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. Intelligent Storage System Based on Automatic Identification

    Directory of Open Access Journals (Sweden)

    Kolarovszki Peter

    2014-09-01

    Full Text Available This article describes RFID technology in conjunction with warehouse management systems. Article also deals with automatic identification and data capture technologies and each processes, which are used in warehouse management system. It describes processes from entering goods into production to identification of goods and also palletizing, storing, bin transferring and removing goods from warehouse. Article focuses on utilizing AMP middleware in WMS processes in Nowadays, the identification of goods in most warehouses is carried through barcodes. In this article we want to specify, how can be processes described above identified through RFID technology. All results are verified by measurement in our AIDC laboratory, which is located at the University of Žilina, and also in Laboratory of Automatic Identification Goods and Services located in GS1 Slovakia. The results of our research bring the new point of view and indicate the ways using of RFID technology in warehouse management system.

  3. Closed-loop spontaneous baroreflex transfer function is inappropriate for system identification of neural arc but partly accurate for peripheral arc: predictability analysis

    Science.gov (United States)

    Kamiya, Atsunori; Kawada, Toru; Shimizu, Shuji; Sugimachi, Masaru

    2011-01-01

    . Furthermore, the predictabilities of the neural arc transfer functions obtained in open-loop and closed-loop conditions were validated by closed-loop pharmacological (phenylephrine and nitroprusside infusions) pressure interventions. Time-series SNA responses to drug-induced AP changes predicted by the open-loop transfer function matched closely the measured responses (r2, 0.9 ± 0.1), whereas SNA responses predicted by closed-loop-spontaneous transfer function deviated greatly and were the inverse of measured responses (r, −0.8 ± 0.2). These results indicate that although the spontaneous baroreflex transfer function obtained by closed-loop analysis has been believed to represent the neural arc function, it is inappropriate for system identification of the neural arc but is essentially appropriate for the peripheral arc under resting conditions, when compared with open-loop analysis. PMID:21486839

  4. 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.

  5. Molecular identification of house dust mites and storage mites.

    Science.gov (United States)

    Wong, Shew Fung; Chong, Ai Ling; Mak, Joon Wah; Tan, Jessie; Ling, Suk Jiun; Ho, Tze Ming

    2011-10-01

    Mites are known causes of allergic diseases. Currently, identification of mites based on morphology is difficult if only one mite is isolated from a (dust) sample, or when only one gender is found, or when the specimen is not intact especially with the loss of the legs. The purpose of this study was to use polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) of the ITS2 gene, to complement the morphological data for the identification of mites to the species level. For this, six species were cultured: Dermatophagoides pteronyssinus, D. farinae, Blomia tropicalis, Tyrophagus putrescentiae, Aleuroglyphus ovatus and Glycycometus malaysiensis. Genomic DNA of the mites was extracted, quantified, amplified and digested individually with restriction enzymes. Hinf I and Ple I differentiated the restriction patterns of D. pteronyssinus and D. farinae. Bfa I and Alu I enzymes differentiated B. tropicalis and G. malaysiensis. Ple I enzyme was useful for the differentiation between T. putrescentiae and A. ovatus. Bfa I was useful for the differentiation of G. malaysiensis from the rest of the species. In conclusion, different species of mites can be differentiated using PCR-RFLP of ITS2 region. With the established PCR-RFLP method in this study, identification of these mites to the species level is possible even if complete and intact adult specimens of both sexes are not available. As no study to date has reported PCR-RFLP method for the identification of domestic mites, the established method should be validated for the identification of other species of mites that were not included in this study.

  6. Identification of Dynamic Simulation Models for Variable Speed Pumped Storage Power Plants

    Science.gov (United States)

    Moreira, C.; Fulgêncio, N.; Silva, B.; Nicolet, C.; Béguin, A.

    2017-04-01

    This paper addresses the identification of reduced order models for variable speed pump-turbine plants, including the representation of the dynamic behaviour of the main components: hydraulic system, turbine governors, electromechanical equipment and power converters. A methodology for the identification of appropriated reduced order models both for turbine and pump operating modes is presented and discussed. The methodological approach consists of three main steps: 1) detailed pumped-storage power plant modelling in SIMSEN; 2) reduced order models identification and 3) specification of test conditions for performance evaluation.

  7. 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.

  8. Simple protocols for oblivious transfer and secure identification in the noisy-quantum-storage model

    Science.gov (United States)

    Schaffner, Christian

    2010-09-01

    We present simple protocols for oblivious transfer and password-based identification which are secure against general attacks in the noisy-quantum-storage model as defined in R. König, S. Wehner, and J. Wullschleger [e-print arXiv:0906.1030]. We argue that a technical tool from König suffices to prove security of the known protocols. Whereas the more involved protocol for oblivious transfer from König requires less noise in storage to achieve security, our “canonical” protocols have the advantage of being simpler to implement and the security error is easier control. Therefore, our protocols yield higher OT rates for many realistic noise parameters. Furthermore, a proof of security of a direct protocol for password-based identification against general noisy-quantum-storage attacks is given.

  9. Simple protocols for oblivious transfer and secure identification in the noisy-quantum-storage model

    International Nuclear Information System (INIS)

    Schaffner, Christian

    2010-01-01

    We present simple protocols for oblivious transfer and password-based identification which are secure against general attacks in the noisy-quantum-storage model as defined in R. Koenig, S. Wehner, and J. Wullschleger [e-print arXiv:0906.1030]. We argue that a technical tool from Koenig et al. suffices to prove security of the known protocols. Whereas the more involved protocol for oblivious transfer from Koenig et al. requires less noise in storage to achieve security, our ''canonical'' protocols have the advantage of being simpler to implement and the security error is easier control. Therefore, our protocols yield higher OT rates for many realistic noise parameters. Furthermore, a proof of security of a direct protocol for password-based identification against general noisy-quantum-storage attacks is given.

  10. 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

  11. Identification of mutations in Type IV glycogen storage disease

    Energy Technology Data Exchange (ETDEWEB)

    Bao, Y.; Kishnani, P.; Chen, Y.T. [Duke Univ. Medical Center, Durham, NC (United States)] [and others

    1994-09-01

    Type IV glycogen storage disease (GSD IV, Andersen disease) is caused by a deficiency of glycogen branching enzyme (GBE) activity, which results in the accumulation of glycogen with unbranched, long, outer chains in the tissues. The molecular basis of the disease is not known. We studied four patients with the disease; three with typical presentation of progressive liver cirrhosis and failure, and one with severe and fatal neonatal hypotonia and cardiomyopathy. Southern blot analysis with EcoRI or MspI did not detect gross DNA rearrangement, deletion or duplication in patients` glycogen branching enzyme genes. Northern analysis with total cellular RNAs isolated from skin fibroblast MI strains of three patients with typical clinical presentation showed a normal level and size (2.95 kb) of GBE mRNA hybridization band in two and absent mRNA hybridization band in the remaining one. The patient with atypical severe neonatal hypotonia demonstrated a less intense and smaller size (2.75 kb) of mRNA hybridization band. A 210 hp deletion from nucleotide sequence 873 to 1082 which causes 70 amino acids missing from amino acid sequence 262 to 331 was detected in all 17 clones sequenced from the fatal hypotonia patient. This deletion is located in the region which is highly conserved between prokaryotic, yeast and human GBE polypeptide sequences, and also includes the first of the four regions which constitute the catalytic active sites of most of amylolytic enzymes. A point mutation C-T (1633) which changes the amino acid from Arginine to Cystine was found in 19 of 20 cDNA clones from a patient with classical clinical presentation. This point mutation was unique to this patient and was not observed in three other patients or normal controls. This is the first report on the molecular basis of GSD IV and our data indicated the presence of extensive genetic heterogeneity in the disease.

  12. 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.

  13. 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.

  14. [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.

  15. 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.

  16. 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.

  17. 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

  18. 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

  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 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

  1. 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.

  2. 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

  3. Three Cases With Inappropriate TSH Syndrome

    Directory of Open Access Journals (Sweden)

    Hatice Sebila Dökmetaş

    2012-12-01

    Full Text Available Inappropriate thyroid-stimulating hormone (TSH syndrome or central hyperthyroidism is a rare disorder characterized by inappropriately normal or elevated levels of TSH and elevated levels of T3 and T4. The syndrome is associated with TSH-secreting pituitary adenoma (TSHoma or thyroid hormone resistance (THR. Thyroid-releasing hormone stimulation test and T3 suppression test can be useful for the differential diagnosis of central hyperthyroidism. In the present study, we report three cases of inappropriate TSH syndrome diagnosed after TRH stimulation and T3 suppression tests. Turk Jem 2012; 16: 105-8

  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. 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.

  6. 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.

  7. Drug Utilization and Inappropriate Prescribing in Centenarians.

    Science.gov (United States)

    Hazra, Nisha C; Dregan, Alex; Jackson, Stephen; Gulliford, Martin C

    2016-05-01

    To use primary care electronic health records (EHRs) to evaluate prescriptions and inappropriate prescribing in men and women at age 100. Population-based cohort study. Primary care database in the United Kingdom, 1990 to 2013. Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084; n = 8,982 women, n = 2,102 men). Main drug classes prescribed and potentially inappropriate prescribing according to the 2012 American Geriatrics Society Beers Criteria. At the age of 100, 73% of individuals (79% of women, 54% of men) had received one or more prescription drugs, with a median of 7 (interquartile range 0-12) prescription items. The most frequently prescribed drug classes were cardiovascular (53%), central nervous system (CNS) (53%), and gastrointestinal (47%). Overall, 32% of participants (28% of men, 32% of women) who received drug prescriptions may have received one or more potentially inappropriate prescriptions, with temazepam and amitriptyline being the most frequent. CNS prescriptions were potentially inappropriate in 23% of individuals, and anticholinergic prescriptions were potentially inappropriate in 18% of individuals. The majority of centenarians are prescribed one or more drug therapies, and the prescription may be inappropriate for up to one-third of these individuals. Research using EHRs offers opportunities to understand prescribing trends and improve pharmacological care of the oldest adults. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

  8. 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...... months, 48 out of 581 S-ICD patients (71% male, age 49 ± 18 years) experienced 101 inappropriate shocks (8.3%). The most common cause was cardiac signal oversensing (73%), such as T-wave oversensing. Eighteen shocks (18%) were due to supraventricular tachycardias (SVT), of which 15 occurred in the shock......-only zone. Cox-proportional hazard modeling using time-dependent covariates demonstrated that patients with a history of atrial fibrillation (HR 2.4) and patients with hypertrophic cardiomyopathy (HR 4.6) had an increased risk for inappropriate shocks, while programming the primary vector for sensing (from...

  9. 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.

  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.

  11. Inappropriate Intensive Care Unit admissions: Nigerian doctors ...

    African Journals Online (AJOL)

    2015-12-04

    Dec 4, 2015 ... Conclusion: Inappropriate ICU admissions were perceived as a common event and were mainly attributed to pressure from seniors, referring clinicians, and hospital management. Further work is ..... Financial support and sponsorship. Nil. Conflicts of interest. There are no conflicts of interest. References. 1.

  12. 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, ...

  13. Bullying and Inappropriate Behaviour among Faculty Personnel

    Science.gov (United States)

    Meriläinen, Matti; Sinkkonen, Hanna-Maija; Puhakka, Helena; Käyhkö, Katinka

    2016-01-01

    This study focuses on the degree, nature and consequences of bullying or inappropriate behaviour among faculty personnel (n = 303) in a Finnish university. A total of 114 (38%) faculty members answered the email questionnaire. According to the results, 15% of the respondents had experienced bullying; in addition, 45% had experienced inappropriate…

  14. Prevalence of inappropriate prescribing in primary care

    DEFF Research Database (Denmark)

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

    2007-01-01

    OBJECTIVE: To describe the prevalence of inappropriate prescribing in primary care in Copenhagen County, according to the Medication Appropriateness Index (MAI) and to identify the therapeutic areas most commonly involved. SETTING: A cross-sectional study was conducted among 212 elderly ( >65 years...

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

    African Journals Online (AJOL)

    Coverage would have increased by 10% for diphtheria pertusistetanus (DPT) doses DPTI and DPT2, and 7% for DPT3. Measles immunisation coverage would have increased by 19% had missed immunisation opportunities and inappropriately administered vaccinations been avoided. The overall missed opportunities rate ...

  16. 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.

  17. 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

  18. 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)

  19. 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...

  20. Secure identification and QKD in the bounded-quantum-storage model

    NARCIS (Netherlands)

    Damgård, I.; Fehr, S.; Salvail, L.; Schaffner, C.

    2014-01-01

    We consider the problem of secure identification: user U proves to server S that he knows an agreed (possibly low-entropy) password w, while giving away as little information on w as possible—the adversary can exclude at most one possible password for each execution. We propose a solution in the

  1. Secure Identification and QKD in the Bounded-Quantum-Storage Model

    NARCIS (Netherlands)

    I.B. Damgård (Ivan); S. Fehr (Serge); L. Salvail (Louis); C. Schaffner (Christian)

    2014-01-01

    htmlabstractWe consider the problem of secure identification: user U proves to server S that he knows an agreed (possibly low-entropy) password w, while giving away as little information on w as possible - the adversary can exclude at most one possible password for each execution. We propose a

  2. 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,…

  3. POPI (Pediatrics: Omission of Prescriptions and Inappropriate prescriptions: development of a tool to identify inappropriate prescribing.

    Directory of Open Access Journals (Sweden)

    Sonia Prot-Labarthe

    Full Text Available INTRODUCTION: Rational prescribing for children is an issue for all countries and has been inadequately studied. Inappropriate prescriptions, including drug omissions, are one of the main causes of medication errors in this population. Our aim is to develop a screening tool to identify omissions and inappropriate prescriptions in pediatrics based on French and international guidelines. METHODS: A selection of diseases was included in the tool using data from social security and hospital statistics. A literature review was done to obtain criteria which could be included in the tool called POPI. A 2-round-Delphi consensus technique was used to establish the content validity of POPI; panelists were asked to rate their level of agreement with each proposition on a 9-point Likert scale and add suggestions if necessary. RESULTS: 108 explicit criteria (80 inappropriate prescriptions and 28 omissions were obtained and submitted to a 16-member expert panel (8 pharmacists, 8 pediatricians hospital-based -50%- or working in community -50%-. Criteria were categorized according to the main physiological systems (gastroenterology, respiratory infections, pain, neurology, dermatology and miscellaneous. Each criterion was accompanied by a concise explanation as to why the practice is potentially inappropriate in pediatrics (including references. Two round of Delphi process were completed via an online questionnaire. 104 out of the 108 criteria submitted to experts were selected after 2 Delphi rounds (79 inappropriate prescriptions and 25 omissions. DISCUSSION CONCLUSION: POPI is the first screening-tool develop to detect inappropriate prescriptions and omissions in pediatrics based on explicit criteria. Inter-user reliability study is necessary before using the tool, and prospective study to assess the effectiveness of POPI is also necessary.

  4. 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

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. Identification of seven water-soluble non-storage proteins from pomegranate (Punica granatum Linn.) seeds.

    Science.gov (United States)

    Yang, Haixia; Li, Meiliang; Qi, Xin; Lv, Chenyan; Deng, Jianjun; Zhao, Guanghua

    2012-08-01

    As pomegranate (Punica granatum Linn.) processing is fast growing, the usage of pomegranate processing wastes containing seeds has been receiving great attention. The protein component accounts for 100-130 g/kg of the seeds in weight. However, so far, there is no information on the composition and function of the pomegranate seed proteins. In this study, a global view of water-soluble non-storage proteins isolated from mature pomegranate seeds were studied using two-dimensional polyacrylamide gel electrophoresis coupled with liquid chromatography-tandem mass spectrometry. With the two-dimensional polyacrylamide gel electrophoresis approach, over 120 protein spots were resolved, of which 7 abundant protein spots showing low molecular mass were identified. These identified proteins may be linked to seed development and metabolism, but more importantly, the occurrence of these proteins provides the possibility of conversion the pomegranate processing wastes into useful products or raw material for food industry.

  10. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    none,

    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.

  12. Identification of radiation hazards associated with handling, processing and storage of phosphate ores and its products

    International Nuclear Information System (INIS)

    Chruscielewski, W.; Olszewski, J.; Kaminski, Z.

    1999-01-01

    According to article 2 of the 1996 EU Directive 96/26/Euratom, the Directive is also applicable to activities associated with the presence of natural radiation sources, leading to significantly increased exposure of workers and the population at large, which cannot be disregarded from the viewpoint of radiation protection. Article 40 of the Directive commits the member states to identify, through surveys or other means, this kind of activities. These include in particular occupational activities involving the use and storage of materials generally not recognized as radioactive, but containing natural nuclides responsible for increased exposure of workers and other groups of the population. Phosphate ores, extensively used throughout the word to manufacture fertilizers and other chemical products, may serve as an example of such materials. In Poland, this kind of hazard may occur in chemical plants manufacturing phosphate fertilizers, on ships transporting raw materials, and at phosphogypsum waste dumping sites. Poland's total phosphate supply comes from abroad at a rate of about 1.7 million metric tons per annum, and is used to produce nearly 500000 metric tons of phosphate fertilizers. About 70% of Poland's phosphate fertilizer production comes from the Police Chemical Plant where the radiation hazard is assessed in production departments, transport facilities and warehouses of raw materials and final products. Gamma radiation dose rate and air radon pollution were determined, and the collected samples of ores, fertilizers and wastes were tested for the presence of radioactive elements. The Morocco phosphate was found to be most radioactive. The dose rate determined in the air of the warehouse was almost 0.7 μSvh -1 , which is about five times higher than the outside natural background radiation. In the warehouse with final products, the dose rate was not higher than 0.6 μSvh -1 . Increased radon concentrations were also detected in the ore warehouse in

  13. 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

  14. 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.

  15. [Patients with hyperlipidemia: inappropriate nutritional intake].

    Science.gov (United States)

    Lecerf, Jean-Michel; Hottin, Delphine Mastin

    2004-10-23

    Gather knowledge on nutritional supplementation in patients with hyperlipidemia. In an observational study on patients with hyperlipidemia, nutritional intake was assessed using a 7-day dietary questionnaire, provided on the first visit to a lipid clinic. 291 patients (201 men and 90 women) were studied. Calorie intake and proportion of energetic nutrients revealed low carbohydrate intake, low intake of dietary fibres, and excessive lipid and saturated fatty acid intakes. Patients with isolated hypercholesterolemia had nutritional intake very similar to the daily allowances recommended in France. Men with type III hyperlipidemia had the highest calorie intake and those with type IV dyslipidemia had the highest alcohol intake. Triglycerides increased with total energy intake and with fat intake (%). Body mass index was inversely correlated to carbohydrate intake. The duration of dyslipidemia was related to low vitamin C and B9 intake. The existence of risk factors (type 2 diabetes, hypertension, smoking or inactivity) was associated with less well-balanced diet and low protective micronutrient status. In the case of atherosclerosis, vitamin B9, C, E and beta-carotene intake was insufficient. Interactions existed between nutrient intake with correlations between fibres, vitamin B9, C and beta-carotene, suggesting that nutritional education should favour foodstuffs that provide them simultaneously. Nutritional intake in patients with hyperlipidemia is often far from that recommended and does not greatly differ from that in large non-selected populations. It can be considered as inappropriate because of the metabolic and cardiovascular risks in these patients. Adapted nutritional management is crucial.

  16. Accommodating Presuppositions Is Inappropriate in Implausible Contexts.

    Science.gov (United States)

    Singh, Raj; Fedorenko, Evelina; Mahowald, Kyle; Gibson, Edward

    2016-04-01

    According to one view of linguistic information (Karttunen, 1974; Stalnaker, 1974), a speaker can convey contextually new information in one of two ways: (a) by asserting the content as new information; or (b) by presupposing the content as given information which would then have to be accommodated. This distinction predicts that it is conversationally more appropriate to assert implausible information rather than presuppose it (e.g., von Fintel, 2008; Heim, 1992; Stalnaker, 2002). A second view rejects the assumption that presuppositions are accommodated; instead, presuppositions are assimilated into asserted content and both are correspondingly open to challenge (e.g., Gazdar, 1979; van der Sandt, 1992). Under this view, we should not expect to find a difference in conversational appropriateness between asserting implausible information and presupposing it. To distinguish between these two views of linguistic information, we performed two self-paced reading experiments with an on-line stops-making-sense judgment. The results of the two experiments-using the presupposition triggers the and too-show that accommodation is inappropriate (makes less sense) relative to non-presuppositional controls when the presupposed information is implausible but not when it is plausible. These results provide support for the first view of linguistic information: the contrast in implausible contexts can only be explained if there is a presupposition-assertion distinction and accommodation is a mechanism dedicated to reasoning about presuppositions. Copyright © 2015 Cognitive Science Society, Inc.

  17. Inappropriate treatments for patients with cognitive decline.

    Science.gov (United States)

    Robles Bayón, A; Gude Sampedro, F

    2014-01-01

    Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol<40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases. Polypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population. Copyright © 2012 Sociedad Española de Neurolog

  18. Functional Analysis and Treatment of Multiply Controlled Inappropriate Mealtime Behavior

    Science.gov (United States)

    Bachmeyer, Melanie H.; Piazza, Cathleen C.; Fredrick, Laura D.; Reed, Gregory K.; Rivas, Kristi D.; Kadey, Heather J.

    2009-01-01

    Functional analyses identified children whose inappropriate mealtime behavior was maintained by escape and adult attention. Function-based extinction procedures were tested individually and in combination. Attention extinction alone did not result in decreases in inappropriate mealtime behavior or a significant increase in acceptance. By contrast,…

  19. Prescribing Patterns and Inappropriate Use of Medications in Elderly ...

    African Journals Online (AJOL)

    Prescribing Patterns and Inappropriate Use of Medications in Elderly Outpatients in a Tertiary Hospital in Nigeria. ... Tropical Journal of Pharmaceutical Research ... Purpose: To determine the prescribing patterns and occurrence of potentially inappropriate medications (PIM) among elderly outpatients visiting a tertiary ...

  20. 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.

  1. 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.

  2. Inappropriate urinary catheter reinsertion in hospitalized older patients.

    Science.gov (United States)

    Hu, Fang-Wen; Tsai, Chuan-Hsiu; Lin, Huey-Shyan; Chen, Ching-Huey; Chang, Chia-Ming

    2017-01-01

    We investigated the incidence and rationale for inappropriate reinsertion of urinary catheters and elucidated whether reinsertion is an independent predictor of adverse outcomes. A longitudinal study was adopted. Patients aged ≥65 years with urinary catheters placed within 24 hours of hospitalization were enrolled. Data collection, including demographic variables and health conditions, was conducted within 48 hours after admission. Patients with catheters in place were followed-up every day. If the patient had catheter reinsertion, the reinsertion information was reviewed from medical records. Adverse outcomes were collected at discharge. A total of 321 patients were enrolled. Urinary catheters were reinserted in 66 patients (20.6%), with 95 reinsertions; 49.5% of catheter reinsertions were found to be inappropriate. "No evident reason for urinary catheter use" was the most common rationale for inappropriate reinsertion. Inappropriate reinsertion was found to be a significant predictor for prolonged length of hospital stay, development of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. This study indicates a considerable percentage of inappropriate urinary catheter reinsertions in hospitalized older patients. Inappropriate reinsertion was significantly associated with worsening outcomes. Efforts to improve appropriateness of reinsertion and setting clinical policies for catheterization are necessary to reduce the high rate of inappropriate reinsertion. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  3. HADES : A Mission Concept for the Identification of New Saline Aquifer Sites Suitable for Carbon Capture & Storage (CCS)

    Science.gov (United States)

    Pechorro, Ed; Lecuyot, Arnaud; Bacon, Andrew; Chalkley, Simon; Milnes, Martin; Williams, Ivan; Williams, Stuart; Muthu, Kavitha

    2014-05-01

    The Hidden Aquifer & Deep Earth Sounder (HADES) is a ground penetrating radar mission concept for identifying new saline aquifer sites suitable for Carbon Capture & Storage (CCS). HADES uses a newly proposed type of Earth Observation technique, previously deployed in Mars orbit to search for water. It has been proposed to globally map the sub-surface layers of Earth's land area down to a maximum depth of 3km to detect underground aquifers of suitable depth and geophysical conditions for CCS. We present the mission concept together with the approach and findings of the project from which the concept has arisen, a European Space Agency (ESA) study on "Future Earth Observation Missions & Techniques for the Energy Sector" performed by a consortium of partners comprising CGI and SEA. The study aims to improve and increase the current and future application of Earth Observation in provision of data and services to directly address long term energy sector needs for a de-carbonised economy. This is part of ESA's cross-agency "Space and Energy" initiative. The HADES mission concept is defined by our specification of (i) mission requirements, reflecting the challenges and opportunities with identifying CCS sites from space, (ii) the observation technique, derived from ground penetrating radar, and (iii) the preliminary system concept, including specification of the resulting satellite, ground and launch segments. Activities have also included a cost-benefit analysis of the mission, a defined route to technology maturation, and a preliminary strategic plan towards proposed implementation. Moreover, the mission concept maps to a stakeholder analysis forming the initial part of the study. Its method has been to first identify the user needs specific to the energy sector in the global transition towards a de-carbonised economy. This activity revealed the energy sector requirements geared to the identification of suitable CCS sites. Subsequently, a qualitative and quantitative

  4. 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

  5. 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

  6. Inappropriate oophorectomy at time of benign premenopausal hysterectomy.

    Science.gov (United States)

    Mahal, Amandeep S; Rhoads, Kim F; Elliott, Christopher S; Sokol, Eric R

    2017-08-01

    We assessed rates of oophorectomy during benign hysterectomy around the release of the American College of Obstetricians and Gynecologists 2008 practice bulletin on prophylactic oophorectomy, and evaluated predictors of inappropriate premenopausal oophorectomy. A cross-sectional administrative database analysis was performed utilizing the California Office of Statewide Health Planning Development Patient Discharge Database for years 2005 to 2011. After identifying all premenopausal women undergoing hysterectomy for benign conditions, International Classification of Diseases (ICD)-9 diagnosis codes were reviewed to create a master list of indications for oophorectomy. We defined appropriate oophorectomy as cases with concomitant coding for ovarian cyst, breast cancer susceptibility gene carrier status, and other diagnoses. Using patient demographics and hospital characteristics to predict inappropriate oophorectomy, a logistic regression model was created. We identified 57,776 benign premenopausal hysterectomies with oophorectomies during the period studied. Of the premenopausal oophorectomies, 37.7% (21,783) were deemed "inappropriate" with no documented reason for removal. The total number of premenopausal inpatient hysterectomies with oophorectomy decreased yearly (12,227/y in 2005 to 5,930/y in 2011). However, the percentage of inappropriate oophorectomies remained stable. In multivariate analysis, Hispanic and African American ethnicity/race associated with increased odds of inappropriate oophorectomy (P Urban and at low Medi-Cal utilization hospitals showed increased odds of inappropriate oophorectomy. In premenopausal women undergoing benign hysterectomy, over one-third undergo oophorectomy without an appropriate indication documented. The rate of inappropriate oophorectomy in California has not changed since the 2008 American College of Obstetricians and Gynecologists guidelines. Whereas the absolute number of inpatient hysterectomies for benign

  7. Prevalence and correlates of inappropriate use of benzodiazepines in Kosovo.

    Science.gov (United States)

    Tahiri, Zejdush; Kellici, Suela; Mone, Iris; Shabani, Driton; Qazimi, Musa; Burazeri, Genc

    2017-08-01

    In post-war Kosovo, the magnitude of inappropriate use of benzodiazepines is unknown to date. The aim of this study was to assess the prevalence and correlates of continuation of intake of benzodiazepines beyond prescription (referred to as "inappropriate use") in the adult population of Gjilan region in Kosovo. A cross-sectional study was conducted in Gjilan region in 2015 including a representative sample of 780 individuals attending different pharmacies and reporting use of benzodiazepines (385 men and 395 women; age range 18-87 years; response rate: 90%). A structured questionnaire was administered to all participants inquiring about the use of benzodiazepines and socio-demographic characteristics. Overall, the prevalence of inappropriate use of benzodiazepines was 58%. In multivariable-adjusted models, inappropriate use of benzodiazepines was significantly associated with older age (OR 1.7, 95% CI 1.1-2.7), middle education (OR 1.8, 95% CI 1.2-2.7), daily use (OR 1.4, 95% CI 1.1-2.0) and addiction awareness (OR 2.7, 95% CI 2.0-3.8). Furthermore, there was evidence of a borderline relationship with rural residence (OR 1.2, 95% CI 0.9-1.7). Our study provides novel evidence about the prevalence and selected correlates of inappropriate use of benzodiazepines in Gjilan region of Kosovo. Health professionals and policymakers in Kosovo should be aware of the magnitude and determinants of drug misuse in this transitional society.

  8. 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

  9. 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.

  10. 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

  11. Hypercalcemia, inappropriate calcitriol levels, and tuberculosis on hemodialysis.

    Science.gov (United States)

    Peces, R; Pobes, A; Díaz-Corte, C; Gago, E

    2000-08-01

    We describe a female patient undergoing hemodialysis who developed tuberculosis, hypercalcemia, and inappropriately elevated calcitriol levels. These findings suggest ectopic production of calcitriol by tuberculous granulomas. Successful treatment of tuberculosis led to a substantial decrease in the levels of calcium and calcitriol.

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

    African Journals Online (AJOL)

    updating physicians on the practice guidelines, participation of a clinical pharmacist in making therapeutic decisions and modifying hospital ... inappropriate overuse of PPIs include physician type, practice setting, formulary status and ... Well-trained assistants, using a structured questionnaire, recruited the study sample.

  13. [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.

  14. 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…

  15. [Identification of a novel mutation of AGL gene in two siblings affected with glycogen storage disease type IIIa].

    Science.gov (United States)

    Guo, Li; Lin, Weixia; Mao, Man; Song, Yuanzong

    2017-08-10

    To detect potential mutation of the AGL gene in two siblings affected with glycogen storage disease type IIIa. Clinical data of the two siblings was collected and analyzed. Genomic DNA was extracted from peripheral venous blood samples from the patients and their parents. All exons and their flanking sequences of the AGL gene were subjected to PCR amplification and Sanger sequencing. Suspected mutation was verified in 75 healthy controls. The main clinical features of the two siblings included hypoglycemia and hepatomegaly, along with markedly elevated liver and myocardial enzymes. Genetic analysis revealed that both siblings harbored compound heterozygous mutations c.1735+1G>T and c.959-1G>C of the AGL gene. Among these, the splicing mutation c.959-1G>C was a novel one with an allele frequency of glycogen storage disease type IIIa. The c.959-1G>C has enriched the spectrum of AGL gene mutations.

  16. 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

  17. High level waste storage tank farms/242-A evaporator standards/requirements identification document phase 1 assessment report

    Energy Technology Data Exchange (ETDEWEB)

    Biebesheimer, E., Westinghouse Hanford Co.

    1996-09-30

    This document, the Standards/Requirements Identification Document (S/RID) Phase I Assessment Report for the subject facility, represents the results of an Administrative Assessment to determine whether S/RID requirements are fully addressed by existing policies, plans or procedures. It contains; compliance status, remedial actions, and an implementing manuals report linking S/RID elements to requirement source to implementing manual and section.

  18. 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

  19. 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.

  20. Factors associated with inappropriate utilisation of emergency department services.

    Science.gov (United States)

    Selasawati, H G; Naing, L; Wan Aasim, W A; Winn, T; Rusli, B N

    2007-01-01

    This study was carried out to determine the associated factors and the reasons for inappropriate utilisation of Emergency Department (ED) services at Universiti Sains Malaysia Hospital. A case-control study was conducted with 170 cases from ED and 170 controls from the Outpatient Department (OPD). A self-administered questionnaire was designed and used to obtain sociodemographic data, knowledge on the functions of ED and OPD, health seeking attitude and behaviour, and reasons for seeking treatment at ED. The study found that gender, marital status, family size, shift work, perceived illness, and knowledge on the role and functions of ED and OPD were significant associated factors. The three most common reasons for inappropriate utilisation of ED were as follows: "due to severity of illness" (85%), "can't go to OPD during office hours" (42%), and "ED near my house" (27%).

  1. 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.

  2. 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

  3. 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.

  4. Requests for "inappropriate" treatment based on religious beliefs.

    Science.gov (United States)

    Orr, R D; Genesen, L B

    1997-06-01

    Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured.

  5. 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.

  6. 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

  7. Potentially inappropriate medications among older adults in Pelotas, Southern Brazil.

    Science.gov (United States)

    Lutz, Bárbara Heather; Miranda, Vanessa Irribarem Avena; Bertoldi, Andréa Dâmaso

    2017-06-22

    To assess the use of potentially inappropriate medications among older adults. This is a population-based cross-sectional study with 1,451 older individuals aged 60 years or more in the city of Pelotas, State of Rio Grande do Sul, Brazil, in 2014. We have investigated the use of medications in the last 15 days. Using the Beers criteria (2012), we have verified the use of potentially inappropriate medications and their relationship with socioeconomic and demographic variables, polypharmacy, self-medication, and burden of disease. Among the 5,700 medications used, 5,651 could be assessed as to being inappropriate. Of these, 937 were potentially inappropriate for the older adults according to the 2012 Beers criteria (16.6%). Approximately 42.4% of the older adults studied used at least one medication considered as potentially inappropriate. The group of medications for the nervous system accounted for 48.9% of the total of the potentially inappropriate medications. In the adjusted analysis, the variables female, advanced age, white race, low educational level, polypharmacy, self-medication, and burden of disease were associated with the use of potentially inappropriate medications. It is important to known the possible consequences of the use of medication among older adults. Special attention should be given to the older adults who use polypharmacy. Specific lists should be created with more appropriate medications for the older population in the National Essential Medicine List. Avaliar o uso de medicamentos potencialmente inadequados entre idosos. Estudo transversal de base populacional com 1.451 idosos com 60 anos ou mais em Pelotas, RS, em 2014. Investigou-se o uso de medicamentos nos últimos 15 dias. Utilizando os critérios de Beers (2012), verificou-se a potencial inadequação dos medicamentos e sua relação com variáveis socioeconômicas e demográficas, polifarmácia, automedicação e carga de doença. Dentre os 5.700 medicamentos utilizados, 5

  8. 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.

  9. 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.

  10. 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

  11. 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.

  12. 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

  13. Medically Inappropriate or Futile Treatment: Deliberation and Justification 1

    Science.gov (United States)

    Misak, Cheryl J.; White, Douglas B.; Truog, Robert D.

    2016-01-01

    This paper reframes the futility debate, moving away from the question “Who decides when to end what is considered to be a medically inappropriate or futile treatment?” and toward the question “How can society make policy that will best account for the multitude of values and conflicts involved in such decision-making?” It offers a pragmatist moral epistemology that provides us with (1) a clear justification of why it is important to take best standards, norms, and physician judgment seriously and (2) a clear justification of why ample opportunity must be made for patients, families, and society to challenge those standards and norms. PMID:26681796

  14. Mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy

    DEFF Research Database (Denmark)

    Suppli, M.; Aabenhus, R.; Harboe, Z.B.

    2010-01-01

    Enterococcus species are common in nosocomial bloodstream infections and their incidence is rising. Although well recognized in several serious bacterial infections, the influence of appropriate antimicrobial therapy in enterococcal bacteraemia has not been fully settled. The aim of the study.......7-10), thrombocytopenia (3.9, 1.6-9.3), chronic liver failure (3.3, 1.1-10) and age >/=60 years (2.2, 0.99-5.0). Antibiotics not appropriately covering enterococci are frequently administered empirically in suspected bloodstream infections. Inappropriate antibiotic therapy was an independent risk factor for mortality...

  15. Quetiapine-Induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone

    Directory of Open Access Journals (Sweden)

    Theocharis Koufakis

    2016-01-01

    Full Text Available The syndrome of inappropriate secretion of antidiuretic hormone (SIADH can be induced by various conditions, including malignant neoplasms, infections, central nervous system disorders, and numerous drugs. We here report a case of a 65-year-old female patient, treated with quetiapine for schizophrenia, who presented with generalized tonic-clonic seizures and was finally diagnosed with quetiapine-induced SIADH. Quetiapine-associated hyponatremia is extremely uncommon and only a few, relevant reports can be found in the literature. This case underlines the fact that patients on antipsychotic medication and more specifically on quetiapine should be closely monitored and routinely tested for electrolyte disorders.

  16. 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...... peptide (P = 0.007), elevated mean arterial blood pressure (P = 0.03), and lower plasma levels of creatinine (P = 0.002) compared to the controls. CONCLUSION: A spot urine sample seems to be sufficient to confirm the diagnosis of SIADH....

  17. Case report: Hepatocellular carcinoma in type 1a glycogen storage disease with identification of a glucose-6-phosphatase gene mutation in one family.

    Science.gov (United States)

    Nakamura, T; Ozawa, T; Kawasaki, T; Yasumi, K; Wang, D Y; Kitagawa, M; Takehira, Y; Tamakoshi, K; Yamada, M; Kida, H; Sugie, H; Nakamura, H; Sugimura, H

    1999-06-01

    A 40-year-old man with glycogen storage disease type 1a (von Gierke disease, GSD1a) developed hepatocellular carcinoma (HCC). Cold single-strand conformation polymorphism (SSCP) with 12% glycerol identified the G727T mutation in the glucose-6-phosphatase (G6Pase) gene, which has been reported to be the most common mutation in Japanese GSD1a patients. This case report is the first documentation of HCC in a case with G727T mutation. Given the prevalence of HCC in GSD1a with various germline mutations, analysis is needed to confirm that the germline mutation in this case is really related to hepatocarcinogenesis. DNA analysis of the family pedigree of this case, revealed three individuals with GSD1a and seven heterozygous carriers of the G727T mutation. As the diagnosis of GSD1a in this family was made only after these three patients reached adulthood, DNA diagnosis may help early identification of GSD1a patients and prevention of the progression of the disease. This DNA-based diagnosis permits prenatal diagnosis in at-risk patients and may facilitate screening and counselling of patients clinically suspected of having this disease.

  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. 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

  20. [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.

  1. Prospective evaluation of inappropriate unable-to-assess CAM-ICU documentations of critically ill adult patients.

    Science.gov (United States)

    Terry, Kimberly J; Anger, Kevin E; Szumita, Paul M

    2015-01-01

    Delirium occurs in the intensive care unit and identification is often performed using a validated assessment tool such as the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) patients. The CAM-ICU has three ratings: positive, negative, and unable to assess (UTA). Patients may often be assigned UTA when it is inappropriate given the level of sedation or medical condition. The purpose of this study is to evaluate the rate of inappropriate UTA CAM-ICU documentations. A single-center prospective observational analysis was performed evaluating CAM-ICU documentations from October 27, 2014, to December 26, 2014. Patients admitted to the medical and surgical ICU were included and excluded if admitted to the ICU for less than 24 h. CAM-ICU assessments were performed per institutional guidelines using CAM-ICU scoring as validated in literature. CAM-ICU patient documentations were recorded as positive, negative, UTA, or not assessed. Patients with an appropriate UTA documentation were deeply sedated, non-English speaking, or not medically able to participate in the assessment. The major endpoint assessed rates of inappropriate UTA CAM-ICU documentations. Minor endpoints evaluated adherence to CAM-ICU documentations and use of pharmacologic agents for symptoms of delirium. Sixty-one patients were identified with 45 (74 %) medical, 16 (26 %) surgical, of which 27 (44.3 %) were mechanically ventilated. There were 116 UTA documentations with 35 (30.2 %) identified as inappropriate. Of the 906 identified CAM-ICU documentation opportunities, adherence was 439 (48.5 %). Overall, 18 (29.5 %) of the 61 patients were administered pharmacologic agents for delirium management and 5 (27.7 %) had a positive CAM-ICU documented within 24 h. Rates of inappropriate UTA CAM-ICU documentations may be significantly higher than reported in literature. Additional research is needed to identify an acceptable rate of inappropriate UTA CAM-ICU assessments and its clinical impact

  2. 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

  3. Potentially inappropriate prescriptions in patients admitted to a psychiatric hospital

    DEFF Research Database (Denmark)

    Soerensen, Ann Lykkegaard; Nielsen, Lars Peter; Poulsen, Birgitte Klindt

    2016-01-01

    Background Very little is known about the general appropriateness of prescribing for psychiatric patients. Aims To identify prevalence and types of potentially inappropriate prescribing (PIP) of psychotropic and somatic medications, to assess the severity of potential clinical consequences...... and to identify possible predictive factors of PIP in a sample of adult psychiatric in-patients. Methods A descriptive, cross-sectional design using medication reviews by clinical pharmacologists to identify PIP during a 3-month period. The setting was in-patient units in a psychiatric department of a Danish...... the most frequent PIP. Predictive factors for PIP were polypharmacy (>5 prescriptions) and having one or more somatic diagnoses. Conclusion PIP is common in psychiatric patients and potentially fatal. Particularly polypharmacy (>5 prescriptions) and concomitant somatic illness were associated...

  4. Inappropriate sexual behaviour experienced by speech-language therapists.

    Science.gov (United States)

    Williams, T H; de Seriere, J; Boddington, L

    1999-01-01

    Inappropriate sexual behaviour by clients or patients of health professionals has been noted as a considerable problem in a number of professions. Similarly, sexual harassment by colleagues or employers has been identified as causing stress and harm. The primary objective of this study was to investigate the experience of speech-language therapists in New Zealand of inappropriate sexual behaviour (ISB) by colleagues, clients, and care givers of clients. A questionnaire developed by McComas and colleagues to investigate ISB directed by patients at physical therapists in Canada was adapted to meet the broader requirements of this study. This questionnaire was sent to all members of the New Zealand Speech-Language Therapists' Association and to current third- and fourth-year students in the Bachelor of Speech and Language Therapy degree programme in 1994. The overall return rate was 70%. A large number of respondents (81%) reported experiencing some level of ISB. The number of incidents of ISB from clients and colleagues was identified with equal frequency; care givers less frequently. Fewer students than qualified therapists reported ISB as sexual harassment. ISB affects work performance (e.g. absenteeism) and causes psychological reactions (e.g. stress). A majority of respondents reported being satisfied with how they handled ISB but considered there would be value in having training for both qualified and student therapists in managing such behaviour. Conclusions drawn from the study are that colleagues as well as clients are a serious source of ISB for qualified and student speech-language therapists; that negative effects in this group are similar to those in other professions; that speech-language therapists experience less ISB from clients than some other professions; and that, despite legal steps to curb sexual harassment, it continues to be an issue that requires local administrative and educative attention.

  5. Syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH).

    Science.gov (United States)

    Hamilton, Mark G; Price, Angel V

    2012-01-01

    Most patients with acute hydrocephalus have ventriculomegaly and high intracranial pressure (ICP). However, there is a subset of patients who are symptomatic with acute ventriculomegaly and inappropriately low ICP. Two patient groups were defined. Each patient presented with clinical deterioration that included a significant decrease in level of consciousness with new and significant ventriculomegaly. Patients in group 1 (n = 10) were managed without endoscopic third ventriculostomy (ETV). Group 2 was a series of patients (n = 10) managed with ETV. Treatment for both groups involved insertion of an external ventricular drain (EVD) with ICP <5 cmH(2)O. Further treatment consisted of either neck wrapping with a tensor bandage and/or lowering the EVD to negative levels to facilitate drainage of cerebrospinal fluid (CSF), which resulted in clinical improvement and resolution of ventriculomegaly. All 20 patients had anatomical obstruction to CSF flow into the subarachnoid space (SAS) confirmed by magnetic resonance imaging (MRI) with cine MRI studies. Group 1 patients were treated until shunt revision/insertion was possible (n = 7), ICP normalized, and the EVD could be removed (n = 2), or death (n = 1) occurred. Patients in group 2 all underwent ETV, and ICP patterns normalized in all. Group 2 patients were managed with an EVD until shunt revision/insertion was required (n = 2), ICP normalized and the EVD could be removed (n = 7), or death (n = 1) occurred. The syndrome of inappropriately low-pressure acute hydrocephalus (SILPAH) is an important entity in both children and adults. A possible hypothesis invokes loss of an effective SAS. ETV reestablishes communication between the SAS and ventricles, producing a rapid return of normal ICP dynamics and a significant decrease in the number of shunt-dependent patients.

  6. 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

  7. Molecular analysis of the AGL gene: identification of 25 novel mutations and evidence of genetic heterogeneity in patients with Glycogen Storage Disease Type III.

    Science.gov (United States)

    Goldstein, Jennifer L; Austin, Stephanie L; Boyette, Keri; Kanaly, Angela; Veerapandiyan, Aravind; Rehder, Catherine; Kishnani, Priya S; Bali, Deeksha S

    2010-07-01

    Glycogen Storage Disease Type III (limit dextrinosis; Cori or Forbes disease) is an autosomal recessive disorder of glycogen metabolism caused by deficient activity of glycogen debranching enzyme in liver and muscle (Glycogen Storage Disease Type IIIa) or liver only (Glycogen Storage Disease Type IIIb). These two clinically distinct phenotypes are caused by mutations in the same gene (amylo-1,6-glucosidase or AGL). Although most patients with Glycogen Storage Disease Type III have private mutations, common mutations have been identified in some populations, and two specific mutations in exon 3, c.18_19delGA (p.Gln6HisfsX20) and c.16C>T (p.Gln6X), are associated with the Glycogen Storage Disease Type IIIb phenotype. To further examine the heterogeneity found in Glycogen Storage Disease Type III patients, we have sequenced the AGL gene in 34 patients with a clinically and/or biochemically confirmed diagnosis of Glycogen Storage Disease Type III. We have identified 38 different mutations (25 novel and 13 previously reported) and have compiled a list of all mutations previously reported in the literature. We conclude that Glycogen Storage Disease Type III is a highly heterogeneous disorder usually requiring full gene sequencing to identify both pathogenic mutations. The finding of at least one of the two exon 3 mutations in all of the Glycogen Storage Disease Type IIIb patients tested allows for diagnosis of this subtype without the need for a muscle biopsy.

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

    OpenAIRE

    Lee, Chun-Hsien; Chang, Fong-Ching; Hsu, Sheng-Der; Chi, Hsueh-Yun; Huang, Li-Jung; Yeh, Ming-Kung

    2017-01-01

    Background 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. Method 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 factor...

  9. 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.

  10. 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.

  11. 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.

  12. 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.

  13. Molecular identification of the microbiota of peeled and unpeeled brown shrimp (Crangon crangon) during storage on ice and at 7.5 °C.

    Science.gov (United States)

    Broekaert, Katrien; Heyndrickx, Marc; Herman, Lieve; Devlieghere, Frank; Vlaemynck, Geertrui

    2013-12-01

    The dominant microbiota of brown shrimp (Crangon crangon) were systematically identified during storage under different conditions. Freshly caught shrimp were processed on board the fishing vessel under the best possible hygienic conditions (IDEAL), unpeeled and manually (sterile) peeled, then stored on ice and at 7.5 °C until microbiologically spoiled. Results were compared with industrially processed (INDUSTRIAL) shrimp. Isolates grown on various media were identified by 16S rRNA and gyrB gene sequencing. We examined the total microbiota and microbial population shifts of shrimp under various storage conditions using denaturant gradient gel electrophoresis (DGGE). The microbiota differed somewhat during storage and among the various storage conditions; however, members of the genera Psychrobacter and Pseudoalteromonas were found to dominate the microbiota of all shrimp samples regardless of processing procedures or storage conditions. Most isolates could be identified by gyrB gene sequencing as Psychrobacter immobilis or Psychrobacter cibarius. Also Pseudoalteromonas nigrifaciens, Pseudoalteromonas elyakovii or Pseudoalteromonas paragorgicola dominated the microbiota of brown shrimp during storage. Also species from the genera Planocuccus, Exiguobacterium, Carnobacterium, Pseudomonas, Chryseobacterium and Staphylococcus were detected during storage of brown shrimp. Culture-dependent and culture-independent DGGE analysis produced different results in band patterns. Both methods are therefore required to accurately identify the microbiota and bacterial population shifts on seafood during storage. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. 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.

  15. 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.

  16. 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

  17. Inappropriate shock: a failure of SVT discriminators in a dual chamber ICD?

    Science.gov (United States)

    Al-Ahmad, Amin; Tsiperfal, Angela; Hsia, Henry H; Wang, Paul J

    2006-12-01

    Inappropriate shock remains a major issue in patients with implantable cardioverter defibrillators. We examine an inappropriate shock delivered in a patient with atrial tachycardia that conducted 1:1. We reconstruct the device algorithms that led to therapy delivery and discuss programming changes that could be considered.

  18. 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…

  19. [Management of inappropriate shocks/T-wave-oversensing in S-ICD®-patients].

    Science.gov (United States)

    Larbig, Robert; Bettin, Markus; Motloch, Lukas J; Fischer, Alicia; Bode, Niklas; Frommeyer, Gerrit; Reinke, Florian; Loeher, Andreas; Eckardt, Lars; Köbe, Julia

    2018-02-12

    Inappropriate shocks are a feared complication after implantable cardioverter-defibrillator (ICD) implantation and have a tremendous impact on quality of life. Inappropriate shocks in patients with subcutaneous ICD (S-ICD®, Boston Scientific, Marlborough, MA, USA) have various underlying causes. This review summarizes the current literature on this topic and lists possible treatment options.

  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

    independently by two authors. RESULTS: The definition of 'Inappropriate admissions' near the end of life incorporated system factors, social and family factors. The prevalence of inappropriate admissions ranged widely depending largely on non-clinical reasons: poor availability of alternative sites of care...

  1. 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.

  2. Factors predictive of inappropriateness in requests for parenteral antimicrobials for therapeutic purposes: a study in a small teaching hospital in Brazil.

    Science.gov (United States)

    Kawanami, Gustavo Hideki; Fortaleza, Carlos Magno Castelo Branco

    2011-07-01

    The identification of patterns of inappropriate antimicrobial prescriptions in hospitals contributes to the improvement of antimicrobial stewardship programs (ASP). We conducted a cross-sectional study to identify predictors of inappropriateness in requests for parenteral antimicrobials (RPAs) in a teaching hospital with 285 beds. We reviewed 25% of RPAs for therapeutic purposes from y 2005. Appropriateness was evaluated according to current guidelines for antimicrobial therapy. We assessed predictors of inappropriateness through univariate and multivariate models. RPAs classified as 'appropriate' or 'probably appropriate' were selected as controls. Case groups comprised inappropriate RPAs, either in general or for specific errors. Nine hundred and sixty-three RPAs were evaluated, 34.6% of which were considered inappropriate. In the multivariate analysis, general predictors of inappropriateness were: prescription on weekends/holidays (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.20-2.28, p = 0.002), patient in the intensive care unit (OR 1.57, 95% CI 1.11-2.23, p = 0.01), peritoneal infection (OR 2.15, 95% CI 1.27-3.65, p = 0.004), urinary tract infection (OR 1.89, 95% CI 1.25-2.87, p = 0.01), combination therapy with 2 or more antimicrobials (OR 1.72, 95% CI 1.15-2.57, p = 0.008) and prescriptions including penicillins (OR 2.12, 95% CI 1.39-3.25, p = 0.001) or 1(st) generation cephalosporins (OR 1.74, 95% CI 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR 0.34, 95% CI 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR 0.04, 95% CI 0.01-0.26, p = 0.001) and requests for agents with an insufficient antimicrobial spectrum (OR 0.14, 95% CI 0.03-0.30, p = 0.01). Our results demonstrate the importance of

  3. Analysis of Inappropriate Medication Use in Older Adults Discharged From Hospitals Affiliated With Tehran University of Medical Sciences (TUMS Using the Beers Criteria in 2010

    Directory of Open Access Journals (Sweden)

    Leila Vali

    2011-10-01

    Full Text Available Objectives: Studies demonstrate that chronic diseases are more frequent among the elderly than other age groups. Therefore, it is reasonable to assume that more pharmaceuticals are consumed by this age group than by others and that older patients are more prone to pharmaceutical side effects and complications due to such higher drug consumption rates. Changes in pharmacokinetics and pharmacodynamics, among others, are considered as major causes of medication related complications among the elderly. Another factor worth noting is the inappropriate choice of medications prescribed for such patients, who can benefit from the identification of such medications and better care in their prescription. These issues are among the well known factors discussed in recent and relevant literature and may inflict significant harm on the health and well-being of the elderly population. Methods & Materials: For the purpose of the present study 212 patients aged 60yr and over (mean age: 69.32 yr discharged from 4 (2 teaching and 2 non-teaching general hospitals affiliated with TUMS were selected. The Beers Criteria was employed to assess inappropriate use of pharmaceuticals by the sample population. Results: Findings reveal that there was a significant relation between the level of income and the inappropriate use of medications among the sample population (P=0.041. The most frequent inappropriate use of medications, in order of frequency, included alprazolam (16.66%, chlordiazepoxide (14.28%, fluoxetine (11.90%, and oxazepam (11.90%. The highest rate of drug interactions was observed for the drug clopidogrel (29.4%. Benzodiazepines were recognized as the most frequent class of pharmaceuticals consumed by the patients (49.98%. There was no significant relationship between income rates and the amount of inappropriate drug use (P=0.041. Conclusion: Inappropriate consumption of pharmaceuticals was relatively high among the study population, in comparison to similar

  4. 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.

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

    Science.gov (United States)

    Lee, Chun-Hsien; Chang, Fong-Ching; Hsu, Sheng-Der; Chi, Hsueh-Yun; Huang, Li-Jung; Yeh, Ming-Kung

    2017-01-01

    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.

  6. 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.

  7. 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.

  8. 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

  9. 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

  10. Understanding Factors Contributing to Inappropriate Critical Care: A Mixed-Methods Analysis of Medical Record Documentation.

    Science.gov (United States)

    Neville, Thanh H; Tarn, Derjung M; Yamamoto, Myrtle; Garber, Bryan J; Wenger, Neil S

    2017-11-01

    Factors leading to inappropriate critical care, that is treatment that should not be provided because it does not offer the patient meaningful benefit, have not been rigorously characterized. We explored medical record documentation about patients who received inappropriate critical care and those who received appropriate critical care to examine factors associated with the provision of inappropriate treatment. Medical records were abstracted from 123 patients who were assessed as receiving inappropriate treatment and 66 patients who were assessed as receiving appropriate treatment but died within six months of intensive care unit (ICU) admission. We used mixed methods combining qualitative analysis of medical record documentation with multivariable analysis to examine the relationship between patient and communication factors and the receipt of inappropriate treatment, and present these within a conceptual model. One academic health system. Medical records revealed 21 themes pertaining to prognosis and factors influencing treatment aggressiveness. Four themes were independently associated with patients receiving inappropriate treatment according to physicians. When decision making was not guided by physicians (odds ratio [OR] 3.76, confidence interval [95% CI] 1.21-11.70) or was delayed by patient/family (OR 4.52, 95% CI 1.69-12.04), patients were more likely to receive inappropriate treatment. Documented communication about goals of care (OR 0.29, 95% CI 0.10-0.84) and patient's preferences driving decision making (OR 0.02, 95% CI 0.00-0.27) were associated with lower odds of receiving inappropriate treatment. Medical record documentation suggests that inappropriate treatment occurs in the setting of communication and decision-making patterns that may be amenable to intervention.

  11. 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

  12. 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.

  13. 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.

  14. Inappropriate antibiotic prescription for respiratory tract indications : most prominent in adult patients

    NARCIS (Netherlands)

    Dekker, Anne R. J.; Verheij, Theo J. M.; van der Velden, Alike W.

    Background. Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient

  15. Effects of Personality on Social Network Disclosure: Do Emotionally Intelligent Individuals Post Inappropriate Content?

    Directory of Open Access Journals (Sweden)

    Chockalingam Viswesvaran

    2012-12-01

    Full Text Available The prevalence of individuals using social networking sites to stay connected has increased considerably in only a few years and the information posted is now being used by organizations for employee selection. The purpose of the current study was to investigating how differences on the Big Five Personality traits, honesty-integrity, and emotional intelligence influence whether individuals post inappropriate social network content. Participants were 506 college students from a large metropolitan state university in the Southeastern United States. Results suggest individuals scoring high on emotional intelligence and honesty/integrity disclosed less inappropriate social network content. Emotional intelligence was not, however, predictive of inappropriate disclosure above and beyond the Big Five Personality traits. Honest and emotionally intelligent individuals seem to understand the negative implications of disclosing inappropriate social network content. Future research should examine how social network information is being used in employee selection and the predictive validity of this method.

  16. 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.

  17. Correlates of (inappropriate) benzodiazepine use : the Netherlands Study of Depression and Anxiety (NESDA)

    NARCIS (Netherlands)

    Manthey, Leonie; van Veen, Tineke; Giltay, Erik J.; Stoop, Jose E.; Neven, Arie Knuistingh; Penninx, Brenda W. J. H.; Zitman, Frans G.

    AIM Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. METHODS We

  18. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA)

    NARCIS (Netherlands)

    Manthey, L.; van Veen, T.; Giltay, E.J.; Stoop, J.E.; Neven, A.K.; Penninx, B.W.J.H.; Zitman, F.G.

    2011-01-01

    AIM Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model.METHODS We

  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.......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 Detection of a Supraventricular Tachycardia as Dual Tachycardia by the PR Logic™ Algorithm

    Directory of Open Access Journals (Sweden)

    Ajit Thachil, MD, DM, CCDS

    2014-05-01

    Full Text Available Tachycardia detection and therapy algorithms in Implantable Cardioverter-Defibrillators (ICD reduce, but do not eliminate inappropriate ICD shocks. Awareness of the pros and cons of a particular algorithm helps to predict its utility in specific situations. We report a case where PR logic™, an algorithm commonly used in currently implanted ICDs to differentiate supraventricular tachycardia (SVT from ventricular tachycardia resulted in inappropriate detection and shock for an SVT, and discuss several solutions to the problem.

  1. 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

  2. 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.

  3. Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study.

    Directory of Open Access Journals (Sweden)

    Giuseppe Colloca

    Full Text Available BACKGROUND: It has been estimated that Nursing Home (NH residents with impaired cognitive status receive an average of seven to eight drugs daily. The aim of this study was to determine prevalence and factors associated with use of inappropriate drugs in elderly patients with severe cognitive impairment living in NH in Europe. METHODS: Cross-sectional data from a sample of 1449 NH residents with severe cognitive impairment, participating in the Services and Health for Elderly in Long TERm care (SHELTER study were analysed. Inappropriate drug use was defined as the use of drugs classified as rarely or never appropriate in patients with severe cognitive impairment based on the Holmes criteria published in 2008. RESULTS: Mean age of participating residents was 84.2±8.9 years, 1087 (75.0% were women. Inappropriate drug use was observed in 643 (44.9% residents. Most commonly used inappropriate drugs were lipid-lowering agents (9.9%, antiplatelet agents (excluding Acetylsalicylic Acid - ASA - (9.9%, acetylcholinesterase, inhibitors (7.2% and antispasmodics (6.9%. Inappropriate drug use was directly associated with specific diseases including diabetes (OR 1.64; 95% CI 1.21-2.24, heart failure (OR 1.48; 95% CI 1.04-2.09, stroke (OR 1.43; 95% CI 1.06-1.93, and recent hospitalization (OR 1.69; 95% CI 1.20-2.39. An inverse relation was shown between inappropriate drug use and presence of a geriatrician in the facility (OR 0.55; 95% CI 0.39-0.77. CONCLUSION: Use of inappropriate drugs is common among older EU NH residents. Determinants of inappropriate drug use include comorbidities and recent hospitalization. Presence of a geriatrician in the facility staff is associated with a reduced rate of use of these medications.

  4. 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.

  5. 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.

  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. Identification and quantification of the oxidation products derived from α-acids and β-acids during storage of hops ( Humulus lupulus L.).

    Science.gov (United States)

    Taniguchi, Yoshimasa; Matsukura, Yasuko; Ozaki, Hiromi; Nishimura, Koichi; Shindo, Kazutoshi

    2013-03-27

    α-Acids and β-acids, two main components of hop resin, are known to be susceptible to oxygen and degraded during hop storage, although the oxidation products in stored hops have not been fully identified. In this study, we developed a high-performance liquid chromatography (HPLC) analysis method suitable for separation and quantification of the oxidation products. This HPLC analysis clearly proved, for the first time, that humulinones and hulupones are major products in oxidized hops. We are also the first to identify novel 4'-hydroxy-allohumulinones, suggested to be oxidative products of humulinones, by means of NMR spectroscopy and high-resolution mass spectrometry. Using the developed analytical method, changes in α- and β-acids and their oxidation products during hop storage were clearly revealed for the first time.

  8. 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.

  9. Identification and dating of indigenous water storage reservoirs along the Rio San José at Laguna Pueblo, western New Mexico, USA

    Science.gov (United States)

    Huckleberry, Gary; Ferguson, T.J.; Rittenour, Tammy M.; Banet, Chris; Mahan, Shannon

    2016-01-01

    An investigation into indigenous water storage on the Rio San José in western New Mexico was conducted in support of efforts by the Pueblo of Laguna to adjudicate their water rights. Here we focus on stratigraphy and geochronology of two Native American-constructed reservoirs. One reservoir located near the community of Casa Blanca was formed by a ∼600 m (2000 feet) long stone masonry dam that impounded ∼1.6 × 106 m3 (∼1300 acre-feet) of stored water. Four optically stimulated luminescence (OSL) ages obtained on reservoir deposits indicate that the dam was constructed prior to AD 1825. The other reservoir is located adjacent to Old Laguna Pueblo and contains only a small remnant of its former earthen dam. The depth and distribution of reservoir deposits and a photogrammetric analyses of relict shorelines indicate a storage capacity of ∼6.5 × 106 m3 (∼5300 ac-ft). OSL ages from above and below the base of the reservoir indicate that the reservoir was constructed sometime after AD 1370 but before AD 1750. The results of our investigation are consistent with Laguna oral history and Spanish accounts demonstrating indigenous construction of significant water-storage reservoirs on the Rio San José prior to the late nineteenth century.

  10. Inappropriate and cloned clinical histories on radiology request forms for sick children.

    Science.gov (United States)

    Shah, Chetan Chandulal; Linam, Leann; Greenberg, S Bruce

    2013-10-01

    An appropriate clinical history improves the perception and interpretation of radiographic examinations in children and adults. However, clinical history provided on radiology request has not been studied for its appropriateness and frequency of cloned clinical history. The purpose of this study was to determine the frequency of inappropriate histories and cloned histories at a tertiary-care children's hospital. We analyzed radiology request forms of 388 outpatient and inpatient radiographic examinations obtained on 3 days during the same month at a tertiary-care children's hospital. Appropriateness of the clinical history was judged by its relevance to the examination ordered and appropriate associated billable ICD-9 code. Cloning was defined as identical clinical histories appearing on the radiology request on three consecutive days. Cloned histories were further subdivided as being appropriate or inappropriate. A total of 18% (70/388) of the requests for clinical history were either inappropriate, cloned or both. Neonatal intensive care unit (NICU) referrals constituted the majority (82%, 9/11) of combined inappropriate history and cloning. NICU referrals accounted for 52% (28/54) of all inappropriate clinical histories, a significantly higher percentage than other inpatient locations (P = 0.006). The cardiovascular intensive care unit (CVICU) was the second most common patient location for inappropriate clinical histories (11%, 6/54). About one-third of the radiographic requests from the NICU had inappropriate histories (35%, 28/79). Among the outpatient referrals, 50% (4/8) of the inappropriate histories were from the emergency department. The most common cloned histories included "hypoplastic left heart syndrome" (15%, 4/27), "endotracheal tube placement" (11%, 3/27) and "evaluate lung fields and bowel" (11%, 3/27). The most commonly cloned clinical history was seen on referrals from the NICU at 63% (17/27), a significantly higher percentage than other

  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. 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

  13. 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

  14. 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.

  15. 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

  16. 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.

  17. Inappropriate implantable cardioverter defibrillator shocks-incidence, effect, and implications for driver licensing.

    Science.gov (United States)

    Watanabe, Eiichi; Okajima, Katsunori; Shimane, Akira; Ozawa, Tomoya; Manaka, Tetsuyuki; Morishima, Itsuro; Asai, Toru; Takagi, Masahiko; Honda, Toshihiro; Kasai, Atsunobu; Fujii, Eitaro; Yamashiro, Kohei; Kohno, Ritsuko; Abe, Haruhiko; Noda, Takashi; Kurita, Takashi; Watanabe, Shigeyuki; Ohmori, Hiroya; Nitta, Takashi; Aizawa, Yoshifusa; Kiyono, Ken; Okumura, Ken

    2017-09-01

    Patients with implantable cardioverter defibrillators (ICDs) have an ongoing risk of sudden incapacitation that may cause traffic accidents. However, there are limited data on the magnitude of this risk after inappropriate ICD therapies. We studied the rate of syncope associated with inappropriate ICD therapies to provide a scientific basis for formulating driving restrictions. Inappropriate ICD therapy event data between 1997 and 2014 from 50 Japanese institutions were analyzed retrospectively. The annual risk of harm (RH) to others posed by a driver with an ICD was calculated for private driving habits. We used a commonly employed annual RH to others of 5 in 100,000 (0.005%) as an acceptable risk threshold. Of the 4089 patients, 772 inappropriate ICD therapies occurred in 417 patients (age 61 ± 15 years, 74% male, and 65% secondary prevention). Patients experiencing inappropriate therapies had a mean number of 1.8 ± 1.5 therapy episodes during a median follow-up period of 3.9 years. No significant differences were found in the age, sex, or number of inappropriate therapies between patients receiving ICDs for primary or secondary prevention. Only three patients (0.7%) experienced syncope associated with inappropriate therapies. The maximum annual RH to others after the first therapy in primary and secondary prevention patients was calculated to be 0.11 in 100,000 and 0.12 in 100,000, respectively. We found that the annual RH from driving was far below the commonly cited acceptable risk threshold. Our data provide useful information to supplement current recommendations on driving restrictions in ICD patients with private driving habits.

  18. 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.

  19. 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. PMID:26973669

  20. 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.

  1. 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.)

  2. 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

  3. 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

  4. 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.

  5. Healthcare providers attitudes and perceptions of 'inappropriate attendance' in the Emergency Department.

    Science.gov (United States)

    Breen, Bernadette M; McCann, Margaret

    2013-07-01

    Emergency Departments (EDs) worldwide are facing a crisis from overcrowding and a common perception exists that inappropriate use of the ED is a major contributing factor. Patients, who attend the ED with non-urgent problems, could be dealt with by a General Practitioner; such patients use time and resources that would otherwise be used for patients with more appropriate needs. To explore attitudes and perceptions of healthcare providers regarding 'inappropriate attendance' in the ED. Using a survey questionnaire, this descriptive quantitative study included ED nurses, doctors and paramedics from three regional hospitals in the Republic of Ireland. A total of 163 surveys were returned (59% response rate). There was an overwhelming agreement among respondents that inappropriate attendance in Irish ED exists and poses a considerable challenge for healthcare providers. Results suggest differences of opinion on what represents inappropriate ED use. Potential solutions to address the issue of inappropriate ED attendance include General Practitioners and Advanced Nurse Practitioners practicing within the ED setting; education and greater public awareness and faster access to a specialist opinion in the Out Patient Department. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    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

  8. 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.

  9. 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.

  10. 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

    BACKGROUND: The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy...... 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...... (hazard ratio, 4.17; 95% confidence interval, 1.52-11.40; P=0.005) and appropriate therapy (hazard ratio, 2.49; 95% confidence interval, 1.06-5.87; P=0.037) compared with those who did not. CONCLUSIONS: Innovative high-rate cutoff or delayed ICD programming was associated with a reduction in inappropriate...

  11. The Effect of ICD Programming on Inappropriate and Appropriate ICD Therapies in Ischemic and Nonischemic Cardiomyopathy

    DEFF Research Database (Denmark)

    Sedláček, Kamil; Ruwald, Anne-Christine; Kutyifa, Valentina

    2015-01-01

    INTRODUCTION: 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. METHODS AND RESULTS: 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......-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

  12. 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

    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...

  13. Dementia and inappropriate sexual behavior (ISB: What we know and what we need to know

    Directory of Open Access Journals (Sweden)

    Josep Fabà

    2013-12-01

    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 adaptive potential in old age.

  14. 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.

  15. Inappropriate shock for myopotential over-sensing in a patient with subcutaneous ICD

    Directory of Open Access Journals (Sweden)

    Alessandro Corzani

    2015-01-01

    Full Text Available Inappropriate ICD shocks are common adverse events; they are mainly due to supraventricular arrhythmias and secondly are related to noise, undersensing, oversensing, device malfunctions. We present a case of inappropriate device therapy due to myopotential oversensing in a patient with a subcutaneous ICD (s-ICD. A 58 years old male with an s-ICD during the device interrogation showed a previous episode of suspected sustained ventricular tachycardia at 210 bpm, which was effectively treated with ICD shock. The patient experienced the electrical shock while holding a big gas-cylinder in his arms. The EGM analysis revealed many irregular ventricular signals of low amplitude lasting for 24 s and interrupted by the shock. The device showed no malfunctions. This is the first case report of inappropriate S-ICD shock related to myopotential over-sensing. By recording intracardiac EGM, we demonstrated that the noise was created by the activity of the pectorals muscles.

  16. A European perspective on alternatives to animal testing for environmental hazard identification and risk assessment

    NARCIS (Netherlands)

    Scholz, S.; Sela, E.; Blaha, L.; Braunbeck, T.; Galay-Burgos, M.; Garcia-Franco, M.; Guinea, J.; Kluver, N.; Schirmer, K.; Tanneberger, K.; Tobor-Kaplon, M.; Witters, H.; Belanger, S.; Benfenati, E.; Creton, S.; Cronin, M.T.D.; Eggen, R.I.L.; Embry, M.; Ekman, D.; Gourmelon, A.; Halder, M.; Hardy, B.; Hartung, T.; Hubesch, B.; Jungmann, D.; Lampi, M.A.; Lee, van L.; Leonard, M.; Kuster, E.; Lillicrap, A.; Luckenbach, T.; Murk, A.J.; Navas, J.M.; Peijnenburg, W.; Repetto, G.; Salinas, E.; Schuurmann, G.; Spielmann, H.; Tollefsen, K.E.; Walter-Rohde, S.; Whale, G.; Wheeler, J.R.; Winter, M.J.

    2013-01-01

    Tests with vertebrates are an integral part of environmental hazard identification and risk assessment of chemicals, plant protection products, pharmaceuticals, biocides, feed additives and effluents. These tests raise ethical and economic concerns and are considered as inappropriate for assessing

  17. Storage rings

    Energy Technology Data Exchange (ETDEWEB)

    O' Neill, Gerald K.

    1963-04-15

    The development of storage rings is discussed. Advantages of such devices are pointed out as well as their limits, requirements, and design and fabrication problems. Information gained by the operation of small electron storage rings is included, and three experiments are proposed for colliding-beam facilities. (D.C.W.)

  18. Elevator talk: observational study of inappropriate comments in a public space.

    Science.gov (United States)

    Ubel, P A; Zell, M M; Miller, D J; Fischer, G S; Peters-Stefani, D; Arnold, R M

    1995-08-01

    We conducted a study to determine the type and frequency of inappropriate comments made by hospital employees while riding hospital elevators. Four observers rode in elevators at five hospitals, listening for any comments made by hospital employees that might be deemed inappropriate. All potentially inappropriate comments were reviewed by the research team and were classified as inappropriate if they met at least one of the following criteria: violated patient confidentiality, raised concerns about the speaker's ability or desire to provide high-quality patient care, raised concerns about poor quality of care in the hospital (by persons other than the speaker), or contained derogatory remarks about patients or their families. We observed 259 one-way elevator trips offering opportunity for conversation. We overheard a total of 39 inappropriate comments, which took place on 36 rides (13.9% of the trips). The most frequent comments (18) were violations of patients confidentiality. Next most frequent (10 comments) were unprofessional remarks in which clinicians talked about themselves in ways that raised questions about their ability or desire to provide high-quality patient care. Other comments included derogatory statements about the general quality of hospital care (8) and derogatory remarks about patients (5). Physicians were involved in 15 of the comments, nurses in 10, and other hospital employees in the remainder. Inappropriate comments took place with disturbing frequency in the elevator rides we sampled. These comments did not exclusively involve violations of patient confidentiality, but encompassed a range of discussions that health care employees must be careful to avoid.

  19. 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

  20. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA).

    Science.gov (United States)

    Manthey, Leonie; van Veen, Tineke; Giltay, Erik J; Stoop, José E; Neven, Arie Knuistingh; Penninx, Brenda W J H; Zitman, Frans G

    2011-02-01

    Results on determinants of benzodiazepine (BZD) use in general and inappropriate use were inconsistent and mostly univariate. The relative importance of sociodemographic, psychological and physical determinants has never been investigated in a comprehensive, multivariate model. We included 429 BZD users and 2423 non-users from the Netherlands Study of Depression and Anxiety (NESDA) in order to investigate sociodemographic, psychological and physical determinants of BZD use and inappropriate use by logistic and linear regression analyses. BZDs were used by a considerable proportion of the 2852 NESDA participants (15.0%). BZD use was independently associated with older age, singleness, unemployment, treatment in secondary care, higher medical consumption (more severe) anxiety, depression (OR [95% CI]=1.95 [1.29, 2.93]), comorbidity, insomnia, SSRI (OR [95% CI]=2.05 [1.55, 2.70]), TCA and other antidepressant (OR [95% CI]=2.44 [1.64, 3.62]) use. Overall, BZD use was rarely in accordance with all guidelines, mainly because most users (82.5%) exceeded the recommended duration of safe use. Inappropriate use was independently associated with older age (β=0.130) and chronic illnesses (β=0.120). Higher scores on agreeableness were associated with less inappropriate use. Mentally or physically vulnerable subjects were most likely to use BZDs. The most vulnerable (i.e. the old and physically ill) BZD users were at highest risk of inappropriate BZD use. Without further evidence of the effectiveness of BZDs in long-term use, caution in initiating BZD prescriptions is recommended, particularly when patients are chronically ill and old, as those are most likely to display inappropriate use. © 2011 The Authors. British Journal of Clinical Pharmacology © 2011 The British Pharmacological Society.

  1. 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

  2. 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.

  3. Reducing inappropriate testing in the diagnosis of the menopause and peri-menopause.

    Science.gov (United States)

    Williams, Jac; Currie, Heather; Foster, Adele; Anderson, Julia

    2016-09-01

    The menopause should be diagnosed based on age, menstrual history and clinical symptoms, and as such, follicle stimulating hormone testing may be considered inappropriate when diagnosing the menopause or peri-menopause in women aged 45 and over. As part of a demand optimisation programme, the number of follicle stimulating hormone tests requested to diagnose the menopause in this age group was quantified and educational interventions were implemented to reduce inappropriate testing. The number of follicle stimulating hormone tests requested to diagnose the menopause in women aged 45 and over was successfully and sustainably reduced. © The Author(s) 2016.

  4. 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

    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...... 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...

  5. 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.

  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. 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…

  8. [Characteristics of potentially inappropriate prescribing of drugs in elderly polypathological patients].

    Science.gov (United States)

    Rivas-Cobas, Paula Carlota; Ramírez-Duque, Nieves; Gómez Hernández, Mercedes; García, Juana; Agustí, Antonia; Vidal, Xavier; Formiga, Francesc; López-Soto, Alfonso; Torres, Olga H; San-José, Antonio

    To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). Multicentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. Of the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. Given the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. 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.

  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. 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.

  12. 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.

  13. 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.

  14. College Student Perceptions of the (In)Appropriateness and Functions of Teacher Disclosure

    Science.gov (United States)

    Hosek, Angela M.; Presley, Rachel

    2018-01-01

    This study investigated college student perceptions of the (in)appropriateness of instructor disclosures and perceived functions of instructor disclosures. An interpretive analysis of 35 college students identified that family relationships, life experiences and background, and everyday talk and activities were forms of appropriate disclosures;…

  15. Inappropriate Care in European ICUs Confronting Views From Nurses and Junior and Senior Physicians

    NARCIS (Netherlands)

    Piers, Ruth D.; Azoulay, Elie; Ricou, Bara; Ganz, Freda DeKeyser; Max, Adeline; Michalsen, Andrej; Maia, Paulo Azevedo; Owczuk, Radoslaw; Rubulotta, Francesca; Meert, Anne-Pascale; Reyners, Anna K.; Decruyenaere, Johan; Benoit, Dominique D.

    BACKGROUND: ICU care providers oft en feel that the care given to a patient may be inconsistent with their professional knowledge or beliefs. This study aimed to assess differences in, and reasons for, perceived inappropriate care (PIC) across ICU care providers with varying levels of

  16. 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.”

  17. 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…

  18. 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.

  19. 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

  20. 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.…

  1. Inappropriate behaviors and hypersexuality in individuals with dementia: An overview of a neglected issue.

    Science.gov (United States)

    Torrisi, Michele; Cacciola, Alberto; Marra, Angela; De Luca, Rosaria; Bramanti, Placido; Calabrò, Rocco Salvatore

    2017-06-01

    Behavioral and psychological symptoms of dementia are very common in patients affected by dementia, and are associated with high rates of institutionalization. Behavioral and psychological symptoms of dementia consist of aggressive behavior, delusions, hallucinations, depression, apathy, wandering, stereotyped and inappropriate sexual behavior. Interestingly, the latter has been reported to be relatively uncommon, but causing immense distress to patients and their caregivers. The genesis of inappropriate behavior is considered a combination of neurological, psychological and social factors. Although assessment is mainly carried out by clinical observation and interviews with caregivers, the most appropriate management of behavioral and psychological symptoms of dementia, including hypersexuality, is a combination of pharmacological and non-pharmacological interventions, according to specific symptoms, degree of cognitive dysfunction and subtype of dementia. The present narrative review will mainly focus on aggressiveness, disinhibition, aberrant motor, and sexually inappropriate behavior diagnostic work-up and treatment, in an attempt to provide both the patients and their caregivers with useful information to better manage these symptoms and improve their quality of life. Space is particularly dedicated to inappropriate sexual behavior, which is still considered a neglected issue. Geriatr Gerontol Int 2017; 17: 865-874. © 2016 Japan Geriatrics Society.

  2. Healthcare Utilization and Expenditures Associated With Appropriate and Inappropriate Implantable Defibrillator Shocks.

    Science.gov (United States)

    Turakhia, Mintu P; Zweibel, Steven; Swain, Andrea L; Mollenkopf, Sarah A; Reynolds, Matthew R

    2017-02-01

    In patients with implantable cardioverter-defibrillators, healthcare utilization (HCU) and expenditures related to shocks have not been quantified. We performed a retrospective cohort study of patients with implantable cardioverter-defibrillators identified from commercial and Medicare supplemental claims databases linked to adjudicated shock events from remote monitoring data. A shock event was defined as ≥1 spontaneous shocks delivered by an implanted device. Shock-related HCU was ascertained from inpatient and outpatient claims within 7 days following a shock event. Shock events were adjudicated and classified as inappropriate or appropriate, and HCU and expenditures, stratified by shock type, were quantified. Of 10 266 linked patients, 963 (9.4%) patients (61.3±13.6 years; 81% male) had 1885 shock events (56% appropriate, 38% inappropriate, and 6% indeterminate). Of these events, 867 (46%) had shock-related HCU (14% inpatient and 32% outpatient). After shocks, inpatient cardiovascular procedures were common, including echocardiography (59%), electrophysiology study or ablation (34%), stress testing (16%), and lead revision (11%). Cardiac catheterization was common (71% and 51%), but percutaneous coronary intervention was low (6.5% and 5.0%) after appropriate and inappropriate shocks. Expenditures related to appropriate and inappropriate shocks were not significantly different. After implantable cardioverter-defibrillator shock, related HCU was common, with 1 in 3 shock events followed by outpatient HCU and 1 in 7 followed by hospitalization. Use of invasive cardiovascular procedures was substantial, even after inappropriate shocks, which comprised 38% of all shocks. Implantable cardioverter-defibrillator shocks seem to trigger a cascade of health care. Strategies to reduce shocks could result in cost savings. © 2017 American Heart Association, Inc.

  3. [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.

  4. Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study.

    Science.gov (United States)

    Márquez, Paola H Ponte; Torres, Olga H; San-José, Anonio; Vidal, Xavier; Agustí, Antonia; Formiga, Francesc; López-Soto, Alfonso; Ramírez-Duque, Nieves; Fernández-Moyano, Antonio; Garcia-Moreno, Juana; Arroyo, Juan A; Ruiz, Domingo

    2017-06-01

    Previous studies of antihypertensive treatment of older patients have focused on blood pressure control, cardiovascular risk or adherence, whereas data on inappropriate antihypertensive prescriptions to older patients are scarce. The aim of the study was to assess inappropriate antihypertensive prescriptions to older patients. An observational, prospective multicentric study was conducted to assess potentially inappropriate prescription of antihypertensive drugs, in patients aged 75 years and older with arterial hypertension (HTN), in the month prior to hospital admission, using four instruments: Beers, Screening Tool of Older Person's Prescriptions (STOPP), Screening Tool to Alert Doctors to the Right Treatment (START) and Assessing Care of Vulnerable Elders 3 (ACOVE-3). Primary care and hospital electronic records were reviewed for HTN diagnoses, antihypertensive treatment and blood pressure readings. Of 672 patients, 532 (median age 85 years, 56% female) had HTN. 21.6% received antihypertensive monotherapy, 4.7% received no hypertensive treatment, and the remainder received a combination of antihypertensive therapies. The most frequently prescribed antihypertensive drugs were diuretics (53.5%), angiotensin-converting enzyme inhibitors (ACEIs) (41%), calcium antagonists (32.2%), angiotensin receptor blockers (29.7%) and beta-blockers (29.7%). Potentially inappropriate prescription was observed in 51.3% of patients (27.8% overprescription and 35% underprescription). The most frequent inappropriately prescribed drugs were calcium antagonists (overprescribed), ACEIs and beta-blockers (underprescribed). ACEI and beta-blocker underprescriptions were independently associated with heart failure admissions [beta-blockers odds ratio (OR) 0.53, 95% confidence interval (CI) 0.39-0.71, p treatment. Underprescription was more frequent than overprescription. ACEIs and beta-blockers were frequently underprescribed and were associated with heart failure admissions.

  5. Echocardiographic assessment of inappropriate left ventricular mass and left ventricular hypertrophy in patients with diastolic dysfunction

    Directory of Open Access Journals (Sweden)

    Hasan Shemirani

    2012-01-01

    Full Text Available Background: early diagnosis of left ventricular mass (LVM inappropriateness and left ventricular hypertrophy (LVH can result in preventing diastolic left ventricular dysfunction and its related morbidity and mortality. This study was performed to determine if diastolic dysfunction is associated with LVH and inappropriate LVM. Materials and Methods: one hundred and twenty five uncomplicated hypertension from Isfahan Healthy Heart Program underwent two-dimensional echocardiography. Inappropriate LVM was defined as an LVM index greater than 88 g/m2 of body-surface area in women and greater than 102 g/m2 in men. LVH-defined septal and posterior wall thickness greater than 0/9 cm in women and greater than 1 cm in men, respectively. Echocardiographic parameters, including early diastolic peak velocity (E/late diastolic peak velocity (A, deceleration time (DT, and E/early mitral annulus velocity (E′ were measured. Results: the mean systolic and diastolic blood pressure at the patients′ admission day were 142.87 ± 18.12 and 88.45 ± 9.18 mmHg, respectively. Totally, 21.7% of subjects had inappropriate LV mass that moderate and severe abnormal LV mass was revealed in 5.6% and 5.6%, respectively. The mean of age and BMI was significantly higher in patients with moderate left ventricular hypertrophy (P 0.05. Spearman′s Rank test was used to test the correlation between diastolic dysfunction and LV mass (P = 0.025. Conclusion: LVH is correlated with the severity of diastolic dysfunction manifested by the E/A value and deceleration time, but inappropriate LVM can slightly predict diastolic dysfunction severity in uncomplicated hypertension.

  6. 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

  7. Energy storage cells

    Energy Technology Data Exchange (ETDEWEB)

    Gulia, N.V.

    1980-01-01

    The book deals with the characteristics and potentialities of energy storage cells of various types. Attention is given to electrical energy storage cells (electrochemical, electrostatic, and electrodynamic cells), mechanical energy storage cells (mechanical flywheel storage cells), and hybrid storage systems.

  8. Potentially inappropriate medication use in nursing homes: an observational study using the NORGEP-NH criteria.

    Science.gov (United States)

    Nyborg, Gunhild; Brekke, Mette; Straand, Jørund; Gjelstad, Svein; Romøren, Maria

    2017-09-19

    Frail residents in the nursing home sector call for extra care in prescribing. The Norwegian General Practice Nursing Home (NORGEP-NH) list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed explicitly for this population. The aim of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. Cross-sectional observational pharmacoepidemiological study from residents in nursing homes in the county of Vestfold, Norway. Data collected 2009-11 included residents' demographic and clinical status and all medications, regular and on demand. 881 patients from 30 institutions (mean 85.9 years, 68.6% female), were included. According to NORGEP-NH, 43.8% were prescribed at least one potentially inappropriate regular medication, and 9.9% regularly received three or more potentially inappropriate medications. When also including a) the NORGEP-NH Deprescribing Criteria and b) including drugs prescribed for use as needed, 92.7% of all residents received medication that needs particular surveillance according to the NORGEP-NH. 69.7% of the nursing home residents used at least one psychotropic drug regularly. Female residents received more often than males at least one potentially inappropriate regular medication (OR 1.60, p=0.007). Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1.79 (p=0.03) compared to males. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs. Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration (odds ratio 1.70, p=0.009). Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially

  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. 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.

  11. 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.

  12. 21 CFR 864.3250 - Specimen transport and storage container.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Specimen transport and storage container. 864.3250 Section 864.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES....3250 Specimen transport and storage container. (a) Identification. A specimen transport and storage...

  13. Effects of temperature, light, desiccation and cold storage on ...

    African Journals Online (AJOL)

    Identification of the seed storage behaviour of a target species is essential prior to seed storage so that suitable storage strategies are taken. In the present experiments, germination characteristics, desiccation, and low temperature tolerance of seeds of Sophora tonkinensis was studied; a traditional Chinese medicine on ...

  14. 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.

  15. Abdominal pain and syndrome of inappropriate antidiuretic hormone secretion as clinical presentation of acute intermittent porphyria.

    Science.gov (United States)

    Valle Feijóo, M L; Bermúdez Sanjurjo, J R; González Vázquez, L; Rey Martínez, M; de la Fuente Aguado, J

    2015-01-01

    Acute intermittent porphyria (AIP) is a rare condition characterized by abdominal pain and a wide range of nonspecific symptoms. We report the case of a woman with abdominal pain and syndrome of inappropriate antidiuretic hormone secretion (SIADH) as clinical presentation of AIP. The diagnosis was achieved through the etiologic study of the SIADH. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  16. 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 ...

  17. 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.

  18. 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.

  19. Beers Criteria as a Proxy for Inappropriate Prescribing of Other Medications Among Older Adults

    Science.gov (United States)

    Lund, Brian C; Steinman, Michael A; Chrischilles, Elizabeth A; Kaboli, Peter J

    2014-01-01

    BACKGROUND The Beers criteria are a compilation of medications deemed potentially inappropriate for older adults, and widely used a prescribing quality indicator. OBJECTIVE To determine whether Beers criteria serve as a proxy measure for other forms of inappropriate prescribing, as measured by comprehensive implicit review. METHODS Data for patients 65 years and older were obtained from the VA Enhanced Pharmacy Outpatient Clinic (EPOC) and the Iowa Medicaid Pharmaceutical Case Management (PCM) studies. Comprehensive measurement of prescribing quality was conducted using expert clinician review of medical records according to the Medication Appropriateness Index (MAI). MAI scores attributable to non-Beers medications (non-Beers MAI) were contrasted between patients who did and did not receive a Beers criteria medication. RESULTS Beers criteria medications accounted for 12.9% and 14.0% of total MAI scores in the two studies. Importantly, non-Beers MAI scores were significantly higher in patients receiving a Beers criteria medication in both studies (EPOC: 15.1 vs. 12.4, p = 0.02; PCM: 11.1 vs. 8.7, p = 0.04), after adjusting for important confounding factors. CONCLUSIONS Beers criteria utility extended beyond direct measurement of a limited set of inappropriate prescribing practices by serving as a clinically meaningful proxy for other inappropriate practices. Using prescribing quality indicators to guide interventions should thus identify patients for comprehensive medication review, rather than identifying specific targets for discontinuation. Future research should explore both the quality measurement and the intervention targeting applications of the Beers criteria, particularly when integrated with other indicators. PMID:21972251

  20. Syndrome of inappropriate antidiuretic hormone caused by continuous lumbar spinal fluid drainage after transphenoidal surgery.

    Science.gov (United States)

    Norlela, S; Azmi, K N; Khalid, B A K

    2006-01-01

    A 53-year-old acromegalic woman had cerebrospinal fluid rhinorrhoea following transphenoidal surgery for a pituitary microadenoma. A continuous lumbar spinal fluid drainage catheter was inserted and on the sixth postoperative day, she developed hyponatremia with features of syndrome of inappropriate antidiuretic hormone (SIADH) requiring hypertonic saline administration. Over-drainage is potentially hazardous and close biochemical monitoring is required. To our knowledge, this is the first reported case of SIADH caused by continuous lumbar drainage in an adult.

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

    OpenAIRE

    Vivatkusol, Yada; Thavaramara, Thaovalai; Phaloprakarn, Chadakarn

    2017-01-01

    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 preg...

  2. 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...

  3. 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.

  4. Reduction of the inappropriate ICD therapies by implementing a new fuzzy logic-based diagnostic algorithm.

    Science.gov (United States)

    Lewandowski, Michał; Przybylski, Andrzej; Kuźmicz, Wiesław; Szwed, Hanna

    2013-09-01

    The aim of the study was to analyze the value of a completely new fuzzy logic-based detection algorithm (FA) in comparison with arrhythmia classification algorithms used in existing ICDs in order to demonstrate whether the rate of inappropriate therapies can be reduced. On the basis of the RR intervals database containing arrhythmia events and controls recordings from the ICD memory a diagnostic algorithm was developed and tested by a computer program. This algorithm uses the same input signals as existing ICDs: RR interval as the primary input variable and two variables derived from it, onset and stability. However, it uses 15 fuzzy rules instead of fixed thresholds used in existing devices. The algorithm considers 6 diagnostic categories: (1) VF (ventricular fibrillation), (2) VT (ventricular tachycardia), (3) ST (sinus tachycardia), (4) DAI (artifacts and heart rhythm irregularities including extrasystoles and T-wave oversensing-TWOS), (5) ATF (atrial and supraventricular tachycardia or fibrillation), and 96) NT (sinus rhythm). This algorithm was tested on 172 RR recordings from different ICDs in the follow-up of 135 patients. All diagnostic categories of the algorithm were present in the analyzed recordings: VF (n = 35), VT (n = 48), ST (n = 14), DAI (n = 32), ATF (n = 18), NT (n = 25). Thirty-eight patients (31.4%) in the studied group received inappropriate ICD therapies. In all these cases the final diagnosis of the algorithm was correct (19 cases of artifacts, 11 of atrial fibrillation and 8 of ST) and fuzzy rules algorithm implementation would have withheld unnecessary therapies. Incidence of inappropriate therapies: 3 vs. 38 (the proposed algorithm vs. ICD diagnosis, respectively) differed significantly (p fuzzy logic based algorithm seems to be promising and its implementation could diminish ICDs inappropriate therapies. We found FA usefulness in correct diagnosis of sinus tachycardia, atrial fibrillation and artifacts in comparison with tested ICDs.

  5. 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.

  6. Inappropriate Dexamethasone Use by a Trekker in Nepal: A Case Report.

    Science.gov (United States)

    Haslam, Nicholas R; Garth, Rachel; Kelly, Nicola

    2017-12-01

    We present a case of inappropriate dexamethasone use in a trekker in the Everest region of Nepal. We aim to increase awareness among health professionals of the possible use of this medication by trekkers and promote knowledge of potential complications. In this case, a previously altitude-naive trekker was prescribed prophylactic dexamethasone by physicians in a Western travel clinic before high-altitude trekking in Nepal. There were no indications for prophylactic medication nor for the use of dexamethasone. The trekker reported that no discussion regarding risks and benefits, alternatives, side effects, contraindications, or dose tapering on completion of the course had occurred before travel. Side effects were temporary, but serious complications may have ensued if it not for timely interventions by doctors at the International Porter Protection Group rescue post. The events leading to inappropriate dexamethasone use in this case cannot be known for certain. However, it is clear that the trekker lacked the knowledge to use the medication safely. Although the efficacy of dexamethasone in the prevention of acute mountain sickness is undisputed, associated side effects and other limitations make acetazolamide the prophylactic drug of choice. Inappropriate use of dexamethasone can lead to severe complications, and such a case has been reported from Mount Everest. Clinicians prescribing dexamethasone must understand the indications and risks, and health professionals at altitude should be aware of its use by trekkers and the potential complications. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  7. Phantom movements from physiologically inappropriate muscles: A case study with a high transhumeral amputee.

    Science.gov (United States)

    Gade, Julie; Hugosdottir, Rosa; Kamavuako, Ernest N

    2015-08-01

    Individuals with high-level amputation have a great need for functional prostheses because of their vast functional deficits. Conventional techniques are considered inappropriate for high-level amputees due to the lack of physiologically appropriate muscles. This study investigates how accurate phantom movements (PMs) can be classified from physiologically inappropriate muscles. The study involves a case study of a 42-year-old transhumeral amputee. Suitable PMs and best electrode configuration were identified using the sequential forward selection method and brute-force technique. Using linear discriminant analysis, the best PMs (elbow extension/flexion, wrist supination/pronation) and rest were classified with error ranging from 3% to 0.18% when using 3 to 8 EMG channels respectively. A completion rate of 93 % was obtained during a targeted achievement control test in a virtual reality environment. This case indicates that a proximal transhumeral amputee can generate muscle activation patterns related to distinct PMs; and these PMs can be decoded from physiologically inappropriate muscles.

  8. 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.

  9. 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.

  10. The Impact of a Computerized Clinical Decision Support Tool on Inappropriate Clostridium difficile Testing.

    Science.gov (United States)

    White, Duncan R; Hamilton, Keith W; Pegues, David A; Hanish, Asaf; Umscheid, Craig A

    2017-10-01

    OBJECTIVE To evaluate the effectiveness of a computerized clinical decision support intervention aimed at reducing inappropriate Clostridium difficile testing DESIGN Retrospective cohort study SETTING University of Pennsylvania Health System, comprised of 3 large tertiary-care hospitals PATIENTS All adult patients admitted over a 2-year period INTERVENTION Providers were required to use an order set integrated into a commercial electronic health record to order C. difficile toxin testing. The order set identified patients who had received laxatives within the previous 36 hours and displayed a message asking providers to consider stopping laxatives and reassessing in 24 hours prior to ordering C. difficile testing. Providers had the option to continue or discontinue laxatives and to proceed with or forgo testing. The primary endpoint was the change in inappropriate C. difficile testing, as measured by the number of patients who had C. difficile testing ordered while receiving laxatives. RESULTS Compared to the 1-year baseline period, the intervention resulted in a decrease in the proportion of inappropriate C. difficile testing (29.6% vs 27.3%; P=.02). The intervention was associated with an increase in the number of patients who had laxatives discontinued and did not undergo C. difficile testing (5.8% vs 46.4%; Ptesting (5.4% vs 35.2%; Ptesting and improving the timely discontinuation of laxatives. Infect Control Hosp Epidemiol 2017;38:1204-1208.

  11. Energy storage

    International Nuclear Information System (INIS)

    Hermans, J.H.W.E.

    1998-01-01

    A brief overview is given of the research activities of the Dutch association for energy distribution companies EnergieNed in the field of energy storage techniques, carried out within the framework of the long-range programme Study and Research (MSO, abbreviated in Dutch)

  12. 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)

  13. 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

  14. 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

  15. 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...

  16. Influence of diabetes mellitus on inappropriate and appropriate implantable cardioverter-defibrillator therapy and mortality in the Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy (MADIT-RIT) Trial

    DEFF Research Database (Denmark)

    Ruwald, Martin H.; Zareba, Wojciech; Jons, Christian

    2013-01-01

    The relationship between diabetes mellitus and risk of inappropriate or appropriate therapy in patients receiving an implantable cardioverter-defibrillator (ICD) and resynchronization therapy has not been investigated thoroughly. The effect of innovative ICD programming on therapy delivery...

  17. 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

  18. Charlson Comorbidity Index, inappropriate medication use and cognitive impairment : Bermuda Triangle.

    Science.gov (United States)

    Silay, Kamile; Yalcin, Ahmet; Akinci, Sema; Gursoy, Fatma Gul; Sener Dede, Didem

    2017-11-01

    The aim is to evaluate the association between the Charlson Comorbidity Index (CCI), polypharmacy, inappropriate medication use and cognitive impairment in long-term care facility patients. A cross-sectional study including 105 long-term care facility residents was performed. The Charlson Comorbidity Index (CCI) was used. Inappropriate drug use (IDU) was defined according to the STOPP (Screening Tool of Older People's Prescriptions) criteria. Univariate analysis to identify variables associated with patient outcome related with cognitive impairment was investigated with χ 2 , Pearson correlation, Fisher exact, and Mann-Whitney U test where appropriate. For the multivariate analysis, the possible factors identified with univariate analysis were further entered into logistic regression analysis. A significant difference was found between gender, CCI and cognitive impairment (p = 0.038, p = 0.01). While every one point increment in the CCI increases the risk of cognitive impairment 3.1 fold (95% CI = 1.8-5.4, p < 0.001), hypertension increases the risk 12 fold (95% CI = 2.5-67.8, p = 0.002). While the correlation between Mini-Mental Status Examination (MMSE) score and polypharmacy is significant (p = 0.015), the correlation between MMSE and IDU was insignificant (p = 0.739). The association of urogenital system drugs and dementia was significant (p = 0.044). Comorbidities, especially hypertension and old age, are risk factors for cognitive impairment. Polypharmacy correlates with MMSE and is considered a risk factor for cognitive impairment. Inappropriate medication use is high among long-term care facility residents. More studies on large cohorts are needed regarding optimal drug prescription and detection of specific drugs that may have an impact on cognitive performance.

  19. Failed Attempts to Reduce Inappropriate Laboratory Utilization in an Emergency Department Setting in Cyprus: Lessons Learned.

    Science.gov (United States)

    Petrou, Panagiotis

    2016-03-01

    Laboratory test ordering is a significant part of the diagnosis definition and disease treatment monitoring process. Inappropriate laboratory test ordering wastes scarce resources, places unnecessary burden on the health care delivery system, and exposes patients to unnecessary discomfort. Inappropriate ordering is caused by many factors, such as lack of guidelines, defensive medicine, thoughtless ordering, and lack of awareness of costs incurred to the system. The purpose of this study is to assess two successive measures, which were introduced in a Cyprus emergency department (ED) for the purpose of synergistically reducing inappropriate laboratory ordering: the introduction of a copayment fee to reduce nonemergent visits, and the development of a Web-based protocol defining the tests emergency physicians could order. An autoregressive integrated moving average model for interrupted time series analysis was constructed. Data include number and type of tests ordered, along with number of visits for a period of 4 years from an ED in Cyprus. Copayment fee and introduction of a revised Web-based protocol for a test ordering form did not reduce the number of ordered tests in the ED unit. Copayment fee alone resulted in a statistically significant reduction in ED visits. The implementation of two consecutive measures resulted in an increase of ordered tests per patient. Laboratory ordering is a multidimensional process that is primarily supplier induced, therefore, all underlying possible causes must be scrutinized by health authorities. These include lack of guidelines, defensive medicine and thoughtless prescribing. To attain significant gains, an integrated approach must be implemented. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Reducing inappropriate accident and emergency department attendances: a systematic review of primary care service interventions.

    Science.gov (United States)

    Ismail, Sharif A; Gibbons, Daniel C; Gnani, Shamini

    2013-12-01

    Inappropriate attendances may account for up to 40% of presentations at accident and emergency (A&E) departments. There is considerable interest from health practitioners and policymakers in interventions to reduce this burden. To review the evidence on primary care service interventions to reduce inappropriate A&E attendances. Systematic review of UK and international primary care interventions. Studies published in English between 1 January 1986 and 23 August 2011 were identified from PubMed, the NHS Economic Evaluation Database, the Cochrane Collaboration, and Health Technology Assessment databases. The outcome measures were A&E attendances, patient satisfaction, clinical outcome, and intervention cost. Two authors reviewed titles and abstracts of retrieved results, with adjudication of disagreements conducted by the third. Studies were quality assessed using the Scottish Intercollegiate Guidelines Network checklist system where applicable. In total, 9916 manuscripts were identified, of which 34 were reviewed. Telephone triage was the single best-evaluated intervention. This resulted in negligible impact on A&E attendance, but exhibited acceptable patient satisfaction and clinical safety; cost effectiveness was uncertain. The limited available evidence suggests that emergency nurse practitioners in community settings and community health centres may reduce A&E attendance. For all other interventions considered in this review (walk-in centres, minor injuries units, and out-of-hours general practice), the effects on A&E attendance, patient outcomes, and cost were inconclusive. Studies showed a negligible effect on A&E attendance for all interventions; data on patient outcomes and cost-effectiveness are limited. There is an urgent need to examine all aspects of primary care service interventions that aim to reduce inappropriate A&E attendance.

  1. 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.

  2. 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

  3. Effect of nurse practitioner and pharmacist counseling on inappropriate medication use in family practice.

    Science.gov (United States)

    Fletcher, John; Hogg, William; Farrell, Barbara; Woodend, Kirsten; Dahrouge, Simone; Lemelin, Jacques; Dalziel, William

    2012-08-01

    To measure the effect of nurse practitioner and pharmacist consultations on the appropriate use of medications by patients. We studied patients in the intervention arm of a randomized controlled trial. The main trial intervention was provision of multidisciplinary team care and the main outcome was quality and processes of care for chronic disease management. Patients were recruited from a single publicly funded family health network practice of 8 family physicians and associated staff serving 10 000 patients in a rural area near Ottawa, Ont. A total of 120 patients 50 years of age or older who were on the practice roster and who were considered by their family physicians to be at risk of experiencing adverse health outcomes. A pharmacist and 1 of 3 nurse practitioners visited each patient at his or her home, conducted a comprehensive medication review, and developed a tailored plan to optimize medication use. The plan was developed in consultation with the patient and the patient's doctor. We assessed medication appropriateness at the study baseline and again 12 to 18 months later. We used the medication appropriateness index to assess medication use. We examined associations between personal characteristics and inappropriate use at baseline and with improvements in medication use at the follow-up assessment. We recorded all drug problems encountered during the trial. At baseline, 27.2% of medications were inappropriate in some way and 77.7% of patients were receiving at least 1 medication that was inappropriate in some way. At the follow-up assessments these percentages had dropped to 8.9% and 38.6%, respectively (P trial. This might provide a mechanism to explain some of the reductions in mortality and morbidity observed in other trials of counseling and advice provided by pharmacists and nurses. NCT00238836 (ClinicalTrials.gov).

  4. 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.

  5. Appeal of inappropriate technologies: self-inflicted wages, ethnic pride and corruption

    Energy Technology Data Exchange (ETDEWEB)

    Winston, G.C.

    1979-08-01

    A survey of manufacturing firms in Nigeria produced a set of useful clues to why firms in poor countries so often choose inappropriate production technologies. Some of their explanations do and some do not fit neatly in the neoclassical modelling of production by which economists have judged technological appropriateness. Much of what the firms described affect their real costs and do so in ways that escape economists' notice; technology is appropriate to the managers' view of costs. Often they were responding to more complicated goals than simple profit maximization for the firm; defense of ethnic identity or the goal of increasing their own incomes by stealing from the firm.

  6. Urea for management of the syndrome of inappropriate secretion of ADH: A systematic review.

    Science.gov (United States)

    de Solà-Morales, Oriol; Riera, Maribel

    2014-11-01

    Urea has been recently proposed for the management of hyponatremia linked to the syndrome of inappropriate secretion of ADH (SIADH). The objective of the study was to review the levels of evidence for treatment of hyponatremia associated with SIADH with urea. We performed a: systematic review of experimental trials and grading according to SIGN. No clinical trials were found. The 6 studies analysed had methodological limitations and were prone to biases. In conclusion, there is no evidence to support the efficacy of urea for the treatment of hyponatremia following SIADH. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  7. Adrenal insufficiency secondary to inappropriate oral administration of topical exogenous steroids presenting with hypercalcaemia.

    Science.gov (United States)

    Bhatti, Rahila Sarwar; Flynn, Michael D

    2012-06-21

    A 59-year-old Caucasian gentleman presented with malaise, fatigue and proximal muscle weakness. He had history of long-standing roseate psoriasis treated with topical clobetasol propionate (dermovate). On admission, he had significant postural hypotension, and hypercalcaemia. Endocrinological investigation revealed hypercalcaemia, a serum cortisol of <30 nmol/l, a flat short synacthen test and undetectable adrenocorticotropic hormone. He was treated with hydrocortisone. The abrupt withdrawal of the topical steroids by the patient precipitated the addisonian crisis. Further enquiry documented inappropriate oral administration of clobetasol for more than 10 years in addition to prescribed topical usage.

  8. 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

  9. Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis

    Directory of Open Access Journals (Sweden)

    Baskerville Neill

    2005-03-01

    Full Text Available Abstract Background Outreach facilitation has been proven successful in improving the adoption of clinical preventive care guidelines in primary care practice. The net costs and savings of delivering such an intensive intervention need to be understood. We wanted to estimate the proportion of a facilitation intervention cost that is offset and the potential for savings by reducing inappropriate screening tests and increasing appropriate screening tests in 22 intervention primary care practices affecting a population of 90,283 patients. Methods A cost-consequences analysis of one successful outreach facilitation intervention was done, taking into account the estimated cost savings to the health system of reducing five inappropriate tests and increasing seven appropriate tests. Multiple data sources were used to calculate costs and cost savings to the government. The cost of the intervention and costs of performing appropriate testing were calculated. Costs averted were calculated by multiplying the number of tests not performed as a result of the intervention. Further downstream cost savings were determined by calculating the direct costs associated with the number of false positive test follow-ups avoided. Treatment costs averted as a result of increasing appropriate testing were similarly calculated. Results The total cost of the intervention over 12 months was $238,388 and the cost of increasing the delivery of appropriate care was $192,912 for a total cost of $431,300. The savings from reduction in inappropriate testing were $148,568 and from avoiding treatment costs as a result of appropriate testing were $455,464 for a total savings of $604,032. On a yearly basis the net cost saving to the government is $191,733 per year (2003 $Can equating to $3,687 per physician or $63,911 per facilitator, an estimated return on intervention investment and delivery of appropriate preventive care of 40%. Conclusion Outreach facilitation is more expensive

  10. Dual AV Nodal Nonreentrant Tachycardia Resulting in Inappropriate ICD Therapy in a Patient with Cardiac Sarcoidosis

    Directory of Open Access Journals (Sweden)

    Ankur A. Karnik, MD

    2014-01-01

    Full Text Available Dual atrioventricular nodal nonreentrant tachycardia (DAVNNT occurs due to concurrent antegrade conduction over fast and slow atrioventricular nodal pathways and is treated by slow pathway modification. We describe a unique case of a patient with cardiac sarcoidosis who received inappropriate ICD shocks for DAVNNT. Atrial and ventricular device electrograms satisfied both rate and V>A criteria for ventricular tachycardia. We postulate that alterations in refractoriness and conduction as is seen in cardiac sarcoidosis (CS may have contributed to occurrence of DAVNNT.

  11. Metrics of quality care in veterans: correlation between primary-care performance measures and inappropriate myocardial perfusion imaging.

    Science.gov (United States)

    Winchester, David E; Kitchen, Andrew; Brandt, John C; Dusaj, Raman S; Virani, Salim S; Bradley, Steven M; Shaw, Leslee J; Beyth, Rebecca J

    2015-04-01

    Approximately 10% to 20% of myocardial perfusion imaging (MPI) tests are inappropriate based on professional-society recommendations. The correlation between inappropriate MPI and quality care metrics is not known. Inappropriate MPI will be associated with low achievement of quality care metrics. We conducted a retrospective cross-sectional investigation at a single Veterans Affairs medical center. Myocardial perfusion imaging tests ordered by primary-care clinicians between December 2010 and July 2011 were assessed for appropriateness (by 2009 criteria). Using documentation of the clinical encounter where MPI was ordered, we determined how often quality care metrics were achieved. Among 516 MPI patients, 52 (10.1%) were inappropriate and 464 (89.9%) were not inappropriate (either appropriate or uncertain). Hypertension (82.2%), diabetes mellitus (41.3%), and coronary artery disease (41.1%) were common. Glycated hemoglobin levels were lower in the inappropriate MPI cohort (6.6% vs 7.5%; P = 0.04). No difference was observed in the proportion with goal hemoglobin (62.5% vs 46.3% for appropriate/uncertain; P = 0.258). Systolic blood pressure was not different (132 mm Hg vs 135 mm Hg; P = 0.34). Achievement of several other categorical quality metrics was low in both cohorts and no differences were observed. More than 90% of clinicians documented a plan to achieve most metrics. Inappropriate MPI is not associated with performance on metrics of quality care. If an association exists, it may be between inappropriate MPI and overly aggressive care. Most clinicians document a plan of care to address failure of quality metrics, suggesting awareness of the problem. © 2015 Wiley Periodicals, Inc.

  12. 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)

  13. Storage pond

    International Nuclear Information System (INIS)

    Hunter, E.; Watson, E.

    1983-01-01

    A pond is described for the storage of hazardous materials, such as irradiated nuclear fuel elements, under water. Upper and lower impervious membranes extend without interruption beneath the floor of the pond and the edges of the membranes lead into a trench surrounding the pond. Any leakage through the floor is directed normally by the upper membrane into the trench. The lower membrane provides an additional impervious barrier in the event of a leak in the upper membrane and again directs the leakage into the trench thereby avoiding contamination of the ground beneath the pond. (author)

  14. Energy Storage

    CSIR Research Space (South Africa)

    Bladergroen, B

    2015-10-01

    Full Text Available will be an important tool in the toolbox of system designers – together with primary energy providers solar PV, wind, biogas and potentially backup through diesel-based generators. Outside the electricity sector, eMobility will largely drive the demand for battery...-to-Fuel is, together with eMobility, the connector between the historically separated electricity and transport sector. Challenge Questions  What will drive the future battery market?  Is energy storage a necessary condition for a large uptake...

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients.

    Science.gov (United States)

    Dekker, Anne R J; Verheij, Theo J M; van der Velden, Alike W

    2015-08-01

    Numerous studies suggest overprescribing of antibiotics for respiratory tract indications (RTIs), without really authenticating inappropriate prescription; the strict criteria of guideline recommendations were not taken into account as information on specific diagnoses, patient characteristics and disease severity was not available. The aim of this study is to quantify and qualify inappropriate antibiotic prescribing for RTIs. This is an observational study of the (antibiotic) management of patients with RTIs, using a detailed registration of RTI consultations by general practitioners (GPs). Consultations of which all necessary information was available were benchmarked to the prescribing guidelines for acute otitis media (AOM), acute sore throat, rhinosinusitis or acute cough. Levels of overprescribing for these indications and factors associated with overprescribing were determined. The overall antibiotic prescribing rate was 38%. Of these prescriptions, 46% were not indicated by the guidelines. Relative overprescribing was highest for throat (including tonsillitis) and lowest for ear consultations (including AOM). Absolute overprescribing was highest for lower RTIs (including bronchitis). Overprescribing was highest for patients between 18 and 65 years of age, when GPs felt patients' pressure for an antibiotic treatment, for patients presenting with fever and with complaints longer than 1 week. Underprescribing was observed in overprescribing can help in the development of targeted strategies to improve GPs' prescribing routines for RTIs. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  20. Voluntary Rehabilitation? On Neurotechnological Behavioural Treatment, Valid Consent and (In)appropriate Offers.

    Science.gov (United States)

    Bomann-Larsen, Lene

    2013-04-01

    Criminal offenders may be offered to participate in voluntary rehabilitation programs aiming at correcting undesirable behaviour, as a condition of early release. Behavioural treatment may include direct intervention into the central nervous system (CNS). This article discusses under which circumstances voluntary rehabilitation by CNS intervention is justified. It is argued that although the context of voluntary rehabilitation is a coercive circumstance, consent may still be effective, in the sense that it can meet formal criteria for informed consent. Further, for a consent to be normatively valid ("take the wronging out of the act") under a coercive circumstance, the subject to be treated must (1) have the sovereign authority to consent, and (2) the offer-giver must be in the right normative position to make the offer. While I argue that subjects do have the sovereign authority to consent to treatment, I also argue that inappropriate offers yield invalid consents. Considerations on inappropriate offers should therefore inform which kinds of CNS intervention-based rehabilitation schemes the state may propose as part of the criminal justice system. Yet as I conclude in this paper, while there are some intrinsic constraints on voluntary rehabilitation programs, the main constraints on voluntary rehabilitation are likely to be contingent overriders. However, CNS intervention is not ruled out as such in the context of voluntary rehabilitation.

  1. Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments.

    Science.gov (United States)

    Stewart, Derek; Mair, Alpana; Wilson, Martin; Kardas, Przemyslaw; Lewek, Pawel; Alonso, Albert; McIntosh, Jennifer; MacLure, Katie

    2017-02-01

    Single disease state led evidence-based guidelines do not provide sufficient coverage of issues of multimorbidities, with the cumulative impact of recommendations often resulting in overwhelming medicines burden. Inappropriate polypharmacy increases the likelihood of adverse drug events, drug interactions and non-adherence. Areas covered: A detailed description of a pan-European initiative, 'Stimulating Innovation Management of Polypharmacy and Adherence in the Elderly, SIMPATHY', which is a project funded by the European Commission to support innovation across the European Union. This includes a systematic review of the literature aiming to summarize and review critically current policies and guidelines on polypharmacy management in older people. The policy driven, evidence-based approach to managing inappropriate polypharmacy in Scotland is described, with consideration of a change management strategy based on Kotter's eight step process for leading sustainable change. Expert opinion: The challenges around promoting appropriate polypharmacy are on many levels, primarily clinical, organisational and political, all of which any workable solution will need to address. To be effective, safe and efficient, any programme that attempts to deal with the complexities of prescribing in this population must be patient-centred, clinically robust, multidisciplinary and designed to fit into the healthcare system in which it is delivered.

  2. Inappropriate Timing of Swallow in the Respiratory Cycle Causes Breathing–Swallowing Discoordination

    Directory of Open Access Journals (Sweden)

    Naomi Yagi

    2017-09-01

    Full Text Available Rationale: Swallowing during inspiration and swallowing immediately followed by inspiration increase the chances of aspiration and may cause disease exacerbation. However, the mechanisms by which such breathing–swallowing discoordination occurs are not well-understood.Objectives: We hypothesized that breathing–swallowing discoordination occurs when the timing of the swallow in the respiratory cycle is inappropriate. To test this hypothesis, we monitored respiration and swallowing activity in healthy subjects and in patients with dysphagia using a non-invasive swallowing monitoring system.Measurements and Main Results: The parameters measured included the timing of swallow in the respiratory cycle, swallowing latency (interval between the onset of respiratory pause and the onset of swallow, pause duration (duration of respiratory pause for swallowing, and the breathing–swallowing coordination pattern. We classified swallows that closely follow inspiration (I as I-SW, whereas those that precede I as SW-I pattern. Patients with dysphagia had prolonged swallowing latency and pause duration, and tended to have I-SW or SW-I patterns reflecting breathing–swallows discoordination.Conclusions: We conclude that swallows at inappropriate timing in the respiratory cycle cause breathing–swallowing discoordination, and the prolongation of swallowing latency leads to delayed timing of the swallow, and results in an increase in the SW-I pattern in patients with dysphagia.

  3. [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.

  4. 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

  5. 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.

  6. Inappropriateness of medication prescriptions about chronic kidney disease patients without dialysis therapy in a Chinese tertiary teaching hospital

    Directory of Open Access Journals (Sweden)

    Yang P

    2016-10-01

    Full Text Available Ping Yang, Na Chen, Rong-Rong Wang, Lu Li, Sai-Ping Jiang Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China Background: With the increasing incidence rate of chronic kidney disease (CKD, inappropriate use of medicine in CKD patients is an important issue, as it may cause adverse effects in patients and progression to chronic renal failure.Objective: The aim of this study is to assess the frequency of inappropriate medicine use among CKD patients.Methods: A cross-sectional study was conducted from November 1 to December 1, 2014 in a Chinese teaching tertiary hospital. All medication prescriptions for CKD patients with serum creatinine level above normal value were enrolled. The prescriptions, including unreasonable dosage, contraindicated, and cautiously used medicines in CKD patients, were evaluated and the related medications were also analyzed and classified.Results: Two hundred and two patients were included, and a total of 1,733 lines of medication prescriptions were evaluated. The prevalence of inappropriate medication prescriptions in CKD patients was 15.18%, of which, unreasonable dosage (n=56, contraindicated (n=46, and cautiously used medicines (n=161 accounted for 3.23%, 2.65%, and 9.29%, respectively. Spearman’s rank correlation coefficient implied that there was a significant correlation between the severity of renal insufficiency and frequency of inappropriate medication prescriptions (P=0.02, r=0.056. Among the inappropriate medication prescriptions, nutraceutical and electrolytes (n=65, 24.71%, cardiovascular drugs (n=61, 23.19%, and antimicrobial drugs (n=55, 20.91% represented the top three medicine categories in CKD patients.Conclusion: The study confirmed that inappropriate medication prescriptions were prevalent in CKD patients. Improving the quality of medication prescriptions in CKD patients is necessary. Keywords: inappropriateness of

  7. [Potentially inappropriate prescription according to the "STOPP" Criteria in heavily polymedicated elderly patients].

    Science.gov (United States)

    Terán-Álvarez, L; González-García, M J; Rivero-Pérez, A L; Alonso-Lorenzo, J C; Tarrazo-Suárez, J A

    2016-01-01

    Appropriate prescribing is especially relevant in elderly people. The objective of this study is to analyse the potentially inappropriate prescription (PIP) in heavily polymedicated elderly patients according to the criteria Screening Tool of Older Person's Prescriptions. A descriptive cross-sectional study was conducted in Primary Care on patients assigned to the Siero-Sariego (Asturias) Health Centre, who were over 64 years old and heavily polymedicated (consumption >10 drugs for six months). The 65 Screening Tool of Older Person's Prescriptions criteria were reviewed in the electronic Primary Care patient records, collecting sociodemographic variables, prescribed medications, and chronic diseases. Frequency distributions were made for each criterion, and causes related to PIP were explored using contingency tables, the Spearman correlation coefficient, and logistic regression. A total of 349 polymedicated elderly patients were analysed with a prevalence of 6.4 (95% CI:5.76-7.08), a mean age of 79.2 years (SD:3.7), 62.2% were female, 14% institutionalised, a Charlson index of 2.9. The mean of number of drugs was 11.5 (SD:1.7), and the most frequent pathologies were high blood pressure (64%), diabetes (46%), and osteoarticular diseases (41%). There was at least one PIP in 72.9% of heavily polymedicated elderly patients [(Mean: 1.32 (SD:1.2)]. The Screening Tool of Older Person's Prescriptions criteria least complied with were: therapeutic duplication (25.2%), use of long-acting benzodiazepines (15.8%), and inappropriate use of aspirin (10.9%). An association was found between having any inappropriate prescription and the number of medications prescribed (OR=1.22 [95% CI:1.04-1.43]) and inversely to the Charlson index (OR=0.76 [95% CI:0.65-0.89]). PIP is common in heavily polymedicated elderly patients. Special attention must be paid to the use of psychotropic drugs, which are implicated in a high volume of PIP. Copyright © 2014 Sociedad Española de Médicos de

  8. 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

  9. Combined intervention programme reduces inappropriate prescribing in elderly patients exposed to polypharmacy in primary care

    DEFF Research Database (Denmark)

    Bregnhøj, L; Thirstrup, S; Kristensen, M

    2009-01-01

    PURPOSE: To evaluate the effect of a combined or a single educational intervention on the prescribing behaviour of general practitioners (GPs). The primary endpoint was effect on inappropriate prescribing according to the Medication Appropriateness Index (MAI). METHODS: General practitioners were...... to polypharmacy (>/=5 medications) were identified and approached for inclusion. Data on medications prescribed over a 3-month period were collected, and the GPs provided detailed information on their patients before and after the intervention. A pre- and post-MAI were scored for all medications. RESULTS......: Of the 277 GPs invited to participate; 41 (14.8%) volunteered. Data were obtained from 166 patients before and after the intervention. Medication appropriateness improved in the combined intervention group but not in the single intervention group. The mean change in MAI and number of medications was -5 [95...

  10. 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.

  11. 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

  12. 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.

  13. Decreasing Inappropriate Use of Antibiotics in Primary Care in Four Countries in South America

    DEFF Research Database (Denmark)

    Urbiztondo, Inés; Bjerrum, Lars; Caballero, Lidia

    2017-01-01

    High antibiotic prescribing and antimicrobial resistance in patients attending primary care have been reported in South America. Very few interventions targeting general practitioners (GPs) to decrease inappropriate antibiotic prescribing have been investigated in this region. This study assessed...... limited effect. A cluster randomized two-arm control trial was implemented. Healthcare centres from Bolivia, Argentina, Paraguay and Uruguay participating in the quality improvement program HAPPY AUDIT were randomly allocated to either intervention or control group. During ten consecutive weeks, GPs...... in the intervention group received evidence-based online feedback on the management of suspected RTIs. In patients with acute bronchitis, the intervention reduced the antibiotic prescribing rate from 71.6% to 56% (control group from 61.2% to 52%). In patients with acute otitis media, the intervention reduced...

  14. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH in Strongyloides stercoralis hyperinfection

    Directory of Open Access Journals (Sweden)

    Deepshikha Nag Chowdhury

    2014-01-01

    Full Text Available Strongyloides stercoralis (S. stercoralis is a soil transmitted intestinal roundworm that has a unique ability to multiply within the human host and reinfect the human carrier by a process of autoinfection. By this property, S. stercoralis can persist as an occult infection for many decades. In situations of immunosuppression or other permissive gastrointestinal conditions, there occurs a massive increase in parasite multiplication. The parasites penetrate through the intestinal mucosa and are carried in circulation and can cause multisystem involvement. We report a case of a 76-year-old Columbian male who presented with intractable vomiting and hyponatremia who was then diagnosed to have syndrome of inappropriate antidiuretic hormone (SIADH. The patient′s symptoms improved after treatment with two doses of ivermectin and his serum sodium levels returned to normal. S. stercoralis infection should be suspected in patients from endemic regions who present with gastrointestinal symptoms and unexplained hyponatremia.

  15. [Validity of the protocol for evaluating the inappropriate use of hospitalization].

    Science.gov (United States)

    Peiró, S; Meneu, R; Roselló, M L; Portella, E; Carbonell-Sanchís, R; Fernández, C; Lázaro, G; Llorens, M A; Martínez-Mas, E; Moreno, E; Ruano, M; Rincón, A; Vila, M

    1996-06-22

    The study was carried out in order to assess the inter-observer reliability and validity in respect of clinical appraisal given by the Appropriateness Evaluation Protocol (AEP), in the context of the Spanish Public Hospital System. In order to assess the reliability a total of 614 hospital stays chosen at random from 56 hospital admissions were independently analysed by three reviewers (two doctors and one nurse). In order to assess the validity, the findings obtained by the nurse were compared with the majority opinion given by the 7 hospital specialists in respect of each of hospital stays under evaluation. As part of the analytical procedure, indices for observed agreement, and specific agreement were calculated, as well as the Kappa statistic, all forming of various random samples of 614 hospital stays. In order to assess the predictive validity of the AEP, its sensitivity, specificity and predictive values were all measured against the majority clinical judgement. The study exhibited a high degree of inter-observer reliability (specific agreement > 64%, kappa > 0.75) and a reasonable validity in comparison with the consensus of opinions formed by a least 4 or 5 of its 7 clinical reviewers (specific agreement > 61%, kappa > 0.64), these values decreasing notably when the consensus of 6 or 7 of the reviewers was required. The AEP revealed a high degree of sensitivity and a low degree of specificity in comparison with the majority clinical assessment, thus minimising the occurrence of false results when the stay was regarded as appropriate, and producing false negatives (appropriate hospital stays regarded as inappropriate) varying in degree from moderate to very high. The results showing high reliability and moderate validity regarding clinical assessment shows the AEP to be a useful instrument in the sifting-out of inappropriate use of hospitalisation, although they do not allow a definitive judgement to be made concerning the efficiency of hospital services

  16. 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.

  17. 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.

  18. High-dose oral medroxyprogesterone for inappropriate hypersexuality in elderly men with dementia: a case series.

    Science.gov (United States)

    Cross, Bethany S; DeYoung, G Robert; Furmaga, Kevin M

    2013-01-01

    To retrospectively examine the utility of high-dose oral medroxyprogesterone (MPA) for the treatment of inappropriate hypersexuality (IH) in elderly men with dementia. Ten men aged 65 years or older (median 79.5 years, range 65-93 years) were identified from all admissions at a 170-bed tertiary referral psychiatric hospital between December 2005 and January 2011. Admission records were used to identify subjects who received at least 100 mg daily of oral MPA. The primary outcome of successful treatment was chart documentation of a substantial decline in IH, such that subjects could return to preadmission residence. Data were collected to assess trends in dose, adverse effects, use of other symptom-modifying medications prior to MPA initiation, and successful return to preadmission placement. A trial serotoneric agent was used in 70% of subjects prior to MPA initiation. Sixty percent of subjects failed a trial of an antipsychotic, while 40% did not have response to the use of both a serotonergic agent and an antipsychotic before MPA was initiated. The average daily dose of MPA was 300 mg (range 100-400 mg/day). No adverse effects were documented from physician, nursing, or behavioral health rounding notes; however, adverse effects may not have been systematically assessed at the time of MPA administration. Seventy percent of subjects experienced favorable changes in target behaviors from MPA. Few data exist on effective therapy options for treatment of IH. The minimum concentration of MPA needed to suppress IH in the male body is unknown. MPA was titrated upward, with the efficacy measure being a decrease in inappropriate behaviors. Use of MPA likely contributed to decreased IH; however, other factors involved in hospitalization could have contributed to improved behavior. While requiring further study, high-dose (100-400 mg/day) oral MPA may represent an effective and well-tolerated treatment option for subjects displaying IH.

  19. Seasonal thermal energy storage

    Energy Technology Data Exchange (ETDEWEB)

    Allen, R.D.; Kannberg, L.D.; Raymond, J.R.

    1984-05-01

    This report describes the following: (1) the US Department of Energy Seasonal Thermal Energy Storage Program, (2) aquifer thermal energy storage technology, (3) alternative STES technology, (4) foreign studies in seasonal thermal energy storage, and (5) economic assessment.

  20. 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

  1. 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.

  2. A Review and Treatment Selection Model for Individuals with Developmental Disabilities Who Engage in Inappropriate Sexual Behavior.

    Science.gov (United States)

    Davis, Tonya N; Machalicek, Wendy; Scalzo, Rachel; Kobylecky, Alicia; Campbell, Vincent; Pinkelman, Sarah; Chan, Jeffrey Michael; Sigafoos, Jeff

    2016-12-01

    Some individuals with developmental disabilities develop inappropriate sexual behaviors such as public masturbation, disrobing, and touching others in an unwanted sexual manner. Such acts are problematic given the taboo nature of the behaviors and the potential for significant negative consequences, such as restricted community access, injury, and legal ramifications. Therefore, it is necessary to equip caregivers and practitioners with effective treatment options. The purpose of this paper is to review studies that have evaluated behavioral treatments to reduce inappropriate sexual behavior in persons with developmental disabilities. The strengths and weaknesses of each treatment are reviewed, and a model for treatment selection is provided.

  3. Evaluating Storage Systems for Lustre

    Energy Technology Data Exchange (ETDEWEB)

    Oral, H. Sarp [Oak Ridge National Lab. (ORNL), Oak Ridge, TN (United States)

    2015-08-20

    Storage systems are complex, including multiple subsystems and components. Sustained operations with top performance require all these subsystems and components working as expected. Having a detailed performance profile helps establishing a baseline. This baseline can be used for easier identification of possible future problems. A systematic bottom-to-top approach, starting with a detailed performance analysis of disks and moving up across layers and subsystems, provides a quantitative breakdown of each component's capabilities and bottlenecks. Coupling these low-level tests with Lustre-level evaluations will present a better understanding of performance expectations under different I/O workloads.

  4. "Normal" and "Inappropriate" Childhood Sexual Behaviours: Findings from a Delphi Study of Professionals in the United Kingdom

    Science.gov (United States)

    Vosmer, Susanne; Hackett, Simon; Callanan, Margie

    2009-01-01

    This paper presents the results of a three-stage Delphi study examining the current level of consensus among 24 professionals in the United Kingdom regarding definitions of and distinctions between normal, inappropriate and sexually abusive behaviours in children under 10 years, as well as factors influencing their views. Although firm conclusions…

  5. Group Contingencies, Randomization of Reinforcers, and Criteria for Reinforcement, Self-Monitoring, and Peer Feedback on Reducing Inappropriate Classroom Behavior

    Science.gov (United States)

    Coogan, Brenda Anne; Kehle, Thomas J.; Bray, Melissa A.; Chafouleas, Sandra M.

    2007-01-01

    Considerable research has demonstrated the effectiveness of interdependent and unknown dependent group contingencies on reducing inappropriate classroom behavior. Several investigators have focused on the addition of self-monitoring and peer feedback to these interdependent and unknown dependent group contingencies in order to further improve…

  6. 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.

  7. Teachers' Self-Reported Beliefs on Developmentally Appropriate and Inappropriate Practices in Grade K-4 EFL Classrooms

    Science.gov (United States)

    Mede, Enisa

    2017-01-01

    This study investigated the perceived beliefs and reported practices of fourth-grade English teachers in primary (elementary) public schools in Turkey. Significantly, it aimed to examine the participating K-4 English as a foreign language (EFL) teachers' beliefs about the developmentally appropriate and inappropriate practices, discover the…

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

    Science.gov (United States)

    Lucena-Silva, Norma; Assunção, Maria Elisa Lucena Sales de Melo; Ramos, Frederico Antônio Pereira; Azevedo, Fernanda; Lessa, Ronaldo; Cordeiro, Marli Tenório; Brito, Carlos Alexandre Antunes de

    2017-01-01

    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.

  9. 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.

  10. Nontechnical Strategies To Reduce Children's Exposure to Inappropriate Material on the Internet. Summary of a Workshop (December 13, 2000).

    Science.gov (United States)

    Iannotta, Joah G., Ed.

    In response to a Congressional mandate in conjunction with the Protection of Children from Sexual Predators Act of 1998, a committee of experts was formed to explore both technical and nontechnical strategies for protecting children from pornography and other inappropriate Internet content. This book summarizes a workshop held in December 2000 to…

  11. 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

    2012-08-24

    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.

  12. 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.

  13. 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.

  14. [Potentially inappropriate prescribing in older Spanish population according to STOPP/START criteria (STARTREC study)].

    Science.gov (United States)

    Cruz-Esteve, Inés; Marsal-Mora, Josep Ramón; Galindo-Ortego, Gisela; Galván-Santiago, Leonardo; Serrano-Godoy, Marcos; Ribes-Murillo, Esther; Real-Gatius, Jordi

    2017-03-01

    Rational prescribing in older people is a priority for health care organizations. The STOPP/START screening tool has been developed to identify potentially inappropriate prescribing (PIP) in individuals. In a primary care setting, STOPP/START can estimate PIP prevalence and related factors at population level. The aim of this study is to measure the prevalence rates of PPI in elderly population using clinical and prescription claim databases. Cross-sectional population study. Primary Care, Lleida Health Region, Spain. 45.408 patients 70 years old and over, attended in the primary health care centers at least once the last year. 43 STOPP and 12 START criteria are applied to their 2012 clinical and prescription records. Logistic regression models are adjusted to determine PIP association with several factors. 45,408 patients are included. The mean age is 79.7 years, 58% being female. The overall prevalence of PPI is 58.1%. According to STOPP, the most common drugs identified are benzodiazepines, non-steroidal anti-inflammatory drugs and proton pump inhibitors; according to START, osteoporosis treatments, antiplatelet agents, statins, metformin and beta blockers. PIP increases with age and polypharmacy and it is higher in long-term care facilities residents and patients receiving home health care. In our Health Region, at least 50% of the population aged 70 or older has one or more PIP, according to STOPP/START criteria. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  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. 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.

  18. 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.

  19. Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases.

    Science.gov (United States)

    Pérez-Jover, Virtudes; Mira, José J; Carratala-Munuera, Concepción; Gil-Guillen, Vicente F; Basora, Josep; López-Pineda, Adriana; Orozco-Beltrán, Domingo

    2018-02-10

    The growth of the aging population leads to the increase of chronic diseases, of the burden of multimorbility, and of the complexity polypharmacy. The prevalence of medication errors rises in patients with polypharmacy in primary care, and this is a major concern to healthcare systems. This study reviews the published literature on the inappropriate use of medicines in order to articulate recommendations on how to reduce it in chronic patients, particularly in those who are elderly, polymedicated, or multipathological. A systematic review of articles published from January 2000 to October 2015 was performed using MEDLINE, EMBASE, PsychInfo, Scopus, The Cochrane Library, and Index Medicus databases. We selected 80 studies in order to analyse the content that addressed the question under consideration. Our literature review found that half of patients know what their prescribed treatment is; that most of elderly people take five or more medications a day; that in elderly, polymedicated people, the probability of a medication error occurring is higher; that new tools have been recently developed to reduce errors; that elderly patients can understand written information but the presentation and format is an important factor; and that a high percentage of patients have remaining doubts after their visit. Thus, strategies based on the evidence should be applied in order to reduce medication errors.

  20. 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.

  1. Proton pump inhibitors overuse: only inappropriate prescriptions or further iatrogenic damage?

    Directory of Open Access Journals (Sweden)

    Mario Visconti

    2015-09-01

    Full Text Available Proton pump inhibitors (PPIs are the most potent drugs for reducing gastric acid secretion; so, since their release in the late 1980s, they have been recommended as the first therapeutic choice for many gastroesophageal diseases, risk reduction in or healing of non-steroidal anti-inflammatory drugs-associated ulcer disease and stress ulcer prophylaxis in intensive care unit patients. Thus PPIs account for a significant proportion of pharmaceutical health-care expenditure. Much of this high expenditure results from overuse of PPIs in account of inappropriate indications or prolongation of therapies for excessive time compared to real need. PPIs overutilization occurs in all medical care settings: in the majority of hospitalized patients with low risks for gastrointestinal bleeding, in patients healed at discharge from hospital, in outpatients in ambulatory practice. However potential adverse effects associated with PPIs therapy have been described, including enteric (especially by Clostridium difficile in elderly patients and pneumonia infections, nutritional deficiencies, rebound acid hypersecretion, acute interstitial nephritis, gastric neoplasms, bone fractures. Caution is required for some coprescription, particularly with clopidogrel.

  2. [The treament of hyponatremia secundary to the syndrome of inappropriate antidiuretic hormone secretion].

    Science.gov (United States)

    Runkle, Isabelle; Villabona, Carles; Navarro, Andrés; Pose, Antonio; Formiga, Francesc; Tejedor, Alberto; Poch, Esteban

    2013-12-07

    The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the most frequent cause of hyponatremia in a hospital setting. However, detailed protocols and algorithms for its management are lacking. Our objective was to develop 2 consensus algorithms for the therapy of hyponatremia due to SIADH in hospitalized patients. A multidisciplinary group made up of 2 endocrinologists, 2 nephrologists, 2 internists, and one hospital pharmacist held meetings over the period of a year. The group worked under the auspices of the European Hyponatremia Network and the corresponding Spanish medical societies. Therapeutic proposals were based on widely-accepted recommendations, expert opinion and consensus guidelines, as well as on the authors' personal experience. Two algorithms were developed. Algorithm 1 addresses acute correction of hyponatremia posing as a medical emergency, and is applicable to both severe euvolemic and hypovolemic hyponatremia. The mainstay of this algorithm is the iv use of 3% hypertonic saline solution. Specific infusion rates are proposed, as are steps to avoid or reverse overcorrection of serum sodium levels. Algorithm 2 is directed to the therapy of SIADH-induced mild or moderate, non-acute hyponatremia. It addresses when and how to use fluid restriction, solute, furosemide, and tolvaptan to achieve eunatremia in patients with SIADH. Two complementary strategies were elaborated to treat SIADH-induced hyponatremia in an attempt to increase awareness of its importance, simplify its therapy, and improve prognosis. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  3. Liquid Cloud Storage

    OpenAIRE

    Luby, Michael G.; Padovani, Roberto; Richardson, Thomas J.; Minder, Lorenz; Aggarwal, Pooja

    2017-01-01

    A liquid system provides durable object storage based on spreading redundantly generated data across a network of hundreds to thousands of potentially unreliable storage nodes. A liquid system uses a combination of a large code, lazy repair, and a flow storage organization. We show that a liquid system can be operated to enable flexible and essentially optimal combinations of storage durability, storage overhead, repair bandwidth usage, and access performance.

  4. 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.

  5. 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 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 outpatient imaging. Copyright © 2017

  6. Decreasing inappropriate unable-to-assess ratings for the confusion assessment method for the intensive care unit.

    Science.gov (United States)

    Swan, Joshua T

    2014-01-01

    The Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) is a validated tool for diagnosing delirium in the ICU and yields 1 of 3 ratings: positive, negative, and unable to assess (UTA). It was hypothesized that an educational campaign focused on establishing patients' arousal as comatose versus noncomatose before initiating the CAM-ICU would decrease the incidence of inappropriate UTA ratings. To compare the incidence of inappropriate UTA ratings before and after an educational campaign. An interventional, quasi-experimental study was conducted in a surgical ICU at a tertiary academic medical center. A nursing educational campaign was conducted from March 1 to March 7, 2012. Patients admitted to the surgical ICU from December 25, 2011 through January 25, 2012 were included in the baseline cohort, and patients admitted from March 9 through April 9, 2012 were included in the posteducation cohort. Inclusion criteria were admission to the surgical ICU for at least 24 hours and at least 1 CAM-ICU assessment. The baseline cohort included 93 patients and the posteducation cohort included 96 patients. Patients were 41% less likely to receive an inappropriate UTA rating after the educational campaign (32% [30 of 93] baseline vs 19% [18 of 96], P = .03). Patients with concurrent mechanical ventilation were more likely to receive an inappropriate UTA rating in the baseline cohort (odds ratio, 30.7; 95% CI, 8.9-105.9; P < .001) and the posteducation cohort (odds ratio, 15.5; 95% CI, 4.1-59.5; P < .001). The educational campaign decreased the incidence of inappropriate UTA ratings.

  7. 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.

  8. 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.

  9. 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

  10. 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.

  11. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem

    Science.gov (United States)

    Parsons, Carole

    2016-01-01

    Multimorbidity and polypharmacy are increasingly prevalent across healthcare systems and settings as global demographic trends shift towards increased proportions of older people in populations. Numerous studies have demonstrated an association between polypharmacy and potentially inappropriate prescribing (PIP), and have reported high prevalence of PIP across settings of care in Europe and North America and, as a consequence, increased risk of adverse drug reactions, healthcare utilization, morbidity and mortality. These studies have not focused specifically on people with dementia, despite the high risk of adverse drug reactions and PIP in this patient cohort. This narrative review considers the evidence currently available in the area, including studies examining prevalence of PIP in older people with dementia, how appropriateness of prescribing is assessed, the medications most commonly implicated, the clinical consequences, and research priorities to optimize prescribing for this vulnerable patient group. Although there has been a considerable research effort to develop criteria to assess medication appropriateness in older people in recent years, the majority of tools do not focus on people with dementia. Of the limited number of tools available, most focus on the advanced stages of dementia in which life expectancy is limited. The development of tools to assess medication appropriateness in people with mild to moderate dementia or across the full spectrum of disease severity represents an important gap in the research literature and is beginning to attract research interest, with recent studies considering the medication regimen as a whole, or misprescribing, overprescribing or underprescribing of certain medications/medication classes, including anticholinergics, psychotropics, antibiotics and analgesics. Further work is required in development and validation of criteria to assess prescribing appropriateness in this vulnerable patient population, to

  12. [Results of an intervention to reduce potentially inappropriate prescriptions of beta blockers and calcium channel blockers].

    Science.gov (United States)

    Machado-Alba, J E; Giraldo-Giraldo, C; Aguirre Novoa, A

    2016-01-01

    To determine the frequency of simultaneous prescription of β-blockers and calcium channel blockers, notify the cardiovascular risk of these patients to the health care professionals in charge of them, and achieve a reduction in the number of those who use them. Quasi-experimental, prospective study by developing an intervention on medical prescriptions of patients older than 65 years treated between January 1 and July 30, 2014, affiliated to the Health System in 101 cities in Colombia. A total of 43,180 patients received a β-blocker each month, and 14,560 receiving a calcium channel blocker were identified. Educational interventions were performed and an evaluation was made, using sociodemographic and pharmacological variables, on the number of patients that stopped taking any of the two drugs in the following three months. A total of 535 patients, with a mean age 75.8±6.7 years received concomitant β-blockers plus calcium channel blockers. Modification of therapy was achieved in 235 patients (43.9% of users) after 66 educational interventions. In 209 cases (88.9%) one of the two drugs was suspended, and 11.1% changed to other antihypertensive drugs. The variable of being more than 85 years old (OR: 1.93; 95% CI: 1.07-3.50), and receiving concomitant medication with inhibitors of the renin-angiotensin system (OR: 2.16; 95% CI: 1.28-3.65) were associated with increased risk of their doctor changing or stopping the prescription. An improved adherence to recommendations for appropriate use of β-blockers and calcium channel blockers by health service providers was achieved. Intervention programs that reduce potentially inappropriate prescriptions for patients treated for cardiovascular disease should be used more frequently. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

  13. 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.

  14. Radiation Therapy Results of Invasive Cervical Carcinoma Found After Inappropriate Hysterectomy

    International Nuclear Information System (INIS)

    Choi, Doo Ho; Kim, Eun Seog; Nam, Kae Hyun; Huh, Seung Jae

    1996-01-01

    remained after inappropriate hysterectomy was poor. So, early cancer detection and proper management with precise pretreatment staging is necessary to avoid inadherent hysterectomy especially in the cases of gross residual disease

  15. 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.

  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. Prevalence and factors associated with inappropriate use of treadmill exercise stress test for coronary artery disease: a cross-sectional study.

    Science.gov (United States)

    Silva, Antônio M L; Armstrong, Anderson C; Silveira, Fernando J C; Cavalcanti, Marcelo D; França, Fernando M F; Correia, Luis C L

    2015-06-16

    In some countries, the public health system has less availability when compared to the population covered by health insurance. In addition, inappropriate referrals for treadmill exercise stress test increase spending and lead to unnecessary interventions. We aim to determine the prevalence and characteristics of inappropriate referrals for treadmill exercise stress tests in the assessment of coronary artery disease (CAD), considering public and private health systems scenarios. A cross-sectional design was used to describe the frequency of inappropriate use of exercise testing in the diagnosis of CAD and to determine its predictors. We consecutively enrolled 191 patients from two outpatient facilities in Northeast Brazil. For inclusion, the exercise testing should be referred for the assessment of CAD. We performed logistic regression models to identify independent predictors of inappropriate use. Treadmill exercise stress tests were rated as inappropriate in 150 (78 %) patients. The majority of patients had low or very low pre-test probability of CAD. Presence of hypertension, diabetes and dyslipidemia were more frequent in the appropriate than inappropriate indications (71 %, 19 % and 29 % versus 43 %, 8 % and 16 %, respectively). Tests performed both at the public and private system showed high prevalence of inappropriate examinations, higher in the latter (57 % versus 87 %, P test referrals in the assessment of CAD were inappropriate. The availability of the method and not the estimate probability of CAD appear to be the underlying condition for a treadmill test referral.

  18. 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....

  19. Inadequate drug prescribing: comparison of inappropriate drug rates at the end of a geriatric short-stay service with three prescribing tools.

    Science.gov (United States)

    Fanon, Jean-Luc; Dechavigny, Sandra; Dramé, Moustapha; Godaert, Lidvine

    2017-12-01

    To compare the proportion of prescriptions containing at least one inappropriate drug, as identified using three tools for optimizing drug prescriptions in the elderly. Cross-sectional, observational study based on the analysis of prescriptions of patients discharged between 1 September and 31 October 2014 in a short-stay geriatrics unit at the Louis Domergue de Trinité Hospital in Martinique (France). Each prescription was analysed using 3 tools, namely one for general medicine (Vidal © drug dictionary) and two tools specifically designed for geriatrics (the Laroche list of potentially inappropriate medications, and the STOPP-START toolkit). The number of prescriptions containing at least one inappropriate medication was recorded as evaluated with each tool. These prescriptions were then compared to investigate whether the two geriatric tools identified the same prescriptions as being inappropriate. In total, 53 prescriptions were analysed. The male-female sex ratio was 0.70. The average age of the patients was 84.5±6.2 years. Analysis according to the Vidal © drug dictionary identified the greatest number of inappropriate prescriptions (28.3% of all prescriptions). The proportion of prescriptions containing at least one inappropriate drug was lower with the two tools specific to geriatrics (11% for the Laroche list and 7.5% for the STOPP-START method). The general medicine Vidal © drug dictionary identified more inappropriate prescriptions than the tools specifically designed for geriatrics. The tools for aiding drug prescriptions in the elderly identified different drugs as being inappropriate.

  20. 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.

  1. 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.

  2. Fungal suppression of resistance against inappropriate ¤Blumeria graminis formae speciales¤ in barley, oat and wheat

    DEFF Research Database (Denmark)

    Olesen, K.L.; Carver, T.L.W.; Lyngkjær, Michael Foged

    2003-01-01

    When barley, wheat or oat leaf epidermal cells were attacked by their appropriate forma specialis (f.sp.) of Blumeria graminis DC. Speer (f.sp. hordei, tritici and avenae, respectively), many attempted penetrations succeeded, functional haustoria were formed and very few plant cells died. When...... attacked by either of the two possible inappropriate ff.spp., penetration attempts failed in association with papilla deposition by epidermal cells, attacked cells died, or if visible haustoria were formed the plant cell died very soon afterwards. Double inoculation experiments were performed where each...... the inducer haustorium, evident to some extent in adjacent cells, but undetectable at two cells distance. Suppression of penetration resistance allowed most challenger attacks, even by inappropriate ff.spp., to form a haustorium. Furthermore, death of penetrated epidermal cells was also suppressed so...

  3. 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.)

  4. Abstract Storage Devices

    OpenAIRE

    Koenig, Robert; Maurer, Ueli; Tessaro, Stefano

    2007-01-01

    A quantum storage device differs radically from a conventional physical storage device. Its state can be set to any value in a certain (infinite) state space, but in general every possible read operation yields only partial information about the stored state. The purpose of this paper is to initiate the study of a combinatorial abstraction, called abstract storage device (ASD), which models deterministic storage devices with the property that only partial information about the state can be re...

  5. 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

  6. 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.)

  7. Fuel storage systems

    Energy Technology Data Exchange (ETDEWEB)

    Donakowski, T.D.; Tison, R.R.

    1979-08-01

    Storage technologies are characterized for solid, liquid, and gaseous fuels. Emphasis is placed on storage methods applicable to Integrated Community Energy Systems based on coal. Items discussed here include standard practice, materials and energy losses, environmental effects, operating requirements, maintenance and reliability, and cost considerations. All storage systems were found to be well-developed and to represent mature technologies; an exception may exist for low-Btu gas storage, which could have materials incompatability.

  8. [Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments].

    Science.gov (United States)

    Toledo del Castillo, B; González Ruiz de León, E; Rivas García, A; Vázquez López, P; Miguez Navarro, M C; Marañón Pardillo, R

    2016-01-01

    To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  9. Thyroid storm due to inappropriate administration of a compounded thyroid hormone preparation successfully treated with plasmapheresis.

    Science.gov (United States)

    Jha, Sujeet; Waghdhare, Swati; Reddi, Rajashekar; Bhattacharya, Priyanka

    2012-12-01

    Thyroid storm (TS) is a rare life-threatening condition that is characterized by fever and altered mental status precipitated by endogenous or exogenous critical events, illness/injury, acute iodine load, and thyroid or non thyroid surgery. A large number of thyroid extracts are available and extensively used, even though they are not recommended clinically in hypothyroid or euthyroid patients. Consumption of such products can be dangerous and result in life-threatening TS. Here, we report a case of TS caused by inadvertent intake of very high dosages of triiodothyronine (T3) and thyroxine (T4) in compounded thyroid extracts. Plasmapheresis may be considered an option for the management of exogenous TS. A 62-year-old woman with no significant past medical history presented with severe myalgia, fever, tachycardia, and blood pressure of 170/80 mmHg, which precipitated to an altered mental state within 24 hours. Neurological examination did not reveal any focal deficit or any signs of meningeal irritation. Further investigation revealed that she had been taking thyroid supplements. The patient had accidentally been supplied with a batch of thyroid extract pills that had an inadvertently high content of T4. Her free T3 (FT3) and free T4 (FT4) levels were found to be very high beyond the laboratory readable range (FT3>30 pg/mL; FT4>6.06 ng/dL; thyrotropin [TSH]=0.07 IU/mL). Three days post commencement of standard conservative management of TS, the patient developed posterior reversible encephalopathy syndrome, resulting in a seizure. She remained unresponsive and in a poor mental state. The confirmed exogenous etiology for TS led to a decision to conduct plasmapheresis. Plasmapheresis conducted for two consecutive days proved successful as a therapeutic measure for TS and improved her thyroid profile as well as her mental state. The inappropriate use of thyroid extracts in euthyroid and hypothyroid patients can result in life-threatening TS. Plasmapheresis is probably

  10. Inappropriate Use of Proton Pump Inhibitors in Elderly Patients Discharged from Acute Care Hospitals.

    Science.gov (United States)

    Schepisi, R; Fusco, S; Sganga, F; Falcone, B; Vetrano, D L; Abbatecola, A; Corica, F; Maggio, M; Ruggiero, C; Fabbietti, P; Corsonello, A; Onder, G; Lattanzio, F

    2016-01-01

    Proton-pump inhibitors (PPI) are extensively prescribed in older patients. However, little information is available on factors associated to PPI prescribing patterns among older patients discharged from hospital. To evaluate the appropriateness and clinical correlates of PPI prescription at discharge in a population of 1081 older patients discharged from acute care Italian hospitals. We used data from the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) study, a multicenter observational study. The appropriateness of PPI prescriptions was defined according to the Italian Medicines Agency (AIFA) rules. Correlates of overprescribing (i.e prescribing without recognized AIFA indications) and underprescribing (i.e. not prescribing despite the presence of recognized AIFA indications) were investigated by logistic regression analysis. Overprescribing was observed in 30% of patients receiving PPIs at discharge. Underprescribing was observed in 11% of patients not receiving PPIs at discharge. Overprescribing of PPIs at discharge was negatively associated with age (OR=0.88, 95%CI=0.85-0.91), depression (OR=0.58, 95%CI=0.35-0.96), use of aspirin (OR=0.03, 95%CI=0.02-0.06) and systemic corticosteroids (OR=0.02, 95%CI=0.01-0.04). The negative association with number of medications (OR=0.95, 95%CI=0.88-1.03) and overall comorbidities (OR=0.92, 95%CI=0.83-1.02) was nearly significant. Conversely, older age (OR=1.09, 95%CI=1.04-1.14), use of aspirin (OR=24.0, 95%CI=11.5-49.8) and systemic corticosteroids (OR=19.3, 95%CI=11.5-49.8) and overall comorbidities (OR=1.22, 95%CI=1.04-1.42) were independent correlates of underprescribing. Overprescribing of PPIs is more frequent in younger patients with lower burden of depression, whilst underprescribing is characterized by older age and greater burden of comorbidity and polypharmacy. Hospitalization should be considered as a clue to identify inappropriate use of PPIs and improve appropriateness of

  11. Impact of potential inappropriate NSAIDs use in chronic pain

    Directory of Open Access Journals (Sweden)

    Ussai S

    2015-04-01

    Full Text Available S Ussai,1,2 L Miceli,3 F E Pisa,4 R Bednarova,5 A Giordano,1,2 G Della Rocca,3 R Petelin6 1Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; 2Sbarro Institute for Cancer Research and Molecular Medicine and Center of Biotechnology, College of Science and Technology, Temple University, Philadelphia, PA, USA; 3Department of Anesthesiology and Intensive Care Medicine, 4Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, 5Department of Palliative Care and Pain Medicine, Health Company n.5, Bassa Friulana, Italy; 6School of Management, Santa Clara University, Santa Clara, CA, USA Abstract: Pain remains one of the main reasons for medical consultation worldwide: moderate- to severe-intensity pain occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Nonsteroidal anti-inflammatory drugs (NSAIDs are not recommended for long-term use and a careful surveillance to monitor for toxicity and efficacy is critical. This study aims to assess: 1 the pattern of use of NSAIDs and opioids in a population covered by a cloud-based pharmacovigilance surveillance system; and 2 potential inappropriate use. A retrospective 18-months systematic analysis on patients’ pain treatment was performed. The primary endpoint was evaluating the prevalence of NSAIDs and opioids use and the duration of therapy regimen. The secondary endpoint was to investigate the prevalence of NSAIDs taken for >21 consecutive days concomitant with drugs for peptic ulcer and gastroesophageal reflux disease (GORD or antiplatelet drugs. The yearly cost for individual users of concomitant NSAIDs for more than 21 consecutive days and of GORD medications has been estimated. A total of 3,050 subjects with chronic pain were enrolled; 97% of them took NSAIDs for >21 consecutive days; about one-fourth of these users also received drugs for peptic ulcer and GORD (Anatomical Therapeutic Chemical

  12. 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...

  13. 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

  14. 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

  15. 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

  16. Glycogen storage disease type III diagnosis and management guidelines.

    Science.gov (United States)

    Kishnani, Priya S; Austin, Stephanie L; Arn, Pamela; Bali, Deeksha S; Boney, Anne; Case, Laura E; Chung, Wendy K; Desai, Dev M; El-Gharbawy, Areeg; Haller, Ronald; Smit, G Peter A; Smith, Alastair D; Hobson-Webb, Lisa D; Wechsler, Stephanie Burns; Weinstein, David A; Watson, Michael S

    2010-07-01

    glycogen storage disease type III, expedite diagnosis, and minimize stress and negative sequelae from delayed diagnosis and inappropriate management. It will also help identify gaps in scientific knowledge that exist today and suggest future studies.

  17. 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.

  18. Energy storage technologies

    International Nuclear Information System (INIS)

    Brunet, Y.

    2009-01-01

    This book takes stock of the advantages and drawbacks of the different energy storage solutions apart from the classical fossil fuels (oil, uranium, gas), and details the technologies developed for an electric end-use. Storage is one of the most critical point for the development of new energy technologies, in particular those that use the electricity vector all along the energy source chain (generation, production, transport, utilisation). Storage is important not only for individual or independent applications, that use renewable energies or not, often intermittent, but also to secure coupled systems like power transportation and distribution systems. The development and choice of the most relevant technologies is dependent of technical-economical parameters. It can also supply new services, in particular in the framework of new electricity markets. Content: power film-capacitors, magnetic storage, kinetic energy storage, compressed air energy storage (CAES), hydro-pneumatic storage, high-temperature thermal storage of electricity, hydraulic gravity storage, power electronic systems for energy storage. (J.S.)

  19. Spent fuel centralized storage

    International Nuclear Information System (INIS)

    Chometon, P.L.

    1985-01-01

    Nuclear energy producer countries have felt the need to build a centralized spent fuel storage before reprocessing (for example, COGEMA in FRANCE), either in an adjoining plant on an appropriate site, or isolated. More rarely, this storage enables to decide whether to reprocess or to definitely store spent fuel considered as being waste: for example CLAB in Sweden. Our Company is specialized in the design and construction of spent fuel centralized storage plants. Storage generally takes place in a pool in order to facilitate handling operations and retrieving of these fuels, but these operations may also be effected in a dry way, either in concrete structures or in storage casks. With respect to pools, which might currently be the most appropriate and flexible system, several improvements have recently been made in the design of cask reception facilities and spent fuel storage. These improvements are presented, hereafter [fr

  20. Spent fuel centralized storage

    International Nuclear Information System (INIS)

    Baillif, L.; Chometon, P.L.

    1986-01-01

    Nuclear energy producer countries have felt the need to build a centralized spent fuel storage before reprocessing, either in an adjoining plant on an appropriate site, or isolated. More rarely, this storage enables to decide whether to reprocess or to definitely store spent fuel considered as being waste: for example CLAB in Sweden. Our Company SGN is specialized among others in the design and construction of spent fuel centralized storage plants. Storage generally takes place in a pool in order to facilitate handling operations and retrieving of these fuels, but these operations may also be effected in a dry way, either in concrete structures or in storage casks. With respect to pools, which might currently be the most appropriate and flexible system, several improvements have recently been made in the design of cask reception facilities and spent fuel storage. These improvements are presented, hereafter [fr

  1. Network Atached Storage

    OpenAIRE

    Griffee, Bill

    2013-01-01

    Digital distribution of media has grown increasingly important as an additional requirement is to have this media available to multiple users. Traditionally, servers have filled this role in companies by providing storage that can be accessed by other devices on a network, typically through file sharing or serving or via a storage area network, while providing other services as well. Network attached storage (NAS) systems expand upon traditional servers in that they are built specifically wit...

  2. 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

  3. Differences Between Access to Follow-Up Care and Inappropriate Shocks Based on Insurance Status of Implantable Cardioverter Defibrillator Recipients.

    Science.gov (United States)

    Sager, Solomon J; Healy, Chris; Ramireddy, Archana; Rivner, Harold; Viles Gonzalez, Juan F; Coffey, James O; Rossin, Natalia; Lo, Ka M; Goldberger, Jeffrey J; Myerburg, Robert J; Mitrani, Raul D

    2017-02-15

    Differences in implantable cardioverter defibrillator (ICD) utilization based on insurance status have been described, but little is known about postimplant follow-up patterns associated with insurance status and outcomes. We collected demographic, clinical, and device data from 119 consecutive patients presenting with ICD shocks. Insurance status was classified as uninsured/Medicaid (uninsured) or private/Health Maintenance Organization /Medicare (insured). Shock frequencies were analyzed before and after a uniform follow-up pattern was implemented regardless of insurance profile. Uninsured patients were more likely to present with an inappropriate shock (63% vs 40%, p = 0.01), and they were more likely to present with atrial fibrillation (AF) as the shock trigger (37% vs 19%, p = 0.04). Uninsured patients had a longer interval between previous physician contact and index ICD shock (147 ± 167 vs 83 ± 124 days, p = 0.04). Patients were followed for a mean of 521 ± 458 days after being enrolled in a uniform follow-up protocol, and there were no differences in the rate of recurrent shocks based on insurance status. In conclusion, among patients presenting with an ICD shock, underinsured/uninsured patients had significantly longer intervals since previous physician contact and were more likely to present with inappropriate shocks and AF, compared to those with private/Medicare coverage. After the index shock, both groups were followed uniformly, and the differences in rates of inappropriate shocks were mitigated. This observation confirms the importance of regular postimplant follow-up as part of the overall ICD management standard. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. 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

  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. 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.

  8. Underground Storage Tank (working)

    Data.gov (United States)

    Vermont Center for Geographic Information — Database contains information on ownership and system construction for underground storage tank facilities statewide. Database was developed in early 1990's for...

  9. 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...

  10. Clinical guidelines for management of diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion after pituitary surgery.

    Science.gov (United States)

    Lamas, Cristina; del Pozo, Carlos; Villabona, Carles

    2014-04-01

    Changes in water metabolism and regulation of vasopressin (AVP) or antidiuretic hormone (ADH) are common complications of pituitary surgery. The scarcity of studies comparing different treatment and monitoring strategies for these disorders and the lack of prior clinical guidelines makes it difficult to provide recommendations following a methodology based on grades of evidence. This study reviews the pathophysiology of diabetes insipidus and inappropriate ADH secretion after pituitary surgery, and is intended to serve as a guide for their diagnosis, differential diagnosis, treatment, and monitoring. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.

  11. Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated with Amyotrophic Lateral Sclerosis in a Patient Developing Carbon Dioxide Narcosis.

    Science.gov (United States)

    Inoue, Yui; Murakami, Takaaki; Nakamura, Takeshi; Morita, Kyohei; Kaneda, Daita; Nishino, Ichizo; Hayashi, Tetsuya; Shinoto, Yuya; Hatoko, Tomonobu; Kato, Tomoko; Yonemitsu, Shin; Muro, Seiji; Oki, Shogo

    2017-01-01

    We report a rare case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) associated with amyotrophic lateral sclerosis (ALS). A 69-year-old man was admitted to our hospital with sustained hyponatremia. Hyposmolality with elevated urinary osmolality and sodium excretion was observed, which indicated SIADH. The treatment for SIADH was challenging; the patient developed carbon dioxide narcosis, which led to the diagnosis of ALS. After the initiation of noninvasive positive-pressure ventilation, the patient's serum sodium concentration normalized and became stable. Thus, ALS should be recognized as a possible cause of SIADH in the clinical setting.

  12. Inappropriate Shock Delivered By Implantable Cardioverter Defibrillator - Cardiac Resynchronization Therapy (ICD-CRT Due To Myopotential Oversensing

    Directory of Open Access Journals (Sweden)

    Hamid Barakpour

    2009-01-01

    Full Text Available The clinical efficacy of ICD-CRT therapy depends on accurate sensing of intracardiac signals and sensing algorithms. We report the occurrence of sensing abnormality in a patient with ICD-CRT. In this patient, oversensing of myopotentials during strenuous muscular activity resulted in an inappropriate ICD-CRT discharge. Although modern ICDs are highly effective in detecting and terminating malignant tachyarrhythmias, their detection specificity must be improved. It is possible to find the mechanism of arrhythmia by EGM. Simple device reprogramming make it possible to avoid the oversensing of myopotentials.

  13. 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.

  14. 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.

  15. 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

  16. The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients. A modified Delphi study.

    Science.gov (United States)

    Rognstad, Sture; Brekke, Mette; Fetveit, Arne; Spigset, Olav; Wyller, Torgeir Bruun; Straand, Jørund

    2009-01-01

    To establish a clinically relevant list with explicit criteria for pharmacologically inappropriate prescriptions in general practice for elderly people > or =70 years. A three-round Delphi process for validating the clinical relevance of suggested criteria (n = 37) for inappropriate prescriptions to elderly patients. A postal consensus process undertaken by a panel of specialists in general practice, clinical pharmacology, and geriatrics. Main outcome measures. The Norwegian General Practice (NORGEP) criteria, a relevance-validated list of drugs, drug dosages, and drug combinations to be avoided in the elderly (general practice. Relevance of three of the criteria was rated significantly higher in Round 3 than in Round 1. At the end of the Delphi process, a significant difference between the different specialist groups' scores was seen for only one of the 36 criteria. The NORGEP criteria may serve as rules of thumb for general practitioners (GPs) related to their prescribing practice for elderly patients, and as a tool for evaluating the quality of GPs' prescribing in settings where access to clinical information for individual patients is limited, e.g. in prescription databases and quality improvement interventions.

  17. 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.

  18. 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.

  19. National cultural dimensions as drivers of inappropriate ambulatory care consumption of antibiotics in Europe and their relevance to awareness campaigns.

    Science.gov (United States)

    Borg, Michael A

    2012-03-01

    European countries exhibit significant geographical differences in antibiotic consumption per capita within ambulatory care, especially inappropriate use for colds/flu/sore throat (CFSt). One potential explanation could be national cultural differences resulting in varying perceptions and, therefore, influences. Publicly available data on the proportions of respondents in the 2009 Eurobarometer survey who had taken antibiotics for CFSt were tested for association against country scores derived from the Hofstede cultural dimension model. They were also correlated with knowledge of respondents about various key antibiotic facts. The Eurobarometer dataset incorporated 26,259 responses from all European Union (EU) countries except Cyprus. Using multiple regression, uncertainty avoidance and masculinity were identified as the two national cultural dimensions significantly associated with the use of antibiotics for CFSt (R-adjusted = 0.45; PCFSt was found to be inversely correlated with respondents' knowledge that antibiotics are ineffective against viruses (r=-0.724; P<0.001) and that misuse will render them ineffective in the longer term (r=-0.775; P<0.001). National cultural dimensions, especially uncertainty avoidance and masculinity, appear to have a very significant impact on inappropriate antibiotic use within European countries. Nevertheless, their influence can be reduced by making EU citizens more knowledgeable about antibiotics through appropriate messages and targeted campaigns.

  20. Obesity is more strongly associated with inappropriate eating behaviors than with mental health in older adults receiving congregate meals.

    Science.gov (United States)

    Porter, Kathryn N; Johnson, Mary Ann

    2011-01-01

    This study explored the relationships of inappropriate eating behaviors and mental health with obesity in congregate meal participants in Georgia (N = 120, mean age = 75 years, 75% female, 43% African American). Inappropriate eating behaviors were evaluated with the Three-Factor Eating Questionnaire (18 questions); mental health was assessed with the Depression Anxiety Stress Scale (21 questions); history of depression was assessed with the Behavioral Risk Factor Surveillance Survey; and height and weight were measured to calculate body mass index (BMI) and obesity (52% ≥ 30 kg/m(2)). In bivariate analyses, obesity was associated with cognitive restraint (rho = 0.49, p eating (rho = 0.22; p emotional eating (rho = 0.32, p eating behavior and mental health indices, only cognitive restraint and emotional eating were consistently associated with obesity (p eating behaviors, particularly cognitive restraint and emotional eating, may be important targets for future research and intervention. Additional research is needed to better understand how cognitive restraint and emotional eating contribute to obesity in this population so that interdisciplinary research and health care teams can appropriately prevent and manage obesity in congregate meal participants.

  1. Energy Storage and Retrieval

    Indian Academy of Sciences (India)

    GENERAL I ARTICLE. Energy Storage and Retrieval. The Secondary Battery Route. A K Shukla and P Vishnu Kamath. Harnessing sunlight for the production of electrical energy is an engrossing prospect. The crucial concept underlying the success of solar power stations is energy storage and its retrieval on demand which ...

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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

  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. Gas Storage Technology Consortium

    Energy Technology Data Exchange (ETDEWEB)

    Joel L. Morrison; Sharon L. Elder

    2007-06-30

    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 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 crucial in meeting the needs of these new markets. 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 the 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. This report addresses the activities for the quarterly period of April 1, 2007 through June 30, 2007. Key activities during this time period included: (1) Organizing and hosting the 2007 GSTC Spring Meeting; (2) Identifying the 2007 GSTC projects, issuing award or declination letters, and begin drafting subcontracts; (3) 2007 project mentoring teams identified; (4) New NETL Project Manager; (5) Preliminary planning for the 2007 GSTC Fall Meeting; (6) Collecting and compiling the 2005 GSTC project final reports; and (7) Outreach and communications.

  9. Gas Storage Technology Consortium

    Energy Technology Data Exchange (ETDEWEB)

    Joel L. Morrison; Sharon L. Elder

    2006-05-10

    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. This report addresses the activities for the quarterly period of January 1, 2006 through March 31, 2006. Activities during this time period were: (1) Organize and host the 2006 Spring Meeting in San Diego, CA on February 21-22, 2006; (2) Award 8 projects for co-funding by GSTC for 2006; (3) New members recruitment; and (4) Improving communications.

  10. 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

  11. 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

  12. 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

  13. Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Micek Scott T

    2010-06-01

    Full Text Available Abstract Background Candida represents the most common cause of invasive fungal disease, and candidal blood stream infections (CBSI are prevalent in the ICU. Inappropriate antifungal therapy (IAT is known to increase a patient's risk for death. We hypothesized that in an ICU cohort it would also adversely affect resource utilization. Methods We retrospectively identified all patients with candidemia on or before hospital day 14 and requiring an ICU stay at Barnes-Jewish Hospital between 2004 and 2007. Hospital length of stay following culture-proven onset of CBSI (post-CBSI HLOS was primary and hospital costs secondary endpoints. IAT was defined as treatment delay of ≥24 hours from candidemia onset or inadequate dose of antifungal agent active against the pathogen. We developed generalized linear models (GLM to assess independent impact of inappropriate therapy on LOS and costs. Results Ninety patients met inclusion criteria. IAT was frequent (88.9%. In the IAT group antifungal delay ≥24 hours occurred in 95.0% and inappropriate dosage in 26.3%. Unadjusted hospital mortality was greater among IAT (28.8% than non-IAT (0% patients, p = 0.059. Both crude post-CBSI HLOS (18.4 ± 17.0 vs. 10.7 ± 9.4, p = 0.062 and total costs ($66,584 ± $49,120 vs. $33,526 ± $27,244, p = 0.006 were higher in IAT than in non-IAT. In GLMs adjusting for confounders IAT-attributable excess post-CBSI HLOS was 7.7 days (95% CI 0.6-13.5 and attributable total costs were $13,398 (95% CI $1,060-$26,736. Conclusions IAT of CBSI, such as delays and incorrect dosing, occurs commonly. In addition to its adverse impact on clinical outcomes, IAT results in substantial prolongation of hospital LOS and increase in hospital costs. Efforts to enhance rates of appropriate therapy for candidemia may improve resource use.

  14. 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.

  15. 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

  16. Thermal energy storage

    Science.gov (United States)

    Grodzka, P. G.; Picklesimer, E. A.

    1978-01-01

    The general scope of study on thermal energy storage development includes: (1) survey and review possible concepts for storing thermal energy; (2) evaluate the potentials of the surveyed concepts for practical applications in the low and high temperature ranges for thermal control and storage, with particular emphasis on the low temperature range, and designate the most promising concepts; and (3) determine the nature of further studies required to expeditiously convert the most promising concept(s) to practical applications. Cryogenic temperature control by means of energy storage materials was also included.

  17. 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.

  18. 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)

  19. An educational intervention on drug use in nursing homes improves health outcomes resource utilization and reduces inappropriate drug prescription.

    Science.gov (United States)

    García-Gollarte, Fermín; Baleriola-Júlvez, José; Ferrero-López, Isabel; Cuenllas-Díaz, Álvaro; Cruz-Jentoft, Alfonso J

    2014-12-01

    Inappropriate drug prescription is a common problem in people living in nursing homes and is linked to adverse health outcomes. This study assessed the effect of an educational intervention directed to nursing home physicians in reducing inappropriate prescription and improving health outcomes and resource utilization. Prospective, randomized, multicenter study. A private organization of nursing homes in Spain. Sixty nursing home physicians caring for approximately 3900 nursing home residents in 37 centers were randomized to receive an educational intervention (30) or as a control group (30). 10 hours educational program, followed by on demand support by phone. Outcomes were assessed in 1018 randomly selected nursing home residents. Appropriateness of drug use [measured by the Screening Tool of Older Persons Prescriptions (STOPP) and Screening Tool to Alert Doctors to Right Treatment (START) criteria], incidence of selected geriatric syndromes (falls, delirium) and health resource utilization (visits to physicians and nursing homes, visits to the emergency room, days of hospitalization) were recorded for 3 months before the intervention started and 3 months after the intervention finished. O total of 716 residents finished the study (344 cared for by the intervention group physicians, 372 cared for by control physicians). Mean age was 84.4 ± 12.7 years; 73% were women. The mean number of inappropriate drugs (STOPP criteria) was higher at the end of the study in the control than in the intervention group (1.29 ± 1.56 vs 0.81 ± 1.13), as was the number of residents on 6 or more drugs (76.5% vs.67.0%), using antipsychotics (9.1% vs 3.2%) or duplicate medications (32.5% vs 9.2%). The number of fallers increased in the control group (from 19.3% to 28%) and did not significantly change in the intervention group (from 25.3% to 23.9%); the number of residents with delirium increased in the control group (from 3.8% to 9.1%) and decreased in the intervention group (from 6

  20. Inverted hysteresis loops: Experimental artifacts arising from inappropriate or asymmetric sample positioning and the misinterpretation of experimental data

    Energy Technology Data Exchange (ETDEWEB)

    Jin Hanmin [Reserch Center for Advanced Magnetic Materials, Chungnam National University, 220, Gung-dong, Youseong-gu, Daejeon, 305-764 (Korea, Republic of) and Department of Physics, Jilin University, 119 Jiefang road, 130023, Changchun (China)]. E-mail: jinhanmin@jlu.edu.cn; Sun Dongsheng [Reserch Center for Advanced Magnetic Materials, Chungnam National University, 220, Gung-dong, Youseong-gu, Daejeon, 305-764 (Korea, Republic of); Gao Cunxu [Department of Materials Science and Engineering, Chungnam National University, 220, Gung-dong, Youseong-gu, Daejeon, 305-764 (Korea, Republic of); Kim, Hyojin [Department of Materials Science and Engineering, Chungnam National University, 220, Gung-dong, Youseong-gu, Daejeon, 305-764 (Korea, Republic of)

    2007-01-15

    Inverted hysteresis loops (IHL) of negative net area have been measured for some films using vibrating sample magnetometer (VSM), SQUID magnetometer or magneto-optic Kerr effect magnetometer. All of the IHL were observed in the field direction along the hard axis. An IHL violates the thermo-mechanical second law. This work points out that an IHL arises when |M{sub x}|-bar |M{sub z}| (M{sub x} and M{sub z}: the parallel and normal to the field direction components of magnetization vector) if the sample is set at certain inappropriate positions in VSM and SQUID magnetometer experiments, and the sense voltage is solely attributed to M{sub x} while it also relates to M{sub z}.

  1. 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'.

  2. Storage: Asset or albatross?

    Energy Technology Data Exchange (ETDEWEB)

    Peldner, P.J. [Tejas Power Corp., Houston, TX (United States)

    1994-12-31

    Development of storage was originally intended to: act as a surrogate for transportation capacity and capture seasonal commodity differentials. Historically, storage was developed by the pipeline companies as a means to minimize capital expenditures in terms of long haul transportation. By building storage, gas could be transported to the market are and stored using available transportation capacity when load requirements were down in the summer, then withdrawn during the winter season without requiring additional transportation capacity to be built. With the advent of deregulation, gas prices were no longer fixed with respect to time. Due to the seasonal demand of gas, there developed a fairly predictable and very consistent corresponding seasonality to the pricing of natural gas. With this phenomenon, seasonal storage developed an added local distribution companies.

  3. 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

  4. 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 ...

  5. Lipid Storage Diseases

    Science.gov (United States)

    ... seizures, loss of muscle tone, learning problems, spasticity, feeding and swallowing difficulties, slurred speech, hypersensitivity to ... storage diseases are a group of inherited metabolic disorders in which harmful amounts ...

  6. 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.

  7. Transuranic storage and assay facility interim safety basis

    Energy Technology Data Exchange (ETDEWEB)

    Porten, D.R., Fluor Daniel Hanford

    1997-02-12

    The Transuranic Waste Storage and Assay Facility (TRUSAF) Interim Safety Basis document provides the authorization basis for the interim operation and restriction on interim operations for the TRUSAF. The TRUSAF ISB demonstrates that the TRUSAF can be operated safely, protecting the workers, the public, and the environment. The previous safety analysis document TRUSAF Hazards Identification and Evaluation (WHC 1987) is superseded by this document.

  8. 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

  9. 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

  10. 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.

  11. Persistent nonmalignant pain management using nonsteroidal anti-inflammatory drugs in older patients and use of inappropriate adjuvant medications

    Directory of Open Access Journals (Sweden)

    Rianon N

    2015-01-01

    Full Text Available Nahid Rianon,1 Maureen E Knell,2 Walter Agbor-Bawa,3 Joan Thelen,4 Crystal Burkhardt,3 Rafia S Rasu3 1Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA; 2Department of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA; 3Department of Pharmacy Practice, University of Kansas School of Pharmacy, Lawrence, KS, USA; 4Department of Psychology, University of Missouri-Kansas City, Kansas City, MO, USA Objective: Due to the high risk of life-threatening side effects, nonsteroidal anti-inflammatory drugs (NSAIDs are not favored for treating persistent nonmalignant pain in the elderly. We report national prescription trends with determinants of NSAIDs prescription for persistent nonmalignant pain among older patients (age 65 and over in the US outpatient setting. Methods: A cross-sectional analysis was performed using National Ambulatory Medical Care Survey data. Prescriptions for NSAIDs, opioids, and adjuvant agents were identified using five-digit National Ambulatory Medical Care Survey drug codes. Results: About 89% of the 206,879,848 weighted visits in the US from 2000 to 2007 recorded NSAIDs prescriptions in patients (mean age =75.4 years. Most NSAIDs users had Medicare (75%, and about 25% were prescribed with adjuvant medications considered inappropriate for their age. Compared to men, women were 1.79 times more likely to be prescribed NSAIDs. Conclusion: The high percentage of NSAIDs prescription in older patients is alarming. We recommend investigating the appropriateness of the high prevalence of NSAIDs use among older patients reported in our study. Keywords: pain management, NSAIDs, inappropriate adjuvant, AGS guideline, NAMCS

  12. 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

    2018-02-25

    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.

  13. Energy Storage Criteria Handbook.

    Science.gov (United States)

    1982-10-01

    derived from the process of electrolysis in which electri- city is used to break water, H20, into its constituents, H and 0. The hydrogen and oxygen are...cavity because of incipient problems with surface brine . There are some problems with air leakage also. Storage in porous media covers variable pressure...with hydrogen and oxygen is more likely to be useful in an energy storage application. The hydrogen and oxygen can be initially generated by electrolysis

  14. 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

  15. Trustworthy Cloud Storage

    OpenAIRE

    Augier, Maxime

    2016-01-01

    The Cloud trend is an attempt to leverage economics of scale in the domain of computing resources. Unfortunately, this often means losing control of the lower levels of a computer system, and exposing users to new threat vectors. These threats may be significant enough to forbid the use of clouds, and force giving up on their economical advantages. Chapter 1 introduces some issues with current cloud storage systems, that should be fixed before a cloud storage system can be considered as safe ...

  16. Securing Cloud Storage Service

    OpenAIRE

    Zapolskas, Vytautas

    2012-01-01

    Cloud computing brought flexibility, scalability, and capital cost savings to the IT industry. As more companies turn to cloud solutions, securing cloud based services becomes increasingly important, because for many organizations, the final barrier to adopting cloud computing is whether it is sufficiently secure. More users rely on cloud storage as it is mainly because cloud storage is available to be used by multiple devices (e.g. smart phones, tablets, notebooks, etc.) at the same time. Th...

  17. Cloud Storage Vault

    OpenAIRE

    Haver, Eirik; Melvold, Eivind; Ruud, Pål

    2011-01-01

    Today, major IT-companies, such as Microsoft, Amazon and Google, are offering online storage services to their customers. This is a favourable solution -- as opposed to regular storage -- in terms of low costs, reliability, scalability and capacity. However, important security features such as data privacy and integrity are often absent.To address these issues, a cryptographic architecture is proposed that ensures the confidentiality and integrity of the data stored by users, independent of t...

  18. 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.

  19. 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)

  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. 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. SOLID-STATE STORAGE DEVICE WITH PROGRAMMABLE PHYSICAL STORAGE ACCESS

    DEFF Research Database (Denmark)

    2017-01-01

    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...... 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...

  4. 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

  5. Application of PSA to storage of Pu at SRS

    International Nuclear Information System (INIS)

    Lux, C.R.

    1995-01-01

    Pu is stored in a wide variety of physical forms and containers at the Savannah River Site (SRS). Probabilistic Safety Analysis (PSA) techniques are used to determine the risk associated with each of these storage modes and assist in identification of the controls necessary to minimize the risk. One storage method involves solids in exposed drum storage where the drums are vulnerable to external events, natural phenomena, and release of material due to weathering of the containers. Another storage method may involve liquids being processed inside the canyon facilities where the greatest risks are not from external events but from process upsets. PSA techniques have been particularly useful in the evaluation of criticality situations concerning Pu processing and storage. The applications include ''normal'' operating situations, problems following a seismic event, and the identification of potential problems during the decontamination and decommissioning of a facility. In this paper I would like to discuss two specific examples of the use of PSA techniques. The first involves the analysis of potential accidents in a Pu receipt and storage facility. The second example involves processing solutions that have the potential for experiencing an uncontrolled ''red oil'' reaction

  6. A comparison of the effects of hard rock and easy listening on the frequency of observed inappropriate behaviors: control of environmental antecedents in a large public area.

    Science.gov (United States)

    Harris, C S; Bradley, R J; Titus, S K

    1992-01-01

    Observation of clients at a state mental health hospital by direct care staff indicated that they appeared to act in more inappropriate ways when "hard rock" or "rap" music was played in an open courtyard than when "easy listening" or "country" music was played. A study was conducted to compare the inappropriate behavior of clients when hard rock and rap music were played (21 days), followed by easy listening and country and western music (21 days). This comparison was followed by a reversal phase in which hard rock and rap music were again played (18 days). The behaviors of the clients were observed and recorded via a controlled methodology. The results demonstrated that more inappropriate behavior was observed under conditions in which hard rock and rap music were played than when easy listening and country western music were played. The implications of these findings are discussed.

  7. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey.

    Science.gov (United States)

    Cusini, Alexia; Rampini, Silvana K; Bansal, Vineeta; Ledergerber, Bruno; Kuster, Stefan P; Ruef, Christian; Weber, Rainer

    2010-11-16

    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. 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. Audits of individual patient care provide important data to identify local problems in antimicrobial prescription practice. In our study, antimicrobial

  8. 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

  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. Storage and retrieval of mass spectral information

    Science.gov (United States)

    Hohn, M. E.; Humberston, M. J.; Eglinton, G.

    1977-01-01

    Computer handling of mass spectra serves two main purposes: the interpretation of the occasional, problematic mass spectrum, and the identification of the large number of spectra generated in the gas-chromatographic-mass spectrometric (GC-MS) analysis of complex natural and synthetic mixtures. Methods available fall into the three categories of library search, artificial intelligence, and learning machine. Optional procedures for coding, abbreviating and filtering a library of spectra minimize time and storage requirements. Newer techniques make increasing use of probability and information theory in accessing files of mass spectral information.

  11. Natural products as storage media for avulsed tooth

    Directory of Open Access Journals (Sweden)

    Deepika Jain

    2015-01-01

    Full Text Available Avulsion of tooth is complete displacement of tooth out of its socket that results in mutilation of periodontal ligaments. The desirable treatment option is replantation of the tooth. However, unsuccessful replantation is a matter of great discontentment. Unsuccessful replantation is due to inappropriate management of the avulsed tooth. Protection of teeth from desiccation due to drying of the periodontal ligament tissue, by keeping it in storage media can improve the outcome of the treatment. This review paper focuses on the use of natural products as storage media for avulsed teeth. In vitro and in vivo research published during 1995-2014, allowing open access on National Center for Biotechnology Information (NCBI database and articles on EBSCO host (EBSCO-Elton B. Stephens Company were included. It was found that natural products such as milk, coconut water, propolis, green tea, red mulberry, Aloe vera, egg-white and pomegranate have shown ability to maintain viability of periodontal ligament cells of avulsed teeth. Few natural products such as coconut water and milk can be used in raw form, while other products such as green tea and red mulberry need processing. Ability to maintain periodontal cell viability for a longer time is warranted in cases of major accidents, where teeth can be replanted only after other major surgeries. Natural products have easy availability, greater efficacy and longer storage time as compared to Hank′s balanced salt solution which has been recommended by the International Association of Dental Traumatology as standard solution for storage of avulsed teeth. Natural products have shown good qualities in in vitro experiments; further in vivo studies are needed to evaluate their efficacy as storage media.

  12. Identification device

    Science.gov (United States)

    Lin, Jian-Shian; Su, Chih-Chieh; Chou, Ta-Hsin; Wu, Mount-Learn; Lai, Chieh-Lung; Hsu, Che-Lung; Lan, Hsiao-Chin; Huang, Hung-I.; Liu, Yung-Chih; Tu, Zong-Ru; Lee, Chien-Chieh; Chang, Jenq-Yang

    2007-09-01

    In this Letter, the identification device disclosed in the present invention is comprised of: a carrier and a plurality of pseudo-pixels; wherein each of the plural pseudo-pixels is formed on the carrier and is further comprised of at least a light grating composed of a plurality of light grids. In a preferred aspect, each of the plural light grids is formed on the carrier while spacing from each other by an interval ranged between 50nm and 900nm. As the aforesaid identification device can present specific colors and patterns while it is being viewed by naked eye with respect to a specific viewing angle, the identification device is preferred for security and anti-counterfeit applications since the specific colors and patterns will become invisible when it is viewed while deviating from the specific viewing angle.

  13. Radioactive waste storage issues

    Energy Technology Data Exchange (ETDEWEB)

    Kunz, Daniel E. [Colorado Christian Univ., Lakewood, CO (United States)

    1994-08-15

    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.

  14. 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

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. 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.)

  20. 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

  1. Synchronous replication of remote storage

    OpenAIRE

    Mirzoev, Dr. Timur

    2014-01-01

    Storage replication is one of the essential requirements for network environments. While many forms of Network Attached Storage (NAS), Storage Area Networks (SAN) and other forms of network storage exist, there is a need for a reliable synchronous storage replication technique between distant sites (less than 1 mile). Such technology allows setting new standards for network failover and failback systems for virtual servers; specifically, addressing the growing need for effective disaster reco...

  2. 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)

  3. 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)

  4. 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

  5. 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

  6. 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

  7. 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, ...

  8. Costs of Archival Storage

    DEFF Research Database (Denmark)

    Nielsen, Anders Bo; Thirifays, Alex; Kejser, Ulla Bøgvad

    2012-01-01

    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...... 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...... 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...

  9. Clinical Predictors for Delayed or Inappropriate Initial Diagnosis of Type A Acute Aortic Dissection in the Emergency Room.

    Science.gov (United States)

    Hirata, Kazuhito; Wake, Minoru; Takahashi, Takanori; Nakazato, Jun; Yagi, Nobuhito; Miyagi, Tadayoshi; Shimotakahara, Junichi; Mototake, Hidemitsu; Tengan, Toshiho; Takara, Tsuyoshi R; Yamaguchi, Yutaka

    2015-01-01

    Initial diagnosis of acute aortic dissection (AAD) in the emergency room (ER) is sometimes difficult or delayed. The aim of this study is to define clinical predictors related to inappropriate or delayed diagnosis of Stanford type A AAD. We conducted a retrospective analysis of 127 consecutive patients with type A AAD who presented to the ER within 12 h of symptom onset (age: 69.0 ± 15.4 years, male/female = 49/78). An inappropriate initial diagnosis (IID) was considered if AAD was not included in the differential diagnosis or if chest computed tomography or echocardiography was not performed as initial imaging tests. Clinical variables were compared between IID and appropriate diagnosis group. The time to final diagnosis (TFD) was also evaluated. Delayed diagnosis (DD) was defined as TFD > third quartile. Clinical factors predicting DD were evaluated in comparison with early diagnosis (defined as TFD within the third quartile). In addition, TFD was compared with respect to each clinical variable using a rank sum test. An IID was determined for 37% of patients. Walk-in (WI) visit to the ER [odds ratio (OR) 2.6, 95% confidence interval (CI) = 1.01-6.72, P = 0.048] and coronary malperfusion (CM, OR = 6.48, 95% CI = 1.14-36.82, P = 0.035) were predictors for IID. Overall, the median TFD was 1.5 h (first/third quartiles = 0.5/4.0 h). DD (>4.5 h) was observed in 27 cases (21.3%). TFD was significantly longer in WI patients (median and first/third quartiles = 1.0 and 0.5/2.85 h for the ambulance group vs. 3.0 and 1.0/8.0 h for the WI group, respectively; P = 0.003). Multivariate analysis revealed that WI visit was the only predictor for DD (OR = 3.72, 95% CI = 1.39-9.9, P = 0.009). TFD was significantly shorter for appropriate diagnoses than for IIDs (1.0 vs. 6.0 h, respectively; P < 0.0001). WI visit to the ER and CM were predictors for IID, and WI was the only predictor for DD in acute type A AAD in the community hospital.

  10. Clinical Predictors for Delayed or Inappropriate Initial Diagnosis of Type A Acute Aortic Dissection in the Emergency Room.

    Directory of Open Access Journals (Sweden)

    Kazuhito Hirata

    Full Text Available Initial diagnosis of acute aortic dissection (AAD in the emergency room (ER is sometimes difficult or delayed. The aim of this study is to define clinical predictors related to inappropriate or delayed diagnosis of Stanford type A AAD.We conducted a retrospective analysis of 127 consecutive patients with type A AAD who presented to the ER within 12 h of symptom onset (age: 69.0 ± 15.4 years, male/female = 49/78. An inappropriate initial diagnosis (IID was considered if AAD was not included in the differential diagnosis or if chest computed tomography or echocardiography was not performed as initial imaging tests. Clinical variables were compared between IID and appropriate diagnosis group. The time to final diagnosis (TFD was also evaluated. Delayed diagnosis (DD was defined as TFD > third quartile. Clinical factors predicting DD were evaluated in comparison with early diagnosis (defined as TFD within the third quartile. In addition, TFD was compared with respect to each clinical variable using a rank sum test.An IID was determined for 37% of patients. Walk-in (WI visit to the ER [odds ratio (OR 2.6, 95% confidence interval (CI = 1.01-6.72, P = 0.048] and coronary malperfusion (CM, OR = 6.48, 95% CI = 1.14-36.82, P = 0.035 were predictors for IID. Overall, the median TFD was 1.5 h (first/third quartiles = 0.5/4.0 h. DD (>4.5 h was observed in 27 cases (21.3%. TFD was significantly longer in WI patients (median and first/third quartiles = 1.0 and 0.5/2.85 h for the ambulance group vs. 3.0 and 1.0/8.0 h for the WI group, respectively; P = 0.003. Multivariate analysis revealed that WI visit was the only predictor for DD (OR = 3.72, 95% CI = 1.39-9.9, P = 0.009. TFD was significantly shorter for appropriate diagnoses than for IIDs (1.0 vs. 6.0 h, respectively; P < 0.0001.WI visit to the ER and CM were predictors for IID, and WI was the only predictor for DD in acute type A AAD in the community hospital.

  11. 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

  12. [Potentially inappropriate prescribing cardiovascular medications in the aged population: prospective study in a district hospital centre (France)].

    Science.gov (United States)

    Gentes, Élodie; Hertzog, Maurice; Vogel, Thomas; Lang, Pierre Olivier

    2015-02-01

    Cardiovascular disease is a leading cause of morbidity and mortality in the elderly population. We evaluated the adequacy of prescribing (miss and under used) with respect to STOPP-START criteria. A sample of 100 patients hospitalized in cardiovascular specialty divisions (medicine or surgery) or in the different sectors making up the geriatric network (day-care hospital, short or rehabilitation ward, nursing home) has been considered. Drug prescriptions at the admission time were analysed. Eight hundred and seventy-four prescriptions were analysed. In 65% of patients, from 5 to 10 medications were prescribed and in 28% over 10. Fifty-four percent of patients had, at least, one potentially inappropriate prescription (PIP) by STOPP. Among them, 48% of PIP prescriptions contained 1, 41% 2 and 11% 3 or more. The omission of one medication according to START criteria concerned 57% of the sample. Among them, 46% had one omission, 44% 2 to 3 and 10% 4 omissions or over. The cardiovascular system is the one most concerned by the PIP. Whether 28.1% of the PIP by STOPP criteria concerned cardiovascular drugs, the omission of prescription, according to START criteria, was 41.8%. There was no significant difference between the different settings studied. There was no effect of age or sex on the impact of PIP (P>0.20) or being polymédiqué (P=0.44). According to the criteria STOPP-A, the prescription of antiplatelet (indication and dose) was highlighted. Prescribing omission also concerned antiplatelet agents but also statins in patients with atherosclerosis as well as antiplatelet and anticoagulant in patients with permanent atrial fibrillation and inhibitor of angiotensin converting enzyme (ACE) after myocardial infarction or with chronic heart failure. Potentially inappropriate prescribing medications were very common in elderly patients with cardiovascular conditions. They concerned as much as underusing of important drugs with potential benefits and prescribing

  13. 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

  14. 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

  15. Thermal energy storage material

    Science.gov (United States)

    Leifer, Leslie

    1976-01-01

    A thermal energy storage material which is stable at atmospheric temperature and pressure and has a melting point higher than 32.degree.F. is prepared by dissolving a specific class of clathrate forming compounds, such as tetra n-propyl or tetra n-butyl ammonium fluoride, in water to form a substantially solid clathrate. The resultant thermal energy storage material is capable of absorbing heat from or releasing heat to a given region as it transforms between solid and liquid states in response to temperature changes in the region above and below its melting point.

  16. Magnesium for Hydrogen Storage

    DEFF Research Database (Denmark)

    Pedersen, Allan Schrøder; Kjøller, John; Larsen, B.

    1983-01-01

    A study of the hydrogenation characteristics of fine magnesium powder during repeated cycling has been performed using a high-pressure microbalance facility. No effect was found from the cycling regarding kinetics and storage capacity. The reaction rate of the absorption process was fast at tempe......A study of the hydrogenation characteristics of fine magnesium powder during repeated cycling has been performed using a high-pressure microbalance facility. No effect was found from the cycling regarding kinetics and storage capacity. The reaction rate of the absorption process was fast...

  17. 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

  18. Thermal energy storage

    Science.gov (United States)

    Tomlinson, J. J.

    1992-03-01

    The Department of Energy (DOE) is supporting development of thermal energy storage (TES) as a means of efficiently coupling energy supplies to variable heating or cooling demands. Uses of TES include electrical demand-side management in buildings and industry, extending the utilization of renewable energy resources such as solar, and recovery of waste heat from periodic industrial processes. Technical progress to develop TES for specific diurnal and industrial applications under Oak Ridge National Laboratory's TES program from April 1990 to March 1992 is reported and covers research in the areas of low temperature sorption, direct contact ice making, latent heat storage plasterboard and latent/sensible heat regenerator technology development.

  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. Neptunium storage at Hanford

    International Nuclear Information System (INIS)

    Alderman, C.J.; Shiraga, S.S.; Schwartz, R.A.; Smith, R.J.; Wootan, D.W.

    1993-06-01

    A decision must be made regarding whether the United State's stockpile of neptunium should be discarded into the waste stream or kept for the production of Pu-238. Although the cost of long term storage is not inconsequential, to dispose of the material means the closing of our option to maintain control over our Pu-238 stockpile. Within the Fuels and Materials Examination Facility at Hanford there exists a remotely operated facility that can be converted for neptunium storage. This paper describes the facility and the anticipated handling requirements

  1. Extremely secure identification documents

    Energy Technology Data Exchange (ETDEWEB)

    Tolk, K.M. [Sandia National Labs., Albuquerque, NM (United States); Bell, M. [Sandia National Labs., Livermore, CA (United States)

    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. 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

  3. 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.

  4. 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…

  5. An Evaluation of a High-Probability Instructional Sequence to Increase Acceptance of Food and Decrease Inappropriate Behavior in Children with Pediatric Feeding Disorders

    Science.gov (United States)

    Patel, Meeta R.; Reed, Gregory K.; Piazza, Cathleen C.; Bachmeyer, Melainie H.; Layer, Stacy A.; Pabico, Ryan S.

    2006-01-01

    We evaluated the effects of escape extinction with and without a high-probability (high-p) instructional sequence on food acceptance and inappropriate behavior for children diagnosed with feeding problems. The high-p sequence consisted of three presentations of a response that was similar topographically (i.e., presentations of an empty nuk[R],…

  6. 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.

  7. 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.

  8. Frequency of inappropriate therapy in patients implanted with dual- versus single-chamber ICD devices in the ICD arm of MADIT-CRT

    DEFF Research Database (Denmark)

    Ruwald, Anne-Christine H; Sood, Nitesh; Ruwald, Martin H

    2013-01-01

    The majority of implantable cardioverter defibrillators (ICDs) are dual-chamber devices, but studies on the frequency of inappropriate therapy in dual- versus single-chamber devices have shown conflicting results. The aim of this study is to determine whether implantation of dual-chamber ICD...

  9. [Point of view of older adults on the potentially inappropriate medications prescribing in primary care facilities in Bobo-Dioulasso, Burkina Faso].

    Science.gov (United States)

    Hien, H; Berthé, A; Drabo, M K; Konaté, B; Toé, N; Tou, F; Adiara, M; Badini-Kinda, F; Ouédraogo, M; Meda, N; Macq, J

    2016-02-01

    Little is known about the organization of primary care facilities in sub-Saharan Africa that might lead to potentially inappropriate prescribing. The aim of this study was to analyze the factors that could lead to potentially inappropriate prescribing in primary care facilities in Bobo-Dioulasso (Burkina Faso), taking into consideration the patient's perspective. A cross-sectional qualitative study was conducted in primary care facilities from November 2013 to February 2014. People aged 60 years or more with at least one chronic disease were included. Individual interviews were conducted. An analysis of the thematic content of the interviews was conducted. Our results showed that the patient referral system was insufficient. We also found many different prescribers for older people seeking care and poor communication between prescribers and patients. This caused some consequences such as the absence of review of drugs consumed before a new prescription, a lack of exchange on medication changes and repeated treatment change during hospitalization. Most of the persons who prescribed potentially inappropriate medications were nurses. The poor communication between prescribers and patients is a challenge for the prevention of prescribing potentially inappropriate medications. Teamwork is an important feature of the organizational care system, strengthening it could be a way to improve rational prescription. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  10. Inappropriate glucagon response after oral compared with isoglycemic intravenous glucose administration in patients with type 1 diabetes

    DEFF Research Database (Denmark)

    Hare, Kristine J; Vilsbøll, Tina; Holst, Jens Juul

    2010-01-01

    glucose infusion (IIGI) in patients with type 1 diabetes. Nine patients without residual beta-cell function [age: 25 +/- 9 yr; body mass index (BMI): 24 +/- 2 kg/m(2); fasting plasma glucose (FPG): 9.5 +/- 2.1 mM; Hb A(1c): 8.4 +/- 1.2% (mean +/- SD)] and eight healthy subjects (age: 28 +/- 5 yr; BMI: 24...... +/- 3 kg/m(2); FPG: 5.3 +/- 0.2 mM; Hb A(1c): 5.0 +/- 0.1%) were examined on two separate occasions: 4-h 50-g OGTT and IIGI. Isoglycemia during IIGIs was obtained using 53 +/- 5 g of glucose in patients with type 1 diabetes and 30 +/- 3 g in control subjects (P gastrointestinal...... that the inappropriate glucagon response to glucose in patients with type 1 diabetes occurs as a consequence of the oral administration way, suggesting a role of the gastrointestinal tract, possibly via glucagonotropic signaling from gut hormones (e.g., glucose-dependent insulinotropic polypeptide), in type 1 diabetic...

  11. 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.

  12. [Identifying potentially inappropriate prescriptions in patients over 65 years-old using original Beers criteria and their Spanish adaptation].

    Science.gov (United States)

    Pastor Cano, Josep; Aranda García, Ana; Gascón Cánovas, Juan José; Sánchez Ruiz, José Francisco; Rausell Rausell, Víctor José; Tobaruela Soto, Mariana

    2018-02-01

    To compare the detection of potentially inappropriate medication (PIM) using the original Beers criteria, a global reference for evaluating prescriptions in the elderly, and their Spanish version. Retrospective observational study LOCATION: A Primary Care area in the province of Murcia, Spain. A total of 7,856 subjects aged 65 and over, with at least one drug prescribed in a Primary Care Area of Spain during study period. Illnesses and treatments registered in the Primary Care computerised medical history of patients were analysed during a 12month study period (2012). The original Beers criteria and their Spanish adaptation were used to evaluate PIM, considering both sets of criteria overall, and individually. The median age of the patients was 76.0years, with the majority females (56.6%). Patients received a median of 13 active substances and 66 medical prescriptions. The percentage of patients prescribed PIM ranged from 44.8% according to the original Beers criteria to 49.4% with the Spanish adaptation. PIMs are frequent in our context. The original Beers criteria, if not adapted to the local drug catalogue, underestimated the frequency of PIM in the elderly population studied. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  13. 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.

  14. Effects of tannin-fluoride and milk-fluoride mixture on human enamel erosion from inappropriately chlorinated pool water.

    Science.gov (United States)

    Boonviriya, Sumalee; Tannukit, Sissada; Jitpukdeebodintra, Suwanna

    2017-01-01

    This in vitro study aimed to investigate the efficacy of tannin-fluoride and milk-fluoride mixtures on human enamel erosion after exposure to inappropriately chlorinated pool water. Enamel specimens were immersed in swimming pool water (pH 2.7) for 30 min and in each test reagent for 4 min once a day for 60 consecutive days (group I: control, group II: tannin-fluoride, group III: milk-fluoride, group IV: tannin-fluoride before and milk-fluoride after erosive challenge, and group V: milk containing tannin-fluoride before and after erosive exposure). Surface microhardness was assessed on days 0, 30, and 60. Scanning electron microscopy (SEM) and electron probe microanalysis (EPMA) were performed after treatment of samples for 60 days. Surface microhardness of experimental groups was ranked as follows: group III > group IV-group V > group II > group I (P erosive enamel surface after treatment with tannin-fluoride and milk-fluoride mixtures. Furthermore, EPMA profiles showed decrease of phosphorus and increase of fluoride content in groups II and IV. In conclusion, we demonstrated that treatment with fluoridated milk with or without tannin-fluoride has protective effects against enamel erosion caused by low-pH swimming pool water.

  15. 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.

  16. A Case Report of Tooth Wear Associated with a Patient's Inappropriate Efforts to Reduce Oral Malodor Caused by Endodontic Lesion

    Directory of Open Access Journals (Sweden)

    Masahiro Yoneda

    2009-01-01

    Full Text Available Here, we report a case of severe tooth wear associated with a patient's inappropriate efforts to reduce oral malodor. A 72-year-old male patient visited our breath clinic complaining of strong breath odor. Former dentists had performed periodontal treatments including scaling and root planing, but his oral malodor did not decrease. His own subsequent breath odor-reducing efforts included daily use of lemons and vinegar to reduce or mask the odor, eating and chewing hard foods to clean his teeth, and extensive tooth brushing with a hard-bristled toothbrush. Oral malodor was detected in our breath clinic by several tests, including an organoleptic test, portable sulphide monitor, and gas chromatography. Although patient's oral hygiene and periodontal condition were not poor on presentation, his teeth showed heavy wear and hypersensitiving with an unfitted restoration on tooth 16. Radiographic examination of the tooth did not reveal endodontic lesion, but when the metal crown was removed, severe pus discharge and strong malodor were observed. When this was treated, his breath odor was improved. After dental treatment and oral hygiene instruction, no further tooth wear was observed; he was not concerned about breath odor thereafter.

  17. Inappropriate heat dissipation ignites brown fat thermogenesis in mice with a mutant thyroid hormone receptor α1.

    Science.gov (United States)

    Warner, Amy; Rahman, Awahan; Solsjö, Peter; Gottschling, Kristina; Davis, Benjamin; Vennström, Björn; Arner, Anders; Mittag, Jens

    2013-10-01

    Thyroid hormone is a major regulator of thermogenesis, acting both in peripheral organs and on central autonomic pathways. Mice heterozygous for a point mutation in thyroid hormone receptor α1 display increased thermogenesis as a consequence of high sympathetic brown fat stimulation. Surprisingly, despite the hypermetabolism, their body temperature is not elevated. Here we show, using isolated tail arteries, that defective thyroid hormone receptor α1 signaling impairs acetylcholine-mediated vascular relaxation as well as phenylephrine-induced vasoconstriction. Using infrared thermography on conscious animals, we demonstrate that these defects severely interfere with appropriate peripheral heat conservation and dissipation, which in turn leads to compensatory alterations in brown fat activity. Consequently, when the vasoconstrictive defect in mice heterozygous for a point mutation in thyroid hormone receptor α1 was reversed with the selective α1-adrenergic agonist midodrine, the inappropriate heat loss over their tail surface was reduced, normalizing brown fat activity and energy expenditure. Our analyses demonstrate that thyroid hormone plays a key role in vascular heat conservation and dissipation processes, adding a unique aspect to its well-documented functions in thermoregulation. The data thus facilitate understanding of temperature hypersensitivity in patients with thyroid disorders. Moreover, the previously unrecognized connection between cardiovascular regulation and metabolic activity revealed in this study challenges the interpretation of several experimental paradigms and questions some of the currently derived hypotheses on the role of thyroid hormone in thermogenesis.

  18. Inappropriate heat dissipation ignites brown fat thermogenesis in mice with a mutant thyroid hormone receptor α1

    Science.gov (United States)

    Warner, Amy; Rahman, Awahan; Solsjö, Peter; Gottschling, Kristina; Davis, Benjamin; Vennström, Björn; Arner, Anders; Mittag, Jens

    2013-01-01

    Thyroid hormone is a major regulator of thermogenesis, acting both in peripheral organs and on central autonomic pathways. Mice heterozygous for a point mutation in thyroid hormone receptor α1 display increased thermogenesis as a consequence of high sympathetic brown fat stimulation. Surprisingly, despite the hypermetabolism, their body temperature is not elevated. Here we show, using isolated tail arteries, that defective thyroid hormone receptor α1 signaling impairs acetylcholine-mediated vascular relaxation as well as phenylephrine-induced vasoconstriction. Using infrared thermography on conscious animals, we demonstrate that these defects severely interfere with appropriate peripheral heat conservation and dissipation, which in turn leads to compensatory alterations in brown fat activity. Consequently, when the vasoconstrictive defect in mice heterozygous for a point mutation in thyroid hormone receptor α1 was reversed with the selective α1-adrenergic agonist midodrine, the inappropriate heat loss over their tail surface was reduced, normalizing brown fat activity and energy expenditure. Our analyses demonstrate that thyroid hormone plays a key role in vascular heat conservation and dissipation processes, adding a unique aspect to its well-documented functions in thermoregulation. The data thus facilitate understanding of temperature hypersensitivity in patients with thyroid disorders. Moreover, the previously unrecognized connection between cardiovascular regulation and metabolic activity revealed in this study challenges the interpretation of several experimental paradigms and questions some of the currently derived hypotheses on the role of thyroid hormone in thermogenesis. PMID:24046370

  19. Inappropriate Antidiuretic Hormone Secretion

    African Journals Online (AJOL)

    1974-06-08

    7. 4;5. Blood urea (mg/l00 ml). 28. 26. 28. Serum osmolality (m-osmole/kg). 262. 270. 280. Urine osmolality (m-osmole/kg). 675. 515. 306. Plasma cortisol (l'-g/100 ml). 25. Creatinine clearance (ml/min). 70. Urine Na+ (mEq{L).

  20. Inappropriate requests from patients

    African Journals Online (AJOL)

    Patients occasionally request interventions that doctors are reluctant to provide. Some of these requests are plainly inap- propriate — requests for actions that are illegal, for instance, or for interventions that are clearly and uncontroversially inef- fective. But other requests are more diffi- cult. At issue are ethical questions ...

  1. Patterns of Work Identification

    Science.gov (United States)

    Hebden, J. E.

    1975-01-01

    The paper examines ways in which the concept of work identification may provide a useful means of delineating the boundaries of occupational groups. Two kinds of identification are discussed: identification with employing organizations and identification with occupation.

  2. 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

  3. Nanomaterials for Hydrogen Storage

    Indian Academy of Sciences (India)

    Separation of a solution from the pure solvent by a porous partition that is impermeable to the solute leads to ... important in quantitative analysis of colligative properties such. Nanomaterials for Hydrogen Storage. The van 't Hoff ... Hydrogen as a source of energy offers an attractive solution. Future cars could be fuelled by ...

  4. DPM: Future Proof Storage

    CERN Document Server

    Alvarez, Alejandro; Furano, Fabrizio; Hellmich, Martin; Keeble, Oliver; Rocha, Ricardo

    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...

  5. oils on storage

    African Journals Online (AJOL)

    GREGO

    2007-03-01

    Mar 1, 2007 ... storage process (Figure 3). Joseph (1979) and Magnus. (1992) have reported similar observation for the oils from damaged soya bean and cotton seeds. The pattern of change in saponification value (SV) showed little increase over the period of study, with sto- rage time. This behaviour is parallel to other ...

  6. Tuber Storage Proteins

    Science.gov (United States)

    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 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. PMID:12730067

  7. Nanomaterials for Hydrogen Storage

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 12; Issue 5. Nanomaterials for Hydrogen Storage - The van't Hoff Connection. C S Sunandana. General Article Volume 12 Issue 5 May 2007 pp 31-36. Fulltext. Click here to view fulltext PDF. Permanent link:

  8. 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

  9. Storage to Energy Calculator

    NARCIS (Netherlands)

    Taal, A.; Makkes, M.X.; Grosso, P.

    2014-01-01

    Computational and storage tasks can nowadays be offloaded among data centers, in order to optimize costs and or performance. We set out to investigate what are the environmental effects, namely the total CO2 emission, of such offloading. We built models for the various components present in these

  10. 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 -

  11. 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.

  12. 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

  13. 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

  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. 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.

  16. 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.

  17. 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

  18. 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)

  19. 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.

  20. 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.

  1. 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

  2. Effects of storage conditions and storage period on nutritional and ...

    African Journals Online (AJOL)

    Yam is one of the preferred staple foods in West Africa. The annual vegetative cycle of yam necessitates a long period of storage to make it available all year round. The major problems in yam tuber storage are sprouting, respiration and transpiration, which cause weight and quality losses. In this work, the effects of storage ...

  3. 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

  4. Safety Tips: Hazardous Chemical Storage.

    Science.gov (United States)

    Williamson, J. R.

    1983-01-01

    Discusses storage of hazardous chemicals and provides a list of eight basic safety rules to use in developing a safe storage system. Suggestions include not storing materials alphabetically, storing nonreactive chemicals together, and not storing oxidizers and fuels together. (JN)

  5. 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...

  6. 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.

  7. 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

  8. 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...

  9. 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)

  10. Optical Storage Technology Subgroup (FIMUG)

    Science.gov (United States)

    1990-04-01

    by a scanning device and transforming these data into a form suitable for computer use. Computer-Output Microfilms containing data produced by a...CD-ROM and optical storage technologies for the storage and distribution of digitar data is strongly recommended. It is obvious that optical storage

  11. Distributed storage in the plane

    NARCIS (Netherlands)

    Altman, Eitan; Avrachenkov, Konstatin; Goseling, Jasper

    2013-01-01

    We consider storage devices located in the plane according to a general point process and specialize the results for the homogeneous Poisson process. A large data file is stored at the storage devices, which have limited storage capabilities. Hence, they can only store parts of the data. Clients can

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. Influence of Admission to a Tertiary Care Hospital after a Fall on Use of Potentially Inappropriate Medications among Older Patients.

    Science.gov (United States)

    Francis, Erin; Dyks, Derek; Kanji, Salmaan

    2014-11-01

    Each year, about one-third of individuals over the age of 65 years will experience a fall, and half of these will experience a subsequent fall in the following year. The use of potentially inappropriate medications (PIMs) is an important factor contributing to increased fall risk in geriatric patients. To determine the proportion of patients over the age of 65 admitted to orthopedics and general medicine services with diagnosis of a fall who experienced a change in the total number or dosage of PIMs, as defined by the Beers criteria, upon discharge from hospital. This retrospective observational study involved patients admitted to a tertiary care hospital with diagnosis of a fall between January 1 and December 31, 2011. Those aged 65 years or older with at least one PIM on admission were eligible for inclusion. Data analysis included χ(2) and Fisher testing, as well as multivariate analysis. A total of 148 patients were included, of whom 63 (43%) had an overall change in the dosage or number of PIMs during their hospital stay. Forty patients (27%) had an overall reduction in the dosage or number of PIMs upon discharge from hospital, whereas 23 (16%) experienced an overall increase in the dosage or total number of PIMs. The mean number (± standard deviation) of PIMs decreased during the hospital stay, from 1.6 ± 0.8 on admission to 1.4 ± 0.9 on discharge (p = 0.03). Benzodiazepines were the class of PIMs most frequently discontinued or reduced in dosage. One-quarter of patients admitted with falls had de-escalation of PIMs upon hospital discharge. Although dosage reduction or drug discontinuation may not be appropriate for all patients, a standardized approach to medication review during the hospital stay and improved prescriber education and awareness of PIM use among elderly individuals are warranted.

  17. 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.

  18. Trends of the potentially inappropriate medication consumption over 10 years in older adults in the East of France.

    Science.gov (United States)

    Bongue, Bienvenu; Naudin, Florence; Laroche, Marie-Laure; Galteau, Marie-Madeleine; Guy, Claire; Guéguen, René; Convers, Jean-Pierre; Colvez, Alain; Maarouf, Nabil

    2009-12-01

    To describe the trends of potentially inappropriate medication (PIM) use in older adults from 1995 to 2004 in the East of France, by using the 1997 Beers criteria and its French update, and to assess risk factors for this PIM use. We carried out a repeated cross-sectional study using data collected among people aged >/=65 years, examined in the Center for Preventive Medicine. Studied variables were socio-demographic, clinical data, medication consumption and the self-health status. Joinpoint regression analysis was used to estimate the temporal changes in PIM rate. 30 683 participants were included. 51.2% were women. The mean age was 70.1 +/- 4.3 years [65-99]. The annual overall rate of PIM use decreased significantly during the study period. These rates range from 14.9% in 1995 to 9.0% in 2004 according the Beers criteria (-3.4% per year) and from 33.5% in 1995 to 19.3% in 2004 according to the French update criteria (-3.6% per year). The annual rate of medication users increased during the same period (+0.75% per year). The risk of PIM consumption increased with age, number of drugs and frequency of the visits to the physician (OR = 1.26 [1.18-1.35]). This risk was also higher among women (OR = 1.29 [1.18-1.40]), elderly living alone (OR = 1.09 [1.02-1.17]) and with those with low education level (OR = 1.19 [1.02-1.38]). This study shows a decrease in PIM consumption. Despite an increase of drug use in the elderly, an improving of the quality of this consumption remains possible. Copyright (c) 2009 John Wiley & Sons, Ltd.

  19. Polypharmacy and use of potentially inappropriate medications in long-term care facilities: does coordinated primary care make a difference?

    Science.gov (United States)

    Andrew, Melissa K; Purcell, Chad A; Marshall, Emily G; Varatharasan, Nirupa; Clarke, Barry; Bowles, Susan K

    2017-09-27

    Polypharmacy is both common and harmful for frail residents of long-term care facilities (LTCF). We aimed to study rates of polypharmacy and potentially inappropriate medications (PIMs) before and after the implementation of a new model of coordinated primary care in LTCF, 'Care by Design (CBD)'. This was an observational before/after study in 10 LTCFs in Halifax, NS, Canada. Chart reviews were conducted for 529 LTCF residents for whom medication use was available. Both regularly scheduled and PRN medications were included but topical, inhaled and other non-systemic agents were excluded. Polypharmacy was defined as the concomitant use of more than 10 medications. PIMs were identified using Beers Criteria. Mean age of LTCF residents was older pre- versus post-CBD (85.7 versus 82.1 years; P = 0.0015). The burden of polypharmacy was high, but decreased significantly from 86.8% pre-CBD to 79.5% post-CBD (P = 0.046). The mean number of medications per resident decreased from 16.7 (SD 5.6) pre- to 15.5 (SD 6.2) post-CBD (P = 0.037). Residents with dementia were taking fewer medications both overall and following the implementation of CBD (mean 15.9, SD 0.6 pre-CBD versus 14.4, SD 0.4 post-CBD; P = 0.04). PIM rates were high and showed no change with CBD (86.2% versus 81.1%, P = 0.16). Polypharmacy was the norm of this sample of LTCF residents. Implementation of coordinated care through the CBD model was associated with a small decrease in polypharmacy but not overall use of PIMs. Further targeted efforts are required to substantially reduce both polypharmacy and PIMs in clinical practice. © 2017 Royal Pharmaceutical Society.

  20. Institutionalization as a risk factor for inappropriate drug use in the elderly: a Swedish nationwide register-based study.

    Science.gov (United States)

    Haasum, Ylva; Fastbom, Johan; Johnell, Kristina

    2012-03-01

    Few studies have investigated institutionalization as a potential risk factor for potentially inappropriate drug use (PIDU). Sweden now has unique possibilities for comparisons of drug use in large populations of institutionalized and home-dwelling elderly through linkage of the Swedish Prescribed Drug Register (SPDR) with the Swedish Social Services Register. To compare PIDU in institutionalized versus home-dwelling elderly persons in Sweden. We conducted a cross-sectional retrospective study of 1,260,843 home-dwelling and 86,721 institutionalized elderly individuals. We analyzed data on age, sex, and dispensed drugs for individuals aged 65 years or older registered in the SPDR from July to September 2008. Data on type of housing were retrieved from the Social Services Register. The main outcome measures of PIDU were use of anticholinergic drugs, long-acting benzodiazepines, concurrent use of 3 or more psychotropics, and potentially serious drug-drug interactions (DDIs). Thirty percent of the institutionalized and 12% of the home-dwelling elderly were exposed to PIDU. Living in an institution was strongly associated with overall PIDU (OR 2.36; 95% CI 2.29 to 2.44), use of anticholinergic drugs (OR 2.58; 95% CI 2.48 to 2.68), long-acting benzodiazepines (OR 1.50; 95% CI 1.41 to 1.60), and concurrent use of 3 or more psychotropics (OR 7.26; 95% CI 6.96 to 7.59), after controlling for age, sex, and number of drugs (used as proxy for comorbidity). However, institutionalization was associated with a lower probability of potentially serious DDIs (OR 0.60; 95% CI 0.55 to 0.65). Our results indicate that institutionalization is a potential risk factor for PIDU. This implies that more cautious prescribing is warranted in institutions, where the frailest and most vulnerable elderly individuals reside. Research is needed to identify underlying risk factors for PIDU within these settings.