B; Mahande, Michael J; Msuya, Sia E; Mboya, Innocent B; Juma, Abdul; Philemon, Rune N

    2018-01-01

    Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania. This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%). The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply.

  10. Identification of sixteen peptides reflecting heat and/or storage induced processes by profiling of commercial milk samples.

    Science.gov (United States)

    Ebner, Jennifer; Baum, Florian; Pischetsrieder, Monika

    2016-09-16

    Peptide profiles of different drinking milk samples were examined to study how the peptide fingerprint of milk reflects processing conditions. The combination of a simple and fast method for peptide extraction using stage tips and MALDI-TOF-MS enabled the fast and easy generation and relative quantification of peptide fingerprints for high-temperature short-time (HTST), extended shelf life (ESL) and ultra-high temperature (UHT) milk of the same dairies. The relative quantity of 16 peptides changed as a function of increasing heat load. Additional heating experiments showed that among those, the intensity of peptide β-casein 196-209 (m/z 1460.9Da) was most heavily influenced by heat treatment indicating a putative marker peptide for milk processing conditions. Storage experiments with HTST- and UHT milk revealed that the differences between different types of milk samples were not only caused by the heating process. Relevant was also the proteolytic activity of enzymes during storage, which were differently influenced by the heat treatment. These results indicate that the peptide profile may be suitable to monitor processing as well as storage conditions of milk. In the present study, peptide profiling of different types of milk was carried out by MALDI-TOF-MS after stage-tip extraction and relative quantification using an internal reference peptide. Although MALDI-TOF-MS covers only part of the peptidome, the method is easy and quick and is, therefore, suited for routine analysis to address several aspects of food authenticity. Using this method, 16 native peptides were detected in milk that could be modulated by different industrial processes. Subsequent heating and storage experiments with pasteurized and UHT milk confirmed that these peptides are indeed related to the production or storage conditions of the respective products. Furthermore, the heating experiments revealed one peptide, namely the β-casein-derived sequence β-casein 196-209, which underwent

  11. Inappropriate secretion of antidiuretic hormone treated with frusemide.

    Science.gov (United States)

    Decaux, G; Waterlot, Y; Genette, F; Hallemans, R; Demanet, J C

    1982-07-10

    Seven out of nine patients with chronic inappropriate secretion of antidiuretic hormone were successfully treated with 40 mg frusemide daily. One patient needed 80 mg, and the remaining patient achieved only a small increase in diuresis after 40 mg frusemide; this was probably related to his low creatinine clearance. In order to maintain a salt intake high enough to compensate for the loss of urine electrolytes 3 to 6 g sodium chloride was added as tablets to the sodium-free diet in six patients. Hypokalaemia occurred in five patients but was easily corrected with either supplements of potassium chloride or a potassium-sparing diuretic. These findings add further weight to evidence that Frusemide is a good alternative for the treatment of patients with inappropriate secretion of antidiuretic hormone who cannot tolerate water restriction.

  12. Inappropriate prescribing in the older population: need for new criteria.

    LENUS (Irish Health Repository)

    O'Mahony, Denis

    2012-02-03

    Inappropriate prescribing (IP) is a common and serious global healthcare problem in elderly people, leading to increased risk of adverse drug reactions (ADRs), polypharmacy being the main risk factor for both IP and ADRs. IP in older people is highly prevalent but preventable; hence screening tools for IP have been devised, principally Beers\\' Criteria and the Inappropriate Prescribing in the Elderly Tool (IPET). Although Beers\\' Criteria have become the most widely cited IP criteria in the literature, nevertheless, they have serious deficiencies, including several drugs that are rarely prescribed nowadays, a lack of structure in the presentation of the criteria and omission of several important and common IP instances. New, more up-to-date, systems-based and easily applicable criteria are needed that can be applied in the routine clinical setting.

  13. The syndrome of inappropriate antidiuretic hormone: prevalence, causes and consequences.

    LENUS (Irish Health Repository)

    Hannon, M J

    2010-06-01

    Hyponatraemia is the commonest electrolyte abnormality found in hospital inpatients, and is associated with a greatly increased morbidity and mortality. The syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent cause of hyponatraemia in hospital inpatients. SIADH is the clinical and biochemical manifestation of a wide range of disease processes, and every case warrants investigation of the underlying cause. In this review, we will examine the prevalence, pathophysiology, clinical characteristics and clinical consequences of hyponatraemia due to SIADH.

  14. Clinical hyperthyroidism due to non-neoplastic inappropriate thyrotrophin secretion.

    OpenAIRE

    Chan, A. W.; MacFarlane, I. A.; van Heyningen, C.; Foy, P. M.

    1990-01-01

    We report a case of hyperthyroidism due to inappropriate thyrotrophin (TSH) secretion in a patient with selective pituitary resistance to thyroid hormone action. Symptoms of hyperthyroidism in patients with this disorder are usually mild, implying some peripheral tissue resistance to the metabolic effects of thyroid hormone. Our patient had unusually severe symptoms, including marked weight loss and cardiac arrythmias which required carbimazole and beta-blocker therapy for control. Somatostat...

  15. Detecting Inappropriate Access to Electronic Health Records Using Collaborative Filtering.

    Science.gov (United States)

    Menon, Aditya Krishna; Jiang, Xiaoqian; Kim, Jihoon; Vaidya, Jaideep; Ohno-Machado, Lucila

    2014-04-01

    Many healthcare facilities enforce security on their electronic health records (EHRs) through a corrective mechanism: some staff nominally have almost unrestricted access to the records, but there is a strict ex post facto audit process for inappropriate accesses, i.e., accesses that violate the facility's security and privacy policies. This process is inefficient, as each suspicious access has to be reviewed by a security expert, and is purely retrospective, as it occurs after damage may have been incurred. This motivates automated approaches based on machine learning using historical data. Previous attempts at such a system have successfully applied supervised learning models to this end, such as SVMs and logistic regression. While providing benefits over manual auditing, these approaches ignore the identity of the users and patients involved in a record access. Therefore, they cannot exploit the fact that a patient whose record was previously involved in a violation has an increased risk of being involved in a future violation. Motivated by this, in this paper, we propose a collaborative filtering inspired approach to predicting inappropriate accesses. Our solution integrates both explicit and latent features for staff and patients, the latter acting as a personalized "finger-print" based on historical access patterns. The proposed method, when applied to real EHR access data from two tertiary hospitals and a file-access dataset from Amazon, shows not only significantly improved performance compared to existing methods, but also provides insights as to what indicates an inappropriate access.

  16. Identification of the Most Effective Point of Connection for Battery Energy Storage Systems Focusing on Power System Frequency Response Improvement

    Directory of Open Access Journals (Sweden)

    Thiago Pieroni

    2018-03-01

    Full Text Available With the massive penetration of intermittent generation (wind and solar, the reduction of Electrical Power Systems’ (EPSs inertial frequency response represents a new challenge. One alternative to deal with this scenario may be the application of a Battery Energy Storage System (BESS. However, the main constraint for the massive deployment of BESSs is the high acquisition cost of these storage systems which in some situations, can preclude their use in transmission systems. The main goal of this paper is to propose a systematic procedure to include BESSs in power system aiming to improve the power system frequency response using full linear models and geometric measures. In this work, a generic battery model is developed in a two-area test system with assumed high wind penetration and full conventional generators models. The full power system is linearized, and the geometric measures of controllability associated with of the frequency regulation mode are estimated. Then, these results are used to identify the most effective point of connection for a BESS aiming at the improvement of the power system frequency response. Nonlinear time-domain simulations are carried out to evaluate and validate the results.

  17. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 1

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The purpose of this Requirements Identification Document (RID) section is to identify, in one location, all of the facility specific requirements and good industry practices which are necessary or important to establish an effective Issues Management Program for the Tank Farm Facility. The Management Systems Functional Area includes the site management commitment to environmental safety and health (ES&H) policies and controls, to compliance management, to development and management of policy and procedures, to occurrence reporting and corrective actions, resource and issue management, and to the self-assessment process.

  18. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 1

    International Nuclear Information System (INIS)

    1994-04-01

    The purpose of this Requirements Identification Document (RID) section is to identify, in one location, all of the facility specific requirements and good industry practices which are necessary or important to establish an effective Issues Management Program for the Tank Farm Facility. The Management Systems Functional Area includes the site management commitment to environmental safety and health (ES ampersand H) policies and controls, to compliance management, to development and management of policy and procedures, to occurrence reporting and corrective actions, resource and issue management, and to the self-assessment process

  19. Low disease prevalence and inappropriate implantable cardioverter defibrillator shock rate in Brugada syndrome

    DEFF Research Database (Denmark)

    Holst, Anders Gaarsdal; Jensen, Henrik Kjærulf; Eschen, Ole

    2012-01-01

    AimsBrugada syndrome (BrS) is an inherited channelopathy that predisposes to malignant ventricular arrhythmias and thereby syncope and sudden cardiac death. Prior studies characterizing BrS patients have used highly selected referral populations from tertiary centres and prevalence estimates have...... been carried out using electrocardiogram (ECG) surveys only. We aimed to identify and characterize all diagnosed BrS patients in Denmark (population 5.4 million).Methods and resultsBrugada syndrome patients were identified using several modalities including identification in all Danish tertiary......%) experienced inappropriate shocks during a median follow-up of 47 months. No patient died or experienced aborted sudden cardiac death during follow-up.ConclusionsWe report the first nationwide study of BrS patients. We found a low incidence of diagnosed definite BrS compared with estimates from ECG surveys...

  20. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 6

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The scope of the Environmental Restoration and Waste Management (EM) Functional Area includes the programmatic controls associated with the management and operation of the Hanford Tank Farm Facility. The driving management organization implementing the programmatic controls is the Tank Farms Waste Management (WM)organization whose responsibilities are to ensure that performance objectives are established; and that measurable criteria for attaining objectives are defined and reflected in programs, policies and procedures. Objectives for the WM Program include waste minimization, establishment of effective waste segregation methods, waste treatment technology development, radioactive (low-level, high-level) hazardous and mixed waste transfer, treatment, and storage, applicability of a corrective action program, and management and applicability of a decontamination and decommissioning (D&D) program in future years.

  1. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 6

    International Nuclear Information System (INIS)

    1994-04-01

    The scope of the Environmental Restoration and Waste Management (EM) Functional Area includes the programmatic controls associated with the management and operation of the Hanford Tank Farm Facility. The driving management organization implementing the programmatic controls is the Tank Farms Waste Management (WM)organization whose responsibilities are to ensure that performance objectives are established; and that measurable criteria for attaining objectives are defined and reflected in programs, policies and procedures. Objectives for the WM Program include waste minimization, establishment of effective waste segregation methods, waste treatment technology development, radioactive (low-level, high-level) hazardous and mixed waste transfer, treatment, and storage, applicability of a corrective action program, and management and applicability of a decontamination and decommissioning (D ampersand D) program in future years

  2. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 3

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The Safeguards and Security (S&S) Functional Area address the programmatic and technical requirements, controls, and standards which assure compliance with applicable S&S laws and regulations. Numerous S&S responsibilities are performed on behalf of the Tank Farm Facility by site level organizations. Certain other responsibilities are shared, and the remainder are the sole responsibility of the Tank Farm Facility. This Requirements Identification Document describes a complete functional Safeguards and Security Program that is presumed to be the responsibility of the Tank Farm Facility. The following list identifies the programmatic elements in the S&S Functional Area: Program Management, Protection Program Scope and Evaluation, Personnel Security, Physical Security Systems, Protection Program Operations, Material Control and Accountability, Information Security, and Key Program Interfaces.

  3. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 3

    International Nuclear Information System (INIS)

    1994-04-01

    The Safeguards and Security (S ampersand S) Functional Area address the programmatic and technical requirements, controls, and standards which assure compliance with applicable S ampersand S laws and regulations. Numerous S ampersand S responsibilities are performed on behalf of the Tank Farm Facility by site level organizations. Certain other responsibilities are shared, and the remainder are the sole responsibility of the Tank Farm Facility. This Requirements Identification Document describes a complete functional Safeguards and Security Program that is presumed to be the responsibility of the Tank Farm Facility. The following list identifies the programmatic elements in the S ampersand S Functional Area: Program Management, Protection Program Scope and Evaluation, Personnel Security, Physical Security Systems, Protection Program Operations, Material Control and Accountability, Information Security, and Key Program Interfaces

  4. Energy storage

    International Nuclear Information System (INIS)

    Anon.

    1992-01-01

    This chapter discusses the role that energy storage may have on the energy future of the US. The topics discussed in the chapter include historical aspects of energy storage, thermal energy storage including sensible heat storage, latent heat storage, thermochemical heat storage, and seasonal heat storage, electricity storage including batteries, pumped hydroelectric storage, compressed air energy storage, and superconducting magnetic energy storage, and production and combustion of hydrogen as an energy storage option

  5. Potentially inappropriate prescribing to older patients in primary care in the Netherlands: a retrospective longitudinal study

    NARCIS (Netherlands)

    Bruin-Huisman, Linette; Abu-Hanna, Ameen; van Weert, Henk C. P. M.; Beers, Erna

    2017-01-01

    potentially inappropriate prescribing (PIP) is associated with adverse health effects in older patients. PIP comprises prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). to estimate the prevalence of PIMs and PPOs among older patients in primary

  6. Identification of salt-alloy combinations for thermal energy storage applications in advanced solar dynamic power systems

    Science.gov (United States)

    Whittenberger, J. D.; Misra, A. K.

    1987-01-01

    Thermodynamic calculations based on the available data for flouride salt systems reveal that a number of congruently melting compositions and eutectics exist which have the potential to meet the lightweight, high energy storage requirements imposed for advanced solar dynamic systems operating between about 1000 and 1400 K. Compatibility studies to determine suitable containment alloys to be used with NaF-22CaF2-13MgF2, NaF-32CaF2, and NaF-23MgF2 have been conducted at the eutectic temperature + 25 K for each system. For these three NaF-based eutectics, none of the common, commercially available high temperature alloys appear to offer adequate corrosion resistance for a long lifetime; however mild steel, pure nickel and Nb-1Zr could prove useful. These latter materials suggest the possibility that a strong, corrosion resistant, nonrefractory, elevated temperature alloy based on the Ni-Ni3Nb system could be developed.

  7. Grain Handling and Storage.

    Science.gov (United States)

    Harris, Troy G.; Minor, John

    This text for a secondary- or postecondary-level course in grain handling and storage contains ten chapters. Chapter titles are (1) Introduction to Grain Handling and Storage, (2) Elevator Safety, (3) Grain Grading and Seed Identification, (4) Moisture Control, (5) Insect and Rodent Control, (6) Grain Inventory Control, (7) Elevator Maintenance,…

  8. Diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone

    DEFF Research Database (Denmark)

    Holm, Ellen Astrid; Bie, Peter; Ottesen, Michael

    2009-01-01

    BACKGROUND: Hyponatremia is a frequent condition in elderly patients. In diagnostic workup, a 24-hour urine sample is used to measure urinary osmolality and urinary sodium concentration necessary to confirm the diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH...... natriuretic peptides, renin, and aldosterone were measured in the supine and upright positions of patients and compared with nine healthy age-matched control patients. RESULTS: The patients had low plasma osmolality (median 266 mOsm/kg) and measurable levels of arginine vasopressin (median 1.8 pg/mL). Values...

  9. Tariffs, Quotas, and the Corrupt Purchasing of Inappropriate Technology

    OpenAIRE

    Neil Campbell

    2005-01-01

    This paper develops a simple model where a manager of a firm in a Less-Developed Country (LDC) has the choice of whether or not to purchase an inappropriate technology in return for a bribe (kick-back) from the supplier of the technology. Provided that the manager achieves some minimum level of profit, the manager has a positive probability of not getting caught taking the bribe. The actual size of the bribe is determined by Nash axiomatic bargaining between the manager and the supplier. An i...

  10. Cost analysis of inappropriate treatments for suspected dermatomycoses

    Directory of Open Access Journals (Sweden)

    Emanuela Fiammenghi

    2015-06-01

    Full Text Available Superficial mycoses are estimated to affect more than 20-25% of the world’s population with a consistent increase over the years. Most patients referred to our clinic for suspected dermatomycoses have already been treated with pharmacotherapy, without a previous mycological examination and many show changes in the clinical manifestations. Indeed, some medications, such as steroids, antiviral, antibiotics and antihistamines are not able to erase a fungal infection, but also they can cause atypical clinical manifestations. The consequences of inappropriate treatment include delayed diagnosis, prolonged healing time, and additional costs. The aims of this study were (1 to evaluate the incidence of increased costs attributable to inappropriate therapy sustained by the National Health Service and patients and (2 to highlight the importance of mycological evaluation before starting treatment, in order to improve diagnostic accuracy. An observational retrospective and prospective study was performed from September 2013 to February 2014, in 765 patients referred to our center (University Hospital “ Federico II” in Naples, Italy, for suspected mycological infection. The following treatments (alone or in combination were defined as inappropriate: (1 cortisone in a patient with at least one positive site; (2 antifungals in (a patients with all negative sites or (b ineffective antifungal treatment (in terms of drug chosen, dose or duration in those with all positive sites; or (3 antibiotics; (4 antivirals or (5 antihistamines, in patients with ≥ 1 positive site. Five hundred and fifty patients were using medications before the assessment visit. The total amount of avoidable costs related to inappropriate previous treatments was € 121,417, representing 74% of the total treatment costs. 253/550 patients received drugs also after the visit. For these patients, the cost of treatment prescribed after mycological testing was € 42,952, with a decrease

  11. Inappropriate mode switching clarified by using a chest radiograph

    Directory of Open Access Journals (Sweden)

    Brian Marino, DO

    2015-08-01

    Full Text Available An 80-year-old woman with a history of paroxysmal atrial fibrillation and atrioventricular node disease status post-dual chamber pacemaker placement was noted to have abnormal pacing episodes during a percutaneous coronary intervention. Pacemaker interrogation revealed a high number of short duration mode switching episodes. Representative electrograms demonstrated high frequency nonphysiologic recordings predominantly in the atrial lead. Intrinsic pacemaker malfunction was excluded. A chest radiograph showed excess atrial and ventricular lead slack in the right ventricular inflow. It was suspected that lead–lead interaction resulted in artifacts and oversensing, causing frequent short episodes of inappropriate mode switching.

  12. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 2

    Energy Technology Data Exchange (ETDEWEB)

    1994-04-01

    The Quality Assurance Functional Area Requirements Identification Document (RID), addresses the programmatic requirements that ensure risks and environmental impacts are minimized, ensure safety, reliability, and performance are maximized through the application of effective management systems commensurate with the risks posed by the Tank Farm Facility and its operation. This RID incorporates guidance intended to provide Tank Farms management with the necessary requirements information to develop, upgrade, or assess the effectiveness of a Quality Assurance Program in the performance of organizational and functional activities. Quality Assurance is defined as all those planned and systematic actions necessary to provide adequate confidence that a facility, structure, system, or component will perform satisfactorily and safely in service. This document will provide the specific requirements to meet DNFSB recommendations and the guidance provided in DOE Order 5700.6C, utilizing industry codes, standards, regulatory guidelines, and industry good practices that have proven to be essential elements for an effective and efficient Quality Assurance Program as the nuclear industry has matured over the last thirty years.

  13. High-level waste storage tank farms/242-A evaporator standards/requirements identification document (S/RID), Vol. 2

    International Nuclear Information System (INIS)

    1994-04-01

    The Quality Assurance Functional Area Requirements Identification Document (RID), addresses the programmatic requirements that ensure risks and environmental impacts are minimized, ensure safety, reliability, and performance are maximized through the application of effective management systems commensurate with the risks posed by the Tank Farm Facility and its operation. This RID incorporates guidance intended to provide Tank Farms management with the necessary requirements information to develop, upgrade, or assess the effectiveness of a Quality Assurance Program in the performance of organizational and functional activities. Quality Assurance is defined as all those planned and systematic actions necessary to provide adequate confidence that a facility, structure, system, or component will perform satisfactorily and safely in service. This document will provide the specific requirements to meet DNFSB recommendations and the guidance provided in DOE Order 5700.6C, utilizing industry codes, standards, regulatory guidelines, and industry good practices that have proven to be essential elements for an effective and efficient Quality Assurance Program as the nuclear industry has matured over the last thirty years

  14. Real-Time Clinical Decision Support Decreases Inappropriate Plasma Transfusion.

    Science.gov (United States)

    Shah, Neil; Baker, Steven A; Spain, David; Shieh, Lisa; Shepard, John; Hadhazy, Eric; Maggio, Paul; Goodnough, Lawrence T

    2017-08-01

    To curtail inappropriate plasma transfusions, we instituted clinical decision support as an alert upon order entry if the patient's recent international normalized ratio (INR) was 1.7 or less. The alert was suppressed for massive transfusion and within operative or apheresis settings. The plasma order was automatically removed upon alert acceptance while clinical exception reasons allowed for continued transfusion. Alert impact was studied comparing a 7-month control period with a 4-month intervention period. Monthly plasma utilization decreased 17.4%, from a mean ± SD of 3.40 ± 0.48 to 2.82 ± 0.6 plasma units per hundred patient days (95% confidence interval [CI] of difference, -0.1 to 1.3). Plasma transfused below an INR of 1.7 or less decreased from 47.6% to 41.6% (P = .0002; odds ratio, 0.78; 95% CI, 0.69-0.89). The alert recommendation was accepted 33% of the time while clinical exceptions were chosen in the remaining cases (active bleeding, 31%; other clinical indication, 33%; and apheresis, 2%). Alert acceptance rate varied significantly among different provider specialties. Clinical decision support can help curtail inappropriate plasma use but needs to be part of a comprehensive strategy including audit and feedback for comprehensive, long-term changes. © American Society for Clinical Pathology, 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  15. [Prevalence of potentially inappropriate drug prescription in the elderly].

    Science.gov (United States)

    Fajreldines, A; Insua, J; Schnitzler, E

    2016-01-01

    One of the causes of preventable adverse drug events (ADES) in older patients constitutes inappropriate prescription of drugs (PIM). The PIM is where risks exceed the clinical benefit. Several instruments can be use to measure this problem, the most used are: a) Beers criteria; b) Screening tool to Older People Potentially inappropriate Prescription (STOPP); c) Screening tool to Alert Doctors to Right Appropriate indicated Treatments (START); d) The Medication Appropriateness Index (MAI). This study aims to assess the prevalence of PIM, in a population of older adults in three clinical scopes of university hospital. cross sectional study of 300 cases from a random sample of fields: hospitalization (n=100), ambulatory (n=100) and emergency (n=100), all patients over 65 years old or more who where treated at our hospital. 1355 prescription drugs were analized, finding patients hospitalized (PIM) of 57.7%, 55%, 26%, and 80% according to Beers, in ambulatory 36%, 36.5%, 5% and 52% with the same tools and in emergency 35%, 35%, 6% y 52% with the same tools. Was found significant association the PIM with polipharmacy with Beers, STOPP and MAI. results can be compare to world literature (26-80% vs 11-73.1%). The STOPP-START used in an integrated manner would be best estimating the problem of PIM. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Rates of inappropriate antiretroviral prescription among injection drug users

    Directory of Open Access Journals (Sweden)

    Bonner Simon

    2007-01-01

    Full Text Available Abstract Background Although the survival benefits of antiretroviral therapy (ART for the treatment of HIV infection are well established, the clinical management of HIV disease continues to present major challenges. There are particular concerns regarding access to appropriate HIV treatment among HIV-infected injection drug users (IDU. Methods In a prospective cohort study of HIV-infected IDU in Vancouver, Canada, we examined initial ART regimens vis-à-vis the provincial government's therapeutic guidelines at the time ART was initiated. Briefly, there have been four sets of guidelines: Era 1 (1992 to November 1995; double-drug (dual NRTIs ART for patients with a CD4 cell count of 350 or less; Era 2 (December 1995 to May 1996; double-drug therapy for patients with a CD4+ cell count of 500 or less; Era 3 (June 1996 to June 1997; triple-drug therapy (dual NRTIs with a PI or NNRTI for patients who had a plasma viral load of > 100,000 HIV-1 RNA copies/mL; dual therapy with two NRTIs for those with a plasma viral load of 5,000 to 100,000 HIV-1 RNA copies/mL; Era 4 (since July 1997; universal use of triple drug therapy as first-line treatment. Results Between May 1996 and May 2003, 431 HIV-infected individuals were enrolled into the cohort. By May 31, 2003, 291 (67.5% individuals had initiated ART. We noted instances of inappropriate antiretroviral prescription in each guideline era, with 9 (53% in Era 1, 3 (12% in Era 2, 22 (28% in Era 3, and 23 (15% in Era 4. Of the 57 subjects who received an inappropriate ART regimen initially, 14 never received the appropriate therapy; among the remaining 43, the median time to the initiation of a guideline-appropriate ART regimen was 12 months (inter-quartile range 5 – 20. Conclusion The present study identified measurable rates of guideline-inappropriate ART prescription for patients who were injection drug users. Rates were highest in the era of dual therapy, although high rates persisted into the triple

  17. Identification of Shewanella baltica as the most important H2S-producing species during iced storage of Danish marine fish.

    Science.gov (United States)

    Fonnesbech Vogel, Birte; Venkateswaran, Kasthuri; Satomi, Masataka; Gram, Lone

    2005-11-01

    Shewanella putrefaciens has been considered the main spoilage bacteria of low-temperature stored marine seafood. However, psychrotropic Shewanella have been reclassified during recent years, and the purpose of the present study was to determine whether any of the new Shewanella species are important in fish spoilage. More than 500 H2S-producing strains were isolated from iced stored marine fish (cod, plaice, and flounder) caught in the Baltic Sea during winter or summer time. All strains were identified as Shewanella species by phenotypic tests. Different Shewanella species were present on newly caught fish. During the warm summer months the mesophilic human pathogenic S. algae dominated the H2S-producing bacterial population. After iced storage, a shift in the Shewanella species was found, and most of the H2S-producing strains were identified as S. baltica. The 16S rRNA gene sequence analysis confirmed the identification of these two major groups. Several isolates could only be identified to the genus Shewanella level and were separated into two subgroups with low (44%) and high (47%) G+C mol%. The low G+C% group was isolated during winter months, whereas the high G+C% group was isolated on fish caught during summer and only during the first few days of iced storage. Phenotypically, these strains were different from the type strains of S. putrefaciens, S. oneidensis, S. colwelliana, and S. affinis, but the high G+C% group clustered close to S. colwelliana by 16S rRNA gene sequence comparison. The low G+C% group may constitute a new species. S. baltica, and the low G+C% group of Shewanella spp. strains grew well in cod juice at 0 degrees C, but three high G+C Shewanella spp. were unable to grow at 0 degrees C. In conclusion, the spoilage reactions of iced Danish marine fish remain unchanged (i.e., trimethylamine-N-oxide reduction and H2S production); however, the main H2S-producing organism was identified as S. baltica.

  18. Energy Storage.

    Science.gov (United States)

    Eaton, William W.

    Described are technological considerations affecting storage of energy, particularly electrical energy. The background and present status of energy storage by batteries, water storage, compressed air storage, flywheels, magnetic storage, hydrogen storage, and thermal storage are discussed followed by a review of development trends. Included are…

  19. Potentially inappropriate medication use in a city of Southeast Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Cunha Xavier Pinto

    2012-03-01

    Full Text Available Potentially inappropriate medication use by the Diamantina (Minas Gerais State population was investigated by analyzing medicine consumption, self-medication, polypharmacy and drug interactions of medicines prescribed among those interviewed. Level of knowledge about rational drug use and its relationship to socio-economic variables was also evaluated using a semi-structured questionnaire. This survey was based on stratified sampling of 423 individuals selected randomly. The prevalence of prescription drug consumption was 42.32% (n=179 and cardiovascular drugs were the most prescribed. Drug interactions were found in 45.81% (n=82 of prescriptions and 92.68% (n=76 of these interactions were moderate, with co-administration of cardiovascular drugs occurring in more than half of the cases. The inappropriate use of medication, according to Beers criteria, occurred in 44.73% of prescriptions to the elderly. The prevalence of self-medication was 63.34% (n=268 while 21.99% (n=91 of individuals administered medications to their children without formal prescriptions, where this practice was associated to analgesic/antipyretic consumption. The population showed a high prevalence of inappropriate use of drugs across all strata of society, representing an issue requiring effective actions to promote rational use of medicines.O consumo inapropriado de medicamentos pela população de Diamantina-MG foi investigado através da análise do consumo de medicamentos, automedicação, polifarmácia e interações medicamentosas prescritas aos entrevistados. Também foi avaliado o nível de conhecimento sobre uso racional de medicamentos e sua relação com variáveis sócio-econômicas através de um questionário semi-estruturado. Este estudo transversal foi baseado em amostragem estratificada e contou com a participação de 423 indivíduos selecionados aleatoriamente. A prevalência do consumo de medicamentos prescritos foi de 42,32% (n=179, sendo os

  20. What is inappropriate hospital use for elderly people near the end of life?

    DEFF Research Database (Denmark)

    Cardona-Morrell, Magnolia; Kim, James C H; Brabrand, Mikkel

    2017-01-01

    : English language publications in Medline, EMBASE, PubMed, Cochrane library, and the grey literature (January 1995-December 2016) covering community and nursing home residents aged ≥60years admitted to hospital. OUTCOMES: measurements of inappropriateness. A 17-item quality score was estimated...... estimation of clinical inappropriateness. CONCLUSIONS: Clinical inappropriateness and system factors that preclude alternative community care must be measured separately. They are two very different justifications for hospital admissions, requiring different solutions. Society has a duty to ensure...

  1. Potentially inappropriate prescribing in an Irish elderly population in primary care.

    LENUS (Irish Health Repository)

    Ryan, Cristín

    2009-12-01

    WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * Potentially inappropriate prescribing in older people is a well-documented problem and has been associated with adverse drug reactions and hospitalization. * Beers\\' criteria, Screening Tool of Older Persons\\' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) are screening tools that have been formulated to help physicians and pharmacists identify potentially inappropriate prescribing and potential prescribing omissions. * The prevalence of potentially inappropriate prescribing and prescribing omissions in the elderly population presenting to hospital with acute illness is high according to STOPP and START criteria.

  2. The Prevalence of Inappropriate Image Duplication in Biomedical Research Publications

    Science.gov (United States)

    Casadevall, Arturo; Fang, Ferric C.

    2016-01-01

    ABSTRACT Inaccurate data in scientific papers can result from honest error or intentional falsification. This study attempted to determine the percentage of published papers that contain inappropriate image duplication, a specific type of inaccurate data. The images from a total of 20,621 papers published in 40 scientific journals from 1995 to 2014 were visually screened. Overall, 3.8% of published papers contained problematic figures, with at least half exhibiting features suggestive of deliberate manipulation. The prevalence of papers with problematic images has risen markedly during the past decade. Additional papers written by authors of papers with problematic images had an increased likelihood of containing problematic images as well. As this analysis focused only on one type of data, it is likely that the actual prevalence of inaccurate data in the published literature is higher. The marked variation in the frequency of problematic images among journals suggests that journal practices, such as prepublication image screening, influence the quality of the scientific literature. PMID:27273827

  3. Between two beds: inappropriately delayed discharges from hospitals.

    Science.gov (United States)

    Holmås, Tor Helge; Islam, Mohammad Kamrul; Kjerstad, Egil

    2013-12-01

    Acknowledging the necessity of a division of labour between hospitals and social care services regarding treatment and care of patients with chronic and complex conditions, is to acknowledge the potential conflict of interests between health care providers. A potentially important conflict is that hospitals prefer comparatively short length of stay (LOS) at hospital, while social care services prefer longer LOS all else equal. Furthermore, inappropriately delayed discharges from hospital, i.e. bed blocking, is costly for society. Our aim is to discuss which factors that may influence bed blocking and to quantify bed blocking costs using individual Norwegian patient data, merged with social care and hospital data. The data allow us to divide hospital LOS into length of appropriate stay (LAS) and length of delay (LOD), the bed blocking period. We find that additional resources allocated to social care services contribute to shorten LOD indicating that social care services may exploit hospital resources as a buffer for insufficient capacity. LAS increases as medical complexity increases indicating hospitals incentives to reduce LOS are softened by considerations related to patients’ medical needs. Bed blocking costs constitute a relatively large share of the total costs of inpatient care.

  4. An inappropriate tool: criminal law and HIV in Asia.

    Science.gov (United States)

    Csete, Joanne; Dube, Siddharth

    2010-09-01

    Asian countries have applied criminal sanctions widely in areas directly relevant to national HIV programmes and policies, including criminalization of HIV transmission, sex work, homosexuality and drug injection. This criminalization may impede universal access to HIV prevention and treatment services in Asia and undermine vulnerable people's ability to be part of the HIV response. To review the status of application of criminal law in key HIV-related areas in Asia and analyze its impact. Review of literature and application of human rights norms to analysis of criminal law measures. Criminal laws in the areas considered here and their enforcement, while intended to reduce HIV transmission, are inappropriate and counterproductive with respect to health and human rights. Governments should remove punitive laws that impede the HIV response and should ensure meaningful participation of people living with HIV, people who use illicit drugs, sex workers and men who have sex with men in combating stigma and discrimination and developing rights-centered approaches to HIV.

  5. Inappropriate eating behavior: a longitudinal study with female adolescents

    Directory of Open Access Journals (Sweden)

    Leonardo de Sousa Fortes

    2014-03-01

    Full Text Available Objective: To evaluate the inappropriate eating behaviors (IEB of female adolescents over a one-year period. Methods: 290 adolescents aged between 11 and 14 years old participated in the three research stages (T1: first four months, T2: second four months and T3: third four months. The Eating Attitudes Test (EAT-26 was applied to assess the IEB. Weight and height were measured to calculate body mass index (BMI in the three study periods. Analysis of variance for repeated measures was used to analyze the data, adjusted for the scores of the Body Shape Questionnaire and the Brazil Economic Classification Criteria. Results: Girls at T1 showed a higher frequency of IEB compared to T2 (p=0.001 and T3 (p=0.001. The findings also indicated higher values for BMI in T3 in relation to T1 (p=0.04. The other comparisons did not show statistically significant differences. Conclusions: IEB scores of female adolescents declined over one year.

  6. Prevalence and predictors of potentially inappropriate medications among home care elderly patients in Qatar.

    Science.gov (United States)

    Alhmoud, Eman; Khalifa, Sabah; Bahi, Asma Abdulaziz

    2015-10-01

    Older patients receiving home health care are particularly at risk of receiving potentially inappropriate medications compared to community-dwelling population. Data on appropriateness of prescribing in these patients is limited. To investigate the prevalence, patterns and determinants of potentially inappropriate medications among elderly patients receiving Home Health Care Services in Qatar. Home Health Care Services department in Hamad Medical Corporation-Qatar. A cross-sectional study, conducted over a 3 months period. Patients 65 years and older, taking at least one medication and receiving home care services were included. Potentially inappropriate medications were identified and classified in accordance with the American Geriatrics Society 2012 Beers Criteria. Prevalence of potentially inappropriate medications using updated Beers criteria. A total of 191 patients (38.2%) had at least one potentially inappropriate medication. As per Beers criteria, 35% of medications were classified as medications to be avoided in older adults regardless of conditions and 9% as potentially inappropriate medications when used with certain diseases or syndromes. The majority of potentially inappropriate medications (56%) were classified as medications to be used with caution. The two leading classes of potentially inappropriate medications were antipsychotics (27.4%) and selective serotonin reuptake inhibitors (16%). Significant predictors of inappropriate prescribing were hypertension [adjusted OR 1.7; 95% CI (1.0, 2.8)], dementia [adjusted OR 2.0; 95% CI (1.2, 3.1)], depression [adjusted OR 21.6; 95% CI (2.8, 168.4)], and taking more than ten prescribed medications [adjusted OR 1.9; 95% CI (1.3, 2.8)]. Prescribing potentially inappropriate medications is common among older adults receiving home health care services in Qatar, a finding that warrants further attention. Polypharmacy, hypertension, depression and dementia were significantly associated with potentially

  7. Inappropriate prescribing and adverse drug events in older people

    Directory of Open Access Journals (Sweden)

    Gallagher Paul F

    2009-01-01

    Full Text Available Abstract Inappropriate prescribing (IP in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs, morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  8. Inappropriate prescribing and adverse drug events in older people.

    LENUS (Irish Health Repository)

    Hamilton, Hilary J

    2009-01-01

    Inappropriate prescribing (IP) in older patients is highly prevalent and is associated with an increased risk of adverse drug events (ADEs), morbidity, mortality and healthcare utilisation. Consequently, IP is a major safety concern and with changing population demographics, it is likely to become even more prevalent in the future. IP can be detected using explicit or implicit prescribing indicators. Theoretically, the routine clinical application of these IP criteria could represent an inexpensive and time efficient method to optimise prescribing practice. However, IP criteria must be sensitive, specific, have good inter-rater reliability and incorporate those medications most commonly associated with ADEs in older people. To be clinically relevant, use of prescribing appropriateness tools must translate into positive patient outcomes, such as reduced rates of ADEs. To accurately measure these outcomes, a reliable method of assessing the relationship between the administration of a drug and an adverse clinical event is required. The Naranjo criteria are the most widely used tool for assessing ADE causality, however, they are often difficult to interpret in the context of older patients. ADE causality criteria that allow for the multiple co-morbidities and prescribed medications in older people are required. Ultimately, the current high prevalence of IP and ADEs is unacceptable. IP screening criteria need to be tested as an intervention to assess their impact on the incidence of ADEs in vulnerable older patients. There is a role for IP screening tools in everyday clinical practice. These should enhance, not replace good clinical judgement, which in turn should be based on sound pharmacogeriatric training.

  9. The Inappropriate Symmetries of Multivariate Statistical Analysis in Geometric Morphometrics.

    Science.gov (United States)

    Bookstein, Fred L

    In today's geometric morphometrics the commonest multivariate statistical procedures, such as principal component analysis or regressions of Procrustes shape coordinates on Centroid Size, embody a tacit roster of symmetries -axioms concerning the homogeneity of the multiple spatial domains or descriptor vectors involved-that do not correspond to actual biological fact. These techniques are hence inappropriate for any application regarding which we have a-priori biological knowledge to the contrary (e.g., genetic/morphogenetic processes common to multiple landmarks, the range of normal in anatomy atlases, the consequences of growth or function for form). But nearly every morphometric investigation is motivated by prior insights of this sort. We therefore need new tools that explicitly incorporate these elements of knowledge, should they be quantitative, to break the symmetries of the classic morphometric approaches. Some of these are already available in our literature but deserve to be known more widely: deflated (spatially adaptive) reference distributions of Procrustes coordinates, Sewall Wright's century-old variant of factor analysis, the geometric algebra of importing explicit biomechanical formulas into Procrustes space. Other methods, not yet fully formulated, might involve parameterized models for strain in idealized forms under load, principled approaches to the separation of functional from Brownian aspects of shape variation over time, and, in general, a better understanding of how the formalism of landmarks interacts with the many other approaches to quantification of anatomy. To more powerfully organize inferences from the high-dimensional measurements that characterize so much of today's organismal biology, tomorrow's toolkit must rely neither on principal component analysis nor on the Procrustes distance formula, but instead on sound prior biological knowledge as expressed in formulas whose coefficients are not all the same. I describe the problems

  10. Functional Analysis of Inappropriate Social Interactions in Students with Asperger's Syndrome

    Science.gov (United States)

    Roantree, Christina F.; Kennedy, Craig H.

    2012-01-01

    We analyzed the inappropriate social interactions of 3 students with Asperger's syndrome whose behavior was maintained by social positive reinforcement. We tested whether inappropriate social behavior was sensitive to social positive reinforcement contingencies and whether such contingencies could be reversed to increase the probability of…

  11. The Association between Inappropriate Weight Control Behaviors and Suicide Ideation and Attempt among Korean Adolescents.

    Science.gov (United States)

    Lee, Sang Ah; Jang, Suk Yong; Shin, Jaeyong; Ju, Yeong Jun; Nam, Jin Young; Park, Eun Cheol

    2016-10-01

    Suicide is a leading cause of death among adolescents globally, and body weight is also a recognized reason for adolescent suicide. Therefore, we investigated the association between weight control behaviors (WCB) and suicide ideation and attempt, focusing on inappropriate weight control measures. We used data from the 2014 Korea Youth Risk Behavior Web-based Survey, representing a total of 35,224 boys and 34,361 girls aged 12 to 18 years. Adolescents were classified into groups based on WCB: appropriate WCB, inappropriate WCB, and no WCB. We performed logistic regression models to examine associations between WCB and suicide ideation and attempt, controlling for covariates. Both boys and girls with inappropriate WCB were more likely to report suicide ideation and attempt. Underweight and normal weight boys with inappropriate WCB were more likely to think or attempt suicide, and underweight girls with inappropriate WCB were also more likely to attempt suicide. Among five common WCB combinations, the combination of "regular exercise, fasting, eating less" was highly associated with suicide ideation and attempt. We confirmed that inappropriate WCB is associated with suicide ideation and attempt among Korean adolescents. Given the high incidence rate of suicide among adolescents and the adverse effect of inappropriate WCB, encouraging adolescents to control their weight in healthy ways is imperative.

  12. Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use.

    Directory of Open Access Journals (Sweden)

    Chun-Hsien Lee

    Full Text Available While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication.In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication.The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%, cold or cough medicines (prevalence = 21.6%, analgesics (prevalence = 19.3%, and antacids (prevalence = 17.3%. Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%, using excessive dosages (21.6%, and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy (30.3%. The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication.Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

  13. Impact of a warning CPOE system on the inappropriate pill splitting of prescribed medications in outpatients.

    Directory of Open Access Journals (Sweden)

    Chia-Chen Hsu

    Full Text Available Prescribing inappropriate pill splitting is not rare in clinical practice. To reduce inappropriate pill splitting, we developed an automatic warning system linked to a computerized physician order entry (CPOE system for special oral formulation drugs in outpatient settings. We examined the impact of the warning system on inappropriate prescribing of pill splitting and assess prescribers' responses to the warnings.Drugs with extended-release or enteric-coated formulations that were not originally intended to be split were recognized as "special oral formulations". A hard-stop system which could examine non-integer doses of drugs with special oral formulations, provide warnings to interrupt inappropriate prescriptions was integrated in CPOE in a medical center since June 2010. We designed an intervention study to compare the inappropriate splitting before and after the implementation of the warning system (baseline period 2010 January to May vs. intervention period 2010 June to 2011 August. During the intervention period, prescription changes in response to a warning were logged and analyzed.A total of 470,611 prescribed drug items with 34 different drugs with special oral formulations were prescribed in the study period. During the 15-month intervention period, 909 warnings for 26 different drugs were triggered among 354,523 prescribed drug items with special oral formulations. The warning rate of inappropriate splitting in the late intervention period was lower than those in baseline period (0.16% vs. 0.61%, incidence rate ratio 0.27, 95% CI 0.23-0.31, P<0.001. In respond to warnings, physicians had to make adjustments, of which the majority was changing to an unsplit pill (72.9%.The interruptive warning system could avoid the prescriptions with inappropriate pill splitting. Accordingly, physicians changed their behavior of prescribing special oral formulations regarding inappropriate pill splitting. We suggest the establishment of such system

  14. Individual and hospital-related determinants of potentially inappropriate admissions emerging from administrative records.

    Science.gov (United States)

    Fusco, Marco; Buja, Alessandra; Piergentili, Paolo; Golfetto, Maria Teresa; Serafin, Gianni; Gallo, Silvia; Dalla Barba, Livio; Baldo, Vincenzo

    2016-11-01

    The appropriate use of health care is an important issue in developed countries. The purpose of this study was to ascertain the extent of potentially inappropriate hospital admissions and their individual, clinical and hospital-related determinants. Medical records were analyzed for the year 2014 held by the Local Heath Unit n. 13 in the Veneto Region of north-east Italy (19,000 records). The outcomes calculated were: admissions for conditions amenable to day hospital care; brief medical admissions; outlier lengths of stay for elderly patients' medical admissions; and medical admissions to surgical wards. Univariate analyses and logistic regression models were used to test associations with demographic, clinical and hospital ward covariates, including organizational indicators. Inappropriate reliance on acute care beds ranged from 6% to 28%, depending on the type of quality indicator analyzed. Some individual features, and wards' specific characteristics were associated with at least one of the phenomena of inappropriate hospital resource usage. In particular, male gender, younger age and transferals seemed to affect inappropriate admissions to surgical wards. Potentially avoidable admissions featuring inpatients amenable to day hospital care were associated with subjects with fewer comorbidities and lower case-mix wards, while inappropriately short medical stays were influenced by patients' higher functional status and local residency and by lower bed occupancy rates. In conclusion, inappropriately long hospital stays for elderly cases were associated with patients with multiple pathologies in wards with a low bed-occupancy. Education level and citizenship did not seem to influence inappropriate admissions. Some individual, clinical ad structural characteristics of patients and wards emerging from administrative records could be associated with inappropriate reliance on acute hospital beds. Analyzing the indicators considered in this study could generate

  15. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    Directory of Open Access Journals (Sweden)

    Yamada Yukari

    2006-01-01

    Full Text Available Abstract Background The prevalence and risk factors of potentially inappropriate medication use among the elderly patients have been studied in various countries, but because of the difficulty of obtaining data on patient characteristics and medications they have not been studied in Japan. Methods We conducted a retrospective cross-sectional study in 17 Japanese long-term care (LTC facilities by collecting data from the comprehensive MDS assessment forms for 1669 patients aged 65 years and over who were assessed between January and July of 2002. Potentially inappropriate medications were identified on the basis of the 2003 Beers criteria. Results The patients in the sample were similar in terms of demographic characteristics to those in the national survey. Our study revealed that 356 (21.1% of the patients were treated with potentially inappropriate medication independent of disease or condition. The most commonly inappropriately prescribed medication was ticlopidine, which had been prescribed for 107 patients (6.3%. There were 300 (18.0% patients treated with at least 1 inappropriate medication dependent on the disease or condition. The highest prevalence of inappropriate medication use dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511, medication cost of per day (OR = 1.173, number of medications (OR = 1.140, and age (OR = 0.981 as factors related to inappropriate medication use independent of disease or condition. Neither patient characteristics nor facility characteristics emerged as predictors of inappropriate prescription. Conclusion The prevalence and predictors of inappropriate medication use in Japanese LTC facilities were similar to those in other countries.

  16. Knudsen-Like Scaling May Be Inappropriate for Gas Shales

    KAUST Repository

    Patzek, Tadeusz

    2017-10-02

    Summary We assert that a classification of gas flow regimes in shales that is widely accepted in the petroleum industry, may be inconsistent with the physics of high-pressure gas flow in capillaries. This classification follows from the 1946 work by Brown et al. (1946) that deals with the flow of gases in large industrial metal pipes, elbows and orifices under vacuum, with gas pressures of the order of 1 mm Hg or less. In another pioneering paper that year, Tsien (1946) analyzed the hypersonic flight of rockets in the thermosphere (above 50 miles of altitude), and established the widely accepted Knudsen flow regimes for the high-Reynolds, high-Mach flow of rarified gases. We show why both these papers are not quite applicable to flow of compressed gas in the hot, high-pressure shale pores with rough surfaces. In addition, it may be inappropriate to use the capillary tube metaphor to describe shale micropores or microcracks, simply because each is fed with gas by dozens or hundreds of intricately connected nanopores, which themselves may be slits rather than circular cylinders, and are charged with the dense, liquid-like gas. In the small-scale, low-velocity flows of gases, failure of the standard Navier-Stokes description (the standard Darcy law in petroleum engineering) can be quantified by the Knudsen number, ratio of the mean free path, λ, of gas molecules at the reservoir pressure and temperature to the characteristic pore radius, R. We carefully enumerate the multiple restrictive conditions that must hold for the slip-flow boundary condition to emerge. We also describe the dependence of the slip correction factor on the gas pressure and temperature, as well as the median pore size and rock roughness. In the derivation, we revisit the original approaches of Helmholtz and von Piotrowski (1860) and Maxwell, Niven (1890), which were somehow lost in the multiple translations from physics to petroleum engineering. For example, in Barnett mudrocks, naturally

  17. Tritium storage

    International Nuclear Information System (INIS)

    Hircq, B.

    1990-01-01

    This document represents a synthesis relative to tritium storage. After indicating the main storage particularities as regards tritium, storages under gaseous and solid form are after examined before establishing choices as a function of the main criteria. Finally, tritium storage is discussed regarding tritium devices associated to Fusion Reactors and regarding smaller devices [fr

  18. The frequency of agitation due to inappropriate use of naltrexone in addicts

    Directory of Open Access Journals (Sweden)

    Sima Siadat

    2014-01-01

    Conclusion: Considering the high prevalence of agitation in the poisoning emergency department due to inappropriate use of naltrexone, more accurate planning for administration of naltrexone in addicts seems necessary.

  19. Impact of carvedilol and metoprolol on inappropriate implantable cardioverter-defibrillator therapy

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Abu-Zeitone, Abeer; Jons, Christian

    2013-01-01

    The goal of this study was to evaluate the effects of carvedilol and metoprolol on the endpoint of inappropriate implantable cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy) study....

  20. Inappropriate prescribing and prescribing omissions among drug-related problems using STOPP-START criteria

    NARCIS (Netherlands)

    Verdoorn, M.A.; Kwint, H.-F.; Faber, A.; L. Bouvy, M.

    2013-01-01

    Background and objectives: Medication review has been suggested as a way to prevent drug related problems (DRPs). Screening tools have been formulated to identify potentially inappropriate medicines (PIMs) and potential prescribing omissions (PPOs) respectively called Screening Tool of Older

  1. Inappropriate use of urinary catheters in patients admitted to medical wards in a university hospital.

    Science.gov (United States)

    Fernández-Ruiz, Mario; Calvo, Beatriz; Vara, Rebeca; Villar, Rocío N; Aguado, José María

    2013-10-01

    The prevalence and predisposing factors were determined for inappropriate urinary catheterization (UC) among inpatients in medical wards. A cross-sectional study was conducted including all patients aged ≥ 18 years admitted to medical wards in a 1300-bed tertiary-care centre, and who had a urinary catheter in place on the day of the survey. Of 380 patients observed, 46 (12.1%) had a urinary catheter in place. Twelve of them (26.1%) were inappropriately catheterized. The most common indication for inappropriate UC was urine output monitoring in a cooperative, non-critically ill patient. Inappropriateness was associated with increased age, poor functional status, urinary incontinence, dementia, and admission from a long-term care facility. Further educational efforts should be focused on improving catheterization prescribing practices by physicians. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  2. Cryptography from noisy storage.

    Science.gov (United States)

    Wehner, Stephanie; Schaffner, Christian; Terhal, Barbara M

    2008-06-06

    We show how to implement cryptographic primitives based on the realistic assumption that quantum storage of qubits is noisy. We thereby consider individual-storage attacks; i.e., the dishonest party attempts to store each incoming qubit separately. Our model is similar to the model of bounded-quantum storage; however, we consider an explicit noise model inspired by present-day technology. To illustrate the power of this new model, we show that a protocol for oblivious transfer is secure for any amount of quantum-storage noise, as long as honest players can perform perfect quantum operations. Our model also allows us to show the security of protocols that cope with noise in the operations of the honest players and achieve more advanced tasks such as secure identification.

  3. Correlation analysis between team communication characteristics and frequency of inappropriate communications

    International Nuclear Information System (INIS)

    Kim, Ar Ryum; Lee, Seung Woo; Park, Jinkyun; Kang, Hyun Gook; Seong, Poong Hyun

    2013-01-01

    Highlights: • We proposed a method to evaluate team communication characteristics based on social network analysis. • We compare team communication characteristics with the frequency of inappropriate communications. • Frequency of inappropriate communications were decreased when more operators perform the same types of role as others. • Frequency of inappropriate communications were decreased for teams who provide more number of acknowledgment. - Abstract: The characteristics of team communications are important since large process systems such as nuclear power plants, airline, and railways are operated by operating teams. In such situation, inappropriate communications can cause a lack of situational information and lead to serious consequences for the systems. As a result, the communication characteristics of operating teams should be understood in order to extract meaningful insights to address the nature of inappropriate communications. The purpose of this study was to develop a method to evaluate the characteristics of team communications based on social network analysis and compare them with the frequency of inappropriate communications. In order to perform the analysis, verbal protocol data, which were audio-visual recorded under training sessions by operating teams, were used and interfacing system loss of coolant accident scenarios were selected. As a result of the study, it was found that the frequency of inappropriate communications decreased when more operators perform the same types of role as other operators, since they can easily and effectively back up each other. Also, the frequency of inappropriate communication is decreased for teams which provide a relatively large communication content that acknowledge or confirm another communication content

  4. Reduction in inappropriate hospital use based on analysis of the causes

    Directory of Open Access Journals (Sweden)

    Soria-Aledo Víctor

    2012-10-01

    Full Text Available Abstract Background To reduce inappropriate admissions and stays with the application of an improvement cycle in patients admitted to a University Hospital. The secondary objective is to analyze the hospital cost saved by reducing inadequacy after the implementation of measures proposed by the group for improvement. Methods Pre- and post-analysis of a sample of clinical histories studied retrospectively, in which the Appropriateness Evaluation Protocol (AEP was applied to a representative hospital sample of 1350 clinical histories in two phases. In the first phase the AEP was applied retrospectively to 725 admissions and 1350 stays. The factors associated with inappropriateness were analysed together with the causes, and specific measures were implemented in a bid to reduce inappropriateness. In the second phase the AEP was reapplied to a similar group of clinical histories and the results of the two groups were compared. The cost of inappropriate stays was calculated by cost accounting. Setting: General University Hospital with 426 beds serving a population of 320,000 inhabitants in the centre of Murcia, a city in south-eastern Spain. Results Inappropriate admissions were reduced significantly: 7.4% in the control group and 3.2% in the intervention group. Likewise, inappropriate stays decreased significantly from 24.6% to 10.4%. The cost of inappropriateness in the study sample fell from 147,044 euros to 66,642 euros. The causes of inappropriateness for which corrective measures were adopted were those that showed the most significant decrease. Conclusions It is possible to reduce inadequacy by applying measures based on prior analysis of the situation in each hospital.

  5. Inappropriateness of cardiovascular radiological imaging testing; a tertiary care referral center study.

    Directory of Open Access Journals (Sweden)

    Clara Carpeggiani

    Full Text Available AIMS: Radiological inappropriateness in medical imaging leads to loss of resources and accumulation of avoidable population cancer risk. Aim of the study was to audit the appropriateness rate of different cardiac radiological examinations. METHODS AND PRINCIPAL FINDINGS: With a retrospective, observational study we reviewed clinical records of 818 consecutive patients (67 ± 12 years, 75% males admitted from January 1-May 31, 2010 to the National Research Council - Tuscany Region Gabriele Monasterio Foundation cardiology division. A total of 940 procedures were audited: 250 chest x-rays (CXR; 240 coronary computed tomographies (CCT; 250 coronary angiographies (CA; 200 percutaneous coronary interventions (PCI. For each test, indications were rated on the basis of guidelines class of recommendation and level of evidence: definitely appropriate (A, including class I, appropriate, and class IIa, probably appropriate, uncertain (U, class IIb, probably inappropriate, or inappropriate (I, class III, definitely inappropriate. Appropriateness was suboptimal for all tests: CXR (A = 48%, U = 10%, I = 42%; CCT (A = 58%, U = 24%, I = 18%; CA (A = 45%, U = 25%, I = 30%; PCI (A = 63%, U = 15%, I = 22%. Top reasons for inappropriateness were: routine on hospital admission (70% of inappropriate CXR; first line application in asymptomatic low-risk patients (42% of CCT or in patients with unchanged clinical status post-revascularization (20% of CA; PCI in patients either asymptomatic or with miscellaneous symptoms and without inducible ischemia on non-invasive testing (36% of inappropriate PCI. CONCLUSION AND SIGNIFICANCE: Public healthcare system--with universal access paid for with public money--is haemorrhaging significant resources and accumulating avoidable long-term cancer risk with inappropriate cardiovascular imaging prevention.

  6. Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding.

    Science.gov (United States)

    Peeraully, R; Henderson, K; Davies, B

    2016-04-01

    Introduction In England, emergency readmissions within 30 days of hospital discharge after an elective admission are not reimbursed if they do not meet Payment by Results (PbR) exclusion criteria. However, coding errors could inappropriately penalise hospitals. We aimed to assess the accuracy of coding for emergency readmissions. Methods Emergency readmissions attributed to paediatric surgery and urology between September 2012 and August 2014 to our tertiary referral centre were retrospectively reviewed. Payment by Results (PbR) coding data were obtained from the hospital's Family Health Directorate. Clinical details were obtained from contemporaneous records. All readmissions were categorised as appropriately coded (postoperative or nonoperative) or inappropriately coded (planned surgical readmission, unrelated surgical admission, unrelated medical admission or coding error). Results Over the 24-month period, 241 patients were coded as 30-day readmissions, with 143 (59%) meeting the PbR exclusion criteria. Of the remaining 98 (41%) patients, 24 (25%) were inappropriately coded as emergency readmissions. These readmissions resulted in 352 extra bed days, of which 117 (33%) were attributable to inappropriately coded cases. Conclusions One-quarter of non-excluded emergency readmissions were inappropriately coded, accounting for one-third of additional bed days. As a stay on a paediatric ward costs up to £500 a day, the potential cost to our institution due to inappropriate readmission coding was over £50,000. Diagnoses and the reason for admission for each care episode should be accurately documented and coded, and readmission data should be reviewed at a senior clinician level.

  7. Heart failure severity, inappropriate ICD therapy, and novel ICD programming: a MADIT-RIT substudy.

    Science.gov (United States)

    Daimee, Usama A; Vermilye, Katherine; Rosero, Spencer; Schuger, Claudio D; Daubert, James P; Zareba, Wojciech; McNitt, Scott; Polonsky, Bronislava; Moss, Arthur J; Kutyifa, Valentina

    2017-12-01

    The effects of heart failure (HF) severity on risk of inappropriate implantable cardioverter-defibrillator (ICD) therapy have not been thoroughly investigated. We aimed to study the association between HF severity and inappropriate ICD therapy in MADIT-RIT. MADIT-RIT randomized 1,500 patients to three ICD programming arms: conventional (Arm A), high-rate cut-off (Arm B: ≥200 beats/min), and delayed therapy (Arm C: 60-second delay for ≥170 beats/min). We evaluated the association between New York Heart Association (NYHA) class III (n = 256) versus class I-II (n = 251) and inappropriate ICD therapy in Arm A patients with ICD-only and cardiac resynchronization therapy with defibrillator (CRT-D). We additionally assessed benefit of novel ICD programming in Arms B and C versus Arm A by NYHA classification. In Arm A, the risk of inappropriate therapy was significantly higher in those with NYHA III versus NYHA I-II for both ICD (hazard ratio [HR] = 2.55, confidence interval [CI]: 1.51-4.30, P programming significantly reduced inappropriate therapy in patients with both NYHA III (Arm B vs Arm A: HR = 0.08, P programming with high-rate cut-off or delayed detection reduces inappropriate ICD therapies in both mild and moderate HF. © 2017 Wiley Periodicals, Inc.

  8. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Binit N Jhaveri

    2014-01-01

    Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

  9. Predictors of Inappropriate Use of Diagnostic Tests and Management of Bronchiolitis

    Science.gov (United States)

    Sarmiento, Lorena; Rojas-Soto, Gladys E.

    2017-01-01

    Background The aim of the present study was to determine predictors of inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. Methods In an analytical cross-sectional study, we determined independent predictors of the inappropriate use of diagnostic tests and management of bronchiolitis in a population of hospitalized infants. We defined a composite outcome score as the main outcome variable. Results Of the 303 included patients, 216 (71.3%) experienced an inappropriate use of diagnostic tests and treatment of bronchiolitis. After controlling for potential confounders, it was found that atopic dermatitis (OR 5.30; CI 95% 1.14–24.79; p = 0.034), length of hospital stay (OR 1.48; CI 95% 1.08–2.03; p = 0.015), and the number of siblings (OR 1.92; CI 95% 1.13–3.26; p = 0.015) were independent predictors of an inappropriate use of diagnostic tests and treatment of the disease. Conclusions Inappropriate use of diagnostic tests and treatment of bronchiolitis was a highly prevalent outcome in our population of study. Participants with atopic dermatitis, a longer hospital stay, and a greater number of siblings were at increased risk for inappropriate use of diagnostic tests and management of the disease. PMID:28758127

  10. Emotion Knowledge and Attentional Differences in Preschoolers Showing Context-Inappropriate Anger.

    Science.gov (United States)

    Locke, Robin L; Lang, Nichole J

    2016-08-01

    Some children show anger inappropriate for the situation based on the predominant incentives, which is called context-inappropriate anger. Children need to attend to and interpret situational incentives for appropriate emotional responses. We examined associations of context-inappropriate anger with emotion recognition and attention problems in 43 preschoolers (42% male; M age = 55.1 months, SD = 4.1). Parents rated context-inappropriate anger across situations. Teachers rated attention problems using the Child Behavior Checklist-Teacher Report Form. Emotion recognition was ability to recognize emotional faces using the Emotion Matching Test. Anger perception bias was indicated by anger to non-anger situations using an adapted Affect Knowledge Test. 28% of children showed context-inappropriate anger, which correlated with lower emotion recognition (β = -.28) and higher attention problems (β = .36). Higher attention problems correlated with more anger perception bias (β = .32). This cross-sectional, correlational study provides preliminary findings that children with context-inappropriate anger showed more attention problems, which suggests that both "problems" tend to covary and associate with deficits or biases in emotion knowledge. © The Author(s) 2016.

  11. Impact of 2015 Update to the Beers Criteria on Estimates of Prevalence and Costs Associated with Potentially Inappropriate Use of Antimuscarinics for Overactive Bladder.

    Science.gov (United States)

    Suehs, Brandon T; Davis, Cralen; Ng, Daniel B; Gooch, Katherine

    2017-07-01

    Research has demonstrated that the use of potentially inappropriate medication (PIM) is highly prevalent among older individuals and may lead to increased healthcare costs, adverse drug reactions, hospitalizations, and mortality. The purpose of this study was to examine the impact of the 2015 updates to the Beers Criteria on estimates of prevalence and cost associated with potentially inappropriate use of antimuscarinic medications indicated for treatment of overactive bladder (OAB). A retrospective database analysis was conducted using a historical cohort design and including data collected between 2007 and 2013. Claims data were used to identify Medicare Advantage patients aged ≥65 years newly initiated on antimuscarinic OAB treatment. Patients were classified with potentially inappropriate use of antimuscarinic OAB drugs based on either the 2012 Beers Criteria or the 2015 Beers Criteria. Prevalence of PIM at the time of antimuscarinic initiation was determined. Bivariate comparisons of healthcare costs and medical condition burden were conducted to compare the marginal groups of patients (who qualified based on the 2012 Beers Criteria only or the 2015 Beers Criteria only). Differences in healthcare costs for patients with and without potentially inappropriate use of urinary antimuscarinics based on the 2012 and 2015 Beers Criteria were also examined. Of 66,275 patients, overall prevalence of potentially inappropriate use of OAB antimuscarinics was higher using 2015 Beers Criteria than when using the 2012 Beers Criteria (25.0 vs. 20.6%). Dementia was the most common PIM-qualifying condition under both versions. The 2015 Beers Criteria identified more females, more White people, and a younger population with PIM. Comorbid medical condition burden was lower using the 2015 Beers Criteria. The 2015 Beers Criteria only group had lower median unadjusted healthcare costs ($7104 vs. 8301; p cost associated with potentially inappropriate use of antimuscarinic

  12. Using a social story intervention to decrease inappropriate behavior of preschool children with autism

    Directory of Open Access Journals (Sweden)

    Angkhana Khantreejitranon

    2018-01-01

    Full Text Available This research investigated the inappropriate behavior of preschool children with autism in a classroom and examined the effectiveness of the use of social stories to decrease inappropriate autistic behavior. An A-B-A-B single subject design was used across the five participants selected for the study. Investigating the problematic social skills and developing a social story intervention for the preschool autistic children was completed, followed by an examination of the effectiveness of the social story intervention. Ten common problematic social skills among the autistic children in preschool were identified—walking around, making loud noises, not sharing their toys with others, showing frustration when feeling unsatisfied, having no patience, not putting toys away when finished, taking other people's belongings without permission, not knowing how to greet others, destroying things when feeling frustrated, and giving a hug to other people at inappropriate times. It was found that the social story intervention helped to decrease inappropriate behavior in children with autism. The social story intervention consisted of five social story books and five e-books (one story per child using a single subject design with an A-B-A-B pattern. The autistic children preferred social stories from the hardcopy books compared with stories from the e-books. A fourth stage time trial was used over 6 weeks, five times per week, for a total of 30 times. The findings suggested that the use of properly constructed social stories can be effective in decreasing the inappropriate behavior of children with autism. However, each story intervention should be applied with caution because of individual differences between children. The social story intervention should be designed only for autistic children who exhibit specific inappropriate social behavior. Keywords: autistic child, inappropriate behavior, social skills, social story

  13. Potentially inappropriate medication use: the Beers' Criteria used among older adults with depressive symptoms

    Directory of Open Access Journals (Sweden)

    Lee D

    2013-09-01

    Full Text Available INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3 years and 59% were women. The median number of medications used was 6 (range 1-21 medications. The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49% of the participants were prescribed at least one potentially inappropriate medication; 29% were considered to suffer significant depressive symptoms (Geriatric Depression Scale ≥5 and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54. DISCUSSION: Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed.

  14. Factors predisposing nursing home resident to inappropriate transfer to emergency department. The FINE study protocol

    Directory of Open Access Journals (Sweden)

    Amélie Perrin

    2017-09-01

    Full Text Available Background: Each year, around one out of two nursing home (NH residents are hospitalized in France, and about half to the emergency department (ED. These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED. Methods/design: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i.e. case versus control NH residents is determined by a multidisciplinary team of experts. Results: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED. Discussion: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization. Keywords: Inappropriate transfer, Nursing home resident, Emergency department transfer, Potentially avoidable transfer, Appropriateness of transfer, Inappropriate hospitalization

  15. Potentially inappropriate prescriptions for older patients in long-term care

    Directory of Open Access Journals (Sweden)

    Laurin Danielle

    2004-10-01

    Full Text Available Abstract Background Inappropriate medication use is a major healthcare issue for the elderly population. This study explored the prevalence of potentially inappropriate prescriptions (PIPs in long-term care in metropolitan Quebec. Methods A cross sectional chart review of 2,633 long-term care older patients of the Quebec City area was performed. An explicit criteria list for PIPs was developed based on the literature and validated by a modified Delphi method. Medication orders were reviewed to describe prescribing patterns and to determine the prevalence of PIPs. A multivariate analysis was performed to identify predictors of PIPs. Results Almost all residents (94.0% were receiving one or more prescribed medication; on average patients had 4.8 prescribed medications. A majority (54.7% of treated patients had a potentially inappropriate prescription (PIP. Most common PIPs were drug interactions (33.9% of treated patients, followed by potentially inappropriate duration (23.6%, potentially inappropriate medication (14.7% and potentially inappropriate dosage (9.6%. PIPs were most frequent for medications of the central nervous system (10.8% of prescribed medication. The likelihood of PIP increased significantly as the number of drugs prescribed increased (odds ratio [OR]: 1.38, 95% confidence interval [CI]: 1.33 – 1.43 and with the length of stay (OR: 1.78, CI: 1.43 – 2.20. On the other hand, the risk of receiving a PIP decreased with age. Conclusion Potentially inappropriate prescribing is a serious problem in the highly medicated long-term care population in metropolitan Quebec. Use of explicit criteria lists may help identify the most critical issues and prioritize interventions to improve quality of care and patient safety.

  16. The challenge of sustainability in healthcare systems: Frequency and cost of inappropriate patterns of breast cancer care (the E.Pic.A study).

    Science.gov (United States)

    Massa, Ilaria; Balzi, William; Burattini, Costanza; Gentili, Nicola; Bucchi, Lauro; Nanni, Oriana; Gallegati, Davide; Pierini, Andrea; Amadori, Dino; Falcini, Fabio; Altini, Mattia

    2017-08-01

    In a context of decreasing economic health resources and a rise in health needs, it is urgent to face this sustainability crisis through the analysis of healthcare expenditures. Wastages, deriving from inappropriate interventions, erode resources which could be reallocated to high-value activities. To identify these areas of wastages, we developed a method for combining and analyzing data from multiple sources. Here we report the preliminary results of a retrospective cohort study evaluating the performance of breast cancer (BC) care at IRST, an Italian cancer institute. Four data sources gathered in a real-world setting (a clinical database, two administrative databases and a cancer registry) were linked. Essential Key Performance Indexes (KPIs) in the pattern of BC diagnosis (KPI 1 and 2) and treatment (KPI 3 and 4) based on current guidelines were developed by a board of professionals. The costs of inappropriate examinations were associated with the diagnostic KPIs. We found that 2798 patients treated at IRST from January 2010 to June 2016 received a total of 2516 inappropriate examinations accounting for € 573,510.80. Linkage from multiple routine healthcare data sources is feasible: it allows the measurement of important KPIs specifically designed for BC care, and the identification of areas of low-value use of the resources. If systematically applied, this method could help provide a complete picture of inappropriateness and waste, redirect these resources to higher-value interventions for patients, and fill the gap between proper use of the resources and the best clinical results. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  17. Energy storage

    Science.gov (United States)

    Kaier, U.

    1981-04-01

    Developments in the area of energy storage are characterized, with respect to theory and laboratory, by an emergence of novel concepts and technologies for storing electric energy and heat. However, there are no new commercial devices on the market. New storage batteries as basis for a wider introduction of electric cars, and latent heat storage devices, as an aid for solar technology applications, with satisfactory performance standards are not yet commercially available. Devices for the intermediate storage of electric energy for solar electric-energy systems, and for satisfying peak-load current demands in the case of public utility companies are considered. In spite of many promising novel developments, there is yet no practical alternative to the lead-acid storage battery. Attention is given to central heat storage for systems transporting heat energy, small-scale heat storage installations, and large-scale technical energy-storage systems.

  18. Container/Closure Integrity Testing and the Identification of a Suitable Vial/Stopper Combination for Low-Temperature Storage at -80 {degrees}C.

    Science.gov (United States)

    Zuleger, Brigitte; Werner, Uwe; Kort, Alexander; Glowienka, Rene; Wehnes, Engelbert; Duncan, Derek

    2012-01-01

    It was recently found that after storage of a live viral vaccine at -80 °C in glass vials closed with rubber stoppers, a phenomenon was revealed which had not been observed before with other viral products stored at -20 °C: overpressure in the vials. As this phenomenon poses a serious safety problem for medical personnel as well as for the product itself, an investigation was initiated to identify the root cause of the overpressure. After exclusion of possible root causes (differences in air temperature or atmospheric air pressure during filling and quality control testing, outgassing from the formulation buffer) the remaining hypothesis involved a possible container closure integrity issue at low temperature. The glass transition temperatures (T(g)) of many rubber stopper formulations are in the range -55 to -70 °C. At storage temperatures below T(g), the rubber stopper loses its elastic properties and there is a risk that the seal integrity of the vial could be compromised. Loss of seal integrity of the vials near storage temperatures of -80 °C would result in an ingress of cold dense gas into the vial headspace. After removal of the vials from storage at -80 °C, the rubber stoppers could regain their elastic properties and the vials would quickly reseal, thereby trapping the ingressed gas, which leads to overpressure in the vial headspace. Nondestructive laser-based headspace analysis was used to investigate the maintenance of container closure integrity as a function of the filling and capping/crimping process, storage and transport conditions, and vial/stopper designs. This analytical method is based on frequency modulation spectroscopy (FMS) and can be used for noninvasive headspace measurements of headspace pressure and headspace gas composition. Changes in the vial headspace composition and/or pressure are a clear marker for vials that have lost container closure integrity. After storage of a live viral vaccine at -80 °C in glass vials closed with

  19. Identification and determination of trapping parameters as key site parameters for CO2 storage for the active CO2 storage site in Ketzin (Germany) - Comparison of different experimental approaches and analysis of field data

    Science.gov (United States)

    Zemke, Kornelia; Liebscher, Axel

    2015-04-01

    Petrophysical properties like porosity and permeability are key parameters for a safe long-term storage of CO2 but also for the injection operation itself. The accurate quantification of residual trapping is difficult, but very important for both storage containment security and storage capacity; it is also an important parameter for dynamic simulation. The German CO2 pilot storage in Ketzin is a Triassic saline aquifer with initial conditions of the target sandstone horizon of 33.5 ° C/6.1 MPa at 630 m. One injection and two observation wells were drilled in 2007 and nearly 200 m of core material was recovered for site characterization. From June 2008 to September 2013, slightly more than 67 kt food-grade CO2 has been injected and continuously monitored. A fourth observation well has been drilled after 61 kt injected CO2 in summer 2012 at only 25 m distance to the injection well and new core material was recovered that allow study CO2 induced changes in petrophysical properties. The observed only minor differences between pre-injection and post-injection petrophysical parameters of the heterogeneous formation have no severe consequences on reservoir and cap rock integrity or on the injection behavior. Residual brine saturation for the Ketzin reservoir core material was estimated by different methods. Brine-CO2 flooding experiments for two reservoir samples resulted in 36% and 55% residual brine saturation (Kiessling, 2011). Centrifuge capillary pressure measurements (pc = 0.22 MPa) yielded the smallest residual brine saturation values with ~20% for the lower part of the reservoir sandstone and ~28% for the upper part (Fleury, 2010). The method by Cerepi (2002), which calculates the residual mercury saturation after pressure release on the imbibition path as trapped porosity and the retracted mercury volume as free porosity, yielded unrealistic low free porosity values of only a few percent, because over 80% of the penetrated mercury remained in the samples after

  20. Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery

    Directory of Open Access Journals (Sweden)

    Paolo Bifulco

    2014-01-01

    Full Text Available Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs. A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences. As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients.

  1. Clinical pharmacist evaluation of medication inappropriateness in the emergency department of a teaching hospital in Malta

    Directory of Open Access Journals (Sweden)

    West LM

    2012-12-01

    Full Text Available Appropriate prescribing remains an important priority in all medical areas of practice. Objective: The objective of this study was to apply a Medication Appropriateness Index (MAI to identify issues of inappropriate prescribing amongst patients admitted from the Emergency Department (ED.Method: This study was carried out at Malta’s general hospital on 125 patients following a two-week pilot period on 10 patients. Patients aged 18 years and over and on medication therapy were included. Medication treatment for inappropriateness was assessed by using the MAI. Under-prescribing was also screened for. Results: Treatment charts of 125 patients, including 697 medications, were assessed using a MAI. Overall, 115 (92% patients had one or more medications with one or more MAI criteria rated as inappropriate, giving a total of 384 (55.1% medications prescribed inappropriately. The mean SD MAI score per drug was 1.78 (SD=2.19. The most common medication classes with appropriateness problems were supplements (20.1%, antibiotics (20.0% and steroids (19.8%. The most common problems involved incorrect directions (26% and incorrect dosages (18.5%. There were 36 omitted medications with untreated indications. Conclusion: There is considerable inappropriate prescribing which could have significant negative effects regarding patient care.

  2. Inappropriate sexual behaviour in adolescents with autism spectrum disorder: what education is recommended and why.

    Science.gov (United States)

    Beddows, Nicola; Brooks, Rachel

    2016-08-01

    Autism spectrum disorder (ASD) is a neurodevelopmental disorder impairing social skills and communication. Adolescents with ASD have sexual needs, but may not understand their physical and emotional development resulting in inappropriate sexual behaviour. The aim of this review is to describe the type of inappropriate behaviour that presents in these adolescents, explain why such behaviours occur, suggest what education is suitable and identify current gaps in research. The databases EMBASE, OVID MEDLINE and PSYCINFO were searched for relevant articles. In total, 5241 articles were found, with an additional 15 sources found via soft searches, of which 42 met inclusion criteria and were subsequently reviewed. Sexual behaviours that occur in these adolescents with ASD include hypermasturbation, public masturbation, inappropriate romantic gestures, inappropriate arousal and exhibitionism. Such behaviours are thought to be caused via a lack of understanding of normal puberty, the absence of appropriate sex education, the severity of their ASD and other associated problems. It is suggested that individualized, repetitive education should be started from an early age in an accessible form. Social skills development is also important before more technical aspects of sex education are taught. Despite being such a common problem for schools, institutions and families to manage, it is surprising how sparse literature is particularly regarding why inappropriate behaviour occurs and what education is effective. © 2015 Wiley Publishing Asia Pty Ltd.

  3. Potentially inappropriate prescribing in elderly population: A study in medicine out-patient department

    Directory of Open Access Journals (Sweden)

    Ajit Kumar Sah

    2017-03-01

    Full Text Available Background & Objectives: Older individuals often suffer from multiple systemic diseases and are particularly more vulnerable to potentially inappropriate medicine prescribing. Inappropriate medication can cause serious medical problem for the elderly. The study was conducted with objectives to determine the prevalence of potentially inappropriate medicine (PIM prescribing in older Nepalese patients in a medicine outpatient department.Materials & Methods: A prospective observational analysis of drugs prescribed in medicine out-patient department (OPD of a tertiary hospital of central Nepal was conducted during November 2012 to October 2013 among 869 older adults aged 65 years and above. The use of potentially inappropriate medications (PIM in elderly patients was analysed using Beer’s Criteria updated to 2013. Results: In the 869 patients included, the average number of drugs prescribed per prescription was 5.56. The most commonly used drugs were atenolol (24.3%, amlodipine (23.16%, paracetamol (17.6%, salbutamol (15.72% and vitamin B complex (13.26%. The total number of medications prescribed was 4833. At least one instance of PIM was experienced by approximately 26.3% of patients when evaluated using the Beers criteria. Conclusion: Potentially inappropriate medications are highly prevalent among older patients attending medical OPD and are associated with number of medications prescribed. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  4. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes

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    Vivatkusol Y

    2017-05-01

    Full Text Available Yada Vivatkusol, Thaovalai Thavaramara, Chadakarn Phaloprakarn Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand Objective: To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG among teenage pregnant women.Methods: A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG.Results: Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m2. The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P<0.001. The rates of gestational diabetes mellitus among women who were underweight, overweight, or appropriate weight were not significantly different.Conclusion: More than 60% of teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes. Keywords: prevalence, pregnancy outcome, inappropriate gestational weight gain, teenage pregnancy

  5. Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul F

    2012-02-03

    INTRODUCTION: Adverse drug events (ADEs) are associated with inappropriate prescribing (IP) and result in increased morbidity, mortality and resource utilisation. We used Beers\\' Criteria to determine the three-month prevalence of IP in a non-selected community-dwelling population of acutely ill older people requiring hospitalisation. METHODS: A prospective, observational study of 597 consecutive acute admissions was performed. Diagnoses and concurrent medications were recorded before hospital physician intervention, and Beers\\' Criteria applied. RESULTS: Mean patient age (SD) was 77 (7) years. Median number of medications was 5, range 0-13. IP occurred in 32% of patients (n = 191), with 24%, 6% and 2% taking 1, 2 and 3 inappropriate medications respectively. Patients taking >5 medications were 3.3 times more likely to receive an inappropriate medication than those taking < or =5 medications (OR 3.34: 95%, CI 2.37-4.79; P<0.001). Forty-nine per cent of patients with inappropriate prescriptions were admitted with adverse effects of the inappropriate medications. Sixteen per cent of all admissions were associated with such adverse effects. CONCLUSION: IP is highly prevalent in acutely ill older patients and is associated with polypharmacy and hospitalisation. However, Beers\\' Criteria cannot be used as a gold standard as they do not comprehensively address all aspects of IP in older people.

  6. Energy storage

    International Nuclear Information System (INIS)

    2012-01-01

    After having outlined the importance of energy storage in the present context, this document outlines that it is an answer to economic, environmental and technological issues. It proposes a brief overview of the various techniques of energy storage: under the form of chemical energy (hydrocarbons, biomass, hydrogen production), thermal energy (sensitive or latent heat storage), mechanical energy (potential energy by hydraulic or compressed air storage, kinetic energy with flywheels), electrochemical energy (in batteries), electric energy (super-capacitors, superconductor magnetic energy storage). Perspectives are briefly evoked

  7. Solar applications analysis for energy storage

    Science.gov (United States)

    Blanchard, T.

    1980-01-01

    The role of energy storage as it relates to solar energy systems is considered. Storage technologies to support solar energy applications, the status of storage technologies, requirements and specifications for storage technologies, and the adequacy of the current storage research and development program to meet these requirements are among the factors discussed. Emphasis is placed on identification of where the greatest potential exists for energy storage in support of those solar energy systems which could have a significant impact on the U.S. energy mix.

  8. Development and identification of SSR markers associated with starch properties and β-carotene content in the storage root of sweet potato (Ipomoea batatas L.

    Directory of Open Access Journals (Sweden)

    Kai eZhang

    2016-03-01

    Full Text Available Sweet potato (Ipomoea batatas L. is a nutritious food crop and, based on the high starch content of its storage root, a potential bioethanol feedstock. Enhancing the nutritional value and starch quantity of storage roots are important goals of sweet potato breeding programs aimed at developing improved varieties for direct consumption, processing, and industrial uses. However, developing improved lines of sweet potato is challenging due to the genetic complexity of this plant and the lack of genome information. Short sequence repeat (SSR markers are powerful molecular tools for tracking important loci in crops and for molecular-based breeding strategies; however, few SSR markers and marker-trait associations have hitherto been identified in sweet potato. In this study, we identified 1,824 SSRs by using a de novo assembly of publicly available ESTs and mRNAs in sweet potato, and designed 1,476 primer pairs based on SSR-containing sequences. We mapped 214 pairs of primers in a natural population comprised of 239 germplasms, and identified 1,278 alleles with an average of 5.972 alleles per locus and a major allele frequency of 0.7702. Population structure analysis revealed two subpopulations in this panel of germplasms, and phenotypic characterization demonstrated that this panel is suitable for association mapping of starch-related traits. We identified 32, 16, and 17 SSR markers associated with starch content, β-carotene content, and starch composition in the storage root, respectively, using association analysis and further evaluation of a subset of sweet potato genotypes with various characteristics. The SSR markers identified here can be used to select varieties with desired traits and to investigate the genetic mechanism underlying starch and carotenoid formation in the starchy roots of sweet potato.

  9. Development and Identification of SSR Markers Associated with Starch Properties and β-Carotene Content in the Storage Root of Sweet Potato (Ipomoea batatas L.).

    Science.gov (United States)

    Zhang, Kai; Wu, Zhengdan; Tang, Daobin; Lv, Changwen; Luo, Kai; Zhao, Yong; Liu, Xun; Huang, Yuanxin; Wang, Jichun

    2016-01-01

    Sweet potato (Ipomoea batatas L.) is a nutritious food crop and, based on the high starch content of its storage root, a potential bioethanol feedstock. Enhancing the nutritional value and starch quantity of storage roots are important goals of sweet potato breeding programs aimed at developing improved varieties for direct consumption, processing, and industrial uses. However, developing improved lines of sweet potato is challenging due to the genetic complexity of this plant and the lack of genome information. Short sequence repeat (SSR) markers are powerful molecular tools for tracking important loci in crops and for molecular-based breeding strategies; however, few SSR markers and marker-trait associations have hitherto been identified in sweet potato. In this study, we identified 1824 SSRs by using a de novo assembly of publicly available ESTs and mRNAs in sweet potato, and designed 1476 primer pairs based on SSR-containing sequences. We mapped 214 pairs of primers in a natural population comprised of 239 germplasms, and identified 1278 alleles with an average of 5.972 alleles per locus and a major allele frequency of 0.7702. Population structure analysis revealed two subpopulations in this panel of germplasms, and phenotypic characterization demonstrated that this panel is suitable for association mapping of starch-related traits. We identified 32, 16, and 17 SSR markers associated with starch content, β-carotene content, and starch composition in the storage root, respectively, using association analysis and further evaluation of a subset of sweet potato genotypes with various characteristics. The SSR markers identified here can be used to select varieties with desired traits and to investigate the genetic mechanism underlying starch and carotenoid formation in the starchy roots of sweet potato.

  10. Dementia and inappropriate sexual behavior: What we know and what we need to know

    Directory of Open Access Journals (Sweden)

    Josep Fabà

    2012-06-01

    Full Text Available Traditionally, there has been no place for sexuality in older age. However, research has shown that sexuality plays an important role in older people’s life, even in situations such as dementia. The goal of the article is to review the scientific literature regarding the inappropriate sexual behavior that these kind of patients might present. In order to do so, we will firstly address the definition of inappropriate sexual behavior or, more precisely, its multiple definitions. After that, we will deal with other issues such as its prevalence, factors that can cause its appearance, its consequences and some of the available therapeutic options. Finally, in the last section some recommendations for future research will be provided, such as the need to clarify the concept of inappropriate sexual behavior, to find more efficient ways to address this problem, and the desirability of considering sexuality as a human dimension with a high potential for adaptation in old age.

  11. [Impact of potentially inappropriate drug usage on health insurance business results].

    Science.gov (United States)

    Kirschke, Malin; Böhme, Jacqueline

    2014-09-01

    In Germany a list was drawn up that included 83 potentially inappropriate drugs. The PRISCUS list published in 2010 was intended to highlight certain problems in the pharmakotherapy of elderly patients and serve as a support for improved medicine safety. Almost a third of the insurance portfolio of the HALLESCHE Krankenversicherung aged over 75 years takes drugs that are on the PRISCUS list. Benzodiazepine and Z-drugs are taken most frequently. The costs per insurant with potentially inappropriate medication are on average higher than for policyholders who do not take drugs on the PRISCUS list. The costs per insurant are rising, with an increase in the number of PRISCUS agents being taken as well. However, there is still no scientific proof that potentially inappropriate drugs lead to adverse drug events.

  12. Assessment of inappropriate antibiotic prescribing among a large cohort of general dentists in the United States.

    Science.gov (United States)

    Durkin, Michael J; Feng, Qianxi; Warren, Kyle; Lockhart, Peter B; Thornhill, Martin H; Munshi, Kiraat D; Henderson, Rochelle R; Hsueh, Kevin; Fraser, Victoria J

    2018-05-01

    The purpose of this study was to assess dental antibiotic prescribing trends over time, to quantify the number and types of antibiotics dentists prescribe inappropriately, and to estimate the excess health care costs of inappropriate antibiotic prescribing with the use of a large cohort of general dentists in the United States. We used a quasi-Poisson regression model to analyze antibiotic prescriptions trends by general dentists between January 1, 2013, and December 31, 2015, with the use of data from Express Scripts Holding Company, a large pharmacy benefits manager. We evaluated antibiotic duration and appropriateness for general dentists. Appropriateness was evaluated by reviewing the antibiotic prescribed and the duration of the prescription. Overall, the number and rate of antibiotic prescriptions prescribed by general dentists remained stable in our cohort. During the 3-year study period, approximately 14% of antibiotic prescriptions were deemed inappropriate, based on the antibiotic prescribed, antibiotic treatment duration, or both indicators. The quasi-Poisson regression model, which adjusted for number of beneficiaries covered, revealed a small but statistically significant decrease in the monthly rate of inappropriate antibiotic prescriptions by 0.32% (95% confidence interval, 0.14% to 0.50%; P = .001). Overall antibiotic prescribing practices among general dentists in this cohort remained stable over time. The rate of inappropriate antibiotic prescriptions by general dentists decreased slightly over time. From these authors' definition of appropriate antibiotic prescription choice and duration, inappropriate antibiotic prescriptions are common (14% of all antibiotic prescriptions) among general dentists. Further analyses with the use of chart review, administrative data sets, or other approaches are needed to better evaluate antibiotic prescribing practices among dentists. Copyright © 2018 American Dental Association. Published by Elsevier Inc. All

  13. The inappropriate use of lumbar magnetic resonance imaging in a health service area

    International Nuclear Information System (INIS)

    Rodriguez Recio, F. J.; Sanz, J. C.; Vera, S.; Peiro, S.

    1999-01-01

    To identify the percentage of inappropriate lumbar spine magnetic resonance imaging in the Soria Health Service, to quantify the costs and the possible association between inadequate use, the characteristics of the patient and the services requested. A descriptive study of the inappropriate use of MRI of the lumbar spine, taken from the retrospective examination, carried out by a radiologist, of the 233 MRI's requested between 1995 and 1998. For the valuation, the criteria of the American College of Radiology (ACR) and the Basque Agency for the Evaluation of Technologies (OSTEBA) were used. All the MRI's were carried out at an approved centre, the costs were calculated taken form the expenses paid by the Insalud, including the transport costs, calculated at prices applicable for the year in question. 11.7% of the studies were values as inappropriate, 2.1% debatable and the remainder adequate according to the ACR criteria, concentrating the inadequacy on studies for lumbago, that reached 80% of the inappropriate requests. The ACR and OSTEBA criteria coincided to a high degree (kappa statistics: 0.87). The expense related to the unnecessary studies was a litter higher than a million pesetas. No differences were found in the proportion of inappropriate studies according to the characteristics of the patient or the service requested, except the one already mentioned for the supposition diagnosis. Although the results of the study cannot be generalised to other environments, they suggest the possibility of a significant proportion of inappropriate use of lumbar spine MRI that could have an important repercussion on health care expenses. (Author) 11 refs

  14. Potentially inappropriate medication prescribed to elderly outpatients at a general medicine unit

    Directory of Open Access Journals (Sweden)

    Christine Grützmann Faustino

    2011-03-01

    Full Text Available Objective: To establish the prevalence of potentially inappropriate medications prescribed for elderly patients, to identify the most commonly involved drugs, and to investigate whether age, sex and number of medications were related with the prescription of these drugs. Methods: Prescriptions for 1,800 elderly patients (≥ 60 years were gathered from a database. These prescriptions were written by general physicians at a tertiary level university hospital in the city of Sao Paulo, Brazil, from February to May 2008. Only one prescription per patient was considered. The prescriptions were classified according to sex and age (60-69, 70-79 and ≥ 80. The Beers criteria (2003 version were used to evaluate potentially inappropriate medications. Results: Most of the sample comprised women (66.6% with a mean age of 71.3 years. The mean prevalence of potentially inappropriate medication prescriptions was 37.6%. The 60-69 age group presented the highest prevalence (49.9%. The most frequently prescribed potentially inappropriate medications to women were carisoprodol, amitriptyline, and fluoxetine; amitriptyline, carisoprodol, fluoxetine and clonidine were prescribed more often to men. The female sex (p<0.001; OR=2.0 and number of medications prescribed (p<0.001 were associated with prescription of potentially inappropriate medications. The chance of having a prescription of these drugs was lower among patients aged over 80 years (OR=0.7. The mean number of prescribed medications for both sexes and all age groups was 7.1. The mean number of medications per patient was higher among females (p<0.001; this result was not age-dependent (p=0.285. Conclusion: The prevalence of potentially inappropriate medications was similar to previously reported values in the literature and was correlated with the female sex. The chance of having a potentially inappropriate medication prescription was lower among patients aged over 80 years. The chance of having a

  15. Understanding inappropriate hospital admissions of patients presenting to the Emergency Department.

    Directory of Open Access Journals (Sweden)

    Roberta Siliquini

    2005-06-01

    Full Text Available

    Objectives. To identify 1 the characteristics of patients receiving non acute (inappropriate care and 2 the variables associated to inappropriate hospital use, in order to 3 estimate the relevance of the problem and to 4 focus future concurrent reviews and efforts to allocate patients to alternative health care settings.

    Design. A prospective review of a random sample of adult patients who presented to the Emergency Department of the Molinette Hospital. Patients were assessed at admission and on day 3, 5and 8 using the Appropriateness Evaluation Protocol (Italian validated version. Patients: 490 overall; 312 (64 % medical and 178 (36 % surgical.

    Outcome measures. Acute (appropriate and non acute (inappropriate admissions, Major Disease Category, costs, mean weights of Diagnosis Related Groups, and length of stay (days.

    Results. The proportion of patients requiring acute care declined rapidly from presentation (84.5% to the fifth day of admission (60.9%. Patients admitted during weekends showed a higher rate of inappropriate stay on day 5 (P=0.04. The proportion of inappropriate admissions was higher for medical rather than surgical patients (P=0.07 at presentation and at day 5 (P < 0.01. Traditional social-demographic variables were not significant risk indicators for inappropriate admissions. The likelihood ratio for inappropriate admission at presentation was significantly higher for minor illnesses and disturbances (P=0.03.

    Inappropriate stay on day 5 was significantly associated with lower cost (P < 0.01, lower mean DRG weight (P < 0.01 and shorter length of stay (P=0.05 for medical but not for surgical admissions.

    Conclusions. Traditional epidemiological indicators are inadequate to target prospective concurrent reviews. Qualitative studies focusing on patient physician dialogue in different situations and contexts could

  16. Development of laser-based techniques for identification of breached nuclear fuel elements in storage. Progress report, 1 October 1978-1 September 1979

    International Nuclear Information System (INIS)

    Anderson, R.J.; Esherick, P.

    1980-06-01

    From many possible laser-based techniques of atomic and molecular spectroscopy we have selected multiphoton ionization spectroscopy (MIS) as that one technique which best conforms to the constraints imposed by the problem of identifying breached nuclear fuel assemblies in storage. We describe experiments utilizing MIS to specifically and sensitively detect xenon (Xe) and nitric oxide (NO). We therefore experimentally demonstrate the applicability of this technique to the detection of volatile fission products leaking from breached nuclear fuel assemblies stored in water cooled basins. Even for the non-ideal circumstances of these preliminary experiments, we estimate a detection limit of 10 10 atoms/cm 3 for xenon, roughly 1% of the atmospheric content of xenon at sea level

  17. Identification and assessment of groundwater flow and storage components of the relict Schöneben Rock Glacier, Niedere Tauern Range, Eastern Alps (Austria)

    Science.gov (United States)

    Winkler, Gerfried; Wagner, Thomas; Pauritsch, Marcus; Birk, Steffen; Kellerer-Pirklbauer, Andreas; Benischke, Ralf; Leis, Albrecht; Morawetz, Rainer; Schreilechner, Marcellus G.; Hergarten, Stefan

    2016-06-01

    More than 2,600 relict rock glaciers are known in the Austrian Alps but the knowledge of their hydraulic properties is severely limited. The relict Schöneben Rock Glacier (Niedere Tauern Range, Austria), with an extension of 0.17 km2, was investigated based on spring data (2006-2014) and seismic refraction survey. Spring-discharge hydrographs and natural and artificial tracer data suggest a heterogeneous aquifer with a layered internal structure for the relict rock glacier. The discharge behavior exhibits a fast and a delayed flow component. The spring discharge responds to recharge events within a few hours but a mean residence time of several months can also be observed. The internal structure of the rock glacier (up to several tens of meters thick) consists of: an upper blocky layer with a few meters of thickness, which lacks fine-grained sediments; a main middle layer with coarse and finer-grained sediments, allowing for fast flow; and an approximately 10-m-thick basal till layer as the main aquifer body responsible for the base flow. The base-flow component is controlled by (fine) sandy to silty sediments with low hydraulic conductivity and high storage capacity, exhibiting a difference in hydraulic conductivity to the upper layer of about three orders of magnitude. The high storage capacity of relict rock glaciers has an impact on water resources management in alpine catchments and potentially regulates the risk of natural hazards such as floods and related debris flows. Thus, the results highlight the importance of such aquifer systems in alpine catchments.

  18. Neutron storage

    International Nuclear Information System (INIS)

    Strelkov, A.V.

    2004-01-01

    The report is devoted to neutron storage (NS) and describes the history of experiments on the NS development. Great attention is paid to ultracold neutron (UCN) storage. The experiments on the UCN generation, transport, spectroscopy, storage and detection are described. Experiments on searching the UCN electric-dipole moment and electric charge are continued. Possible using of UCN for studying the nanoparticles is discussed [ru

  19. Energy storage

    International Nuclear Information System (INIS)

    Odru, P.

    2010-01-01

    This book proposes a broad overview of the technologies developed in the domains of on-board electricity storage (batteries, super-capacitors, flywheels), stationary storage (hydraulic dams, compressed air, batteries and hydrogen), and heat storage (sensible, latent and sorption) together with their relative efficiency, their expected developments and what advantages they can offer. Eminent specialists of this domain have participated to the redaction of this book, all being members of the Tuck's Foundation 'IDees' think tank. (J.S.)

  20. Energy storage

    CERN Document Server

    Brunet, Yves

    2013-01-01

    Energy storage examines different applications such as electric power generation, transmission and distribution systems, pulsed systems, transportation, buildings and mobile applications. For each of these applications, proper energy storage technologies are foreseen, with their advantages, disadvantages and limits. As electricity cannot be stored cheaply in large quantities, energy has to be stored in another form (chemical, thermal, electromagnetic, mechanical) and then converted back into electric power and/or energy using conversion systems. Most of the storage technologies are examined: b

  1. Tritium storage

    International Nuclear Information System (INIS)

    Hircq, B.

    1989-01-01

    A general synthesis about tritium storage is achieved in this paper and a particular attention is given to practical application in the Fusion Technology Program. Tritium, storage under gaseous form and solid form are discussed (characteristics, advantages, disadvantages and equipments). The way of tritium storage is then discussed and a choice established as a function of a logic which takes into account the main working parameters

  2. Development of new taxonomy of inappropriate communication and its application to operating teams in nuclear power plants

    International Nuclear Information System (INIS)

    Kim, Ar Ryum; Lee, Seung Woo; Jang, In Seok; Kang, Hyun Gook; Seong, Poong Hyun; Park, Jin Kyun

    2012-01-01

    Inappropriate communications can cause a lack of necessary information exchange between operators and lead to serious consequences in large process systems such as nuclear power plants (NPPs). In this regard, various kinds of taxonomies of inappropriate communications have been developed to prevent inappropriate communications. However, there seems to be difficult to identify inappropriate communications from verbal protocol data between operators. Because the existing taxonomies were developed for use in report analysis, there is a problem of 'uncertainty'. In consequence, this paper proposes a new taxonomy of inappropriate communications and provides some insights to prevent inappropriate communications. In order to develop the taxonomy, existing taxonomies for four industries from 1980 to 2010 were collected and a new taxonomy is developed based on the simplified one-way communication model. In addition, the ratio of inappropriate communications from 8 samples of audio-visual format verbal protocol data recorded during emergency training sessions by operating teams is compared with performance scores calculated based on the task analysis. As a result, inappropriate communications can be easily identified from the verbal protocol data using the suggested taxonomy, and teams with a higher ratio of inappropriate communications tend to have a lower performance score.

  3. Development of new taxonomy of inappropriate communication and its application to operating teams in nuclear power plants

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ar Ryum; Lee, Seung Woo; Jang, In Seok; Kang, Hyun Gook; Seong, Poong Hyun [Dept. of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of); Park, Jin Kyun [Integrated Safety Assessment Division, Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2012-12-15

    Inappropriate communications can cause a lack of necessary information exchange between operators and lead to serious consequences in large process systems such as nuclear power plants (NPPs). In this regard, various kinds of taxonomies of inappropriate communications have been developed to prevent inappropriate communications. However, there seems to be difficult to identify inappropriate communications from verbal protocol data between operators. Because the existing taxonomies were developed for use in report analysis, there is a problem of 'uncertainty'. In consequence, this paper proposes a new taxonomy of inappropriate communications and provides some insights to prevent inappropriate communications. In order to develop the taxonomy, existing taxonomies for four industries from 1980 to 2010 were collected and a new taxonomy is developed based on the simplified one-way communication model. In addition, the ratio of inappropriate communications from 8 samples of audio-visual format verbal protocol data recorded during emergency training sessions by operating teams is compared with performance scores calculated based on the task analysis. As a result, inappropriate communications can be easily identified from the verbal protocol data using the suggested taxonomy, and teams with a higher ratio of inappropriate communications tend to have a lower performance score.

  4. Inappropriate gestational weight gain among teenage pregnancies: prevalence and pregnancy outcomes.

    Science.gov (United States)

    Vivatkusol, Yada; Thavaramara, Thaovalai; Phaloprakarn, Chadakarn

    2017-01-01

    To study the prevalence and pregnancy outcomes of inappropriate gestational weight gain (GWG) among teenage pregnant women. A retrospective descriptive study was conducted on 2,165 teenage pregnant women who attended our antenatal clinic between January 2007 and August 2015. Adverse pregnancy outcomes, including maternal and neonatal outcomes of women with inappropriate GWG, including underweight and overweight, were studied and compared with those of women with appropriate GWG. Complete data of 1,943 women were obtained. Among these women, the mean age was 17.4±1.4 years and mean body mass index at first visit was 19.1±3.0 kg/m 2 . The prevalence of inappropriate GWG was 61.7%. Underweight women were more likely to experience anemia and preterm delivery, whereas overweight women required more cesarean sections because of cephalopelvic disproportion and preeclampsia, compared to women with appropriate weight gain (all P teenage pregnancies showed inappropriate GWG. GWG had a significant impact on pregnancy outcomes.

  5. Improving Inappropriate Social Behavior of Autistic Students Using the LISTEN Intervention Strategy

    Science.gov (United States)

    Al-Shammari, Zaid; Daniel, Cathy; Faulkner, Paula; Yawkey, Thomas D.

    2010-01-01

    A case study was conducted on the development of the LISTEN intervention strategy for use with autistic students to improve inappropriate social behaviors. The study was conducted in a special education classroom in an autism school in Kuwait. Examination of LISTEN Intervention Strategy applications included: duration of targeted behavior; methods…

  6. Unveiling common responses of Medicago truncatula to appropriate and inappropriate rust species

    Science.gov (United States)

    Vaz Patto, Maria Carlota; Rubiales, Diego

    2014-01-01

    Little is known about the nature of effective defense mechanisms in legumes to pathogens of remotely related plant species. Some rust species are among pathogens with broad host range causing dramatic losses in various crop plants. To understand and compare the different host and nonhost resistance (NHR) responses of legume species against rusts, we characterized the reaction of the model legume Medicago truncatula to one appropriate (Uromyces striatus) and two inappropriate (U. viciae-fabae and U. lupinicolus) rusts. We found that similar pre and post-haustorial mechanisms of resistance appear to be operative in M. truncatula against appropriate and inappropriate rust fungus. The appropriate U. striatus germinated better on M. truncatula accessions then the inappropriate U. viciae-fabae and U. lupinicolus, but once germinated, germ tubes of the three rusts had a similar level of success in finding stomata and forming an appressoria over a stoma. However, responses to different inappropriate rust species also showed some specificity, suggesting a combination of non-specific and specific responses underlying this legume NHR to rust fungi. Further genetic and expression analysis studies will contribute to the development of the necessary molecular tools to use the present information on host and NHR mechanisms to breed for broad-spectrum resistance to rust in legume species. PMID:25426128

  7. Teaching Women with Intellectual Disabilities to Identify and Report Inappropriate Staff-to-Resident Interactions

    Science.gov (United States)

    Bollman, Jessica R.; Davis, Paula K.

    2009-01-01

    This study examined the effectiveness of behavioral skills training in teaching 2 adult women with mild intellectual disabilities to report inappropriate staff-to-resident interactions. The reporting skill included making a self-advocacy response, walking away, and reporting the interaction. Participants' performance was measured during baseline,…

  8. Inappropriate implantable cardioverter-defibrillator shocks in Brugada syndrome: Pattern in primary and secondary prevention

    Directory of Open Access Journals (Sweden)

    Aimé Bonny

    2017-01-01

    Conclusion: Inappropriate shock is common in Brugada syndrome during the early periods after an ICD implantation, and seems to be more likely in asymptomatic patients. This finding may warrant a review of the indications for ICD implantation, especially in the young and apparently healthy population of patients with Brugada syndrome.

  9. Inappropriate complementary feeding practice increases risk of stunting in children aged 12-24 months

    Directory of Open Access Journals (Sweden)

    Hijra Hijra

    2016-12-01

    Inappropriate complementary feeding practice increased the risk of stunting in 12-24 months old children by 8.26. This study confirms the need to scale up interventions during the first 2 years of life, including appropriate infant feeding practices.

  10. Potentially Inappropriate Medication Use Among Elderly Home Care Patients in Europe

    Czech Academy of Sciences Publication Activity Database

    Fialová, D.; Topinková, E.; Gambassi, G.; Finne-Soveri, H.; Jónsson, P.; Carpenter, I.; Schroll, M.; Onder, G.; Sorbye, L.W.; Wagner, C.; Reissigová, Jindra; Bernabei, R.

    2005-01-01

    Roč. 293, č. 11 (2005), s. 1348-1358 ISSN 0098-7484 Institutional research plan: CEZ:AV0Z10300504 Keywords : potentially inappropriate medication * prevalence * independent correlates Subject RIV: FQ - Public Health Care , Social Medicine Impact factor: 23.332, year: 2005 http://jama.ama-assn.org/cgi/content/abstract/293/11/1348

  11. Using an Electronic Highlighter to Eliminate the Negative Effects of Pre-Existing, Inappropriate Highlighting

    Science.gov (United States)

    Gier, Vicki; Kreiner, David; Hudnell, Jason; Montoya, Jodi; Herring, Daniel

    2011-01-01

    The purpose of the present experiment was to determine whether using an active learning technique, electronic highlighting, can eliminate the negative effects of pre-existing, poor highlighting on reading comprehension. Participants read passages containing no highlighting, appropriate highlighting, or inappropriate highlighting. We hypothesized…

  12. An Action Research Study of Intellectual Disabilities, Inappropriate Behaviors and Learned Helplessness

    Science.gov (United States)

    Luper, Elizabeth P. S.; Lockley, Jeannie

    2008-01-01

    This study focused on a population of 36 female patients, aged 25 to 65, who were diagnosed with intellectual disabilities, all of whom had long-standing patterns of inappropriate behaviors. In an attempt to increase more appropriate behaviors in these patients, a set of standardized contingency rules were established. These rules were implemented…

  13. Performance Costs when Emotion Tunes Inappropriate Cognitive Abilities: Implications for Mental Resources and Behavior

    Science.gov (United States)

    Storbeck, Justin

    2012-01-01

    Emotion tunes cognition, such that approach-motivated positive states promote verbal cognition, whereas withdrawal-motivated negative states promote spatial cognition (Gray, 2001). The current research examined whether self-control resources become depleted and influence subsequent behavior when emotion tunes an inappropriate cognitive tendency.…

  14. Unveiling common responses of Medicago truncatula to appropriate and inappropriate rust species

    Directory of Open Access Journals (Sweden)

    Maria Carlota eVaz Patto

    2014-11-01

    Full Text Available Little is known about the nature of effective defense mechanisms in legumes to pathogens of remotely related plant species. Some rust species are among pathogens with broad host range causing dramatic losses in various crop plants. To understand and compare the different host and nonhost resistance responses of legume species against rusts, we characterized the reaction of the model legume Medicago truncatula to one appropriate (Uromyces striatus and two inappropriate (U. viciae-fabae and U. lupinicolus rusts. We found that similar pre and post-haustorial mechanisms of resistance appear to be operative in M. truncatula against appropriate and inappropriate rust fungus. The appropriate U. striatus germinated better on M. truncatula accessions then the inappropriate U. viciae-fabae and U. lupinicolus, but once germinated, germ tubes of the three rusts had a similar level of success in finding stomata and forming an appressoria over a stoma. However responses to different inappropriate rust species also showed some specificity, suggesting a combination of non specific and specific responses underlying this legume nonhost resistance to rust fungi. Further genetic and expression analysis studies will contribute to the development of the necessary molecular tools to use the present information on host and nonhost resistance mechanisms to breed for broad-spectrum resistance to rust in legume species.

  15. Statin therapy reduces inappropriate shock in non-ischemic patients with mild heart failure

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine H.; Zareba, Wojciech; Jons, Christian

    2013-01-01

    tachycardia zone of 170 to 199 bpm (arm A), high-rate cutoff with a ventricular tachycardia zone ≥200 bpm (arm B), or 60-second-delayed therapy (arm C). The end points of inappropriate therapy, appropriate therapy, and death were assessed among 485 patients with and 998 without diabetes mellitus. Innovative...

  16. Prevalence of inappropriate medication using Beers criteria in Japanese long-term care facilities

    DEFF Research Database (Denmark)

    Niwata, Satoko; Yamada, Yukari; Ikegami, Naoki

    2006-01-01

    dependent on the disease or condition was found in patients with chronic constipation. Multiple logistic regression analysis revealed psychotropic drug use (OR = 1.511), medication cost of per day (OR = 1.173), number of medications (OR = 1.140), and age (OR = 0.981) as factors related to inappropriate...

  17. Potentially inappropriate medication use among institutionalized elderly individuals in southeastern Brazil

    Directory of Open Access Journals (Sweden)

    Mauro Cunha Xavier Pinto

    2013-12-01

    Full Text Available In recent decades, the elderly population in Brazil has grown rapidly, as has concern for the health of this population. Institutionalization in nursing homes has appeared as an alternative form of health care for frail elderly that live alone. The present study evaluated the pharmacotherapy and inappropriate drug prescriptions for institutionalized elderly patients living in long-term institutions in southeastern Brazil. This research was conducted at five institutions with a total sample of 151 individuals aged at least 60 years. Databases were used to identify drug interactions, defined daily dose and inappropriate prescriptions. The prevalence of drug intake among the elderly was 95.36%, and there were an average of 3.31 ± 1.80 drug prescriptions per individual. Based on Beers criteria, the prevalence of inappropriate prescriptions was 25.83%. In addition, 70.2% of prescriptions were prescribed at a higher dosage than the defined daily dose (ATC/WHO. Potential drug interactions were identified for 54.11% of prescriptions; 81.42% of these were of moderate severity. The main inappropriate drugs were prescribed for cardiovascular and nervous system problems. Institutionalized elderly individuals presented a high consumption and misuse of medications, requiring professional intervention to monitor prescriptions and improve the quality of service for this population.

  18. Inappropriate use of urinary catheters and its common complications in different hospital wards

    Directory of Open Access Journals (Sweden)

    Parivash Davoodian

    2012-01-01

    Full Text Available Inappropriate use of indwelling urinary catheters (IUCs and their related complications is one of the most important problems in hospital wards. The aim of this study was to evaluate inappropriate use of IUCs and their complications among patients in Tehran, Iran. Two hundred and six consecutive patients hospitalized in the intensive care unit (ICU as well as medical and surgical wards at the Shahid Mohammadi Hospital in Bandarabbas from September 1 to 30, 2005 and in whom IUCs were used, were studied. Data collected included age of the patients, diagnoses, reason for use of IUC and the complications related to it. Overall, 164 patients (79.6% had IUCs used appropriately while 42 of them (20.6% were catheterized unjustifiably. Inappropriate use of IUCs in the ICU, medical and surgical wards was reported in 12 (18.5%, 16 (19.0% and 14 patients (24.6%, respectively. The most common complication of IUCs was urinary tract infection, which occurred in 91 patients (44.2% and hematuria, which was seen in 3.9% of the patients. Our study suggests that inappropriate use of IUCs is prevalent, particularly in the surgical wards, and the most common complication observed was catheter-associated urinary tract infection.

  19. Inappropriate shock delivery by implantable cardioverter defibrillator due to electrical interference with washing machine.

    Science.gov (United States)

    Chongtham, Dhanaraj Singh; Bahl, Ajay; Kumar, Rohit Manoj; Talwar, K K

    2007-05-31

    We report a patient with hypertrophic cardiomyopathy who received an inappropriate implantable cardioverter defibrillator shock due to electrical interference from a washing machine. This electrical interference was detected as an episode of ventricular fibrillation with delivery of shock without warning symptoms.

  20. Electromagnetic Interference from Swimming Pool Generator Current Causing Inappropriate ICD Discharges

    Directory of Open Access Journals (Sweden)

    Edward Samuel Roberto

    2017-01-01

    Full Text Available Electromagnetic interference (EMI includes any electromagnetic field signal that can be detected by device circuitry, with potentially serious consequences: incorrect sensing, pacing, device mode switching, and defibrillation. This is a unique case of extracardiac EMI by alternating current leakage from a submerged motor used to recycle chlorinated water, resulting in false rhythm detection and inappropriate ICD discharge. A 31-year-old female with arrhythmogenic right ventricular cardiomyopathy and Medtronic dual-chamber ICD placement presented after several inappropriate ICD shocks at the public swimming pool. Patient had never received prior shocks and device was appropriate at all regular follow-ups. Intracardiac electrograms revealed unique, high-frequency signals at exactly 120 msec suggestive of EMI from a strong external source of alternating current. Electrical artifact was incorrectly sensed as a ventricular arrhythmia which resulted in discharge. ICD parameters including sensing, pacing thresholds, and impedance were all normal suggesting against device malfunction. With device failure and intracardiac sources excluded, EMI was therefore strongly suspected. Avoidance of EMI source brought complete resolution with no further inappropriate shocks. After exclusion of intracardiac interference, device malfunction, and abnormal settings, extracardiac etiologies such as EMI must be thoughtfully considered and excluded. Elimination of inappropriate shocks is to “first, do no harm.”

  1. Age-Related Differences in Judgments of Inappropriate Behavior are Related to Humor Style Preferences

    Science.gov (United States)

    Stanley, Jennifer Tehan; Lohani, Monika; Isaacowitz, Derek M.

    2014-01-01

    Identifying social gaffes is important for maintaining relationships. Older adults are less able than young to discriminate between socially appropriate and inappropriate behavior in video clips. One open question is how these social appropriateness ratings relate to potential age differences in the perception of what is actually funny or not. In the present study, young, middle-aged, and older adults were equally able to discriminate between appropriate and inappropriate social behavior in a diverse set of clips relevant to both age groups. However, young and middle-aged adults rated the gaffe clips as funnier than control clips and young adults smiled more during the inappropriate clips than the control clips. Older adults did not show this pattern, suggesting that they did not find the inappropriate clips funny. Additionally, young adults endorsed a more aggressive humor style than middle-aged and older adults and aggressive humor style endorsement mediated age differences in social appropriateness ratings. Results are discussed in terms of possible mechanisms such as cohort differences in humor and developmental prioritization of certain humor styles, as well as the importance of investigating age differences in both abilities and preferences. PMID:25244473

  2. Inappropriate and Excessive Guilt: Instrument Validation and Developmental Differences in Relation to Depression

    Science.gov (United States)

    Tilghman-Osborne, Carlos; Cole, David A.; Felton, Julia W.

    2012-01-01

    Inappropriate or excessive guilt is listed as a symptom of depression by the American Psychiatric Association ("1994"). Although many measures of guilt have been developed, definitional and operational problems exist, especially in the application of such measures in childhood and adolescence. To address these problems, the current study…

  3. [The forensic medical aspects of the inappropriate medical care in the modern-day Ukraine].

    Science.gov (United States)

    Franchuk, V V

    2018-01-01

    Despite the fact that the ever growing relevance of the problem of the inappropriate medical care was long ago brought to the worldwide attention, it has not been practically addressed in the Ukraine since the country gained independence in 1991. The objective of the present study was to consider the specific features of expert examination of the cases of inappropriate medical care as exemplified by the materials of the legal actions and lawsuits instituted against healthcare specialists violating their occupational duties. The results of forensic medical examination by the local Bureaux of forensic medical expertise concerning the 350 so-called malpractice suits instituted in the Ternopol, Zhitomir, and Chernovtsy regions during the period from 207 to 2016 were available for the analysis. The facts of inadequate and inappropriate medical care were documented in 245 (72.0%) cases. The frequency of diagnostic and therapeutic errors amounted to 29.7% and 26.9% respectively while the improper formulation of the medical documentation was recorded in 21.3% of the cases. The cases of poor organization of the diagnostic and treatment process accounted for 14.6% of the total whereas the improper behaviour of the medical personnel was reported in 7.5% of all the known cases of provision of the healthcare services. It is concluded that in the majority of the cases, the citizens of the modern-day Ukraine receive the inappropriate (insufficient and untimely) medical care. Over 80% of the cases of the inappropriate medical care currently provided in the country can be accounted for by the objective reasons, with each fifths case being due to the violation of professional responsibilities by the healthcare providers.

  4. [Reasons for inappropriate prescribing of antibiotics in a high-complexity pediatric hospital].

    Science.gov (United States)

    Ruvinsky, Silvina; Mónaco, Andrea; Pérez, Guadalupe; Taicz, Moira; Inda, Laura; Kijko, Ivana; Constanzo, Patricia; Bologna, Rosa

    2011-12-01

    Determine the reasons for inappropriate prescription of antibiotics and identify opportunities to improve prescription of these drugs in pediatric patients hospitalized in intermediate and intensive care units. A prospective, descriptive longitudinal study was conducted of pediatric patients in intermediate and intensive care units who received parenteral administration of antibiotics, with the exception of newborns, burn unit patients, and surgical prophylaxis patients. A univariate analysis and multiple logistic regression were performed. A total of 376 patients with a median of age of 50 months were studied (interquartile range [IQR] 14.5-127 months). Out of the total patients studied, 75% had one or more underlying conditions. A total of 40.6% of these patients had an oncologic pathology and 33.5% had neurological conditions. The remaining 25.9% had other underlying conditions. Antibiotic treatment was inappropriate in 35.6% of the patients studied (N = 134). In 73 (54.4%) of the 134 cases, inappropriate use was due to the type of antibiotic prescribed, the dose administered, or the treatment period. The 61 (45.5%) remaining cases did not require antibiotic treatment. In the multivariate analysis, the risk factors for inappropriate use of antibiotics were: administration of ceftriaxone OR 2 (95% CI, 1.3-3.7; P = 0.02); acute lower respiratory tract infection OR 1.8 (95% CI, 1.1-3.3; P < 0.04); onset of fever of unknown origin in hospital inpatients OR 5.55 (95% CI, 2.5-12; P < 0.0001); and febrile neutropenia OR 0.3 (95% CI, 0.1-0.7; P = 0.009). Inappropriate use of antibiotics was less common in the clinical conditions that were well-characterized. Prescribing practices that could be improved were identified through the preparation and circulation of guidelines for antibiotic use in hospital inpatients.

  5. Probe Storage

    NARCIS (Netherlands)

    Gemelli, Marcellino; Abelmann, Leon; Engelen, Johannes Bernardus Charles; Khatib, M.G.; Koelmans, W.W.; Zaboronski, Olog; Campardo, Giovanni; Tiziani, Federico; Laculo, Massimo

    2011-01-01

    This chapter gives an overview of probe-based data storage research over the last three decades, encompassing all aspects of a probe recording system. Following the division found in all mechanically addressed storage systems, the different subsystems (media, read/write heads, positioning, data

  6. Comparative Transcriptomic Analysis in Paddy Rice under Storage and Identification of Differentially Regulated Genes in Response to High Temperature and Humidity.

    Science.gov (United States)

    Zhao, Chanjuan; Xie, Junqi; Li, Li; Cao, Chongjiang

    2017-09-20

    The transcriptomes of paddy rice in response to high temperature and humidity were studied using a high-throughput RNA sequencing approach. Effects of high temperature and humidity on the sucrose and starch contents and α/β-amylase activity were also investigated. Results showed that 6876 differentially expressed genes (DEGs) were identified in paddy rice under high temperature and humidity storage. Importantly, 12 DEGs that were downregulated fell into the "starch and sucrose pathway". The quantitative real-time polymerase chain reaction assays indicated that expression of these 12 DEGs was significantly decreased, which was in parallel with the reduced level of enzyme activities and the contents of sucrose and starch in paddy rice stored at high temperature and humidity conditions compared to the control group. Taken together, high temperature and humidity influence the quality of paddy rice at least partially by downregulating the expression of genes encoding sucrose transferases and hydrolases, which might result in the decrease of starch and sucrose contents.

  7. Identification and characterization of finger millet OPAQUE2 transcription factor gene under different nitrogen inputs for understanding their role during accumulation of prolamin seed storage protein.

    Science.gov (United States)

    Gaur, Vikram Singh; Kumar, Lallan; Gupta, Supriya; Jaiswal, J P; Pandey, Dinesh; Kumar, Anil

    2018-03-01

    In this study, we report the isolation and characterization of the mRNA encoding OPAQUE2 (O2) like TF of finger millet (FM) ( Eleusine coracana) ( EcO2 ). Full-length EcO2 mRNA was isolated using conserved primers designed by aligning O2 mRNAs of different cereals followed by 3' and 5' RACE (Rapid Amplification of cDNA Ends). The assembled full-length EcO2 mRNA was found to contain an ORF of 1248-nt coding the 416 amino acids O2 protein. Domain analysis revealed the presence of the BLZ and bZIP-C domains which is a characteristic feature of O2 proteins. Phylogenetic analysis of EcO2 protein with other bZIP proteins identified using finger millet transcriptome data and O2 proteins of other cereals showed that EcO2 shared high sequence similarity with barley BLZ1 protein. Transcripts of EcO2 were detected in root, stem, leaves, and seed development stages. Furthermore, to investigate nitrogen responsiveness and the role of EcO2 in regulating seed storage protein gene expression, the expression profiles of EcO2 along with an α-prolamin gene were studied during the seed development stages of two FM genotypes (GE-3885 and GE-1437) differing in grain protein content (13.8 and 6.2%, respectively) grown under increasing nitrogen inputs. Compared to GE-1437, the EcO2 was relatively highly expressed during the S2 stage of seed development which further increased as nitrogen input was increased. The Ecα - prolamin gene was strongly induced in the high protein genotype (GE-3885) at all nitrogen inputs. These results indicate the presence of nitrogen responsiveness regulatory elements which might play an important role in accumulating protein in FM genotypes through modulating EcO2 expression by sensing plant nitrogen status.

  8. Explicit versus implicit evaluation to detect inappropriate medication use in geriatric outpatients.

    Science.gov (United States)

    Bahat, Gulistan; Ilhan, Birkan; Bay, Ilker; Kilic, Cihan; Kucukdagli, Pinar; Oren, Meryem Merve; Karan, Mehmet Akif

    2018-04-19

    The rates and reasons why clinicians decide not to follow recommendations from explicit-criteria have been studied scarce. We aimed to compare STOPP version 2 representing one of the most commonly used excplicit tool with the implicit comprehensive geriatric assessment mediated clinical evaluation considered as gold standard. Two hundred and six (n = 206) outpatients ≥65 years old were included. The study was designed as retrospective, cross-sectional, and randomised. STOPP version 2 criteria were systematically used to assess pre-admission treatments followed by implicit clinical evaluation regarding two questions: Were the STOPP criteria recommendations valid for the individual patient and were there any potentially inappropriate-prescription other than depicted by STOPP version 2 criteria? The underlying reason(s) and associated clinical-features were noted. About 62.6% potentially inappropriate-prescriptions were identified (0.6 per-subject) according to systematic application of STOPP v2 while it was 53.4% (0.5 potentially inappropriate-prescriptions per subject) by clinician's application of STOPP v2. Prevalence of non-compliance was 14.7% in 18 (21.7%) of 83 patients identified by systematic application. Suggestion to stop a drug was not accepted because of need of treatment despite likelihood of anticipated side-effects in about 2/3 and with no-anticipated side-effects in about 1/3 of non-compliances. Not following STOPP v2 was significantly associated with lower functional level. According to clinician's implicit-evaluation, there were an extra 59.2% potentially inappropriate-prescriptions (0.6 per subject) in 80 (38.8%) patients yielding a total of 112.6% potentially inappropriate-prescription. Most of the STOPP v2 directed drug cessations are decided valid by the clinicians. In patients with higher functional dependency, it is likely that they are not followed due to palliation focussed care/patient-family preferences. There may be as much as STOPP

  9. Potentially inappropriate medications defined by STOPP criteria and the risk of adverse drug events in older hospitalized patients.

    LENUS (Irish Health Repository)

    Hamilton, Hilary

    2011-06-13

    Previous studies have not demonstrated a consistent association between potentially inappropriate medicines (PIMs) in older patients as defined by Beers criteria and avoidable adverse drug events (ADEs). This study aimed to assess whether PIMs defined by new STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) criteria are significantly associated with ADEs in older people with acute illness.

  10. Brief Report: Reduction of Inappropriate Vocalizations for a Child with Autism Using a Self-Management Treatment Program.

    Science.gov (United States)

    Mancina, Catherine; Tankersley, Melody; Kamps, Debra; Kravits, Tammy; Parrett, Jean

    2000-01-01

    A study examined the effects of a self-management program used to reduce high rates of inappropriate vocalizations (e.g., humming, tongue clucking, perseveration, and echolalic words/phases) in a 12-year-old girl with autism. When self-management was applied to inappropriate vocalizations during leisure, prevocational, and reading tasks, the…

  11. Energy storage

    Energy Technology Data Exchange (ETDEWEB)

    1962-07-01

    The papers on energy storage problems, given to the United Nations Conference on New Sources of Energy, Rome, 1961, are reviewed. Many aspects of the subject are discussed: comparisons between the costs of storing energy in batteries and in fuel cells; the use, efficiency and expected improvement of fuel cells; the principles involved in the chemical conversion of solar energy to chemical energy; the use of metal hydride fuel cells; the chemical conversion and storage of concentrated solar energy for which the solar furnace is used for photochemical reactions. Finally, the general costs of storing energy in any form and delivering it are analyzed with particular reference to storage batteries and fuel cells.

  12. Identification and understanding the factors affecting the public and political acceptance of long term storage of spent fuel and high-level radioactive wastes

    International Nuclear Information System (INIS)

    Gorea, Valica

    2006-01-01

    , during the storage. There is a powerful scientific and technical consensus according to which a well placed final repository must be provided with some barriers, including the geological and engineered ones. The wide-spread and accepted concept of final repository for spent fuel and high level waste is the so-called geological disposal which means the solid radioactive waste storage in underground repositories in a stable geological structure (ordinary at some hundreds of meters deep) so ensuring the isolation of radionuclides from biosphere on long term. The types of radioactive waste (high level and long life waste) which will be placed in geological repository are established by the national strategy and politics for the safe management of the radioactive waste. The development and implementation process of a repository can be achieved in the next non compulsory steps: - Developing the national politics in the field of safe management of the radioactive waste - Developing the legislative and institutional framework - Developing the technical concept of geological repository - Initiation of underground and surface investigations for the characterization of the host rock - Selecting the suitable site for an underground repository - Design, licensing for construction (which takes into account the environmental impact, nuclear safety and so on), operation and shut down. The decision to construct a geological repository must be taken by the Government or by the producers of waste. The steps for the establishing the legal framework, regulation and licensing are prerogatives of the Government, all the others steps could be achieved by non governmental organizations. The achievement of a geological repository, from the technical concept to the operation may last even more than 50 years and its operation some hundreds years. The paper contains the following sections: 1. Introduction; 2. Public and political acceptance; 3. Factors which affect the public and political

  13. Urea for long-term treatment of syndrome of inappropriate secretion of antidiuretic hormone.

    Science.gov (United States)

    Decaux, G; Genette, F

    1981-10-24

    The efficacy of oral urea in producing a sufficiently high osmotic diuresis was tested in seven patients with the syndrome of inappropriate secretion of antidiuretic hormone. In all patients urea corrected the hyponatraemia despite a normal fluid intake. Five patients were controlled (serum sodium concentration greater than 128 mmol(mEq)/1) with a dose of 30 g urea daily, and two with 60 g daily. The patients who needed 30 g drank 1-2 1 of fluid daily, while those who needed 60 g drank up to 3.1 per day. No major side effects were noted, even after treatment periods of up to 270 days. These findings suggest that urea is a safe and efficacious treatment of the syndrome of inappropriate secretion of antidiuretic hormone.

  14. Collecting duct renal cell carcinoma with the syndrome of inappropriate antidiuresis: An autopsy case report

    Directory of Open Access Journals (Sweden)

    Emi Yasuda

    2013-01-01

    Full Text Available A 57-year-old Japanese man visited our hospital with a moist cough. Chest radiographic imaging showed a left hilar shadow. Adenocarcinoma cells were found on cytologic screening of fresh sputum. Although multiple metastases including brain were detected, no tumor was observed in the kidneys. The patient underwent whole-brain irradiation and chemotherapy for advanced-stage lung cancer. One month before his death, carcinomatous meningitis was detected. Hyponatremia, hypo-osmolality, and hypertonic urine suggested the syndrome of inappropriate antidiuresis. Restricting water intake improved the hyponatremia; however, he developed fever and hematuria. Despite systemic administration of an antibacterial drug, he died. Primary tumor in the lung was absent, but adenocarcinoma of the right kidney was evident on autopsy. Lectin histochemical analysis of the carcinoma revealed its distal nephron origin, confirming collecting duct carcinoma. Severe carcinomatous meningitis, which is possibly caused the syndrome of inappropriate antidiuresis, was observed, with no cancer involvement of the pituitary gland and hypothalamus.

  15. Long-Term Outcomes in a Family with Nephrogenic Syndrome of Inappropriate Antidiuresis

    Directory of Open Access Journals (Sweden)

    Yoon Hi Cho

    2009-01-01

    Full Text Available We report a familial case of the nephrogenic syndrome of inappropriate antidiuresis (NSIAD, including 30-year followup data on two patients. The proband and one maternal uncle presented in their infancy with severe recurrent hyponatremia, and clinical pictures consistent with the syndrome of inappropriate antidiuretic hormone (SIADH in the absence of an elevated ADH level. They were both confirmed to be hemizygous for the R137C mutation on the V2R gene (AVPR2, the same locus of the gain of function mutation demonstrated in the original reports of this condition. The proband's mother was identified as an asymptomatic carrier of this X-linked condition. Our case describes a favourable long-term outcome for NSIAD, in particular, successful treatment with oral urea during the infancy period, and with self-regulated precautions on fluid intake into adult life.

  16. Long-Term Outcomes in a Family with Nephrogenic Syndrome of Inappropriate Antidiuresis

    Directory of Open Access Journals (Sweden)

    Rosenthal Stephen

    2009-12-01

    Full Text Available We report a familial case of the nephrogenic syndrome of inappropriate antidiuresis (NSIAD, including 30-year followup data on two patients. The proband and one maternal uncle presented in their infancy with severe recurrent hyponatremia, and clinical pictures consistent with the syndrome of inappropriate antidiuretic hormone (SIADH in the absence of an elevated ADH level. They were both confirmed to be hemizygous for the R137C mutation on the V2R gene (AVPR2, the same locus of the gain of function mutation demonstrated in the original reports of this condition. The proband's mother was identified as an asymptomatic carrier of this X-linked condition. Our case describes a favourable long-term outcome for NSIAD, in particular, successful treatment with oral urea during the infancy period, and with self-regulated precautions on fluid intake into adult life.

  17. Clinical analysis of asthenopia caused by wearing inappropriate glasses in college students

    Directory of Open Access Journals (Sweden)

    Li Wang

    2015-01-01

    Full Text Available AIM: To proposed control measures by exploring visual fatigue caused by college students wearing inappropriate glasses.METHODS: A total of 124 cases of asthenopia patients underwent optometry students audition, checked the original spectacles; TOPCON-CL100 computer center was used to checked the original mirror glasses(glasses, the distance between the optical center; with near vision as the standard examination table nearly with vergence and regulation near point, and checked the visual function. RESULTS: All 124 cases(248 eyeshad refractive errors, 77% were spherical mirror and 69% column mirror with error ≥±0.50D, and the pupil center distance from the lens had significant difference(U=5.27, PCONCLUSION: Students wearing inappropriate spectacle asthenopia is caused by one of the main scientific wearing glasses can effectively control asthenopia.

  18. Sudden Onset of Life-Threatening Methaemoglobinaemia After Intake of Inappropriately Stored Vegetable (Collard Greens Meal in a 2.5-Year-Old Child

    Directory of Open Access Journals (Sweden)

    Ozlem Cakmak Yilmaz

    2015-06-01

    Full Text Available Acquired methaemoglobinaemia most commonly occurs due to intake of or contact to certain drugs, such as local anesthetics. However, intake of certain vegetables which are essential for a healthy diet may also cause methaemoglobinaemia due to their high nitrate or nitrite content, and prolonged and inappropriate storage after preparation of vegetable meals increases the risk. We present a 2.5-year-old girl with Down's syndrome who presented with central cyanosis due to severe methaemoglobinemiae with a methaemoglobin level of 62% after intake of collard greens (Brassica oleracea var. acephala soup. Although development of methaemoglobinaemia after food intake has been reported rarely before, recognition of this potentially life-threatening condition early in its course may be life-saving. [Cukurova Med J 2015; 40(2.000: 353-357

  19. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries.

    Science.gov (United States)

    Renom-Guiteras, Anna; Meyer, Gabriele; Thürmann, Petra A

    2015-07-01

    The aim of the study was to develop a European list of potentially inappropriate medications (PIM) for older people, which can be used for the analysis and comparison of prescribing patterns across European countries and for clinical practice. A preliminary PIM list was developed, based on the German PRISCUS list of potentially inappropriate medications and other PIM lists from the USA, Canada and France. Thirty experts on geriatric prescribing from Estonia, Finland, France, the Netherlands, Spain and Sweden participated; eight experts performed a structured expansion of the list, suggesting further medications; twenty-seven experts participated in a two-round Delphi survey assessing the appropriateness of drugs and suggesting dose adjustments and therapeutic alternatives. Finally, twelve experts completed a brief final survey to decide upon issues requiring further consensus. Experts reached a consensus that 282 chemical substances or drug classes from 34 therapeutic groups are PIM for older people; some PIM are restricted to a certain dose or duration of use. The PIM list contains suggestions for dose adjustments and therapeutic alternatives. The European Union (EU)(7)-PIM list is a screening tool, developed with participation of experts from seven European countries, that allows identification and comparison of PIM prescribing patterns for older people across European countries. It can also be used as a guide in clinical practice, although it does not substitute the decision-making process of individualised prescribing for older people. Further research is needed to investigate the feasibility and applicability and, finally, the clinical benefits of the newly developed list.

  20. A case of appropriate inappropriate device therapy: Hyperkalemia-induced ventricular oversensing

    OpenAIRE

    Oudit, Gavin Y; Cameron, Doug; Harris, Louise

    2008-01-01

    The present case describes a patient who received inappropriate, but potentially life-saving, therapy from her implantable cardioverter defibrillator (ICD) in the setting of acute hyperkalemia (plasma potassium concentration = 8 mM). Hyperkalemia was associated with the development of a slow sinusoidal ventricular tachycardia, at a rate of 100 beats/min to 125 beats/min (610 ms to 480 ms) in a patient who is pacemaker-dependent. There was associated fractionation of the ICD electrogram and T ...

  1. Short notes and reviews Simplifying hydrozoan classification: inappropriateness of the group Hydroidomedusae in a phylogenetic context

    OpenAIRE

    Marques, Antonio C.

    2001-01-01

    The systematics of Hydrozoa is considered from the viewpoint of logical consistency between phylogeny and classification. The validity of the nominal taxon Hydroidomedusae (including all groups of Hydrozoa except the Siphonophorae) is discussed with regard to its distinctness and inclusive relationships. In general, phylogenetic systematic evidence suggest that the use of the term Hydroidomedusae is inappropriate given our current level of understanding. It is concluded that no new, or resurr...

  2. Morvan syndrome: a rare cause of syndrome of inappropriate antidiuretic hormone secretion

    OpenAIRE

    DEMIRBAS, SEREF; AYKAN, MUSA BARIS; ZENGIN, HAYDAR; MAZMAN, SEMIR; SAGLAM, KENAN

    2017-01-01

    The syndrome of inappropriate antidiuretic hormone secretion (SIADH) accounts for an important part of hyponatremia cases. The causes of SIADH can be detected almost always. As a rare disorder, Morvan Syndrome can be defined by the sum of peripheral nerve hyperexcitability, autonomic instability and neuropsychiatric features. Antibodies to voltage-gated potassium channels (Anti ? VGKC-Ab) including contactin associated protein-like 2 antibodies (CASPR2-Ab) and leucine-rich glioma inactivated ...

  3. Impact of oncology-related direct-to-consumer advertising: association with appropriate and inappropriate prescriptions.

    Science.gov (United States)

    Abel, Gregory A; Chen, Kun; Taback, Nathan; Hassett, Michael J; Schrag, Deborah; Weeks, Jane C

    2013-03-01

    Little is known about the impact of direct-to-consumer advertising (DTCA) on appropriate versus inappropriate prescribing. Aromatase inhibitor (AI) therapy for breast cancer provides an ideal paradigm for studying this issue, because AIs have been the focus of substantial DTCA, and because they should only be used in postmenopausal women, age can serve as a simple surrogate marker of appropriateness. Data regarding national DTCA spending for the AIs were obtained from TNS Multimedia; hormonal therapy prescription data were obtained from IMS Health. Time series analyses were performed to characterize the association between monthly changes in DTCA spending for the AIs and monthly changes in the proportion of all new hormonal therapy prescriptions represented by the AIs from October 2005 to September 2007. Analyses were stratified by age, considering prescriptions for women ≤ 40 (likely premenopausal) to be inappropriate and those for women > 60 (likely postmenopausal) to be appropriate. Monthly dollars spent on AI-associated DTCA varied considerably ($118,600 to $22,019,660). Time series analysis revealed that for every million dollars spent on DTCA for the AIs, there was an associated increase 3 months later in the new AI prescription proportion of 0.15% for all ages (P 60 years (P < .0001), but no significant change for those ≤ 40 at any time from 0 to 6 months. DTCA for the AIs was associated with increases in appropriate prescriptions with no significant effect on inappropriate prescriptions, suggesting that DTCA may not foster inappropriate medication use for certain drug classes. Copyright © 2012 American Cancer Society.

  4. Potentially inappropriate prescribing and cost outcomes for older people: a national population study.

    LENUS (Irish Health Repository)

    Cahir, Caitriona

    2010-05-01

    Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP.

  5. An automated technique to identify potential inappropriate traditional Chinese medicine (TCM) prescriptions.

    Science.gov (United States)

    Yang, Hsuan-Chia; Iqbal, Usman; Nguyen, Phung Anh; Lin, Shen-Hsien; Huang, Chih-Wei; Jian, Wen-Shan; Li, Yu-Chuan

    2016-04-01

    Medication errors such as potential inappropriate prescriptions would induce serious adverse drug events to patients. Information technology has the ability to prevent medication errors; however, the pharmacology of traditional Chinese medicine (TCM) is not as clear as in western medicine. The aim of this study was to apply the appropriateness of prescription (AOP) model to identify potential inappropriate TCM prescriptions. We used the association rule of mining techniques to analyze 14.5 million prescriptions from the Taiwan National Health Insurance Research Database. The disease and TCM (DTCM) and traditional Chinese medicine-traditional Chinese medicine (TCMM) associations are computed by their co-occurrence, and the associations' strength was measured as Q-values, which often referred to as interestingness or life values. By considering the number of Q-values, the AOP model was applied to identify the inappropriate prescriptions. Afterwards, three traditional Chinese physicians evaluated 1920 prescriptions and validated the detected outcomes from the AOP model. Out of 1920 prescriptions, 97.1% of positive predictive value and 19.5% of negative predictive value were shown by the system as compared with those by experts. The sensitivity analysis indicated that the negative predictive value could improve up to 27.5% when the model's threshold changed to 0.4. We successfully applied the AOP model to automatically identify potential inappropriate TCM prescriptions. This model could be a potential TCM clinical decision support system in order to improve drug safety and quality of care. Copyright © 2016 John Wiley & Sons, Ltd.

  6. Evaluation of potentially inappropriate medications among older residents of Malaysian nursing homes.

    Science.gov (United States)

    Chen, Li Li; Tangiisuran, Balamurugan; Shafie, Asrul Akmal; Hassali, Mohamed Azmi Ahmad

    2012-08-01

    There is an increasing evidence of medicines related issues such as inappropriate prescribing among older people. Inappropriate prescribing is an important risk factor for adverse drug reactions and hospitalizations in the older people. To assess and characterize the prevalence of Potentially Inappropriate Medications (PIMs) in nursing home care in Malaysia as defined by Screening Tool of Older Peoples Prescriptions (STOPP) and Beers criteria. Four Nursing Homes situated in Penang, Malaysia. A multicenter and cross-sectional study was conducted over 2 months period at four large non-governmental organizations nursing homes in Penang, Malaysia. The study population included older residents (≥65 years old) taking at least one medication. Residents who had been diagnosed with dementia or taking anti dementia drugs, delirium, too frail or refused to give consent were excluded. Demographic, clinical data and concurrent medications were collected through direct interview and also by reviewing medical records. STOPP and Beers criteria were applied in the medical review to screen for PIMs. Potentially Inappropriate Medication using STOPP and Beers criteria. Two hundred eleven residents were included in the study with the median age of 77 (inter quartile range (IQR) 72-82) years. Median number of prescription medicines was 4 (IQR 1-14). STOPP identified less residents (50 residents, 23.7 %) being prescribed on PIMs compared with Beers criteria (69 residents, 32.7 %) (p older residents living in the nursing homes and are associated with number of medications and longer nursing home stay. Further research is warranted to study the impact of PIMs towards health related outcomes in these elderly.

  7. Congenital short QT syndrome and implantable cardioverter defibrillator treatment: inherent risk for inappropriate shock delivery.

    Science.gov (United States)

    Schimpf, Rainer; Wolpert, Christian; Bianchi, Francesca; Giustetto, Carla; Gaita, Florenzo; Bauersfeld, Urs; Borggrefe, Martin

    2003-12-01

    A congenital short QT interval constitutes a new primary electrical abnormality associated with syncope and/or sudden cardiac death. We report on the initial use of implantable cardioverter defibrillator (ICD) therapy in patients with inherited short QT interval and discuss sensing abnormalities and detection issues. In five consecutive patients from two unrelated European families who had structurally normal hearts, excessively shortened QT intervals, and a strong positive family history of sudden cardiac death, ICDs were placed for primary and secondary prevention. Mean QT intervals were 252 +/- 13 ms (QTc 287 +/- 13 ms). Despite normal sensing behavior during intraoperative and postoperative device testing, 3 of 5 patients experienced inappropriate shock therapies for T wave oversensing 30 +/- 26 days after implantation. Programming lower sensitivities and decay delays prevented further inappropriate discharges. The congenital short QT syndrome constitutes a new clinical entity with an increased risk for sudden cardiac death. Currently, ICD treatment is the only therapeutic option. In patients with short QT interval and implanted ICD, increased risk for inappropriate therapy is inherent due to the detection of short-coupled and prominent T waves. Careful testing of ICD function and adaptation of sensing levels and decay delays without sacrificing correct arrhythmia detection are essential.

  8. Inappropriate drug donations: what has happened since the 1999 WHO guidelines?

    Science.gov (United States)

    van Dijk, D P; Dinant, G; Jacobs, J A

    2011-08-01

    Drug donations to developing countries may be part of medical relief operations in acute emergencies, development aid in non-emergency situations, or a corporate donations programme. After a number of documented inappropriate drug donations, the World Health Organization developed the 'Guidelines for Drug Donations', with the second and final version published in 1999. We reviewed the medical literature on drug donations since the Guidelines publication in 1999. Literature was retrieved from PubMed and other on-line databases as well as from relevant websites providing medical literature for use in developing countries. We considered the following donations to be inappropriate: (i) essential drugs in excessive quantities; (ii) mixed unused drugs (unsorted medicines and free samples); and (iii) drug dumping (large quantities of useless medicines). We retrieved 25 publications dated after 1999, including 20 and 5 from the scientific literature and 'grey' literature (technical reports, working papers), respectively. New information concerned emergencies in East Timor, Mozambique, El Salvador, Gujarat State (India), Aceh (Indonesia) and Sri Lanka. Except for East Timor and Gujarat, inappropriate donations still occurred, accounting for 85%, 37%, 70% and 80% of donations in Mozambique, El Salvador, Aceh and Sri Lanka, respectively. Very little information was found on drug donations in non-emergency situations. There are few recent reports on the compliance of drug donations with the World Health Organization guidelines. For emergency situations, there is still room for improvement. Drug donations in non-emergency situations need to be evaluated. A reform of drug donations policy is needed.

  9. The syndrome of inappropriate antidiuretic hormone secretion after giant leaf frog (Phyllomedusa bicolor) venom exposure.

    Science.gov (United States)

    Leban, Vid; Kozelj, Gordana; Brvar, Miran

    2016-09-15

    In Europe body purification and natural balance restoring rituals are becoming increasingly popular, but an introduction of Amazonian shamanic rituals in urban Europe can result in unexpected adverse events. A 44-year-old woman attended a Kambô or Sapo ritual in Slovenia where dried skin secretion from a giant leaf frog (Phyllomedusa bicolor) was applied to five freshly burned wounds at her shoulder. Afterwards, she drank 6 litres of water and gradually developed nausea and vomiting, confusion, lethargy, muscle weakness, spasms and cramps, seizure, decreased consciousness level and short-term memory loss. The initial laboratory tests showed profound plasma hypoosmolality (251 mOsm/kg) proportional to hyponatremia (116 mmol/L) combined with inappropriately elevated urine osmolality (523 mOsm/kg) and high urine sodium concentration (87 mmol/L) indicating a syndrome of inappropriate antidiuretic hormone secretion. The patient was treated with 0.9% sodium chloride and a restriction of water intake. Plasma osmolality and hyponatremia improved one day after venom exposure, but the symptoms disappeared as late as the third day. In patients presenting with neurological symptoms and a line of small body burns Phyllomedusa bicolor venom exposure should be suspected. Acute symptomatic hyponatremia after Phyllomedusa bicolor venom exposure is the result of inappropriate antidiuretic hormone secretion that can be exacerbated by excessive water intake. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Amusia results in abnormal brain activity following inappropriate intonation during speech comprehension.

    Science.gov (United States)

    Jiang, Cunmei; Hamm, Jeff P; Lim, Vanessa K; Kirk, Ian J; Chen, Xuhai; Yang, Yufang

    2012-01-01

    Pitch processing is a critical ability on which humans' tonal musical experience depends, and which is also of paramount importance for decoding prosody in speech. Congenital amusia refers to deficits in the ability to properly process musical pitch, and recent evidence has suggested that this musical pitch disorder may impact upon the processing of speech sounds. Here we present the first electrophysiological evidence demonstrating that individuals with amusia who speak Mandarin Chinese are impaired in classifying prosody as appropriate or inappropriate during a speech comprehension task. When presented with inappropriate prosody stimuli, control participants elicited a larger P600 and smaller N100 relative to the appropriate condition. In contrast, amusics did not show significant differences between the appropriate and inappropriate conditions in either the N100 or the P600 component. This provides further evidence that the pitch perception deficits associated with amusia may also affect intonation processing during speech comprehension in those who speak a tonal language such as Mandarin, and suggests music and language share some cognitive and neural resources.

  11. Amusia results in abnormal brain activity following inappropriate intonation during speech comprehension.

    Directory of Open Access Journals (Sweden)

    Cunmei Jiang

    Full Text Available Pitch processing is a critical ability on which humans' tonal musical experience depends, and which is also of paramount importance for decoding prosody in speech. Congenital amusia refers to deficits in the ability to properly process musical pitch, and recent evidence has suggested that this musical pitch disorder may impact upon the processing of speech sounds. Here we present the first electrophysiological evidence demonstrating that individuals with amusia who speak Mandarin Chinese are impaired in classifying prosody as appropriate or inappropriate during a speech comprehension task. When presented with inappropriate prosody stimuli, control participants elicited a larger P600 and smaller N100 relative to the appropriate condition. In contrast, amusics did not show significant differences between the appropriate and inappropriate conditions in either the N100 or the P600 component. This provides further evidence that the pitch perception deficits associated with amusia may also affect intonation processing during speech comprehension in those who speak a tonal language such as Mandarin, and suggests music and language share some cognitive and neural resources.

  12. Identification of soils susceptible to risk erosion and with hight capacity of water storage Identificación de suelos susceptibles a riesgos de erosión y con mayor capacidad de almacenamiento de agua

    Directory of Open Access Journals (Sweden)

    Escobar Chalarca Carlos Alberto

    2007-09-01

    Full Text Available The investigation was carried out in seven methodological steps under integral approaches, holistic analysis, logical sequence, participation and simplicity. The following aspects were highlighted: Conceptualization and contextualizacion, soil sampling , data processing, data spacializatión of the information, identification of susceptible areas to risk erosion with higher capacity of water storage, management norms and socialization of the investigation. The methodological proposal was validated and adjusted by a case of study in the rural areas of Chicoral, watershed of the Bitaco river, Municipality of La Cumbre, Cauca Valley , Colombia. Using participation processes and agreement with the communities of the study area, the diagnostic of the causes and consequences that intervene in processes of physical soil degradation were reached. At the same time, the places with higher potentiality of water storage were localized. All of these factors are important for planning and rational use of the natural resources in a watershed.La investigación se basó en el desarrollo de siete etapas metodológicas con criterios de integralidad, análisis holístico, secuencia lógica, participación y sencillez, destacándose los siguientes aspectos: Conceptualización y contextualización, muestreo de suelos, procesamiento de la información, espacialización de la información, identificación de zonas susceptibles a riesgos de erosión y con mayor capacidad de almacenamiento de agua, recomendaciones de manejo y socialización de la investigación. La propuesta metodológica se validó y ajustó mediante un caso de estudio en la vereda Chicoral, subcuenca del río Bitaco, municipio de La Cumbre, Valle del Cauca, Colombia. Mediante procesos de participación y concertación con los actores socioeconómicos del área de estudio se lograron diagnosticar las causas

  13. Identificación de suelos susceptibles a riesgos de erosión y con mayor capacidad de almacenamiento de agua Identification of soils susceptible to risk erosion and with hight capacity of water storage

    Directory of Open Access Journals (Sweden)

    Velásquez Valencia Henry

    Full Text Available La investigación se basó en el desarrollo de siete etapas metodológicas con criterios de integralidad, análisis holístico, secuencia lógica, participación y sencillez, destacándose los siguientes aspectos: Conceptualización y contextualización, muestreo de suelos, procesamiento de la información, espacialización de la información, identificación de zonas susceptibles a riesgos de erosión y con mayor capacidad de almacenamiento de agua, recomendaciones de manejo y socialización de la investigación. La propuesta metodológica se validó y ajustó mediante un caso de estudio en la vereda Chicoral, subcuenca del río Bitaco, municipio de La Cumbre, Valle del Cauca, Colombia. Mediante procesos de participación y concertación con los actores socioeconómicos del área de estudio se lograron diagnosticar las causas y consecuencias que intervienen en procesos de degradación física del suelo y a la vez se localizaron los sitios con mayor potencialidad de almacenamiento de agua, factores importantes para la planificación y uso racional de los recursos naturales en una cuenca hidrográfica.The investigation was carried out in seven methodological steps under integral approaches, holistic analysis, logical sequence, participation and simplicity. The following aspects were highlighted: Conceptualization and contextualizacion, soil sampling , data processing, data spacializatión of the information, identification of susceptible areas to risk erosion with higher capacity of water storage, management norms and socialization of the investigation. The methodological proposal was validated and adjusted by a case of study in the rural areas of Chicoral, watershed of the Bitaco river, Municipality of La Cumbre, Cauca Valley, Colombia. Using participation processes and agreement with the communities of the study area, the diagnostic of the causes and consequences that intervene in processes of physical soil degradation were reached. At the same

  14. Potentially inappropriate medications in elderly Japanese patients: effects of pharmacists' assessment and intervention based on Screening Tool of Older Persons' Potentially Inappropriate Prescriptions criteria ver.2.

    Science.gov (United States)

    Kimura, T; Ogura, F; Yamamoto, K; Uda, A; Nishioka, T; Kume, M; Makimoto, H; Yano, I; Hirai, M

    2017-04-01

    The Screening Tool of Older Persons' Potentially Inappropriate Prescriptions (stopp) criteria were updated in 2014 (stopp criteria ver.2), but few studies have evaluated the usefulness of stopp criteria in elderly patients. This prospective observational study evaluated the prevalence of potentially inappropriate medications (PIMs), and the efficacy of hospital pharmacists' assessment and intervention based on stopp criteria ver.2. The study was conducted at three medical units of Kobe University Hospital between April 2015 and March 2016. Pharmacists assessed and detected PIMs based on stopp criteria ver.2 and considered the patient's intention to change the prescription at the time of admission of each patient. If the pharmacists judged that benefits outweighed risks of prescription change and the patients consented to change the medications, they recommended the doctor to change the prescription. If there was a risk of exacerbation of disease by the change of medications and the pharmacists judged it to be difficult to adjust medications during hospitalization or the patients did not consent to change the medications, they did not recommend to change it. The pharmacists and the doctors discussed and finally decided whether to change the PIMs or not. The number of patients prescribed PIMs, the number and contents of PIMs, and the number of medications changed after pharmacists' intervention were calculated. Totally, 822 new inpatients aged ≥65 years prescribed ≥1 daily medicine were included. Their median (interquartile range) age was 75·0 (71·0-80·0) years, and 54·9% were male. According to the criteria, 346 patients (42·1%) were prescribed ≥1 PIMs. Patients prescribed PIMs took significantly more medications than others: 10·0 (7·0-13·0) vs. 6·0 (4·0-9·0), P older people (benzodiazepines) (30/67) and (iii) drugs that predictably increase the risk of falls in older people (hypnotic Z-drugs) (15/31). Over 40% elderly patients were prescribed PIMs

  15. Inappropriate pharmacological treatment in older adults affected by cardiovascular disease and other chronic comorbidities: a systematic literature review to identify potentially inappropriate prescription indicators

    Directory of Open Access Journals (Sweden)

    Lucenteforte E

    2017-10-01

    Full Text Available Ersilia Lucenteforte,1 Niccolò Lombardi,1,* Davide Liborio Vetrano,2,* Domenico La Carpia,2,* Zuzana Mitrova,3 Ursula Kirchmayer,3 Giovanni Corrao,4 Francesco Lapi,5 Alessandro Mugelli,1 Alfredo Vannacci1 On behalf of the Italian Group for Appropriate Drug prescription in the Elderly (I-GrADE 1Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA, University of Florence, Florence, Italy; 2Department of Geriatrics Catholic University, Rome, Italy; 3Department of Epidemiology, ASL 1 Rome, Italy; 4Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; 5Epidemiology Unit, ARS Toscana, Florence, Italy *These authors contributed equally to this work Abstract: Avoiding medications in which the risks outweigh the benefits in the elderly patient is a challenge for physicians, and different criteria to identify inappropriate prescription (IP exist to aid prescribers. Definition of IP indicators in the Italian geriatric population affected by cardiovascular disease and chronic comorbidities could be extremely useful for prescribers and could offer advantages from a public health perspective. The purpose of the present study was to identify IP indicators by means of a systematic literature review coupled with consensus criteria. A systematic search of PubMed, EMBASE, and CENTRAL databases was conducted, with the search structured around four themes and combining each with the Boolean operator “and”. The first regarded “prescriptions”, the second “adverse events”, the third “cardiovascular conditions”, and the last was planned to identify studies on “older people”. Two investigators independently reviewed titles, abstracts, full texts, and selected articles addressing IP in the elderly affected by cardiovascular condition using the following inclusion criteria: studies on people aged ≥65 years; studies on patients with no restriction on age but with data on subjects

  16. Energy Storage

    CSIR Research Space (South Africa)

    Bladergroen, B

    2015-10-01

    Full Text Available In commercial arena, the most recent developments in EES are in electrochemical storage, singling out Li-ion batteries and Vanadium Redox flow batteries, while power-to-gas/-fuels (electrolysis of water into hydrogen and subsequent methanisation...

  17. Liver Storage

    African Journals Online (AJOL)

    1971-10-23

    Oct 23, 1971 ... The need for whole-organ preservation has become in- cre.asingly important ... ideally fulfil the same purpose as the circulation of blood through the body, ... Hepatic hypothermia produced by the introduction of cold electrolyte ... Recently, we reported successful hypothermic immersion storage for up to 8 ...

  18. Dry storage

    International Nuclear Information System (INIS)

    Arnott, Don.

    1985-01-01

    The environmental movement has consistently argued against disposal of nuclear waste. Reasons include its irretrievability in the event of leakage, the implication that reprocessing will continue and the legitimacy attached to an expanding nuclear programme. But there is an alternative. The author here sets out the background and a possible future direction of a campaign based on a call for dry storage. (author)

  19. A qualitative examination of inappropriate hospital admissions and lengths of stay

    Directory of Open Access Journals (Sweden)

    Hammond Christina L

    2009-03-01

    Full Text Available Abstract Background Research has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions. We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group. Methods Two focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach. Results The participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS, including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations. Conclusion Clinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed.

  20. Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.

    Science.gov (United States)

    Fried, Terri R; Niehoff, Kristina M; Street, Richard L; Charpentier, Peter A; Rajeevan, Nallakkandi; Miller, Perry L; Goldstein, Mary K; O'Leary, John R; Fenton, Brenda T

    2017-10-01

    To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. Randomized clinical trial. Primary care clinics at a Veterans Affairs Medical Center. Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The

  1. Proximal femoral osteosarcoma: Diagnostic challenges translate into delayed and inappropriate management.

    Science.gov (United States)

    Dahan, M; Anract, P; Babinet, A; Larousserie, F; Biau, D

    2017-11-01

    The proximal femuris is an uncommon site of osteosarcoma. The unusual manifestations at this site may lead to diagnostic and therapeutic mistakes. We therefore performed a retrospective study to estimate the proportions of patients with imaging study findings and/or clinical manifestations typical for osteosarcoma and/or inappropriate treatment decisions. Proximal femoral osteosarcoma often produces atypical clinical and radiological presentations. Consecutive patients who underwent surgery at our center to treat proximal femoral osteosarcoma were included. For each patient, we collected the epidemiological characteristics, clinical symptoms, imaging study findings, treatment, and tumor outcome. Proportions were computed with their confidence intervals. Twelve patients had surgery for proximal femoral osteosarcoma between 1986 and 2015. Imaging findings were typical in 1 (8%) patient; they consisted of ill-defined osteolysis in 11/12 (92%) patients, a periosteal reaction in 1/12 (8%) patient, soft tissue involvement in 7/12 (58%) patients, and immature osteoid matrix in 11/12 (92%) patients. No patient had the typical combination of pain with a soft tissue swelling. Management was inappropriate in 2/12 (17%) patients, who did not undergo all the recommended imaging studies before surgery and were treated in another center before the correct diagnosis was established. At last follow-up, 4 patients had died (after a mean of 7 years) and 8 were alive (after a mean of 4 years). Proximal femoral osteosarcoma is uncommon and rarely produces the typical clinical and imaging study findings. The atypical presentation often results in diagnostic errors and inappropriate treatments. Ill-defined osteolysis on standard radiographs should prompt computed tomography or magnetic resonance imaging of the proximal femur. Treatment in a specialized center is imperative. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Quetiapine effective in treatment of inappropriate sexual behavior of lewy body disease with predominant frontal lobe signs.

    Science.gov (United States)

    Prakash, Ravi; Pathak, Amit; Munda, Sanjay; Bagati, Dhruv

    2009-01-01

    Dementia of Lewy body disease is the second most common degenerative cause of dementia after Alzheimer's disease, among all the dementias. The core features are a progressive dementia, fluctuations in cognitive functions, visual hallucinations, and spontaneous parkinsonism. Rapid eye movement sleep behavior disorder, severe neuroleptic sensitivity, and low dopamine transporter uptake in basal ganglia are other suggestive features. Behavioral abnormalities are commonly present in the form of aggressive behavior, irritability, and uninhibited behaviors. These are mostly seen in the advanced stages of dementia. However, inappropriate sexual behavior is uncommonly seen in such cases. Three types of inappropriate sexual behaviors commonly found in cases of dementia are sex talks, sexual acts, and implied sexual acts. Such inappropriate sexual behaviors have not been described adequately in dementia of Lewy body disease. We report inappropriate sexual behaviors in a case of dementia of Lewy body disease, which improved rapidly after treatment with quetiapine.

  3. Hypertrophic Pachymeningitis and the Syndrome of Inappropriate Antidiuretic Hormone Secretion: Coincidence or Cause?

    Science.gov (United States)

    Harsch, Igor Alexander; Schiffer, Anne; Konturek, Peter C

    2017-01-01

    To investigate a potential cause of the syndrome of inappropriate antidiuretic hormone secretion (SIADH). A 70-year-old female patient had nausea and collapsed. Although euvolemic, pathological laboratory findings showed hyponatremia and hypoosmolality, and cerebral magnetic resonance imaging showed hypertrophic pachymeningitis. Secondary hypertrophic pachymeningitis was excluded. Other nonneurological reasons for SIADH were also excluded. Moderate fluid restriction restored an almost normal serum osmolality and sodium. This case of SIADH was conservatively treated with moderate fluid restriction that almost restored normal serum osmolality and sodium levels. © 2017 S. Karger AG, Basel.

  4. Morvan syndrome: a rare cause of syndrome of inappropriate antidiuretic hormone secretion.

    Science.gov (United States)

    Demirbas, Seref; Aykan, Musa Baris; Zengin, Haydar; Mazman, Semir; Saglam, Kenan

    2017-01-01

    The syndrome of inappropriate antidiuretic hormone secretion (SIADH) accounts for an important part of hyponatremia cases. The causes of SIADH can be detected almost always. As a rare disorder, Morvan Syndrome can be defined by the sum of peripheral nerve hyperexcitability, autonomic instability and neuropsychiatric features. Antibodies to voltage-gated potassium channels (Anti - VGKC-Ab) including contactin associated protein-like 2 antibodies (CASPR2-Ab) and leucine-rich glioma inactivated protein 1 antibodies (LGI1-Ab) were previously known for the potential association with this condition. We present a Morvan Syndrome in a patient who presented with various neuropsychiatric symptoms and SIADH.

  5. Inappropriate emergency laboratory test ordering: defensive or peer evidence shared based medicine?

    Directory of Open Access Journals (Sweden)

    C. Descovich

    2013-05-01

    Full Text Available BACKGROUND The laboratory overuse is widely prevalent in hospital practice, mostly in the emergency care. Reasons for excessive and inappropriate test-ordering include defensive behaviour and fear or uncertainty, lack of experience, the misuse of protocols and guidelines, “routine” and local attitudes, inadequate educational feedback and clinician’s unawareness about the cost of examinations and their related implications. AIM OF THE STUDY AND METHODS The primary target of our working group was to reduce inappropriate ordering on a urgent basis test, implementing further examinations not yet previewed in the hospital panel of the available urgencies, according to the evidence based diagnosis concept. The secondary goal was to indicate strategies of re-engineering of the processes, improving turnaround time in the laboratory management of emergencies. After evaluating, as first intervention, the more reliable sources for practice guidelines, systematic reviews and RCTs, the committee further discussed main topics with in-hospital stakeholders, selected from Emergency, Internal Medicine and Surgery Depts. The working group, in many subsequent audits, tried to obtain a systematic feed back with all involved professionals. RESULTS After reviewing literature’s evidence, the board constrained testing options by defining the basic emergency laboratory panel tests (blood type, hemogram, blood urea nitrogen, plasma creatinine, glucose, sodium, potassium, chloride, osmolarity, CRP, bicarbonate, CPK, creatine phosphokinase-MB, myoglobin, troponin, BNP and NT-proBNP, PT-INR, PTT, D-dimer, beta- HCG, biochemical urinalysis etc.. As final result, the proposed tests reduced the overall number of inappropriate investigations and increased, with newer and updated tests, the available panel for critical patients. DISCUSSION A collegiate review of data reporting, in-hospital deepening of problems and the inter- professional discussion of the evidences

  6. Storage Rings

    International Nuclear Information System (INIS)

    Fischer, W.

    2010-01-01

    Storage rings are circular machines that store particle beams at a constant energy. Beams are stored in rings without acceleration for a number of reasons (Tab. 1). Storage rings are used in high-energy, nuclear, atomic, and molecular physics, as well as for experiments in chemistry, material and life sciences. Parameters for storage rings such as particle species, energy, beam intensity, beam size, and store time vary widely depending on the application. The beam must be injected into a storage ring but may not be extracted (Fig. 1). Accelerator rings such as synchrotrons are used as storage rings before and after acceleration. Particles stored in rings include electrons and positrons; muons; protons and anti-protons; neutrons; light and heavy, positive and negative, atomic ions of various charge states; molecular and cluster ions, and neutral polar molecules. Spin polarized beams of electrons, positrons, and protons were stored. The kinetic energy of the stored particles ranges from 10 -6 eV to 3.5 x 10 12 eV (LHC, 7 x 10 12 eV planned), the number of stored particles from one (ESR) to 1015 (ISR). To store beam in rings requires bending (dipoles) and transverse focusing (quadrupoles). Higher order multipoles are used to correct chromatic aberrations, to suppress instabilities, and to compensate for nonlinear field errors of dipoles and quadrupoles. Magnetic multipole functions can be combined in magnets. Beams are stored bunched with radio frequency systems, and unbunched. The magnetic lattice and radio frequency system are designed to ensure the stability of transverse and longitudinal motion. New technologies allow for better storage rings. With strong focusing the beam pipe dimensions became much smaller than previously possible. For a given circumference superconducting magnets make higher energies possible, and superconducting radio frequency systems allow for efficient replenishment of synchrotron radiation losses of large current electron or positron beams

  7. Underground Storage Tanks - Storage Tank Locations

    Data.gov (United States)

    NSGIC Education | GIS Inventory — A Storage Tank Location is a DEP primary facility type, and its sole sub-facility is the storage tank itself. Storage tanks are aboveground or underground, and are...

  8. The Blunt Tool: Inappropriateness of the Concept of Transition for the Analyses of Democratic Consolidation

    Directory of Open Access Journals (Sweden)

    Dražen Lalić

    2010-01-01

    Full Text Available The article is analyzing the inappropriateness of the “classical” theories of transition for the analyses of democratic consolidation in the contemporary post-communist societies, including the Croatian one. The authors are claiming that the aforementioned theories are insufficient for a subtle explanation of the recent ongoing major political and social changes in the post-communist societies. The article is stressing the most characteristic examples of the “bluntness”, i.e. of the inappropriateness of the transition theory basic concepts for the analyses of democratic consolidation, as well as of the socio-cultural and socio-structural assumptions and other important concepts related to the post-communist transition phenomenon. Furthermore, the article is exposing the problems connected with various interpretations of the phases of the transition period in relation to the cleavage between the institutional constitution of the democratic system and the democratic deficit characteristic of the post-communist states. Finally, the article is bolding the necessity of re-conceptualization of the basic concepts of the theory of transition; however, not towards the construction of a new theory, but rather towards the adaptation of the existing theory to the recent social and political processes in the contemporaneous post-communist societies.

  9. Lean Methodology Reduces Inappropriate Use of Antipsychotics for Agitation at a Psychiatric Hospital.

    Science.gov (United States)

    Goga, Joshana K; Depaolo, Antonio; Khushalani, Sunil; Walters, J Ken; Roca, Robert; Zisselman, Marc; Borleis, Christopher

    2017-01-01

    To Evaluate the Effects of Applying Lean Methodology-Improving Quality Increasing Efficiency by Eliminating Waste and Reducing Costs-An Approach To Decrease the Prescribing Frequency of Antipsychotics for The Indication of Agitation. Historically Controlled Study. Bheppard Pratt Health System is the Largest Private Provider of Psychiatric Care in Maryland With a Total Bed Capacity of 300. There Were 4 337 Patient Days From November 1 2012 to October 31 2013 on the Dementia Unit. All Patients Admitted on the Dementia Unit Were 65 Years of Age and Older with a Primary Diagnosis of Dementia. our Multidisciplinary Team Used Lean Methodology to Identify the Root Causes and Interventions Necessary to Reduce Inappropriate Antipsychotic Use. The Primary Outcome Was Rate of Inappropriately Indicating Agitation as the Rationale When Prescribing Antipsychotic Medications. There Was a 90% (P Agitation. The Lean Methodology Interventions Led To A 90% (P Agitation and a 10% Rate Reduction in Overall Antipsychotic Prescribing. Key Words: Agitation Alzheimer's Antipsychotics Behavioral and Psychological Symptoms of Dementia Centers For Medicare & Medicaid Services Dementia Root-cause Analysis. BPSD = Behavioral and Psychological Symptoms of Dementia CATIE-AD = Clinical Antipsychotic Trials of Intervention Effectiveness in Alzheimer's Disease EMR = Electronic Medical Records GAO = Government Accountability Office GNCIS = Geriatric Neuropsychiatric Clinical Indicator Scale.

  10. Rooting out institutional corruption to manage inappropriate off-label drug use.

    Science.gov (United States)

    Rodwin, Marc A

    2013-01-01

    Prescribing drugs for uses that the FDA has not approved - off-label drug use - can sometimes be justified but is typically not supported by substantial evidence of effectiveness. At the root of inappropriate off-label drug use lie perverse incentives for pharmaceutical firms and flawed oversight of prescribing physicians. Typical reform proposals such as increased sanctions for manufacturers might reduce the incidence of unjustified off-label use, but they do not remove the source of the problem. Public policy should address the cause and control the practice. To manage inappropriate off-label drug use, off-label prescriptions must be tracked in order to monitor the risks and benefits and the manufacturers' conduct. Even more important, reimbursement rules should be changed so that manufacturers cannot profit from off-label sales. When off-label sales pass a critical threshold, manufacturers should also be required to pay for independent testing of the safety and effectiveness of off-label drug uses and for the FDA to review the evidence. Manufacturers should also finance, under FDA supervision, programs designed to warn physicians and the public about the risks of off-label drug use. © 2013 American Society of Law, Medicine & Ethics, Inc.

  11. Excess Baggage for Birds: Inappropriate Placement of Tags on Gannets Changes Flight Patterns

    Science.gov (United States)

    Vandenabeele, Sylvie P.; Grundy, Edward; Friswell, Michael I.; Grogan, Adam; Votier, Stephen C.; Wilson, Rory P.

    2014-01-01

    Devices attached to flying birds can hugely enhance our understanding of their behavioural ecology for periods when they cannot be observed directly. For this, scientists routinely attach units to either birds' backs or their tails. However, inappropriate payload distribution is critical in aircraft and, since birds and planes are subject to the same laws of physics during flight, we considered aircraft aerodynamic constraints to explain flight patterns displayed by northern gannets Sula bassana equipped with (small ca. 14 g) tail- and back-mounted accelerometers and (larger ca. 30 g) tail-mounted GPS units. Tail-mounted GPS-fitted birds showed significantly higher cumulative numbers of flap-glide cycles and a higher pitch angle of the tail than accelerometer-equipped birds, indicating problems with balancing inappropriately placed weights with knock-on consequences relating to energy expenditure. These problems can be addressed by carefully choosing where to place tags on birds according to the mass of the tags and the lifestyle of the subject species. PMID:24671007

  12. Performance costs when emotion tunes inappropriate cognitive abilities: implications for mental resources and behavior.

    Science.gov (United States)

    Storbeck, Justin

    2012-08-01

    Emotion tunes cognition, such that approach-motivated positive states promote verbal cognition, whereas withdrawal-motivated negative states promote spatial cognition (Gray, 2001). The current research examined whether self-control resources become depleted and influence subsequent behavior when emotion tunes an inappropriate cognitive tendency. In 2 experiments, either an approach-motivated positive state or a withdrawal-motivated negative state was induced, and then participants completed a verbal or a spatial working memory task creating conditions of emotion-cognition alignment (e.g., approach/verbal) or misalignment (e.g., approach/spatial). A control condition was also included. To examine behavioral costs due to depleted self-control resources, participants completed either a Stroop task (Stroop, 1935; Experiment 1) or a Black/White implicit association test (IAT; Greenwald, McGhee, & Schwartz, 1998; Experiment 2). Participants in the misalignment conditions performed worse on the Stroop task, and they were worse at controlling their implicit attitude biases on the IAT. Thus, when emotion tunes inappropriate cognitive tendencies for one's current environment, self-control resources become depleted, impairing behavioral control. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

  13. How to predict a high rate of inappropriateness for upper endoscopy in an endoscopic centre?

    Science.gov (United States)

    Buri, L; Bersani, G; Hassan, C; Anti, M; Bianco, M A; Cipolletta, L; Di Giulio, E; Di Matteo, G; Familiari, L; Ficano, L; Loriga, P; Morini, S; Pietropaolo, V; Zambelli, A; Grossi, E; Intraligi, M; Tessari, F; Buscema, M

    2010-09-01

    Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres. A post-hoc analysis of two multicentre cross-sectional studies, including 6270 and 8252 patients consecutively referred to EGD in 44 (group A) and 55 (group B) endoscopic Italian centres in 2003 and 2007, respectively, was performed. A multiple forward stepwise regression was applied to group A, and independently validated in group B. A <70% threshold was adopted to define inadequate appropriateness rate clustered by centre. discrete variability of clustered appropriateness rates among the 44 group A centres was observed (median: 77%; range: 41-97%), and a <70% appropriateness rate was detected in 11 (25%). Independent predictors of centre appropriateness rate were: percentage of patients referred by general practitioners (GP), rate of urgent examinations, prevalence of relevant diseases, and academic status. For group B, sensitivity, specificity and area under receiver operating characteristic curve of the model in detecting centres with a <70% appropriateness rate were 54%, 93% and 0.72, respectively. A simple predictive rule, based on rate of patients referred by GPs, rate of urgent examinations, prevalence of relevant diseases and academic status, identified a small subset of centres characterised by a high rate of inappropriateness. These centres may be presumed to obtain the largest benefit from targeted educational programs. Copyright (c) 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  14. [Severe nutritional deficiencies in young infants with inappropriate plant milk consumption].

    Science.gov (United States)

    Le Louer, B; Lemale, J; Garcette, K; Orzechowski, C; Chalvon, A; Girardet, J-P; Tounian, P

    2014-05-01

    Over the past few years, we have observed increasing consumption of inappropriate plant milks as an alternative to infant milk formula. Some families believe that foods labeled as natural are the most healthy and an appropriate nutritional choice. However, their composition does not respect European recommendations. They are always hypocaloric and protein, vitamin, and mineral concentrations are inadequate. The aim of this study was to report severe nutritional complications after inappropriate plant milk consumption. Between 2008 and 2011, we studied severe nutritional deficiencies caused by consumption of plant milks bought in health food stores or online shops. Infants were identified in our centers and examined through medical history, physical examination, and laboratory testing. Nine cases of infants aged from 4 to 14 months were observed. In all cases, these milks were used as an alternative to milk formulas for supposed cow's milk allergy. At diagnosis, four patients were aged 6 months or less. They had received plant milk exclusively for 1-3 months. The beverages consumed were rice, soya, almond and sweet chestnut milks. In three cases, infants presented severe protein-calorie malnutrition with substantial hypoalbuminemia (slow down the progress of this social trend. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  15. Storage of catch crops to produce biogas

    DEFF Research Database (Denmark)

    Molinuevo-Salces, Beatriz; Ahring, Birgitte Kiær; Uellendahl, Hinrich

    2014-01-01

    . On the contrary, the poor quality of IR silage, due to its high TS content, made it inappropriate as feedstock for biogas production. A TS content of 25-35% is preferable, to obtain a proper fermentation avoid leachate run-off and growth of Clostridium sp. or mold formation. Avoiding soil particles in the bales......Catch crop biomass is a promising co-substrate for manure-based biogas plants in Denmark since the cultivation of catch crops is mandatory to retain nutrients in the soil, contributing to protect the aquatic environment. In general, the growth period for catch crops is from harvest of the previous...... crop in July-August to the end of the growing season and harvest in late October. Hence, for use of the biomass in biogas production there is a need for storage of the biomass. Storage as silage would guarantee the availability of the feedstock for biogas production during the whole year. A proper...

  16. Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

    Directory of Open Access Journals (Sweden)

    Lott Alison

    2007-06-01

    Full Text Available Abstract Background There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1 prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2 initiation of anticoagulation for patients with atrial fibrillation (AF, where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin. Methods For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2 to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be

  17. Design and methods of the Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen SignificantlY) study: An investigator-blinded randomized controlled trial of education and feedback intervention to reduce inappropriate echocardiograms.

    Science.gov (United States)

    Bhatia, R Sacha; Ivers, Noah; Yin, Cindy X; Myers, Dorothy; Nesbitt, Gillian; Edwards, Jeremy; Yared, Kibar; Wadhera, Rishi; Wu, Justina C; Wong, Brian; Hansen, Mark; Weinerman, Adina; Shadowitz, Steven; Johri, Amer; Farkouh, Michael; Thavendiranathan, Paaladinesh; Udell, Jacob A; Rambihar, Sherryn; Chow, Chi-Ming; Hall, Judith; Thorpe, Kevin E; Rakowski, Harry; Weiner, Rory B

    2015-08-01

    Appropriate use criteria (AUC) for transthoracic echocardiography (TTE) were developed to address concerns regarding inappropriate use of TTE. A previous pilot study suggests that an educational and feedback intervention can reduce inappropriate TTEs ordered by physicians in training. It is unknown if this type of intervention will be effective when targeted at attending level physicians in a variety of clinical settings. The aim of this international, multicenter study is to evaluate the hypothesis that an AUC-based educational and feedback intervention will reduce the proportion of inappropriate echocardiograms ordered by attending physicians in the ambulatory environment. In an ongoing multicentered, investigator-blinded, randomized controlled trial across Canada and the United States, cardiologists and primary care physicians practicing in the ambulatory setting will be enrolled. The intervention arm will receive (1) a lecture outlining the AUC and most recent available evidence highlighting appropriate use of TTE, (2) access to the American Society of Echocardiography mobile phone app, and (3) individualized feedback reports e-mailed monthly summarizing TTE ordering behavior including information on inappropriate TTEs and brief explanations of the inappropriate designation. The control group will receive no education on TTE appropriate use and order TTEs as usual practice. The Echo WISELY (Will Inappropriate Scenarios for Echocardiography Lessen Significantly in an education RCT) study is the first multicenter randomized trial of an AUC-based educational intervention. The study will examine whether an education and feedback intervention will reduce the rate of outpatient inappropriate TTEs ordered by attending level cardiologists and primary care physicians (www.clinicaltrials.gov identifier NCT02038101). Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Inappropriate medication use and risk of falls – A prospective study in a large community-dwelling elderly cohort

    Directory of Open Access Journals (Sweden)

    Fourrier Annie

    2009-07-01

    Full Text Available Abstract Background Explicit criteria for determining potentially inappropriate medication consumption in elderly were elaborated by Beers et al. These lists have been used worldwide to evaluate medical prescriptions but there is little epidemiologic evidence demonstrating negative consequences of inappropriate medication use. It has been reported that some drugs could increase the risk of falls, which are a frequent and serious problem in elderly population. We aimed to evaluate the association between the use of potentially inappropriate medications and the risk of falls. Methods The 3C Study is a multicentre prospective cohort study conducted in France with 4 years of follow-up. Non-institutionalized men and women aged 65 years or over (N = 6343 were randomly selected from electoral rolls. Data on socio-demographic, medical characteristics and medication use (based on self-reports and data from the national healthcare insurance were collected. Use of inappropriate medication for elderly was defined from established criteria. Data about falls were collected at the two follow-up examinations (2 years and 4 years after baseline. The association between the exposure to inappropriate medications and the risk of falls was evaluated using multivariate models (Cox model and logistic regression. Results 32% of subjects reported inappropriate medication use at baseline and 29% at least two of the three examinations; 22% had fallen 2 times or more during follow-up. Overall, inappropriate medication users had an increased risk of falling. This increase was mainly due to the use of long-acting benzodiazepines (adjusted odds ratio (OR = 1.4, 95% confidence interval: [1.1–1.8], in both occasional and regular users, other inappropriate psychotropics (adjusted OR = 1.7 [1.7–2.7] in regular users, or medication with anticholinergic properties (adjusted OR = 1.6 [1.2–2.1] in regular users. Neither occasional, nor regular use of short- or intermediate

  19. Standardized programming to reduce the burden of inappropriate therapies in implantable cardioverter defibrillators - Single centre follow up results

    Directory of Open Access Journals (Sweden)

    U. Boles

    2018-03-01

    Full Text Available Background: Current algorithms and device morphology templates have been proposed in current Implantable Cardioverter-Defibrillators (ICDs to minimize inappropriate therapies (ITS, but this has not been completely successful. Aim: Assess the impact of a deliberate strategy of using an atrial lead implant with standardized parameters; based on all current ICD discriminators and technologies, on the burden of ITS. Method: A retrospective single-centre analysis of 250 patients with either dual chamber (DR ICDs or biventricular ICDs (CRTDs over a (41.9 ± 27.3 month period was performed. The incidence of ITS on all ICD and CRTD patients was chronicled after the implementation of standardized programming. Results: 39 events of anti-tachycardial pacing (ATP and/or shocks were identified in 20 patients (8% incidence rate among patients. The total number of individual therapies was 120, of which 34% were inappropriate ATP, and 36% were inappropriate shocks. 11 patients of the 250 patients received ITS (4.4%. Of the 20 patients, four had ICDs for primary prevention and 16 for a secondary prevention. All the episodes in the primary indication group were inappropriate, while seven patients (43% of the secondary indication group experienced inappropriate therapies. Conclusions: The burden of ITS in the population of patients receiving ICDs was 4.4% in the presence of atrial leads. The proposed rationalized programming criteria seems an effective strategy to minimize the burden of inappropriate therapies and will require further validation. Keywords: Implantable cardioverter-defibrillator (ICDs, Inappropriate therapies, Standardized programming

  20. Modified Reporting of Positive Urine Cultures to Reduce Inappropriate Treatment of Asymptomatic Bacteriuria Among Nonpregnant, Noncatheterized Inpatients: A Randomized Controlled Trial.

    Science.gov (United States)

    Daley, Peter; Garcia, David; Inayatullah, Raheel; Penney, Carla; Boyd, Sarah

    2018-05-28

    DESIGNWe conducted a randomized, parallel, unblinded, superiority trial of a laboratory reporting intervention designed to reduce antibiotic treatment of asymptomatic bacteriuria (ASB).METHODSResults of positive urine cultures from 110 consecutive inpatients at 2 urban acute-care hospitals were randomized to standard report (control) or modified report (intervention). The standard report included bacterial count, bacterial identification, and antibiotic susceptibility information including drug dosage and cost. The modified report stated: "This POSITIVE urine culture may represent asymptomatic bacteriuria or urinary tract infection. If urinary tract infection is suspected clinically, please call the microbiology laboratory … for identification and susceptibility results." We used the following exclusion criteria: age pregnancy, presence of an indwelling urinary catheter, samples from patients already on antibiotics, neutropenia, or admission to an intensive care unit. The primary efficacy outcome was the proportion of appropriate antibiotic therapy prescribed.RESULTSAccording to our intention-to-treat (ITT) analysis, the proportion of appropriate treatment (urinary tract infection treated plus ASB not treated) was higher in the modified arm than in the standard arm: 44 of 55 (80.0%) versus 29 of 55 (52.7%), respectively (absolute difference, -27.3%; RR, 0.42; P = .002; number needed to report for benefit, 3.7).CONCLUSIONSModified reporting resulted in a significant reduction in inappropriate antibiotic treatment without an increase in adverse events. Safety should be further assessed in a large effectiveness trial before implementationTRIAL REGISTRATION. clinicaltrials.gov#NCT02797613Infect Control Hosp Epidemiol 2018;1-6.

  1. Fuel storage

    International Nuclear Information System (INIS)

    Palacios, C.; Alvarez-Miranda, A.

    2009-01-01

    ENSA is a well known manufacturer of multi-system primary components for the nuclear industry and is totally prepared to satisfy future market requirements in this industry. At the same time that ENSA has been gaining a reputation world wider for the supply of primary components, has been strengthening its commitment and experience in supplying spent fuel components, either pool racks or storage and transportation casks, and offers not only fabrication but also design capabilities for its products. ENSA has supplied Spent Fuel Pool Racks, in spain, Finland, Taiwan, Korea, China, and currently it is in the process of licensing its own rack design in the United States of America for the ESBWR along with Ge-Hitachi. ENSA has supplied racks for 20 pools and 22 different reactors and it has also manufactured racks under all available technologies and developed a design known as Interlock Cell Matrix whose main features are outlined in this article. Another ENSA achievement in rack technology is the use of remote control for re-racking activities instead of using divers, which improves the ALARA requirements. Regarding casks for storage and transportation, ENSA also has al leading worldwide position, with exports prevailing over the Spanish market where ENSA has supplied 16 storage and transportation casks to the Spanish nuclear power Trillo. In some cases, ENSA acts as subcontractor for other clients. Foreign markets are still a major challenge for ENSA. ENSA-is well known for its manufacturing capabilities in the nuclear industry, but has been always involved in design activities through its engineering division, which carries out different tasks: components Design; Tooling Design; Engineering and Documentation; Project Engineering; Calculations, Design and Development Engineering. (Author)

  2. Underground storage

    Energy Technology Data Exchange (ETDEWEB)

    1965-06-10

    A procedure is described for making an underground storage cavity in a soluble formation. Two holes are drilled, and fluid is pumped into the first hole. This fluid is a non-solute for the formation material. Then pressure is applied to the fluid until the formation is fractured in the direction of the second hole. More non-solute fluid is injected to complete the fracture between the 2 holes. A solute fluid is then circulated between the 2 holes, which results in removal of that part of the formation next to the fracture and the forming of a chamber.

  3. Pumped storage

    International Nuclear Information System (INIS)

    Strauss, P.L.

    1991-01-01

    The privately financed 1,000 MW Rocky Point Pumped Storage Project located in central Colorado, USA, will be one of the world's highest head, 2,350 feet reversible pump/turbine projects. The project will offer an economical supply of peaking power and spinning reserve power to Colorado and other southwestern states. This paper describes how the project will be made compatible with the environmental conditions in the project area and the type of terrestrial mitigation measures that are being proposed for those situations where the project impacts the environment, either temporarily or permanently

  4. A case of appropriate inappropriate device therapy: Hyperkalemia-induced ventricular oversensing

    Science.gov (United States)

    Oudit, Gavin Y; Cameron, Doug; Harris, Louise

    2008-01-01

    The present case describes a patient who received inappropriate, but potentially life-saving, therapy from her implantable cardioverter defibrillator (ICD) in the setting of acute hyperkalemia (plasma potassium concentration = 8 mM). Hyperkalemia was associated with the development of a slow sinusoidal ventricular tachycardia, at a rate of 100 beats/min to 125 beats/min (610 ms to 480 ms) in a patient who is pacemaker-dependent. There was associated fractionation of the ICD electrogram and T wave oversensing, leading to ventricular oversensing with resultant detection in the ventricular fibrillation rate zone. This was followed by shock therapy, even though the ventricular tachycardia rate was below the programmed detection rate of the ICD. The subsequent emergency treatment of the hyperkalemia normalized the electrogram, corrected the ventricular oversensing and arrhythmia, and restored rate-adaptive single-chamber ventricular pacing. PMID:18340383

  5. Syndrome of inappropriate antidiuretic hormone secretion: Revisiting a classical endocrine disorder

    Directory of Open Access Journals (Sweden)

    Binu P Pillai

    2011-01-01

    Full Text Available Hyponatremia occurs in about 30% of hospitalized patients and syndrome of inappropriate antidiuretic hormone secretion (SIADH is a common cause of hyponatremia. SIADH should be differentiated from other causes of hyponatremia like diuretic therapy, hypothyroidism and hypocortisolism. Where possible, all attempts should be made to identify and rectify the cause of SIADH. The main problem in SIADH is fluid excess, and hyponatremia is dilutional in nature. Fluid restriction is the main stay in the treatment of SIADH; however, cerebral salt wasting should be excluded in the clinical setting of brain surgeries, subarachnoid hemorrhage, etc. Fluid restriction in cerebral salt wasting can be hazardous. Sodium correction in chronic hyponatremia (onset >48 hours should be done slowly to avoid deleterious effects in brain.

  6. Establishing benchmarks and metrics for disruptive technologies, inappropriate and obsolete tests in the clinical laboratory.

    Science.gov (United States)

    Kiechle, Frederick L; Arcenas, Rodney C; Rogers, Linda C

    2014-01-01

    Benchmarks and metrics related to laboratory test utilization are based on evidence-based medical literature that may suffer from a positive publication bias. Guidelines are only as good as the data reviewed to create them. Disruptive technologies require time for appropriate use to be established before utilization review will be meaningful. Metrics include monitoring the use of obsolete tests and the inappropriate use of lab tests. Test utilization by clients in a hospital outreach program can be used to monitor the impact of new clients on lab workload. A multi-disciplinary laboratory utilization committee is the most effective tool for modifying bad habits, and reviewing and approving new tests for the lab formulary or by sending them out to a reference lab. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. The syndrome of inappropriate antidiuretic hormone: current and future management options.

    LENUS (Irish Health Repository)

    Sherlock, Mark

    2010-06-01

    Hyponatraemia is the commonest electrolyte abnormality, and syndrome of inappropriate antidiuretic hormone (SIADH) is the most frequent underlying pathophysiology. Hyponatraemia is associated with significant morbidity and mortality, and as such appropriate treatment is essential. Treatment options for SIADH include fluid restriction, demeclocycline, urea, frusemide and saline infusion, all of which have their limitations. The introduction of the vasopressin-2 receptor antagonists has allowed clinicians to specifically target the underlying pathophysiology of SIADH. Initial studies have shown good efficacy and safety profiles in the treatment of mild to moderate hyponatraemia. However, studies assessing the efficacy and safety of these agents in acute severe symptomatic hyponatraemia are awaited. Furthermore, the cost of these agents at present may limit their use.

  8. Vancomycin intoxication in a patient with inappropriate antidiuretic hormone syndrome and diarrhea

    Directory of Open Access Journals (Sweden)

    Patricia Hidalgo-Collazos

    2015-07-01

    Full Text Available Vancomycin is an antibiotic used for infections by gram-positive bacteria with a two-compartment pharmacokinetic model. Its monitoring has an established therapeutic range (10-20 mg/L to prevent nephrotoxicity and ototoxicity due to supratherapeutic levels, and inefficiency and development of resistance by subtherapeutic levels. Nephrotoxicity for vancomycin monotherapy at standard doses according to pathogen and typical regimens (usual dose: 15-20 mg/kg/12 h is rare and usually reversible. Moreover, monitoring plasma concentrations allows to achieve concentrations within therapeutic range to allow safe and effective drug use. The renal hypoperfusion can cause pre-renal damage, resulting in elevated levels of serum creatinine, resulting in decreased antibiotic elimination and nephrotoxicity. We report a case of unexpected vancomycin nephrotoxicity in a patient with syndrome Inappropriate antidiuretic hormone secretion associated paraneoplastic

  9. Identifying and acting on potentially inappropriate care? Inadequacy of current hospital coding for this task.

    Science.gov (United States)

    Cooper, P David; Smart, David R

    2017-06-01

    Recent Australian attempts to facilitate disinvestment in healthcare, by identifying instances of 'inappropriate' care from large Government datasets, are subject to significant methodological flaws. Amongst other criticisms has been the fact that the Government datasets utilized for this purpose correlate poorly with datasets collected by relevant professional bodies. Government data derive from official hospital coding, collected retrospectively by clerical personnel, whilst professional body data derive from unit-specific databases, collected contemporaneously with care by clinical personnel. Assessment of accuracy of official hospital coding data for hyperbaric services in a tertiary referral hospital. All official hyperbaric-relevant coding data submitted to the relevant Australian Government agencies by the Royal Hobart Hospital, Tasmania, Australia for financial year 2010-2011 were reviewed and compared against actual hyperbaric unit activity as determined by reference to original source documents. Hospital coding data contained one or more errors in diagnoses and/or procedures in 70% of patients treated with hyperbaric oxygen that year. Multiple discrete error types were identified, including (but not limited to): missing patients; missing treatments; 'additional' treatments; 'additional' patients; incorrect procedure codes and incorrect diagnostic codes. Incidental observations of errors in surgical, anaesthetic and intensive care coding within this cohort suggest that the problems are not restricted to the specialty of hyperbaric medicine alone. Publications from other centres indicate that these problems are not unique to this institution or State. Current Government datasets are irretrievably compromised and not fit for purpose. Attempting to inform the healthcare policy debate by reference to these datasets is inappropriate. Urgent clinical engagement with hospital coding departments is warranted.

  10. Polypharmacy and potentially inappropriate medication use as the precipitating factor in readmissions to the hospital

    Directory of Open Access Journals (Sweden)

    Vishal Sehgal

    2013-01-01

    Full Text Available Background and Aim: Readmission to the hospital within 30 days of discharge from the hospital is a common occurrence. Congestive heart failure is the most common cause of readmissions in the hospital. We hypothesized that irrespective of the admission diagnosis polypharmacy and potentially inappropriate use of medications (PIM leads to readmissions within 30 days of discharge from the hospital. Materials and Methods: A retrospective study was carried out by reviewing the hospital records of 414 patients who were readmitted to the hospital within 30 days of discharge from the hospital between January 2008 and December 2009. The data was stratified to see which patients were on polypharmacy and/or on PIM. Polypharmacy was defined as use of more than 5 medications. PIM was defined as per the modified Beers criteria. Day 0 was defined as the day of discharge and day1 was defined as the day-after Admission to the hospital. Statistical analysis was carried out using a two-way analysis of variance (ANOVA on the data to see if polypharmacy and/or PIM was related to readmission within 30 days of discharge irrespective of admission diagnosis. Results: Polypharmacy was related to hospital readmission at day 1 and day 0, however inappropriate drug use was found to be not related at any day. Polypharmacy and PIM combined had a positive correlation to readmission only on days 1 and 0 and it was statistically significant. The use of minimal and appropriate use of drugs was statistically significant compared to polypharmacy and PIM use. Conclusions: Polypharmacy and PIM are under recognized cause of readmissions to the hospital.

  11. Potentially inappropriate prescribing in community-dwelling older people across Europe: a systematic literature review.

    Science.gov (United States)

    Tommelein, Eline; Mehuys, Els; Petrovic, Mirko; Somers, Annemie; Colin, Pieter; Boussery, Koen

    2015-12-01

    Potentially inappropriate prescribing (PIP) is one of the main risk factors for adverse drug events (ADEs) in older people. This systematic literature review aims to determine prevalence and type of PIP in community-dwelling older people across Europe, as well as identifying risk factors for PIP. The PubMed and Web of Science database were searched systematically for relevant manuscripts (January 1, 2000-December 31, 2014). Manuscripts were included if the study design was observational, the study participants were community-dwelling older patients in Europe, and if a published screening method for PIP was used. Studies that focused on specific pathologies or that focused on merely one inappropriate prescribing issue were excluded. Data analysis was performed using R statistics. Fifty-two manuscripts were included, describing 82 different sample screenings with an estimated overall PIP prevalence of 22.6 % (CI 19.2-26.7 %; range 0.0-98.0 %). Ten of the sample screenings were based on the Beers 1997 criteria, 19 on the Beers 2003 criteria, 14 on STOPP criteria (2008 version), 8 on START-criteria (2008 version), and 7 on the PRISCUS list. The 24 remaining sample screenings were carried out using compilations of screening methods or used country-specific lists such as the Laroche criteria. It appears that only PIP prevalence calculated from insurance data significantly differs from the other data collection method categories. Furthermore, risk factors most often positively associated with PIP prevalence were polypharmacy, poor functional status, and depression. Drug groups most often involved in PIP were anxiolytics (ATC-code: N05B), antidepressants (N06A), and nonsteroidal anti-inflammatory and anti-rheumatic products (M01A). PIP prevalence in European community-dwelling older adults is high and depends partially on the data collection method used. Polypharmacy, poor functional status, and depression were identified as the most common risk factors for PIP.

  12. Gas storage materials, including hydrogen storage materials

    Science.gov (United States)

    Mohtadi, Rana F; Wicks, George G; Heung, Leung K; Nakamura, Kenji

    2013-02-19

    A material for the storage and release of gases comprises a plurality of hollow elements, each hollow element comprising a porous wall enclosing an interior cavity, the interior cavity including structures of a solid-state storage material. In particular examples, the storage material is a hydrogen storage material such as a solid state hydride. An improved method for forming such materials includes the solution diffusion of a storage material solution through a porous wall of a hollow element into an interior cavity.

  13. Effect of rational and irrational statements on intensity and 'inappropriateness' of emotional distress and irrational beliefs in psychotherapy patients.

    Science.gov (United States)

    Cramer, D; Kupshik, G

    1993-09-01

    Ellis's rational-emotive theory postulates that since irrational statements augment emotional distress, replacing irrational with rational statements should lessen distress. This hypothesis was tested in the initial stages of psychotherapy by having 13 and 14 clinical out-patients respectively repeat for one minute either rational or irrational statements about their major presenting psychological problem. The distinction by Ellis & Harper (1975) that 'inappropriate' emotions differ qualitatively from 'appropriate' emotions was also examined. Although the experimental intervention had no effect on a post-test measure of irrational beliefs, patients repeating rational statements had significantly lower appropriate and inappropriate negative emotions at post-test, suggesting that inappropriate emotions do not differ qualitatively from appropriate emotions and that making rational statements may lower emotional distress in patients. Patients reiterating irrational statements showed no change in emotions, implying that these kinds of irrational cognitions may have already been present.

  14. Substantial reduction of inappropriate tablet splitting with computerised decision support: a prospective intervention study assessing potential benefit and harm

    Directory of Open Access Journals (Sweden)

    Quinzler Renate

    2009-06-01

    Full Text Available Abstract Background Currently ambulatory patients break one in four tablets before ingestion. Roughly 10% of them are not suitable for splitting because they lack score lines or because enteric or modified release coating is destroyed impairing safety and effectiveness of the medication. We assessed impact and safety of computerised decision support on the inappropriate prescription of split tablets. Methods We performed a prospective intervention study in a 1680-bed university hospital. Over a 15-week period we evaluated all electronically composed medication regimens and determined the fraction of tablets and capsules that demanded inappropriate splitting. In a subsequent intervention phase of 15 weeks duration for 10553 oral drugs divisibility characteristics were indicated in the system. In addition, an alert was generated and displayed during the prescription process whenever the entered dosage regimen demanded inappropriate splitting (splitting of capsules, unscored tablets, or scored tablets unsuitable for the intended fragmentation. Results During the baseline period 12.5% of all drugs required splitting and 2.7% of all drugs (257/9545 required inappropriate splitting. During the intervention period the frequency of inappropriate splitting was significantly reduced (1.4% of all drugs (146/10486; p = 0.0008. In response to half of the alerts (69/136 physicians adjusted the medication regimen. In the other half (67/136 no corrections were made although a switch to more suitable drugs (scored tablets, tablets with lower strength, liquid formulation was possible in 82% (55/67. Conclusion This study revealed that computerised decision support can immediately reduce the frequency of inappropriate splitting without introducing new safety hazards.

  15. Potentially inappropriate prescribing in institutionalised older patients in Spain: the STOPP-START criteria compared with the Beers criteria

    Directory of Open Access Journals (Sweden)

    Bonet M

    2012-06-01

    Full Text Available Objective: The aims of this study were to identify potentially inappropriate prescribing using the Beers and STOPP criteria. The START criteria were applied to detect prescription omission in the geriatric population. We compared the utility of these criteria in institutionalised older people.Methods: Descriptive study reviewing the medication and clinical records of 81 residents (aged 65 years and more by pharmacists in a nursing home in the Lleida region (Spain.Results: The mean patients’ age was 84 (SD=8 years, with an average of 5 drugs per resident (total prescriptions: 416 medicines. The Beers criteria identified potentially inappropriate medication use in 25% of patients and 48% of patients used at least 1 inappropriate medication according to STOPP criteria. The most frequent potentially inappropriate medications for both criteria were long-acting benzodiazepines and NSAIDs. START detected 58 potential prescribing omissions in 44% of patients. Calcium-vitamin D supplementation in osteoporosis was the most frequent rule (15%, but omissions corresponding to the cardiovascular system implied 23% of patients.Conclusion: The STOPP-START criteria reveal that potentially inappropriate prescribing (PIP is a highly prevalent problem among Spanish nursing home residents, and a statistically significant positive correlation was found between the number of medicines prescribed and the number of PIP detected in this study. The STOPP criteria detect a larger number of PI medications in this geriatric population than the Beers criteria. The prescribing omissions detected by the START criteria are relevant and require intervention. Pharmacists’ review of medications may help identify potentially inappropriate prescribing and, through an interdisciplinary approach, working with physicians may improve prescribing practices among geriatric residents of nursing homes.

  16. Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector medicare HMOs.

    Science.gov (United States)

    Barnett, Mitchell J; Perry, Paul J; Langstaff, Jodi D; Kaboli, Peter J

    2006-06-01

    Inappropriate prescribing in the elderly is common, but rates across different health care systems and the impact of formulary restrictions are not well described. To determine if rates of inappropriate medication use in the elderly differ between the Veterans Affairs (VA) health care system and the private sector Medicare health maintenance organization (HMO) patients. A cross-sectional study design compared administrative pharmacy claims from 10 distinct geographic regions in the United States in the VA health care system and 10 analogous regions for patients enrolled in Medicare HMOs. The cohorts included 123,633 VA and 157,517 Medicare HMO patients aged 65 years and older. Inappropriate medication use was identified using the Zhan modification of the Beers criteria, which categorizes 33 potentially inappropriate drugs into 3 major classifications: "always avoid," "rarely appropriate," and "some indications." Comparisons between the VA health care system and the private sector Medicare HMO were performed for overall differences and stratified by gender and age. The drug formulary status of the Zhan-criteria drugs was known for the VA health system but not for the Medicare HMO patients. Compared with private sector patients, VA patients were less likely to receive any inappropriate medication (21% vs. 29%, P private sector for males (21% vs. 24%, P private sector Medicare HMOs, elderly VA patients were less likely to receive medications defined by the Zhan criteria as potentially inappropriate. A restrictive formulary that excludes 12 of the 33 Zhan criteria drugs may be a factor in the reduction of undesired prescribing patterns in elderly populations.

  17. Encephalitis associated with inappropriate antidiuretic hormone secretion due to chikungunya infection in Recife, State of Pernambuco, Brazil

    Directory of Open Access Journals (Sweden)

    Norma Lucena-Silva

    Full Text Available Abstract The symptoms of chikungunya virus (CHIKV infection include fever, headache, muscle aches, skin rash, and polyarthralgia, characterized by intense pain, edema, and temporary functional impairment. This is the first report of encephalitis caused by CHIKV infection associated with an atypical presentation of syndrome of inappropriate antidiuretic hormone secretion, evolving to cognitive impairment and apraxia of speech.

  18. Introduction of inappropriate complementary feeding in the first year of life and associated factors in children with low socioeconomic status.

    Science.gov (United States)

    Dallazen, Camila; Silva, Sara Araújo da; Gonçalves, Vivian Siqueira Santos; Nilson, Eduardo Augusto Fernandes; Crispim, Sandra Patricia; Lang, Regina Maria Ferreira; Moreira, Júlia Dubois; Tietzmann, Daniela Cardoso; Vítolo, Márcia Regina

    2018-02-19

    The study aimed to identify factors associated with the introduction of inappropriate complementary feeding in the first year of life in children living in municipalities (counties) with low socioeconomic statusl. This was a cross-sectional multicenter study in 1,567 children 12 to 59 months of age in 48 municipalities participating in the Brazil Without Poverty plan in the South of Brazil. A structured questionnaire was applied to the children's parents to obtain socio-demographic information and the age at which inappropriate complementary foods were introduced for the first time in complementary feeding. Prevalence of introduction of sugar before four months of age was 35.5% (n = 497; 95%CI: 33.1-38.0). The prevalence rates for the introduction of cookies/crackers, creamy yogurt, and jelly before six months of age were 20.4% (n = 287; 95%CI: 18.3-22.3), 24.8% (n = 349; 95%CI: 22.4-27.1), and 13.8% (n = 192; 95%CI: 12.0-15.7), respectively. Associations were identified between low maternal schooling (PR = 1.25; 95%CI: 1.03-1.51) and low monthly family income (PR = 1.22; CI95%: 1.01-1.48) and the introduction of inappropriate complementary feeding. The study identified the introduction of inappropriate complementary feeding in the first year of life among children in municipalities with high socioeconomic vulnerability in the South of Brazil, associated with low maternal schooling and low monthly family income.

  19. Evaluation of electrical aversion therapy for inappropriate sexual behaviour after traumatic brain injury: a single case experimental design study

    Science.gov (United States)

    ter Mors, Bert Jan; van Heugten, Caroline M; van Harten, Peter N

    2012-01-01

    Inappropriate sexual behaviour after acquired brain injury is a severe complication. Evidence for effective treatment is not available. Electrical aversion therapy (EAT) is a behavioural therapeutic option used in persons with intellectual disabilities, which might be suitable for brain-injured individuals for whom other therapies are not effective. The effect of EAT in brain injury has not been investigated previously. A single case experimental design was used. In an ABBA (baseline-treatment-treatment-withdrawal) design the frequency of the target behaviour (ie, inappropriate sexual behaviour) in a 40-year-old man was measured daily. A total of 551 measurements were recorded. A significant reduction of the target behaviour was seen after the first treatment phase (baseline 12.18 (2.59) vs 3.15 (3.19) mean target behaviours daily); this reduction remained stable over time. We conclude that EAT was effective in this patient with inappropriate sexual behaviour due to severe brain injury. EAT can therefore be considered in therapy resistant inappropriate sexual behaviour in brain-injured patients. PMID:22922913

  20. The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients : A Nested Case Control Study

    NARCIS (Netherlands)

    van der Stelt, C. A K; Vermeulen Windsant-van den Tweel, A. M A; Egberts, A. C G; van den Bemt, P. M L A; Leendertse, A. J.; Hermens, W. A J J; van Marum, R. J.; Derijks, H. J.

    2016-01-01

    Introduction: Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will

  1. The Association Between Potentially Inappropriate Prescribing and Medication-Related Hospital Admissions in Older Patients: A Nested Case Control Study

    NARCIS (Netherlands)

    van der Stelt, C.A.K.; Vermeulen Windsant-van den Tweel, A.M.A.; Egberts, A.C.G.|info:eu-repo/dai/nl/162850050; van den Bemt, P.M.L.A.|info:eu-repo/dai/nl/151330689; Leendertse, A.J.; Hermens, W.A.J.J.; van Marum, R.J.; Derijks, Jeroen|info:eu-repo/dai/nl/304840505

    2016-01-01

    Introduction: Medication-related problems can cause serious adverse drug events (ADEs) that may lead to hospitalization of the patient. There are multiple screening methods to detect and reduce potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs). Whether this will

  2. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals.

    LENUS (Irish Health Repository)

    Gallagher, Paul

    2011-11-01

    Potentially inappropriate prescribing is common in older people presenting to hospital with acute illness in Ireland. The aim of this study was to determine if this phenomenon is unique to Ireland or whether it is a more widespread problem in hospitals across Europe.

  3. [Discontinuation of potentially inappropriate medications at the end of life: perspectives from patients, their relatives, and physicians

    NARCIS (Netherlands)

    Geijteman, E.C.; Tempelman, M.M.; Dees, M.K.; Huisman, B.A.H.; Perez, R.S.; Zuylen, L. van; Heide, A. van der

    2017-01-01

    OBJECTIVE: To obtain insight into the perspectives of patients, relatives and physicians towards potentially inappropriate medications (PIMs) at the end of life. DESIGN: Qualitative interview study. METHOD: An analysis of in-depth interviews with 17 patients who were diagnosed as having a life

  4. Adult female with symptomatic AVPR2-related nephrogenic syndrome of inappropriate antidiuresis (NSIAD

    Directory of Open Access Journals (Sweden)

    Jennifer Hague

    2018-01-01

    Full Text Available Activating mutations in AVPR2 are associated with nephrogenic syndrome of inappropriate antidiuresis (NSIAD. NSIAD causes hyponatremia, decreased serum osmolality and clinical symptoms, which may present from birth or in infancy and include hypotonia, irritability, vomiting and/or seizures. Symptoms in later life are often less specific and include malaise, dizziness, confusion, tiredness and headache. NSIAD is a rare X-linked condition, which is associated with a variable phenotype in males, of whom some present in infancy but others do not become symptomatic until adulthood, or occasionally, never. Female carriers may present with episodes of hyponatremia, usually found incidentally. Literature in this field is limited; namely, two clinical reports describing a female proband, both diagnosed in infancy. We describe, for the first time, the case of an adult female proband with NSIAD, who had longstanding associated symptoms of tiredness, headache, temporary memory loss and mood changes as well as hyponatremia and decreased serum osmolality. A water load test demonstrated an inability to dilute urine and gene sequencing confirmed a recurrent activating mutation in AVPR2. The variant was inherited from the proband’s mother who had had longstanding episodes of transient asymptomatic hyponatremia. This is the third report of a female proband with NSIAD and is the first female reported who sought medical treatment for chronic symptoms from adulthood. This case acts as a reminder of the importance of considering NSIAD as a diagnosis in females of all ages with unexplained hyponatremia.

  5. Avoiding inappropriate paediatric admission: facilitating General Practitioner referral to Community Children’s Nursing Teams

    Directory of Open Access Journals (Sweden)

    Kyle Richard G

    2013-01-01

    Full Text Available Abstract Background Children’s emergency admissions in England are increasing. Community Children’s Nursing Teams (CCNTs have developed services to manage acutely ill children at home to reduce demand for unscheduled care. Referral between General Practitioners (GPs and CCNTs may reduce avoidable admissions and minimise the psychosocial and financial impact of hospitalisation on children, families and the NHS. However, facilitators of GP referral to CCNTs are not known. The aim of this study was to identify facilitators of GP referral to CCNTs. Methods Semi-structured interviews with 39 health professionals were conducted between June 2009 and February 2010 in three Primary Care Trusts served by CCNTs in North West England. Interviewees included GPs, Community Children’s Nurses (CCNs, consultant paediatricians, commissioners, and service managers. Qualitative data were analysed thematically using the Framework approach in NVivo 8. Results Five facilitators were identified: 1 CCN/CCNT visibility; 2 clear clinical governance procedures; 3 financial and organisational investment in the role of CCNTs in acute care pathways; 4 access and out of hours availability; 5 facilitative financial frameworks. Conclusion GPs required confidence in CCNs’ competence to safely manage acutely ill children at home and secure rapid referral if a child’s condition deteriorated. Incremental approaches to developing GP referral to CCNTs underpinned by clear clinical governance protocols are likely to be most effective in building GP confidence and avoiding inappropriate admission.

  6. Making the Tg-Confinement Effect Disappear in Thin Polystyrene Films: Good Physics vs. Inappropriate Analysis

    Science.gov (United States)

    Torkelson, John; Chen, Lawrence

    2013-03-01

    The Tg-confinement effect in polymers was first characterized in supported polystyrene (PS) films by Keddie et al. in 1994. Since then, many researchers have shown that (pseudo-)thermodynamic Tg measurements of supported PS films taken on cooling consistently yield the same qualitative results, with a decrease from bulk Tg beginning at 40-60 nm thickness and becoming very strong below 20 nm thickness. Some quantitative differences have been noted between studies, which may be ascribed to measurement method or the analysis employed. In 2004, we showed that the Tg-confinement effect in PS may be suppressed by adding several wt% of small-molecule diluents such as dioctyl phthalate. Recently, Kremer and co-workers (Macromolecules 2010, 43, 9937) reported that there was no Tg-confinement in supported PS films based on an analysis of the second derivative of ellipsometry data and use of a ninth order polynomial fit. Here, we demonstrate a new method for suppressing the Tg-confinement effect. In particular, PS made by emulsion polymerization yields no Tg-confinement effect as measured by ellipsometry or fluorescence, while PS made by anionic or conventional free radical polymerization yield strong Tg-confinement effects. The difference is hypothesized to result from surfactant in the emulsion polymerized PS. We also show that the absence of the Tg-confinement effect reported by Kremer is due to inappropriate analysis of ellipsometry data and that correct analysis yields Tg-confinement effects.

  7. An observation on inappropriate probiotic subgroup classifications in the meta-analysis by Lau and Chamberlain

    Directory of Open Access Journals (Sweden)

    McFarl

    2016-09-01

    Full Text Available Lynne V McFarland Department of Medicinal Chemistry, University of Washington, Seattle, WA, USA I read with great interest the systematic review of meta-analysis assessing probiotics for the prevention of Clostridium difficile-associated diarrhea (CDAD published in the International Journal of General Medicine. These authors pooled 26 randomized controlled trials (RCTs and concluded that Lactobacilli, mixtures, and Saccharomyces probiotics were effective in preventing CDAD. However, the meta-analysis by Lau and Chamberlain is flawed due to improper classification by the types of probiotics. It is important to recognize that the efficacy of probiotics for various diseases has been shown to be strain specific for each probiotic product, and thus the data should only be pooled for probiotics that are of the identical type. In their analysis of probiotic subgroups by various species, the authors have inappropriately merged different types of Lactobacilli into one subgroup “Lactobacilli” and different types of mixtures into one group classified as “Mix”.View the original paper by Lau and Chamberlain. 

  8. Appropriate and inappropriate influences on outpatient discharge decision making in dermatology: a prospective qualitative study.

    Science.gov (United States)

    Harun, N A; Finlay, A Y; Salek, M S; Piguet, V

    2015-09-01

    Outpatient discharge decision making in dermatology is poorly understood. To identify the influences on clinicians' thought processes when making discharge decisions in dermatology outpatient clinics. Forty clinicians from 11 National Health Service Trusts in England were interviewed. The interviews were audiorecorded, transcribed, coded and thematically analysed. The mean age of the clinicians was 48.8 years (range 33.0-67.0), 17 (43%) were men and 19 (48%) had > 20 years of clinical experience. One hundred and forty-eight influences were reported, with five main themes: (i) disease-based influences included type of diagnosis (100% of clinicians), guidelines (100%) and treatment needed (100%); (ii) clinician-based influences included the clinician's level of experience (100%), seniority (37%), emotional attitude (95%), 'gut feeling' (25%), personal attitude towards discharge (45%) and level of perception (100%); (iii) patient-based influences included patients' ability to cope with their disease (100%), wishes (70%), quality of life (32%), command of English (40%) and cultural background (25%); (iv) practice-based influences included good primary care (100%), secondary support structure (100%) and clinic capacity pressure (67%); (v) policy-based influences included pressure from hospital managers (57%) and an active discharge policy (7%). Fourteen (9%) influences were potentially inappropriate. This study has identified multiple factors influencing outpatient discharge decision making. This provides the basis for developing evidence-based training to improve discharge decision appropriateness. © 2015 British Association of Dermatologists.

  9. Knowledge Translation Strategy to Reduce the Use of Potentially Inappropriate Medications in Hospitalized Elderly Adults.

    Science.gov (United States)

    Cossette, Benoit; Bergeron, Josée; Ricard, Geneviève; Éthier, Jean-François; Joly-Mischlich, Thomas; Levine, Mitchell; Sene, Modou; Mallet, Louise; Lanthier, Luc; Payette, Hélène; Rodrigue, Marie-Claude; Brazeau, Serge

    2016-12-01

    To evaluate the effect of a knowledge translation (KT) strategy to reduce potentially inappropriate medication (PIM) use in hospitalized elderly adults. Segmented regression analysis of an interrupted time series. Teaching hospital. Individuals aged 75 and older discharged from the hospital in 2013/14 (mean age 83.3, 54.5% female). The KT strategy comprises the distribution of educational materials, presentations by geriatricians, pharmacist-physician interventions based on alerts from a computerized alert system, and comprehensive geriatric assessments. Rate of PIM use (number of patient-days with use of at least one PIM/number of patient-days of hospitalization for individuals aged ≥75). For 8,622 patients with 14,071 admissions, a total of 145,061 patient-days were analyzed. One or more PIMs were prescribed on 28,776 (19.8%) patient-days; a higher rate was found for individuals aged 75 to 84 (24.0%) than for those aged 85 and older (14.4%) (P patient-days with at least one PIM was observed immediately after the intervention. A KT strategy resulted in decreased use of PIM in elderly adults in the hospital. Additional interventions will be implemented to maintain or further reduce PIM use. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  10. Syndrome of inappropriate antidiuretic hormone secretion induced by the phytotherapy Harpagophytum procumbers: case report

    Directory of Open Access Journals (Sweden)

    Renata Reis Carvalho

    Full Text Available Abstract Introduction: The syndrome of inappropriate antidiuretic hormone secretion (SIADH is the inability of antidiuretic hormone (ADH suppression, compromising the mechanisms of water excretion and urinary concentration. It manifests as hyponatremia and its symptoms, especially neurological. There are many causes that trigger such disease, notably: central nervous system disorders, malignant neoplasm, drugs and others. Case Report: A 65 years female hypertensive patient presented clinical and laboratory manifestations of hyponatremia due to SIADH. It happened twice under use of herbal medication for osteoarthritis treatment. Discussion: The drug-related hyponatremia can be triggered by direct effect of the drug or by association with SIADH. The clinical manifestations presented could have been related to psychiatric condition and may have severe outcome if not properly diagnosed. The association of an herbal medicine to SIADH could be confirmed after a new episode of hyponatremia related to Harpagophytum procumbers reintroduction. Our literature review did not find this herbal medicine associated with SIADH, so far. Conclusion: SIADH may be caused by herbal medicine described from now on their association in the literature.

  11. Acute motor and sensory axonal neuropathy-associated syndrome of inappropriate antidiuretic hormone secretion

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    Weeraporn Srisung

    2015-10-01

    Full Text Available A 36-year-old man presented with a six week history of progressive ascending weakness. Physical examination showed generalized motor weakness, more severe in the lower extremities (LE, muscle wasting, absent LE reflexes, dysesthesia, and no cranial nerve involvement. Neurologic workup was consistent with acute motor and sensory axonal neuropathy (AMSAN, a variant of Guillain-Barre syndrome. Concomitantly on admission, serum chemistry panel showed a sodium (Na 115 mmol/L with normal kidney function. Urine showed Na <20 mmol/L, and specific gravity 1.045. Urine osmolality was not available initially. He received IV fluid for volume expansion. The Na did not significantly improve after he became euvolemic. Fluid restriction was then tried with mild improvement. Endocrine work-up ruled out hypothyroidism and adrenal insufficiency. Repeat labs showed serum Na 124 mmol/L, urine Na 191 mmol/L and urine Osm 531 mOsm, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH was diagnosed. Our case report suggests that SIADH should be high on the differential diagnosis for hyponatremia in patients with AMSAN, especially in the setting of euvolemia.

  12. Reduction in inappropriate prevention of urinary tract infections in long-term care facilities.

    Science.gov (United States)

    Rummukainen, Maija-Liisa; Jakobsson, Aino; Matsinen, Maire; Järvenpää, Salme; Nissinen, Antti; Karppi, Pertti; Lyytikäinen, Outi

    2012-10-01

    Urinary tract infection (UTI) is the most common diagnosis made in prescribing antimicrobials in long-term care facilities (LTCF). The diagnostic criteria for UTI vary among institutions and prescribers. Our aim was to reduce the inappropriate use of antimicrobials in LTCFs. A team comprising infectious disease consultant, infection control nurse, and geriatrician visited all LTCFs for older persons (2,321 patients in 25 primary care hospitals and 39 nursing homes and dementia units) in the Central Finland Healthcare District (population 267,000) during 2004-2005. The site visits consisted of a structured interview concerning patients, ongoing systematic antimicrobials, and diagnostic practices for UTI. Following the visits, regional guidelines for prudent use of antimicrobials in LTCFs were published, and the use of antimicrobials was followed up by an annual questionnaire. The proportions of patients receiving antimicrobials in 2005, 2006, 2007, and 2008 were 19.9%, 16.9%, 16.2%, and 15.4%, respectively. Most of the antibiotics were used for UTI (range by year, 66.6%-81.1%). From 2005 through 2008, the proportion of patients on antibiotic prophylaxis for UTI decreased from 13% to 6%. The decrease was statistically significant in both types of settings. The visits and guidelines were associated with a reduction in the usage of antimicrobials. To sustain this, UTI surveillance and close collaboration between infection control experts and LTCFs are crucial. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  13. Reduction of inappropriate prescriptions and adverse effects to medications in hospitalized elderly patients

    Directory of Open Access Journals (Sweden)

    Ana Fajreldines

    2018-01-01

    Full Text Available Together, potentially inappropriate prescribing of medications (PIP and appropriate prescribing omission (APO constitute a problem that requires multiple interventions to reduce its size and the occurrence of adverse drug events (ADE. This study aims to assess PIP, APO, ADE before and after the intervention of a clinical pharmacist over medical prescriptions for elderly hospitalized patients. In a before-after study, a total of 16 542 prescriptions for 1262 patients were analyzed applying the criteria defined in both STOPP- START (screening tool of older people's prescriptions and screening tool to alert to right treatment. The intervention consisted in lectures and publications on STOPP-START criteria made available to all the areas of the hospital and suggestions made by the clinical pharmacist to the physician on each individual prescription. Before intervention, PIM was 48.9% on admission and 46.1% at discharge, while after the intervention it was 47.4% on admission and 16.7% at discharge. APO was 10% on admission and 7.6% at discharge, while after intervention it was 12.2% on admission and 7.9% at discharge. ADE were 50.9% before and 34.4% after intervention. The frequency of return to emergency was 12.2% and 4.7% before and after intervention. PIM, EAM, conciliation error, clinically serious drug interaction, and delirium were reduced to statistically significant levels. In line with various international studies, the intervention showed to attain positive results.

  14. Inappropriate sexual behaviours of patients towards practising physiotherapists: a study using qualitative methods.

    Science.gov (United States)

    O'Sullivan, V; Weerakoon, P

    1999-01-01

    Recent research recognizes the occurrence of inappropriate sexual behaviour (ISB) by patients towards health professionals. The objective of this study was to explore in-depth the clinical context and effect of incidents of ISB towards practising physiotherapists. In-depth interviews were conducted with a sub-sample of nine physiotherapists who were part of a larger survey on ISB. Quantitative analyses of the survey responses are reported elsewhere. Interview participants were asked to describe an incident of ISB by a patient that was either perceived to be the worst or was the most recent. They were asked questions on a variety of themes, such as their relationship with the patient prior to incident, the effects of the incident, the strategies used to deal with the incident, and changes in practice as a result of the incident. All interview participants reported encountering some level of ISB from patients. Although the overall frequency of these behaviours was relatively low, the range of behaviours was diverse. Regardless of the perceived severity of the incident, only four participants labelled their experience as 'sexual harassment'. Many reported negative effects on work performance. Participants mainly used physical measures to prevent further incidents, rather than confronting the perpetrator or reporting the incident. The findings are discussed in the context of theory pertaining to boundaries and issues of transference and counter-transference. This emphasized the need for effective communication skills training of both undergraduate and graduate physiotherapists in the prevention and management of ISB from patients.

  15. Fractionated laser resurfacing corrects the inappropriate UVB response in geriatric skin.

    Science.gov (United States)

    Spandau, Dan F; Lewis, Davina A; Somani, Ally-Khan; Travers, Jeffrey B

    2012-06-01

    Non-melanoma skin cancer is a disease primarily afflicting geriatric patients as evidenced by the fact that 80% of all non-melanoma skin cancers are diagnosed in patients over the age of 60 years. As such, geriatric skin responds to cancer-inducing UVB irradiation in a manner that allows the establishment of tumor cells. Currently, the only effective treatment for non-melanoma skin cancer is the removal of the tumors after they appear, indicating the need for a more cost-effective prophylactic therapy. Geriatric volunteers were treated with fractionated laser resurfacing therapy on either sun-protected (upper buttocks) or chronically sun-exposed (dorsal forearm) skin. Fractionated laser resurfacing therapy was shown to decrease the occurrence of senescent fibroblasts in geriatric dermis, increase the dermal expression of IGF-1, and correct the inappropriate UVB response observed in untreated geriatric skin. These responses to fractionated laser resurfacing were equal to the effects seen previously using the more aggressive wounding following dermabrasion. Furthermore, fractionated laser resurfacing was equally effective in both sun-protected and sun-exposed skin. The ability of fractionated laser resurfacing treatment to protect against the occurrence of UVB-damaged proliferating keratinocytes indicates the potential of fractionated laser resurfacing to reduce or prevent aging-associated non-melanoma skin cancer.

  16. Paliperidone Inducing Concomitantly Syndrome of Inappropriate Antidiuretic Hormone, Neuroleptic Malignant Syndrome, and Rhabdomyolysis

    Directory of Open Access Journals (Sweden)

    Jaspinder Kaur

    2016-01-01

    Full Text Available Paliperidone, an active metabolite of risperidone, is a new atypical antipsychotic agent. Syndrome of inappropriate antidiuretic hormone (SIADH, neuroleptic malignant syndrome (NMS, and rhabdomyolysis are the uncommon side effects of psychotropic drugs. We report a case of 35-year-old male with schizoaffective disorder who was admitted for acute-on-chronic exacerbation of his psychotic disorder for which intramuscular paliperidone 234 mg injection was given. Two days later, the patient developed hyponatremic seizures secondary to SIADH which was treated with hypertonic saline. On the third day, he developed high grade fever and severe muscle rigidity with raised creatine phosphokinase (CPK and liver enzymes levels. He was treated with dantrolene 100 mg, bromocriptine 2.5 mg, and lorazepam 2 mg. Our patient required management of the three rare conditions following treatment with paliperidone. This case highlights the need for health care providers to be aware of the rare, potentially life threatening but preventable hyponatremia, NMS, and rhabdomyolysis as a possible adverse effect of paliperidone.

  17. Factors underlying students’ appropriate or inappropriate use of scholarly sources in academic writing, and instructors’ responses

    Directory of Open Access Journals (Sweden)

    John Sivell

    2013-07-01

    Full Text Available At first glance it is surprising that – in remarkable contrast to grammatical or lexical failings which, while certainly not viewed as insignificant, are rarely greeted with outright anger or hostility – inappropriate documentation of scholarly sources so frequently provokes very harsh penalties. Rather than the constructively pedagogical approach that one would expect with regard to other defects in writing, why do we so often witness a rush to negative evaluation of what may, after all, be evidence of nothing more culpable than misinformation, confusion, or oversight? Much has of course been written about possible remedies for ineffective use of scholarly sources and, on the other hand, about available monitoring and punishment for deliberate plagiarism; so, in a sense, the alternatives appear quite simple. However, decisions about when to adopt a more pedagogical or a more disciplinary viewpoint are complicated by difficult and potentially emotional factors that can disrupt calm, confident and well-reasoned judgment. Thus, this paper will focus not on pedagogical or disciplinary strategies, whichever may be considered suitable in a given case, but on a framework for thorough reflection earlier in the thinking process. It will explore multiple perspectives on possible origins for the innocent if maladroit mishandling of scholarly sources, with a view to highlighting a number of informative but potentially neglected reference points – a cognitive psychological perspective on human error and error management, plausible ambiguities in determining what actually constitutes plagiarism, and communication challenges – that may enter into the instructor’s final determination.

  18. Inappropriate Use of Psychotropic Drugs in People Aged 60 and over

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    María Magdalena Caro Mantilla

    2013-03-01

    Full Text Available Background: indiscriminate use of psychoactive medication can provoke multiple disorders to the elderly system. Furthermore, it can also result in drug abuse. Objective: to characterize the inappropriate use of psychotropic drugs in people aged 60 and over. Methods: a descriptive, cross-sectional and prospective study was conducted in two consultations of Health Area # II in the municipality of Cienfuegos from June to December 2006. The sample consisted of 93 adults aged over 60. The variables analyzed were age, sex, educational level, prescribed medication and its application, symptoms leading to the indication, duration of the treatment according to the prescription, follow-up, therapeutic alternatives, tolerance and abstinence. We applied a functional assessment scale: the Lawton and Brody Scale. For the statistical processing, descriptive statistics tests were performed. For computational processing, a database was created in the SPSS 11.0 program for Windows. Results: it is mostly women who consume these types of drugs. The most consumed psychoactive drugs were benzodiazepines and mainly through self-medication. Elderly presented tolerance and abstinence. There was a misuse of these drugs in relation to the time of consumption, prescription, follow-up and treatment options such as natural and traditional medicine. Conclusions: high rates of medical prescription, failures in patient’s follow-up, self-medication and non-use of therapeutic alternatives are some of the many causes of the indiscriminate use of psychoactive drugs in people aged over 60.

  19. Biomarker for Glycogen Storage Diseases

    Science.gov (United States)

    2017-07-03

    Fructose Metabolism, Inborn Errors; Glycogen Storage Disease; Glycogen Storage Disease Type I; Glycogen Storage Disease Type II; Glycogen Storage Disease Type III; Glycogen Storage Disease Type IV; Glycogen Storage Disease Type V; Glycogen Storage Disease Type VI; Glycogen Storage Disease Type VII; Glycogen Storage Disease Type VIII

  20. Attributes and circumstances that induce inappropriate health services demand: a study of the health sector in Brazil.

    Science.gov (United States)

    Guimarães, Djalma S; Soares, Eduardo J O; Júnior, Gileno Ferraz; Medeiros, Denise D

    2015-02-18

    The current economic and social context has required health systems to provide top quality services and to be efficient in controlling costs. An obstacle to achieve these goals is the inappropriate health services demand. This study aims to present these inappropriate health service demand determinants from data on telephone calls made to a medical advice call centre. This study used a Brazilian medical advice call centre data sample in the period of November and December 2012 (n = 19690), which supplied data on the user's initial request, the physician's recommendation, information on the patient and circumstances (the day and time of the day of the telephone call). The convergence between user intent and medical recommendation consists in adequate demand; otherwise the divergence consists in an inadequate one. In this way, using a logistic regression model, the critical factors that determine inappropriate health services request could be estimated. In general, the user's initial intent is the most critical for the inappropriate health system demand occurrence: the greater the complexity of the patient's initial intent, the greater the chance the intent is wrong: (OR: 1.160; 95% CI: 1.113-1.210). With regard to the social characteristics, men are more likely to make inappropriate requests (OR: 1.102; 95% CI: 1038-1169); as well as youngsters are more likely to use the system incorrectly (OR = .993; 95% CI: .992 - .994). Regarding the circumstances (day and time of the call), requests in the final hours of the day and on days close to the weekend are more likely to be the inappropriate ones (OR: 1.082 for each six hour increase; 95% CI: 1.049-1.116) and weekday (OR: 1.017 for each day increase; 95% CI: 1.002-1.032). The critical profile for the inappropriate use occurrence consists of males and youngsters, who use the health service in the final hours of the day and at weekends, and mainly want to use more complex services. A practical implication of this

  1. HiRITER - An evaluation tool to reduce the adverse effect of inappropriate human actions in nuclear power plants

    International Nuclear Information System (INIS)

    Park, J.; Jung, W.; Kim, J.; Kim, S.; Heo, G.

    2012-01-01

    From end-users to regulatory bodies, it is widely recognized that human-induced events including inappropriate human actions are one of the most crucial sources degrading the overall safety of nuclear power plants (NPPs). This means that a systematic framework through which inappropriate human actions can be effectively identified is necessary to enhance the safety of NPPs. For this reason, HiRITER (High Risk Inducible Task Evaluator) has been developed, which is able to evaluate the effect of inappropriate human actions on risk as well as performance. To this end, HiRITER integrates three modules that have distinctive roles: human error prediction module that is able to determine the types of failure modes resulting from inappropriate human actions with the associated daily task, performance evaluation module that computes the loss of electric power due to the change of component configurations caused by human error and risk evaluation module that clarifies whether or not the propagation of human error can trigger an unexpected shutdown of NPPs. In addition, a couple of real events that had occurred in domestic NPPs are simulated in order to validate the feasibility of HiRITER. As a result, it is observed that the results of HiRITER are largely congruent with those of real events. Therefore, although a huge amount of additional effort is indispensable to enhance the overall accuracy of estimated results, it is expected that HiRITER could be a good starting point to reduce the adverse effect of inappropriate human actions in NPPs

  2. Physical violence by an intimate partner and the inappropriate use of prenatal care services among women in Northeastern Brazil.

    Science.gov (United States)

    Carneiro, Jackelyne Faierstein; Valongueiro, Sandra; Ludermir, Ana Bernarda; Araújo, Thália Velho Barreto de

    2016-01-01

    To analyze the association between physical violence by an intimate partner (PVIP) and the inappropriate use of prenatal care services. A nested cross-sectional study was conducted with 1,026 women, based on data from a prospective cohort study designed to investigate intimate partner violence among pregnant women enrolled in the Family Health Program (PSF) in Recife, Northeastern Brazil. The use of prenatal care services was assessed with basis on the guidelines from the Program for Humanization of Prenatal Care and Childbirth (Brazilian Ministry of Health) and considered the time of the first prenatal care visit and the total number of visits during the pregnancy. Data were collected through two face-to-face interviews (one in the last pregnancy trimester and the other in the postpartum period), using standardized questionnaires and data on Pregnancy Card records. An unconditional logistic regression was performed to estimate the odds ratio (OR) and the 95% confidence intervals to measure the association between an PVIP and the inappropriate use of prenatal care services, using the stepwise method. The prevalence of the inappropriate use of prenatal care services was 44.1% and of an PVIP, 25.6%. In the logistic regression analysis, an intimatePVIP was associated with inappropriate prenatal care (OR = 1.37; 95%CI 1.01 - 1.85; p = 0.04) after adjustment by variables confirmed as confounders (parity, alcohol use in pregnancy, and education level). Women who are victims of an PVIP have more chance of receiving inappropriate prenatal care due to late onset of prenatal care, fewer prenatal care visits, or both.

  3. Level, pattern, and determinants of polypharmacy and inappropriate use of medications by village doctors in a rural area of Bangladesh

    Directory of Open Access Journals (Sweden)

    Rasu RS

    2014-12-01

    Full Text Available Rafia S Rasu,1 Mohammad Iqbal,2 SMA Hanifi,2 Ariful Moula2 Shahidul Hoque,2 Sabrina Rasheed,2 Abbas Bhuiya2 1School of Pharmacy, University of Missouri-Kansas City, Kansas City, MO, USA; 2Centre for Equity and Health System, International Centre for Diarrhoeal Disease Research (ICDDR,B, Dhaka, Bangladesh Objective: Village doctors, informal health care providers practicing modern medicine, are dominant health care providers in rural Bangladesh. Given their role, it is important to examine their prescription pattern and inappropriate use of medication. Methods: These cross-sectional study data were collected through surveys of patients seen by village doctors during 2008 and 2010 at Chakaria, a typical rural area of Bangladesh. Categorization of appropriate, inappropriate, and harmful prescriptions by disease conditions was based on guidelines defined by the World Health Organization (WHO, the United Nations Children’s Fund (UNICEF, and the Government of Bangladesh. Analytical categorization of polypharmacy was defined when five or more medications were prescribed for a patient at a single visit. Findings: A total of 2,587 prescriptions were written by village doctors during the survey periods. Among the prescriptions were appropriate (10%, inappropriate (8%, combination of appropriate and inappropriate (63%, and harmful medications (19%. Village doctors with more than high school education were 53% less likely (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.26–0.86 to give polypharmacy prescriptions than those with less than high school education. While exploring determinants of prescribing inappropriate and harmful medications, this study found that polypharmacy prescriptions were six times more likely [OR: 6.00, 95% CI: 3.88–9.29] to have harmful medications than prescriptions with <5 medications. Conclusion: Village doctors’ training and supervision may improve the quality of services and establish accountability for the

  4. Health IT and inappropriate utilization of outpatient imaging: A cross-sectional study of U.S. hospitals.

    Science.gov (United States)

    Appari, Ajit; Johnson, M Eric; Anthony, Denise L

    2018-01-01

    To determine whether the use of information technology (IT), measured by Meaningful Use capability, is associated with lower rates of inappropriate utilization of imaging services in hospital outpatient settings. A retrospective cross-sectional analysis of 3332 nonfederal U.S. hospitals using data from: Hospital Compare (2011 outpatient imaging efficiency measures), HIMSS Analytics (2009 health IT), and Health Indicator Warehouse (market characteristics). Hospitals were categorized for their health IT infrastructure including EHR Stage-1 capability, and three advanced imaging functionalities/systems including integrated picture archiving and communication system, Web-based image distribution, and clinical decision support (CDS) with physician pathways. Three imaging efficiency measures suggesting inappropriate utilization during 2011 included: percentage of "combined" (with and without contrast) computed tomography (CT) studies out of all CT studies for abdomen and chest respectively, and percentage of magnetic resonance imaging (MRI) studies of lumbar spine without antecedent conservative therapy within 60days. For each measure, three separate regression models (GLM with gamma-log link function, and denominator of imaging measure as exposure) were estimated adjusting for hospital characteristics, market characteristics, and state fixed effects. Additionally, Heckman's Inverse Mills Ratio and propensity for Stage-1 EHR capability were used to account for selection bias. We find support for association of each of the four health IT capabilities with inappropriate utilization rates of one or more imaging modality. Stage-1 EHR capability is associated with lower inappropriate utilization rates for chest CT (incidence rate ratio IRR=0.72, p-value value value value value value value use of Stage-1 Meaningful Use capable EHR systems along with advanced imaging related functionalities could have a beneficial impact on reducing some of the inappropriate utilization of

  5. Dual paraneoplastic syndromes: small cell lung carcinoma-related oncogenic osteomalacia, and syndrome of inappropriate antidiuretic hormone secretion: report of a case and review of the literature.

    Science.gov (United States)

    Tantisattamo, Ekamol; Ng, Roland C K

    2011-07-01

    Acquired isolated renal phosphate wasting associated with a tumor, known as oncogenic osteomalacia or tumor-induced osteomalacia, is a rare paraneoplastic syndrome caused by overproduction of fibroblast growth factor 23. Oncogenic osteomalacia is usually associated with benign mesenchymal tumors. Syndrome of inappropriate antidiuretic hormone secretion (SIADH), on the other hand, is a common paraneoplastic syndrome caused by small cell carcinoma (SCC). Concomitant oncogenic osteomalacia and SIADH associated with SCC is very rare with only 4 other cases reported in the literature. The authors report a case of small cell lung cancer (SCLC)-related renal wasting hypophosphatemia and concurrent SIADH, and review the literature reporting 9 other cases of SCC associated with oncogenic osteomalacia. Almost half of reported cases of renal phosphate wasting associated with SCC concomitantly presented with SIADH. These cases had initial serum phosphorus level lower and survival periods shorter than those without SIADH. This rare combination of a dual paraneoplastic syndrome and low serum phosphorus may be a poor prognostic sign. In addition, both renal phosphate wasting and SIADH usually occur in a short period of time before identification of SCC. Therefore, renal wasting hypophosphatemia with concomitant SIADH/hyponatremia should prompt a search for SCC rather than a benign mesenchymal tumor.

  6. Treatment of the syndrome of inappropriate secretion of antidiuretic hormone by urea.

    Science.gov (United States)

    Decaux, G; Brimioulle, S; Genette, F; Mockel, J

    1980-07-01

    Recent data have shown the role of urea in the urinary concentrating mechanism. We studied the effects of exogenous urea administration in hyponatremia associated with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In 20 patients with SIADH, we observed a positive correlation between serum sodium and blood urea levels (r = 0.65; p less than 0.01). In one patient with an oat cell carcinoma and SIADH-induced hyponatremia, we observed the same positive correlation (r = 0.80; p less than 0.01) but also a negative one between the excreted fraction of filtered sodium and urinary urea (r = -0.67; p less than 0.001). The short-term administration of low doses of urea (4 to 10 g) resulted in correcting the "salt-losing" tendency of this patient. Longer term administration of high doses of urea (30 g/day) was attempted with the same patient as well as with a healthy volunteer subject with Pitressin-induced SIADH. in both patients, urea treatment lowered urinary sodium excretion as long as hyponatremia was significant (less than 130 meq/liter). Urea treatment also induced a persistent osmotic diuresis, allowing a normal daily intake of water despite SIADH. This was clearly shown during the long-term treatment of a third patient with SIADH who was taking 30 g urea/day during 11 weeks. It is concluded that urea is a good alternative in the treatment of patients with SIADH who presented with persistent hyponatremia despite the restriction of water intake.

  7. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2.

    Science.gov (United States)

    O'Mahony, Denis; O'Sullivan, David; Byrne, Stephen; O'Connor, Marie Noelle; Ryan, Cristin; Gallagher, Paul

    2015-03-01

    Screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START) criteria were first published in 2008. Due to an expanding therapeutics evidence base, updating of the criteria was required. We reviewed the 2008 STOPP/START criteria to add new evidence-based criteria and remove any obsolete criteria. A thorough literature review was performed to reassess the evidence base of the 2008 criteria and the proposed new criteria. Nineteen experts from 13 European countries reviewed a new draft of STOPP & START criteria including proposed new criteria. These experts were also asked to propose additional criteria they considered important to include in the revised STOPP & START criteria and to highlight any criteria from the 2008 list they considered less important or lacking an evidence base. The revised list of criteria was then validated using the Delphi consensus methodology. The expert panel agreed a final list of 114 criteria after two Delphi validation rounds, i.e. 80 STOPP criteria and 34 START criteria. This represents an overall 31% increase in STOPP/START criteria compared with version 1. Several new STOPP categories were created in version 2, namely antiplatelet/anticoagulant drugs, drugs affecting, or affected by, renal function and drugs that increase anticholinergic burden; new START categories include urogenital system drugs, analgesics and vaccines. STOPP/START version 2 criteria have been expanded and updated for the purpose of minimizing inappropriate prescribing in older people. These criteria are based on an up-to-date literature review and consensus validation among a European panel of experts. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society.

  8. Potentially inappropriate prescribing and the risk of adverse drug reactions in critically ill older adults

    Directory of Open Access Journals (Sweden)

    Galli TB

    2016-12-01

    Full Text Available Background: Potentially inappropriate medication (PIM use in the elderly is associated with increased risk of adverse drug reactions (ADRs, but there is limited information regarding PIM use in the intensive care unit (ICU setting. Objective: The aim of the study is to describe the prevalence and factors associated with the use of PIM and the occurrence of PIM-related adverse reactions in the critically ill elderly. Methods: This study enrolled all critically ill older adults (60 years or more admitted to medical or cardiovascular ICUs between January and December 2013, in a large tertiary teaching hospital. For all patients, clinical pharmacists listed the medications given during the ICU stay and data on drugs were analyzed using 2012 Beers Criteria, to identify the prevalence of PIM. For each identified PIM the medical records were analyzed to evaluate factors associated with its use. The frequency of ADRs and, the causal relationship between PIM and the ADRs identified were also evaluated through review of medical records. Results: According to 2012 Beers Criteria, 98.2% of elderly patients used at least one PIM (n=599, of which 24.8% were newly started in the ICUs. In 29.6% of PIMs, there was a clinical circumstance that justified their prescription. The number of PIMs was associated with ICU length of stay and total number of medications. There was at least one ADR identified in 17.8% of patients; more than 40% were attributed to PIM, but there was no statistical association. Conclusions: There is a high prevalence of PIM used in acutely ill older people, but they do not seem to be the major cause of adverse drug reactions in this population. Although many PIMs had a clinical circumstance that led to their prescription during the course of ICU hospitalization, many were still present upon hospital discharge. Therefore, prescription of PIMs should be minimized to improve the safety of elderly patients.

  9. Empagliflozin Increases Short-Term Urinary Volume Output in Artificially Induced Syndrome of Inappropriate Antidiuresis

    Directory of Open Access Journals (Sweden)

    Julie Refardt

    2017-01-01

    Full Text Available Objective. Syndrome of inappropriate antidiuresis (SIADH is the predominant cause of hyponatremia, but treatment options are unsatisfying. SGLT2 inhibitors increase urinary glucose excretion with concomitant osmotic diuresis. We therefore hypothesized SGLT2-inhibitors as a novel treatment for SIADH. Design. Double-blind placebo-controlled randomised crossover study in 14 healthy volunteers. Methods. We induced an artificial SIADH model by administration of desmopressin and overhydration. Afterwards, empagliflozin 25 mg or placebo was given in random order. The main outcomes were total urinary excretion, glucosuria, and the area under the curve (AUC of serum sodium concentration. Outcome measures were obtained 2–8 hours after administration of study drug. Results. 14 participants (64% males, BMI 23 kg/m2 (±2.4, aged 28.6 years (±9, completed the study. Empagliflozin led to significantly increased total urinary excretion (579.3 ml (±194.8 versus 367.3 ml (±158.8; treatment effect 158 ml (CI 48.29, 267.74, p=0.017 due to glucosuria (74.18 mmol (±22.3 versus 0.12 mmol (±0.04; treatment effect (log scale 2.85 (CI 2.75, 2.96, p<0.001. There was no difference in the AUC of serum sodium concentration (treatment effect 0.2 (CI −7.38, 6.98, p=0.96. Conclusion. In our SIADH model, empagliflozin increased urinary excretion due to osmotic diuresis. Due to the short treatment duration, serum sodium levels remained unchanged. Real-live studies are needed to further examine empagliflozin as a new treatment for SIADH.

  10. Ibuprofen Can Induce Syndrome of Inappropriate Diuresis in Healthy Young Patients

    Directory of Open Access Journals (Sweden)

    Céline Roche

    2013-01-01

    Full Text Available A 30-year-old caucasian woman, without past medical history or known drug use, was admitted to the emergency department for persistent fever and arthralgias. The laboratory analysis showed moderate hypoosmolar hyponatremia (Na: 132 mmol/L, osmolality: 239 mOsm/L, normal sodium excretion (<20 mmol/L, and a high urinary osmolality (415 mOsm/L. Later, she deteriorated with seizures and deeper hyponatremia (Na: 113 mmol/L and so was moved to the critical care unit. At first, no obvious aetiology was found, the patient was euvolemic, as she was well hydrated and lacked concerning findings of heart failure, renal disease, or liver cirrhosis. A syndrome of inappropriate diuresis (SIAD was proposed, and corrective measures were started immediately to reduce her hyponatremia, including restriction of fluid intake. The administration of intravenous hypertonic saline solution permitted normal neurological status to be restored and corrected the sodium concentration but induced reversible acute renal failure. Further investigation revealed that the patient had ingested 8 g ibuprofen two days before admission. After other aetiologies were ruled out, drug-induced SIAD due to ibuprofen was the most likely diagnosis for this patient. SIAD-associated hyponatremia and acute renal failure are rare side effects of nonsteroidal anti-inflammatory drugs, particularly in young people. Therefore, this case may represent a unique case of NSAID-induced SIAD and highlight the need to obtain thorough medication histories and exclude all other potential causes in hyponatremic patients.

  11. Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list.

    Science.gov (United States)

    Pohl-Dernick, Katharina; Meier, Florian; Maas, Renke; Schöffski, Oliver; Emmert, Martin

    2016-04-01

    Several lists of potentially inappropriate medication (PIM) for elderly patients have been developed worldwide in recent years. Those lists intend to reduce prescriptions of drugs that carry an unnecessarily high risk of adverse drug events in elderly patients. In 2010, an expert panel published the PRISCUS list for the German drug market. This study calculates the amount of drug reimbursement for PIM in Germany and potential cost effects from the perspective of statutory health insurance when these are replaced by the substitutes recommended by the PRISCUS list. Register-based data for the 30 top-selling drugs on the PRISCUS list in 2009 for patients greater than or equal to 65 years of age were provided by the Scientific Institute of the German Local Health Care Fund. We calculated the percentage of sales and defined daily doses for patients greater than or equal to 65 years of age compared with the total statutory health insurance population. Reimbursement costs for the recommended substitutions were estimated by considering different scenarios. In 2009, drug reimbursement for the 30 top-selling PIM prescribed to patients greater than or equal to 65 years of age were calculated to be €305.7 million. Prescribing the recommended substitution medication instead of PIM would lead to an increased total reimbursement cost for the German health care system ranging between from €325.9 million to €810.0 million. The results show that the substitution of PIM by medication deemed to be more appropriate for the elderly comes along with additional costs. Consequently, there is no short-term incentive for doing so from a payer perspective. Future studies have to consider the long-term effects and other sectors.

  12. Positive urine cultures: A major cause of inappropriate antimicrobial use in hospitals?

    Science.gov (United States)

    Silver, Samuel A; Baillie, Laura; Simor, Andrew E

    2009-01-01

    Urine specimens are among the most common samples submitted for culture to microbiology laboratories. The objectives of the present study were to describe the indications for obtaining urine cultures in a cohort of hospitalized patients, and to determine the appropriateness of antimicrobial therapy in response to urine culture results. The study was performed at a teaching hospital with an adjoining long-term care facility from June 1 to July 31, 2006. The medical records of nonpregnant adult patients with and without bacteriuria were reviewed. A symptomatic urinary tract infection was defined as the presence of bacteriuria in a patient with fever or urinary symptoms; asymptomatic bacteriuria was defined as bacteriuria without urinary symptoms and no infection evident at another site. Medical records of 335 eligible patients (64% male; mean age 68 years) were reviewed, including all 137 with bacteriuria, and 198 with negative urine cultures. In total, 51% of the urine specimens were obtained from an indwelling urinary catheter, and 28% were voided urine samples. Confusion (57%) and fever (36%) were the most common indications noted for obtaining the urine cultures. Only 34 patients (25% of those with positive urine cultures) met the criteria for a symptomatic urinary tract infection; 67 (49%) had asymptomatic bacteriuria and 36 (26%) had infection at a nonurinary site. Of those with asymptomatic bacteriuria, 64% received antimicrobial therapy for a total of 347 days. Confused patients with asymptomatic bacteriuria were more likely to be treated than were bacteriuric patients without altered mental status (OR 1.8, 95% CI 1.2 to 4.1; P=0.03). Urine cultures are frequently obtained from hospitalizedpatients,evenintheabsenceofurinarysymptoms.Asymptomatic bacteriuria is often treated in these patients, and accounts for a substantial burden of inappropriate antimicrobial use in hospitals. Effective strategies to improve urine culture ordering and antimicrobial

  13. A copeptin-based classification of the osmoregulatory defects in the syndrome of inappropriate antidiuresis.

    Science.gov (United States)

    Fenske, Wiebke Kristin; Christ-Crain, Mirjam; Hörning, Anna; Simet, Jessica; Szinnai, Gabor; Fassnacht, Martin; Rutishauser, Jonas; Bichet, Daniel G; Störk, Stefan; Allolio, Bruno

    2014-10-01

    Hyponatremia, the most frequent electrolyte disorder, is caused predominantly by the syndrome of inappropriate antidiuresis (SIAD). A comprehensive characterization of SIAD subtypes, defined by type of osmotic dysregulation, is lacking, but may aid in predicting therapeutic success. Here, we analyzed serial measurements of serum osmolality and serum sodium, plasma arginine vasopressin (AVP), and plasma copeptin concentrations from 50 patients with hyponatremia who underwent hypertonic saline infusion. A close correlation between copeptin concentrations and serum osmolality existed in 68 healthy controls, with a mean osmotic threshold±SD of 282±4 mOsM/kg H2O. Furthermore, saline-induced changes in copeptin concentrations correlated with changes in AVP concentrations in controls and patients. With use of copeptin concentration as a surrogate measure of AVP concentration, patients with SIAD could be grouped according to osmoregulatory defect: Ten percent of patients had grossly elevated copeptin concentrations independent of serum osmolality (type A); 14% had copeptin concentrations that increased linearly with rising serum osmolality but had abnormally low osmotic thresholds (type B); 44% had normal copeptin concentrations independent of osmolality (type C), and 12% had suppressed copeptin concentrations independent of osmolality (type D). A novel SIAD subtype discovered in 20% of patients was characterized by a linear decrease in copeptin concentrations with increasing serum osmolality (type E or "barostat reset"). In conclusion, a partial or complete loss of AVP osmoregulation occurs in patients with SIAD. Although the mechanisms underlying osmoregulatory defects in individual patients are presumably diverse, we hypothesize that treatment responses and patient outcomes will vary according to SIAD subtype. Copyright © 2014 by the American Society of Nephrology.

  14. Potentially inappropriate medication: Association between the use of antidepressant drugs and the subsequent risk for dementia.

    Science.gov (United States)

    Heser, Kathrin; Luck, Tobias; Röhr, Susanne; Wiese, Birgitt; Kaduszkiewicz, Hanna; Oey, Anke; Bickel, Horst; Mösch, Edelgard; Weyerer, Siegfried; Werle, Jochen; Brettschneider, Christian; König, Hans-Helmut; Fuchs, Angela; Pentzek, Michael; van den Bussche, Hendrik; Scherer, Martin; Maier, Wolfgang; Riedel-Heller, Steffi G; Wagner, Michael

    2018-01-15

    Potentially inappropriate medication (PIM) is associated with an increased risk for detrimental health outcomes in elderly patients. Some antidepressant drugs are considered as PIM, but previous research on the association between antidepressants and subsequent dementia has been inconclusive. Therefore, we investigated whether the intake of antidepressants, particularly of those considered as PIM according to the Priscus list, would predict incident dementia. We used data of a prospective cohort study of non-demented primary care patients (n = 3239, mean age = 79.62) to compute Cox proportional hazards models. The risk for subsequent dementia was estimated over eight follow-ups up to 12 years depending on antidepressant intake and covariates. The intake of antidepressants was associated with an increased risk for subsequent dementia (HR = 1.53, 95% CI: 1.16-2.02, p = .003; age-, sex-, education-adjusted). PIM antidepressants (HR = 1.49, 95% CI: 1.06-2.10, p = .021), but not other antidepressants (HR = 1.04, 95% CI: 0.66-1.66, p = .863), were associated with an increased risk for subsequent dementia (in age-, sex-, education-, and depressive symptoms adjusted models). Significant associations disappeared after global cognition at baseline was controlled for. Methodological limitations such as selection biases and self-reported drug assessments might have influenced the results. Only antidepressants considered as PIM were associated with an increased subsequent dementia risk. Anticholinergic effects might explain this relationship. The association disappeared after the statistical control for global cognition at baseline. Nonetheless, physicians should avoid the prescription of PIM antidepressants in elderly patients whenever possible. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Carbon dioxide narcosis due to inappropriate oxygen delivery: a case report.

    Science.gov (United States)

    Herren, Thomas; Achermann, Eva; Hegi, Thomas; Reber, Adrian; Stäubli, Max

    2017-07-28

    Oxygen delivery to patients with chronic obstructive pulmonary disease may be challenging because of their potential hypoxic ventilatory drive. However, some oxygen delivery systems such as non-rebreathing face masks with an oxygen reservoir bag require high oxygen flow for adequate oxygenation and to avoid carbon dioxide rebreathing. A 72-year-old Caucasian man with severe chronic obstructive pulmonary disease was admitted to the emergency department because of worsening dyspnea and an oxygen saturation of 81% measured by pulse oximetry. Oxygen was administered using a non-rebreathing mask with an oxygen reservoir bag attached. For fear of removing the hypoxic stimulus to respiration the oxygen flow was inappropriately limited to 4L/minute. The patient developed carbon dioxide narcosis and had to be intubated and mechanically ventilated. Non-rebreathing masks with oxygen reservoir bags must be fed with an oxygen flow exceeding the patient's minute ventilation (>6-10 L/minute.). If not, the amount of oxygen delivered will be too small to effectively increase the arterial oxygen saturation. Moreover, the risk of carbon dioxide rebreathing dramatically increases if the flow of oxygen to a non-rebreathing mask is lower than the minute ventilation, especially in patients with chronic obstructive pulmonary disease and low tidal volumes. Non-rebreathing masks (with oxygen reservoir bags) must be used cautiously by experienced medical staff and with an appropriately high oxygen flow of 10-15 L/minute. Nevertheless, arterial blood gases must be analyzed regularly for early detection of a rise in partial pressure of carbon dioxide in arterial blood in patients with chronic obstructive pulmonary disease and a hypoxic ventilatory drive. These patients are more safely managed using a nasal cannula with an oxygen flow of 1-2L/minute or a simple face mask with an oxygen flow of 5L/minute.

  16. Addressing the Issue of Chronic, Inappropriate Benzodiazepine Use: How Can Pharmacists Play a Role?

    Directory of Open Access Journals (Sweden)

    Helen C. Gallagher

    2013-09-01

    Full Text Available Prescribing guidelines do not recommend the long-term use of benzodiazepines since their effectiveness with chronic use is out-weighed by risks including dependence, memory and cognitive impairment, hip fractures and traffic accidents. Despite these guidelines, historical data points to an increasing proportion of inappropriate, repeat prescribing of benzodiazepines in Ireland and elsewhere, with up to 33% of patients who use these drugs doing so long-term. The typical long-term benzodiazepine user is an older, socio-economically disadvantaged patient who has been prescribed these medicines by their general practitioner (GP and dispensed them by their community pharmacist. Misuse of benzodiazepines in nursing homes and psychiatric institutions is also of concern, with one Irish study indicating that almost half of all admissions to a psychiatric hospital were prescribed these drugs, usually despite a lack of clear clinical need. Discontinuation of benzodiazepines has proven to be of benefit, as it is followed by improvements in cognitive and psychomotor function, particularly in elderly patients. It is obvious that an inter-professional effort, focusing on the primary care setting, is required to address benzodiazepine misuse and to ensure appropriate pharmaceutical care. Pharmacists must be an integral part of this inter-professional effort, not least because they are uniquely positioned as the health professional with most frequent patient contact. There is already some supporting evidence that pharmacists’ involvement in interventions to reduce benzodiazepine use can have positive effects on patient outcomes. Here, this evidence is reviewed and the potential for pharmacists to play an expanded role in ensuring the appropriate use of benzodiazepines is discussed.

  17. Women born preterm or with inappropriate weight for gestational age are at risk of subsequent gestational diabetes and pre-eclampsia

    DEFF Research Database (Denmark)

    á Rogvi, Rasmus; Forman, Julie Lyng; Damm, Peter

    2012-01-01

    Low birthweight, which can be caused by inappropriate intrauterine growth or prematurity, is associated with development of gestational diabetes mellitus (GDM) as well as pre-eclampsia later in life, but the relative effects of prematurity and inappropriate intrauterine growth remain uncertain....

  18. Symptomatic Hypoglycemia Related to Inappropriately High IGF-II Serum Levels in a Patient with Desmoplastic Small Round Cell Tumor

    Directory of Open Access Journals (Sweden)

    Williams Fernandes Barra

    2010-01-01

    Full Text Available A 45-year old man was diagnosed with desmoplastic small round cell tumor (DSRCT with involvement of the peritoneum and pelvis. Disease progression was observed despite systemic chemotherapy. Six months after diagnosis, he developed severe hypoglycemia presented with seizures. He received intravenous glucose infusion and hydrocortisone with poor glycemic control, but with seizures resolution. The investigation excluded insulinoma, adrenal, liver and GH deficiencies. Laboratory showed slight rise of IGF-II and significant increase of the ratio IGF-II : IGF-I, which is pathognomonic of non-islet cell tumor hypoglycemia (NICTH. He received the diagnoses of NICTH related to IGF-II inappropriate production by DSRCT. Despite the attempt to control tumor mass and hypoglycemia, the patient died 9 months after diagnosis. NICTH related to inappropriate IGF-II secretion should be investigated in all cancer patients with refractory hypoglycemia whom insulinoma and other metabolic abnormalities were excluded from.

  19. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

    OpenAIRE

    Pauline Siew Mei Lai; Yin Yen Wong; Yong Chia Low; Hui Ling Lau; Kin-Fah Chin; Sanjiv Mahadeva

    2014-01-01

    Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hosp...

  20. Les perceptions de justice et de discrimination des candidats face à des questions inappropriées au recrutement

    OpenAIRE

    Ocana , Tania

    2017-01-01

    Applicants’ reaction research has mostly focused on fairness perceptions, but several researchers encourage the study of perceived job discrimination during the selection process, as well as specific consequences of that discrimination. In order to create a situation in which discrimination was possible, we studied the effects of inappropriate job interview questions related to a stigma on fairness and discrimination perceptions as well their impact on the recruiters’ and the organization’s i...

  1. Response to hypothetical social scenarios in individuals with traumatic brain injury who present inappropriate social behavior: a preliminary report.

    Science.gov (United States)

    Gagnon, Jean; Henry, Anne; Decoste, François-Pierre; Ouellette, Michel; McDuff, Pierre; Daelman, Sacha

    2013-03-01

    Very little research thus far has examined the decision making that underlies inappropriate social behavior (ISB) post-TBI (traumatic brain injury). To verify the usefulness of a new instrument, the Social Responding Task, for investigating whether, in social decision making, individuals with TBI, who present inappropriate social behavior (ISB), have difficulty anticipating their own feelings of embarrassment and others' angry reactions following an ISB. Seven subjects with TBI presenting with inappropriate social behavior (TBI-ISB), 10 presenting with appropriate social behavior (TBI-ASB), and 15 healthy controls were given 12 hypothetical scenarios three times, each time ending with a different behavioral response. Subjects were asked to gauge the likelihood of their displaying the behavior in that situation (part A) and of it being followed by an angry reaction from the other or by feelings of embarrassment in themselves (part B). TBI-ISB subjects scored higher than TBI-ASB and healthy controls on a scale of likelihood of displaying an ISB. RESULTS regarding expectations of angry reactions from others and feelings of embarrassment after an ISB were similar among groups. Negative correlations between endorsement of an inappropriate behavior and anticipation of negative emotional consequences were significant for both TBI-ASB and control subjects, but not for TBI-ISB subjects. RESULTS suggest that the TBI-ISB participants were likely to endorse an ISB despite being able to anticipate a negative emotional response in themselves or others, suggesting that there were other explanations for their poor behavior. A self-reported likely response to hypothetical social scenarios can be a useful approach for studying the neurocognitive processes behind the poor choices of individuals with TBI-ISB, but the task needs further validation studies. A comprehensive discussion follows on the underlying mechanisms affecting social behaviors after a TBI.

  2. Response to Hypothetical Social Scenarios in Individuals with Traumatic Brain Injury Who Present Inappropriate Social Behavior: A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Michel Ouellette

    2013-01-01

    Full Text Available Background: Very little research thus far has examined the decision making that underlies inappropriate social behavior (ISB post-TBI (traumatic brain injury. Objectives: To verify the usefulness of a new instrument, the Social Responding Task, for investigating whether, in social decision making, individuals with TBI, who present inappropriate social behavior (ISB, have difficulty anticipating their own feelings of embarrassment and others’ angry reactions following an ISB. Methods: Seven subjects with TBI presenting with inappropriate social behavior (TBI-ISB, 10 presenting with appropriate social behavior (TBI-ASB, and 15 healthy controls were given 12 hypothetical scenarios three times, each time ending with a different behavioral response. Subjects were asked to gauge the likelihood of their displaying the behavior in that situation (part A and of it being followed by an angry reaction from the other or by feelings of embarrassment in themselves (part B. Results: TBI-ISB subjects scored higher than TBI-ASB and healthy controls on a scale of likelihood of displaying an ISB. Results regarding expectations of angry reactions from others and feelings of embarrassment after an ISB were similar among groups. Negative correlations between endorsement of an inappropriate behavior and anticipation of negative emotional consequences were significant for both TBI-ASB and control subjects, but not for TBI-ISB subjects. Conclusions: Results suggest that the TBI-ISB participants were likely to endorse an ISB despite being able to anticipate a negative emotional response in themselves or others, suggesting that there were other explanations for their poor behavior. A self-reported likely response to hypothetical social scenarios can be a useful approach for studying the neurocognitive processes behind the poor choices of individuals with TBI-ISB, but the task needs further validation studies. A comprehensive discussion follows on the underlying

  3. Hospitalization Risk and Potentially Inappropriate Medications among Medicare Home Health Nursing Patients.

    Science.gov (United States)

    Lohman, Matthew C; Cotton, Brandi P; Zagaria, Alexandra B; Bao, Yuhua; Greenberg, Rebecca L; Fortuna, Karen L; Bruce, Martha L

    2017-12-01

    Hospitalizations and potentially inappropriate medication (PIM) use are significant and costly issues among older home health patients, yet little is known about the prevalence of PIM use in home health or the relationship between PIM use and hospitalization risk in this population. To describe the prevalence of PIM use and association with hospitalization among Medicare home health patients. Cross-sectional analysis using data from 132 home health agencies in the US. Medicare beneficiaries starting home health nursing services between 2013 and 2014 (n = 87,780). Prevalence of individual and aggregate PIM use at start of care, measured using the 2012 Beers criteria. Relative risk (RR) of 30-day hospitalization or re-hospitalization associated with individual and aggregate PIM use, compared to no PIM use. In total, 30,168 (34.4%) patients were using at least one PIM, with 5969 (6.8%) taking at least two PIMs according to the Beers list. The most common types of PIMs were those affecting the brain or spinal cord, analgesics, and medications with anticholinergic properties. With the exception of nonsteroidal anti-inflammatory drugs (NSAIDs), PIM use across all classes was associated with elevated risk (10-33%) of hospitalization compared to non-use. Adjusting for demographic and clinical characteristics, patients using at least one PIM (excluding NSAIDs) had a 13% greater risk (RR = 1.13, 95% CI: 1.09, 1.17) of being hospitalized than patients using no PIMs, while patients using at least two PIMs had 21% greater risk (RR = 1.21, 95% CI: 1.12, 1.30). Similar associations were found between PIMs and re-hospitalization risk among patients referred to home health from a hospital. Given the high prevalence of PIM use and the association between PIMs and hospitalization risk, home health episodes represent opportunities to substantially reduce PIM use among older adults and prevent adverse outcomes. Efforts to address medication use during home health episodes

  4. A comparison of two tools to screen potentially inappropriate medication in internal medicine patients.

    Science.gov (United States)

    Blanc, A-L; Spasojevic, S; Leszek, A; Théodoloz, M; Bonnabry, P; Fumeaux, T; Schaad, N

    2018-04-01

    Potentially inappropriate medication (PIM) is an important issue for inpatient management; it has been associated with safety problems, such as increases in adverse drugs events, and with longer hospital stays and higher healthcare costs. To compare two PIM-screening tools-STOPP/START and PIM-Check-applied to internal medicine patients. A second objective was to compare the use of PIMs in readmitted and non-readmitted patients. A retrospective observational study, in the general internal medicine ward of a Swiss non-university hospital. We analysed a random sample of 50 patients, hospitalized in 2013, whose readmission within 30 days of discharge had been potentially preventable, and compared them to a sample of 50 sex- and age-matched patients who were not readmitted. PIMs were screened using the STOPP/START tool, developed for geriatric patients, and the PIM-Check tool, developed for internal medicine patients. The time needed to perform each patient's analysis was measured. A clinical pharmacist counted and evaluated each PIM detected, based on its clinical relevance to the individual patient's case. The rates of screened and validated PIMs involving readmitted and non-readmitted patients were compared. Across the whole population, PIM-Check and STOPP/START detected 1348 and 537 PIMs, respectively, representing 13.5 and 5.4 PIMs/patient. Screening time was substantially shorter with PIM-Check than with STOPP/START (4 vs 10 minutes, respectively). The clinical pharmacist judged that 45% and 42% of the PIMs detected using PIM-Check and STOPP/START, respectively, were clinically relevant to individual patients' cases. No significant differences in the rates of detected and clinically relevant PIM were found between readmitted and non-readmitted patients. Internal medicine patients are frequently prescribed PIMs. PIM-Check's PIM detection rate was three times higher than STOPP/START's, and its screening time was shorter thanks to its electronic interface. Nearly

  5. Indicators of inappropriate tumour marker use through the mining of electronic health records.

    Science.gov (United States)

    Gion, Massimo; Cardinali, Giulia; Trevisiol, Chiara; Zappa, Marco; Rainato, Giulia; Fabricio, Aline S C

    2017-08-01

    Although the issue of monitoring appropriateness of tumour markers (TMs) request in outpatients remains crucial, proper indicators are still demanding. The present study developed and explored indicators of inappropriate TM ordering in outpatients through the data mining of electronic health records (EHRs). Carcinoembryonic antigen (CEA), alfa-fetoprotein (AFP), carbohydrate antigen (CA)125, CA15.3, CA19.9, and prostate-specific antigen (PSA) ordered in outpatients during a year were examined by mining EHRs of a Local Health Authority in Italy. Evidence-based criteria were used to develop performance indicators. Demographic and clinical information associated with TM orders were examined. A total of 80 813 TMs were ordered in 52 536 outpatients (1.54 markers/patient). Indicators related to disease codes, gender, age, and TM repetitions were developed, and their application showed that (1) CA15.3 and CEA are prevalently requested in patients with cancer (79.2% and 65.6%) whereas the other TMs are largely requested also in patients without cancer; (2) requests of PSA in women and of CA125 or CA15.3 in men are negligible; (3) although requests in people older than 80 years are relevant (16.4% of total), the highest rate of request of all markers occurs in patients aged 40 to 79 years; (4) CA15.3 and CEA are mainly requested in cancer cases between 50 and 79 years and AFP, CA19.9, and CA125 in those between 60 and 69 years; (5) associated with cancer code for all age intervals; and (6) multiple repetitions of AFP, CA125, CA15.3, CA19.9, and CEA are prevalent in cancer patients or benign diseases to which TMs are appropriate, whereas PSA repetitions occur mainly in patients without cancer. The developed indicators resulted suitable to monitor TM overordering in outpatients through the mining of EHRs. The present study is a first approach towards the use of big-data mining for TM appropriateness evaluation purposes. © 2017 John Wiley & Sons, Ltd.

  6. Lipid storage myopathies.

    Science.gov (United States)

    Bruno, Claudio; Dimauro, Salvatore

    2008-10-01

    The aim of this review is to provide an update on disorders of lipid metabolism affecting skeletal muscle exclusively or predominantly and to summarize recent clinical, genetic, and therapeutic studies in this field. Over the past 5 years, new clinical phenotypes and genetic loci have been described, unusual pathogenic mechanisms have been elucidated, and novel pharmacological approaches have been developed. At least one genetic defect responsible for the myopathic form of CoQ10 deficiency has been identified, causing a disorder that is allelic with the late-onset riboflavine-responsive form of multiple acyl-coenzyme A dehydrogenation deficiency. Novel mechanisms involved in the lipolytic breakdown of cellular lipid depots have been described and have led to the identification of genes and mutations responsible for multisystemic neutral lipid storage disorders, characterized by accumulation of triglyceride in multiple tissues, including muscle. Defects in lipid metabolism can affect either the mitochondrial transport and oxidation of exogenous fatty acid or the catabolism of endogenous triglycerides. These disorders impair energy production and almost invariably involve skeletal muscle, causing progressive myopathy with muscle weakness, or recurrent acute episodes of rhabdomyolysis triggered by exercise, fasting, or infections. Clinical and genetic characterization of these disorders has important implications both for accurate diagnostic approach and for development of therapeutic strategies.

  7. Plutonium waste container identification

    International Nuclear Information System (INIS)

    Schmierer, T.J.

    1979-01-01

    The purpose of this paper is to define the parameters of a method for identifying plutonium waste containers. This information will form the basis for a permanent committee to develop a complete identification program for use throughout the world. Although a large portion of the information will be on handwritten notebooks and may not be as extensive as is desired, it will all be helpful. The final information will be programmed into computer language and be available to all interested parties as well as a central control committee which will have the expertise to provide each government with advice on the packaging, storage, and measurement of the waste for which it is responsible. As time progresses, this central control committee should develop permanent storage sites and establish a system of records which will last for hundreds of years

  8. The Use of Grid Storage Protocols for Healthcare Applications

    CERN Document Server

    Donno, F; CERN. Geneva. IT Department

    2008-01-01

    Grid computing has attracted worldwide attention for a variety of domains. Healthcare projects focus on data mining and standardization techniques, the issue of data accessibility and transparency over the storage systems on the Grid has seldom been tackled. In this position paper, we identify the key issues and requirements imposed by Healthcare applications and point out how Grid Storage Technology can be used to satisfy those requirements. The main contribution of this work is the identification of the characteristics and protocols that make Grid Storage technology attractive for building a Healthcare data storage infrastructure.

  9. Energy Conversion and Storage Program

    Energy Technology Data Exchange (ETDEWEB)

    Cairns, E.J.

    1992-03-01

    The Energy Conversion and Storage Program applies chemistry and materials science principles to solve problems in (1) production of new synthetic fuels, (2) development of high-performance rechargeable batteries and fuel cells, (3) development of advanced thermochemical processes for energy conversion, (4) characterization of complex chemical processes, and (5) application of novel materials for energy conversion and transmission. Projects focus on transport-process principles, chemical kinetics, thermodynamics, separation processes, organic and physical chemistry, novel materials, and advanced methods of analysis. Electrochemistry research aims to develop advanced power systems for electric vehicle and stationary energy storage applications. Topics include identification of new electrochemical couples for advanced rechargeable batteries, improvements in battery and fuel-cell materials, and the establishment of engineering principles applicable to electrochemical energy storage and conversion. Chemical Applications research includes topics such as separations, catalysis, fuels, and chemical analyses. Included in this program area are projects to develop improved, energy-efficient methods for processing waste streams from synfuel plants and coal gasifiers. Other research projects seek to identify and characterize the constituents of liquid fuel-system streams and to devise energy-efficient means for their separation. Materials Applications research includes the evaluation of the properties of advanced materials, as well as the development of novel preparation techniques. For example, the use of advanced techniques, such as sputtering and laser ablation, are being used to produce high-temperature superconducting films.

  10. Novel ICD Programming and Inappropriate ICD Therapy in CRT-D Versus ICD Patients: A MADIT-RIT Sub-Study.

    Science.gov (United States)

    Kutyifa, Valentina; Daubert, James P; Schuger, Claudio; Goldenberg, Ilan; Klein, Helmut; Aktas, Mehmet K; McNitt, Scott; Stockburger, Martin; Merkely, Bela; Zareba, Wojciech; Moss, Arthur J

    2016-01-01

    The Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate therapy (MADIT-RIT) trial showed a significant reduction in inappropriate implantable cardioverter defibrillator (ICD) therapy in patients programmed to high-rate cut-off (Arm B) or delayed ventricular tachycardia therapy (Arm C), compared with conventional programming (Arm A). There is limited data on the effect of cardiac resynchronization therapy with a cardioverter defibrillator (CRT-D) on the effect of ICD programming. We aimed to elucidate the effect of CRT-D on ICD programming to reduce inappropriate ICD therapy in patients implanted with CRT-D or an ICD, enrolled in MADIT-RIT. The primary end point of this study was the first inappropriate ICD therapy. Secondary end points were inappropriate anti-tachycardia pacing and inappropriate ICD shock. The study enrolled 742 (49%) patients with an ICD and 757 (51%) patients with a CRT-D. Patients implanted with a CRT-D had 62% lower risk of inappropriate ICD therapy than those with an ICD only (hazard ratio [HR] =0.38, 95% confidence interval: 0.25-0.57; Pprogramming significantly reduced the risk of inappropriate ICD therapy compared with conventional ICD programming in ICD (HR=0.14 [B versus A]; HR=0.21 [C versus A]) and CRT-D patients (HR=0.15 [B versus A]; HR=0.23 [C versus A]; Pprogramming significantly reduces the risk of inappropriate ICD therapy in both ICD and CRT-D patients. http://clinicaltrials.gov; Unique identifier: NCT00947310. © 2016 American Heart Association, Inc.

  11. 2012 American Geriatrics Society Beers criteria: enhanced applicability for detecting potentially inappropriate medications in European older adults? A comparison with the Screening Tool of Older Person's Potentially Inappropriate Prescriptions.

    Science.gov (United States)

    Blanco-Reina, Encarnación; Ariza-Zafra, Gabriel; Ocaña-Riola, Ricardo; León-Ortiz, Matilde

    2014-07-01

    To determine the prevalence of potentially inappropriate medications (PIMs) and related factors through a comparative analysis of the Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP), the 2003 Beers criteria, and the 2012 AGS update of the Beers criteria. Cross-sectional. Primary care. Community-dwelling persons aged 65 and older who live on the island of Lanzarote, Spain (N = 407). Sociodemographic characteristics; independence in activities of daily living; cognitive function; Geriatric Depression Scale; clinical diagnoses; and complete data on indication, dosage, and length of drug treatments. One thousand eight hundred seventh-two prescriptions were examined, and the rate of PIMs was assessed with the three criteria. The primary endpoint was the percentage of participants receiving at least one PIM. Multivariate logistic regression was used to examine the factors related to PIMs. Potentially inappropriate medications were present in 24.3%, 35.4%, and 44% of participants, according to the 2003 Beers criteria, STOPP, and 2012 Beers criteria, respectively. The profile of PIMs was also different (the most frequent being benzodiazepines in both Beers criteria lists and aspirin in the STOPP). The number of drugs was associated with risk of prescribing PIMs in all three models, as was the presence of a psychological disorder in the 2003 Beers criteria (odds ratio (OR) = 2.07, 95% confidence interval (CI) = 1.26-3.40) and the 2012 Beers criteria (OR = 2.91, 95% CI = 1.83-4.66). The kappa for degree of agreement between STOPP and the 2012 Beers criteria was 0.35 (95% CI = 0.25-0.44). The 2012 Beers criteria detected the highest number of PIMs, and given the scant overlapping with the STOPP criteria, the use of both tools may be seen as complementary. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  12. Fuel assembly storage pool

    International Nuclear Information System (INIS)

    Hiranuma, Hiroshi.

    1976-01-01

    Object: To remove limitation of the number of storage of fuel assemblies to increase the number of storage thereof so as to relatively reduce the water depth required for shielding radioactive rays. Structure: Fuel assembly storage rack containers for receiving a plurality of spent fuel assembly racks are stacked in multi-layer fashion within a storage pool filled with water for shielding radioactive rays and removing heat. (Furukawa, Y.)

  13. Heat transport and storage

    International Nuclear Information System (INIS)

    Despois, J.

    1977-01-01

    Recalling the close connections existing between heat transport and storage, some general considerations on the problem of heat distribution and transport are presented 'in order to set out the problem' of storage in concrete form. This problem is considered in its overall plane, then studied under the angle of the different technical choices it involves. The two alternatives currently in consideration are described i.e.: storage in a mined cavity and underground storage as captive sheet [fr

  14. Storage in Europe

    International Nuclear Information System (INIS)

    Cabanes, J.M.; Rottenberg, J.; Abiad, A.; Caudron, S.; Girault, Ph.

    2007-01-01

    Storage represents one of the key elements among the different modulation tools. How the problem of storage is put forward in Europe in front of the increasing uncertainty of the gas demand and prices? What are the policies implemented by storage facility operators? To what extend storage can amortize gas prices volatility or allow the market actors to take the best profit of this volatility? These are the questions debated at this workshop by four specialists of this domain. (J.S.)

  15. Pit Water Storage Ottrupgaard

    DEFF Research Database (Denmark)

    Heller, Alfred

    2000-01-01

    The pit water storage, a seasonal thermal storage, was built in 1993 with floating lid and hybrid clay-polymer for pit lining. The storage was leaking severe and solutions were to be found. In the paper solutions for pit lining and floating lids are discussed, cost estimations given and coming...

  16. Portable exhauster POR-007/Skid E and POR-008/Skid F storage plan

    International Nuclear Information System (INIS)

    Nelson, O.D.

    1998-01-01

    This document provides storage requirements for 1,000 CFM portable exhausters POR-O07/Skid E and POR-008/Skid F. These requirements are presented in three parts: preparation for storage, storage maintenance and testing, and retrieval from storage. The exhauster component identification numbers listed in this document contain the prefix POR-007 or POR-008 depending on which exhauster is being used

  17. On the ''circular vacuum noise'' in electron storage rings

    International Nuclear Information System (INIS)

    Rosu, H.

    1992-02-01

    We clarify in some essential points the proposal of Bell and Leinaas to measure the circular Unruh effect in storage rings. In particular the term 'circular Unruh effect' is inappropriate and should be replaced by the better 'circular vacuum noise'. This concept has been used by Takagi in his PTP Supplement of 1986 and corresponds best to the BL discussion. The BL resonance behavior does not fit to the SPEAR first order betatron resonance at 3.605 GeV, but of course, the real experimental situation is much more complicated, corresponding, as a matter of fact, to the rather general term 'synchrotron noise'. The detailed aspects of the synchrotron noise are, as yet, not very well understood. Besides, the much more practical accelerator jargon is to be preferred. We also include a section with comments on radiometry at storage rings. (author). 27 refs

  18. Wind turbine storage systems

    International Nuclear Information System (INIS)

    Ibrahim, H.; Ilinca, A.; Perron, J.

    2005-01-01

    Electric power is often produced in locations far from the point of utilization which creates a challenge in stabilizing power grids, particularly since electricity cannot be stored. The production of decentralized electricity by renewable energy sources offers a greater security of supply while protecting the environment. Wind power holds the greatest promise in terms of environmental protection, competitiveness and possible applications. It is known that wind energy production is not always in phase with power needs because of the uncertainty of wind. For that reason, energy storage is the key for the widespread integration of wind energy into the power grids. This paper proposed various energy storage methods that can be used in combination with decentralized wind energy production where an imbalance exists between electricity production and consumption. Energy storage can play an essential role in bringing value to wind energy, particularly if electricity is to be delivered during peak hours. Various types of energy storage are already in use or are being developed. This paper identified the main characteristics of various electricity storage techniques and their applications. They include stationary or embarked storage for long or short term applications. A comparison of characteristics made it possible to determine which types of electricity storage are best suited for wind energy. These include gravity energy; thermal energy; compressed air energy; coupled storage with natural gas; coupled storage with liquefied gas; hydrogen storage for fuel cells; chemical energy storage; storage in REDOX batteries; storage by superconductive inductance; storage in supercondensers; and, storage as kinetic energy. 21 refs., 21 figs

  19. Detention storage volume for combined sewer overflow into a river.

    Science.gov (United States)

    Temprano, J; Tejero, I

    2002-06-01

    This article discusses the storage volume needed in a combined sewer system tank in order to preserve the water quality. There are a lot of design criteria which do not take into account the conditions of the receiving water, and as a result are inappropriate. A model was used to simulate the performance of a theoretical combined sewer system where a tank was located downstream. Results were obtained from the overflows produced by the rain recorded in Santander (Spain) for 11 years, with several combinations of storage volume and treatment capacity in the wastewater treatment plant. Quality criteria were also proposed for faecal coliforms, BOD, and total nitrogen to evaluate the effects from the overflows in the river water quality. Equations have been obtained which relate the number of overflows, the storage volume and the treatment plant capacity. The bacteriological pollution, quantified by means of faecal coliforms, was the analytical parameter which produced the most adverse effects in the river, so that more storage volume is needed (45 to 180 m3 ha(-1) net) than with other simulated pollutants (5 to 50 m3 ha(-1) net for BOD, and less than 4 m3 ha(-1) net for the total nitrogen). The increase in the treatment plant's capacity, from two to three times the flow in dry weather, reduces the impact on the river water in a more effective way, allowing a reduction of up to 65% in the number of overflows rather than increasing the storage volume.

  20. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors.

    Science.gov (United States)

    Lai, Pauline Siew Mei; Wong, Yin Yen; Low, Yong Chia; Lau, Hui Ling; Chin, Kin-Fah; Mahadeva, Sanjiv

    2014-01-01

    Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25-75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing. Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution. Setting. Prospective audit in a tertiary hospital in Malaysia. Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients' demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI. Main Outcome Measure. Proportion of appropriate IV PPI prescriptions. Results. Data for 106 patients were collected. Most patients were male [65(61.3%)], Chinese [50(47.2%)], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%)] and medical [42(39.6%)] departments. Only 50/106(47.2%) patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%)] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9%) were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8%) patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%), followed by clinical pharmacists (50%), and inpatient pharmacists (37.5%, p = 0.027). Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence-based prescribing

  1. Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors

    Directory of Open Access Journals (Sweden)

    Pauline Siew Mei Lai

    2014-06-01

    Full Text Available Background. Proton pump inhibitors (PPIs are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing.Objective. To examine the appropriate use of intravenous PPIs in accordance with guidelines and the efficacy of a prescribing awareness intervention at an Asian teaching institution.Setting. Prospective audit in a tertiary hospital in Malaysia.Method. Every 4th intravenous PPI prescription received in the pharmacy was screened against hospital guidelines. Interventions for incorrect indication/dose/duration were performed. Patients’ demographic data, medical history and the use of intravenous PPI were collected. Included were all adult inpatients prescribed intravenous PPI.Main Outcome Measure. Proportion of appropriate IV PPI prescriptions.Results. Data for 106 patients were collected. Most patients were male [65(61.3%], Chinese [50(47.2%], with mean age ± SD = 60.3 ± 18.0 years. Most intravenous PPI prescriptions were initiated by junior doctors from the surgical [47(44.3%] and medical [42(39.6%] departments. Only 50/106(47.2% patients had upper gastrointestinal endoscopy/surgery performed to verify the source of bleeding. Unexplained abdominal pain [81(76.4%] was the main driver for prescribing intravenous PPIs empirically, out of which 73(68.9% were for suspected upper gastrointestinal bleed. Overall, intravenous PPI was found to be inappropriately prescribed in 56(52.8% patients for indication, dose or duration. Interventions on the use of intravenous PPI were most effective when performed by senior doctors (100%, followed by clinical pharmacists (50%, and inpatient pharmacists (37.5%, p = 0.027.Conclusion. Inappropriate intravenous PPI usage is still prevalent despite the enforcement of hospital guidelines. The promotion of prescribing awareness and evidence

  2. Prevalence and Risk of Inappropriate Sexual Behavior of Patients Toward Physical Therapist Clinicians and Students in the United States.

    Science.gov (United States)

    Boissonnault, Jill S; Cambier, Ziádee; Hetzel, Scott J; Plack, Margaret M

    2017-11-01

    For health care providers in the United States, the risk for nonfatal violence in the workplace is 16 times greater than that for other workers. Inappropriate patient sexual behavior (IPSB) is directed at clinicians, staff, or other patients and may include leering, sexual remarks, deliberate touching, indecent exposure, and sexual assault. Inappropriate patient sexual behavior may adversely affect clinicians, the organization, or patients themselves. Few IPSB risk factors for physical therapists have been confirmed. The US prevalence was last assessed in the 1990s. The objectives of this study were to determine career and 12-month exposure to IPSB among US physical therapists, physical therapist assistants, physical therapist students, and physical therapist assistant students and to identify IPSB risk factors. This was a retrospective and observational study. An electronic survey was developed; content validity and test-retest reliability were established. Participants were recruited through physical therapist and physical therapist assistant academic programs and sections of the American Physical Therapy Association. Inappropriate patient sexual behavior risk models were constructed individually for any, mild, moderate, and severe IPSB events reported over the past 12 months. Open-ended comments were analyzed using qualitative methods. Eight hundred ninety-two physical therapist professionals and students completed the survey. The career prevalence among respondents was 84%, and the 12-month prevalence was 47%. Statistical risk modeling for any IPSB over the past 12 months indicated the following risks: having fewer years of direct patient care, routinely working with patients with cognitive impairments, being a female practitioner, and treating male patients. Qualitative analysis of 187 open-ended comments revealed patient-related characteristics, provider-related characteristics, and abusive actions. Self-report, clinician memory, and convenience sampling are

  3. Fuel storage tank

    International Nuclear Information System (INIS)

    Peehs, M.; Stehle, H.; Weidinger, H.

    1979-01-01

    The stationary fuel storage tank is immersed below the water level in the spent fuel storage pool. In it there is placed a fuel assembly within a cage. Moreover, the storage tank has got a water filling and a gas buffer. The water in the storage tank is connected with the pool water by means of a filter, a surge tank and a water purification facility, temperature and pressure monitoring being performed. In the buffer compartment there are arranged catalysts a glow plugs for recombination of radiolysis products into water. The supply of water into the storage tank is performed through the gas buffer compartment. (DG) [de

  4. Continuous inventory in SNM storage facilities

    International Nuclear Information System (INIS)

    Chambers, W.H.

    1975-01-01

    Instrumentation and data processing techniques that provide inexpensive verification of material in storage were investigated. Transfers of special nuclear materials (SNM) into the storage area are accompanied by an automated verification of the container identity, weight, and the radiation signature of the contents. This information is computer-processed and stored for comparison at subsequent transfers and also provides the data base for record purposes. Physical movement of containers across the boundary of the storage area is presently accomplished by operating personnel in order to minimize expensive modifications to existing storage facilities. Personnel entering and leaving the storage area are uniquely identified and also through portal monitors capable of detecting small quantities of SNM. Once material is placed on the storage shelves, simple, low-cost container tagging and radiation sensors are activated. A portion of the prescribed gamma signature, obtained by duplicate shelf monitors during the transfer verification, is thus continuously checked against the stored identification data. Radiation detector design is severely constrained by the need to discriminate individual signatures in a high background area and the need for low unit costs. In operation any unauthorized change in signal is analyzed along with auxiliary data from surveillance sensors to activate the appropriate alarms. (auth))

  5. Inappropriate prescribing in outpatient healthcare: an evaluation of respiratory infection visits among veterans in teaching versus non-teaching primary care clinics

    Directory of Open Access Journals (Sweden)

    Diane M. Parente

    2017-03-01

    Full Text Available Abstract A recent study led by the Centers for Disease Control and Prevention (CDC revealed at least 30% of antibiotic prescriptions in the outpatient setting were inappropriate. In this study of all ages, among adult patients, results were similar to the overall population, with the majority of inappropriate prescribing relating to respiratory infections. We applied the same methodology to investigate rates of antibiotic prescribing for respiratory tract infections in outpatient primary care clinics at the Providence Veterans Affairs Medical Center. The results of our evaluation reflected comparable rates of inappropriate prescribing, but when stratified by teaching versus non-teaching primary care clinics, inappropriate prescribing was significantly higher in non-teaching clinics (17.6% vs 44.0%, p < .0001. Respiratory infection visits in non-teaching outpatient clinics may be a pragmatic target for antimicrobial stewardship programs.

  6. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) or hyponatraemia associated with valproic Acid : four case reports from the Netherlands and a case/non-case analysis of vigibase

    NARCIS (Netherlands)

    Beers, Erna; van Puijenbroek, Eugène P; Bartelink, Imke H; van der Linden, Carolien M J; Jansen, Paul A F

    The Netherlands Pharmacovigilance Centre Lareb received four cases of severe symptomatic hyponatraemia or syndrome of inappropriate antidiuretic hormone secretion (SIADH) in association with valproic acid use, in which a causal relationship was suspected. This study describes these cases and gives

  7. Is modification of the VVI backup mode in implantable cardioverter-defibrillators from St Jude medical required due to increased risk of inappropriate shocks?

    DEFF Research Database (Denmark)

    Philbert, Berit Thornvig; Tfelt-Hansen, Jacob; Jacobsen, Peter K

    2017-01-01

    Inappropriate implantable cardioverter-defibrillator (ICD) shock therapy is painful, stressful, and typically occurs unexpected in conscious patients and may be related to a less favourable prognosis. In our institution, we have observed four cases of multiple inappropriate ICD shocks during reset...... a ventricular fibrillation (VF) zone starting at 146 b.p.m., with shock therapy only and changes in sensitivity settings making the ICD more sensitive. In all cases, the reason for the multiple inappropriate shocks was that the VF zone was reached due to exercise-induced sinus tachycardia or due to oversensing...... during sinus rhythm. The VVI backup mode has to balance between protection from failure of ICD therapy during life-threatening ventricular arrhythmias and from inappropriate shocks. It seems the non-programmable parameters in VVI backup mode of St Jude Medical ICDs carry an unacceptable high risk...

  8. Analysis of Inappropriate Admissions of Residents of Medicalized Nursing Homes to Emergency Departments: A Prospective Multicenter Study in Burgundy.

    Science.gov (United States)

    Manckoundia, Patrick; Menu, Didier; Turcu, Alin; Honnart, Didier; Rossignol, Sylvie; Alixant, Jean-Christophe; Sylvestre, Franck-Henry; Bailly, Vanessa; Dion, Michèle; Putot, Alain

    2016-07-01

    To determine the rate of inappropriate admissions to emergency departments (EDs) and to identify determinants of these admissions. Prospective multicenter study. Burgundy (France), EDs and medical nursing homes (MNHs). 1000 Burgundy MNH residents admitted to EDs, from April 17 to June 20, 2013. For each subject, a questionnaire was completed. Data included age, gender, type of health professional who referred the resident to the ED (THP), whether or not a medical dispatcher organized the transfer to the ED, transport mode, reason for admission to the ED, level of independence according to the Groupes Iso-Ressource score (GIRS), and diagnosis made in the ED. The French version of the Appropriateness Evaluation Protocol grid was applied to each admission to the ED, and in some situations, the expert committee ruled on the appropriateness of the admission to the ED. MNH characteristics were also recorded. Two groups were constituted according to the appropriateness or not of admission to the ED. Mean age of the 1000 residents was 87. There were 706 women. Two-thirds were referred to the EDs by a physician, mainly a general practitioner. In 91.7%, the transfer to the ED was organized by a medical dispatcher, and 8.8% were transported by medicalized transport. More than 95% had a GIRS ≤4. Among the admissions to EDs, 18.1% were inappropriate. Female gender (P = .017), nonmedicalized transport (P = .002), public MNH (P = .044), and nonaccess to a geriatric opinion in an emergency (P = .043) were determinants of inappropriate admission to EDs. In this first study on admissions to EDs of MNH residents using French data, we found a lower rate of admissions to the ED than that reported in the literature. Female gender, nonmedicalized transport, public MNH, and nonaccess to a geriatric opinion in an emergency were associated with inappropriate admission to EDs. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier

  9. Erroneous Magnet Positioning Leads to Failure of Inhibition of Inappropriate Shock during Fast Conducting Atrial Fibrillation Episodes.

    Science.gov (United States)

    Römers, Hans; VAN Dijk, Vincent; Balt, Jippe

    2017-06-01

    We present the case of a 75-year-old patient with a single-chamber St. Jude Medical internal cardioverter defibrillator (ICD; St. Jude Medical, St. Paul, MN, USA) for primary prevention, who was admitted with 39 inappropriate ICD shocks because of atrial fibrillation with rapid ventricular frequention, despite magnet placement. Review of the device manual and literature revealed that apart from different responses to magnet placement programmed for the various manufacturers, the type of magnet and the positioning can be of specific interest. In the case presented, the donut-shaped magnet should have been placed off-center instead of directly over the device. © 2017 Wiley Periodicals, Inc.

  10. Assessing storage adequacy

    International Nuclear Information System (INIS)

    Amirault, P.

    2004-01-01

    Government policy encourages the use of natural gas. It is expected that liquefied natural gas (LNG) and Arctic gas will make up 20 to 25 per cent of supply. This presentation provided an outlook of storage value based on a technical analysis by the National Petroleum Counsel (NPC) report. A moderately robust growth is expected in the residential and commercial load which may be partially offset by robust growth in electricity. The net result is an increase in storage requirements. It was concluded that there is a strong case for growth in storage demand but a lack of good sites for additional capacity. This will lead to higher storage values. The NPC sees the need for 1 Tcf more storage use by 2025, of which 700 Bcf will need to come from new storage. In particular, current storage levels may not be sufficient to meet a colder than normal winter, and deliverability is affected by field inventory. Most storage capacity was built before 1985, mostly by regulated entities. It is expected that only 250 to 400 Bcf will be added over the next 25 years in North America. If storage becomes scarce, prices will move to the marginal cost of new additions, and the upper limit on price will be determined by salt cavern storage. An increase of $1.00 in the price of leasing storage would add about $0.11 to the average price of consumed gas. tabs., figs

  11. Spent fuel storage rack

    International Nuclear Information System (INIS)

    Morikawa, Matsuo; Uchiyama, Yuichi.

    1983-01-01

    Purpose: To improve the safety and facilitate the design by limiting the relative displacement in a storage rack. Constitution: The outer wall of a storage rack disposed in water within a fuel pool, the pool wall opposing to the storage rack and the structure between the opposing storages racks are made as a space for confining the pool water or a structure formed with a slight gap, for example, a combination of a recessed structure and a protruded structure. In such a constitution, a space for confirming the pool water is established and the pool water thus confined forms a flow resistance when the storage rack vibrates upon earthquakes, serves as a damper and significantly reduces the responsivity. Furthermore, the relative displacement in the storage rack is limited to inhibit excess earthquake forces to exert on setting bolts and rack clamping bolts of the storage rack. (Sekiya, K.)

  12. Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards.

    Science.gov (United States)

    Goulding, Lucy; Adamson, Joy; Watt, Ian; Wright, John

    2015-10-01

    Prior research suggests that the placement of patients on clinically inappropriate hospital wards may increase the risk of experiencing patient safety issues. To explore patients' perspectives of the quality and safety of the care received during their inpatient stay on a clinically inappropriate hospital ward. Qualitative study using semi-structured interviews. Nineteen patients who had spent time on at least one clinically inappropriate ward during their hospital stay at a large NHS teaching hospital in England. Patients would prefer to be treated on the correct specialty ward, but it is generally accepted that this may not be possible. When patients are placed on inappropriate wards, they may lack a sense of belonging. Participants commented on potential failings in communication, medical staff availability, nurses' knowledge and the resources available, each of which may contribute to unsafe care. Patients generally acknowledge the need for placement on inappropriate wards due to demand for inpatient beds, but may report dissatisfaction in terms of preference and belonging. Importantly, patients recount issues resulting from this placement that may compromise their safety. Hospital managers should be encouraged to appreciate this insight and potential threat to safe practice and where possible avoid inappropriate ward transfers and admissions. Where such admissions are unavoidable, staff should take action to address the gaps in safety of care that have been identified. © 2013 John Wiley & Sons Ltd.

  13. Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression.

    Science.gov (United States)

    Guligowska, Agnieszka; Pigłowska, Małgorzata; Fife, Elizaveta; Kostka, Joanna; Sołtysik, Bartłomiej K; Kroc, Łukasz; Kostka, Tomasz

    2016-01-01

    The study is a case-control analysis of whether depression impairs physical and cognitive functioning and quality of life, and whether there is a relationship between nutrient deficiencies and these adverse changes. A total of 130 older subjects participated in the study: 65 with diagnosed depression (16 men and 49 women) and 65 age- and sex-matched controls without depression. All patients underwent comprehensive geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment, cognitive performance was evaluated by the Mini-Mental State Examination and physical functioning by the Timed "Up & Go" test and handgrip strength. The pattern of consumption of various nutrients was analyzed in detail. The differences in cognitive functioning observed between the groups were related to specific nutrient intake, as was handgrip strength to some extent. The differences in nutritional status, several functional tests and muscle strength were related to both the presence of depression and inappropriate consumption of certain nutrients. The incidence of falls and poor quality of life may be partially associated with the presence of depression. The inappropriate intake of selected nutrients may impair the functioning and quality of life of older adults with depression, such as the excess consumption of sucrose and insufficient consumption of protein, fiber, eicosapentaenoic acid, niacin and vitamin B6. Particular nutrients should be translated into dietary patterns which allow the individual patient to address these nutrient deficiencies.

  14. STOPP (Screening Tool of Older Persons' potentially inappropriate Prescriptions): application to acutely ill elderly patients and comparison with Beers' criteria.

    LENUS (Irish Health Repository)

    Gallagher, Paul

    2012-02-03

    Introduction: STOPP (Screening Tool of Older Persons\\' potentially inappropriate Prescriptions) is a new, systems-defined medicine review tool. We compared the performance of STOPP to that of established Beers\\' criteria in detecting potentially inappropriate medicines (PIMs) and related adverse drug events (ADEs) in older patients presenting for hospital admission. METHODS: we prospectively studied 715 consecutive acute admissions to a university teaching hospital. Diagnoses, reason for admission and concurrent medications were recorded. STOPP and Beers\\' criteria were applied. PIMs with clear causal connection or contribution to the principal reason for admission were determined. RESULTS: median patient age (interquartile range) was 77 (72-82) years. Median number of prescription medicines was 6 (range 0-21). STOPP identified 336 PIMs affecting 247 patients (35%), of whom one-third (n = 82) presented with an associated ADE. Beers\\' criteria identified 226 PIMs affecting 177 patients (25%), of whom 43 presented with an associated ADE. STOPP-related PIMs contributed to 11.5% of all admissions. Beers\\' criteria-related PIMs contributed to significantly fewer admissions (6%). CONCLUSION: STOPP criteria identified a significantly higher proportion of patients requiring hospitalisation as a result of PIM-related adverse events than Beers\\' criteria. This finding has significant implications for hospital geriatric practice.

  15. Can attribution theory explain carers' propensity to help men with intellectual disabilities who display inappropriate sexual behaviour?

    Science.gov (United States)

    Willner, P; Smith, M

    2008-01-01

    This study examined the responses of care managers and direct care staff to vignettes of inappropriate sexual behaviour by a man with an intellectual disability. The aim was to test the theory that helping behaviour is determined by emotional responses (positive and negative emotional reactions, and optimism), which in turn are determined by causal attributions (respectively: controllability and stability of the incident depicted in the vignette). The vignettes varied in response topography and the age of the victim. Regression analysis was used to examine the relationships between causal attributions, emotional responses, and willingness to invest extra time and effort in the service user's care. No support was found for the pathway: low controllability --> increased sympathy and/or decreased negative emotions --> increased helping. However, strong support was found for the pathway: low stability --> high optimism --> increased helping, particularly in direct care staff. High levels of sympathy were also associated with increased helping, the effect again being mediated by feelings of optimism. The data provide support for one (but not the other) strand of attribution theory as applied to inappropriate sexual behaviour. The discussion considers the discrepancy between the present data and the far less encouraging literature on attribution theory as applied to challenging behaviour.

  16. Inappropriately low aldosterone concentrations in adults with AIDS-related diarrhoea in Zambia: a study of response to fluid challenge

    Directory of Open Access Journals (Sweden)

    Lumayi Ruth

    2008-04-01

    Full Text Available Abstract Background Chronic diarrhoea is one of the most debilitating consequences of HIV infection in sub-Saharan Africa and it carries a high mortality rate. We report unexpectedly low concentrations of circulating aldosterone in 12 patients (6 men, 6 women in the University Teaching Hospital, Lusaka, who all had diarrhoea for over one month. Changes in serum electrolytes, blood pressure, Karnofsky score and serum aldosterone concentration were being monitored during a short study of responses to saline infusion (3 litres/24 h over 72 hours. Findings At baseline, 9/12 (75% of the patients were hyponatraemic, 10/11 (91% were hypokalaemic, and 6/12 (50% had undetectable aldosterone concentrations. Blood pressure and Karnofsky score rose and creatinine concentration fell in response to the infusion. Conclusion Circulating aldosterone concentrations were inappropriately low and complicate the profound electrolyte deficiencies resulting from chronic diarrhoea. Management of these deficiencies needs to be more aggressive than is currently practised and consideration should be given to a formal clinical trial of mineralocorticoid replacement in these severely ill patients. If the inappropriately low aldosterone reflects a general adrenal failure, it may explain a considerable proportion of the high mortality seen both before and after initiation of anti-retroviral therapy.

  17. Isolation of Protein Storage Vacuoles and Their Membranes.

    Science.gov (United States)

    Shimada, Tomoo; Hara-Nishimura, Ikuko

    2017-01-01

    Protein-storage vacuoles (PSVs) are specialized vacuoles that sequester large amounts of storage proteins. During seed development, PSVs are formed de novo and/or from preexisting lytic vacuoles. Seed PSVs can be subdivided into four distinct compartments: membrane, globoid, matrix, and crystalloid. In this chapter, we introduce easy methods for isolation of PSVs and their membranes from pumpkin seeds. These methods facilitate the identification and characterization of PSV components.

  18. Evaluation of continued storage of samples at the 325 Laboratory

    International Nuclear Information System (INIS)

    McVey, C.B.

    1996-01-01

    This report provides identification of potential Program users for samples that are archived at Pacific Northwest National Laboratory (PNNL) facilities, establishes cost releated to packaging and transportation of these samples to 222-S, for continued storage at 325 facilities, disposal and transfer costs. The report provides a recommendation to dispose of 20 samples, transfer 99 samples to PNNL and to continue storage of the remaining samples at PNNL's 325 facility

  19. Isotope Identification

    Energy Technology Data Exchange (ETDEWEB)

    Karpius, Peter Joseph [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-09-18

    The objective of this training modules is to examine the process of using gamma spectroscopy for radionuclide identification; apply pattern recognition to gamma spectra; identify methods of verifying energy calibration; and discuss potential causes of isotope misidentification.

  20. PC-Cluster based Storage System Architecture for Cloud Storage

    OpenAIRE

    Yee, Tin Tin; Naing, Thinn Thu

    2011-01-01

    Design and architecture of cloud storage system plays a vital role in cloud computing infrastructure in order to improve the storage capacity as well as cost effectiveness. Usually cloud storage system provides users to efficient storage space with elasticity feature. One of the challenges of cloud storage system is difficult to balance the providing huge elastic capacity of storage and investment of expensive cost for it. In order to solve this issue in the cloud storage infrastructure, low ...

  1. Large mass storage facility

    International Nuclear Information System (INIS)

    Peskin, A.M.

    1978-01-01

    The report of a committee to study the questions surrounding possible acquisition of a large mass-storage device is presented. The current computing environment at BNL and justification for an online large mass storage device are briefly discussed. Possible devices to meet the requirements of large mass storage are surveyed, including future devices. The future computing needs of BNL are prognosticated. 2 figures, 4 tables

  2. Diverse definitions of prolonged labour and its consequences with sometimes subsequent inappropriate treatment

    Science.gov (United States)

    2014-01-01

    Background Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women’s experiences of prolonged and normal labour. Method Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic and obstetric background, birth outcome and women’s feelings and experiences of birth. The prevalence of prolonged labour, as defined by a documented ICD-code and inspection of partogram was calculated. Four groups were identified; women with prolonged labour as identified by documented ICD-codes or by partogram inspection but no ICD-code; women with normal labour augmented with oxytocin or not. Results Every fifth woman experienced a prolonged labour. The prevalence with the documented ICD-code was (13%) and without ICD-code but positive partogram was (8%). Seven percent of women with prolonged labour were not treated with oxytocin. Approximately one in three women (28%) received oxytocin augmentation despite having no evidence of prolonged labour. The length of labour differed between the four groups of women, from 7 to 23 hours. Women with a prolonged labour had a negative birth experience more often (13%) than did women who had a normal labour (3%) (P women with prolonged labour were emergency Caesarean section (OR 9.0, 95% CI 1.2-3.0) and to strongly agree with the following statement ‘My birth experience made me decide not to have any more children’ (OR 41.3, 95% CI 4.9-349.6). The factors that contributed most strongly to a negative birth experience in women with normal labour were less agreement with the statement ‘It was exiting to give birth’ (OR 0.13, 95% CI 0.34-0.5). Conclusions There is need for increased clinical skill in identification and classification

  3. Benchmarking Cloud Storage Systems

    OpenAIRE

    Wang, Xing

    2014-01-01

    With the rise of cloud computing, many cloud storage systems like Dropbox, Google Drive and Mega have been built to provide decentralized and reliable file storage. It is thus of prime importance to know their features, performance, and the best way to make use of them. In this context, we introduce BenchCloud, a tool designed as part of this thesis to conveniently and efficiently benchmark any cloud storage system. First, we provide a study of six commonly-used cloud storage systems to ident...

  4. A new storage-ring light source

    Energy Technology Data Exchange (ETDEWEB)

    Chao, Alex [SLAC National Accelerator Lab., Menlo Park, CA (United States)

    2015-06-01

    A recently proposed technique in storage ring accelerators is applied to provide potential high-power sources of photon radiation. The technique is based on the steady-state microbunching (SSMB) mechanism. As examples of this application, one may consider a high-power DUV photon source for research in atomic and molecular physics or a high-power EUV radiation source for industrial lithography. A less challenging proof-of-principle test to produce IR radiation using an existing storage ring is also considered.

  5. Potentially inappropriate liver transplantation in the era of the "sickest first" policy - A search for the upper limits.

    Science.gov (United States)

    Linecker, Michael; Krones, Tanja; Berg, Thomas; Niemann, Claus U; Steadman, Randolph H; Dutkowski, Philipp; Clavien, Pierre-Alain; Busuttil, Ronald W; Truog, Robert D; Petrowsky, Henrik

    2017-11-11

    Liver transplantation has emerged as a highly efficient treatment for a variety of acute and chronic liver diseases. However, organ shortage is becoming an increasing problem globally, limiting the applicability of liver transplantation. In addition, potential recipients are becoming sicker, thereby increasing the risk of losing the graft during transplantation or in the initial postoperative period after liver transplantation (three months). This trend is challenging the model for end-stage liver disease allocation system, where the sickest candidates are prioritised and no delisting criteria are given. The weighting of the deontological demand for "equity", trying to save every patient, regardless of the overall utility; and "efficiency", rooted in utilitarianism, trying to save as many patients as possible and increase the overall quality of life of patients facing the same problem, has to be reconsidered. In this article we are aiming to overcome the widespread concept of futility in liver transplantation, providing a definition of potentially inappropriate liver transplantation and giving guidance on situations where it is best not to proceed with liver transplantation, to decrease the mortality rate in the first three months after transplantation. We propose "absolute" and "relative" conditions, where early post-transplant mortality is highly probable, which are not usually captured in risk scores predicting post-transplant survival. Withholding liver transplantation for listed patients in cases where liver transplant is not deemed clearly futile, but is potentially inappropriate, is a far-reaching decision. Until now, this decision had to be discussed extensively on an individual basis, applying explicit communication and conflict resolution processes, since the model for end-stage liver disease score and most international allocation systems do not include explicit delisting criteria to support a fair delisting process. More work is needed to better

  6. Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials

    Directory of Open Access Journals (Sweden)

    Gjerberg Elisabeth

    2011-04-01

    Full Text Available Abstract Background Studies have shown that residents in nursing homes often are exposed to inappropriate medication. Particular concern has been raised about the consumption of psychoactive drugs, which are commonly prescribed for nursing home residents suffering from dementia. This review is an update of a Norwegian systematic review commissioned by the Norwegian Directorate of Health. The purpose of the review was to identify and summarise the effect of interventions aimed at reducing potentially inappropriate use or prescribing of drugs in nursing homes. Methods We searched for systematic reviews and randomised controlled trials in the Cochrane Library, MEDLINE, EMBASE, ISI Web of Knowledge, DARE and HTA, with the last update in April 2010. Two of the authors independently screened titles and abstracts for inclusion or exclusion. Data on interventions, participants, comparison intervention, and outcomes were extracted from the included studies. Risk of bias and quality of evidence were assessed using the Cochrane Risk of Bias Table and GRADE, respectively. Outcomes assessed were use of or prescribing of drugs (primary and the health-related outcomes falls, physical limitation, hospitalisation and mortality (secondary. Results Due to heterogeneity in interventions and outcomes, we employed a narrative approach. Twenty randomised controlled trials were included from 1631 evaluated references. Ten studies tested different kinds of educational interventions while seven studies tested medication reviews by pharmacists. Only one study was found for each of the interventions geriatric care teams, early psychiatric intervening or activities for the residents combined with education of health care personnel. Several reviews were identified, but these either concerned elderly in general or did not satisfy all the requirements for systematic reviews. Conclusions Interventions using educational outreach, on-site education given alone or as part of an

  7. Water Storage: Quo Vadis?

    Science.gov (United States)

    Smakhtin, V.

    2017-12-01

    Humans stored water - in various forms - for ages, coping with water resources variability, and its extremes - floods and droughts. Storage per capita, and other storage-related indicators, have essentially become one way of reflecting the progress of economic development. Massive investments went into large surface water reservoirs that have become the characteristic feature of the earth's landscapes, bringing both benefits and controversy. As water variability progressively increases with changing climate, globally, on one hand, and the idea of sustainable development receives strong traction, on another - it may be worth the while to comprehensively examine current trends and future prospects for water storage development. The task is surely big, to say the least. The presentation will aim to initiate a structured discussion on this multi-facet issue and identify which aspects and trends of water storage development may be most important in the context of Sustainable Development Goals, Sendai Framework for Disaster Risk Reduction, Paris Agreement on Climate Change, and examine how, where and to what extent water storage planning can be improved. It will cover questions like i) aging of large water storage infrastructure, the current extent of this trend in various geographical regions, and possible impacts on water security and security of nations; ii) improved water storage development planning overall in the context of various water development alternatives and storage options themselves and well as their combinations iii) prospects for another "storage revolution" - speed increase in dam numbers, and where, if at all this is most likely iv) recent events in storage development, e.g. is dam decommissioning a trend that picks pace, or whether some developing economies in Asia can do without going through the period of water storage construction, with alternatives, or suggestions for alleviation of negative impacts v) the role of subsurface storage as an

  8. Inappropriate use of the title 'chiropractor' and term 'chiropractic manipulation' in the peer-reviewed biomedical literature

    Directory of Open Access Journals (Sweden)

    Wenban Adrian B

    2006-08-01

    contact with the principal researcher revealed that the care provider was not a chiropractor, as defined by the World Federation of Chiropractic. The authors of the other two case reports did not respond to my communications. In the case series, which involved twenty relevant cases, the principal researcher conceded that the term chiropractor had been inappropriately used and that his case series did not relate to chiropractors who had undergone appropriate formal training. The author of the secondary report, a British Medical Journal editor, conceded that he had misused the title chiropractor. Letters to editors were accepted and published by all four journals to which they were sent. To date one of the four journals has published a correction. Conclusion The results of this year-long prospective review suggests that the words 'chiropractor' and 'chiropractic manipulation' are often used inappropriately by European biomedical researchers when reporting apparent associations between cervical spine manipulation and symptoms suggestive of traumatic injury. Furthermore, in those cases reported here, the spurious use of terminology seems to have passed through the peer-review process without correction. Additionally, these findings provide further preliminary evidence, beyond that already provided by Terrett, that the inappropriate use of the title 'chiropractor' and term 'chiropractic manipulation' may be a significant source of over-reporting of the link between the care provided by chiropractors and injury. Finally, editors of peer-reviewed journals were amenable to publishing 'letters to editors', and to a lesser extent 'corrections', when authors had inappropriately used the title 'chiropractor' and/or term 'chiropractic manipulation'.

  9. A patient who sufferred pulmonary tuberculosis with syndrome of inappropriate secretion of antidiuretic hormone, after radiotherapy for pulmonary adenocarcinoma

    International Nuclear Information System (INIS)

    Kobayashi, Kashin; Horiguchi, Takahiko; Hata, Hideharu; Sasaki, Yasushi; Hirose, Masahiro; Shiga, Mamoru; Kondo, Rieko; Tachikawa, Souichi

    2007-01-01

    A 62-year-old man presented in June 2006 with right thoracic pain, cough, and weight loss, which had persisted for 3 months. Chest X-ray showed a mass-like shadow in the right pulmonary apex, suggesting a stage IIIb adenocarcinoma which was confirmed by biopsy. We gave a total radiation dose of 60 Gy, after this which general malaise and weakness were noted. The results of endocrinological examinations suggested syndrome of inappropriate antidiuretic hormone secretion (SIADH). Thoracic CT showed ground-glass opacity (GGO) in both lungs, and we could not rule out pulmonary tuberculosis. A sputum was positive for acid-fast stain and polymerase polymerase chain reaction-Tuberculosa (PCR-Tb), suggesting that SIADH was associated with pulmonary tuberculosis. Water restriction, i.v. physiological saline, and anti-tuberculosis therapy relieved hyponatremia and the symptoms. (author)

  10. Energy Storage Economics

    Energy Technology Data Exchange (ETDEWEB)

    Elgqvist, Emma M [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-09-07

    This presentation provides an overview on energy storage economics including recent market trends, battery terminology and concepts, value streams, challenges, and an example of how photovoltaics and storage can be used to lower demand charges. It also provides an overview of the REopt Lite web tool inputs and outputs.

  11. System for secure storage

    NARCIS (Netherlands)

    2005-01-01

    A system (100) comprising read means (112) for reading content data and control logic data from a storage medium (101), the control logic data being uniquely linked to the storage medium (101), processing means (113-117), for processing the content data and feeding the processed content data to an

  12. Wind-energy storage

    Science.gov (United States)

    Gordon, L. H.

    1980-01-01

    Program SIMWEST can model wind energy storage system using any combination of five types of storage: pumped hydro, battery, thermal, flywheel, and pneumatic. Program is tool to aid design of optional system for given application with realistic simulation for further evaluation and verification.

  13. Optical storage networking

    Science.gov (United States)

    Mohr, Ulrich

    2001-11-01

    For efficient business continuance and backup of mission- critical data an inter-site storage network is required. Where traditional telecommunications costs are prohibitive for all but the largest organizations, there is an opportunity for regional carries to deliver an innovative storage service. This session reveals how a combination of optical networking and protocol-aware SAN gateways can provide an extended storage networking platform with the lowest cost of ownership and the highest possible degree of reliability, security and availability. Companies of every size, with mainframe and open-systems environments, can afford to use this integrated service. Three mayor applications are explained; channel extension, Network Attached Storage (NAS), Storage Area Networks (SAN) and how optical networks address the specific requirements. One advantage of DWDM is the ability for protocols such as ESCON, Fibre Channel, ATM and Gigabit Ethernet, to be transported natively and simultaneously across a single fiber pair, and the ability to multiplex many individual fiber pairs over a single pair, thereby reducing fiber cost and recovering fiber pairs already in use. An optical storage network enables a new class of service providers, Storage Service Providers (SSP) aiming to deliver value to the enterprise by managing storage, backup, replication and restoration as an outsourced service.

  14. Can Physicians Identify Inappropriate Nuclear Stress Tests? An Examination of Inter-rater Reliability for the 2009 Appropriate Use Criteria for Radionuclide Imaging

    Science.gov (United States)

    Ye, Siqin; Rabbani, LeRoy E.; Kelly, Christopher R.; Kelly, Maureen R.; Lewis, Matthew; Paz, Yehuda; Peck, Clara L.; Rao, Shaline; Bokhari, Sabahat; Weiner, Shepard D.; Einstein, Andrew J.

    2014-01-01

    Background We sought to determine inter-rater reliability of the 2009 Appropriate Use Criteria (AUC) for radionuclide imaging (RNI) and whether physicians at various levels of training can effectively identify nuclear stress tests with inappropriate indications. Methods and Results Four hundred patients were randomly selected from a consecutive cohort of patients undergoing nuclear stress testing at an academic medical center. Raters with different levels of training (including cardiology attending physicians, cardiology fellows, internal medicine hospitalists, and internal medicine interns) classified individual nuclear stress tests using the 2009 AUC. Consensus classification by two cardiologists was considered the operational gold standard, and sensitivity and specificity of individual raters for identifying inappropriate tests was calculated. Inter-rater reliability of the AUC was assessed using Cohen’s kappa statistics for pairs of different raters. The mean age of patients was 61.5 years; 214 (54%) were female. The cardiologists rated 256 (64%) of 400 NSTs as appropriate, 68 (18%) as uncertain, 55 (14%) as inappropriate; 21 (5%) tests were unable to be classified. Inter-rater reliability for non-cardiologist raters was modest (unweighted Cohen’s kappa, 0.51, 95% confidence interval, 0.45 to 0.55). Sensitivity of individual raters for identifying inappropriate tests ranged from 47% to 82%, while specificity ranged from 85% to 97%. Conclusions Inter-rater reliability for the 2009 AUC for RNI is modest, and there is considerable variation in the ability of raters at different levels of training to identify inappropriate tests. PMID:25563660

  15. The effect of ICD programming on inappropriate and appropriate ICD Therapies in ischemic and nonischemic cardiomyopathy: the MADIT-RIT trial.

    Science.gov (United States)

    Sedláček, Kamil; Ruwald, Anne-Christine; Kutyifa, Valentina; McNitt, Scott; Thomsen, Poul Erik Bloch; Klein, Helmut; Stockburger, Martin; Wichterle, Dan; Merkely, Bela; DE LA Concha, Joaquin Fernandez; Swissa, Moshe; Zareba, Wojciech; Moss, Arthur J; Kautzner, Josef; Ruwald, Martin H

    2015-04-01

    The MADIT-RIT trial demonstrated reduction of inappropriate and appropriate ICD therapies and mortality by high-rate cut-off and 60-second-delayed VT therapy ICD programming in patients with a primary prophylactic ICD indication. The aim of this analysis was to study effects of MADIT-RIT ICD programming in patients with ischemic and nonischemic cardiomyopathy. First and total occurrences of both inappropriate and appropriate ICD therapies were analyzed by multivariate Cox models in 791 (53%) patients with ischemic and 707 (47%) patients with nonischemic cardiomyopathy. Patients with ischemic and nonischemic cardiomyopathy had similar incidence of first inappropriate (9% and 11%, P = 0.21) and first appropriate ICD therapy (11.6% and 14.1%, P = 0.15). Patients with ischemic cardiomyopathy had higher mortality rate (6.1% vs. 3.3%, P = 0.01). MADIT-RIT high-rate cut-off (arm B) and delayed VT therapy ICD programming (arm C) compared with conventional (arm A) ICD programming were associated with a significant risk reduction of first inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy (HR range 0.11-0.34, P programming and delayed VT therapy ICD programming in both ischemic and nonischemic cardiomyopathy patients. High-rate cut-off and delayed VT therapy ICD programming are associated with significant reduction in first and total inappropriate and appropriate ICD therapy in patients with ischemic and nonischemic cardiomyopathy. © 2014 Wiley Periodicals, Inc.

  16. Interaction between shock coils increased the incidence of inappropriate therapies and lead failure in implantable cardioverter defibrillator.

    Science.gov (United States)

    El Garhy, Mohammad; Ohlow, Marc-Alexander; Lauer, Bernward

    Shock coil interaction in patients with multiple implantable cardioverter defibrillator (ICD) leads is occasionally observed. We aimed to evaluate the incidence of shock coil interaction and its clinical relevance. All ICD patients (646 patients) who came to follow up control in our ICD ambulance between January 1, 2011, and December 31, 2011 in the department of cardiology in Bad Berka hospital were retrospectively evaluated in this study. All baseline demographic, clinical, and procedural characteristics and postoperative chest x ray in postero-anterior and lateral view as well as clinical and ICD follow up data were evaluated. Among 646 patients 42 had multiple ICD leads (6.5%) of whom 36 patients (5.5% of total cohort patients and 85.7% of patients with multiple ICD leads) had shock coil interaction and presented the study group (Group I). The control group (Group II) consisted of 610 patients without coil-coil interaction including patients with single shock lead (604 patients) or patients with multiple leads but without interaction between shock coils (6 patients). Inappropriate anti-tachycardia therapies and RV lead revisions were more frequent in patients with interaction between shock coils (Group I vs Group II: 27.7% and 5.7%; p = 0.049 and 30.6% vs 6.4; p = 0.0001, respectively). Interaction between shock coils may be one of possible causes of lead failure and resulted in inappropriate therapies and subsequent lead revision. Copyright © 2018 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

  17. Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression

    Directory of Open Access Journals (Sweden)

    Guligowska A

    2016-10-01

    Full Text Available Agnieszka Guligowska,1 Małgorzata Pigłowska,1 Elizaveta Fife,1 Joanna Kostka,2 Bartłomiej K Sołtysik,1 Łukasz Kroc,1 Tomasz Kostka1 1Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Lodz, Lodz, Poland; 2Department of Physical Medicine, Medical University of Lodz, Lodz, Poland Objectives: The study is a case-control analysis of whether depression impairs physical and cognitive functioning and quality of life, and whether there is a relationship between nutrient deficiencies and these adverse changes.Patients and methods: A total of 130 older subjects participated in the study: 65 with diagnosed depression (16 men and 49 women and 65 age- and sex-matched controls without depression. All patients underwent comprehensive geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment, cognitive performance was evaluated by the Mini-Mental State Examination and physical functioning by the Timed “Up & Go” test and handgrip strength. The pattern of consumption of various nutrients was analyzed in detail.Results: The differences in cognitive functioning observed between the groups were related to specific nutrient intake, as was handgrip strength to some extent. The differences in nutritional status, several functional tests and muscle strength were related to both the presence of depression and inappropriate consumption of certain nutrients.Conclusion: The incidence of falls and poor quality of life may be partially associated with the presence of depression. The inappropriate intake of selected nutrients may impair the functioning and quality of life of older adults with depression, such as the excess consumption of sucrose and insufficient consumption of protein, fiber, eicosapentaenoic acid, niacin and vitamin B6. Particular nutrients should be translated into dietary patterns which allow the individual patient to address these nutrient deficiencies. Keywords: aging, cognitive

  18. How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel.

    Science.gov (United States)

    Piltcher, Otávio Bejzman; Kosugi, Eduardo Macoto; Sakano, Eulalia; Mion, Olavo; Testa, José Ricardo Gurgel; Romano, Fabrizio Ricci; Santos, Marco Cesar Jorge; Di Francesco, Renata Cantisani; Mitre, Edson Ibrahim; Bezerra, Thiago Freire Pinto; Roithmann, Renato; Padua, Francini Greco; Valera, Fabiana Cardoso Pereira; Lubianca Neto, José Faibes; Sá, Leonardo Conrado Barbosa; Pignatari, Shirley Shizue Nagata; Avelino, Melissa Ameloti Gomes; Caixeta, Juliana Alves de Souza; Anselmo-Lima, Wilma Terezinha; Tamashiro, Edwin

    Bacterial resistance burden has increased in the past years, mainly due to inappropriate antibiotic use. Recently it has become an urgent public health concern due to its impact on the prolongation of hospitalization, an increase of total cost of treatment and mortality associated with infectious disease. Almost half of the antimicrobial prescriptions in outpatient care visits are prescribed for acute upper respiratory infections, especially rhinosinusitis, otitis media, and pharyngotonsillitis. In this context, otorhinolaryngologists play an important role in orienting patients and non-specialists in the utilization of antibiotics rationally and properly in these infections. To review the most recent recommendations and guidelines for the use of antibiotics in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, adapted to our national reality. A literature review on PubMed database including the medical management in acute otitis media, acute rhinosinusitis, and pharyngotonsillitis, followed by a discussion with a panel of specialists. Antibiotics must be judiciously prescribed in uncomplicated acute upper respiratory tract infections. The severity of clinical presentation and the potential risks for evolution to suppurative and non-suppurative complications must be taken into 'consideration'. Periodic revisions on guidelines and recommendations for treatment of the main acute infections are necessary to orient rationale and appropriate use of antibiotics. Continuous medical education and changes in physicians' and patients' behavior are required to modify the paradigm that all upper respiratory infection needs antibiotic therapy, minimizing the consequences of its inadequate and inappropriate use. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  19. ERDA's Chemical Energy Storage Program

    Science.gov (United States)

    Swisher, J. H.; Kelley, J. H.

    1977-01-01

    The Chemical Energy Storage Program is described with emphasis on hydrogen storage. Storage techniques considered include pressurized hydrogen gas storage, cryogenic liquid hydrogen storage, storage in hydride compounds, and aromatic-alicyclic hydrogen storage. Some uses of energy storage are suggested. Information on hydrogen production and hydrogen use is also presented. Applications of hydrogen energy systems include storage of hydrogen for utilities load leveling, industrial marketing of hydrogen both as a chemical and as a fuel, natural gas supplementation, vehicular applications, and direct substitution for natural gas.

  20. Electricity Storage. Technology Brief

    Energy Technology Data Exchange (ETDEWEB)

    Simbolotti, G. [Italian National Agency for New Technologies, Energy and Sustainable Economic Development ENEA, Rome (Italy); Kempener, R. [International Renewable Energy Agency IRENA, Bonn (Germany)

    2012-04-15

    Electricity storage is a key technology for electricity systems with a high share of renewables as it allows electricity to be generated when renewable sources (i.e. wind, sunlight) are available and to be consumed on demand. It is expected that the increasing price of fossil fuels and peak-load electricity and the growing share of renewables will result in electricity storage to grow rapidly and become more cost effective. However, electricity storage is technically challenging because electricity can only be stored after conversion into other forms of energy, and this involves expensive equipment and energy losses. At present, the only commercial storage option is pumped hydro power where surplus electricity (e.g. electricity produced overnight by base-load coal or nuclear power) is used to pump water from a lower to an upper reservoir. The stored energy is then used to produce hydropower during daily high-demand periods. Pumped hydro plants are large-scale storage systems with a typical efficiency between 70% and 80%, which means that a quarter of the energy is lost in the process. Other storage technologies with different characteristics (i.e. storage process and capacity, conversion back to electricity and response to power demand, energy losses and costs) are currently in demonstration or pre-commercial stages and discussed in this brief report: Compressed air energy storage (CAES) systems, Flywheels; Electrical batteries; Supercapacitors; Superconducting magnetic storage; and Thermal energy storage. No single electricity storage technology scores high in all dimensions. The technology of choice often depends on the size of the system, the specific service, the electricity sources and the marginal cost of peak electricity. Pumped hydro currently accounts for 95% of the global storage capacity and still offers a considerable expansion potential but does not suit residential or small-size applications. CAES expansion is limited due to the lack of suitable

  1. Plutonium storage criteria

    Energy Technology Data Exchange (ETDEWEB)

    Chung, D. [Scientech, Inc., Germantown, MD (United States); Ascanio, X. [Dept. of Energy, Germantown, MD (United States)

    1996-05-01

    The Department of Energy has issued a technical standard for long-term (>50 years) storage and will soon issue a criteria document for interim (<20 years) storage of plutonium materials. The long-term technical standard, {open_quotes}Criteria for Safe Storage of Plutonium Metals and Oxides,{close_quotes} addresses the requirements for storing metals and oxides with greater than 50 wt % plutonium. It calls for a standardized package that meets both off-site transportation requirements, as well as remote handling requirements from future storage facilities. The interim criteria document, {open_quotes}Criteria for Interim Safe Storage of Plutonium-Bearing Solid Materials{close_quotes}, addresses requirements for storing materials with less than 50 wt% plutonium. The interim criteria document assumes the materials will be stored on existing sites, and existing facilities and equipment will be used for repackaging to improve the margin of safety.

  2. Compact nuclear fuel storage

    International Nuclear Information System (INIS)

    Kiselev, V.V.; Churakov, Yu.A.; Danchenko, Yu.V.; Bylkin, B.K.; Tsvetkov, S.V.

    1983-01-01

    Different constructions of racks for compact storage of spent fuel assemblies (FA) in ''coolin''g pools (CP) of NPPs with the BWR and PWR type reactors are described. Problems concerning nuclear and radiation safety and provision of necessary thermal conditions arising in such rack design are discussed. It is concluded that the problem of prolonged fuel storage at NPPs became Very actual for many countries because of retapdation of the rates of fuel reprocessing centers building. Application of compact storage racks is a promising solution of the problem of intermediate FA storage at NPPs. Such racks of stainless boron steel and with neutron absorbers in the from of boron carbide panels enable to increase the capacity of the present CP 2-2.6 times, and the period of FA storage in them up to 5-10 years

  3. Electricity storage using a thermal storage scheme

    Energy Technology Data Exchange (ETDEWEB)

    White, Alexander, E-mail: ajw36@cam.ac.uk [Hopkinson Laboratory, Cambridge University Engineering Department, Trumpington Street, Cambridge. CB2 1PZ (United Kingdom)

    2015-01-22

    The increasing use of renewable energy technologies for electricity generation, many of which have an unpredictably intermittent nature, will inevitably lead to a greater demand for large-scale electricity storage schemes. For example, the expanding fraction of electricity produced by wind turbines will require either backup or storage capacity to cover extended periods of wind lull. This paper describes a recently proposed storage scheme, referred to here as Pumped Thermal Storage (PTS), and which is based on “sensible heat” storage in large thermal reservoirs. During the charging phase, the system effectively operates as a high temperature-ratio heat pump, extracting heat from a cold reservoir and delivering heat to a hot one. In the discharge phase the processes are reversed and it operates as a heat engine. The round-trip efficiency is limited only by process irreversibilities (as opposed to Second Law limitations on the coefficient of performance and the thermal efficiency of the heat pump and heat engine respectively). PTS is currently being developed in both France and England. In both cases, the schemes operate on the Joule-Brayton (gas turbine) cycle, using argon as the working fluid. However, the French scheme proposes the use of turbomachinery for compression and expansion, whereas for that being developed in England reciprocating devices are proposed. The current paper focuses on the impact of the various process irreversibilities on the thermodynamic round-trip efficiency of the scheme. Consideration is given to compression and expansion losses and pressure losses (in pipe-work, valves and thermal reservoirs); heat transfer related irreversibility in the thermal reservoirs is discussed but not included in the analysis. Results are presented demonstrating how the various loss parameters and operating conditions influence the overall performance.

  4. Performance of high-resolution position-sensitive detectors developed for storage-ring decay experiments

    International Nuclear Information System (INIS)

    Yamaguchi, T.; Suzaki, F.; Izumikawa, T.; Miyazawa, S.; Morimoto, K.; Suzuki, T.; Tokanai, F.; Furuki, H.; Ichihashi, N.; Ichikawa, C.; Kitagawa, A.; Kuboki, T.; Momota, S.; Nagae, D.; Nagashima, M.; Nakamura, Y.; Nishikiori, R.; Niwa, T.; Ohtsubo, T.; Ozawa, A.

    2013-01-01

    Highlights: • Position-sensitive detectors were developed for storage-ring decay spectroscopy. • Fiber scintillation and silicon strip detectors were tested with heavy ion beams. • A new fiber scintillation detector showed an excellent position resolution. • Position and energy detection by silicon strip detectors enable full identification. -- Abstract: As next generation spectroscopic tools, heavy-ion cooler storage rings will be a unique application of highly charged RI beam experiments. Decay spectroscopy of highly charged rare isotopes provides us important information relevant to the stellar conditions, such as for the s- and r-process nucleosynthesis. In-ring decay products of highly charged RI will be momentum-analyzed and reach a position-sensitive detector set-up located outside of the storage orbit. To realize such in-ring decay experiments, we have developed and tested two types of high-resolution position-sensitive detectors: silicon strips and scintillating fibers. The beam test experiments resulted in excellent position resolutions for both detectors, which will be available for future storage-ring experiments

  5. Bibliography of the seasonal thermal energy storage library

    Energy Technology Data Exchange (ETDEWEB)

    Prater, L.S.; Casper, G.; Kawin, R.A.

    1981-08-01

    The Main Listing is arranged alphabetically by the last name of the first author. Each citation includes the author's name, title, publisher, publication date, and where applicable, the National Technical Information Service (NTIS) number or other document number. The number preceding each citation is the identification number for that document in the Seasonal Thermal Energy Storage (STES) Library. Occasionally, one or two alphabetic characters are added to the identification number. These alphabetic characters indicate that the document is contained in a collection of papers, such as the proceedings of a conference. An Author Index and an Identification Number Index are included. (WHK)

  6. Ultrafine hydrogen storage powders

    Science.gov (United States)

    Anderson, Iver E.; Ellis, Timothy W.; Pecharsky, Vitalij K.; Ting, Jason; Terpstra, Robert; Bowman, Robert C.; Witham, Charles K.; Fultz, Brent T.; Bugga, Ratnakumar V.

    2000-06-13

    A method of making hydrogen storage powder resistant to fracture in service involves forming a melt having the appropriate composition for the hydrogen storage material, such, for example, LaNi.sub.5 and other AB.sub.5 type materials and AB.sub.5+x materials, where x is from about -2.5 to about +2.5, including x=0, and the melt is gas atomized under conditions of melt temperature and atomizing gas pressure to form generally spherical powder particles. The hydrogen storage powder exhibits improved chemcial homogeneity as a result of rapid solidfication from the melt and small particle size that is more resistant to microcracking during hydrogen absorption/desorption cycling. A hydrogen storage component, such as an electrode for a battery or electrochemical fuel cell, made from the gas atomized hydrogen storage material is resistant to hydrogen degradation upon hydrogen absorption/desorption that occurs for example, during charging/discharging of a battery. Such hydrogen storage components can be made by consolidating and optionally sintering the gas atomized hydrogen storage powder or alternately by shaping the gas atomized powder and a suitable binder to a desired configuration in a mold or die.

  7. Storage of radioactive wastes

    International Nuclear Information System (INIS)

    1992-07-01

    Even if the best waste minimization measures are undertaken throughout radioisotope production or usage, significant radioactive wastes arise to make management measures essential. For developing countries with low isotope usage and little or no generation of nuclear materials, it may be possible to handle the generated waste by simply practicing decay storage for several half-lives of the radionuclides involved, followed by discharge or disposal without further processing. For those countries with much larger facilities, longer lived isotopes are produced and used. In this situation, storage is used not only for decay storage but also for in-process retention steps and for the key stage of interim storage of conditioned wastes pending final disposal. The report will serve as a technical manual providing reference material and direct step-by-step know-how to staff in radioisotope user establishments and research centres in the developing Member States without nuclear power generation. Considerations are limited to the simpler storage facilities. The restricted quantities and low activity associated with the relevant wastes will generally permit contact-handling and avoid the need for shielding requirements in the storage facilities or equipment used for handling. A small quantity of wastes from some radioisotope production cells and from reactor cooling water treatment may contain sufficient short lived activity from activated corrosion products to require some separate decay storage before contact-handling is suitable. 16 refs, 12 figs, 8 tabs

  8. Aflatoxins & Safe Storage

    Directory of Open Access Journals (Sweden)

    Philippe eVillers

    2014-04-01

    Full Text Available The paper examines both field experience and research on the prevention of the exponential growth of aflatoxins during multi-month post harvest storage in hot, humid countries. The approach described is the application of modern safe storage methods using flexible, Ultra Hermetic™ structures that create an unbreatheable atmosphere through insect and microorganism respiration alone, without use of chemicals, fumigants, or pumps. Laboratory and field data are cited and specific examples are given describing the uses of Ultra Hermetic storage to prevent the growth of aflatoxins with their significant public health consequences. Also discussed is the presently limited quantitative information on the relative occurrence of excessive levels of aflatoxin (>20 ppb before versus after multi-month storage of such crops as maize, rice and peanuts when under high humidity, high temperature conditions and, consequently, the need for further research to determine the frequency at which excessive aflatoxin levels are reached in the field versus after months of post-harvest storage. The significant work being done to reduce aflatoxin levels in the field is mentioned, as well as its probable implications on post harvest storage. Also described is why, with some crops such as peanuts, using Ultra Hermetic storage may require injection of carbon dioxide or use of an oxygen absorber as an accelerant. The case of peanuts is discussed and experimental data is described.

  9. The inappropriate use of lumbar magnetic resonance imaging in a health service area; Utilizacion inapropiada de la resonancia magnetica lumbar en un area de salud

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez Recio, F. J.; Sanz, J. C.; Vera, S. [Hospital General de Soria (Spain); Peiro, S. [Fundacion de Investigacion en Servicios de Salud Valencia (Spain)

    1999-07-01

    To identify the percentage of inappropriate lumbar spine magnetic resonance imaging in the Soria Health Service, to quantify the costs and the possible association between inadequate use, the characteristics of the patient and the services requested. A descriptive study of the inappropriate use of MRI of the lumbar spine, taken from the retrospective examination, carried out by a radiologist, of the 233 MRI's requested between 1995 and 1998. For the valuation, the criteria of the American College of Radiology (ACR) and the Basque Agency for the Evaluation of Technologies (OSTEBA) were used. All the MRI's were carried out at an approved centre, the costs were calculated taken form the expenses paid by the Insalud, including the transport costs, calculated at prices applicable for the year in question. 11.7% of the studies were values as inappropriate, 2.1% debatable and the remainder adequate according to the ACR criteria, concentrating the inadequacy on studies for lumbago, that reached 80% of the inappropriate requests. The ACR and OSTEBA criteria coincided to a high degree (kappa statistics: 0.87). The expense related to the unnecessary studies was a litter higher than a million pesetas. No differences were found in the proportion of inappropriate studies according to the characteristics of the patient or the service requested, except the one already mentioned for the supposition diagnosis. Although the results of the study cannot be generalised to other environments, they suggest the possibility of a significant proportion of inappropriate use of lumbar spine MRI that could have an important repercussion on health care expenses. (Author) 11 refs.

  10. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey.

    Directory of Open Access Journals (Sweden)

    Alexia Cusini

    Full Text Available BACKGROUND: Unnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9-64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription. METHODOLOGY/PRINCIPAL FINDINGS: Experienced infectious diseases (ID fellows performed audits of antimicrobial use at regular intervals among all patients--with or without antimicrobials--hospitalized in predefined surgical, medical, haemato-oncological, or intensive care units. Data were collected from medical and nursing patient charts with a standardized questionnaire. Appropriateness of antimicrobial use was evaluated using a modified algorithm developed by Gyssens et al.; the assessment was double-checked by a senior ID specialist. We evaluated 1577 patients of whom 700 (44.4% had antimicrobials, receiving a total of 1270 prescriptions. 958 (75.4% prescriptions were for therapy and 312 (24.6% for prophylaxis. 37.0% of therapeutic and 16.6% of prophylactic prescriptions were found to be inappropriate. Most frequent characteristics of inappropriate treatments included: No indication (17.5%; incorrect choice of antimicrobials (7.6%; incorrect application of drugs (9.3%; and divergence from institutional guidelines (8%. Characteristics of inappropriate prophylaxes were: No indication (9%; incorrect choice of antimicrobials (1%; duration too long or other inappropriate use (6.7%. Patterns of inappropriate antimicrobial varied widely in the different hospital units; empirical prescriptions were more frequently incorrect than prescriptions based on available microbiological results. CONCLUSIONS/SIGNIFICANCE: Audits of individual patient care provide important data to identify local

  11. Spent-fuel-storage alternatives

    International Nuclear Information System (INIS)

    1980-01-01

    The Spent Fuel Storage Alternatives meeting was a technical forum in which 37 experts from 12 states discussed storage alternatives that are available or are under development. The subject matter was divided into the following five areas: techniques for increasing fuel storage density; dry storage of spent fuel; fuel characterization and conditioning; fuel storage operating experience; and storage and transport economics. Nineteen of the 21 papers which were presented at this meeting are included in this Proceedings. These have been abstracted and indexed

  12. Magnox waste storage complex

    International Nuclear Information System (INIS)

    Anon.

    1990-01-01

    This article looks at the design and construction of British Nuclear Fuel Limited's (BNFL) Magnox waste storage complex by Costain Engineering Limited. Magnox swarf from fuel decanning is stored underwater in specially designed silos. Gas processing capabilities from Costain Engineering Limited and the experience of BNFL combined in this project to provide the necessary problem-solving skills necessary for this waste storage upgrading and extension project. A retrofitted inerting facility was fitted to an existing building and a new storage extension was fitted, both without interrupting reprocessing operations at Sellafield. (UK)

  13. Tiered Storage For LHC

    CERN Multimedia

    CERN. Geneva; Hanushevsky, Andrew

    2012-01-01

    For more than a year, the ATLAS Western Tier 2 (WT2) at SLAC National Accelerator has been successfully operating a two tiered storage system based on Xrootd's flexible cross-cluster data placement framework, the File Residency Manager. The architecture allows WT2 to provide both, high performance storage at the higher tier to ATLAS analysis jobs, as well as large, low cost disk capacity at the lower tier. Data automatically moves between the two storage tiers based on the needs of analysis jobs and is completely transparent to the jobs.

  14. Next generation storage facility

    International Nuclear Information System (INIS)

    Schlesser, J.A.

    1994-01-01

    With diminishing requirements for plutonium, a substantial quantity of this material requires special handling and ultimately, long-term storage. To meet this objective, we at Los Alamos, have been involved in the design of a storage facility with the goal of providing storage capabilities for this and other nuclear materials. This paper presents preliminary basic design data, not for the structure and physical plant, but for the container and arrays which might be configured within the facility, with strong emphasis on criticality safety features

  15. Monitored retrievable storage design

    International Nuclear Information System (INIS)

    Woods, W.D.

    1985-01-01

    The Nuclear Waste Policy Act of 1982 (NWPA) established a national policy for the safe storage and disposal of spent nuclear fuel and high-level radioactive waste. The NWPA requires that DOE... ''submit a proposal to Congress on the need for and feasibility of one or more Monitored Retrievable Storage (MRS) Facilities''... In subsequent evaluations of the commercial nuclear waste management system, DOE has identified important advantages in providing an MRS Facility as an integral part of the total system. The integral MRS Facility serves as an independent, centralized spent nuclear fuel and high-level waste handling and packaging facility with a safe temporary storage capacity

  16. Overview of the National Waste Terminal Storage Program

    International Nuclear Information System (INIS)

    Zerby, C.D.

    1976-01-01

    The following seven distinct steps necessary for developing a terminal storage facility are discussed: identification of formations of interest; reconnaissance surveys; in situ tests; area studies; detailed confirmation studies; pilot plant operations; and conversion of the pilot plant into a federal repository

  17. The Primary Solid Waste Storage Gaps Experienced By Nairobi ...

    African Journals Online (AJOL)

    `123456789jkl''''#

    Key Words: Household Storage, Solid Waste Management; Garbage Bins. Introduction .... depends on people's identification with the SWM system. The character of SWM ..... end up in the right place, and health and safety of those handling the full ... Afullo A (2004) Environmental and occupational health aspects of waste ...

  18. Independent Spent Fuel Storage Installations (ISFSI). Annual report, FY 1978

    International Nuclear Information System (INIS)

    Zima, G.E.

    1979-03-01

    The prime objective of the subject program is the identification of technical aspects of the design, operation and maintenance of independent spent fuel storage installations which could contribute to technical bases for Regulations and Regulatory Guides issued by NRC for these facilities. Activities on the various tasks of the program for the FY 1978 period are discussed in this report

  19. Storage-ring FEL for the vuv

    International Nuclear Information System (INIS)

    Peterson, J.M.; Bisognano, J.J.; Garren, A.A.; Halbach, K.; Kim, K.J.; Sah, R.C.

    1984-09-01

    A free-electron laser for the vuv operating in a storage ring requires an electron beam of high density and low energy spread and a short wavelength, narrow-gap undulator. These conditions tend to produce longitudinal and transverse beam instabilities, excessive beam growth through multiple intrabeam scattering, and a short gas-scattering lifetime. Passing the beam only occasionally through the undulator in a by-pass straight section, as proposed by Murphy and Pellegrini, allows operation in a high-gain, single-pass mode and a long gas-scattering lifetime. Several storage ring designs have been considered to see how best to satisfy the several requirements. Each features a by-pass, a low-emittance lattice, and built-in wigglers for enhanced damping to counteract the intra-beam scattering. 15 references, 3 figures, 2 tables

  20. Identification methods for irradiated wheat

    International Nuclear Information System (INIS)

    Zhu Shengtao; Kume, Tamikazu; Ishigaki, Isao.

    1992-02-01

    The effect of irradiation on wheat seeds was examined using various kinds of analytical methods for the identification of irradiated seeds. In germination test, the growth of sprouts was markedly inhibited at 500Gy, which was not affected by storage. The decrease in germination percentage was detected at 3300Gy. The results of enzymatic activity change in the germ measured by Vita-Scope germinator showed that the seeds irradiated at 10kGy could be identified. The content of amino acids in ungerminated and germinated seeds were analyzed. Irradiation at 10kGy caused the decrease of lysine content but the change was small which need very careful operation to detect it. The chemiluminescence intensity increased with radiation dose and decreased during storage. The wheat irradiated at 10kGy could be identified even after 3 months storage. In the electron spin resonance (ESR) spectrum analysis, the signal intensity with the g value f 2.0055 of skinned wheat seeds increased with radiation dose. Among these methods, germination test was the most sensitive and effective for identification of irradiated wheat. (author)

  1. Extremely secure identification documents

    International Nuclear Information System (INIS)

    Tolk, K.M.; Bell, M.

    1997-09-01

    The technology developed in this project uses biometric information printed on the document and public key cryptography to ensure that an adversary cannot issue identification documents to unauthorized individuals or alter existing documents to allow their use by unauthorized individuals. This process can be used to produce many types of identification documents with much higher security than any currently in use. The system is demonstrated using a security badge as an example. This project focused on the technologies requiring development in order to make the approach viable with existing badge printing and laminating technologies. By far the most difficult was the image processing required to verify that the picture on the badge had not been altered. Another area that required considerable work was the high density printed data storage required to get sufficient data on the badge for verification of the picture. The image processing process was successfully tested, and recommendations are included to refine the badge system to ensure high reliability. A two dimensional data array suitable for printing the required data on the badge was proposed, but testing of the readability of the array had to be abandoned due to reallocation of the budgeted funds by the LDRD office

  2. Program definition and assessment overview. [for thermal energy storage project management

    Science.gov (United States)

    Gordon, L. H.

    1980-01-01

    The implementation of a program level assessment of thermal energy storage technology thrusts for the near and far term to assure overall coherent energy storage program is considered. The identification and definition of potential thermal energy storage applications, definition of technology requirements, and appropriate market sectors are discussed along with the necessary coordination, planning, and preparation associated with program reviews, workshops, multi-year plans and annual operating plans for the major laboratory tasks.

  3. Storage of strawberry pollen

    Directory of Open Access Journals (Sweden)

    Rafet Aslantaş

    2013-12-01

    Full Text Available This study was carried out to determine storage ability of strawberry pollen at different temperatures for three different strawberry cultivars 'Aliso', 'Brio', and 'Cruz'. Strawberry pollen was stored at room temperature (22 ±2°C, +4°C, -4°C and -18°C in stabile humidity conditions. Strawberry poIlen was germinated using the hanging drop method in a 20% sucrose solution. Pollen germination rate increased because of low temperature storage. Pollen stored at room temperature and +4°C, -4°C, and -18°C was kept for 8 months, about one year, and 20 months, respectively. Pollen germination rates decreased as the length of storage period increased. The reaction of all cultivars tested on the duration and temperature of storage was similar.

  4. Hydrogen storage compositions

    Science.gov (United States)

    Li, Wen; Vajo, John J.; Cumberland, Robert W.; Liu, Ping

    2011-04-19

    Compositions for hydrogen storage and methods of making such compositions employ an alloy that exhibits reversible formation/deformation of BH.sub.4.sup.- anions. The composition includes a ternary alloy including magnesium, boron and a metal and a metal hydride. The ternary alloy and the metal hydride are present in an amount sufficient to render the composition capable of hydrogen storage. The molar ratio of the metal to magnesium and boron in the alloy is such that the alloy exhibits reversible formation/deformation of BH.sub.4.sup.- anions. The hydrogen storage composition is prepared by combining magnesium, boron and a metal to prepare a ternary alloy and combining the ternary alloy with a metal hydride to form the hydrogen storage composition.

  5. Memory mass storage

    CERN Document Server

    Campardo, Giovanni; Iaculo, Massimo

    2011-01-01

    Covering all the fundamental storage technologies such as semiconductor, magnetic, optical and uncommon, this volume details their core characteristics. In addition, it includes an overview of the 'biological memory' of the human brain and its organization.

  6. Center for Hydrogen Storage.

    Science.gov (United States)

    2013-06-01

    The main goals of this project were to (1) Establish a Center for Hydrogen Storage Research at Delaware State University for the preparation and characterization of selected complex metal hydrides and the determination their suitability for hydrogen ...

  7. Hydrogen storage using borohydrides

    International Nuclear Information System (INIS)

    Bernard BONNETOT; Laetitia LAVERSENNE

    2006-01-01

    The possibilities of hydrogen storage using borohydrides are presented and discussed specially in regard of the recoverable hydrogen amount and related to the recovering conditions. A rapid analysis of storage possibilities is proposed taking in account the two main ways for hydrogen evolution: the dehydrogenation obtained through thermal decomposition or the hydrolysis of solids or solutions. The recoverable hydrogen is related to the dehydrogenation conditions and the real hydrogen useful percentage is determined for each case of use. The high temperature required for dehydrogenation even when using catalyzed compounds lead to poor outlooks for this storage way. The hydrolysis conditions direct the chemical yield of the water consuming, and this must be related to the experimental conditions which rule the storage capacity of the 'fuel' derived from the borohydride. (authors)

  8. Wet storage integrity update

    International Nuclear Information System (INIS)

    Bailey, W.J.; Johnson, A.B. Jr.

    1983-09-01

    This report includes information from various studies performed under the Wet Storage Task of the Spent Fuel Integrity Project of the Commercial Spent Fuel Management (CSFM) Program at Pacific Northwest Laboratory. An overview of recent developments in the technology of wet storage of spent water reactor fuel is presented. Licensee Event Reports pertaining to spent fuel pools and the associated performance of spent fuel and storage components during wet storage are discussed. The current status of fuel that was examined under the CSFM Program is described. Assessments of the effect of boric acid in spent fuel pool water on the corrosion and stress corrosion cracking of stainless steel and the stress corrosion cracking of stainless steel piping containing stagnant water at spent fuel pools are discussed. A list of pertinent publications is included. 84 references, 21 figures, 11 tables

  9. Spent fuel storage requirements

    International Nuclear Information System (INIS)

    Fletcher, J.

    1982-06-01

    Spent fuel storage requirements, as projected through the year 2000 for U.S. LWRs, were calculated using information supplied by the utilities reflecting plant status as of December 31, 1981. Projections through the year 2000 combined fuel discharge projections of the utilities with the assumed discharges of typical reactors required to meet the nuclear capacity of 165 GWe projected by the Energy Information Administration (EIA) for the year 2000. Three cases were developed and are summarized. A reference case, or maximum at-reactor (AR) capacity case, assumes that all reactor storage pools are increased to their maximum capacities as estimated by the utilities for spent fuel storage utilizing currently licensed technologies. The reference case assumes no transshipments between pools except as currently licensed by the Nuclear Regulatory Commission (NRC). This case identifies an initial requirement for 13 MTU of additional storage in 1984, and a cumulative requirement for 14,490 MTU additional storage in the year 2000. The reference case is bounded by two alternative cases. One, a current capacity case, assumes that only those pool storage capacity increases currently planned by the operating utilities will occur. The second, or maximum capacity with transshipment case, assumes maximum development of pool storage capacity as described above and also assumes no constraints on transshipment of spent fuel among pools of reactors of like type (BWR, PWR) within a given utility. In all cases, a full core discharge capability (full core reserve or FCR) is assumed to be maintained for each reactor, except that only one FCR is maintained when two reactors share a common pool. For the current AR capacity case the indicated storage requirements in the year 2000 are indicated to be 18,190 MTU; for the maximum capacity with transshipment case they are 11,320 MTU

  10. Flywheel energy storage; Schwungmassenspeicher

    Energy Technology Data Exchange (ETDEWEB)

    Bornemann, H.J. [Forschungszentrum Karlsruhe GmbH Technik und Umwelt (Germany)

    1996-12-31

    Energy storages may be chemical systems such as batteries, thermal systems such as hot-water tanks, electromagnetic systems such as capacitors and coils, or mechanical systems such as pumped storage power systems or flywheel energy storages. In flywheel energy storages the energy is stored in the centrifugal mass in the form of kinetic energy. This energy can be converted to electricity via a motor/generator unit and made available to the consumer. The introduction of magnetic bearings has greatly enhanced the potential of flywheel energy storages. As there is no contact between the moving parts of magnetic bearings, this technology provides a means of circumventing the engineering and operational problems involved in the we of conventional bearings (ball, roller, plain, and gas bearings). The advantages of modern flywheel energy storages over conventional accumulators are an at least thousandfold longer service life, low losses during long-time storage, greater power output in the case of short-time storage, and commendable environmental benignity. (orig./HW) [Deutsch] Als Enegiespeicher kommen chemische Systeme, z.B. Batterien, thermische Systeme, z.B. Warmwassertanks, elektromagnetische Systeme, z.B. Kondensatoren und Spulen, sowie mechanische Systeme, z.B. Pumpspeicherwerke und Schwungmassenspeicher in Frage. In einem Schwungmassenspeicher wird Energie in Form von kinetischer Energie in der Schwungmasse gespeichert. Ueber eine Moter/Generator Einheit wird diese Energie in elektrischen Strom umgewandelt und dem Verbraucher zugefuehrt. Mit der Einfuehrung von magnetischen Lagern konnte die Leistungsfaehigkeit von Schwungmassenspeichern erheblich gesteigert werden. Da in einem Magnetlager keine Beruehrung zwischen sich bewegenden Teilen besteht, wird ein Grossteil der mit dem Einsatz konventioneller Lager (Kugel- und Rollenlager, Gleitlager und Gaslager) verbundenen ingenieurtechnischen und betriebstechnischen Probleme vermieden. Die Vorteile von modernen

  11. Optimization of Munitions Storage.

    Science.gov (United States)

    1979-12-01

    zones of land around each facility place a significant economic cost on the storage of munitions (Schreyer, 1970: 1). Munitions storage is a subject...ADDTOT, BTOTAL 353 REAL MPH,MW ,MPD, MPU ,4,MPNEW,MCD 354 IF (SW2.NE.0) GO TO 1 355 SW2 - 1 356 WRITE (6,2) 357 GO TO 3 358 1 IF (REC.EQ.0) GO TO 4 359 IF

  12. Spent fuel storage

    International Nuclear Information System (INIS)

    Huppert

    1976-01-01

    To begin with, the author explains the reasons for intermediate storage of fuel elements in nuclear power stations and in a reprocessing plant and gives the temperature and radioactivity curves of LWR fuel elements after removal from the reactor. This is followed by a description of the facilities for fuel element storage in a reprocessing plant and of their functions. Futher topics are criticality and activity control, the problem of cooling time and safety systems. (HR) [de

  13. Analog storage integrated circuit

    Science.gov (United States)

    Walker, J.T.; Larsen, R.S.; Shapiro, S.L.

    1989-03-07

    A high speed data storage array is defined utilizing a unique cell design for high speed sampling of a rapidly changing signal. Each cell of the array includes two input gates between the signal input and a storage capacitor. The gates are controlled by a high speed row clock and low speed column clock so that the instantaneous analog value of the signal is only sampled and stored by each cell on coincidence of the two clocks. 6 figs.

  14. Annual Report: Carbon Storage

    Energy Technology Data Exchange (ETDEWEB)

    Strazisar, Brian [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United States); Guthrie, George [National Energy Technology Lab. (NETL), Pittsburgh, PA, (United States)

    2012-09-30

    Activities include laboratory experimentation, field work, and numerical modeling. The work is divided into five theme areas (or first level tasks) that each address a key research need: Flow Properties of Reservoirs and Seals, Fundamental Processes and Properties, Estimates of Storage Potential, Verifying Storage Performance, and Geospatial Data Resources. The project also includes a project management effort which coordinates the activities of all the research teams.

  15. Hyponatremia in aneurysmal subarachnoid hemorrhage is due to the syndrome of inappropriate antidiuresis and acute glucocorticoid deficiency

    LENUS (Irish Health Repository)

    Hannon, M J

    2011-06-01

    Hyponatraemia is the most common electrolyte abnormality following subarachnoid haemorrhage (SAH) and contributes to increased morbidity and mortality. Retrospective data suggests that the syndrome of inappropriate diuresis (SIAD) is the most common cause of hyponatraemia in SAH, though cerebral salt wasting has been postulated by some workers to be the predominant abnormality. Data which has shown acute glucocorticoid deficiency following SAH has suggested that some cases of euvolaemic hyponatraemia may also be caused by this mechanism.We prospectively studied the hormonal and haemodynamic influences involved in the development of hyponatraemia in 100 patients (61% female, median age 53 (range 16-82)) with non-traumatic aneurysmal SAH. Each patient had plasma sodium (pNa), urea, osmolality, glucose and 0900h cortisol (PC), and urinary sodium and osmolality measured on days 1, 2, 3, 4, 6, 8, 10 and 12 following SAH. Fluid balance and haemodynamic parameters were recorded daily. Results were compared with 15 patients admitted to ITU following vascular surgery. A PC<300nmol\\/L in a patient in ITU was regarded clinically as inappropriately low.49% of patients developed hyponatraemia (pNa<135 mmol\\/L), including 14% who developed clinically significantly hyponatraemia (pNa<130 mmol\\/L). 36\\/49 (73.4%) developed hyponatraemia between days 1 and 3 post SAH. The median duration of hyponatraemia was 3 days (range 1–10 days).In 35\\/49 (71.4%), hyponatraemia was due to SIAD as defined by standard diagnostic criteria. 14% of SAH patients had at least one PC<300nmol\\/L; 5 of these (35.7%) developed hyponatraemia. In 4 patients hyponatraemia was preceded by acute cortisol deficiency and responded to hydrocortisone treatment. In contrast, all controls had PC>500 nmol\\/L on day 1, and >300 nmol on days 3–12. There were no cases of cerebral salt wasting. There was no relationship between the incidence of hyponatraemia and the defined anatomical territory or severity of

  16. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents.

    Science.gov (United States)

    Al Aqqad, Saná M H; Chen, Li Li; Shafie, Asrul Akmal; Hassali, Mohamed Azmi; Tangiisuran, Balamurugan

    2014-01-01

    Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL) have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs) and the changes observed in the HRQoL among older nursing home residents. A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old) taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP) criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D) and EuroQol-visual analog scale (EQ-VAS) at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. The median age of the 211 participants was 77 years (interquartile range 72-82 years) and the median number of prescription medicines was four (interquartile range three to six). The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months also showed no statistically significant differences. PIMs were found to be relatively common among older nursing home residents. However, no significant changes were observed in HRQoL among these residents. Further studies with a bigger sample size and

  17. The use of potentially inappropriate medications and changes in quality of life among older nursing home residents

    Directory of Open Access Journals (Sweden)

    Al Aqqad S MH

    2014-01-01

    Full Text Available Sana’ MH Al Aqqad, Li Li Chen, Asrul Akmal Shafie, Mohamed Azmi Hassali, Balamurugan Tangiisuran Pharmacy Practice Research Group, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia Background: Nursing home residents are mainly older people with multiple diseases and taking multiple medications. The quality use of medication and its association with health related quality of life (HRQoL have not been reported in Malaysia. This study aims to investigate the association between the use of potentially inappropriate medications (PIMs and the changes observed in the HRQoL among older nursing home residents. Methods: A prospective follow up study was conducted at four nongovernmental organization nursing homes in Penang, Malaysia. Older residents (≥65 years old taking at least one prescribed medication were included. Residents with PIMs were identified by using Screening Tool of Older Person's potentially inappropriate Prescriptions (STOPP criteria. HRQoL was assessed using EuroQol-5 dimension (EQ-5D and EuroQol-visual analog scale (EQ-VAS at baseline and after a 3-month follow up. The association of PIMs with HRQoL was analyzed using Mann-Whitney U test. Results: The median age of the 211 participants was 77 years (interquartile range 72–82 years and the median number of prescription medicines was four (interquartile range three to six. The prevalence of PIMs was 23.7% and 18.6% at baseline and 3 months later, respectively. The most commonly prescribed PIMs in decreasing order were first generation antihistamine, prescriptions of duplicate drug class, glibenclamide with type 2 diabetes mellitus, and anticholinergic to treat extrapyramidal side effects of neuroleptic medications. At baseline, there was no significant difference among residents with or without PIMs in each bracket of EQ-5D, EQ-5D index, or EQ-VAS scores. Comparison of the differences in the mean score index of EQ-5D between baseline and after 3 months

  18. Storage of nuclear wastes

    International Nuclear Information System (INIS)

    Ahlstroem, P.E.

    1988-01-01

    The Swedish system of handling and storage of nuclear wastes is well-developed. Existing plants and systems provide great freedom of action and flexibility regarding future development and decisions of ultimate storage of the spent fuel. The interim storage in CLAB - Central interim storage facility for spent nuclear fuel - could continue without any safety related problems for more than 40 years. In practice the choice of ultimate treatment system is not locked until the encapsulation of the fuel starts. At the same time it is of importance that the generation benefiting by the nuclear power production also be responsible for the development of the ultimate storage system and not unnecessarily postpones important decisions. The ultimate storage system for spent fuel could and should be developed within existing schedule. At the same time is should be worked out to provide coming generations with possibilities to do the type of supervision they like without maintenance and supervision requiring to become a prerequisite for a safe function. (O.S.)

  19. Energy Storage Systems

    Science.gov (United States)

    Elliott, David

    2017-07-01

    As renewable energy use expands there will be a need to develop ways to balance its variability. Storage is one of the options. Presently the main emphasis is for systems storing electrical power in advanced batteries (many of them derivatives of parallel developments in the electric vehicle field), as well as via liquid air storage, compressed air storage, super-capacitors and flywheels, and, the leader so far, pumped hydro reservoirs. In addition, new systems are emerging for hydrogen generation and storage, feeding fuel cell power production. Heat (and cold) is also a storage medium and some systems exploit thermal effects as part of wider energy management activity. Some of the more exotic ones even try to use gravity on a large scale. This short book looks at all the options, their potentials and their limits. There are no clear winners, with some being suited to short-term balancing and others to longer-term storage. The eventual mix adopted will be shaped by the pattern of development of other balancing measures, including smart-grid demand management and super-grid imports and exports.

  20. Superconducting magnetic energy storage

    International Nuclear Information System (INIS)

    Rogers, J.D.; Boenig, H.J.

    1978-01-01

    Superconducting inductors provide a compact and efficient means of storing electrical energy without an intermediate conversion process. Energy storage inductors are under development for diurnal load leveling and transmission line stabilization in electric utility systems and for driving magnetic confinement and plasma heating coils in fusion energy systems. Fluctuating electric power demands force the electric utility industry to have more installed generating capacity than the average load requires. Energy storage can increase the utilization of base-load fossil and nuclear power plants for electric utilities. Superconducting magnetic energy storage (SMES) systems, which will store and deliver electrical energy for load leveling, peak shaving, and the stabilization of electric utility networks are being developed. In the fusion area, inductive energy transfer and storage is also being developed by LASL. Both 1-ms fast-discharge theta-pinch and 1-to-2-s slow tokamak energy transfer systems have been demonstrated. The major components and the method of operation of an SMES unit are described, and potential applications of different size SMES systems in electric power grids are presented. Results are given for a 1-GWh reference design load-leveling unit, for a 30-MJ coil proposed stabilization unit, and for tests with a small-scale, 100-kJ magnetic energy storage system. The results of the fusion energy storage and transfer tests are also presented. The common technology base for the systems is discussed

  1. Secure Storage Architectures

    Energy Technology Data Exchange (ETDEWEB)

    Aderholdt, Ferrol [Tennessee Technological University; Caldwell, Blake A [ORNL; Hicks, Susan Elaine [ORNL; Koch, Scott M [ORNL; Naughton, III, Thomas J [ORNL; Pogge, James R [Tennessee Technological University; Scott, Stephen L [Tennessee Technological University; Shipman, Galen M [ORNL; Sorrillo, Lawrence [ORNL

    2015-01-01

    The purpose of this report is to clarify the challenges associated with storage for secure enclaves. The major focus areas for the report are: - review of relevant parallel filesystem technologies to identify assets and gaps; - review of filesystem isolation/protection mechanisms, to include native filesystem capabilities and auxiliary/layered techniques; - definition of storage architectures that can be used for customizable compute enclaves (i.e., clarification of use-cases that must be supported for shared storage scenarios); - investigate vendor products related to secure storage. This study provides technical details on the storage and filesystem used for HPC with particular attention on elements that contribute to creating secure storage. We outline the pieces for a a shared storage architecture that balances protection and performance by leveraging the isolation capabilities available in filesystems and virtualization technologies to maintain the integrity of the data. Key Points: There are a few existing and in-progress protection features in Lustre related to secure storage, which are discussed in (Chapter 3.1). These include authentication capabilities like GSSAPI/Kerberos and the in-progress work for GSSAPI/Host-keys. The GPFS filesystem provides native support for encryption, which is not directly available in Lustre. Additionally, GPFS includes authentication/authorization mechanisms for inter-cluster sharing of filesystems (Chapter 3.2). The limitations of key importance for secure storage/filesystems are: (i) restricting sub-tree mounts for parallel filesystem (which is not directly supported in Lustre or GPFS), and (ii) segregation of hosts on the storage network and practical complications with dynamic additions to the storage network, e.g., LNET. A challenge for VM based use cases will be to provide efficient IO forwarding of the parallel filessytem from the host to the guest (VM). There are promising options like para-virtualized filesystems to

  2. Spent nuclear fuel storage

    International Nuclear Information System (INIS)

    Romanato, Luiz Sergio

    2005-01-01

    When a country becomes self-sufficient in part of the nuclear cycle, as production of fuel that will be used in nuclear power plants for energy generation, it is necessary to pay attention for the best method of storing the spent fuel. Temporary storage of spent nuclear fuel is a necessary practice and is applied nowadays all over the world, so much in countries that have not been defined their plan for a definitive repository, as well for those that already put in practice such storage form. There are two main aspects that involve the spent fuels: one regarding the spent nuclear fuel storage intended to reprocessing and the other in which the spent fuel will be sent for final deposition when the definitive place is defined, correctly located, appropriately characterized as to several technical aspects, and licentiate. This last aspect can involve decades of studies because of the technical and normative definitions at a given country. In Brazil, the interest is linked with the storage of spent fuels that will not be reprocessed. This work analyses possible types of storage, the international panorama and a proposal for future construction of a spent nuclear fuel temporary storage place in the country. (author)

  3. Special storage of leaking fuel at Paks NPP

    International Nuclear Information System (INIS)

    Biro, Janos; Szőke, L.; Burján, T.; Lukács, R.; Hózer, H.

    2015-01-01

    In this paper the activities related with spent, hermetic as well as leaking fuel handling and storage, including: Spent fuel pool; Transportation criteria for the spent fuel assemblies and Interim spent fuel dry storage; Short-term storage in the spent fuel pool; Identification of the leaking assemblies by the TS-device; Present conception of Identification, handling of the leaking FAs; Modified transport procedure for the leaking FAs; Calculation of solved activity inside the leaking fuel rod; Solved activity limit values for the leaking FAs; Long-term storage in the interim spent Fuel dry storage are presented. At the end authors’ concluded that: 1) The leaking FA can be transported to the interim dry storage together with the other spent fuel assemblies in the transport container. 2) The transport-documentation of the leaking FA has to contain: isotope inventory, calculated solved activity values of the failed FA and the quantity of failed fuel rods. 3) Performing three leakage tests of the identified leaking FA before the transportation in the 5FP. it is useful to decrease the solved activity concentration inside the leaking FA and give additional information about the extent of the leakage. 4) We can calculate simply the solved activity of the leaking FA. 5) The modified transport procedure will have to be authorized. 6) The radiological effects of the leaking FA are negligible relative to the natural background radiation

  4. Neutrino Signals in Electron-Capture Storage-Ring Experiments

    Directory of Open Access Journals (Sweden)

    Avraham Gal

    2016-06-01

    Full Text Available Neutrino signals in electron-capture decays of hydrogen-like parent ions P in storage-ring experiments at GSI are reconsidered, with special emphasis placed on the storage-ring quasi-circular motion of the daughter ions D in two-body decays P → D + ν e . It is argued that, to the extent that daughter ions are detected, these detection rates might exhibit modulations with periods of order seconds, similar to those reported in the GSI storage-ring experiments for two-body decay rates. New dedicated experiments in storage rings, or using traps, could explore these modulations.

  5. SOLID-STATE STORAGE DEVICE WITH PROGRAMMABLE PHYSICAL STORAGE ACCESS

    DEFF Research Database (Denmark)

    2017-01-01

    a storage device action request, and the storage device evaluating a first rule of the one or more rules by determining if the received request fulfills request conditions comprised in the first rule, and in the affirmative the storage device performing request actions comprised in the first rule......Embodiments of the present invention includes a method of operating a solid-state storage device, comprising a storage device controller in the storage device receiving a set of one or more rules, each rule comprising (i) one or more request conditions to be evaluated for a storage device action...... request received from a host computer, and (ii) one or more request actions to be performed on a physical address space of a non-volatile storage unit in the solid-state storage device in case the one or more request conditions are fulfilled; the method further comprises: the storage device receiving...

  6. Developing new transportable storage casks for interim dry storage

    International Nuclear Information System (INIS)

    Hayashi, K.; Iwasa, K.; Araki, K.; Asano, R.

    2004-01-01

    Transportable storage metal casks are to be consistently used during transport and storage for AFR interim dry storage facilities planning in Japan. The casks are required to comply with the technical standards of regulations for both transport (hereinafter called ''transport regulation'') and storage (hereafter called ''storage regulation'') to maintain safety functions (heat transfer, containment, shielding and sub-critical control). In addition to these requirements, it is not planned in normal state to change the seal materials during storage at the storage facility, therefore it is requested to use same seal materials when the casks are transported after storage period. The dry transportable storage metal casks that satisfy the requirements have been developed to meet the needs of the dry storage facilities. The basic policy of this development is to utilize proven technology achieved from our design and fabrication experience, to carry out necessary verification for new designs and to realize a safe and rational design with higher capacity and efficient fabrication

  7. Global Patterns of Legacy Nitrate Storage in the Vadose Zone

    Science.gov (United States)

    Ascott, M.; Gooddy, D.; Wang, L.; Stuart, M.; Lewis, M.; Ward, R.; Binley, A. M.

    2017-12-01

    Global-scale nitrogen (N) budgets have been developed to quantify the impact of man's influence on the nitrogen cycle. However, these budgets often do not consider legacy effects such as accumulation of nitrate in the deep vadose zone. In this presentation we show that the vadose zone is an important store of nitrate which should be considered in future nitrogen budgets for effective policymaking. Using estimates of depth to groundwater and nitrate leaching for 1900-2000, we quantify for the first time the peak global storage of nitrate in the vadose zone, estimated as 605 - 1814 Teragrams (Tg). Estimates of nitrate storage are validated using previous national and basin scale estimates of N storage and observed groundwater nitrate data for North America and Europe. Nitrate accumulation per unit area is greatest in North America, China and Central and Eastern Europe where thick vadose zones are present and there is an extensive history of agriculture. In these areas the long solute travel time in the vadose zone means that the anticipated impact of changes in agricultural practices on groundwater quality may be substantially delayed. We argue that in these areas use of conventional nitrogen budget approaches is inappropriate and their continued use will lead to significant errors.

  8. Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria.

    LENUS (Irish Health Repository)

    Cooper, Janine A

    2016-01-28

    The purpose of this study is to establish the prevalence of potentially inappropriate prescribing (PIP) in middle-aged adults (45-64 years) in two populations with differing socio-economic profiles, and to investigate factors associated with PIP, using the PROMPT (PRescribing Optimally in Middle-aged People\\'s Treatments) criteria.

  9. Variety Is Not the Spice of Life for People with Autism Spectrum Disorders: Frequency Ratings of Central, Variable and Inappropriate Aspects of Common Real-Life Events

    Science.gov (United States)

    Loth, Eva; Happe, Francesca; Gomez, Juan Carlos

    2010-01-01

    This study used a novel rating task to investigate whether high-functioning individuals with autism spectrum disorder (ASD) have difficulties distinguishing essential from variable aspects of familiar events. Participants read stories about everyday events and judged how often central, variable, and inappropriate event-components normally occur in…

  10. Risk of iatrogenic human immunodeficiency virus infection through transfusion of blood tested by inappropriately stored or expired rapid antibody assays in a Zambian hospital

    NARCIS (Netherlands)

    Consten, E. C.; van der Meer, J. T.; de Wolf, F.; Heij, H. A.; Henny, P. C.; van Lanschot, J. J.

    1997-01-01

    BACKGROUND: The purpose of this study was to estimate the risk of human immunodeficiency virus (HIV) infection via the transfusion of blood tested by inappropriately stored or expired rapid antibody assays in Zambia. STUDY DESIGN AND METHODS: Surgical patients (n = 370) were tested with antibody

  11. Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study.

    LENUS (Irish Health Repository)

    Moriarty, Frank

    2015-03-01

    To examine: (1) changes in polypharmacy in 1997, 2002, 2007 and 2012 and; (2) changes in potentially inappropriate prescribing (PIP) prevalence and the relationship between PIP and polypharmacy in individuals aged ≥65 years over this period in Ireland.

  12. Potential Teachers' Appropriate and Inappropriate Application of Pedagogical Resources in a Model-Based Physics Course: A "Knowledge in Pieces" Perspective on Teacher Learning

    Science.gov (United States)

    Harlow, Danielle B.; Bianchini, Julie A.; Swanson, Lauren H.; Dwyer, Hilary A.

    2013-01-01

    We used a "knowledge in pieces" perspective on teacher learning to document undergraduates' pedagogical resources in a model-based physics course for potential teachers. We defined pedagogical resources as small, discrete ideas about teaching science that are applied appropriately or inappropriately in specific contexts. Neither…

  13. Foodborne Infectious Diseases Mediated by Inappropriate Infection Control in Food Service Businesses and Relevant Countermeasures in Korea.

    Science.gov (United States)

    Park, Jong Myong; You, Young-Hyun; Cho, Hyun-Min; Hong, Ji Won; Ghim, Sa-Youl

    2017-06-01

    The objective of this review is to propose an appropriate course of action for improving the guidelines followed by food handlers for control of infection. For this purpose, previous epidemiological reports related to acute gastroenteritis in food service businesses mediated by food handlers were intensively analyzed. Relevant studies were identified in international databases. We selected eligible papers reporting foodborne infectious disease outbreaks. Among primary literature collection, the abstract of each article was investigated to find cases that absolutely identified a causative factor to be food handlers' inappropriate infection control and the taxon of causative microbial agents by epidemiological methodologies. Information about the sites (type of food business) where the outbreaks occurred was investigated. A wide variety of causative microbial agents has been investigated, using several epidemiological methods. These agents have shown diverse propagation pathways based on their own molecular pathogenesis, physiology, taxonomy, and etiology. Depending on etiology, transmission, propagation, and microbiological traits, we can predict the transmission characteristics of pathogens in food preparation areas. The infected food workers have a somewhat different ecological place in infection epidemiology as compared to the general population. However, the current Korean Food Safety Act cannot propose detailed guidelines. Therefore, different methodologies have to be made available to prevent further infections.

  14. [Individualized restorative designs and clinical evaluation for dental implants in the anterior esthetic zone with inappropriate conditions].

    Science.gov (United States)

    Dai, Wen-yong; Zhou, Guo-xing; Zhang, Xiao-zhen; Zhao, Yi; Wang, Jie; Yang, Yi; Zhu, Zhi-jun; Tang, Chun-bo

    2014-08-01

    To offer individualized restorative strategies for patients receiving dental implants in the anterior esthetic zone but with inappropriate available conditions and evaluate the clinical outcomes. Forty-six patients with 58 implants were recruited for the study in accordance with the criteria and received individualized implant prostheses in the anterior esthetic zone. The patients were followed up for 3-24 months, and the clinical outcomes were evaluated by pink and white esthetic scores (PES/WES). The patients were from 18 to 69 years old, and followed up for 12.6 months in average. According to the third month follow-up esthetic scores, for PES, 1.72% of the patients got low scores, 44.83% got medium scores and 53.45% got high scores; For WES, 0% got low scores, 20.69% got medium scores and 79.31% got high scores. No implant failure or peri-implantitis occurred. Individualized restorative designs for implants in the esthetic zone can effectively improve the appearance of the prostheses which originally have no appropriate available space. Close follow-up and monitoring of the peri-implant soft tissue and proper oral hygiene instructions are important to ensure the conditions of the prostheses.

  15. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria.

    LENUS (Irish Health Repository)

    Gallagher, P F

    2011-06-01

    Inappropriate prescribing is particularly common in older patients and is associated with adverse drug events (ADEs), hospitalization, and wasteful utilization of resources. We randomized 400 hospitalized patients aged ≥ 65 years to receive either the usual pharmaceutical care (control) or screening with STOPP\\/START criteria followed up with recommendations to their attending physicians (intervention). The Medication Appropriateness Index (MAI) and Assessment of Underutilization (AOU) index were used to assess prescribing appropriateness, both at the time of discharge and for 6 months after discharge. Unnecessary polypharmacy, the use of drugs at incorrect doses, and potential drug-drug and drug-disease interactions were significantly lower in the intervention group at discharge (absolute risk reduction 35.7%, number needed to screen to yield improvement in MAI = 2.8 (95% confidence interval 2.2-3.8)). Underutilization of clinically indicated medications was also reduced (absolute risk reduction 21.2%, number needed to screen to yield reduction in AOU = 4.7 (95% confidence interval 3.4-7.5)). Significant improvements in prescribing appropriateness were sustained for 6 months after discharge.

  16. Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis.

    Science.gov (United States)

    Zilberberg, Marya D; Nathanson, Brian H; Sulham, Kate; Fan, Weihong; Shorr, Andrew F

    2017-04-17

    Drug resistance among gram-negative pathogens is a risk factor for inappropriate empiric treatment (IET), which in turn increases the risk for mortality. We explored the impact of carbapenem-resistant Enterobacteriaceae (CRE) on the risk of IET and of IET on outcomes in patients with Enterobacteriaceae infections. We conducted a retrospective cohort study in Premier Perspective database (2009-2013) of 175 US hospitals. We included all adult patients with community-onset culture-positive urinary tract infection (UTI), pneumonia, or sepsis as a principal diagnosis, or as a secondary diagnosis in the setting of respiratory failure, treated with antibiotics within 2 days of admission. We employed regression modeling to compute adjusted association of presence of CRE with risk of receiving IET, and of IET on hospital mortality, length of stay (LOS) and costs. Among 40,137 patients presenting to the hospital with an Enterobacteriaceae UTI, pneumonia or sepsis, 1227 (3.1%) were CRE. In both groups, the majority of the cases were UTI (51.4% CRE and 54.3% non-CRE). Those with CRE were younger (66.6+/-15.3 vs. 69.1+/-15.9 years, p pneumonia or sepsis was comparable to other national estimates. Infection with CRE was associated with a four-fold increased risk of receiving IET, which in turn increased mortality, LOS and costs.

  17. What happens if we compare chopsticks with forks? The impact of making inappropriate comparisons in cross-cultural research.

    Science.gov (United States)

    Chen, Fang Fang

    2008-11-01

    It is a common practice to export instruments developed in one culture to another. Little is known about the consequences of making inappropriate comparisons in cross-cultural research. Several studies were conducted to fill in this gap. Study 1 examined the impact of lacking factor loading invariance on regression slope comparisons. When factor loadings of a predictor are higher in the reference group (e.g., United States), for which the scale was developed, than in the focal group (e.g., China), into which the scale was imported, the predictive relationship (e.g., self-esteem predicting life satisfaction) is artificially stronger in the reference group but weaker in the focal group, creating a bogus interaction effect of predictor by group (e.g., self-esteem by culture); the opposite pattern is found when the reference group has higher loadings in an outcome variable. Studies 2 and 3 examined the impact of lacking loading and intercept (i.e., point of origin) invariance on factor means, respectively. When the reference group has higher loadings or intercepts, the mean is overestimated in that group but underestimated in the focal group, resulting in a pseudo group difference. (c) 2008 APA, all rights reserved.

  18. Meaningful learning: The essential factor for conceptual change in limited or inappropriate propositional hierarchies leading to empowerment of learners

    Science.gov (United States)

    Novak, Joseph D.

    2002-07-01

    The construction and reconstruction of meanings by learners requires that they actively seek to integrate new knowledge with knowledge already in their cognitive structure. Ausubel's assimilation theory of cognitive learning has been shown to be effective in guiding research and instructional design to facilitate meaningful learning (Ausubel, The psychology of meaningful verbal learning, New York: Grune and Stratton, 1963; Educational psychology: A cognitive view, New York: Holt, Rinehart and Winston, 1968; The acquisition and retention of knowledge, Dordrecht: Kluwer, 2000). Gowin's Vee heuristic has been employed effectively to aid teachers and students in understanding the constructed nature of knowledge (Gowin, Educating, Ithaca, NY: Cornell University Press, 1981). Situated learning occurs when learning is by rote or at a lower level of meaningful learning. Concept mapping has been used effectively to aid meaningful learning with resulting modification of student's knowledge structures. When these knowledge structures are limited or faulty in some way, they may be referred to as Limited or Inappropriate Propositional Hierarchies (LIPH's). Conceptual change, or more accurately conceptual reconstrution, requires meaningful learning to modify LIPH's. Collaborative group learning facilitates meaningful learning and new knowledge construction. World-wide economic changes are forcing major changes in business and industry placing a premium on the power and value of knowledge and new knowledge production. These changes require changes in school and university education that centers on the nature and power of meaningful learning. New computer tools are available to facilitate teaching activities targeted at modifying LIPH's, and aiding meaningful learning in general.

  19. Inappropriate requests from patients

    African Journals Online (AJOL)

    doctors continue to provide these patients with life-sustaining .... mentally different judgments about the best interests of ... ed suicide is legal. While it is clear ... Epidemiological studies have mainly been used to assess the risk of lung cancer in ...

  20. Can patient safety be improved by reducing the volume of “inappropriate prescribing tasks” handed over to out-of-hours junior doctors?

    Directory of Open Access Journals (Sweden)

    Amis SM

    2018-03-01

    Full Text Available Samuel Martin Amis, Tobin Henry Edgar Osicki Department of Acute Internal Medicine, South Warwickshire Foundation Trust, Warwick, UK Background: First-year doctors found that during out-of-hours shifts they were being delayed and distracted from reviewing potentially sick/deteriorating patients by a high volume of prescribing tasks. This predominately consisted of oral anticoagulation prescribing and rewrites of drug charts. We hoped that if we could reduce this burden of “inappropriate prescribing tasks”, we could not only improve junior doctors’ job satisfaction and opportunities for training but also give them more time for patient reviews. Methods: Three weekends were initially audited to quantify the number of “inappropriate prescribing tasks” using data from the hospital’s computerized task assigning system. On three subsequent weekends, a checklist was handed out to the ward teams on Friday mornings. This checklist was designed to encourage the day teams to check that drug charts would not need oral anticoagulation or rewriting over the weekend. Results: An overall reduction in “inappropriate prescribing tasks” of 46% with a specific reduction in inappropriate oral anticoagulation prescribing of 65% was observed. Inappropriate drug chart rewrites were reduced by 30%. The reduction in the mean number of pre-intervention inappropriate prescribing tasks (as a percentage of total prescribing tasks and the post-intervention mean was 6.94% (95% confidence interval −0.54 to 14.42, p-value=0.062. Conclusion: Improved job satisfaction and a perceived reduced workload were noted from post-intervention qualitative surveys. While improved patient safety directly resulting from this intervention is more difficult to establish, and the observed reduction in inappropriate prescribing was only approaching statistical significance, our colleagues commented in post-intervention feedback that they felt they had more time, and felt less

  1. GAS STORAGE TECHNOLOGY CONSORTIUM

    Energy Technology Data Exchange (ETDEWEB)

    Robert W. Watson

    2004-10-18

    Gas storage is a critical element in the natural gas industry. Producers, transmission and distribution companies, marketers, and end users all benefit directly from the load balancing function of storage. The unbundling process has fundamentally changed the way storage is used and valued. As an unbundled service, the value of storage is being recovered at rates that reflect its value. Moreover, the marketplace has differentiated between various types of storage services, and has increasingly rewarded flexibility, safety, and reliability. The size of the natural gas market has increased and is projected to continue to increase towards 30 trillion cubic feet (TCF) over the next 10 to 15 years. Much of this increase is projected to come from electric generation, particularly peaking units. Gas storage, particularly the flexible services that are most suited to electric loads, is critical in meeting the needs of these new markets. In order to address the gas storage needs of the natural gas industry, an industry-driven consortium was created--the Gas Storage Technology Consortium (GSTC). The objective of the GSTC is to provide a means to accomplish industry-driven research and development designed to enhance operational flexibility and deliverability of the Nation's gas storage system, and provide a cost effective, safe, and reliable supply of natural gas to meet domestic demand. To accomplish this objective, the project is divided into three phases that are managed and directed by the GSTC Coordinator. The first phase, Phase 1A, was initiated on September 30, 2003, and was completed on March 31, 2004. Phase 1A of the project included the creation of the GSTC structure, development and refinement of a technical approach (work plan) for deliverability enhancement and reservoir management. This report deals with Phase 1B and encompasses the period July 1, 2004, through September 30, 2004. During this time period there were three main activities. First was the

  2. Aboveground storage tanks

    International Nuclear Information System (INIS)

    Rizzo, J.A.

    1992-01-01

    With the 1988 promulgation of the comprehensive Resource Conservation and Recovery Act (RCRA) regulations for underground storage of petroleum and hazardous substances, many existing underground storage tank (UST) owners have been considering making the move to aboveground storage. While on the surface, this may appear to be the cure-all to avoiding the underground leakage dilemma, there are many other new and different issues to consider with aboveground storage. The greatest misconception is that by storing materials above ground, there is no risk of subsurface environmental problems. it should be noted that with the aboveground storage tank (AGST) systems, there is still considerable risk of environmental contamination, either by the failure of onground tank bottoms or the spillage of product onto the ground surface where it subsequently finds its way to the ground water. In addition, there are added safety concerns that must be addressed. So what are the other specific areas of concern besides environmental to be addressed when making the decision between underground and aboveground tanks? The primary issues that will be addressed in this paper are: Safety, Product Losses, Cost Comparison of USTs vs AGSTs, Space Availability/Accessibility, Precipitation Handling, Aesthetics and Security, Pending and Existing Regulations

  3. Radioactive waste storage issues

    International Nuclear Information System (INIS)

    Kunz, D.E.

    1994-01-01

    In the United States we generate greater than 500 million tons of toxic waste per year which pose a threat to human health and the environment. Some of the most toxic of these wastes are those that are radioactively contaminated. This thesis explores the need for permanent disposal facilities to isolate radioactive waste materials that are being stored temporarily, and therefore potentially unsafely, at generating facilities. Because of current controversies involving the interstate transfer of toxic waste, more states are restricting the flow of wastes into - their borders with the resultant outcome of requiring the management (storage and disposal) of wastes generated solely within a state's boundary to remain there. The purpose of this project is to study nuclear waste storage issues and public perceptions of this important matter. Temporary storage at generating facilities is a cause for safety concerns and underscores, the need for the opening of permanent disposal sites. Political controversies and public concern are forcing states to look within their own borders to find solutions to this difficult problem. Permanent disposal or retrievable storage for radioactive waste may become a necessity in the near future in Colorado. Suitable areas that could support - a nuclear storage/disposal site need to be explored to make certain the health, safety and environment of our citizens now, and that of future generations, will be protected

  4. High temperature storage loop :

    Energy Technology Data Exchange (ETDEWEB)

    Gill, David Dennis; Kolb, William J.

    2013-07-01

    A three year plan for thermal energy storage (TES) research was created at Sandia National Laboratories in the spring of 2012. This plan included a strategic goal of providing test capability for Sandia and for the nation in which to evaluate high temperature storage (>650ÀC) technology. The plan was to scope, design, and build a flow loop that would be compatible with a multitude of high temperature heat transfer/storage fluids. The High Temperature Storage Loop (HTSL) would be reconfigurable so that it was useful for not only storage testing, but also for high temperature receiver testing and high efficiency power cycle testing as well. In that way, HTSL was part of a much larger strategy for Sandia to provide a research and testing platform that would be integral for the evaluation of individual technologies funded under the SunShot program. DOEs SunShot program seeks to reduce the price of solar technologies to 6/kWhr to be cost competitive with carbon-based fuels. The HTSL project sought to provide evaluation capability for these SunShot supported technologies. This report includes the scoping, design, and budgetary costing aspects of this effort

  5. Energy storage connection system

    Science.gov (United States)

    Benedict, Eric L.; Borland, Nicholas P.; Dale, Magdelena; Freeman, Belvin; Kite, Kim A.; Petter, Jeffrey K.; Taylor, Brendan F.

    2012-07-03

    A power system for connecting a variable voltage power source, such as a power controller, with a plurality of energy storage devices, at least two of which have a different initial voltage than the output voltage of the variable voltage power source. The power system includes a controller that increases the output voltage of the variable voltage power source. When such output voltage is substantially equal to the initial voltage of a first one of the energy storage devices, the controller sends a signal that causes a switch to connect the variable voltage power source with the first one of the energy storage devices. The controller then causes the output voltage of the variable voltage power source to continue increasing. When the output voltage is substantially equal to the initial voltage of a second one of the energy storage devices, the controller sends a signal that causes a switch to connect the variable voltage power source with the second one of the energy storage devices.

  6. Technology Roadmap: Energy Storage

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2014-03-01

    Energy storage technologies are valuable components in most energy systems and could be an important tool in achieving a low-carbon future. These technologies allow for the decoupling of energy supply and demand, in essence providing a valuable resource to system operators. There are many cases where energy storage deployment is competitive or near-competitive in today's energy system. However, regulatory and market conditions are frequently ill-equipped to compensate storage for the suite of services that it can provide. Furthermore, some technologies are still too expensive relative to other competing technologies (e.g. flexible generation and new transmission lines in electricity systems). One of the key goals of this new roadmap is to understand and communicate the value of energy storage to energy system stakeholders. This will include concepts that address the current status of deployment and predicted evolution in the context of current and future energy system needs by using a ''systems perspective'' rather than looking at storage technologies in isolation.

  7. Nuclear fuel storage facility

    International Nuclear Information System (INIS)

    Matsumoto, Takashi; Isaka, Shinji.

    1987-01-01

    Purpose: To increase the spent fuel storage capacity and reduce the installation cost in a nuclear fuel storage facility. Constitution: Fuels handled in the nuclear fuel storage device of the present invention include the following four types: (1) fresh fuels, (2) 100 % reactor core charged fuels, (3) spent fuels just after taking out and (4) fuels after a certain period (for example one half-year) from taking out of the reactor. Reactivity is high for the fuels (1), and some of fuels (2), while low in the fuels (3) (4), Source intensity is strong for the fuels (3) and some of the fuels (2), while it is low for the fuels (1) and (4). Taking notice of the fact that the reactivity, radioactive source intensity and generated after heat are different in the respective fuels, the size of the pool and the storage capacity are increased by the divided storage control. While on the other hand, since the division is made in one identical pool, the control method becomes important, and the working range is restricted by means of a template, interlock, etc., the operation mode of the handling machine is divided into four, etc. for preventing errors. (Kamimura, M.)

  8. WWER spent fuel storage

    Energy Technology Data Exchange (ETDEWEB)

    Bower, C C; Lettington, C [GEC Alsthom Engineering Systems Ltd., Whetstone (United Kingdom)

    1994-12-31

    Selection criteria for PAKS NPP dry storage system are outlined. They include the following: fuel temperature in storage; sub-criticality assurance (avoidance of criticality for fuel in the unirradiated condition without having to take credit for burn-up); assurance of decay heat removal; dose uptake to the operators and public; protection of environment; volume of waste produced during operation and decommissioning; physical protection of stored irradiated fuel assemblies; IAEA safeguards assurance; storage system versus final disposal route; cost of construction and extent of technology transfer to Hungarian industry. Several available systems are evaluated against these criteria, and as a result the GEC ALSTHOM Modular Vault Dry Store (MVDS) system has been selected. The MVDS is a passively cooled dry storage facility. Its most important technical, safety, licensing and technology transfer characteristics are outlined. On the basis of the experience gained some key questions and considerations related to the East European perspective in the field of spent fuel storage are discussed. 8 figs.

  9. WWER spent fuel storage

    International Nuclear Information System (INIS)

    Bower, C.C.; Lettington, C.

    1994-01-01

    Selection criteria for PAKS NPP dry storage system are outlined. They include the following: fuel temperature in storage; sub-criticality assurance (avoidance of criticality for fuel in the unirradiated condition without having to take credit for burn-up); assurance of decay heat removal; dose uptake to the operators and public; protection of environment; volume of waste produced during operation and decommissioning; physical protection of stored irradiated fuel assemblies; IAEA safeguards assurance; storage system versus final disposal route; cost of construction and extent of technology transfer to Hungarian industry. Several available systems are evaluated against these criteria, and as a result the GEC ALSTHOM Modular Vault Dry Store (MVDS) system has been selected. The MVDS is a passively cooled dry storage facility. Its most important technical, safety, licensing and technology transfer characteristics are outlined. On the basis of the experience gained some key questions and considerations related to the East European perspective in the field of spent fuel storage are discussed. 8 figs

  10. The methods of hydrogen storage

    International Nuclear Information System (INIS)

    Joubert, J.M.; Cuevas, F.; Latroche, M.; Percheron-Guegan, A.

    2005-01-01

    Hydrogen may be an excellent energy vector owing to its high specific energy. Its low density is however a serious drawback for its storage. Three techniques exist to store hydrogen. Storage under pressure is now performed in composite tanks under pressures around 700 bar. Liquid storage is achieved at cryogenic temperatures. Solid storage is possible in reversible metal hydrides or on high surface area materials. The three storage means are compared in terms of performance, energetic losses and risk. (authors)

  11. Alternatives to reduce corrosion of carbon steel storage drums

    International Nuclear Information System (INIS)

    Zirker, L.R.; Beitel, G.A.

    1995-11-01

    The major tasks of this research were (a) pollution prevention opportunity assessments on the overpacking operations for failed or corroded drums, (b) research on existing container corrosion data, (c) investigation of the storage environment of the new Resource Conservation and Recovery Act Type II storage modules, (d) identification of waste streams that demonstrate deleterious corrosion affects on drum storage life, and (e) corrosion test cell program development. Twenty-one waste streams from five US Department of Energy (DOE) sites within the DOE Complex were identified to demonstrate a deleterious effect to steel storage drums. The major components of these waste streams include acids, salts, and solvent liquids, sludges, and still bottoms. The solvent-based waste streams typically had the shortest time to failure: 0.5 to 2 years. The results of this research support the position that pollution prevention evaluations at the front end of a project or process will reduce pollution on the back end

  12. Federal Interim Storage program

    International Nuclear Information System (INIS)

    Johnson, E.R.; McBride, J.A.

    1984-01-01

    The DOE has developed a program for providing Federal Interim Storage servies for spent nuclear fuel which complies with the requirements of the Nuclear Waste Policy Act of 1982. Although very little constructive activity in providing storage facilities can be undertaken by DOE until fuel has been certified by NRC as eligible for FIS, DOE planning and background information is such as to provide reasonable assurance that its obligations can be fulfilled when the required certifications have been issued. A fee structure providing fuel recovery of all costs associated with the FIS program, as required by the Act, has been developed. It provides for an equitable distribution of costs among users, based on the quantity of fuel requiring storage

  13. Evolution of clustered storage

    CERN Multimedia

    CERN. Geneva; Van de Vyvre, Pierre

    2007-01-01

    The session actually featured two presentations: * Evolution of clustered storage by Lance Hukill, Quantum Corporation * ALICE DAQ - Usage of a Cluster-File System: Quantum StorNext by Pierre Vande Vyvre, CERN-PH the second one prepared at short notice by Pierre (thanks!) to present how the Quantum technologies are being used in the ALICE experiment. The abstract to Mr Hukill's follows. Clustered Storage is a technology that is driven by business and mission applications. The evolution of Clustered Storage solutions starts first at the alignment between End-users needs and Industry trends: * Push-and-Pull between managing for today versus planning for tomorrow * Breaking down the real business problems to the core applications * Commoditization of clients, servers, and target devices * Interchangeability, Interoperability, Remote Access, Centralized control * Oh, and yes, there is a budget and the "real world" to deal with This presentation will talk through these needs and trends, and then ask the question, ...

  14. Costs of Archival Storage

    DEFF Research Database (Denmark)

    Nielsen, Anders Bo; Thirifays, Alex; Kejser, Ulla Bøgvad

    2012-01-01

    to determine the costs of establishing and maintaining a preservation solution destined for long-term preservation of digital materials and to develop a tool capable of doing this operation. In order to fulfill the purposes, the project employed a combination of own and external experience as well as the OAIS......This paper presents an analysis of the cost of archival storage. The study is part of a project conducted by The Danish National Archives, The Royal Library, and The State and University Library to develop a generic cost model for digital preservation (CMDP). The purposes of the study were...... Reference Model as a framework to fully understand and identify the cost critical activities of bit-preservation as described in Archival Storage. We found that the costs of Archival Storage are obviously closely linked to the data volume, but also to the required preservation quality, especially...

  15. Plutonium storage phenomenology

    International Nuclear Information System (INIS)

    Szempruch, R.

    1995-12-01

    Plutonium has been produced, handled, and stored at Department of Energy (DOE) facilities since the 1940s. Many changes have occurred during the last 40 years in the sources, production demands, and end uses of plutonium. These have resulted in corresponding changes in the isotopic composition as well as the chemical and physical forms of the processed and stored plutonium. Thousands of ordinary food pack tin cans have been used successfully for many years to handle and store plutonium. Other containers have been used with equal success. This paper addressees the exceptions to this satisfactory experience. To aid in understanding the challenges of handling plutonium for storage or immobilization the lessons learned from past storage experience and the necessary countermeasures to improve storage performance are discussed

  16. Whale Identification

    Science.gov (United States)

    1991-01-01

    R:BASE for DOS, a computer program developed under NASA contract, has been adapted by the National Marine Mammal Laboratory and the College of the Atlantic to provide and advanced computerized photo matching technique for identification of humpback whales. The program compares photos with stored digitized descriptions, enabling researchers to track and determine distribution and migration patterns. R:BASE is a spinoff of RIM (Relational Information Manager), which was used to store data for analyzing heat shielding tiles on the Space Shuttle Orbiter. It is now the world's second largest selling line of microcomputer database management software.

  17. Extended storage of spent fuel

    International Nuclear Information System (INIS)

    1992-10-01

    This document is the final report on the IAEA Co-ordinated Research Programme on the Behaviour of Spent Fuel and Storage Facility Components during Long Term Storage (BEFAST-II, 1986-1991). It contains the results on wet and dry spent fuel storage technologies obtained from 16 organizations representing 13 countries who participated in the co-ordinated research programme. Considerable quantities of spent fuel continue to arise and accumulate. Many countries are investigating the option of extended spent fuel storage prior to reprocessing or fuel disposal. Wet storage continues to predominate as an established technology with the construction of additional away-from-reactor storage pools. However, dry storage is increasingly used with most participants considering dry storage concepts for the longer term. Depending on the cladding type options of dry storage in air or inert gas are proposed. Dry storage is becoming widely used as a supplement to wet storage for zirconium alloy clad oxide fuels. Storage periods as long as under wet conditions appear to be feasible. Dry storage will also continue to be used for Al clad and Magnox type fuel. Enhancement of wet storage capacity will remain an important activity. Rod consolidation to increase wet storage capacity will continue in the UK and is being evaluated for LWR fuel in the USA, and may start in some other countries. High density storage racks have been successfully introduced in many existing pools and are planned for future facilities. For extremely long wet storage (≥50 years), there is a need to continue work on fuel integrity investigations and LWR fuel performance modelling. it might be that pool component performance in some cases could be more limiting than the FA storage performance. It is desirable to make concerted efforts in the field of corrosion monitoring and prediction of fuel cladding and poll component behaviour in order to maintain good experience of wet storage. Refs, figs and tabs

  18. Effect of aquifer storage and recovery (ASR) on recovered stormwater quality variability.

    Science.gov (United States)

    Page, D W; Peeters, L; Vanderzalm, J; Barry, K; Gonzalez, D

    2017-06-15

    Aquifer Storage and Recovery (ASR) is increasingly being considered as a means of reusing urban stormwater to supplement available urban water resources. Storage of stormwater in an aquifer has been shown to affect water quality but it has also been claimed that storage will also decrease the stormwater quality variability making for improved predictability and management. This study is the first to document the changes in stormwater quality variability as a result of subsurface storage at four full scale ASR sites using advanced statistical techniques. New methods to examine water quality are required as data is often highly left censored and so traditional measures of variability such as the coefficient of variation are inappropriate. It was observed that for some water quality parameters (most notably E. coli) there was a marked improvement of water quality and a significant decrease in variability at all sites. This means that aquifer storage prior to engineered treatment systems may be advantageous in terms of system design to avoid over engineering. For other parameters such as metal(loids)s and nutrients the trend was less clear due to the numerous processes occurring during storage leading to an increase in variability, especially for geogenic metals and metalloids such as iron and arsenic. Depending upon the specific water quality parameters and end use, use of ASR may not have a dampening effect on stormwater quality variability. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  19. Electrochemical energy storage

    CERN Document Server

    Tarascon, Jean-Marie

    2015-01-01

    The electrochemical storage of energy has become essential in assisting the development of electrical transport and use of renewable energies. French researchers have played a key role in this domain but Asia is currently the market leader. Not wanting to see history repeat itself, France created the research network on electrochemical energy storage (RS2E) in 2011. This book discusses the launch of RS2E, its stakeholders, objectives, and integrated structure that assures a continuum between basic research, technological research and industries. Here, the authors will cover the technological

  20. Nuclear fuel storage

    International Nuclear Information System (INIS)

    Bevilacqua, F.

    1979-01-01

    A method and apparatus for the storage of fuel in a stainless steel egg crate structure within a storage pool are described. Fuel is initially stored in a checkerboard pattern or in each opening if the fuel is of low enrichment. Additional fuel (or fuel of higher enrichment) is later stored by adding stainless steel angled plates within each opening, thereby forming flux traps between the openings. Still higher enrichment fuel is later stored by adding poison plates either with or without the stainless steel angles. 8 claims

  1. Proton storage rings

    International Nuclear Information System (INIS)

    Rau, R.R.

    1978-04-01

    A discussion is given of proton storage ring beam dynamic characteristics. Topics considered include: (1) beam energy; (2) beam luminosity; (3) limits on beam current; (4) beam site; (5) crossing angle; (6) beam--beam interaction; (7) longitudinal instability; (8) effects of scattering processes; (9) beam production; and (10) high magnetic fields. Much of the discussion is related to the design parameters of ISABELLE, a 400 x 400 GeV proton---proton intersecting storage accelerator to be built at Brookhaven National Laboratory

  2. Usage of Video Analysis of Traffic Conflicts for the Evaluation of Inappropriately Designed Building Elements on Intersections

    Science.gov (United States)

    Krivda, Vladislav; Petru, Jan

    2018-04-01

    Human society is constantly evolving in all areas. The transport is no exception – especially development of road transport is considerable and visible on all levels. However, it is necessary to look for tools that can harmonize economic and social progress with the full preservation of the environment for future generations. The so-called sustainable development of road transport is also closely related to the issue of creating safe transport infrastructure. For example, roads must be in compliance with technical rules on one hand and on the other one they have to be clearly understandable for all road participants (drivers, pedestrians, etc.). Unfortunately, even if the designer of transport construction meets the technical requirements, the result is a dangerous place where very frequently the accidents or traffic conflicts take place. There exist statistics of accidents, but on the contrary, there are not any statistics of traffic conflicts. And simply monitoring the traffic conflicts can lead to early detection of problematic places in road infrastructure and thus increasing the safety in the road traffic. There are many methods used for monitoring traffic conflicts. The method used in the Czech Republic is described in the submitted paper. The original method, which monitored mainly and only the behaviour of drivers and their mistakes, was innovated, so that it could be used also for evaluation of inappropriately designed building elements of road constructions. Therefore, the paper deals with the description of so-called Innovated Video Analysis of Traffic Conflicts (IVATC) and with the usage of this method for one particular example of intersection, where larger vehicles (buses, trucks, etc.) had problems with passing through it. It points out to the fact that even a relatively small change can lead to the increase of the road safety.

  3. P-Wave Amplitude and PR Changes in Patients With Inappropriate Sinus Tachycardia: Findings Supportive of a Central Mechanism.

    Science.gov (United States)

    Field, Michael E; Donateo, Paolo; Bottoni, Nicola; Iori, Matteo; Brignole, Michele; Kipp, Ryan T; Kopp, Douglas E; Leal, Miguel A; Eckhardt, Lee L; Wright, Jennifer M; Walsh, Kathleen E; Page, Richard L; Hamdan, Mohamed H

    2018-04-19

    The mechanism of inappropriate sinus tachycardia (IST) remains incompletely understood. We prospectively compared 3 patient groups: 11 patients with IST (IST Group), 9 control patients administered isoproterenol (Isuprel Group), and 15 patients with cristae terminalis atrial tachycardia (AT Group). P-wave amplitude in lead II and PR interval were measured at a lower and higher heart rate (HR1 and HR2, respectively). P-wave amplitude increased significantly with the increase in HR in the IST Group (0.16±0.07 mV at HR1=97±12 beats per minute versus 0.21±0.08 mV at HR2=135±21 beats per minute, P =0.001). The average increase in P-wave amplitude in the IST Group was similar to the Isuprel Group ( P =0.26). PR interval significantly shortened with the increases in HR in the IST Group (146±15 ms at HR1 versus 128±16 ms at HR2, P PR interval was noted in the Isuprel Group ( P =0.6). In contrast, patients in the atrial tachycardia Group experienced PR lengthening during atrial tachycardia when compared with baseline normal sinus rhythm (153±25 ms at HR1=78±17 beats per minute versus 179±29 ms at HR2=140±28 beats per minute, P PR shortening similar to what is seen in healthy controls following isoproterenol infusion. The increase in P-wave amplitude and absence of PR lengthening in IST support an extrinsic mechanism consistent with a state of sympatho-excitation with cephalic shift in sinus node activation and enhanced atrioventricular nodal conduction. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  4. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis.

    Science.gov (United States)

    Anderson, Kristen; Stowasser, Danielle; Freeman, Christopher; Scott, Ian

    2014-12-08

    To synthesise qualitative studies that explore prescribers' perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. All healthcare settings. Medical and non-medical prescribers of medicines to adults. Prescribers' perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. 21 studies were included; most explored primary care physicians' perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. A multitude of highly interdependent factors shape prescribers' behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the

  5. Predictors of initiation and persistence of recurrent binge eating and inappropriate weight compensatory behaviors in college men.

    Science.gov (United States)

    Dakanalis, Antonios; Clerici, Massimo; Caslini, Manuela; Gaudio, Santino; Serino, Silvia; Riva, Giuseppe; Carrà, Giuseppe

    2016-06-01

    The transition to college is considered as a risk period for the development of behavioral symptoms of eating disorders (BSEDs) and some evidence suggests that, amongst men, these symptoms occurring on a regular basis remain relatively stable over the college period. Nevertheless, little is known about factors associated with persistent engagement in and initiation of recurrent (or regular) binge eating and inappropriate weight compensatory behaviors in this population. The objective of this report was to address these research gaps. Data were examined from 2,555 male first-year college students who completed an assessment of potential vulnerability factors and BSEDs at the beginning of the autumn semester (baseline) and nine months later (end of the spring semester; follow-up). Elevated negative affectivity, body dissatisfaction, self-objectification, and lower self-esteem at baseline were predictive of persistent engagement in regular binge eating and four compensatory behaviors (self-induced vomiting, laxative/diuretic abuse, fasting, exercise) at follow-up, as well as initiation of all these behaviors occurring regularly (i.e., at least weekly for 3 months). Self-objectification (thinking and monitoring the body's outward appearance from a third-person perspective) emerged as the largest contributor of both the initiation and persistence of all behavioral symptoms. Data emphasize that the same psychological factors underlie initiation and persistence of recurrent BSEDs and should shape the focus of future interventions for college men. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:581-590). © 2016 Wiley Periodicals, Inc.

  6. Dangerous Pressurization and Inappropriate Alarms during Water Occlusion of the Expiratory Circuit of Commonly Used Infant Ventilators.

    Directory of Open Access Journals (Sweden)

    Murray Hinder

    Full Text Available Non-invasive continuous positive airways pressure is commonly a primary respiratory therapy delivered via multi-purpose ventilators in premature newborns. Expiratory limb occlusion due to water accumulation or 'rainout' from gas humidification is a frequent issue. A case of expiratory limb occlusion due to rainout causing unexpected and excessive repetitive airway pressurisation in a Draeger VN500 prompted a systematic bench test examination of currently available ventilators.To assess neonatal ventilator response to partial or complete expiratory limb occlusion when set to non-invasive continuous positive airway pressure mode.Seven commercially available neonatal ventilators connected to a test lung using a standard infant humidifier circuit with partial and/or complete expiratory limb occlusion were examined in a bench test study. Each ventilator was set to deliver 6 cmH2O in non-invasive mode and respiratory mechanics data for 75%, 80% and 100% occlusion were collected.Several ventilators responded inappropriately with complete occlusion by cyclical pressurisation/depressurisation to peak pressures of between 19·4 and 64·6 cm H2O at rates varying between 2 to 77 inflations per minute. Tidal volumes varied between 10·1 and 24·3mL. Alarm responses varied from 'specific' (tube occluded to 'ambiguous' (Safety valve open. Carefusion Avea responded by continuing to provide the set distending pressure and displaying an appropriate alarm message. Draeger Babylog 8000 did not alarm with partial occlusions and incorrectly displayed airways pressure at 6·1cmH2O compared to the measured values of 13cmH2O.This study found a potential for significant adverse ventilator response due to complete or near complete expiratory limb occlusion in CPAP mode.

  7. Use of posttreatment imaging and biomarkers in survivors of early-stage breast cancer: Inappropriate surveillance or necessary care?

    Science.gov (United States)

    Hahn, Erin E; Tang, Tania; Lee, Janet S; Munoz-Plaza, Corrine E; Shen, Ernest; Rowley, Braden; Maeda, Jared L; Mosen, David M; Ruckdeschel, John C; Gould, Michael K

    2016-03-15

    Advanced imaging and serum biomarkers are commonly used for surveillance in patients with early-stage breast cancer, despite recommendations against this practice. Incentives to perform such low-value testing may be less prominent in integrated health care delivery systems. The purpose of the current study was to evaluate and compare the use of these services within 2 integrated systems: Kaiser Permanente (KP) and Intermountain Healthcare (IH). The authors also sought to distinguish the indication for testing: diagnostic purposes or routine surveillance. Patients with American Joint Committee on Cancer stage 0 to II breast cancer diagnosed between 2009 and 2010 were identified and the use of imaging and biomarker tests over an 18-month period were quantified, starting at 1 year after diagnosis. Chart abstraction was performed on a random sample of patients who received testing to identify the indication for testing. Multivariate regression was used to explore associations with the use of nonrecommended care. A total of 6585 patients were identified; 22% had stage 0 disease, 44% had stage I disease, and 34% had stage II disease. Overall, 24% of patients received at least 1 imaging test (25% at KP vs 22% at IH; P = .009) and 28% of patients received at least 1 biomarker (36% at KP vs 13% at IH; Ptests were performed to evaluate symptoms or signs. Virtually all biomarkers were ordered for routine surveillance. Stage of disease, medical center that provided the services, and provider experience were found to be significantly associated with the use of biomarkers. Advanced imaging was most often performed for appropriate indications, but biomarkers were used for nonrecommended surveillance. Distinguishing between inappropriate use for surveillance and appropriate diagnostic testing is essential when evaluating adherence to recommendations. © 2015 American Cancer Society.

  8. Inappropriate analysis does not reveal the ecological causes of evolution of stickleback armour: a critique of Spence et al. 2013.

    Science.gov (United States)

    MacColl, Andrew D C; Aucott, Beth

    2014-09-01

    In a recent paper in this journal, Spence et al. (2013) sought to identify the ecological causes of morphological evolution in three-spined sticklebacks Gasterosteus aculeatus, by examining phenotypic and environmental variation between populations on the island of North Uist, Scotland. However, by using simple qualitative assessments of phenotype and inappropriate measures of environmental variation, Spence et al. have come to a conclusion that is diametrically opposite to that which we have arrived at in studying the same populations. Our criticisms of their paper are threefold: (1) using a binomial qualitative measure of the variation in stickleback armour ("low" versus "minimal" (i.e., "normal" low-plated freshwater sticklebacks versus spineless and/or plateless fish)) does not represent the full range of phenotypes that can be described by quantitative measures of the individual elements of armour. (2) Their use of unspecified test kits, with a probable accuracy of 4 ppm, may not be accurate in the range of water chemistry on North Uist (1 to 30 ppm calcium). (3) Their qualitative assessment of the abundance of brown trout Salmo trutta as the major predator of sticklebacks does not accurately describe the variation in brown trout abundance that is revealed by catch-per-unit-effort statistics. Repeating Spence et al.'s analysis using our own measurements, we find, in direct contradiction to them, that variation in stickleback bony armour is strongly correlated with variation in trout abundance, and unrelated to variation in the concentration of calcium in the lochs in which they live. Field studies in ecology and evolution seldom address the same question in the same system at the same time, and it is salutary that in this rare instance two such studies arrived at diametrically opposite answers.

  9. Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients.

    Science.gov (United States)

    Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N

    2018-03-01

    Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in

  10. CHEMICAL STORAGE: MYTHS VERSUS REALITY

    International Nuclear Information System (INIS)

    Simmons, F.

    2007-01-01

    A large number of resources explaining proper chemical storage are available. These resources include books, databases/tables, and articles that explain various aspects of chemical storage including compatible chemical storage, signage, and regulatory requirements. Another source is the chemical manufacturer or distributor who provides storage information in the form of icons or color coding schemes on container labels. Despite the availability of these resources, chemical accidents stemming from improper storage, according to recent reports (1) (2), make up almost 25% of all chemical accidents. This relatively high percentage of chemical storage accidents suggests that these publications and color coding schemes although helpful, still provide incomplete information that may not completely mitigate storage risks. This manuscript will explore some ways published storage information may be incomplete, examine the associated risks, and suggest methods to help further eliminate chemical storage risks

  11. Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

    Directory of Open Access Journals (Sweden)

    Opondo Charles

    2011-11-01

    Full Text Available Abstract Background There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial. Methods Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention. Results 9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7% were diagnosed with diarrhoea, with 130 of these being bloody (dysentery therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7% of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02. Conclusion We found some evidence that the multi-faceted, sustained intervention described in this

  12. Appropriate prescribing in the elderly: an investigation of two screening tools, Beers criteria considering diagnosis and independent of diagnosis and improved prescribing in the elderly tool to identify inappropriate use of medicines in the elderly in primary care in Ireland.

    LENUS (Irish Health Repository)

    Ryan, C

    2009-08-01

    Elderly patients are particularly vulnerable to inappropriate prescribing, with increased risk of adverse drug reactions and consequently higher rates of morbidity and mortality. A large proportion of inappropriate prescribing is preventable by adherence to prescribing guidelines, suitable monitoring and regular medication review. As a result, screening tools have been developed to help clinicians improve their prescribing.

  13. Kinetic energy storage system

    Energy Technology Data Exchange (ETDEWEB)

    Jaeggi, M.; Folini, P.

    1983-09-03

    A flywheel system for the purpose of energy storage in decentral solar- or wind energy plants is introduced. The system comprises a rotor made out of plastic fibre, a motor/generator serving as electro-mechanical energy converter and a frequency-voltage transformer serving as electric adapter. The storable energy quantity amounts to several kWh.

  14. Solar Energy: Heat Storage.

    Science.gov (United States)

    Knapp, Henry H., III

    This module on heat storage is one of six in a series intended for use as supplements to currently available materials on solar energy and energy conservation. Together with the recommended texts and references (sources are identified), these modules provide an effective introduction to energy conservation and solar energy technologies. The module…

  15. Benchmarking personal cloud storage

    NARCIS (Netherlands)

    Drago, Idilio; Bocchi, Enrico; Mellia, Marco; Slatman, Herman; Pras, Aiko

    2013-01-01

    Personal cloud storage services are data-intensive applications already producing a significant share of Internet traffic. Several solutions offered by different companies attract more and more people. However, little is known about each service capabilities, architecture and - most of all -

  16. DPM: Future Proof Storage

    CERN Document Server

    Alvarez, Alejandro; Furano, Fabrizio; Hellmich, Martin; Keeble, Oliver; Rocha, Ricardo; CERN. Geneva. IT Department

    2012-01-01

    The Disk Pool Manager (DPM) is a lightweight solution for grid enabled disk storage management. Operated at more than 240 sites it has the widest distribution of all grid storage solutions in the WLCG infrastructure. It provides an easy way to manage and configure disk pools, and exposes multiple interfaces for data access (rfio, xroot, nfs, gridftp and http/dav) and control (srm). During the last year we have been working on providing stable, high performant data access to our storage system using standard protocols, while extending the storage management functionality and adapting both configuration and deployment procedures to reuse commonly used building blocks. In this contribution we cover in detail the extensive evaluation we have performed of our new HTTP/WebDAV and NFS 4.1 frontends, in terms of functionality and performance. We summarize the issues we faced and the solutions we developed to turn them into valid alternatives to the existing grid protocols - namely the additional work required to prov...

  17. Energy Storage and Retrieval

    Indian Academy of Sciences (India)

    Annual Meetings · Mid Year Meetings · Discussion Meetings · Public Lectures · Lecture Workshops · Refresher Courses · Symposia · Live Streaming. Home; Journals; Resonance – Journal of Science Education; Volume 1; Issue 6. Energy Storage and Retrieval The Secondary Battery Route. A K Shukla P Vishnu Kamath.

  18. Tuber storage proteins.

    Science.gov (United States)

    Shewry, Peter R

    2003-06-01

    A wide range of plants are grown for their edible tubers, but five species together account for almost 90 % of the total world production. These are potato (Solanum tuberosum), cassava (Manihot esculenta), sweet potato (Ipomoea batatus), yams (Dioscorea spp.) and taro (Colocasia, Cyrtosperma and Xanthosoma spp.). All of these, except cassava, contain groups of storage proteins, but these differ in the biological properties and evolutionary relationships. Thus, patatin from potato exhibits activity as an acylhydrolase and esterase, sporamin from sweet potato is an inhibitor of trypsin, and dioscorin from yam is a carbonic anhydrase. Both sporamin and dioscorin also exhibit antioxidant and radical scavenging activity. Taro differs from the other three crops in that it contains two major types of storage protein: a trypsin inhibitor related to sporamin and a mannose-binding lectin. These characteristics indicate that tuber storage proteins have evolved independently in different species, which contrasts with the highly conserved families of storage proteins present in seeds. Furthermore, all exhibit biological activities which could contribute to resistance to pests, pathogens or abiotic stresses, indicating that they may have dual roles in the tubers.

  19. Fuel storage rack

    International Nuclear Information System (INIS)

    Mollon, L.

    1977-01-01

    Disclosed is a storage rack for spent nuclear fuel elements comprising a multiplicity of elongated hollow containers of uniform cross-section, preferably square,some of said containers having laterally extending continuous flanges extending between adjacent containers and defining continuous elongated chambers therebetween for the reception of neutron absorbing panels. 18 claims, 7 figures

  20. Carbon Capture and Storage

    NARCIS (Netherlands)

    Benson, S.M.; Bennaceur, K.; Cook, P.; Davison, J.; Coninck, H. de; Farhat, K.; Ramirez, C.A.; Simbeck, D.; Surles, T.; Verma, P.; Wright, I.

    2012-01-01

    Emissions of carbon dioxide, the most important long-lived anthropogenic greenhouse gas, can be reduced by Carbon Capture and Storage (CCS). CCS involves the integration of four elements: CO 2 capture, compression of the CO2 from a gas to a liquid or a denser gas, transportation of pressurized CO 2

  1. Storage of radioactive waste

    International Nuclear Information System (INIS)

    Pittman, F.K.

    1974-01-01

    Four methods for managing radioactive waste in order to protect man from its potential hazards include: transmutation to convert radioisotopes in waste to stable isotopes; disposal in space; geological disposal; and surface storage in shielded, cooled, and monitored containers. A comparison of these methods shows geologic disposal in stable formations beneath landmasses appears to be the most feasible with today's technology. (U.S.)

  2. NGLW RCRA Storage Study

    International Nuclear Information System (INIS)

    Waters, R.J.; Ochoa, R.; Fritz, K.D.; Craig, D.W.

    2000-01-01

    The Idaho Nuclear Technology and Engineering Center (INTEC) at the Idaho National Engineering and Environmental Laboratory contains radioactive liquid waste in underground storage tanks at the INTEC Tank Farm Facility (TFF). INTEC is currently treating the waste by evaporation to reduce the liquid volume for continued storage, and by calcination to reduce and convert the liquid to a dry waste form for long-term storage in calcine bins. Both treatment methods and activities in support of those treatment operations result in Newly Generated Liquid Waste (NGLW) being sent to TFF. The storage tanks in the TFF are underground, contained in concrete vaults with instrumentation, piping, transfer jets, and managed sumps in case of any liquid accumulation in the vault. The configuration of these tanks is such that Resource Conservation and Recovery Act (RCRA) regulations apply. The TFF tanks were assessed several years ago with respect to the RCRA regulations and they were found to be deficient. This study considers the configuration of the current tanks and the RCRA deficiencies identified for each. The study identifies four potential methods and proposes a means of correcting the deficiencies. The cost estimates included in the study account for construction cost; construction methods to minimize work exposure to chemical hazards, radioactive contamination, and ionizing radiation hazards; project logistics; and project schedule. The study also estimates the tank volumes benefit associated with each corrective action to support TFF liquid waste management planning

  3. NGLW RCRA Storage Study

    Energy Technology Data Exchange (ETDEWEB)

    R. J. Waters; R. Ochoa; K. D. Fritz; D. W. Craig

    2000-06-01

    The Idaho Nuclear Technology and Engineering Center (INTEC) at the Idaho National Engineering and Environmental Laboratory contains radioactive liquid waste in underground storage tanks at the INTEC Tank Farm Facility (TFF). INTEC is currently treating the waste by evaporation to reduce the liquid volume for continued storage, and by calcination to reduce and convert the liquid to a dry waste form for long-term storage in calcine bins. Both treatment methods and activities in support of those treatment operations result in Newly Generated Liquid Waste (NGLW) being sent to TFF. The storage tanks in the TFF are underground, contained in concrete vaults with instrumentation, piping, transfer jets, and managed sumps in case of any liquid accumulation in the vault. The configuration of these tanks is such that Resource Conservation and Recovery Act (RCRA) regulations apply. The TFF tanks were assessed several years ago with respect to the RCRA regulations and they were found to be deficient. This study considers the configuration of the current tanks and the RCRA deficiencies identified for each. The study identifies four potential methods and proposes a means of correcting the deficiencies. The cost estimates included in the study account for construction cost; construction methods to minimize work exposure to chemical hazards, radioactive contamination, and ionizing radiation hazards; project logistics; and project schedule. The study also estimates the tank volumes benefit associated with each corrective action to support TFF liquid waste management planning.

  4. Spent-fuel-storage alternatives

    Energy Technology Data Exchange (ETDEWEB)

    1980-01-01

    The Spent Fuel Storage Alternatives meeting was a technical forum in which 37 experts from 12 states discussed storage alternatives that are available or are under development. The subject matter was divided into the following five areas: techniques for increasing fuel storage density; dry storage of spent fuel; fuel characterization and conditioning; fuel storage operating experience; and storage and transport economics. Nineteen of the 21 papers which were presented at this meeting are included in this Proceedings. These have been abstracted and indexed. (ATT)

  5. Economics of dry storage systems

    International Nuclear Information System (INIS)

    Moore, G.R.; Winders, R.C.

    1980-01-01

    This paper postulates a dry storage application suitable as a regional away-from-reactor storage (AFR), develops an economical system design concept and estimates system costs. The system discussed uses the experience gained in the dry storage research activities and attempts to present a best foot forward system concept. The major element of the system is the Receiving and Packaging Building. In this building fuel assemblies are removed from transportation casks and encapsulated for storage. This facility could be equally applicable to silo, vault, or caisson storage. However the caisson storage concept has been chosen for discussion purposes

  6. Silo Storage Preconceptual Design

    Energy Technology Data Exchange (ETDEWEB)

    Stephanie L. Austad; Patrick W. Bragassa; Kevin M Croft; David S Ferguson; Scott C Gladson; Annette L Shafer; John H Weathersby

    2012-09-01

    The National Nuclear Security Administration (NNSA) has a need to develop and field a low-cost option for the long-term storage of a variety of radiological material. The storage option’s primary requirement is to provide both environmental and physical protection of the materials. Design criteria for this effort require a low initial cost and minimum maintenance over a 50-year design life. In 1999, Argonne National Laboratory-West was tasked with developing a dry silo storage option for the BN-350 Spent Fuel in Aktau Kazakhstan. Argon’s design consisted of a carbon steel cylinder approximately 16 ft long, 18 in. outside diameter and 0.375 in. wall thickness. The carbon steel silo was protected from corrosion by a duplex coating system consisting of zinc and epoxy. Although the study indicated that the duplex coating design would provide a design life well in excess of the required 50 years, the review board was concerned because of the novelty of the design and the lack of historical use. In 2012, NNSA tasked Idaho National Laboratory (INL) with reinvestigating the silo storage concept and development of alternative corrosion protection strategies. The 2012 study, “Silo Storage Concepts, Cathodic Protection Options Study” (INL/EST-12-26627), concludes that the option which best fits the design criterion is a passive cathotic protection scheme, consisting of a carbon steel tube coated with zinc or a zinc-aluminum alloy encapsulated in either concrete or a cement grout. The hot dipped zinc coating option was considered most efficient, but the flame-sprayed option could be used if a thicker zinc coating was determined to be necessary.

  7. Diamond identification

    International Nuclear Information System (INIS)

    Lang, A.R.

    1979-01-01

    Methods of producing sets of records of the internal defects of diamonds as a means of identification of the gems by x-ray topography are described. To obtain the records one can either use (a) monochromatic x-radiation reflected at the Bragg angle from crystallographically equivalent planes of the diamond lattice structure, Bragg reflections from each such plane being recorded from a number of directions of view, or (b) white x-radiation incident upon the diamond in directions having a constant angular relationship to each equivalent axis of symmetry of the diamond lattice structure, Bragg reflections being recorded for each direction of the incident x-radiation. By either method an overall point-to-point three dimensional representation of the diamond is produced. (U.K.)

  8. Crystallization study of a glass used for fission product storage

    International Nuclear Information System (INIS)

    Morlevat, J.-P.; Uny, Gisele; Jacquet-Francillon, Noel.

    1981-06-01

    The vitreous matrix used in France is a borosilicate glass of low melting point allowing introduction of volatil fission products and of good chemical stability. However, like any glass, if storage temperature is higher than transformation temperature a partial crystallization can occur. Before final storage, it is important to determine of leaching by water eventually occuring on the choosen site is modified by crystalline phases. The aim of this study is the determination of the leaching rate and the identification of crystalline phases formed during thermal treatment and evaluation of its volumic fraction [fr

  9. NV Energy Electricity Storage Valuation

    Energy Technology Data Exchange (ETDEWEB)

    Ellison, James F.; Bhatnagar, Dhruv; Samaan, Nader A.; Jin, Chunlian

    2013-06-30

    This study examines how grid-level electricity storage may benet the operations of NV Energy in 2020, and assesses whether those benets justify the cost of the storage system. In order to determine how grid-level storage might impact NV Energy, an hourly production cost model of the Nevada Balancing Authority (\\BA") as projected for 2020 was built and used for the study. Storage facilities were found to add value primarily by providing reserve. Value provided by the provision of time-of-day shifting was found to be limited. If regulating reserve from storage is valued the same as that from slower ramp rate resources, then it appears that a reciprocating engine generator could provide additional capacity at a lower cost than a pumped storage hydro plant or large storage capacity battery system. In addition, a 25-MW battery storage facility would need to cost $650/kW or less in order to produce a positive Net Present Value (NPV). However, if regulating reserve provided by storage is considered to be more useful to the grid than that from slower ramp rate resources, then a grid-level storage facility may have a positive NPV even at today's storage system capital costs. The value of having storage provide services beyond reserve and time-of-day shifting was not assessed in this study, and was therefore not included in storage cost-benefit calculations.

  10. Storage Policies and Optimal Shape of a Storage System

    NARCIS (Netherlands)

    Zaerpour, N.; De Koster, René; Yu, Yugang

    2013-01-01

    The response time of a storage system is mainly influenced by its shape (configuration), the storage assignment and retrieval policies, and the location of the input/output (I/O) points. In this paper, we show that the optimal shape of a storage system, which minimises the response time for single

  11. Decreasing Inappropriate Use of Mobile Devices in Urban High School Classrooms: Comparing an Antecedent Intervention With and Without the Good Behavior Game.

    Science.gov (United States)

    Hernan, Colleen J; Collins, Tai A; Morrison, Julie Q; Kroeger, Stephen D

    2018-03-01

    As the capabilities of portable technology continue to advance and become more accessible, educators express concern about the impact of the inappropriate use of mobile devices on academic engagement and learning. An alternating treatments design was used to compare the effectiveness of an antecedent (Clear Box) intervention and an interdependent group contingency (Clear Box + Good Behavior Game [GBG]) intervention to typical classroom management techniques (Control) in increasing the academic engagement and decreasing mobile device use of high school students during instruction. The results indicate an increase in academic engagement and a decrease in the inappropriate presence of mobile devices in both classrooms with the implementation of the Clear Box + GBG, as compared with the Clear Box and Control conditions. In addition, teacher and student social validity data suggested that teachers and students viewed the Clear Box + GBG intervention favorably. Discussion focuses on contributions to the current literature, implications for practice, and suggestions for future areas of research.

  12. Impact of legislation and a prescription monitoring program on the prevalence of potentially inappropriate prescriptions for monitored drugs in Ontario: a time series analysis

    Science.gov (United States)

    Juurlink, David; Yao, Zhan; Camacho, Ximena; Paterson, J. Michael; Singh, Samantha; Dhalla, Irfan; Sproule, Beth; Mamdani, Muhammad

    2014-01-01

    Background The increased use of opioid analgesics, sedative hypnotics and stimulants, coupled with the associated risks of overdose have raised concerns around the inappropriate prescribing of these monitored drugs. We assessed the impact of new legislation, the Narcotics Safety and Awareness Act, and a centralized Narcotics Monitoring System (implemented November 2011 and May 2012, respectively), on the dispensing of prescriptions suggestive of misuse. Methods We conducted a time series analysis of publicly funded prescriptions for opioids, benzodiazepines and stimulants dispensed monthly in Ontario from January 2007 to May 2013, based on information in the Ontario Public Drug Benefit Database. In the primary analysis, a prescription was deemed potentially inappropriate if it was dispensed within 7 days of an earlier prescription and was for at least 30 tablets of a drug in the same class as the earlier prescription, but originated from a different physician and a different pharmacy. Results After enactment of the new legislation, the prevalence of potentially inappropriate opioid prescriptions decreased by 12.5% in 6 months (from 1.6% in October 2011 to 1.4% in April 2012; p = 0.01). No further significant change was observed after the introduction of the narcotic monitoring system (p = 0.8). By May 2013, the prevalence had dropped to 1.0%. Inappropriate benzodiazepine prescribing was significantly influenced by both the legislation (p significantly influenced by the introduction of the monitoring system in May 2012, falling from 0.7% in April 2012 to 0.3% in May 2013 (p = 0.02). Interpretation For a select group of drugs prone to misuse and diversion, legislation and a prescription monitoring program reduced the prevalence of prescriptions suggestive of misuse. This suggests that regulatory interventions can promote appropriate prescribing which could potentially be applied to other jurisdictions and drugs of concern. PMID:25485251

  13. Extent and cost of inappropriate use of tumour markers in patients with pulmonary disease: a multicentre retrospective study in Shanghai, China.

    Science.gov (United States)

    Zhang, Haichen; Song, Yunxiao; Zhang, Xiong; Hu, Jun; Yuan, Suwei; Ma, Jin

    2018-02-28

    The currently implemented healthcare reform in China requires substantial capital investment. Although overtreatment results in serious waste, inappropriate laboratory use is widespread, and overuse of tumour markers (TMs) has attracted increasing attention. Retrospective study. The respiratory, thoracic surgery and oncology departments of three hospitals in Shanghai from 2014 to 2015. Patients with chronic obstructive pulmonary disease (COPD) and primary bronchogenic lung cancer (PLC). Based on clinical guidelines and physician experience, the criteria of suitability of TM examinations were determined, and the number, cost and proportion of inappropriate TM requests were analysed. The area under the receiver operating characteristic curve for carcinoembryonic antigen+cytokeratin fragment 21-1+squamous cell carcinoma antigen+neuron-specific enolase in patients with COPD and PLC was 0.813, in accordance with the cost-effectiveness principle, indicating good clinical and health economics values. In the 2706 patients, 12 496-16 956 (58.27%-79.06%) of TM requests were inappropriate. Furthermore, the involved expense was 650 200-1 014 156 yuan, accounting for 7.69%-12.00% of examination expenses and 1.35%-2.11% of hospitalisation costs. We found that the inappropriate use of TMs was widespread for patients with pulmonary disease. Clinicians should use TMs strictly according to the guidelines to effectively manage laboratory resources and control costs. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. The U.S. Air Force Academy Lacked Effective Controls Over Heritage Assets and Guest House Inventories, and Inappropriately Solicited and Accepted Monetary Gifts

    Science.gov (United States)

    2013-09-23

    Inventories, and Inappropriately Solicited and Accepted Monetary Gifts Report Documentation Page Form ApprovedOMB No. 0704-0188 Public reporting burden...Accepted Monetary Gifts 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK...Monetary Gifts Objective We determined whether the U.S. Air Force Academy (USAFA), its nonappropriated fund instrumentalities (NAFIs), and its supporting

  15. Synthetic methane for power storage

    NARCIS (Netherlands)

    Botta, G.; Barankin, Michael; Walspurger, S.

    2013-01-01

    With increased share of energy generated from variable renewable sources, storage becomes a critical issue to ensure constantly balanced supply/demand. Methane is a promising vector for energy storage and transport.

  16. Hydrogen Storage Technical Team Roadmap

    Energy Technology Data Exchange (ETDEWEB)

    None

    2013-06-01

    The mission of the Hydrogen Storage Technical Team is to accelerate research and innovation that will lead to commercially viable hydrogen-storage technologies that meet the U.S. DRIVE Partnership goals.

  17. Underground Storage Tanks in Iowa

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — Underground storage tank (UST) sites which store petroleum in Iowa. Includes sites which have been reported to DNR, and have active or removed underground storage...

  18. The healthcare utilization and cost of treating patients experiencing inappropriate implantable cardioverter defibrillator shocks: a propensity score study.

    Science.gov (United States)

    Bhavnani, Sanjeev P; Giedrimiene, Dalia; Coleman, Craig I; Guertin, Danette; Azeem, Meena; Kluger, Jeffrey

    2014-10-01

    Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS

  19. Reducing inappropriate non-steroidal anti-inflammatory prescription in primary care patients with chronic kidney disease.

    Science.gov (United States)

    Keohane, David M; Dennehy, Thomas; Keohane, Kenneth P; Shanahan, Eamonn

    2017-08-14

    Purpose The purpose of this paper is to reduce inappropriate non-steroidal anti-inflammatory prescribing in primary care patients with chronic kidney disease (CKD). Once diagnosed, CKD management involves delaying progression to end stage renal failure and preventing complications. It is well established that non-steroidal anti-inflammatories have a negative effect on kidney function and consequently, all nephrology consensus groups suggest avoiding this drug class in CKD. Design/methodology/approach The sampling criteria included all practice patients with a known CKD risk factor. This group was refined to include those with an estimated glomerular filtration rate (eGFR)<60 ml/min per 1.73m2 (stage 3 CKD or greater). Phase one analysed how many prescriptions had occurred in this group over the preceding three months. The intervention involved creating an automated alert on at risk patient records if non-steroidal anti-inflammatories were prescribed and discussing the rationale with practice staff. The re-audit phase occurred three months' post intervention. Findings The study revealed 728/7,500 (9.7 per cent) patients at risk from CKD and 158 (2.1 per cent) who were subsequently found to have an eGFR<60 ml/min, indicating=stage 3 CKD. In phase one, 10.2 per cent of at risk patients had received a non-steroidal anti-inflammatory prescription in the preceding three months. Additionally, 6.2 per cent had received non-steroidal anti-inflammatories on repeat prescription. Phase two post intervention revealed a significant 75 per cent reduction in the total non-steroidal anti-inflammatories prescribed and a 90 per cent reduction in repeat non-steroidal anti-inflammatory prescriptions in those with CKD. Originality/value The study significantly reduced non-steroidal anti-inflammatory prescription in those with CKD in primary care settings. It also created a CKD register within the practice and an enduring medication alert system for individuals that risk nephrotoxic

  20. Identification of irradiated pepper with comet assay

    International Nuclear Information System (INIS)

    Prieto Miranda, Enrique Fco.; Moreno Alvarez, Damaris L.; Carro Palacio, Sandra; Iglesia Enriquez, Isora

    2007-01-01

    The treatment of foods with ionizing radiations is a technological process utilized in order to increase the hygienic quality and the storage time of the foods. Several methods of detection of irradiated foods have been recommended. The comet assay of DNA is one fast and economical technique for the qualitative identification of irradiated foods. The objective of the present paper was to identify with the comet assay technique the modifications of the DNA molecule of irradiated pepper storage at environment and refrigeration temperatures and different post-irradiation times for different absorbed dose values, (0.1, 0.3 and 0.5 kGy). It was demonstrated that for the high absorbed dose values was observed a greater break into fragments of the DNA molecule, which shows the application of this technique for the identification of irradiated foods. (author)

  1. Identification of Hazardous Road Locations on the basis of jerks

    DEFF Research Database (Denmark)

    Agerholm, Niels; Jensen, Robin; Andersen, Camilla Sloth

    The dark figures for the Danish traffic safety have increased for decades and are now around 91%. As the Hazardous Road Location (HRL) identification, a cornerstone in the traffic safety work, is based on the registered accidents, the identification is increasingly more random and uncertain...... on data from three months of driving by 380 cars, which is equivalent to a distance of 1.9 million km. This indicates that concentrations of decelerations are located where there are high traffic volumes, but not that the design and furniture of the road on the location can explain an HRL. This also...... indicates that concentrations of jerks can be found where the road has safety problems or is inappropriately designed. This is supported by literature dealing with this topic. On the other hand, jerks are very sensitive to unevenness in the road surface, and data from these locations must be removed...

  2. Implementation of a Computerized Order Entry Tool to Reduce the Inappropriate and Unnecessary Use of Cardiac Stress Tests With Imaging in Hospitalized Patients.

    Science.gov (United States)

    Gertz, Zachary M; O'Donnell, William; Raina, Amresh; Balderston, Jessica R; Litwack, Andrew J; Goldberg, Lee R

    2016-10-15

    The rising use of imaging cardiac stress tests has led to potentially unnecessary testing. Interventions designed to reduce inappropriate stress testing have focused on the ambulatory setting. We developed a computerized order entry tool intended to reduce the use of imaging cardiac stress tests and improve appropriate use in hospitalized patients. The tool was evaluated using preimplementation and postimplementation cohorts at a single urban academic teaching hospital. All hospitalized patients referred for testing were included. The co-primary outcomes were the use of imaging stress tests as a percentage of all stress tests and the percentage of inappropriate tests, compared between the 2 cohorts. There were 478 patients in the precohort and 463 in the postcohort. The indication was chest pain in 66% and preoperative in 18% and was not significantly different between groups. The use of nonimaging stress tests increased from 4% in the pregroup to 15% in the postgroup (p nonimaging stress tests increased from 7% to 25% (p nonimaging cardiac stress tests and reduced the use of imaging tests yet was not able to reduce inappropriate use. Our study highlights the differences in cardiac stress testing between hospitalized and ambulatory patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Data storage as a service

    OpenAIRE

    Tomšič, Jan

    2016-01-01

    The purpose of the thesis was comparison of interfaces to network attached file systems and object storage. The thesis describes network file system and mounting procedure in Linux operating system. Object storage and distributed storage systems are explained with examples of usage. Amazon S3 is an example of object store with access trough REST interface. Ceph, a system for distributed object storage, is explained in detail, and a Ceph cluster was deployed for the purpose of this thesis. Cep...

  4. Mass storage for microprocessor farms

    International Nuclear Information System (INIS)

    Areti, H.

    1990-01-01

    Experiments in high energy physics require high density and high speed mass storage. Mass storage is needed for data logging during the online data acquisition, data retrieval and storage during the event reconstruction and data manipulation during the physics analysis. This paper examines the storage and speed requirements at the first two stages of the experiments and suggests a possible starting point to deal with the problem. 3 refs., 3 figs

  5. Guidebook on spent fuel storage

    International Nuclear Information System (INIS)

    1984-01-01

    The Guidebook summarizes the experience and information in various areas related to spent fuel storage: technological aspects, the transport of spent fuel, economical, regulatory and institutional aspects, international safeguards, evaluation criteria for the selection of a specific spent fuel storage concept, international cooperation on spent fuel storage. The last part of the Guidebook presents specific problems on the spent fuel storage in the United Kingdom, Sweden, USSR, USA, Federal Republic of Germany and Switzerland

  6. Concrete storage cask for interim storage of spent nuclear fuel

    International Nuclear Information System (INIS)

    Nabemoto, Toyonobu; Fujiwara, Hiroaki; Kobayashi, Shunji; Shionaga, Ryosuke

    2004-01-01

    Experiments and analytical evaluation of the fabrication, non-destructive inspection and structural integrity of reinforced concrete body for storage casks were carried out to demonstrate the concrete storage cask for spent fuel generated from nuclear power plants. Analytical survey on the type of concrete material and fabrication method of the storage cask was performed and the most suitable fabrication method for the concrete body was identified to reduce concrete cracking. The structural integrity of the concrete body of the storage cask under load conditions during storage was confirmed and the long term integrity of concrete body against degradation dependent on environmental factors was evaluated. (author)

  7. Normal matter storage of antiprotons

    International Nuclear Information System (INIS)

    Campbell, L.J.

    1987-01-01

    Various simple issues connected with the possible storage of anti p in relative proximity to normal matter are discussed. Although equilibrium storage looks to be impossible, condensed matter systems are sufficiently rich and controllable that nonequilibrium storage is well worth pursuing. Experiments to elucidate the anti p interactions with normal matter are suggested. 32 refs

  8. Digital device for synchronous storage

    International Nuclear Information System (INIS)

    Kobzar', Yu.M.; Kovtun, V.G.; Pashechko, N.I.

    1991-01-01

    Synchronous storage digital device for IR electron-photon emission spectrometer operating with analogue-to-digital converter F4223 or monocrystal converter K572PV1 is described. The device accomplished deduction of noise-background in each storage cycle. Summation and deduction operational time equals 90 ns, device output code discharge - 20, number of storages -2 23

  9. Electron spin resonance identification of irradiated fruits

    International Nuclear Information System (INIS)

    Raffi, J.J.; Agnel, J.-P.L.

    1989-01-01

    The electron spin resonance spectrum of achenes, pips, stalks and stones from irradiated fruits (stawberry, raspberry, red currant, bilberry, apple, pear, fig, french prune, kiwi, water-melon and cherry) always displays, just after γ-treatment, a weak triplet (a H ∼30 G) due to a cellulose radical; its left line (lower field) can be used as an identification test of irradiation, at least for strawberries, raspberries, red currants or bilberries irradiated in order to improve their storage time. (author)

  10. Test Plan for Cask Identification Detector

    Energy Technology Data Exchange (ETDEWEB)

    Rauch, Eric Benton [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-09-29

    This document serves to outline the testing of a Used Fuel Cask Identification Detector (CID) currently being designed under the DOE-NE MPACT Campaign. A bench-scale prototype detector will be constructed and tested using surrogate neutron sources. The testing will serve to inform the design of the full detector that is to be used as a way of fingerprinting used fuel storage casks based on the neutron signature produced by the used fuel inside the cask.

  11. Volatile liquid storage system

    International Nuclear Information System (INIS)

    Laverman, R.J.; Winters, P.J.; Rinehart, J.K.

    1992-01-01

    This patent describes a method of collecting and abating emission from a volatile liquid in an above ground storage tank. It comprises the liquid storage tank having a bottom, a vertical cylindrical circular wall having a lower edge portion joined to the bottom, and an external fixed roof, the tank having an internal floating roof floating on a volatile liquid stored in the tank, and air vent means in the tank in communication with a vapor space in the tank constituting at least the space above the floating roof when the floating roof floats on a predetermined maximum volume of volatile liquid in the tank; permitting ambient air; pumping emission laden air from the tank vapor space above the floating roof; and by means of the emissions abatement apparatus eliminating most of the emission from the emissions laden air with formation of a gaseous effluent and then discharging the resulting gaseous effluent to the atmosphere

  12. Superconducting magnetic energy storage

    International Nuclear Information System (INIS)

    Rogers, J.D.

    1976-01-01

    Fusion power production requires energy storage and transfer on short time scales to create confining magnetic fields and for heating plasmas. The theta-pinch Scyllac Fusion Test Reactor (SFTR) requires 480 MJ of energy to drive the 5-T compression field with a 0.7-ms rise time. Tokamak Experimental Power Reactors (EPR) require 1 to 2 GJ of energy with a 1 to 2-s rise time for plasma ohmic heating. The design, development, and testing of four 300-kJ energy storage coils to satisfy the SFTR needs are described. Potential rotating machinery and homopolar energy systems for both the Reference Theta-Pinch Reactor (RTPR) and tokamak ohmic-heating are presented

  13. Superconducting Magnetic Energy Storage

    International Nuclear Information System (INIS)

    Hassenzahl, W.

    1989-01-01

    Recent programmatic developments in Superconducting Magnetic Energy Storage (SMES) have prompted renewed and widespread interest in this field. In mid 1987 the Defense Nuclear Agency, acting for the Strategic Defense Initiative Office issued a request for proposals for the design and construction of SMES Engineering Test Model (ETM). Two teams, one led by Bechtel and the other by Ebasco, are now engaged in the first phase of the development of a 10 to 20 MWhr ETM. This report presents the rationale for energy storage on utility systems, describes the general technology of SMES, and explains the chronological development of the technology. The present ETM program is outlined; details of the two projects for ETM development are described in other papers in these proceedings. The impact of high Tc materials on SMES is discussed

  14. Entangled Cloud Storage

    DEFF Research Database (Denmark)

    Ateniese, Giuseppe; Dagdelen, Özgür; Damgård, Ivan Bjerre

    2012-01-01

    keeps the files in it private but still lets each client P_i recover his own data by interacting with S; no cooperation from other clients is needed. At the same time, the cloud provider is discouraged from altering or overwriting any significant part of c as this will imply that none of the clients can......Entangled cloud storage enables a set of clients {P_i} to “entangle” their files {f_i} into a single clew c to be stored by a (potentially malicious) cloud provider S. The entanglement makes it impossible to modify or delete significant part of the clew without affecting all files in c. A clew...... recover their files. We provide theoretical foundations for entangled cloud storage, introducing the notion of an entangled encoding scheme that guarantees strong security requirements capturing the properties above. We also give a concrete construction based on privacy-preserving polynomial interpolation...

  15. Optical information storage

    International Nuclear Information System (INIS)

    Woike, T.

    1996-01-01

    In order to increase storage capacity and data transfer velocity by about three orders of magnitude compared to CD or magnetic disc it is necessary to work with optical techniques, especially with holography. About 100 TByte can be stored in a waver of an area of 50 cm 2 via holograms which corresponds to a density of 2.10 9 Byte/mm 2 . Every hologram contains data of 1 MByte, so that parallel-processing is possible for read-out. Using high-speed CCD-arrays a read-out velocity of 1 MByte/μsec can be reached. Further, holographic technics are very important in solid state physics. We will discuss the existence of a space charge field in Sr 1-x Ba x Nb 2 O 6 doped with cerium and the physical properties of metastable states, which are suited for information storage. (author) 19 figs., 9 refs

  16. Alternatives for water basin spent fuel storage using pin storage

    International Nuclear Information System (INIS)

    Viebrock, J.M.; Carlson, R.W.

    1979-09-01

    The densest tolerable form for storing spent nuclear fuel is storage of only the fuel rods. This eliminates the space between the fuel rods and frees the hardware to be treated as non-fuel waste. The storage density can be as much as 1.07 MTU/ft 2 when racks are used that just satisfy the criticality and thermal limitations. One of the major advantages of pin storage is that it is compatible with existing racks; however, this reduces the storage density to 0.69 MTU/ft 2 . Even this is a substantial increase over the 0.39 MTU/ft 2 that is achievable with current high capacity stainless steel racks which have been selected as the bases for comparison. Disassembly requires extensive operation on the fuel assembly to remove the upper end fitting and to extract the fuel rods from the assembly skeleton. These operations will be performed with the aid of an elevator to raise the assembly where each fuel rod is grappled. Lowering the elevator will free the fuel rod for transfer to the storage canister. A storage savings of $1510 per MTU can be realized if the pin storage concept is incorporated at a new away-from-reactor facility. The storage cost ranges from $3340 to $7820 per MTU of fuel stored with the lower cost applying to storage at an existing away-from-reactor storage facility and the higher cost applying to at-reactor storage

  17. Energy Storage Project

    Science.gov (United States)

    Mercer, Carolyn R.; Jankovsky, Amy L.; Reid, Concha M.; Miller, Thomas B.; Hoberecht, Mark A.

    2011-01-01

    NASA's Exploration Technology Development Program funded the Energy Storage Project to develop battery and fuel cell technology to meet the expected energy storage needs of the Constellation Program for human exploration. Technology needs were determined by architecture studies and risk assessments conducted by the Constellation Program, focused on a mission for a long-duration lunar outpost. Critical energy storage needs were identified as batteries for EVA suits, surface mobility systems, and a lander ascent stage; fuel cells for the lander and mobility systems; and a regenerative fuel cell for surface power. To address these needs, the Energy Storage Project developed advanced lithium-ion battery technology, targeting cell-level safety and very high specific energy and energy density. Key accomplishments include the development of silicon composite anodes, lithiated-mixed-metal-oxide cathodes, low-flammability electrolytes, and cell-incorporated safety devices that promise to substantially improve battery performance while providing a high level of safety. The project also developed "non-flow-through" proton-exchange-membrane fuel cell stacks. The primary advantage of this technology set is the reduction of ancillary parts in the balance-of-plant--fewer pumps, separators and related components should result in fewer failure modes and hence a higher probability of achieving very reliable operation, and reduced parasitic power losses enable smaller reactant tanks and therefore systems with lower mass and volume. Key accomplishments include the fabrication and testing of several robust, small-scale nonflow-through fuel cell stacks that have demonstrated proof-of-concept. This report summarizes the project s goals, objectives, technical accomplishments, and risk assessments. A bibliography spanning the life of the project is also included.

  18. DPM: Future Proof Storage

    Science.gov (United States)

    Alvarez, Alejandro; Beche, Alexandre; Furano, Fabrizio; Hellmich, Martin; Keeble, Oliver; Rocha, Ricardo

    2012-12-01

    The Disk Pool Manager (DPM) is a lightweight solution for grid enabled disk storage management. Operated at more than 240 sites it has the widest distribution of all grid storage solutions in the WLCG infrastructure. It provides an easy way to manage and configure disk pools, and exposes multiple interfaces for data access (rfio, xroot, nfs, gridftp and http/dav) and control (srm). During the last year we have been working on providing stable, high performant data access to our storage system using standard protocols, while extending the storage management functionality and adapting both configuration and deployment procedures to reuse commonly used building blocks. In this contribution we cover in detail the extensive evaluation we have performed of our new HTTP/WebDAV and NFS 4.1 frontends, in terms of functionality and performance. We summarize the issues we faced and the solutions we developed to turn them into valid alternatives to the existing grid protocols - namely the additional work required to provide multi-stream transfers for high performance wide area access, support for third party copies, credential delegation or the required changes in the experiment and fabric management frameworks and tools. We describe new functionality that has been added to ease system administration, such as different filesystem weights and a faster disk drain, and new configuration and monitoring solutions based on the industry standards Puppet and Nagios. Finally, we explain some of the internal changes we had to do in the DPM architecture to better handle the additional load from the analysis use cases.

  19. Tuber Storage Proteins

    OpenAIRE

    SHEWRY, PETER R.

    2003-01-01

    A wide range of plants are grown for their edible tubers, but five species together account for almost 90 % of the total world production. These are potato (Solanum tuberosum), cassava (Manihot esculenta), sweet potato (Ipomoea batatus), yams (Dioscorea spp.) and taro (Colocasia, Cyrtosperma and Xanthosoma spp.). All of these, except cassava, contain groups of storage proteins, but these differ in the biological properties and evolutionary relationships. Thus, patatin from potato exhibits act...

  20. Large mass storage facility

    Energy Technology Data Exchange (ETDEWEB)

    Peskin, Arnold M.

    1978-08-01

    This is the final report of a study group organized to investigate questions surrounding the acquisition of a large mass storage facility. The programatic justification for such a system at Brookhaven is reviewed. Several candidate commercial products are identified and discussed. A draft of a procurement specification is developed. Some thoughts on possible new directions for computing at Brookhaven are also offered, although this topic was addressed outside of the context of the group's deliberations. 2 figures, 3 tables.