Probability of Failure in Random Vibration

DEFF Research Database (Denmark)

Nielsen, Søren R.K.; Sørensen, John Dalsgaard

1988-01-01

Close approximations to the first-passage probability of failure in random vibration can be obtained by integral equation methods. A simple relation exists between the first-passage probability density function and the distribution function for the time interval spent below a barrier before out......-crossing. An integral equation for the probability density function of the time interval is formulated, and adequate approximations for the kernel are suggested. The kernel approximation results in approximate solutions for the probability density function of the time interval and thus for the first-passage probability...

Collaboratively managing sudden oak death using tangible geospatial modeling

Science.gov (United States)

Ross K. Meentemeyer; Francesco Tonini; Douglas Shoemaker; Richard C. Cobb; Brendan A. Harmon; Vaclav Petras; Anna Petrasova; Helena Mitasova

2017-01-01

Failure to build consensus amongst stakeholders has been a primary obstacle barring progress in developing and implementing strategies to manage sudden oak death (SOD). Consensus as to the goals of in situ management of SOD has rarely been reached, because stakeholders’ visions of success vary widely and often compete with each other...

Severe Respiratory Acidosis in Status Epilepticus as a Possible Etiology of Sudden Death in Lesch-Nyhan Disease: A Case Report and Review of the Literature.

Science.gov (United States)

Christy, Alison; Nyhan, William; Wilson, Jenny

2017-01-01

Lesch-Nyhan disease (LND) is an X-linked disorder of purine metabolism, associated with self-mutilation, dystonia, and chorea. Seizures are uncommon in LND. Patients with LND are at risk for sudden and unexpected death. The etiology of this is unknown, but appears to occur from a respiratory process. We propose that respiratory failure secondary to subclinical seizure may lead to sudden death in these patients. We report a case of an 11-year-old boy with LND who had two episodes of nocturnal gasping. The second event was immediately followed by a 10 min generalized seizure. Upon arrival at the hospital, an arterial blood gas test revealed a severe respiratory acidosis. Following aggressive treatment of his seizures, this patient did well, and was discharged home on oxcarbazepine with rectal diazepam. No further seizures have been noted in 1 year of follow-up. In this case report and review, we hypothesize that sudden death from respiratory failure in Lesch-Nyhan disease may in some cases be due to seizure-induced respiratory failure, akin to sudden unexpected death in epilepsy (SUDEP). We suggest screening for paroxysmal respiratory events; consideration of electroencephalography for patients with LND presenting in respiratory distress or failure; and consideration of more aggressive treatment of seizures in these patients. Brief Summary:We present an 11-year-old boy with Lesch-Nyhan disease (LND) who developed respiratory failure and severe respiratory acidosis from his first known seizure, which evolved to subclinical status epilepticus. We propose that patients with LND have a predisposition to respiratory failure and sudden death, which in some cases may be provoked by seizure (sudden unexpected death in epilepsy, or SUDEP).

Sudden transition and sudden change from open spin environments

International Nuclear Information System (INIS)

Hu, Zheng-Da; Xu, Jing-Bo; Yao, Dao-Xin

2014-01-01

We investigate the necessary conditions for the existence of sudden transition or sudden change phenomenon for appropriate initial states under dephasing. As illustrative examples, we study the behaviors of quantum correlation dynamics of two noninteracting qubits in independent and common open spin environments, respectively. For the independent environments case, we find that the quantum correlation dynamics is closely related to the Loschmidt echo and the dynamics exhibits a sudden transition from classical to quantum correlation decay. It is also shown that the sudden change phenomenon may occur for the common environment case and stationary quantum discord is found at the high temperature region of the environment. Finally, we investigate the quantum criticality of the open spin environment by exploring the probability distribution of the Loschmidt echo and the scaling transformation behavior of quantum discord, respectively. - Highlights: • Sudden transition or sudden change from open spin baths are studied. • Quantum discord is related to the Loschmidt echo in independent open spin baths. • Steady quantum discord is found in a common open spin bath. • The probability distribution of the Loschmidt echo is analyzed. • The scaling transformation behavior of quantum discord is displayed

Rapid-rate nonsustained ventricular tachycardia found on implantable cardioverter-defibrillator interrogation: relationship to outcomes in the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial).

Science.gov (United States)

Chen, Jay; Johnson, George; Hellkamp, Anne S; Anderson, Jill; Mark, Daniel B; Lee, Kerry L; Bardy, Gust H; Poole, Jeanne E

2013-05-28

The aim of this study was to examine rapid-rate nonsustained ventricular tachycardia (RR-NSVT) during routine implantable cardioverter-defibrillator (ICD) evaluation in patients with heart failure and its relationship to outcomes. The clinical implications of RR-NSVT identified during routine ICD interrogation are unclear. In this study, the occurrence of RR-NSVT and its association with ICD shocks and mortality in SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) were examined. The 811 patients who received ICDs in SCD-HeFT constituted the study population. The occurrence of RR-NSVT and its association with ICD shocks and mortality in SCD-HeFT were examined. RR-NSVT was documented on ICD interrogation in 186 of 811 patients (22.9%). The mean duration of RR-NSVT was 26.4 ± 9.1 beats (7.5 ± 2.6 s), with a mean cycle length of 259 ± 32 ms. Polymorphic RR-NSVT accounted for 56% of episodes. Compared with patients without RR-NSVT, those with RR-NSVT were less likely to be taking beta-blockers, statins, or aspirin at enrollment. After adjusting for other known predictors of mortality in SCD-HeFT, RR-NSVT was independently associated with appropriate ICD shocks (hazard ratio: 4.25; 95% confidence interval: 2.94 to 6.14; p interrogation should be considered an important clinical event. RR-NSVT during ICD interrogation is associated with appropriate ICD shocks and all-cause mortality. The clinical evaluation of patients with RR-NSVT should include intensification of medical therapy, particularly beta-blockers, or other appropriate clinical interventions. (Sudden Cardiac Death in Heart Failure Trial [SCD-HeFT]; NCT00000609). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

ACE inhibitors and calcium antagonists in the treatment of congestive heart failure

DEFF Research Database (Denmark)

Hansen, J F

1995-01-01

heart failure in the SOLVD trials. In post-myocardial infarction patients, the calcium antagonist nifedipine did not affect mortality or morbidity; diltiazem improved prognosis in patients without congestive heart failure and in patients with non-Q-wave infarction; and verapamil improved prognosis...... by prevention of reinfarction and sudden death. Combination treatment with both verapamil, which has pronounced antiischemic properties and prevents sudden death and reinfarction, and an ACE inhibitor, which prevents the progression of heart failure, is a possibility for future cardiovascular therapy...

Sudden gains in Cognitive Therapy and Interpersonal Psychotherapy for adult depression.

Science.gov (United States)

Lemmens, Lotte H J M; DeRubeis, Robert J; Arntz, Arnoud; Peeters, Frenk P M L; Huibers, Marcus J H

2016-02-01

We examined the rates, baseline predictors and clinical impact of sudden gains in a randomized comparison of individual Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for adult depression. 117 depressed outpatients received 16-20 sessions of either CT or IPT. Session-by-session symptom severity was assessed using the BDI-II. Sudden gains were examined using the original criteria as defined by Tang and DeRubeis (1999b). Furthermore, we examined whether the duration of the between-session interval at which sudden gains were recorded affected the results. There were significantly more patients with sudden gains in CT (42.2%) as compared to IPT (24.5%). The difference appeared to be driven by the criterion representing the stability of the gain. No between-group differences were found with regard to the magnitude, timing and predictors of the gains. Those with sudden gains were less depressed at post-treatment and follow-up. After controlling for the duration of the between-session interval, the difference in rates between the two conditions became a non-significant trend. Other sudden gains characteristics were similar to those observed when allowing for longer intervals as well. The current study indicates differences in occurrence of sudden gains in two treatment modalities that overall showed similar results, which might reflect different mechanisms of change. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Analyses of clinical features and efficacy of sudden deafness with vertigo and dizziness].

Science.gov (United States)

Liu, Bo; Han, Demin; Zhang, Yi; Li, Yongxin; Gong, Shusheng; Chen, Xiuwu; Meng, Xixi; Tang, Junxiang; Xiang, Jie; Jiang, Xuejun; Yang, Ning; Tian, Ying; Hui, Lian; Feng, Shuai

2015-06-01

To investigate the clinical characteristics and the effect of drug treatment for sudden hearing loss with vertigo or dizziness. In a prospective, randomized, single blinded randomized multicenter clinical study, patients with sudden deafness, ranging in age from 18 to 65 years old, with a duration less than 2 weeks, and with no any medical treatments were collected. In accordance with the hearing curve, those patients were divided into four types, i.e., low and intermediate frequency descent type; high frequency descent type; fall flat type; and total deafness type. Each type was treated by four different treatment options, according to the unified design of the random table, and randomly selected one of the options for treatment. The efficacy of the patients with sudden deafness with vertigo and dizziness was analyzed statistically after the follow-up for 4 weeks. SPSS 13.0 software was used to analyze the data. In August 2007 to October 2011, 33 hospitals in the country included 1 024 patients with sudden deafness in line with the inclusion criteria, of whom 296 (28.91%) were accompanied by vertigo/dizziness symptoms, 126 were males and 170 were females, with an average age of (41.2 ± 13.5) years old. types of the different audiometric curves of sudden deafness, the occurrence of complete deafness with vertigo/dizziness was the highest (44.93%), followed by flat down type (25.87%), high frequency descent type (21.28%) and low intermediate frequency descent type (18.54%). After the standard treatment, the vertigo and dizziness symptoms of the sudden deafness patients could disappear, and the hearing in each group was obviously improved. The hearing curative effect on patients accompanied by vertigo/dizziness of low frequency and intermediate frequency descent type was the best, and the total efficiency can reach up to 94.74%, with the cure rate of 68.42%; followed by flat type, in which the total effective rate was 80.76%, with the recovery rate of 22.12%; and

Sudden cardiac death

Directory of Open Access Journals (Sweden)

Neeraj Parakh

2015-01-01

Full Text Available Sudden cardiac death is one of the most common cause of mortality worldwide. Despite significant advances in the medical science, there is little improvement in the sudden cardiac death related mortality. Coronary artery disease is the most common etiology behind sudden cardiac death, in the above 40 years population. Even in the apparently healthy population, there is a small percentage of patients dying from sudden cardiac death. Given the large denominator, this small percentage contributes to the largest burden of sudden cardiac death. Identification of this at risk group among the apparently healthy individual is a great challenge for the medical fraternity. This article looks into the causes and methods of preventing SCD and at some of the Indian data. Details of Brugada syndrome, Long QT syndrome, Genetics of SCD are discussed. Recent guidelines on many of these causes are summarised.

The Metabolic Syndrome and Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study.

Science.gov (United States)

Hess, Paul L; Al-Khalidi, Hussein R; Friedman, Daniel J; Mulder, Hillary; Kucharska-Newton, Anna; Rosamond, Wayne R; Lopes, Renato D; Gersh, Bernard J; Mark, Daniel B; Curtis, Lesley H; Post, Wendy S; Prineas, Ronald J; Sotoodehnia, Nona; Al-Khatib, Sana M

2017-08-23

Prior studies have demonstrated a link between the metabolic syndrome and increased risk of cardiovascular mortality. Whether the metabolic syndrome is associated with sudden cardiac death is uncertain. We characterized the relationship between sudden cardiac death and metabolic syndrome status among participants of the ARIC (Atherosclerosis Risk in Communities) Study (1987-2012) free of prevalent coronary heart disease or heart failure. Among 13 168 participants, 357 (2.7%) sudden cardiac deaths occurred during a median follow-up of 23.6 years. Participants with the metabolic syndrome (n=4444) had a higher cumulative incidence of sudden cardiac death than those without it (n=8724) (4.1% versus 2.3%, P metabolic syndrome, the metabolic syndrome was independently associated with sudden cardiac death (hazard ratio, 1.70, 95% confidence interval, 1.37-2.12, P metabolic syndrome criteria components. The risk of sudden cardiac death varied according to the number of metabolic syndrome components (hazard ratio 1.31 per additional component of the metabolic syndrome, 95% confidence interval, 1.19-1.44, P metabolic syndrome was associated with a significantly increased risk of sudden cardiac death irrespective of sex or race. The risk of sudden cardiac death was proportional to the number of metabolic syndrome components. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Vision Loss, Sudden

Science.gov (United States)

... cornea (the clear layer in front of the iris and pupil), then the lens, and then the ... sudden start of symptoms may instead be sudden recognition. For example, a person with long-standing reduced ...

Probability of failure prediction for step-stress fatigue under sine or random stress

Science.gov (United States)

Lambert, R. G.

1979-01-01

A previously proposed cumulative fatigue damage law is extended to predict the probability of failure or fatigue life for structural materials with S-N fatigue curves represented as a scatterband of failure points. The proposed law applies to structures subjected to sinusoidal or random stresses and includes the effect of initial crack (i.e., flaw) sizes. The corrected cycle ratio damage function is shown to have physical significance.

Sudden gains in Cognitive Therapy and Interpersonal Psychotherapy for adult depression

NARCIS (Netherlands)

Lemmens, L.H.J.M.; DeRubeis, R.J.; Arntz, A.; Peeters, F.P.M.L.; Huibers, M.J.H.

OBJECTIVE: We examined the rates, baseline predictors and clinical impact of sudden gains in a randomized comparison of individual Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for adult depression. METHOD: 117 depressed outpatients received 16-20 sessions of either CT or IPT.

Sudden gains in Cognitive Therapy and Interpersonal Psychotherapy for adult depression.

NARCIS (Netherlands)

Lemmens, L.H.; DeRubeis, R.J.; Arntz, A.; Peeters, F.P.; Huibers, M.J.H.

2016-01-01

Objective: We examined the rates, baseline predictors and clinical impact of sudden gains in a randomized comparison of individual Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for adult depression. Method: 117 depressed outpatients received 16-20 sessions of either CT or IPT.

Sudden onset odontoid fracture caused by cervical instability in hypotonic cerebral palsy.

Science.gov (United States)

Shiohama, Tadashi; Fujii, Katsunori; Kitazawa, Katsuhiko; Takahashi, Akiko; Maemoto, Tatsuo; Honda, Akihito

2013-11-01

Fractures of the upper cervical spine rarely occur but carry a high rate of mortality and neurological disabilities in children. Although odontoid fractures are commonly caused by high-impact injuries, cerebral palsy children with cervical instability have a risk of developing spinal fractures even from mild trauma. We herein present the first case of an odontoid fracture in a 4-year-old boy with cerebral palsy. He exhibited prominent cervical instability due to hypotonic cerebral palsy from infancy. He suddenly developed acute respiratory failure, which subsequently required mechanical ventilation. Neuroimaging clearly revealed a type-III odontoid fracture accompanied by anterior displacement with compression of the cervical spinal cord. Bone mineral density was prominently decreased probably due to his long-term bedridden status and poor nutritional condition. We subsequently performed posterior internal fixation surgically using an onlay bone graft, resulting in a dramatic improvement in his respiratory failure. To our knowledge, this is the first report of an odontoid fracture caused by cervical instability in hypotonic cerebral palsy. Since cervical instability and decreased bone mineral density are frequently associated with cerebral palsy, odontoid fractures should be cautiously examined in cases of sudden onset respiratory failure and aggravated weakness, especially in hypotonic cerebral palsy patients. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Laminopathies: a Pandora's box of heart failure, bradyarrhythmias and sudden death.

Science.gov (United States)

Cabanelas, Nuno; Martins, Vítor Paulo

2015-02-01

The LMNA gene encodes a group of proteins that have an important structural and functional role in the cell nucleus. Mutations in this gene have been found in 6% of all forms of dilated cardiomyopathy and in up to 33% of those with conduction system disturbances. Using a case report as an example, we performed a review of the literature on the pathophysiological mechanisms, clinical manifestations, risk stratification and treatment options of cardiac involvement in laminopathies. We present the case of a 46-year-old man, whose ECG showed bizarre voltage criteria for left ventricular hypertrophy and first-degree atrioventricular block, a dilated left ventricle with mildly impaired global systolic function and non-sustained ventricular tachycardia on Holter monitoring, and with a family history of sudden death. Genetic testing identified an LMNA mutation. No ventricular arrhythmias were induced during electrophysiological study. The patient is under close clinical and echocardiographic monitoring and an event loop recorder has been implanted. Phenotypically, myocardial involvement in laminopathies is indistinguishable from other forms of idiopathic dilated cardiomyopathy. Ventricular arrhythmias are common, but the best method for sudden death risk stratification has yet to be established. The few studies that have been performed, with a very limited number of patients, show that factors associated with an unfavorable prognosis are ejection fraction lack of evidence, indications for an implantable cardioverter-defibrillator for primary prevention in this context are the same as conventional indications for other forms of idiopathic dilated cardiomyopathy. Cardiac involvement as a consequence of LMNA mutations generally has a more aggressive natural history than other forms of non-ischemic dilated cardiomyopathy. A high index of suspicion and prompt referral for genetic testing are essential for appropriate therapeutic management. Copyright © 2014 Sociedade

Sudden Event Recognition: A Survey

Directory of Open Access Journals (Sweden)

Mohd Asyraf Zulkifley

2013-08-01

Full Text Available Event recognition is one of the most active research areas in video surveillance fields. Advancement in event recognition systems mainly aims to provide convenience, safety and an efficient lifestyle for humanity. A precise, accurate and robust approach is necessary to enable event recognition systems to respond to sudden changes in various uncontrolled environments, such as the case of an emergency, physical threat and a fire or bomb alert. The performance of sudden event recognition systems depends heavily on the accuracy of low level processing, like detection, recognition, tracking and machine learning algorithms. This survey aims to detect and characterize a sudden event, which is a subset of an abnormal event in several video surveillance applications. This paper discusses the following in detail: (1 the importance of a sudden event over a general anomalous event; (2 frameworks used in sudden event recognition; (3 the requirements and comparative studies of a sudden event recognition system and (4 various decision-making approaches for sudden event recognition. The advantages and drawbacks of using 3D images from multiple cameras for real-time application are also discussed. The paper concludes with suggestions for future research directions in sudden event recognition.

Renal Hemodynamic Effects of Serelaxin in Patients With Chronic Heart Failure A Randomized, Placebo-Controlled Study

NARCIS (Netherlands)

Voors, Adriaan A.; Dahlke, Marion; Meyer, Sven; Stepinska, Janina; Gottlieb, Stephen S.; Jones, Andrew; Zhang, Yiming; Laurent, Didier; Slart, Riemer H. J. A.; Navis, Gerjan J.

2014-01-01

Background-Serelaxin is a promising therapy for acute heart failure. The renal hemodynamic effects of serelaxin in patients with chronic heart failure are unknown. Methods and Results-In this double-blind, randomized, placebo-controlled, multicenter study, patients with New York Heart Association

Sudden death victims

NARCIS (Netherlands)

Ceelen, Manon; van der Werf, Christian; Hendrix, Anneke; Naujocks, Tatjana; Woonink, Frits; de Vries, Philip; van der Wal, Allard; Das, Kees

2015-01-01

The goal of this study was to ascertain accordance between cause of death established by the forensic physician and autopsy results in young sudden death victims in the Netherlands. Sudden death victims aged 1-45 years examined by forensic physicians operating in the participating regions which also

The first multicenter, randomized, controlled trial of home telemonitoring for Japanese patients with heart failure: home telemonitoring study for patients with heart failure (HOMES-HF).

Science.gov (United States)

Kotooka, Norihiko; Kitakaze, Masafumi; Nagashima, Kengo; Asaka, Machiko; Kinugasa, Yoshiharu; Nochioka, Kotaro; Mizuno, Atsushi; Nagatomo, Daisuke; Mine, Daigo; Yamada, Yoko; Kuratomi, Akiko; Okada, Norihiro; Fujimatsu, Daisuke; Kuwahata, So; Toyoda, Shigeru; Hirotani, Shin-Ichi; Komori, Takahiro; Eguchi, Kazuo; Kario, Kazuomi; Inomata, Takayuki; Sugi, Kaoru; Yamamoto, Kazuhiro; Tsutsui, Hiroyuki; Masuyama, Tohru; Shimokawa, Hiroaki; Momomura, Shin-Ichi; Seino, Yoshihiko; Sato, Yasunori; Inoue, Teruo; Node, Koichi

2018-02-15

Home telemonitoring is becoming more important to home medical care for patients with heart failure. Since there are no data on home telemonitoring for Japanese patients with heart failure, we investigated its effect on cardiovascular outcomes. The HOMES-HF study was the first multicenter, open-label, randomized, controlled trial (RCT) to elucidate the effectiveness of home telemonitoring of physiological data, such as body weight, blood pressure, and pulse rate, for Japanese patients with heart failure (UMIN Clinical Trials Registry 000006839). The primary end-point was a composite of all-cause death or rehospitalization due to worsening heart failure. We analyzed 181 recently hospitalized patients with heart failure who were randomly assigned to a telemonitoring group (n = 90) or a usual care group (n = 91). The mean follow-up period was 15 (range 0-31) months. There was no statistically significant difference in the primary end-point between groups [hazard ratio (HR), 0.95; 95% confidence interval (CI), 0.548-1.648; p = 0.572]. Home telemonitoring for Japanese patients with heart failure was feasible; however, beneficial effects in addition to those of usual care were not demonstrated. Further investigation of more patients with severe heart failure, participation of home medical care providers, and use of a more integrated home telemonitoring system emphasizing communication as well as monitoring of symptoms and physiological data are required.

Sudden cardiac death in children and adolescents (excluding Sudden Infant Death Syndrome

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Gajewski Kelly

2010-01-01

Full Text Available Sudden death in the young is rare. About 25% of cases occur during sports. Most young people with sudden cardiac death (SCD have underlying heart disease, with hypertrophic cardiomyopathy and coronary artery anomalies being commonest in most series. Arrhythmogenic right ventricular dysplasia and long QT syndrome are the most common primary arrhythmic causes of SCD. It is estimated that early cardiopulmonary resuscitation and widespread availability of automatic external defibrillators could prevent about a quarter of pediatric sudden deaths.

Failure in imperfect anisotropic materials

DEFF Research Database (Denmark)

Legarth, Brian Nyvang

2005-01-01

The fundamental cause of crack growth, namely nucleation and growth of voids, is investigated numerically for a two phase imperfect anisotropic material. A unit cell approach is adopted from which the overall stress strain is evaluated. Failure is observed as a sudden stress drop and depending...

Sudden Stratospheric Warming Compendium

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Sudden Stratospheric Warming Compendium (SSWC) data set documents the stratospheric, tropospheric, and surface climate impacts of sudden stratospheric warmings. This...

Sudden death of a child due to respiratory diphtheria.

Science.gov (United States)

Swain, Rajanikanta; Behera, Chittaranjan; Arava, Sudheer Kumar; Kundu, Naveen

2016-06-01

A four-year-old girl presented to the emergency department with respiratory distress. Death occurred despite attempted resuscitation. The illness was not clinically diagnosed. Her father revealed that she had a fever and sore throat for the last four days and was not immunised for diphtheria. Characteristic gross and microscopic pathology of respiratory diphtheria and microbiological findings were observed. The cause of death was acute respiratory failure consequent upon upper airway obstruction from diphtheria. Forensic pathologists should remember that the diphtheria cases can cause sudden death especially in developing countries. © The Author(s) 2016.

Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial design.

Science.gov (United States)

Bartunek, Jozef; Davison, Beth; Sherman, Warren; Povsic, Thomas; Henry, Timothy D; Gersh, Bernard; Metra, Marco; Filippatos, Gerasimos; Hajjar, Roger; Behfar, Atta; Homsy, Christian; Cotter, Gad; Wijns, William; Tendera, Michal; Terzic, Andre

2016-02-01

Cardiopoiesis is a conditioning programme that aims to upgrade the cardioregenerative aptitude of patient-derived stem cells through lineage specification. Cardiopoietic stem cells tested initially for feasibility and safety exhibited signs of clinical benefit in patients with ischaemic heart failure (HF) warranting definitive evaluation. Accordingly, CHART-1 is designed as a large randomized, sham-controlled multicentre study aimed to validate cardiopoietic stem cell therapy. Patients (n = 240) with chronic HF secondary to ischaemic heart disease, reduced LVEF (Heart Failure Questionnaire score, 6 min walk test, LV end-systolic volume, and LVEF at 9 months. The secondary efficacy endpoint is the time to cardiovascular death or worsening HF at 12 months. Safety endpoints include mortality, readmissions, aborted sudden deaths, and serious adverse events at 12 and 24 months. The CHART-1 clinical trial is powered to examine the therapeutic impact of lineage-directed stem cells as a strategy to achieve cardiac regeneration in HF populations. On completion, CHART-1 will offer a definitive evaluation of the efficacy and safety of cardiopoietic stem cells in the treatment of chronic ischaemic HF. NCT01768702. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

Sudden birth versus sudden death of entanglement for the extended Werner-like state in a dissipative environment

International Nuclear Information System (INIS)

Chuan-Jia, Shan; Tao, Chen; Ji-Bing, Liu; Wei-Wen, Cheng; Tang-Kun, Liu; Yan-Xia, Huang; Hong, Li

2010-01-01

In this paper, we investigate the dynamical behaviour of entanglement in terms of concurrence in a bipartite system subjected to an external magnetic field under the action of dissipative environments in the extended Werner-like initial state. The interesting phenomenon of entanglement sudden death as well as sudden birth appears during the evolution process. We analyse in detail the effect of the purity of the initial entangled state of two qubits via Heisenberg XY interaction on the apparition time of entanglement sudden death and entanglement sudden birth. Furthermore, the conditions on the conversion of entanglement sudden death and entanglement sudden birth can be generalized when the initial entangled state is not pure. In particular, a critical purity of the initial mixed entangled state exists, above which entanglement sudden birth vanishes while entanglement sudden death appears. It is also noticed that stable entanglement, which is independent of different initial states of the qubits (pure or mixed state), occurs even in the presence of decoherence. These results arising from the combination of the extended Werner-like initial state and dissipative environments suggest an approach to control and enhance the entanglement even after purity induced sudden birth, death and revival. (general)

Systemic Steroid Application Caused Sudden Death of a Patient with Sudden Deafness

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Eriko Ogino-Nishimura

2013-01-01

Full Text Available A 63-year-old man, who was diagnosed with sudden sensorineural hearing loss (SSHL, showed severe hypertension 10 hours after prednisolone administration. Subsequently, the patient suddenly died due to pulmonary edema. The autopsy indicated a pheochromocytoma in the right adrenal gland, and the cause of death was determined to be a pheochromocytoma crisis induced by systemic administration of prednisolone. Pheochromocytoma crisis is a life-threatening condition and can result from the use of corticosteroids. Physicians should consider the risk of a pheochromocytoma crisis due to systemic corticosteroids in the treatment of patients with sudden sensorineural hearing loss.

Intermittency and roughening in the failure of brittle heterogeneous materials

International Nuclear Information System (INIS)

Bonamy, Daniel

2009-01-01

Stress enhancement in the vicinity of brittle cracks makes the macro-scale failure properties extremely sensitive to the micro-scale material disorder. Therefore, (i) fracturing systems often display a jerky dynamics, so-called crackling noise, with seemingly random sudden energy release spanning over a broad range of scales, reminiscent of earthquakes; (ii) fracture surfaces exhibit roughness at scales much larger than that of material microstructure. Here, I provide a critical review of experiments and simulations performed in this context, highlighting the existence of universal scaling features, independent of both the material and the loading conditions, reminiscent of critical phenomena. I finally discuss recent stochastic descriptions of crack growth in brittle disordered media that seem to capture qualitatively-and sometimes quantitatively-these scaling features.

Sudden Gains in Cognitive Therapy and Interpersonal Therapy for Social Anxiety Disorder

Science.gov (United States)

Bohn, Christiane; Aderka, Idan M.; Schreiber, Franziska; Stangier, Ulrich; Hofmann, Stefan G.

2013-01-01

Objective: The present study examined the effects of sudden gains on treatment outcome in a randomized controlled trial including individual cognitive therapy (CT) and interpersonal therapy (IPT) for social anxiety disorder (SAD). Method: Participants were 67 individuals with SAD who received 16 treatment sessions. Symptom severity at each session…

Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: the QUEST study.

Science.gov (United States)

Häggström, J; Boswood, A; O'Grady, M; Jöns, O; Smith, S; Swift, S; Borgarelli, M; Gavaghan, B; Kresken, J-G; Patteson, M; Ablad, B; Bussadori, C M; Glaus, T; Kovacević, A; Rapp, M; Santilli, R A; Tidholm, A; Eriksson, A; Belanger, M C; Deinert, M; Little, C J L; Kvart, C; French, A; Rønn-Landbo, M; Wess, G; Eggertsdottir, A V; O'Sullivan, M L; Schneider, M; Lombard, C W; Dukes-McEwan, J; Willis, R; Louvet, A; DiFruscia, R

2008-01-01

Myxomatous mitral valve disease (MMVD) continues to be an important cause of morbidity and mortality in geriatric dogs despite conventional therapy. Pimobendan in addition to conventional therapy will extend time to sudden cardiac death, euthanasia for cardiac reasons, or treatment failure when compared with conventional therapy plus benazepril in dogs with congestive heart failure (CHF) attributable to MMVD. Two hundred and sixty client-owned dogs in CHF caused by MMVD were recruited from 28 centers in Europe, Canada, and Australia. A prospective single-blinded study with dogs randomized to PO receive pimobendan (0.4-0.6 mg/kg/d) or benazepril hydrochloride (0.25-1.0 mg/kg/d). The primary endpoint was a composite of cardiac death, euthanized for heart failure, or treatment failure. Eight dogs were excluded from analysis. One hundred and twenty-four dogs were randomized to pimobendan and 128 to benazepril. One hundred and ninety dogs reached the primary endpoint; the median time was 188 days (267 days for pimobendan, 140 days for benazepril hazard ratio = 0.688, 95% confidence limits [CL]=0.516-0.916, P= .0099). The benefit of pimobendan persisted after adjusting for all baseline variables. A longer time to reach the endpoint was also associated with being a Cavalier King Charles Spaniel, requiring a lower furosemide dose, and having a higher creatinine concentration. Increases in several indicators of cardiac enlargement (left atrial to aortic root ratio, vertebral heart scale, and percentage increase in left ventricular internal diameter in systole) were associated with a shorter time to endpoint, as was a worse tolerance for exercise. Pimobendan plus conventional therapy prolongs time to sudden death, euthanasia for cardiac reasons, or treatment failure in dogs with CHF caused by MMVD compared with benazepril plus conventional therapy.

Pattern of sudden death at Ladoke Akintola University of Technology Teaching Hospital, Osogbo, South West Nigeria

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Akinwusi PO

2013-06-01

Full Text Available Patience Olayinka Akinwusi,1,2 Akinwumi Oluwole Komolafe,3 Olanrewaju Olayinka Olayemi,2 Adeleye Abiodun Adeomi41Department of Medicine, College of Health Sciences, Osun State University, 2Department of Medicine, LAUTECH Teaching Hospital, Osogbo, 3Department of Morbid Anatomy, Obafemi Awolowo University Teaching, Hospitals Complex, Ile-Ife, Osun State, 4Department of Community Medicine, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, NigeriaBackground: The purpose of this study was to determine the etiology and epidemiologic characteristics of sudden death at Ladoke Akintola University of Technology (LAUTECH Teaching Hospital, South West Nigeria.Methods: This was a retrospective descriptive study of all cases of natural unexpected death, either occurring out of hospital or less than 24 hours after admission to LAUTECH Teaching Hospital, over a nine-year period from January 2003 to December 2011. Data were generated from information in the case notes and autopsy reports for these cases.Results: Sudden death accounted for 29 (4.0% of 718 adult medical deaths and 1.0% of all adult medical admissions. Out-of-hospital deaths occurred in 72.4% of cases. The mean age of the patients was 46.8 ± 11.5 (range 25–74 years. The male to female ratio was 6.25:1. Cardiovascular disease were the most common cause of death (51.7%, followed by respiratory disease (20.7%, pulmonary thromboembolism (10.4%, central nervous system disease (13.8%, gastrointestinal disorders (13.8%, severe chemical/drug poisoning (13.8%, and combined cardiovascular and central nervous system disease (13.8%. Hypertension-related causes were responsible for 14/29 (48.3% of the sudden deaths. Hypertensive heart disease accounted for 86.7% of the cardiovascular deaths, hypertensive heart failure accounted for 73.3%, whilst all heart failure cases accounted for 80.0%. Left ventricular hypertrophy was present in 69.2% of the patients with hypertensive heart disease. Moderate to severe

Sudden losses and sudden gains during a DBT-PTSD treatment for posttraumatic stress disorder following childhood sexual abuse

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Antje Krüger

2014-09-01

Full Text Available Background: Exposure-based treatment approaches are first-line interventions for patients suffering from posttraumatic stress disorder (PTSD. However, the dissemination of exposure-based treatments for PTSD is challenging, as a large proportion of clinicians report being concerned about symptoms worsening as a result of this type of intervention and are therefore reluctant to offer it to patients with PTSD. However, there is only little empirical evidence to date on the pattern of symptom worsening during exposure-based treatment for PTSD. Objective: The goal of the present study was to explore the frequency of sudden losses and sudden gains in the course of an exposure-based treatment programme for female patients suffering from PTSD related to childhood sexual abuse who also show severe comorbidity. In addition, the relationship between sudden changes and treatment outcome was examined. Methods: Female participants (N=74 were randomised to either a 12-week residential DBT-PTSD programme or a treatment-as-usual wait list. The pattern of symptom change was assessed via weekly assessments using the Posttraumatic Diagnostic Scale (PDS. Sudden changes were computed as suggested by the literature on sudden gains. Results: During treatment, only one participant (3% experienced a sudden loss, whereas 25% of participants experienced sudden gains. In the waiting condition, 8% of the participants experienced sudden losses and 5% experienced sudden gains during the same time period. No symptom worsening was observed in response to exposure sessions. However, sudden gains occurred during exposure and non-exposure treatment weeks. Patients with sudden gains showed better treatment outcome in the post-treatment and follow-up assessments. Conclusions: Exposure-based treatment did not lead to PTSD symptom worsening in the study sample. Results show that sudden gains occur frequently during PTSD treatment and have a prognostic value for treatment outcome.

Incorrect modeling of the failure process of minimally repaired systems under random conditions: The effect on the maintenance costs

International Nuclear Information System (INIS)

Pulcini, Gianpaolo

2015-01-01

This note investigates the effect of the incorrect modeling of the failure process of minimally repaired systems that operates under random environmental conditions on the costs of a periodic replacement maintenance. The motivation of this paper is given by a recently published paper, where a wrong formulation of the expected cost for unit time under a periodic replacement policy is obtained. This wrong formulation is due to the incorrect assumption that the intensity function of minimally repaired systems that operate under random conditions has the same functional form as the failure rate of the first failure time. This produced an incorrect optimization of the replacement maintenance. Thus, in this note the conceptual differences between the intensity function and the failure rate of the first failure time are first highlighted. Then, the correct expressions of the expected cost and of the optimal replacement period are provided. Finally, a real application is used to measure how severe can be the economical consequences caused by the incorrect modeling of the failure process.

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

DEFF Research Database (Denmark)

Røge, B T; Barfod, T S; Kirk, O

2004-01-01

OBJECTIVES: To investigate the interplay between resistance and adherence in the virological failure of three fundamentally different highly active antiretroviral therapy (HAART) regimens. METHODS: We retrospectively identified 56 verified primary virological failures (viral load >400 HIV-1 RNA...... copies/mL) among 293 patients randomized to two nucleoside reverse transcriptase inhibitors (NRTIs)+ritonavir+saquinavir (RS-arm) (n=115), two NRTIs+nevirapine+nelfinavir (NN-arm) (n=118), or abacavir+stavudine+didanosine (ASD-arm) (n=60) followed up for a median of 90 weeks. Data on adherence were...... collected from patient files, and genotyping was performed on plasma samples collected at time of failure. RESULTS: Treatment interruption or poor adherence was mainly caused by side effects and accounted for 74% of failures, and was associated with absence of resistance mutations. In the 30 failing...

Failure at Zainsk thermal power station: lesson for thermal and nuclear power stations

International Nuclear Information System (INIS)

Derkach, A.L.; Klyuchnikov, A.A.; Fedorenko, G.M.; Kuz'min, V.V.

2007-01-01

An account of system failure at Zainsk Thermal PS on January 1-st, 1979 is given. The cause of failure - sudden unauthorized energizing of block transformer which led to a direct asynchronous start of 200 MW turbine generator from grid. The failure resulted in the explosion and fire in generator, shaft destruction, and the damage of the machine hall's roof. The core roots of the failure have been scrutinised

Analysis of cause-specific failure endpoints using simple proportions: an example from a randomized controlled clinical trial in early breast cancer

International Nuclear Information System (INIS)

Panzarella, Tony; Meakin, J. William

1998-01-01

Purpose: To describe a statistically valid method for analyzing cause-specific failure data based on simple proportions, that is easy to understand and apply, and outline under what conditions its implementation is well-suited. Methods and Materials: In the comparison of treatment groups, time to first failure (in any site) was analyzed first, followed by an analysis of the pattern of first failure, preferably at the latest complete follow-up time common to each group. Results: A retrospective analysis of time to contralateral breast cancer in 777 early breast cancer patients was undertaken. Patients previously treated by mastectomy plus radiation therapy to the chest wall and regional nodal areas were randomized to receive further radiation and prednisone (R+P), radiation alone (R), or no further treatment (NT). Those randomized to R+P had a statistically significantly delayed time to first failure compared to the group randomized to NT (p = 0.0008). Patients randomized to R also experienced a delayed time to first failure compared to NT, but the difference was not statistically significant (p 0.14). At 14 years from the date of surgery (the latest common complete follow-up time) the distribution of first failures was statistically significantly different between R+P and NT (p = 0.005), but not between R and NT (p = 0.09). The contralateral breast cancer first failure rate at 14 years from surgery was 7.2% for NT, 4.6% for R, and 3.7% for R+P. The corresponding Kaplan-Meier estimates were 13.2%, 8.2%, and 5.4%, respectively. Conclusion: Analyzing cause-specific failure data using methods developed for survival endpoints is problematic. We encourage the use of the two-step analysis strategy described when, as in the example presented, competing causes of failure are not likely to be statistically independent, and when a treatment comparison at a single time-point is clinically relevant and feasible; that is, all patients have complete follow-up to this point

Sudden cardiac death in athletes

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Fábio Camilo Pellegrino dos Santos

2012-11-01

Full Text Available ABSTRACT The most accepted definition of sudden cardiac death nowadays is an unexplained death occurred suddenly within one hour of symptom onset. If it was not witnessed, individuals need to had been observed for at least 24 hours before the event and should be discarded the possibility of non cardiac causes of sudden death, pulmonary embolism or extensive malignancy. The term athlete refers to individuals of any age who participate in collective or individual regular physical activity, as well as physical training program for regular competitions. The sudden death of a young athlete, whether amateur or professional, especially during competitions, is always dramatic, with strong negative social impact and in the media. The fact that sports are recommended as a formula for longevity and quality of life makes these events a cause for concern in sports and society in general.

Sudden Infant Death Syndrome (SIDS)

Science.gov (United States)

Sudden infant death syndrome (SIDS) Overview Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a seemingly healthy baby ... year old. SIDS is sometimes known as crib death because the infants often die in their cribs. ...

Modification of sudden onset auditory ERP by involuntary attention to visual stimuli.

Science.gov (United States)

Oray, Serkan; Lu, Zhong-Lin; Dawson, Michael E

2002-03-01

To investigate the cross-modal nature of the exogenous attention system, we studied how involuntary attention in the visual modality affects ERPs elicited by sudden onset of events in the auditory modality. Relatively loud auditory white noise bursts were presented to subjects with random and long inter-trial intervals. The noise bursts were either presented alone, or paired with a visual stimulus with a visual to auditory onset asynchrony of 120 ms. In a third condition, the visual stimuli were shown alone. All three conditions, auditory alone, visual alone, and paired visual/auditory, were randomly inter-mixed and presented with equal probabilities. Subjects were instructed to fixate on a point in front of them without task instructions concerning either the auditory or visual stimuli. ERPs were recorded from 28 scalp sites throughout every experimental session. Compared to ERPs in the auditory alone condition, pairing the auditory noise bursts with the visual stimulus reduced the amplitude of the auditory N100 component at Cz by 40% and the auditory P200/P300 component at Cz by 25%. No significant topographical change was observed in the scalp distributions of the N100 and P200/P300. Our results suggest that involuntary attention to visual stimuli suppresses early sensory (N100) as well as late cognitive (P200/P300) processing of sudden auditory events. The activation of the exogenous attention system by sudden auditory onset can be modified by involuntary visual attention in a cross-model, passive prepulse inhibition paradigm.

Effect of Educational Program on Quality of Life of Patients with Heart Failure: A Randomized Clinical Trial

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Mohammad Khajegodary

2013-02-01

Full Text Available Introduction: Heart failure is one of the most common cardiovascular diseases which decrease the quality of life. Most of the factors influencing the quality of life can be modified with educational interventions. Therefore, this study examined the impact of a continuous training program on quality of life of patients with heart failure. Methods: This randomized clinical trial study was conducted during May to August 2011. Forty four participants with heart failure referred to Shahid Madani's polyclinics of Tabriz were selected through convenient sampling method and were randomly allocated to two groups. The intervention group (n = 22 received ongoing training including one-to-one teaching, counseling sessions and phone calls over 3 months. The control group (n = 22 received routine care program. Data on quality of life was collected using the Minnesota Living with Heart Failure Questionnaire at baseline as well as three months later. Results: The statistical tests showed significant differences in the physical, emotional dimensions and total quality of life in intervention group. But in control group, no significant differences were obtained. There was not any significant association in demographic characteristics and quality of life. Conclusion: Ongoing training programs can be effective in improving quality of life of patients with heart failure. Hence applying ongoing educational program as a non-pharmacological intervention can help to improve the quality of life of these patients.

Effect of educational program on quality of life of patients with heart failure: a randomized clinical trial.

Science.gov (United States)

Lakdizaji, Sima; Hassankhni, Hadi; Mohajjel Agdam, Alireza; Khajegodary, Mohammad; Salehi, Rezvanieh

2013-03-01

Heart failure is one of the most common cardiovascular diseases which decrease the quality of life. Most of the factors influencing the quality of life can be modified with educational interventions. Therefore, this study examined the impact of a continuous training program on quality of life of patients with heart failure. This randomized clinical trial study was conducted during May to August 2011. Forty four participants with heart failure referred to Shahid Madani's polyclinics of Tabriz were selected through convenient sampling method and were randomly allocated to two groups. The intervention group (n = 22) received ongoing training including one-to-one teaching, counseling sessions and phone calls over 3 months. The control group (n = 22) received routine care program. Data on quality of life was collected using the Minnesota Living with Heart Failure Questionnaire at baseline as well as three months later. The statistical tests showed significant differences in the physical, emotional dimensions and total quality of life in intervention group. But in control group, no significant differences were obtained. There was not any significant association in demographic characteristics and quality of life. Ongoing training programs can be effective in improving quality of life of patients with heart failure. Hence applying ongoing educational program as a non-pharmacological intervention can help to improve the quality of life of these patients.

Acute administration of fish oil inhibits triggered activity in isolated myocytes from rabbits and patients with heart failure.

NARCIS (Netherlands)

den Ruijter, H.M.; Berecki, G.; Verkerk, A.O.; Bakker, D.; Baartscheer, A.; Schumacher, C.A.; Belterman, C.N.; de Jonge, N.; Fiolet, J.W.; Brouwer, I.A.; Coronel, R.

2008-01-01

Background-Fish oil reduces sudden death in patients with prior myocardial infarction. Sudden death in heart failure may be due to triggered activity based on disturbed calcium handling. We hypothesized that superfusion with ω3-polyunsaturated fatty acids (ω3-PUFAs) from fish inhibits triggered

Sport and sudden death in children

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L. M. Makarov

2017-01-01

Full Text Available The article presents data on contemporary views of the prevalence, causes, circumstances of sudden cardiac death, and its prevention measures in children and adolescents during sports activity. It notes a difficulty in defining the epidemiology of the above condition because the data are primarily based upon mass media news coverage. The incidence of sudden cardiac death is approximately 1 per 100,000 young athletes; more than 90% boys die. The sports, during which sudden cardiac death often occurs, include (both American and European football, basketball, and hockey. Sudden cardiac death due to cоmmоtio cordis (life-threatening cardiac arrhythmias resulting from a blow with a blunt instrument to the area of the heart during the vulnerable phase of the cardiac cycle is considered separately. Children who die suddenly during sports are frequently detected to have hypertrophic cardiomyopathy or myocarditis; but no changes are found in more than 50% of cases at autopsy, which is suggestive of primary arrhythmogenic death. The basis for prevention is the early detection of diseases that can cause sudden death during sports, regular examination, knowledge of ECG characteristics in athletes, and first aid techniques, including the use of automated external defibrillators.

Sudden bilateral hearing loss after organophosphate inhalation

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Mehmet Akif Dundar

2016-12-01

Full Text Available Sudden bilateral hearing loss are seen rarely and the toxic substance exposure constitutes a small part of etiology. A Fifty-eight-year-old woman admitted to our clinic with sudden bilateral hearing loss shortly after chlorpyrifos-ethyl exposure. Otolaryngologic examination findings were normal. The patient had 40 dB sensorineural hearing loss (SNHL on the right ear and 48 dB SNHL on the left ear. Additional diagnostic tests were normal. The conventional treatment for sudden hearing loss was performed. On the second week following organophosphate (OP exposure the patient's hearing loss almost completely resolved. OP's are heavily used in agriculture and should be taken into consideration as an etiologic factor in sudden hearing loss. Keywords: Organophosphates, Hearing loss, Sudden

Dependent failures of diesel generators

International Nuclear Information System (INIS)

Mankamo, T.; Pulkkinen, U.

1982-01-01

This survey of dependent failures (common-cause failures) is based on the data of diesel generator failures in U. S. nuclear power plants as reported in Licensee Event Reports. Failures were classified into random and potentially dependent failures. All failures due to design errors, manufacturing or installation errors, maintenance errors, or deviations in the operational environment were classified as potentially dependent failures.The statistical dependence between failures was estimated from the relative portion of multiple failures. Results confirm the earlier view of the significance of statistical dependence, a strong dependence on the age of the diesel generator was found in each failure class excluding random failures and maintenance errors, which had a nearly constant frequency independent of diesel generator age

CHARITY: Chagas cardiomyopathy bisoprolol intervention study: a randomized double-blind placebo force-titration controlled study with Bisoprolol in patients with chronic heart failure secondary to Chagas cardiomyopathy [NCT00323973

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Casas Juan P

2006-06-01

Full Text Available Abstract Background Chagas' disease is the major cause of disability secondary to tropical diseases in young adults from Latin America, and around 20 million people are currently infected by T. cruzi. Heart failure due to Chagas cardiomyopathy is the main clinical presenation in Colombia. Heart failure due to Chagas' disease may respond to digoxin, diuretics and vasodilator therapy. Beta-adrenoreceptor antagonism seems to protect against the increased risk of cardiac arrhythmia and sudden death due to chronic sympathetic stimulation. The aim of this study is to evaluate the effects of the selective beta-adrenergic receptor blocker Bisoprolol on cardiovascular mortality, hospital readmission due to progressive heart failure and functional status in patients with heart failure secondary to Chagas' cardiomyopathy. Methods/design A cohort of 500 T. cruzi seropositive patients (250 per arm will be selected from several institutions in Colombia. During the pretreatment period an initial evaluation visit will be scheduled in which participants will sign consent forms and baseline measurements and tests will be conducted including blood pressure measurements, twelve-lead ECG and left ventricular ejection fraction assessment by 2D echocardiography. Quality of life questionnaire will be performed two weeks apart during baseline examination using the "Minnesota living with heart failure" questionnaire. A minimum of two 6 minutes corridor walk test once a week over a two-week period will be performed to measure functional class. During the treatment period patients will be randomly assigned to receive Bisoprolol or placebo, initially taking a total daily dose of 2.5 mgrs qd. The dose will be increased every two weeks to 5, 7.5 and 10 mgrs qd (maximum maintenance dose. Follow-up assessment will include clinical check-up, and blood collection for future measurements of inflammatory reactants and markers. Quality of life measurements will be obtained at six

Residual entanglement and sudden death: A direct connection

International Nuclear Information System (INIS)

Oliveira, J.G.G. de; Peixoto de Faria, J.G.; Nemes, M.C.

2011-01-01

We explore the results of [V. Coffman, et al., Phys. Rev. A 61 (2000) 052306] derived for general tripartite states in a dynamical context. We study a class of physically motivated tripartite systems. We show that whenever entanglement sudden death occurs in one of the partitions residual entanglement will appear. For fourpartite systems however, the appearance of residual entanglement is not conditioned by sudden death of entanglement. We can only say that if sudden death of entanglement occurs in some partition there will certainly be residual entanglement. -- Highlights: ► For tripartite systems we show there exists residual entanglement if sudden death occurs. ► For fourpartite systems, the residual entanglement is not conditioned by sudden death. ► If sudden death of entanglement occurs there will certainly be residual entanglement.

Fatigue failure of pb-free electronic packages under random vibration loads

Science.gov (United States)

Saravanan, S.; Prabhu, S.; Muthukumar, R.; Gowtham Raj, S.; Arun Veerabagu, S.

2018-03-01

The electronic equipment are used in several fields like, automotive, aerospace, consumer goods where they are subjected to vibration loads leading to failure of solder joints used in these equipment. This paper presents a methodology to predict the fatigue life of Pb-free surface mounted BGA packages subjected to random vibrations. The dynamic characteristics of the PCB, such as the natural frequencies, mode shapes and damping ratios were determined. Spectrum analysis was used to determine the stress response of the critical solder joint and the cumulative fatigue damage accumulated by the solder joint for a specific duration was determined.

Sudden Cardiac Arrest (SCA) Risk Assessment

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... HRS Find a Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without ... people of all ages and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool ...

Effect of Workplace- versus Home-Based Physical Exercise on Muscle Response to Sudden Trunk Perturbation among Healthcare Workers: A Cluster Randomized Controlled Trial

Science.gov (United States)

Jakobsen, Markus D.; Jay, Kenneth

2015-01-01

Objectives. The present study investigates the effect of workplace- versus home-based physical exercise on muscle reflex response to sudden trunk perturbation among healthcare workers. Methods. Two hundred female healthcare workers (age: 42 [SD 11], BMI: 24 [SD 4], and pain intensity: 3.1 [SD 2.2] on a scale of 0–10) from 18 departments at three hospitals were randomized at the cluster level to 10 weeks of (1) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or (2) home-based physical exercise (HOME) performed during leisure time for 5 × 10 minutes per week. Mechanical and neuromuscular (EMG) response to randomly assigned unloading and loading trunk perturbations and questions of fear avoidance were assessed at baseline and 10-week follow-up. Results. No group by time interaction for the mechanical trunk response and EMG latency time was seen following the ten weeks (P = 0.17–0.75). However, both groups demonstrated within-group changes (P < 0.05) in stopping time during the loading and unloading perturbation and in stopping distance during the loading perturbation. Furthermore, EMG preactivation of the erector spinae and fear avoidance were reduced more following WORK than HOME (95% CI −2.7–−0.7 (P < 0.05) and −0.14 (−0.30 to 0.02) (P = 0.09)), respectively. WORK and HOME performed 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions per week, respectively. Conclusions. Although training adherence was higher following WORK compared to HOME this additional training volume did not lead to significant between-group differences in the responses to sudden trunk perturbations. However, WORK led to reduced fear avoidance and reduced muscle preactivity prior to the perturbation onset, compared with HOME. This trial is registered with Clinicaltrials.gov (NCT01921764). PMID:26583145

Effect of Workplace- versus Home-Based Physical Exercise on Muscle Response to Sudden Trunk Perturbation among Healthcare Workers: A Cluster Randomized Controlled Trial

Directory of Open Access Journals (Sweden)

Markus D. Jakobsen

2015-01-01

Full Text Available Objectives. The present study investigates the effect of workplace- versus home-based physical exercise on muscle reflex response to sudden trunk perturbation among healthcare workers. Methods. Two hundred female healthcare workers (age: 42 [SD 11], BMI: 24 [SD 4], and pain intensity: 3.1 [SD 2.2] on a scale of 0–10 from 18 departments at three hospitals were randomized at the cluster level to 10 weeks of (1 workplace physical exercise (WORK performed in groups during working hours for 5 × 10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise, or (2 home-based physical exercise (HOME performed during leisure time for 5 × 10 minutes per week. Mechanical and neuromuscular (EMG response to randomly assigned unloading and loading trunk perturbations and questions of fear avoidance were assessed at baseline and 10-week follow-up. Results. No group by time interaction for the mechanical trunk response and EMG latency time was seen following the ten weeks (P = 0.17–0.75. However, both groups demonstrated within-group changes (P<0.05 in stopping time during the loading and unloading perturbation and in stopping distance during the loading perturbation. Furthermore, EMG preactivation of the erector spinae and fear avoidance were reduced more following WORK than HOME (95% CI −2.7–−0.7 (P<0.05 and −0.14 (−0.30 to 0.02 (P=0.09, respectively. WORK and HOME performed 2.2 (SD: 1.1 and 1.0 (SD: 1.2 training sessions per week, respectively. Conclusions. Although training adherence was higher following WORK compared to HOME this additional training volume did not lead to significant between-group differences in the responses to sudden trunk perturbations. However, WORK led to reduced fear avoidance and reduced muscle preactivity prior to the perturbation onset, compared with HOME. This trial is registered with Clinicaltrials.gov (NCT01921764.

Analyses Of Techniques On Structural Fatigue Failure Detection ...

African Journals Online (AJOL)

Machines and structures are subjected to variable loading conditions where the stress cycle does not remain the same during the operation of the machine. Fatigue is undoubtedly one of the most serious of all causes of breakdowns of machines and structures which results in sudden failures. The use of the time domain ...

Hypokalemia and sudden cardiac death

DEFF Research Database (Denmark)

Kjeldsen, Keld

2010-01-01

Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient...... of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis....

B-type natriuretic peptides. A diagnostic breakthrough in heart failure.

Science.gov (United States)

McCullough, P A

2003-04-01

B-type natriuretic peptide (BNP) is a neurohormone synthesized in the cardiac ventricles, which is released as N-terminal pro-brain natriuretic peptide (NT-proBNP) and then enzymatically cleaved in to the NT fragment and the immunoreactive BNP. Both tests have been used to identify patients with congestive heart failure (CHF). Important considerations for these tests include their half-lives in plasma, dependence on renal function for clearance, and the interpretation of their units of measure. In general, a BNP level below 100 pg/mL has strong negative predictive value in the assessment of patients with dyspnea caused by a disorder other than CHF. In addition, BNP levels can be used to gauge the effect of short-term treatment of acutely decompensated heart failure, and the peptide has been shown to be a reliable independent predictor of sudden cardiac death. In the absence of renal dysfunction NT-proBNP has also been shown to be an independent predictor of sudden death in CHF patients. Because both a large area of myonecrosis or concomitant left ventricular failure are related to prognosis in acute coronary syndromes, B-type natriuretic peptides have also been linked to outcomes in this condition. This article describes the physiology and timing of release of B-type natriuretic peptides and the rationale for their use in the following settings: 1) evaluation of decompensated CHF, 2) screening for chronic CHF, 3) prognosis of CHF and sudden death, and 4) prognosis in acute coronary syndromes with inferred left ventricular dysfunction.

Sudden Death Following Exercise; a Case Series Study

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Fares Najari

2016-04-01

Full Text Available Introduction: Natural and unexpected death that happens within less than one hour of first symptom occurrence is called sudden death. Cardiovascular diseases are the main known reason of sudden death and more than 75% of sudden deaths in athletes are assigned to it. Here we reported the autopsy results of all cases with sudden death following exercise that were referred to forensic center of Tehran, Iran, from 2009 to 2014. Methods: In this cross sectional study all subjects who were registered to forensic medicine center of Tehran, Iran, from 2009 to 2014, as a case of sudden death following exercise were evaluated. Demographic data and medical history as well as autopsy and toxicology findings were retrospectively gathered using profiles of the deceased. Results were reported using descriptive analysis. Results: 14 cases were registered as sudden death following exercise in forensic medicine profiles during the study period. Exploring the files of the mentioned deceased, revealed five non-compatible cases in this regard. Finally, 9 eligible cases were enrolled (88.9% male. The mean age of the deceased was 28.66 ± 10.86 years (range: 7 – 40. Toxicological tests were available for 7 cases, one of which was positive for tramadol. Sudden death following football was reported most frequently (44.4%. Only 3 (33.3% cases had herald signs such as chest pain, syncope, or loss of consciousness. 1 case (11.11% had a positive history of sudden death in relatives. Conclusion: Although most sudden death victims are asymptomatic until the event, all those who suffer from symptoms such as chest pain, shortness of breath, dizziness, fatigue and irregular heart rate during physical activities, should be screened regarding common probable causes of sudden death.

Sudden unexpected death caused by stroke

DEFF Research Database (Denmark)

Ågesen, Frederik Nybye; Risgaard, Bjarke; Zachariasardóttir, Sára

2017-01-01

Background Stroke is the fifth leading cause of death in young individuals globally. Data on the burden of sudden death by stroke are sparse in the young. Aims The aim of this study was to report mortality rates, cause of death, stroke subtype, and symptoms in children and young adults who suffered....... There was a male predominance (56%) and the median age was 33 years. The incidence of sudden death by stroke in individuals aged 1-49 years was 0.19 deaths per 100,000 person-years. Stroke was hemorrhagic in 94% of cases, whereof subarachnoid hemorrhage was the cause of death in 63% of cases. Seventeen (33%) cases...... contacted the healthcare system because of neurological symptoms, whereof one was suspected of having a stroke (6%). Conclusions Sudden death by stroke in children and young adults occurs primarily due to hemorrhagic stroke. We report a high frequency of neurological symptoms prior to sudden death by stroke...

Change of the mode of failure by interface friction and width-to-height ratio of coal specimens

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Gamal Rashed

2015-06-01

Full Text Available Bumps in coal mines have been recognized as a major hazard for many years. These sudden and violent failures around mine openings have compromised safety, ventilation and access to mine workings. Previous studies showed that the violence of coal specimen failure depends on both the interface friction and width-to-height (W/H ratio of coal specimen. The mode of failure for a uniaxially loaded coal specimen or a coal pillar is a combination of both shear failure along the interface and compressive failure in the coal. The shear failure along the interface triggered the compressive failure in coal. The compressive failure of a coal specimen or a coal pillar can be controlled by changing its W/H ratio. As the W/H ratio increases, the ultimate strength increases. Hence, with a proper combination of interface friction and the W/H ratio of pillar or coal specimen, the mode of failure will change from sudden violent failure which is brittle failure to non-violent failure which is ductile failure. The main objective of this paper is to determine at what W/H ratio and interface friction the mode of failure changes from violent to non-violent. In this research, coal specimens of W/H ratio ranging from 1 to 10 were uniaxially tested under two interface frictions of 0.1 and 0.25, and the results are presented and discussed.

Controllable entanglement sudden birth of Heisenberg spins

International Nuclear Information System (INIS)

Zheng Qiang; Zhi Qijun; Zhang Xiaoping; Ren Zhongzhou

2011-01-01

We investigate the Entanglement Sudden Birth (ESB) of two Heisenberg spins A and B. The third controller, qutrit C is introduced, which only has the Dzyaloshinskii-Moriya (DM) spin-orbit interaction with qubit B. We find that the DM interaction is necessary to induce the Entanglement Sudden Birth of the system qubits A and B, and the initial states of the system qubits and the qutrit C are also important to control its Entanglement Sudden Birth. (authors)

Cardiovascular causes of maternal sudden death. Sudden arrhythmic death syndrome is leading cause in UK.

Science.gov (United States)

Krexi, Dimitra; Sheppard, Mary N

2017-05-01

This study aims to determine the causes of sudden cardiac death during pregnancy and in the postpartum period and patients' characteristics. There are few studies in the literature. Eighty cases of sudden unexpected death due to cardiac causes in relation to pregnancy and postpartum period in a database of 4678 patients were found and examined macroscopically and microscopically. The mean age was 30±7 years with a range from 16 to 43 years. About 30% were 35 years old or older; 50% of deaths occurred during pregnancy and 50% during the postpartum period. About 59.18% were obese or overweight where body mass index data were available. The leading causes of death were sudden arrhythmic death syndrome (SADS) (53.75%) and cardiomyopathies (13.80%). Other causes include dissection of aorta or its branches (8.75%), congenital heart disease (2.50%) and valvular disease (3.75%). This study highlights sudden cardiac death in pregnancy or in the postpartum period, which is mainly due to SADS with underlying channelopathies and cardiomyopathy. We wish to raise awareness of these frequently under-recognised entities in maternal deaths and the need of cardiological screening of the family as a result of the diagnosis. Copyright © 2017 Elsevier B.V. All rights reserved.

OVULATION INDUCTION IN PREMATURE OVARIAN FAILURE - A PLACEBO-CONTROLLED RANDOMIZED TRIAL COMBINING PITUITARY SUPPRESSION WITH GONADOTROPIN STIMULATION

NARCIS (Netherlands)

VANKASTEREN, YM; HOEK, A; SCHOEMAKER, J

Objectives: To determine the effect of pituitary suppression with a GnRH agonist (GnRH-a) on the success of ovulation induction with exogenous gonadotropins in patients with premature ovarian failure (POF). Design: Placebo-controlled, randomized, double-blind study. The data were analyzed with a

Engineering risk assessment for emergency disposal projects of sudden water pollution incidents.

Science.gov (United States)

Shi, Bin; Jiang, Jiping; Liu, Rentao; Khan, Afed Ullah; Wang, Peng

2017-06-01

Without an engineering risk assessment for emergency disposal in response to sudden water pollution incidents, responders are prone to be challenged during emergency decision making. To address this gap, the concept and framework of emergency disposal engineering risks are reported in this paper. The proposed risk index system covers three stages consistent with the progress of an emergency disposal project. Fuzzy fault tree analysis (FFTA), a logical and diagrammatic method, was developed to evaluate the potential failure during the process of emergency disposal. The probability of basic events and their combination, which caused the failure of an emergency disposal project, were calculated based on the case of an emergency disposal project of an aniline pollution incident in the Zhuozhang River, Changzhi, China, in 2014. The critical events that can cause the occurrence of a top event (TE) were identified according to their contribution. Finally, advices on how to take measures using limited resources to prevent the failure of a TE are given according to the quantified results of risk magnitude. The proposed approach could be a potential useful safeguard for the implementation of an emergency disposal project during the process of emergency response.

Sudden Death in Young People--Heart Problems Often Blamed

Science.gov (United States)

Sudden death in young people: Heart problems often blamed Sudden death in young people is rare, but those at ... causes and treatments. By Mayo Clinic Staff Sudden death in people younger than 35, often due to ...

Predictive Value of Beat-to-Beat QT Variability Index across the Continuum of Left Ventricular Dysfunction: Competing Risks of Non-cardiac or Cardiovascular Death, and Sudden or Non-Sudden Cardiac Death

Science.gov (United States)

Tereshchenko, Larisa G.; Cygankiewicz, Iwona; McNitt, Scott; Vazquez, Rafael; Bayes-Genis, Antoni; Han, Lichy; Sur, Sanjoli; Couderc, Jean-Philippe; Berger, Ronald D.; de Luna, Antoni Bayes; Zareba, Wojciech

2012-01-01

Background The goal of this study was to determine the predictive value of beat-to-beat QT variability in heart failure (HF) patients across the continuum of left ventricular dysfunction. Methods and Results Beat-to-beat QT variability index (QTVI), heart rate variance (LogHRV), normalized QT variance (QTVN), and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca (MUSIC) HF study (mean age 63.1±11.7; males 70.6%; LVEF >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance (IDEAL) database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death [hazard ratio (HR) 1.67(95%CI 1.14-2.47), P=0.009] and in particular with non-sudden cardiac death [HR 2.91(1.69-5.01), P<0.001]. Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular [HR 1.57(1.04-2.35), P=0.031], and non-sudden cardiac death in multivariate competing risk model [HR 2.58(1.13-3.78), P=0.001]. No interaction between QTVI and LVEF was found. QTVI predicted neither non-cardiac death (P=0.546) nor SCD (P=0.945). Decreased heart rate variability (HRV) rather than increased QT variability was the reason for increased QTVI in this study. Conclusions Increased QTVI due to depressed HRV predicts cardiovascular mortality and non-sudden cardiac death, but neither SCD nor excracardiac mortality in HF across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from HF patients at risk. PMID:22730411

Supravalvular aortic stenosis with sudden cardiac death

Directory of Open Access Journals (Sweden)

Pradeep Vaideeswar

2015-01-01

Full Text Available Sudden cardiac death (SCD most commonly results from previously undiagnosed congenital, acquired, or hereditary cardiac diseases. Congenital aortic valvular, subvalvular, and supravalvular disease with left ventricular outflow tract obstruction is an important preventable cause of sudden death. This report documents sudden death presumably due to acute myocardial ischemia in a young male with an undiagnosed supravalvular aortic stenosis (SVAS due to a rare association of isolation of coronary sinuses of Valsalva. Congenital supravalvular pulmonary stenosis and mitral valvular dysplasia were also present.

Valvular Heart Disease in Heart Failure

Directory of Open Access Journals (Sweden)

Giuseppe MC Rosano

2017-01-01

Full Text Available Structural valvular heart disease may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure may also develop in patients treated with valve surgery. Patients with heart failure with valvular heart disease are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous all patients should receive appropriate medical and device therapy taking into account that vasodilators must be used with caution in patients with severe aortic stenosis. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of valvular heart disease. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk– benefit ratio of different treatment strategies and should be made by a multidisciplinary ‘heart team’ with a particular expertise in valvular heart disease. The heart team should include heart failure cardiologists, cardiac surgeons/structural valve interventionists, imaging specialists, anaesthetists, geriatricians and intensive care specialists. This article will review recent developments and distill practical guidance in the management of this important heart failure co-morbidity.

Gastrointestinal causes of sudden unexpected death: A review.

Science.gov (United States)

Menezes, Ritesh G; Ahmed, Saba; Pasha, Syed Bilal; Hussain, Syed Ather; Fatima, Huda; Kharoshah, Magdy A; Madadin, Mohammed

2018-01-01

Gastrointestinal conditions are a less common cause of sudden unexpected death when compared to other conditions such as cardiovascular conditions, but they are equally important. Various congenital and acquired gastrointestinal conditions that have resulted in sudden unexpected death are discussed. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, have been described. Through this article, we aim to highlight the need for physicians to prevent death in such conditions by ensuring that subclinical cases are diagnosed correctly before it is too late and by providing timely and efficacious treatment to the patient concerned. In addition, this review would certainly benefit the forensic pathologist while dealing with cases of sudden unexpected death due to gastrointestinal causes. This article is a review of the major gastrointestinal causes of sudden unexpected death. In addition, related fatal cases encountered occasionally in forensic autopsy practice are also included. There are several unusual and rare causes of life-threatening gastrointestinal bleeding that may lead to sudden unexpected death to cover all the entities in detail. Nevertheless, this article is a general guide to the topic of gastrointestinal causes of sudden unexpected death.

Failure analysis of buried tanks

International Nuclear Information System (INIS)

Watkins, R.K.

1994-01-01

Failure of a buried tank can be hazardous. Failure may be a leak through which product is lost from the tank; but also through which contamination can occur. Failures are epidemic -- because buried tanks are out of sight, but also because designers of buried tanks have adopted analyses developed for pressure tanks. So why do pressure tanks fail when they are buried? Most failures of buried tanks are really soil failures. Soil compresses, or slips, or liquefies. Soil is not only a load, it is a support without which the tank deforms. A high water table adds to the load on the tank. It also reduces the strength of the soil. Based on tests, structural analyses are proposed for empty tanks buried in soils of various quality, with the water table at various levels, and with internal vacuum. Failure may be collapse tank. Such collapse is a sudden, audible inversion of the cylinder when the sidefill soil slips. Failure may be flotation. Failure may be a leak. Most leaks are fractures in the welds in overlap seams at flat spots. Flat spots are caused by a hard bedding or a heavy surface wheel load. Because the tank wall is double thick at the overlap, shearing stress in the weld is increased. Other weld failures occur when an end plate shears down past a cylinder; or when the tank is supported only at its ends like a beam. These, and other, failures can be analyzed with justifiable accuracy using basic principles of mechanics of materials. 10 figs

Sudden Cardiac Arrest during Participation in Competitive Sports.

Science.gov (United States)

Landry, Cameron H; Allan, Katherine S; Connelly, Kim A; Cunningham, Kris; Morrison, Laurie J; Dorian, Paul

2017-11-16

The incidence of sudden cardiac arrest during participation in sports activities remains unknown. Preparticipation screening programs aimed at preventing sudden cardiac arrest during sports activities are thought to be able to identify at-risk athletes; however, the efficacy of these programs remains controversial. We sought to identify all sudden cardiac arrests that occurred during participation in sports activities within a specific region of Canada and to determine their causes. In this retrospective study, we used the Rescu Epistry cardiac arrest database (which contains records of every cardiac arrest attended by paramedics in the network region) to identify all out-of-hospital cardiac arrests that occurred from 2009 through 2014 in persons 12 to 45 years of age during participation in a sport. Cases were adjudicated as sudden cardiac arrest (i.e., having a cardiac cause) or as an event resulting from a noncardiac cause, on the basis of records from multiple sources, including ambulance call reports, autopsy reports, in-hospital data, and records of direct interviews with patients or family members. Over the course of 18.5 million person-years of observation, 74 sudden cardiac arrests occurred during participation in a sport; of these, 16 occurred during competitive sports and 58 occurred during noncompetitive sports. The incidence of sudden cardiac arrest during competitive sports was 0.76 cases per 100,000 athlete-years, with 43.8% of the athletes surviving until they were discharged from the hospital. Among the competitive athletes, two deaths were attributed to hypertrophic cardiomyopathy and none to arrhythmogenic right ventricular cardiomyopathy. Three cases of sudden cardiac arrest that occurred during participation in competitive sports were determined to have been potentially identifiable if the athletes had undergone preparticipation screening. In our study involving persons who had out-of-hospital cardiac arrest, the incidence of sudden cardiac

Sudden cardiac death with triple pathologies: A case report

Directory of Open Access Journals (Sweden)

R. Razuin

2017-06-01

Full Text Available Sudden cardiac death in young adults may be associated with rare cardiomyopathies such as left ventricular noncompaction (LVNC and arrhythmogenic right ventricular (ARVC cardiomyopathies. LVNC is characterised by hypertrabeculations and deep recesses of the left ventricle. ARVC presents with thin myocardium as a result of extensive fibro-fatty infiltrations. In both conditions, death may be due to arrhythmia, thromboembolic events or heart failure. We report a case of a 21-year old athletic young man who collapsed at the futsal court right after the game. He was resuscitated but expired at the hospital after a brief admission. A week earlier, he had a similar episode of syncope and revived through cardio-pulmonary resuscitation at the site. Post mortem examination showed extensive acute myocardial infarction (AMI involving the papillary muscles and the left ventricular wall. Features of LVNC were also observed. On top of that, the right ventricle showed patchy thin myocardium as the wall was largely comprised of fat. Histology examination confirmed the presence of AMI and massive fibro-fatty infiltrations of the right ventricle. This unfortunate young man had co-existing cardiomyopathies which is rare indeed. As he succumbed to AMI, this mechanism of death is also uncommonly associated with neither LVNC nor ARVC. In conclusion, young and physically active individuals may not be spared of sudden cardiac death. Mild and non-specific symptoms should not be taken lightly as it may be the subtle signs of cardiomyopathies.

Risk factors and causes of sudden noncardiac death

DEFF Research Database (Denmark)

Risgaard, Bjarke; Lynge, Thomas Hadberg; Wissenberg, Mads

2015-01-01

was to report the risk factors and causes of SNCD. METHODS: We conducted a retrospective, nationwide study including all deaths between 2000 and 2006 of individuals aged 1-35 years and all deaths between 2007 and 2009 of individuals aged 1-49 years. Two physicians identified all sudden death cases through.......3-2.3; OR 3.0, 95% CI 2.0-4.4; and OR 4.3, 95% CI 2.5-7.4, respectively). The most common cause of SNCD was pulmonary disease (n = 115 [40%]). CONCLUSION: Sudden death among individuals aged caused by noncardiac diseases in 28% of cases. Risk factors were female sex, age, and the absence......BACKGROUND: On the performance of an autopsy, sudden deaths may be divided into 2 classifications: (1) sudden cardiac deaths and (2) sudden noncardiac deaths (SNCDs). Families of SNCD victims should not be followed up as a means of searching for cardiac disease. OBJECTIVE: The purpose of this study...

Sudden gains in group cognitive-behavioral therapy for panic disorder.

Science.gov (United States)

Clerkin, Elise M; Teachman, Bethany A; Smith-Janik, Shannan B

2008-11-01

The current study investigates sudden gains (rapid symptom reduction) in group cognitive-behavioral therapy for panic disorder. Sudden gains occurring after session 2 of treatment predicted overall symptom reduction at treatment termination and some changes in cognitive biases. Meanwhile, sudden gains occurring immediately following session 1 were not associated with symptom reduction or cognitive change. Together, this research points to the importance of examining sudden gains across the entire span of treatment, as well as the potential role of sudden gains in recovery from panic disorder.

Maximum Expected Wall Heat Flux and Maximum Pressure After Sudden Loss of Vacuum Insulation on the Stratospheric Observatory for Infrared Astronomy (SOFIA) Liquid Helium (LHe) Dewars

Science.gov (United States)

Ungar, Eugene K.

2014-01-01

The aircraft-based Stratospheric Observatory for Infrared Astronomy (SOFIA) is a platform for multiple infrared observation experiments. The experiments carry sensors cooled to liquid helium (LHe) temperatures. A question arose regarding the heat input and peak pressure that would result from a sudden loss of the dewar vacuum insulation. Owing to concerns about the adequacy of dewar pressure relief in the event of a sudden loss of the dewar vacuum insulation, the SOFIA Program engaged the NASA Engineering and Safety Center (NESC). This report summarizes and assesses the experiments that have been performed to measure the heat flux into LHe dewars following a sudden vacuum insulation failure, describes the physical limits of heat input to the dewar, and provides an NESC recommendation for the wall heat flux that should be used to assess the sudden loss of vacuum insulation case. This report also assesses the methodology used by the SOFIA Program to predict the maximum pressure that would occur following a loss of vacuum event.

Sudden Cardiac Death

DEFF Research Database (Denmark)

Risgaard, Bjarke; Winkel, Bo Gregers; Jabbari, Reza

2017-01-01

Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how...... pharmacotherapy may contribute to the overall burden of SCD in the general population. Methods This was a nationwide study that included all deaths that occurred between 2000 and 2009 and between 2007 and 2009 in people age 1 to 35 years and 36 to 49 years, respectively. Two physicians identified all SCDs through...... review of death certificates. Autopsy reports were collected. Pharmacotherapy prescribed within 90 days before SCD was identified in the Danish Registry of Medicinal Product Statistics. Results We identified 1,363 SCDs; median age was 38 years (interquartile range: 29 to 45 years), and 72% (n = 975) were men...

Parameters affecting the resilience of scale-free networks to random failures.

Energy Technology Data Exchange (ETDEWEB)

Link, Hamilton E.; LaViolette, Randall A.; Lane, Terran (University of New Mexico, Albuquerque, NM); Saia, Jared (University of New Mexico, Albuquerque, NM)

2005-09-01

It is commonly believed that scale-free networks are robust to massive numbers of random node deletions. For example, Cohen et al. in (1) study scale-free networks including some which approximate the measured degree distribution of the Internet. Their results suggest that if each node in this network failed independently with probability 0.99, most of the remaining nodes would still be connected in a giant component. In this paper, we show that a large and important subclass of scale-free networks are not robust to massive numbers of random node deletions. In particular, we study scale-free networks which have minimum node degree of 1 and a power-law degree distribution beginning with nodes of degree 1 (power-law networks). We show that, in a power-law network approximating the Internet's reported distribution, when the probability of deletion of each node is 0.5 only about 25% of the surviving nodes in the network remain connected in a giant component, and the giant component does not persist beyond a critical failure rate of 0.9. The new result is partially due to improved analytical accommodation of the large number of degree-0 nodes that result after node deletions. Our results apply to power-law networks with a wide range of power-law exponents, including Internet-like networks. We give both analytical and empirical evidence that such networks are not generally robust to massive random node deletions.

Sudden Cardiac Death in Children. Part 1

Directory of Open Access Journals (Sweden)

Ye.V. Pshenichnaya

2013-02-01

Full Text Available This article presents the prevalence, terminology, classification of sudden cardiac death. A description of congenital structural heart diseases associated with a risk of sudden cardiac death is given. The issues of etiology and pathogenesis of life-threatening conditions are described in detail.

Effects of self-management intervention on health outcomes of patients with heart failure: a systematic review of randomized controlled trials

Directory of Open Access Journals (Sweden)

Holroyd-Leduc Jayna M

2006-11-01

Full Text Available Abstract Background Heart failure is the most common cause of hospitalization among adults over 65. Over 60% of patients die within 10 years of first onset of symptoms. The objective of this study is to determine the effectiveness of self-management interventions on hospital readmission rates, mortality, and health-related quality of life in patients diagnosed with heart failure. Methods The study is a systematic review of randomized controlled trials. The following data sources were used: MEDLINE (1966-11/2005, EMBASE (1980-11/2005, CINAHL (1982-11/2005, the ACP Journal Club database (to 11/2005, the Cochrane Central Trial Registry and the Cochrane Database of Systematic Reviews (to 11/2005; article reference lists; and experts in the field. We included randomized controlled trials of self-management interventions that enrolled patients 18 years of age or older who were diagnosed with heart failure. The primary outcomes of interest were all-cause hospital readmissions, hospital readmissions due to heart failure, and mortality. Secondary outcomes were compliance with treatment and quality of life scores. Three reviewers independently assessed the quality of each study and abstracted the results. For each included study, we computed the pooled odds ratios (OR for all-cause hospital readmission, hospital readmission due to heart failure, and death. We used a fixed effects model to quantitatively synthesize results. We were not able to pool effects on health-related quality of life and measures of compliance with treatment, but we summarized the findings from the relevant studies. We also summarized the reported cost savings. Results From 671 citations that were identified, 6 randomized trials with 857 patients were included in the review. Self-management decreased all-cause hospital readmissions (OR 0.59; 95% confidence interval (CI 0.44 to 0.80, P = 0.001 and heart failure readmissions (OR 0.44; 95% CI 0.27 to 0.71, P = 0.001. The effect on

A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease

DEFF Research Database (Denmark)

Filippatos, Gerasimos; Anker, Stefan D; Böhm, Michael

2016-01-01

Aims To evaluate oral doses of the non-steroidal mineralocorticoid receptor antagonist finerenone given for 90 days in patients with worsening heart failure and reduced ejection fraction and chronic kidney disease and/or diabetes mellitus. Methods and results Miner Alocorticoid Receptor antagonist...... Tolerability Study-Heart Failure (ARTS-HF) was a randomized, double-blind, phase 2b multicentre study (ClinicalTrials.gov: NCT01807221). Of 1286 screened patients, 1066 were randomized. Patients received oral, once-daily finerenone (2.5, 5, 7.5, 10, or 15 mg, uptitrated to 5, 10, 15, 20, or 20 mg, respectively...

Intravenous Milrinone in Treatment of Advanced Congestive Heart Failure

Science.gov (United States)

Zewail, Aly M.; Nawar, Mohammad; Vrtovec, Bojan; Eastwood, Cathy; Kar, Biswajit; Delgado, Reynolds M.

2003-01-01

Phosphodiesterase inhibitors such as milrinone can relieve symptoms and improve hemodynamics in patients with advanced congestive heart failure. We retrospectively evaluated the hemodynamic and clinical outcomes of long-term combination therapy with intravenous milrinone and oral β-blockers in 65 patients with severe congestive heart failure (New York Heart Association class IV function and ejection fraction milrinone. Oral medical therapy was maximized when possible. The mean duration of milrinone treatment in this combination-treatment group was 269 days (range, 14–1,026 days). Functional class improved from IV to II–III with milrinone therapy. Twenty-four such patients tolerated β-blocker up-titration and were successfully weaned from milrinone. Sixteen patients (31%) died while receiving combination therapy; one died of sudden cardiac death (on treatment day 116); the other 15 died of progressive heart failure or other complications. Hospital admissions during the previous 6 months and admissions within 6 months after milrinone initiation stayed the same. Meanwhile, the total number of hospital days decreased from 450 to 380 (a 15.6% reduction), and the mean length of stay decreased by 1.4 days (a 14.7% reduction). We conclude that 1) milrinone plus β-blocker combination therapy is an effective treatment for heart failure even with β-blocker up-titration, 2) weaning from milrinone may be possible once medications are maximized, 3) patients' functional status improves on the combination regimen, and 4) treatment-related sudden death is relatively infrequent during the combination regimen. (Tex Heart Inst J 2003;30:109–13) PMID:12809251

Sudden cardiac death in adults: causes, incidence and interventions.

Science.gov (United States)

Walker, Wendy Marina

Many nurses will be familiar with the unexpected death of an adult patient following a sudden, life-threatening cardiac event. It is a situation that demands sensitive nursing care and skilled interventions to provide a foundation for recovery and promote healthy bereavement. This article examines the causes and incidence of sudden cardiac death in adults. Possible reactions of those who are suddenly bereaved are described and immediate care interventions aimed at dealing with the grief process are discussed. The article concludes by identifying ways in which the incidence of sudden cardiac death may be reduced.

[Psychological stress and sudden death].

Science.gov (United States)

Pignalberi, Carlo; Ricci, Renato; Santini, Massimo

2002-10-01

Recent studies provide relevant evidence that psychological stress significantly influences the pathogenesis of sudden cardiac death. Psychological stress expresses a situation of imbalance, derived from a real or perceived disparity between environmental demands and the individual's ability to cope with these demands. A situation of psychological stress may include different components: personality factors and character traits, anxiety and depression, social isolation and acute or chronic adverse life events. In particular, it has been documented that a sudden extremely hard event, such as an earthquake or a war strike, can significantly increase the incidence of sudden death. Nevertheless, each one of these factors, if not present, can balance a partially unfavorable situation; this overview suggests a multifactorial situation where almost all elements are present and in which the relative influence of each one varies according to the individual examined. Sudden death occurs when a transient disruption (such as acute myocardial ischemia, platelet activation or neuroendocrine variations), occurring in a patient with a diseased myocardium (such as one with a post-necrotic scar or hypertrophy), triggers a malignant arrhythmia. Psychological stress acts at both levels: by means of a "chronic" action it contributes to create the myocardial background, while by means of an acute action it can create the transient trigger precipitating sudden death. In the chronic action two possible mechanisms can be detected: the first is a direct interaction, which contributes to cause a hypertension status or to exacerbate coronary atherosclerosis consequent to endothelial dysfunction; the second one acts through adverse health behaviors, such as a poor diet, alcohol consumption or smoking. In case of acute psychological stress, the mechanisms involved are mainly the ability to trigger myocardial ischemia, to promote arrhythmogenesis, to stimulate platelet function, and to increase

Structural imaging biomarkers of sudden unexpected death in epilepsy.

Science.gov (United States)

Wandschneider, Britta; Koepp, Matthias; Scott, Catherine; Micallef, Caroline; Balestrini, Simona; Sisodiya, Sanjay M; Thom, Maria; Harper, Ronald M; Sander, Josemir W; Vos, Sjoerd B; Duncan, John S; Lhatoo, Samden; Diehl, Beate

2015-10-01

Sudden unexpected death in epilepsy is a major cause of premature death in people with epilepsy. We aimed to assess whether structural changes potentially attributable to sudden death pathogenesis were present on magnetic resonance imaging in people who subsequently died of sudden unexpected death in epilepsy. In a retrospective, voxel-based analysis of T1 volume scans, we compared grey matter volumes in 12 cases of sudden unexpected death in epilepsy (two definite, 10 probable; eight males), acquired 2 years [median, interquartile range (IQR) 2.8] before death [median (IQR) age at scanning 33.5 (22) years], with 34 people at high risk [age 30.5 (12); 19 males], 19 at low risk [age 30 (7.5); 12 males] of sudden death, and 15 healthy controls [age 37 (16); seven males]. At-risk subjects were defined based on risk factors of sudden unexpected death in epilepsy identified in a recent combined risk factor analysis. We identified increased grey matter volume in the right anterior hippocampus/amygdala and parahippocampus in sudden death cases and people at high risk, when compared to those at low risk and controls. Compared to controls, posterior thalamic grey matter volume, an area mediating oxygen regulation, was reduced in cases of sudden unexpected death in epilepsy and subjects at high risk. The extent of reduction correlated with disease duration in all subjects with epilepsy. Increased amygdalo-hippocampal grey matter volume with right-sided changes is consistent with histo-pathological findings reported in sudden infant death syndrome. We speculate that the right-sided predominance reflects asymmetric central influences on autonomic outflow, contributing to cardiac arrhythmia. Pulvinar damage may impair hypoxia regulation. The imaging findings in sudden unexpected death in epilepsy and people at high risk may be useful as a biomarker for risk-stratification in future studies. The Author (2015). Published by Oxford University Press on behalf of the Guarantors of

Athletes at Risk for Sudden Cardiac Death

Science.gov (United States)

Subasic, Kim

2010-01-01

High school athletes represent the largest group of individuals affected by sudden cardiac death, with an estimated incidence of once or twice per week. Structural cardiovascular abnormalities are the most frequent cause of sudden cardiac death. Athletes participating in basketball, football, track, soccer, baseball, and swimming were found to…

KAMEDO report No. 93-the power failure at Karolinska University Hospital, Huddinge, 07 April 2007.

Science.gov (United States)

Angantyr, Lars-Göran; Häggström, Eskil; Kulling, Per

2009-01-01

A sudden and extensive power failure occurred at Karolinska University Hospital in Huddinge on Easter Saturday, 07 April 2007. The power failure lasted one hour and 22 minutes, but it took a longer time for activities to return to normal. It put many patients at great risk, particularly in the intensive care unit and other departments with critically ill patients. This report details the conditions and response at Karolinska University Hospital during the power failure and provides lessons learned for future events.

Sudden Hearing Loss after Rabies Vaccination

OpenAIRE

Güçlü, Oğuz; Dereköy, Fevzi Sefa

2014-01-01

Background: Sudden hearing loss developing after immunisation is a very rare situation. Rabies is a viral disease characterised by encephalitis and death. Treatment involves active and passive immunisation. Neurologic complications including Guillain-Barre syndrome or facial paralysis are reported in the literature as a side effect after rabies immunisation. Case Report: Sudden hearing loss was detected in an 11 year-old male patient who had taken the medication for rabies immunisatio...

Sudden Hearing Loss after Rabies Vaccination

OpenAIRE

Güçlü, Oğuz; Dereköy, Fevzi Sefa

2013-01-01

Background: Sudden hearing loss developing after immunisation is a very rare situation. Rabies is a viral disease characterised by encephalitis and death. Treatment involves active and passive immunisation. Neurologic complications including Guillain-Barre syndrome or facial paralysis are reported in the literature as a side effect after rabies immunisation. Case Report: Sudden hearing loss was detected in an 11 year-old male patient who had taken the medication for rabies immunisat...

Association of Smoking, Sleep Apnea, and Plasma Alkalosis With Nocturnal Ventricular Arrhythmias in Men With Systolic Heart Failure

Science.gov (United States)

Shukla, Rakesh; Wexler, Laura

2012-01-01

Background: Excess sudden death due to ventricular tachyarrhythmias remains a major mode of mortality in patients with systolic heart failure. The aim of this study was to determine the association of nocturnal ventricular arrhythmias in patients with low ejection fraction heart failure. We incorporated a large number of known pathophysiologic triggers to identify potential targets for therapy to reduce the persistently high incidence of sudden death in this population despite contemporary treatment. Methods: Eighty-six ambulatory male patients with stable low (≤ 45%) ejection fraction heart failure underwent full-night attendant polysomnography and simultaneous Holter recordings. Patients were divided into groups according to the presence or absence of couplets (paired premature ventricular excitations) and ventricular tachycardia (VT) (at least three consecutive premature ventricular excitations) during sleep. Results: In multiple regression analysis, four variables (current smoking status, increased number of arousals, plasma alkalinity, and old age) were associated with VT and two variables (apnea-hypopnea index and low right ventricular ejection fraction) were associated with couplets during sleep. Conclusions: We speculate that cessation of smoking, effective treatment of sleep apnea, and plasma alkalosis could collectively decrease the incidence of nocturnal ventricular tachyarrhythmias and the consequent risk of sudden death, which remains high despite the use of β blockades. PMID:22172636

Sudden Cardiac Death in Children. Part 2

Directory of Open Access Journals (Sweden)

Ye.V. Pshenichnaya

2013-03-01

Full Text Available This article deals with the dysplastic changes in musculo-valve structures of the heart, arrhythmias and conduction disorders, associated with a risk of sudden cardiac death. The diagnostic criteria for sudden cardiac death, the events of cardio-pulmonary resuscitation, prevention of life-threatening conditions in children are provided.

Distillability Sudden Birth of Entanglement for Qutrit-Qutrit Systems

International Nuclear Information System (INIS)

Huang Jiang; Ali Mazhar

2014-01-01

We report the sudden appearance of distillability between two statistically independent reservoirs modelled as qutrit-qutrit systems. This feature of bipartite quantum systems is different from the previously observed phenomenon of entanglement sudden birth. It is found that the states of reservoirs first become bound entangled, thus exhibiting entanglement sudden birth, consequently followed by the sudden birth of distillability, and it is shown that whenever distillability is lost abruptly from principal system, it also necessarily appears abruptly among reservoirs' degrees of freedom. This surprising observation reflects yet another peculiarity of dynamical aspects of quantum entanglement

Sudden Sensorineural Hearing Loss; Prognostic Factors

OpenAIRE

Arjun, Dass; Neha, Goel; Surinder K, Singhal; Ravi, Kapoor

2015-01-01

Introduction: Sudden sensorineural hearing loss (SSNHL) is a frightening and frustrating symptom for the patient as well as the physician. Prognosis is affected by multiple factors including duration of hearing loss, presence of associated vertigo and tinnitus, and co-morbidities such as hypertension and diabetes.   Materials and Methods: Forty subjects presenting to our department with features of sudden hearing loss were included in the study. Detailed otological history and examination, se...

Random safety auditing, root cause analysis, failure mode and effects analysis.

Science.gov (United States)

Ursprung, Robert; Gray, James

2010-03-01

Improving quality and safety in health care is a major concern for health care providers, the general public, and policy makers. Errors and quality issues are leading causes of morbidity and mortality across the health care industry. There is evidence that patients in the neonatal intensive care unit (NICU) are at high risk for serious medical errors. To facilitate compliance with safe practices, many institutions have established quality-assurance monitoring procedures. Three techniques that have been found useful in the health care setting are failure mode and effects analysis, root cause analysis, and random safety auditing. When used together, these techniques are effective tools for system analysis and redesign focused on providing safe delivery of care in the complex NICU system. Copyright 2010 Elsevier Inc. All rights reserved.

Profile of sudden death in an adult population (1999-2008).

LENUS (Irish Health Repository)

Downes, M R

2010-06-01

Sudden death is the sudden and unexpected death of an individual within 24 hours of symptom onset. The vast majority of these cases are found, at autopsy, to be due to underlying ischaemic cardiac disease. We retrospectively reviewed all adult post mortems performed at Beaumont Hospital over a decade (1999-2008). Our aim was to identify all sudden death cases (natural and accidental) and subclassify them according to age profile and organ system involved. We identified 1230 sudden death cases in the review period with 775 (63%) deaths attributable to ischaemic heart disease. The rate of sudden death remained constant over the decade with 663 (54%) deaths occurring in the first five years. Our negative autopsy rate was 2.8% corresponding to 35 cases. This is the first Irish study to retrospectively review all adult sudden deaths within a defined catchment area and analyse them as outlined above.

Six-month bracket failure rate with a flowable composite: A split-mouth randomized controlled trial

Directory of Open Access Journals (Sweden)

Sindhuja Krishnan

Full Text Available ABSTRACT INTRODUCTION: The use of flowable composites as an orthodontic bonding adhesive merits great attention because of their adequate bond strength, ease of clinical handling and reduced number of steps in bonding. OBJECTIVE: The aim of this Randomized Controlled Trial was to comparatively evaluate over a 6-month period the bond failure rate of a flowable composite (Heliosit Orthodontic, Ivoclar Vivadent AG, Schaan and a conventional orthodontic bonding adhesive (Transbond XT, 3M Unitek. METHODS: 53 consecutive patients (23 males and 30 females who fulfilled the inclusion and exclusion criteria were included in the study. A total of 891 brackets were analyzed, where 444 brackets were bonded using Heliosit Orthodontic and 447 brackets were bonded using Transbond XT. The survival rates of brackets were estimated with the Kaplan-Meier analysis. Bracket survival distributions for bonding adhesives, tooth location and dental arch were compared with the log-rank test. RESULTS: The failure rates of the Transbond XT and the Heliosit Orthodontic groups were 8.1% and 6% respectively. No significant differences in the survival rates were observed between them (p= 0.242. There was no statistically significant difference in the bond failure rates when the clinical performance of the maxillary versus the mandibular arches and the anterior versus the posterior segments were compared. CONCLUSIONS: Both systems had clinically acceptable bond failure rates and are adequate for orthodontic bonding needs.

Geomagnetic Storm Sudden Commencements

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Storm Sudden Commencements (ssc) 1868 to present: STORM1 and STORM2 Lists: (Some text here is taken from the International Association of Geomagnetism and Aeronomy...

Antipsychotics and the risk of sudden cardiac death

NARCIS (Netherlands)

Straus, S.M.J.M.; Bleumink, G.S.; Dieleman, J.P.; van der Lei, J.; 't Jong, G.W.; Kingma, J. Herre; Sturkenboom, M.C J M; Stricker, B.H C

2004-01-01

Background Antipsychotics have been associated with prolongation of the corrected QT interval and sudden cardiac death. Only a few epidemiological studies have investigated this association. We performed a case-control study to investigate the association between use of antipsychotics and sudden

Sudden Ionospheric Disturbances (SID)

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National Oceanic and Atmospheric Administration, Department of Commerce — Sudden ionospheric disturbances (SID) are caused by solar flare enhanced X-rays in the 1 to 10 angstrom range. Solar flares can produce large increases of ionization...

Prospective randomized study for optimal insulin therapy in type 2 diabetic patients with secondary failure

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Tojo Katsuyoshi

2008-05-01

Full Text Available Abstract Background The large clinical trials proved that Basal-Bolus (BB insulin therapy was effective in the prevention of diabetic complications and their progression. However, BB therapy needs multiple insulin injections per a day. In this regard, a biphasic insulin analogue needs only twice-daily injections, and is able to correct postprandial hyperglycemia. Therefore it may achieve the blood glucose control as same as that of BB therapy and prevent the diabetic complications including macroangiopathy. Methods In PROBE (Prospective, Randomized, Open, Blinded-Endpoint design, forty-two type 2 diabetic patients (male: 73.8%, median(inter quartile range age: 64.5(56.8~71.0years with secondary failure of sulfonylurea (SU were randomly assigned to BB therapy with a thrice-daily insulin aspart and once-daily basal insulin (BB group or to conventional therapy with a twice-daily biphasic insulin analogue (30 Mix group, and were followed up for 6 months to compare changes in HbA1c, daily glycemic profile, intima-media thickness (IMT of carotid artery, adiponectin levels, amounts of insulin used, and QOL between the two groups. Results After 6 months, HbA1c was significantly reduced in both groups compared to baseline (30 Mix; 9.3(8.1~11.3 → 7.4(6.9~8.7%, p Conclusion Both BB and 30 mix group produced comparable reductions in HbA1c in type 2 diabetic patients with secondary failure. There was no significant change in IMT as an indicator of early atherosclerotic changes between the two groups. The basal-bolus insulin therapy may not be necessarily needed if the type 2 diabetic patients have become secondary failure. Trial registration Current Controlled Trials number, NCT00348231

Giant cardiac fibroma: an unusual cause of failure to thrive.

Science.gov (United States)

Navarini, Susanne; Latzin, Philipp; Kadner, Alexander; Carrel, Thierry; Hutter, Damian

2013-06-01

Cardiac fibromas are extremely rare in the general pediatric population and may present with a wide spectrum of clinical signs, including life-threatening arrhythmias and sudden death. We report a 14-month-old boy who presented with failure to thrive as the only symptom. Echocardiography showed a large cardiac fibroma in the right ventricle. Cardiac magnetic resonance imaging confirmed the diagnosis. After complete surgical tumor resection, the boy showed normal catch-up growth. This case underlines the diversity of clinical features of cardiac tumors, which implies that they should be considered early in the differential diagnosis of infants with failure to thrive.

Primordial spectra from sudden turning trajectory

Science.gov (United States)

Noumi, Toshifumi; Yamaguchi, Masahide

2013-12-01

Effects of heavy fields on primordial spectra of curvature perturbations are discussed in inflationary models with a sudden turning trajectory. When heavy fields are excited after the sudden turn and oscillate around the bottom of the potential, the following two effects are generically induced: deformation of the inflationary background spacetime and conversion interactions between adiabatic and isocurvature perturbations, both of which can affect the primordial density perturbations. In this paper, we calculate primordial spectra in inflationary models with sudden turning potentials taking into account both of the two effects appropriately. We find that there are some non-trivial correlations between the two effects in the power spectrum and, as a consequence, the primordial scalar power spectrum has a peak around the scale exiting the horizon at the turn. Though both effects can induce parametric resonance amplifications, they are shown to be canceled out for the case with the canonical kinetic terms. The peak feature and the scale dependence of bispectra are also discussed.

Magnetic resonance imaging in sudden deafness

International Nuclear Information System (INIS)

Ramos, Hugo Valter Lisboa; Barros, Flavia Alencar; Penido, Norma de Oliveira; Souza, Ana Claudia Valerio de; Yamaoka, Wellington Yugo; Yamashita, Helio

2005-01-01

The etiology of sudden deafness can remain undetermined despite extensive investigation. This study addresses the value of magnetic resonance imaging in the analysis of sudden deafness patients.Study Design: transversal cohort.Material And Method: In a prospective study, 49 patients attended at otolaryngology emergency room of Federal University of Sao Paulo - Escola Paulista de Medicina, from April 2001 to May 2003, were submitted to magnetic resonance imaging.Results: Magnetic Resonance abnormalities were seen in 23 (46.9%) patients and revealed two tumors suggestive of meningioma, three vestibular schwannomas, thirteen microangiopathic changes of the brain and five (21.7%) pathological conditions of the labyrinth.Conclusion: Sudden deafness should be approached as a symptom common to different diseases. The presence of cerebellopontine angle tumors in 10.2% of our cases, among other treatable causes, justifies the recommendation of gadolinium-enhanced magnetic resonance use, not only to study the auditory peripheral pathway, but to study the whole auditory pathway including the brain. (author)

Pathogenesis of sudden unexpected death in a clinical trial of patients with myocardial infarction and left ventricular dysfunction, heart failure, or both

DEFF Research Database (Denmark)

Pouleur, Anne-Catherine; Barkoudah, Ebrahim; Uno, Hajime

2010-01-01

The frequency of sudden unexpected death is highest in the early post-myocardial infarction (MI) period; nevertheless, 2 recent trials showed no improvement in mortality with early placement of an implantable cardioverter-defibrillator after MI....

A meta-analysis of the effects of β-adrenergic blockers in chronic heart failure.

Science.gov (United States)

Zhang, Xiaojian; Shen, Chengwu; Zhai, Shujun; Liu, Yukun; Yue, Wen-Wei; Han, Li

2016-10-01

Adrenergic β-blockers are drugs that bind to, but do not activate β-adrenergic receptors. Instead they block the actions of β-adrenergic agonists and are used for the treatment of various diseases such as cardiac arrhythmias, angina pectoris, myocardial infarction, hypertension, headache, migraines, stress, anxiety, prostate cancer, and heart failure. Several meta-analysis studies have shown that β-blockers improve the heart function and reduce the risks of cardiovascular events, rate of mortality, and sudden death through chronic heart failure (CHF) of patients. The present study identified results from recent meta-analyses of β-adrenergic blockers and their usefulness in CHF. Databases including Medline/Embase/Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed were searched for the periods May, 1985 to March, 2011 and June, 2013 to August, 2015, and a number of studies identified. Results of those studies showed that use of β-blockers was associated with decreased sudden cardiac death in patients with heart failure. However, contradictory results have also been reported. The present meta-analysis aimed to determine the efficacy of β-blockers on mortality and morbidity in patients with heart failure. The results showed that mortality was significantly reduced by β-blocker treatment prior to the surgery of heart failure patients. The results from the meta-analysis studies showed that β-blocker treatment in heart failure patients correlated with a significant decrease in long-term mortality, even in patients that meet one or more exclusion criteria of the MERIT-HF study. In summary, the findings of the current meta-analysis revealed beneficial effects different β-blockers have on patients with heart failure or related heart disease.

CARDIOVASCULAR CAUSES OF SUDDEN DEATH- AN AUTOPSY STUDY

Directory of Open Access Journals (Sweden)

Deepu Thankappan

2016-10-01

Full Text Available BACKGROUND Present study “Cardiovascular Causes of Sudden Death- An Autopsy Study” was a cross-sectional study conducted in Department of Forensic Medicine, Government Medical College, Kottayam, during the time period from June 1 st 2013 to June 1 st 2014. The objective of the study was to find out the cardiovascular causes of sudden deaths and to correlate the postmortem findings with the histopathological examination. 57 cases brought for postmortem examination with history suggestive of sudden natural death were taken into the study and those cases observed to have a cardiovascular cause of sudden death during autopsy were further examined and their heart specimens were subjected to histopathological examination. Then, the sociodemographic factors, postmortem findings and histopathological findings were correlated and analysed. MATERIALS AND METHODS 57 cases brought for autopsy at Department of Forensic Medicine, Government Medical College, Kottayam from 01.06.2013 to 31.05.2014 were autopsied and subjected to histopathological examination of the heart. The socio-demographic data were collected; they were analyzed and correlated with the postmortem and histopathological findings. RESULTS Out of the 57 subjects who were taken into the study, maximum number of Sudden natural deaths were in the 36-50 year age group (42.2%, 33.3% in the 51-65 year age group and 14% of cases were in the 66-80 year age group. CONCLUSION Histopathological examination of the samples showed myocardial infarction in 33.3% of cases; chronic ischaemic heart disease in 56.1% of cases and myocarditis in 19.3% of cases. The major cardiovascular cause of sudden death was ascertained as Coronary artery disease.

Randomised, double-blinded, placebo-controlled, clinical trial of ozone therapy as treatment of sudden sensorineural hearing loss.

Science.gov (United States)

Ragab, A; Shreef, E; Behiry, E; Zalat, S; Noaman, M

2009-01-01

To investigate the safety and efficacy of ozone therapy in adult patients with sudden sensorineural hearing loss. Prospective, randomised, double-blinded, placebo-controlled, parallel group, clinical trial. Forty-five adult patients presented with sudden sensorineural hearing loss, and were randomly allocated to receive either placebo (15 patients) or ozone therapy (auto-haemotherapy; 30 patients). For the latter treatment, 100 ml of the patient's blood was treated immediately with a 1:1 volume, gaseous mixture of oxygen and ozone (from an ozone generator) and re-injected into the patient by intravenous infusion. Treatments were administered twice weekly for 10 sessions. The following data were recorded: pre- and post-treatment mean hearing gains; air and bone pure tone averages; speech reception thresholds; speech discrimination scores; and subjective recovery rates. Significant recovery was observed in 23 patients (77 per cent) receiving ozone treatment, compared with six (40 per cent) patients receiving placebo (p < 0.05). Mean hearing gains, pure tone averages, speech reception thresholds and subjective recovery rates were significantly better in ozone-treated patients compared with placebo-treated patients (p < 0.05). Ozone therapy is a significant modality for treatment of sudden sensorineural hearing loss; no complications were observed.

Cardiac Channelopathies and Sudden Death: Recent Clinical and Genetic Advances

OpenAIRE

Fernández Falgueras, Anna; Sarquella Brugada, Georgia; Brugada Terradellas, Josep; Brugada, Ramon; Campuzano Larrea, Oscar

2017-01-01

Sudden cardiac death poses a unique challenge to clinicians because it may be the only symptom of an inherited heart condition. Indeed, inherited heart diseases can cause sudden cardiac death in older and younger individuals. Two groups of familial diseases are responsible for sudden cardiac death: cardiomyopathies (mainly hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic cardiomyopathy) and channelopathies (mainly long QT syndrome, Brugada syndrome, short QT syndrome, a...

PHOX2B polyalanine repeat length is associated with sudden infant death syndrome and unclassified sudden infant death in the Dutch population

NARCIS (Netherlands)

G. Liebrechts-Akkerman (Germaine); F. Liu (Fan); O. Lao Grueso (Oscar); A.H.A.G. Ooms (Ariadne ); K. van Duijn (Kate); M. Vermeulen (Mark); V.W.V. Jaddoe (Vincent); A. Hofman (Albert); A.C. Engelberts (Adele); M.H. Kayser (Manfred)

2014-01-01

textabstractUnclassified sudden infant death (USID) is the sudden and unexpected death of an infant that remains unexplained after thorough case investigation including performance of a complete autopsy and review of the circumstances of death and the clinical history. When the infant is below 1

Effect of a Collaborative Care Intervention vs Usual Care on Health Status of Patients With Chronic Heart Failure: The CASA Randomized Clinical Trial.

Science.gov (United States)

Bekelman, David B; Allen, Larry A; McBryde, Connor F; Hattler, Brack; Fairclough, Diane L; Havranek, Edward P; Turvey, Carolyn; Meek, Paula M

2018-04-01

Many patients with chronic heart failure experience reduced health status despite receiving conventional therapy. To determine whether a symptom and psychosocial collaborative care intervention improves heart failure-specific health status, depression, and symptom burden in patients with heart failure. A single-blind, 2-arm, multisite randomized clinical trial was conducted at Veterans Affairs, academic, and safety-net health systems in Colorado among outpatients with symptomatic heart failure and reduced health status recruited between August 2012 and April 2015. Data from all participants were included regardless of level of participation, using an intent-to-treat approach. Patients were randomized 1:1 to receive the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) intervention or usual care. The CASA intervention included collaborative symptom care provided by a nurse and psychosocial care provided by a social worker, both of whom worked with the patients' primary care clinicians and were supervised by a study primary care clinician, cardiologist, and palliative care physician. The primary outcome was patient-reported heart failure-specific health status, measured by difference in change scores on the Kansas City Cardiomyopathy Questionnaire (range, 0-100) at 6 months. Secondary outcomes included depression (measured by the 9-item Patient Health Questionnaire), anxiety (measured by the 7-item Generalized Anxiety Disorder Questionnaire), overall symptom distress (measured by the General Symptom Distress Scale), specific symptoms (pain, fatigue, and shortness of breath), number of hospitalizations, and mortality. Of 314 patients randomized (157 to intervention arm and 157 to control arm), there were 67 women and 247 men, mean (SD) age was 65.5 (11.4) years, and 178 (56.7%) had reduced ejection fraction. At 6 months, the mean Kansas City Cardiomyopathy Questionnaire score improved 5.5 points in the intervention arm and 2.9 points in the control

Sudden weaning of angel fish pterophyllum scalare (Lichtenstein) (Pisces; Cichlidae) larvae from brine shrimp (Artemia sp) nauplii to formulated larval feed.

Science.gov (United States)

Herath, Sandamali Sakunthala; Atapaththu, Kerthi Sri Senarathna

2013-12-01

This study investigated the effects of sudden weaning of angel fish larvae (Pteraphylum scalari) from Artemia nauplii to commercial larval feed. Four days post hatch (DPH) larvae were reared in four different weaning protocols (TR1-TR4) with triplicates in a complete randomize design. Larvae in TR1 and TR4 were exclusively fed Artemia nauplii and dry feed respectively. In TR2 and TR3, larvae were initially fed Artemia nauplii and suddenly wean to formulated feed on 14 DPH and 7 DPH respectively. The experiment was lasted for 28 days. At the end of the experiment, final mean weight (FW), total length (FL), height (FH), Daily Weight Gain (DWG), Specific Growth Rate (SGR), survival and stress index were compared. Significantly highest (P larvae solely fed formulated feed. Survival and the stress index were independent from weaning methods. Although sudden weaning is possible on 7 DPH, larvae showed comparatively higher growth when switch off to formulate feed on 14 DPH.

Major life events as potential triggers of sudden cardiac arrest.

Science.gov (United States)

Wicks, April F; Lumley, Thomas; Lemaitre, Rozenn N; Sotoodehnia, Nona; Rea, Thomas D; McKnight, Barbara; Strogatz, David S; Bovbjerg, Viktor E; Siscovick, David S

2012-05-01

We investigated the risk of sudden cardiac arrest in association with the recent loss of, or separation from, a family member or friend. Our case-crossover study included 490 apparently healthy married residents of King County, Washington, who suffered sudden cardiac arrest between 1988 and 2005. We compared exposure to spouse-reported family/friend events occurring ≤ 1 month before sudden cardiac arrest with events occurring in the previous 5 months. We evaluated potential effect modification by habitual vigorous physical activity. Recent family/friend events were associated with a higher risk of sudden cardiac arrest (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1-2.4). ORs for cases with and without habitual vigorous physical activity were 1.1 (0.6-2.2) and 2.0 (1.2-3.1), respectively (interaction P = 0.02). These results suggest family/friend events may trigger sudden cardiac arrest and raise the hypothesis that habitual vigorous physical activity may lower susceptibility to these potential triggers.

Mobile phone usage does not affect sudden sensorineural hearing loss.

Science.gov (United States)

Sagiv, D; Migirov, L; Madgar, O; Nakache, G; Wolf, M; Shapira, Y

2018-01-01

Recent studies found that mobile phone users had a significantly greater risk of having elevated thresholds in speech frequencies. This study investigated the correlation between the laterality of sudden sensorineural hearing loss, handedness and the preferred ear for mobile phone use. The study included all patients who presented with sudden sensorineural hearing loss to the Department of Otolaryngology - Head and Neck Surgery in our tertiary referral medical centre between 2014 and 2016. Patients were asked to indicate their dominant hand and preferred ear for mobile phone use. The study comprised 160 patients. No correlation was found between the dominant hand or preferred ear for mobile phone use and the side of sudden sensorineural hearing loss. There was no correlation between the side of the sudden sensorineural hearing loss (preferable or non-preferable for mobile phone use) and audiometric characteristics. No correlation was found between the laterality of ears used for mobile phone and sudden sensorineural hearing loss.

Long Term Follow-Up after a Randomized Integrated Educational and Psychosocial Intervention in Patient-Partner Dyads Affected by Heart Failure.

Directory of Open Access Journals (Sweden)

Maria Liljeroos

Full Text Available To date, contemporary heart failure care remains patient-focused, but awareness of the partners' and families' situation is increasing. Randomized studies have mainly evaluated the short-term effects of dyadic interventions. Therefore, the aim of this study was to determine the 24-month effects of an intervention with psych-educational support in dyads of heart failure patients and their partners.This study used a randomized study design and 155 patient-partner dyads were enrolled. The intervention included a nurse-led program of three sessions addressing psychoeducational support.The intervention did not have any effect on health, depressive symptoms or perceived control among the patient-partner dyads after 24 months. Furthermore, time to first event did not differ significantly between the intervention group and the control patients.This study may be regarded as a first step in trying to understand dyads' need for supportive care. Individualized and more targeted interventions seem necessary to achieve a higher impact on dyad outcomes.ClinicalTrials.gov NCT02398799.

Tobacco smoking and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies.

Science.gov (United States)

Aune, Dagfinn; Schlesinger, Sabrina; Norat, Teresa; Riboli, Elio

2018-06-01

Smoking is an established risk factor for cardiovascular disease including coronary heart disease and stroke, however, data regarding smoking and sudden cardiac death have not been summarized in a meta-analysis previously. We therefore conducted a systematic review and meta-analysis to clarify this association. We searched the PubMed and Embase databases for studies of smoking and sudden cardiac death up to July 20th 2017. Prospective studies were included if they reported adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for smoking and sudden cardiac death. Summary RRs were estimated by use of a random effects model. Twelve prospective studies were included. The summary RR was 3.06 (95% CI 2.46-3.82, I 2  = 41%, p heterogeneity  = 0.12, n = 7) for current smokers and 1.38 (95% CI 1.20-1.60, I 2  = 0%, p heterogeneity  = 0.55, n = 7) for former smokers compared to never smokers. For four studies using non-current (never + former) smokers as the reference category the summary RR among current smokers was 2.08 (95% CI 1.70-2.53, I 2  = 18%, p heterogeneity  = 0.30). The results persisted in most of the subgroup analyses. There was no evidence of publication bias. These results confirm that smoking increases the risk of sudden cardiac death. Any further studies should investigate in more detail the effects of duration of smoking, number of cigarettes per day, pack-years, and time since quitting smoking and sudden cardiac death.

Sudden unexpected death in infancy in Denmark

DEFF Research Database (Denmark)

Winkel, Bo Gregers; Holst, Anders Gaarsdal; Theilade, Juliane

2011-01-01

Abstract Background. Incidence of sudden unexpected death in infancy (SUDI) and sudden infant death syndrome (SIDS) differs among studies and non-autopsied cases are difficult to assess. Objectives. To investigate causes of sudden death in infancy in a nationwide setting. Validate the use...... of the ICD-10 code for SIDS (R95) in the Danish Cause of Death registry. Design. A retrospective analysis of all infant deaths (death certificates and autopsy reports were read. Results. We identified 192 SUDI cases (10% of total deaths, 0.42 per 1000 births......) with autopsy performed in 87% of cases. In total, 49% of autopsied SUDI cases were defined as SIDS (5% of all deaths, 0.22 per 1000 births); Cardiac cause of death was denoted in 24% of cases. The Danish Cause of Death Registry misclassified 30% of SIDS cases. Conclusions. A large proportion of infant deaths...

Are there long-term benefits in following stable heart failure patients in a heart failure clinic?

DEFF Research Database (Denmark)

Leetmaa, Tina; Villadsen, Henrik; Mikkelsen, Kirsten

2008-01-01

Objectives and Design. This study describes the long-term outcome of 163 patients with stable mild to moderate heart failure (NYHA II-III), who already were enrolled in a heart failure clinic and now were randomized to continued follow-up in the heart failure (HF) clinic or else to usual care (UC...

Cardiac Arrythmias in Acute and Chronic Renal Failure

Directory of Open Access Journals (Sweden)

Ali A. Handjani

1966-01-01

Full Text Available Cardiac arrythmias are frequent complications in acute and chronic renal failure and they may well account for sudden unexplained death in these patients. Based upon our recent study, we strongly believe that among other causative factors, focal degeneration of myocardium is the commonest and the most potentially dangerous cause of cardiac arrythmias. We suggest in emergency instances, ouabain to be used instead of digitalis which appears to be quite safe with dramatic results in cardiac arrythmias of these group.

Perceived Stigma of Sudden Bereavement as a Risk Factor for Suicidal Thoughts and Suicide Attempt: Analysis of British Cross-Sectional Survey Data on 3387 Young Bereaved Adults

Directory of Open Access Journals (Sweden)

Alexandra Pitman

2017-03-01

Full Text Available The sudden death of a friend or relative, particularly by suicide, is a risk factor for suicide. People who experience sudden bereavement report feeling highly stigmatised by the loss, potentially influencing access to support. We assessed whether perceived stigma following sudden bereavement is associated with suicidal thoughts and suicide attempt. We analysed cross-sectional survey data on 3387 young adults bereaved by the sudden death of a close contact. We tested the association of high versus low perceived stigma (on the stigma sub-scale of the Grief Experience Questionnaire with post-bereavement suicidal ideation and suicide attempt, using random effects logistic regression, adjusting for socio-demographic factors, pre-bereavement psychopathology, and mode of sudden bereavement (natural causes/unnatural causes/suicide. Subjects with high perceived stigma scores were significantly more likely to report post-bereavement suicidal thoughts (adjusted odds ratio (AOR = 2.74; 95% confidence interval (CI = 1.93–3.89 and suicide attempt (AOR = 2.73; 95% CI = 2.33–3.18 than those with low stigma scores. People who feel highly stigmatised by a sudden bereavement are at increased risk of suicidal thoughts and suicide attempt, even taking into account prior suicidal behaviour. General practitioners, bereavement counsellors, and others who support people bereaved suddenly, should consider inquiring about perceived stigma, mental wellbeing, and suicidal thoughts, and directing them to appropriate sources of support.

CAUSES OF SUDDEN NATURAL DEATH: A MEDICO-LEGAL ...

African Journals Online (AJOL)

89 No. 10 October 2012 ... The age range of the cases was 19-105 years with a mean age ... majority of cases (39.3%), the cause of death was related to the cardio-vascular ... Six hundred and twenty six cases of sudden natural .... (39/60) and a mean age of 54.2±15years. ..... D. A population-based autopsy study of sudden,.

Relationship between late ventricular potentials and myocardial {sup 123}I-metaiodobenzylguanidine scintigraphy in patients with dilated cardiomyopathy with mild to moderate heart failure: results of a prospective study of sudden death events

Energy Technology Data Exchange (ETDEWEB)

Kasama, Shu [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma (Japan); Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Toyama, Takuji; Kaneko, Yoshiaki; Kurabayashi, Masahiko [Gunma University Graduate School of Medicine, Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma (Japan); Iwasaki, Toshiya; Sumino, Hiroyuki; Kumakura, Hisao; Minami, Kazutomo; Ichikawa, Shuichi [Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Department of Cardiovascular Medicine, Gunma (Japan); Matsumoto, Naoya [Nihon University School of Medicine, Department of Cardiology, Tokyo (Japan); Sato, Yuichi [Health Park Clinic, Department of Imaging, Gunma (Japan)

2012-06-15

Late ventricular potentials (LPs) are considered to be useful for identifying patients with heart failure at risk of developing ventricular arrhythmias. {sup 123}I-metaiodobenzylguanidine (MIBG) scintigraphy, which is used to evaluate cardiac sympathetic activity, has demonstrated cardiac sympathetic denervation in patients with malignant ventricular tachyarrhythmias. This study was undertaken to clarify the relationship between LPs and {sup 123}I-MIBG scintigraphy findings in patients with dilated cardiomyopathy (DCM). A total of 56 patients with DCM were divided into an LP-positive group (n = 24) and an LP-negative group (n = 32). During the compensated period, the delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from {sup 123}I-MIBG images and plasma brain natriuretic peptide (BNP) concentrations were measured. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) were simultaneously determined by echocardiography. LVEDV, LVESV, LVEF and plasma BNP concentrations were similar in the two groups. However, TDS was significantly higher (35 {+-} 8 vs. 28 {+-} 6, p < 0.005), the H/M ratio was significantly lower (1.57 {+-} 0.23 vs. 1.78 {+-} 0.20, p < 0.005), and the WR was significantly higher (60 {+-} 14% vs. 46 {+-} 12%, p < 0.001) in the LP-positive than in the LP-negative group. The average follow-up time was 4.5 years, and there were nine sudden deaths among the 56 patients (16.1%). In logistic regression analysis, the incidences of sudden death events were similar in those LP-negative with WR <50%, LP-negative with WR {>=}50% and LP-positive with WR <50% (0%, 10.0% and 14.3%, respectively), but was significantly higher (41.2%) in those LP-positive with WR {>=}50% (p < 0.01, p < 0.05, and p < 0.05, respectively). The present study demonstrated that the values of cardiac {sup 123}I-MIBG scintigraphic parameters

Social phobia with sudden onset--post-panic social phobia?

DEFF Research Database (Denmark)

Kristensen, Ann Suhl; Mortensen, Erik Lykke; Mors, Ole

2008-01-01

Overlap between social phobia (SP) and panic disorder (PD) has been observed in epidemiological, family, and challenge studies. One possible explanation is that some cases of SP develop as a consequence of a panic attack in a social situation. By definition, these cases of SP have sudden onset...... recruited as part of an etiological study. Patients with SP with sudden onset did, as hypothesized, differ from patients with SP without sudden onset with regard to age of onset and extraversion, but not with regard to symptoms. They did not differ markedly from patients with comorbid SP and PD. The concept...

Technical Problem Identification for the Failures of the Liberty Ships

Directory of Open Access Journals (Sweden)

Wei Zhang

2016-11-01

Full Text Available The U.S. Liberty Ship Building Program in World War II set a record—a total of 2700 Liberty Ships were built in 6 years, in order to support the battle against Nazi-Germany. However, numerous vessels suffered sudden fracture, some of them being split in half. This paper demonstrates and investigation of the Liberty Ships failure and problems, which reveals that the failures are caused by a combination of three factors. The welds produced by largely unskilled work force contain crack type flaws. Beyond these cracks, another important reason for failure associated with welding is the hydrogen embitterment; most of the fractures initiate at deck square hatch corners where there is a stress concentration; and the ship steel has fairly poor Charpy-Impact tested fracture toughness. It has been admitted that, although the numerous catastrophic failures were a painful experience, the failures of the Liberty Ships caused significant progress in the study of fracture mechanics. Considering their effect, the Liberty Ships are still a success.

Good news is bad news: Leverage cycles and sudden stops

OpenAIRE

Akinci, Ozge; Chahrour, Ryan

2015-01-01

We show that a model with imperfectly forecastable changes in future productivity and an occasionally binding collateral constraint can match a set of stylized facts about “sudden stop” events. “Good” news about future productivity raises leverage during times of expansion, increasing the probability that the constraint binds, and a sudden stop occurs, in future periods. The economy exhibits a boom period in the run-up to the sudden stop, with output, consumption, and investment all above tre...

Approximations to the Probability of Failure in Random Vibration by Integral Equation Methods

DEFF Research Database (Denmark)

Nielsen, Søren R.K.; Sørensen, John Dalsgaard

Close approximations to the first passage probability of failure in random vibration can be obtained by integral equation methods. A simple relation exists between the first passage probability density function and the distribution function for the time interval spent below a barrier before...... passage probability density. The results of the theory agree well with simulation results for narrow banded processes dominated by a single frequency, as well as for bimodal processes with 2 dominating frequencies in the structural response....... outcrossing. An integral equation for the probability density function of the time interval is formulated, and adequate approximations for the kernel are suggested. The kernel approximation results in approximate solutions for the probability density function of the time interval, and hence for the first...

A computer case definition for sudden cardiac death.

Science.gov (United States)

Chung, Cecilia P; Murray, Katherine T; Stein, C Michael; Hall, Kathi; Ray, Wayne A

2010-06-01

To facilitate studies of medications and sudden cardiac death, we developed and validated a computer case definition for these deaths. The study of community dwelling Tennessee Medicaid enrollees 30-74 years of age utilized a linked database with Medicaid inpatient/outpatient files, state death certificate files, and a state 'all-payers' hospital discharge file. The computerized case definition was developed from a retrospective cohort study of sudden cardiac deaths occurring between 1990 and 1993. Medical records for 926 potential cases had been adjudicated for this study to determine if they met the clinical definition for sudden cardiac death occurring in the community and were likely to be due to ventricular tachyarrhythmias. The computerized case definition included deaths with (1) no evidence of a terminal hospital admission/nursing home stay in any of the data sources; (2) an underlying cause of death code consistent with sudden cardiac death; and (3) no terminal procedures inconsistent with unresuscitated cardiac arrest. This definition was validated in an independent sample of 174 adjudicated deaths occurring between 1994 and 2005. The positive predictive value of the computer case definition was 86.0% in the development sample and 86.8% in the validation sample. The positive predictive value did not vary materially for deaths coded according to the ICO-9 (1994-1998, positive predictive value = 85.1%) or ICD-10 (1999-2005, 87.4%) systems. A computerized Medicaid database, linked with death certificate files and a state hospital discharge database, can be used for a computer case definition of sudden cardiac death. Copyright (c) 2009 John Wiley & Sons, Ltd.

Efficacy and safety of electroacupuncture in acute decompensated heart failure: a study protocol for a randomized, patient- and assessor-blinded, sham controlled trial.

Science.gov (United States)

Leem, Jungtae; Lee, Seung Min Kathy; Park, Jun Hyeong; Lee, Suji; Chung, Hyemoon; Lee, Jung Myung; Kim, Weon; Lee, Sanghoon; Woo, Jong Shin

2017-07-11

The purpose of this trial is to evaluate the effectiveness and safety of electroacupuncture in the treatment of acute decompensated heart failure compared with sham electroacupuncture. This protocol is for a randomized, sham controlled, patient- and assessor-blinded, parallel group, single center clinical trial that can overcome the limitations of previous trials examining acupuncture and heart failure. Forty-four acute decompensated heart failure patients admitted to the cardiology ward will be randomly assigned into the electroacupuncture treatment group (n = 22) or the sham electroacupuncture control group (n = 22). Participants will receive electroacupuncture treatment for 5 days of their hospital stay. The primary outcome of this study is the difference in total diuretic dose between the two groups during hospitalization. On the day of discharge, follow-up heart rate variability, routine blood tests, cardiac biomarkers, high-sensitivity C-reactive protein (hs-CRP) level, and N-terminal pro b-type natriuretic peptide (NT-pro BNP) level will be assessed. Four weeks after discharge, hs-CRP, NT-pro BNP, heart failure symptoms, quality of life, and a pattern identification questionnaire will be used for follow-up analysis. Six months after discharge, major cardiac adverse events and cardiac function measured by echocardiography will be assessed. Adverse events will be recorded during every visit. The result of this clinical trial will offer evidence of the effectiveness and safety of electroacupuncture for acute decompensated heart failure. Clinical Research Information Service: KCT0002249 .

High Mortality without ESCAPE: The Registry of Heart Failure Patients Receiving Pulmonary Artery Catheters without Randomization

Science.gov (United States)

Allen, Larry A.; Rogers, Joseph G.; Warnica, J. Wayne; DiSalvo, Thomas G.; Tasissa, Gudaye; Binanay, Cynthia; O’Connor, Christopher M.; Califf, Robert M.; Leier, Carl V.; Shah, Monica R.; Stevenson, Lynne W.

2008-01-01

Background In ESCAPE, there was no difference in days alive and out of the hospital for patients with decompensated heart failure (HF) randomly assigned to therapy guided by pulmonary artery catheter (PAC) plus clinical assessment versus clinical assessment alone. The external validity of these findings is debated. Methods and Results ESCAPE sites enrolled 439 patients receiving PAC without randomization in a prospective registry. Baseline characteristics, pertinent trial exclusion criteria, reasons for PAC use, hemodynamics, and complications were collected. Survival was determined from the National Death Index and the Alberta Registry. On average, registry patients had lower blood pressure, worse renal function, less neurohormonal antagonist therapy, and higher use of intravenous inotropes as compared with trial patients. Although clinical assessment anticipated less volume overload and greater hypoperfusion among the registry population, measured filling pressures were similarly elevated in the registry and trial, while measured perfusion was slightly higher among registry patients. Registry patients had longer hospitalization (13 vs. 6 days, p <0.001) and higher 6-month mortality (34% vs. 20%, p < 0.001) than trial patients. Conclusions The decision to use PAC without randomization identified a population with higher disease severity and risk of mortality. This prospective registry highlights the complex context of patient selection for randomized trials. PMID:18926438

Haloperidol and sudden cardiac death in dementia: autopsy findings in psychiatric inpatients.

Science.gov (United States)

Ifteni, Petru; Grudnikoff, Eugene; Koppel, Jeremy; Kremen, Neil; Correll, Christoph U; Kane, John M; Manu, Peter

2015-12-01

Treatment with haloperidol has been shown, in studies using death certificates and prescription files, to be associated with an excess of sudden cardiac deaths, and regulatory warnings highlight this risk in patients with dementia. We used autopsy findings to determine whether the rate of sudden cardiac death is greater in cases of unexpected deaths of patients with dementia treated with haloperidol. From 1989 through 2013, 1219 patients with a primary diagnosis of dementia with behavioral disturbance were admitted to a psychiatric hospital, and 65 (5.3%) died suddenly. Sixty-five patients (5.3%) died unexpectedly. Complete post-mortem examinations after the sudden death were performed in 55 (84.6%) patients. Twenty-seven of the autopsied cases (49.1%) had been treated with haloperidol orally (2.2 mg ± 2.1 mg/day), the only antipsychotic used in this cohort. Univariable comparisons and multivariable regression analyses compared the groups of patients with or without sudden cardiac death. The leading causes of death were sudden cardiac death (32.7%), myocardial infarction (25.5% of patients), pneumonia (23.6%), and stroke (10.9%). Patients with sudden cardiac death and those with anatomically established cause of death were similar regarding the use of haloperidol (p = 0.5). Sudden cardiac death patients were more likely to suffer from Alzheimer's dementia (p = 0.027) and to have a past history of heart disease (p = 0.0094), and less likely to have been treated with a mood stabilizer (p = 0.024), but none of these variables were independent predictors of sudden cardiac death. Autopsy data suggest that oral haloperidol is not associated with increased risk of sudden cardiac death in psychiatric inpatients with dementia. Copyright © 2015 John Wiley & Sons, Ltd.

A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

NARCIS (Netherlands)

Tomini, F.; van Asselt, A. D.

OBJECTIVES: Cardiac resynchronization therapy with biventricular pacemaker (CRT-P) is considered an effective treatment for heart failure (HF). Adding implantable cardioverter defibrillators (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, economic evaluations have shown

A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

NARCIS (Netherlands)

Tomini, F.; van Asselt, A. D.

2012-01-01

OBJECTIVES: Cardiac resynchronization therapy with biventricular pacemaker (CRT-P) is considered an effective treatment for heart failure (HF). Adding implantable cardioverter defibrillators (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, economic evaluations have shown

Effect of heart failure reversal treatment as add-on therapy in patients with chronic heart failure: A randomized, open-label study.

Science.gov (United States)

Sane, Rohit; Aklujkar, Abhijeet; Patil, Atul; Mandole, Rahul

The present study was designed to evaluate effect of heart failure reversal therapy (HFRT) using herbal procedure (panchakarma) and allied therapies, as add-on to standard CHF treatment (SCT) in chronic heart failure (CHF) patients. This open-label, randomized study conducted in CHF patients (aged: 25-65 years, ejection fraction: 30-65%), had 3-phases: 1-week screening, 6-week treatment (randomized [1:1] to HFRT+SCT or SCT-alone) and follow-up (12-week). Twice weekly HFRT (60-75min) consisting of snehana (external oleation), swedana (passive heat therapy), hrudaydhara (concoction dripping treatment) and basti (enema) was administered. Primary endpoints included evaluation of change in metabolic equivalents of task (MET) and peak oxygen uptake (VO 2peak ) from baseline, at end of 6-week treatment and follow-up at week-18 (non-parametric rank ANCOVA analysis). Safety and quality of life (QoL) was assessed. Seventy CHF patients (n=35, each treatment-arm; mean [SD] age: 53.0 [8.6], 80% men) were enrolled in the study. All patients completed treatment phase. Add-on HFRT caused a significant increase in METs (least square mean difference [LSMD], 6-week: 1.536, p=0.0002; 18-week: -1.254, p=0.0089) and VO 2peak (LSMD, 6-week: -5.52, p=0.0002; 18-week: -4.517, p=0.0089) as compared with SCT-alone. Results were suggestive of improved functional capacity in patients with HFRT (QoL; Mean [SD] HFRT+SCT vs. SCT-alone; 6-week: -0.44 [0.34] vs. -0.06 [0.25], p<0.0001 and 18-week: -0.53 [0.35] vs. -0.29 [0.26], p=0.0013). Seven treatment-emergent adverse events (mild severity) were reported in HFRT-arm. Findings of this study highlight therapeutic efficacy of add-on HFRT vs. SCT-alone in CHF patients. The non-invasive HFRT showed no safety concerns. Copyright © 2016. Published by Elsevier B.V.

The Impact of Sudden Gains in Cognitive Behavioral Therapy for Posttraumatic Stress Disorder

Science.gov (United States)

Kelly, Kacie A.; Rizvi, Shireen L.; Monson, Candice M.; Resick, Patricia A.

2009-01-01

This study investigated sudden gains, i.e., rapid and stable improvements, in posttraumatic stress disorder (PTSD) symptoms that may occur in cognitive–behavioral therapy. Twenty-nine of 72 participants (39.2%) experienced a sudden gain during treatment. Mixed model ANOVAs analyzed sudden gains impact on clinician-rated PTSD symptom severity, patient-rated PTSD symptom severity, and patient-rated depressive symptom severity. Sudden gains in PTSD symptomology were associated with greater reductions in PTSD symptom severity for the avoidance/numbing and hyperarousal symptom clusters at posttreatment. By 6-month follow-up, the sudden gains group had maintained those reductions in symptoms, but the nonsudden gains group had achieved equal reductions in symptom severity. Participants experiencing sudden gains on PTSD measures had lower depression severity at posttreatment and follow-up. PMID:19637322

A randomized trial of heart failure disease management in skilled nursing facilities (SNF Connect): Lessons learned.

Science.gov (United States)

Daddato, Andrea; Wald, Heidi L; Horney, Carolyn; Fairclough, Diane L; Leister, Erin C; Coors, Marilyn; Capell, Warren H; Boxer, Rebecca S

2017-06-01

Conducting clinical trials in skilled nursing facilities is particularly challenging. This manuscript describes facility and patient recruitment challenges and solutions for clinical research in skilled nursing facilities. Lessons learned from the SNF Connect Trial, a randomized trial of a heart failure disease management versus usual care for patients with heart failure receiving post-acute care in skilled nursing facilities, are discussed. Description of the trial design and barriers to facility and patient recruitment along with regulatory issues are presented. The recruitment of Denver-metro skilled nursing facilities was facilitated by key stakeholders of the skilled nursing facilities community. However, there were still a number of barriers to facility recruitment including leadership turnover, varying policies regarding research, fear of litigation and of an increased workload. Engagement of facilities was facilitated by their strong interest in reducing hospital readmissions, marketing potential to hospitals, and heart failure management education for their staff. Recruitment of patients proved difficult and there were few facilitators. Identified patient recruitment challenges included patients being unaware of their heart failure diagnosis, patients overwhelmed with their illness and care, and frequently there was no available proxy for cognitively impaired patients. Flexibility in changing the recruitment approach and targeting skilled nursing facilities with higher rates of admissions helped to overcome some barriers. Recruitment of skilled nursing facilities and patients in skilled nursing facilities for clinical trials is challenging. Strategies to attract both facilities and patients are warranted. These include aligning study goals with facility incentives and flexible recruitment protocols to work with patients in "transition crisis."

A cluster randomized controlled trial of a clinical pathway for hospital treatment of heart failure: study design and population

Directory of Open Access Journals (Sweden)

Gardini Andrea

2007-11-01

Full Text Available Abstract Background The hospital treatment of heart failure frequently does not follow published guidelines, potentially contributing to the high morbidity, mortality and economic cost of this disorder. Consequently the development of clinical pathways has the potential to reduce the current variability in care, enhance guideline adherence, and improve outcomes for patients. Despite enthusiasm and diffusion, the widespread acceptance of clinical pathways remain questionable because very little prospective controlled data demonstrated their effectiveness. The Experimental Prospective Study on the Effectiveness and Efficiency of the Implementation of Clinical Pathways was designed in order to conduct a rigorous evaluation of clinical pathways in hospital treatment of acute heart failure. The primary objective of the trial was to evaluate the effectiveness of the implementation of clinical pathways for hospital treatment of heart failure in Italian hospitals. Methods/design Two-arm, cluster-randomized trial. 14 community hospitals were randomized either to arm 1 (clinical pathway: appropriate use of practice guidelines and supplies of drugs and ancillary services, new organization and procedures, patient education, etc. or to arm 2 (no intervention, usual care. 424 patients sample (212 in each group, 80% of power at the 5% significance level (two-sided. The primary outcome measure is in-hospital mortality. We will also analyze the impact of the clinical pathways comparing the length and the appropriateness of the stay, the rate of unscheduled readmissions, the customers' satisfaction and the costs treating the patients with the pathways and with the current practice along all the observation period. The quality of the care will be assessed by monitoring the use of diagnostic and therapeutic procedures during hospital stay and by measuring key quality indicators at discharge. Discussion This paper examines the design of the evaluation of a complex

Equatorial storm sudden commencements and interplanetary magnetic field

International Nuclear Information System (INIS)

Rastogi, R.G.

1980-01-01

A comparison is made of the signatures of interplanetary (IP) shocks in the B and theta plots of interplanetary magnetic field (IMF) data of satellites Explorer 33, 34 and 35 and in the H magnetograms at ground observatories within the equatorial electrojet belt, Huancayo, Addis Ababa and Trivandrum associated with major storm sudden commencements during 1967-70. The IP shocks showing sudden increase of the scalar value of IMF, i.e. B without any change of the latitude theta or with the southward turning of theta, were followed by a purely positive sudden increase of H, at any of the magnetic observatories, either on the dayside or the nightside of the earth. The IP shocks identified by a sudden increase of B and with the northward turning of the latitude theta (positive ΔBsub(z)) were associated with purely positive sudden commencement (SC) at the observatories in the nightside, but at the equatorial observatories in the dayside of the earth the signature of the shock was a SC in H with a preliminary negative impulse followed by the main positive excursion (SC-+). It is suggested that the SCs in H at low latitudes are composed of two effects, viz. (i) one due to hydromagnetic pressure on the magnetosphere by the solar plasma and (ii) the other due to the induced electric field associated with the solar wind velocity, V and the Z-component of the IP magnetic field (E = - V x Bsub(z)). The effect of magnetosphere electric field is faster than the effect due to the compression of the magnetosphere by the impinging solar plasma. The negative impulse of SC-+ at low latitude is seen at stations close to the dip equator and only during daytime due to the existence of high ionospheric conductivities in the equatorial electrojet region. (author)

Acoustic Emission Behavior of Rock-Like Material Containing Two Flaws in the Process of Deformation Failure

Directory of Open Access Journals (Sweden)

Quan-Sheng Liu

2015-01-01

Full Text Available Many sudden disasters (such as rock burst by mining extraction originate in crack initiation and propagation. Meanwhile a large number of shock waves are produced by rock deformation and failure. With the purpose of investigating crack coalescence and failure mechanism in rock, experimental research of rock-like materials with two preexisting flaws was performed. Moreover, the AE technique and photographic monitoring were adopted to clarify further the procedure of the crack coalescence and failure. It reveals that AE location technique can record the moments of crack occurrences and follow the crack growth until final failure. Finally, the influence of different flaw geometries on crack initiation strength is analyzed in detail. This research provides increased understanding of the fracture mechanism of mining-induced disasters.

Sudden cardiac death in athletes and its preventive strategies: review article

Directory of Open Access Journals (Sweden)

Farzin Halabchi

2017-12-01

Full Text Available Sudden cardiac death in sport, although rare, but is a tragic event, attracting the media and public attention. Sport and exercise may act as a trigger for sudden cardiac death. Risk of sudden death in young athletes with cardiovascular disease is 2.5 times more frequent than non-athlete individuals. More than 90% of cases of sudden death occur during or immediately after training or competition. Incidence of sudden cardiac death in any population, including athletes, is related to multiple factors such as gender, age, race, nationality, diagnostic screening methods and preventive measures for sudden cardiac death. Otherwise, incidence rate of sudden cardiac death is linked to the used definition and method of diagnosis. Different cardiovascular disorders may result in death of young athletes and hypertrophic cardiomyopathy, congenital coronary anomalies, arrhythmogenic right ventricular dysplasia and aortic rupture are among the most common causes. Marfan syndrome, dilated cardiomyopathy, viral myocarditis, Wolff-Parkinson-White (WPW syndrome, congenital long QT syndrome, Brugada syndrome and commotio cordis are reported as other etiologies. In older athletes (more than 35 years, ischemic coronary heart disease is responsible for majority of the cases similar to the general population. Because the outcome of sudden cardiac arrest in sports is very poor except in few cases, proper national strategies are needed to diminish the burden of sudden death in young athletes. It seems that there are two main strategies to achieve this goal: A Primary prevention with use of purposeful pre-participation evaluation programs. This evaluation should focuss on the proper history and physical examination. Nevertheless, there is significant debate between American and European countries regarding the use of paraclinical investigations (especially ECG. American heart association does not recommend ECG as an essential part of evaluation. In contrast, European

Treatment of chronic heart failure with aldosterone-blocking agents

NARCIS (Netherlands)

van Veldhuisen, Dirk J.; Swedberg, Karl

Three large randomized trials in advanced heart failure (RALES), in heart failure after myocardial infarction (EPHESUS), and most recently mild heart failure (EMPHASIS-HF) have firmly established the place of aldosterone-blocking agents in patients with heart failure. In this paper we will shortly

Investigating Insight as Sudden Learning

Science.gov (United States)

Ash, Ivan K.; Jee, Benjamin D.; Wiley, Jennifer

2012-01-01

Gestalt psychologists proposed two distinct learning mechanisms. Associative learning occurs gradually through the repeated co-occurrence of external stimuli or memories. Insight learning occurs suddenly when people discover new relationships within their prior knowledge as a result of reasoning or problem solving processes that re-organize or…

Population-based studies of antithyroid drugs and sudden cardiac death

NARCIS (Netherlands)

C. van Noord (Charlotte); M.C.J.M. Sturkenboom (Miriam); S.M.J.M. Straus (Sabine); A. Hofman (Albert); J.C.M. Witteman (Jacqueline); B.H.Ch. Stricker (Bruno)

2009-01-01

textabstractWHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Thyroid hormone free T4 is associated with QTc-interval prolongation, which is a risk factor for sudden cardiac death. • The association between hyperthyroidism and ventricular arrhythmias or sudden cardiac death has been reported in several

Granulocyte colony-stimulating factor in repeated IVF failure, a randomized trial.

Science.gov (United States)

Aleyasin, Ashraf; Abediasl, Zhila; Nazari, Atefeh; Sheikh, Mahdi

2016-06-01

Recent studies have revealed key roles for granulocyte colony-stimulating factor (GCSF) in embryo implantation process and maintenance of pregnancy, and some studies showed promising results by using local intrauterine infusion of GCSF in patients undergoing in vitro fertilization (IVF). This multicenter, randomized, controlled trial included 112 infertile women with repeated IVF failure to evaluate the efficacy of systemic single-dose subcutaneous GCSF administration on IVF success in these women. In this study, the Long Protocol of ovarian stimulation was used for all participants. Sealed, numbered envelopes assigned 56 patients to receive subcutaneous 300 µg GCSF before implantation and 56 in the control group. The implantation (number of gestational sacs on the total number of transferred embryos), chemical pregnancy (positive serum β-HCG), and clinical pregnancy (gestational sac and fetal heart) rates were compared between the two groups. This trial is registered at www.irct.ir (IRCT201503119568N11). The successful implantation (18% vs 7.2%, P=0.007), chemical pregnancy (44.6% vs 19.6%, P=0.005), and clinical pregnancy (37.5% vs 14.3%, P=0.005) rates were significantly higher in the intervention group than in the control group. After adjustment for participants' age, endometrial thickness, good-quality oocyte counts, number of transferred embryos, and anti-Mullerian hormone levels, GCSF treatment remained significantly associated with successful implantation (OR=2.63, 95% CI=1.09-6.96), having chemical pregnancy (OR= 2.74, 95% CI=1.11-7.38) and clinical pregnancy (OR=2.94, 95% CI=1.23-8.33). In conclusion, administration of single-dose systemic subcutaneous GCSF before implantation significantly increases the IVF success, implantation, and pregnancy rates in infertile women with repeated IVF failure. © 2016 Society for Reproduction and Fertility.

Syncope and sudden death from the emergency physician’s perspective: is there room for new biomarkers?

Directory of Open Access Journals (Sweden)

Rossella Marino

2013-10-01

Full Text Available Syncope is a transient loss of consciousness due to temporary global cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Syncope represents 1-2% of emergency department (ED visits and is coupled with a high risk for mortality, prolonged hospital admission, and immediate false diagnosis. Many patients who present to the ED with aspecific symptoms are mainly hospitalized because of diagnostic uncertainty. It is always very important to immediately distinguish syncope of cardiac and non-cardiac origins. Cardiac syncope has higher risk for mortality especially for sudden cardiac death, while non-cardiac one shows risk of repeated events of syncope with poor quality of life. Sudden cardiac death is defined as rapid and unexpected natural death due to cardiac etiology. Researchers from the GREAT Network hypothesized to evaluate some novel biomarkers in order to test acute cardiac condition that can suggest the presence of heart structural diseases, heart failure, and electrical disorders. The primary objective of this study is to test the diagnostic performance from patient history, clinical judgment, and novel biomarkers in the diagnosis of cardiac syncope in patients admitted to the ED. The trial is designed as a prospective international multicenter observational study accounting for 730 patients aged over 40 admitted to the ED with syncope within the last 12 h. A multimarker approach combining markers of different origin and mode of relapse, should add diagnostic information to correctly identify the cardiac conditions and to therefore be pertinent in the early diagnosis of cardiac syncope and in the prediction of cardiac events including sudden death. Future data should be needed to confirm the hypothesis presented here.

Sudden cardiac death in children (1-18 years)

DEFF Research Database (Denmark)

Winkel, Bo Gregers; Risgaard, Bjarke; Sadjadieh, Golnaz

2014-01-01

AIMS: Hitherto, sudden cardiac death in children (SCDc)-defined as sudden cardiac death (SCD) in the 1-18 years old-has been incompletely described in the general population. Knowledge on incidence rates, causes of death and symptoms prior to death is sparse and has been affected by reporting...... and referral bias. METHODS AND RESULTS: In a nationwide setting all deaths in children aged 1-18 years in Denmark in 2000-06 were included. To chart causes of death and incidence rates, death certificates and autopsy reports were collected and read. By additional use of the extensive healthcare registries...... in Denmark, we were also able to investigate prior disease and symptoms. During the 7-year study period there was an average of 1.11 million persons aged 1-18 years. There were a total of 1504 deaths (214 deaths per year) from 7.78 million person-years. A total of 114 (7.5%) were sudden and unexpected...

Imaging spectrum of sudden athlete cardiac death

Energy Technology Data Exchange (ETDEWEB)

Arrigan, M.T., E-mail: martinarrigan@gmail.co [Department of Radiology, Adelaide and Meath Hospital incorporating the National Children' s Hospital, Dublin (Ireland); Killeen, R.P. [Department of Radiology, Adelaide and Meath Hospital incorporating the National Children' s Hospital, Dublin (Ireland); Dodd, J.D. [Department of Radiology, St Vincent' s University Hospital, Dublin (Ireland); Torreggiani, W.C. [Department of Radiology, Adelaide and Meath Hospital incorporating the National Children' s Hospital, Dublin (Ireland)

2011-03-15

Sudden athlete death (SAD) is a widely publicized and increasingly reported phenomenon. For many, the athlete population epitomize human physical endeavour and achievement and their unexpected death comes with a significant emotional impact on the public. Sudden deaths within this group are often without prior warning. Preceding symptoms of exertional syncope and chest pain do, however, occur and warrant investigation. Similarly, a positive family history of sudden death in a young person or a known family history of a condition associated with SAD necessitates further tests. Screening programmes aimed at detecting those at risk individuals also exist with the aim of reducing fatalities. In this paper we review the topic of SAD and discuss the epidemiology, aetiology, and clinical presentations. We then proceed to discuss each underlying cause, in turn discussing the pathophysiology of each condition. This is followed by a discussion of useful imaging methods with an emphasis on cardiac magnetic resonance and cardiac computed tomography and how these address the various issues raised by the pathophysiology of each entity. We conclude by proposing imaging algorithms for the investigation of patients considered at risk for these conditions and discuss the various issues raised in screening.

Imaging spectrum of sudden athlete cardiac death

International Nuclear Information System (INIS)

Arrigan, M.T.; Killeen, R.P.; Dodd, J.D.; Torreggiani, W.C.

2011-01-01

Sudden athlete death (SAD) is a widely publicized and increasingly reported phenomenon. For many, the athlete population epitomize human physical endeavour and achievement and their unexpected death comes with a significant emotional impact on the public. Sudden deaths within this group are often without prior warning. Preceding symptoms of exertional syncope and chest pain do, however, occur and warrant investigation. Similarly, a positive family history of sudden death in a young person or a known family history of a condition associated with SAD necessitates further tests. Screening programmes aimed at detecting those at risk individuals also exist with the aim of reducing fatalities. In this paper we review the topic of SAD and discuss the epidemiology, aetiology, and clinical presentations. We then proceed to discuss each underlying cause, in turn discussing the pathophysiology of each condition. This is followed by a discussion of useful imaging methods with an emphasis on cardiac magnetic resonance and cardiac computed tomography and how these address the various issues raised by the pathophysiology of each entity. We conclude by proposing imaging algorithms for the investigation of patients considered at risk for these conditions and discuss the various issues raised in screening.

Imaging spectrum of sudden athlete cardiac death.

LENUS (Irish Health Repository)

Arrigan, M T

2012-02-01

Sudden athlete death (SAD) is a widely publicized and increasingly reported phenomenon. For many, the athlete population epitomize human physical endeavour and achievement and their unexpected death comes with a significant emotional impact on the public. Sudden deaths within this group are often without prior warning. Preceding symptoms of exertional syncope and chest pain do, however, occur and warrant investigation. Similarly, a positive family history of sudden death in a young person or a known family history of a condition associated with SAD necessitates further tests. Screening programmes aimed at detecting those at risk individuals also exist with the aim of reducing fatalities. In this paper we review the topic of SAD and discuss the epidemiology, aetiology, and clinical presentations. We then proceed to discuss each underlying cause, in turn discussing the pathophysiology of each condition. This is followed by a discussion of useful imaging methods with an emphasis on cardiac magnetic resonance and cardiac computed tomography and how these address the various issues raised by the pathophysiology of each entity. We conclude by proposing imaging algorithms for the investigation of patients considered at risk for these conditions and discuss the various issues raised in screening.

Captopril to Mitigate Chronic Renal Failure After Hematopoietic Stem Cell Transplantation: A Randomized Controlled Trial

International Nuclear Information System (INIS)

Cohen, Eric P.; Irving, Amy A. B.A.; Drobyski, William R.; Klein, John P.; Passweg, Jakob; Talano, Julie-An M.; Juckett, Mark B.; Moulder, John E.

2008-01-01

Purpose: To test whether the angiotensin-converting enzyme inhibitor captopril was effective in mitigating chronic renal failure after hematopoietic stem cell transplantation (HSCT). Methods and Materials: A total of 55 subjects undergoing total body irradiation (TBI)-HSCT were enrolled in this randomized controlled trial. Captopril or identical placebo was started at engraftment and continued as tolerated until 1 year after HSCT. Results: The baseline serum creatinine and calculated glomerular filtration rate (GFR) did not differ between groups. The 1-year serum creatinine level was lower and the GFR higher in the captopril compared with the placebo group (p = 0.07 for GFR). Patient survival was higher in the captopril compared with the placebo group, but this was also not statistically significant (p = 0.09). In study subjects who received the study drug for more than 2 months, the 1-year calculated GFRs were 92 mL/min and 80 mL/min, for the captopril and placebo groups, respectively (p = 0.1). There was no adverse effect on hematologic outcome. Conclusions: There is a trend in favor of captopril in mitigation of chronic renal failure after radiation-based HSCT

Sudden Sensorineural Hearing Loss; Prognostic Factors

Directory of Open Access Journals (Sweden)

Arjun Dass

2015-09-01

Full Text Available Introduction: Sudden sensorineural hearing loss (SSNHL is a frightening and frustrating symptom for the patient as well as the physician. Prognosis is affected by multiple factors including duration of hearing loss, presence of associated vertigo and tinnitus, and co-morbidities such as hypertension and diabetes.   Materials and Methods: Forty subjects presenting to our department with features of sudden hearing loss were included in the study. Detailed otological history and examination, serial audiometric findings and course of disease were studied.   Results: Subjects presenting late (in older age, having associated vertigo, hypertension and diabetes had a significantly lower rate of recovery.   Conclusion:  Only 60–65% of patients experiencing SSNHL recover within a period of 1 month; this rate is further affected by presence of multiple prognostic indicators.

Genetic testing to predict sudden cardiac death: current perspectives and future goals

Directory of Open Access Journals (Sweden)

Silvia G. Priori

2014-01-01

Full Text Available It is known that monogenic traits may predispose young and otherwise healthy individuals to die suddenly. Diseases such as Long QT Syndrome, Brugada Syndrome and Arrhythmogenic Right Ventricular Cardiomyopathy are well known causes of arrhythmic death in young individuals. For several years the concept of “genetic predisposition” to sudden cardiac death has been limited to these uncommon diseases. In the last few years clinical data have supported the view that risk of dying suddenly may cluster in families, supporting the hypothesis of a genetic component for sudden cardiac death. In this review I will try to provide an overview of current knowledge about genetics of sudden death. I will approach this topic by discussing first where we stand in the use of genetics for risk stratification and therapy selection in monogenic diseases and I will then move to discuss the contribution of genetics to patient profiling in acquired cardiovascular diseases.

Haloperidol aggravates transverse aortic constriction-induced heart failure via mitochondrial dysfunction

OpenAIRE

Yasuharu Shinoda; Hideaki Tagashira; Md. Shenuarin Bhuiyan; Hideyuki Hasegawa; Hiroshi Kanai; Kohji Fukunaga

2016-01-01

Haloperidol is an antipsychotic drug that inhibits the dopamine D2 receptor among others. Haloperidol also binds the sigma-1 receptor (σ1R) and inhibits it irreversibly. A serious outcome of haloperidol treatment of schizophrenia patients is death due to sudden cardiac failure. Although the cause remains unclear, we hypothesized that these effects were mediated by chronic haloperidol inhibition of cardiac σ1R. To test this, we treated neonatal rat cardiomyocytes with haloperidol, exposed them...

Randomised trial of low-dose amiodarone in severe congestive heart failure. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA)

Science.gov (United States)

Doval, H C; Nul, D R; Grancelli, H O; Perrone, S V; Bortman, G R; Curiel, R

1994-08-20

In severe heart failure many deaths are sudden and are presumed to be due to ventricular arrhythmias. The GESICA trial evaluated the effect of low-dose amiodarone on two-year mortality in patients with severe heart failure. Our prospective multicentre trial included 516 patients on optimal standard treatment for heart failure. Patients were randomised to 300 mg/day amiodarone (260) or to standard treatment (256). Intention-to-treat analysis showed 87 deaths in the amiodarone group (33.5%) compared with 106 in the control group (41.4%) (risk reduction 28%; 95% CI 4%-45%; log rank test p = 0.024). There were reductions in both sudden death (risk reduction 27%; p = 0.16) and death due to progressive heart failure (risk reduction 23%; p = 0.16). Fewer patients in the amiodarone group died or were admitted to hospital due to worsening heart failure (119 versus 149 in the control group; risk reduction 31%; 95% CI 13-46%; p = 0.0024). The decrease in mortality and hospital admission was present in all subgroups examined and independent of the presence of non-sustained ventricular tachycardia. Side-effects were reported in 17 patients (6.1%); amiodarone was withdrawn in 12. Low-dose amiodarone proved to be an effective and reliable treatment, reducing mortality and hospital admission in patients with severe heart failure independently of the presence of complex ventricular arrhythmias.

Recreational soccer can improve the reflex response to sudden trunk loading among untrained women

DEFF Research Database (Denmark)

Pedersen, Mogens Theisen; Randers, Morten Bredsgaard; Skotte, Jørgen H.

2009-01-01

for 1 hour twice a week (mean heart rate of 165 b.min-1 in SO and 164 b.min-1 in RU) for 16 weeks. Test of reactions to sudden unexpected trunk loading was performed before and after the training period. Furthermore, time-motion analysis of the soccer training was performed for 9 subjects. Group...... training on the reaction to SL among untrained healthy women. Thirty-six healthy, untrained, Danish women (age 19-45 years) were randomly assigned to a soccer group (SO, n = 19) and a running group (RU, n = 17). In addition, an untrained control group (CON, n = 10) was recruited. Training was performed...

Effective cross-over to granisetron after failure to ondansetron, a randomized double blind study in patients failing ondansetron plus dexamethasone during the first 24 hours following highly emetogenic chemotherapy

NARCIS (Netherlands)

R. de Wit (Ronald); A.C. de Boer (Auke); G.H.M. Vd Linden (G. H M); G. Stoter (Gerrit); A. Sparreboom (Alex); J. Verweij (Jaap)

2001-01-01

textabstractIn view of the similarity in chemical structure of the available 5HT 3-receptor antagonists it is assumed, whilst these agents all act at the same receptor, that failure to one agent would predict subsequent failure to all 5HT 3-receptor antagonists. We conducted a randomized double

Post-mortem toxicology in young sudden cardiac death victims

DEFF Research Database (Denmark)

Bjune, Thea; Risgaard, Bjarke; Kruckow, Line

2017-01-01

Aims: Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark. Methods and results: Deaths in persons aged 1-49 years were included over a 10-year period. Death...... certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological...... findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac...

Sudden unexpected death from natural diseases: Fifteen years' experience with 484 cases in Seychelles.

Science.gov (United States)

Zhao, Peng; Wang, Ji-Gang; Gao, Peng; Li, Xia; Brewer, Rubell

2016-01-01

The aim of this study is to identify and subclassify sudden natural death (sudden death from natural diseases) cases in Seychelles. A total of 484 sudden natural death cases with autopsy at the Clinical Pathology Laboratory, Victoria Hospital, Seychelles between 1997 through 2012 were retrospectively reviewed. Among them, 363 cases (75%) were male and 121 (25%) were female. The most frequent sudden deaths were attributed to cardiovascular diseases (78.5%), and then followed by infectious diseases (9.9%), and gastrointestinal diseases (9.1%). This is the largest population-based study on sudden natural deaths in Seychelles. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Comparison of in-vivo failure of single-thread and dual-thread temporary anchorage devices over 18 months: A split-mouth randomized controlled trial.

Science.gov (United States)

Durrani, Owais Khalid; Shaheed, Sohrab; Khan, Arsalan; Bashir, Ulfat

2017-10-01

The purpose of this study was to compare the in-vivo failure rates of single-thread and dual-thread temporary anchorage device (TAD) designs over 18 months. Thirty patients with skeletal Class II Division 1 malocclusion requiring anchorage from TADs for retraction of maxillary incisors into the extracted premolar space were recruited in this parallel group, split-mouth, randomized controlled trial. A block randomization sequence was generated with Random Allocation Software (version 2.0; Isfahan, Iran) with the allocations concealed in sequentially numbered, opaque, sealed envelopes. A total of 60 TADs (diameter, 2 mm; length, 10 mm) were placed in the maxillary arches of these patients with random allocation of the 2 types to the left and the right sides in a 1:1 ratio. All TADs were placed between the roots of the second premolar and the first molar and were immediately loaded. Patients were followed for a minimum of 12 months and a maximum of 18 months for the failure of the TADs. Data were analyzed blindly on an intention-to-treat basis. Four TADs (13.3%) failed in the single-thread group, and 6 TADs (20%) failed in the dual-thread group. The McNemar test showed an insignificant difference (P = 0.72) between the 2 groups. An odds ratio of 1.6 (95% confidence interval, 0.39-6.97) showed no significant associations among the variables. Most TADs failed in the first month after insertion (50%). The failure rate of dual-thread TADs compared with single-thread TADs is statistically insignificant when placed in the maxilla for retraction of the anterior segment. Registration: The trial was not registered before commencement. The protocol was not published before the trial. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Acupuncture therapy for sudden sensorineural hearing loss: a systematic review and meta-analysis of randomized controlled trials.

Science.gov (United States)

Zhang, Xin-chang; Xu, Xiu-ping; Xu, Wen-tao; Hou, Wen-zhen; Cheng, Ying-ying; Li, Chang-xi; Ni, Guang-xia

2015-01-01

Acupuncture has commonly been used in China, either alone or in combination with Western medicine, to treat sudden sensorineural hearing loss (SSHL). The purpose of this systematic review is to assess the efficacy and safety of acupuncture therapy for patients with SSHL. We searched PubMed, the Cochrane Library, Embase, China National Knowledge Internet (CNKI), Database for Chinese Technical Periodicals (VIP), and Chinese Biomedical literature service system (SinoMed) to collect randomized controlled trials of acupuncture for SSHL published before July 2014. A meta-analysis was conducted according to the Cochrane systematic review method using RevMan 5.2 software. The evidence level for each outcome was assessed using the GRADE methodology. Twelve trials involving 863 patients were included. A meta-analysis showed that the effect of manual acupuncture combined with Western medicine comprehensive treatment (WMCT) was better than WMCT alone (RR 1.33, 95%CI 1.19-1.49) and the same as the effect of electroacupuncture combined with WMCT (RR 1.33, 95%CI 1.19-1.50). One study showed a better effect of electroacupuncture than of WMCT (RR 1.34, 95%CI 1.24-1.45). For mean changes in hearing over all frequencies, the meta-analysis showed a better effect with the combination of acupuncture and WMCT than with WMCT alone (MD 10.85, 95%CI 6.84-14.86). However, the evidence levels for these interventions were low or very low due to a high risk of bias and small sample sizes in the included studies. There was not sufficient evidence showing that acupuncture therapy alone was beneficial for treating SSHL. However, interventions combining acupuncture with WMCT had more efficacious results in the treatment of SSHL than WMCT alone. Electroacupuncture alone might be a viable alternative treatment besides WMCT for SSHL. However, given that there were fewer eligible RCTs and limitations in the included trials, such as methodological drawbacks and small sample sizes, large-scale RCTs are

Acupuncture therapy for sudden sensorineural hearing loss: a systematic review and meta-analysis of randomized controlled trials.

Directory of Open Access Journals (Sweden)

Xin-chang Zhang

Full Text Available Acupuncture has commonly been used in China, either alone or in combination with Western medicine, to treat sudden sensorineural hearing loss (SSHL. The purpose of this systematic review is to assess the efficacy and safety of acupuncture therapy for patients with SSHL.We searched PubMed, the Cochrane Library, Embase, China National Knowledge Internet (CNKI, Database for Chinese Technical Periodicals (VIP, and Chinese Biomedical literature service system (SinoMed to collect randomized controlled trials of acupuncture for SSHL published before July 2014. A meta-analysis was conducted according to the Cochrane systematic review method using RevMan 5.2 software. The evidence level for each outcome was assessed using the GRADE methodology.Twelve trials involving 863 patients were included. A meta-analysis showed that the effect of manual acupuncture combined with Western medicine comprehensive treatment (WMCT was better than WMCT alone (RR 1.33, 95%CI 1.19-1.49 and the same as the effect of electroacupuncture combined with WMCT (RR 1.33, 95%CI 1.19-1.50. One study showed a better effect of electroacupuncture than of WMCT (RR 1.34, 95%CI 1.24-1.45. For mean changes in hearing over all frequencies, the meta-analysis showed a better effect with the combination of acupuncture and WMCT than with WMCT alone (MD 10.85, 95%CI 6.84-14.86. However, the evidence levels for these interventions were low or very low due to a high risk of bias and small sample sizes in the included studies.There was not sufficient evidence showing that acupuncture therapy alone was beneficial for treating SSHL. However, interventions combining acupuncture with WMCT had more efficacious results in the treatment of SSHL than WMCT alone. Electroacupuncture alone might be a viable alternative treatment besides WMCT for SSHL. However, given that there were fewer eligible RCTs and limitations in the included trials, such as methodological drawbacks and small sample sizes, large

Tai chi exercise in patients with chronic heart failure: a randomized clinical trial.

Science.gov (United States)

Yeh, Gloria Y; McCarthy, Ellen P; Wayne, Peter M; Stevenson, Lynne W; Wood, Malissa J; Forman, Daniel; Davis, Roger B; Phillips, Russell S

2011-04-25

Preliminary evidence suggests that meditative exercise may have benefits for patients with chronic systolic heart failure (HF); this has not been rigorously tested in a large clinical sample. We sought to investigate whether tai chi, as an adjunct to standard care, improves functional capacity and quality of life in patients with HF. A single-blind, multisite, parallel-group, randomized controlled trial evaluated 100 outpatients with systolic HF (New York Heart Association class I-III, left ventricular ejection fraction ≤40%) who were recruited between May 1, 2005, and September 30, 2008. A group-based 12-week tai chi exercise program (n = 50) or time-matched education (n = 50, control group) was conducted. Outcome measures included exercise capacity (6- minute walk test and peak oxygen uptake) and disease-specific quality of life (Minnesota Living With Heart Failure Questionnaire). Mean (SD) age of patients was 67 (11) years; baseline values were left ventricular ejection fraction, 29% (8%) and peak oxygen uptake, 13.5 mL/kg/min; the median New York Heart Association class of HF was class II. At completion of the study, there were no significant differences in change in 6-minute walk distance and peak oxygen uptake (median change [first quartile, third quartile], 35 [-2, 51] vs 2 [-7, 54] meters, P = .95; and 1.1 [-1.1, 1.5] vs -0.5 [-1.2, 1.8] mL/kg/min, P = .81) when comparing tai chi and control groups; however, patients in the tai chi group had greater improvements in quality of life (Minnesota Living With Heart Failure Questionnaire, -19 [-23, -3] vs 1 [-16, 3], P = .02). Improvements with tai chi were also seen in exercise self-efficacy (Cardiac Exercise Self-efficacy Instrument, 0.1 [0.1, 0.6] vs -0.3 [-0.5, 0.2], P mood (Profile of Mood States total mood disturbance, -6 [-17, 1] vs -1 [-13, 10], P = .01). Tai chi exercise may improve quality of life, mood, and exercise self-efficacy in patients with HF. Trial Registration clinicaltrials.gov Identifier

Protein restriction in chronic renal failure

NARCIS (Netherlands)

ECHTEN, JEKT; NAUTA, J; HOP, WCJ; de Jong, MCJ; REITSMABIERENS, WCC; VANAMSTEL, SLBP; VANACKER, KJ; NOORDZIJ, CM; WOLFF, ED

The aim of the study was to investigate the effect of a protein restricted diet on renal function and growth of children with chronic renal failure. In a multicentre prospective study 56 children (aged 2-18 years) with chronic renal failure were randomly assigned to the protein restricted (0.8-1.1

Inhibition of N-type Ca2+ channels ameliorates an imbalance in cardiac autonomic nerve activity and prevents lethal arrhythmias in mice with heart failure.

Science.gov (United States)

Yamada, Yuko; Kinoshita, Hideyuki; Kuwahara, Koichiro; Nakagawa, Yasuaki; Kuwabara, Yoshihiro; Minami, Takeya; Yamada, Chinatsu; Shibata, Junko; Nakao, Kazuhiro; Cho, Kosai; Arai, Yuji; Yasuno, Shinji; Nishikimi, Toshio; Ueshima, Kenji; Kamakura, Shiro; Nishida, Motohiro; Kiyonaka, Shigeki; Mori, Yasuo; Kimura, Takeshi; Kangawa, Kenji; Nakao, Kazuwa

2014-10-01

Dysregulation of autonomic nervous system activity can trigger ventricular arrhythmias and sudden death in patients with heart failure. N-type Ca(2+) channels (NCCs) play an important role in sympathetic nervous system activation by regulating the calcium entry that triggers release of neurotransmitters from peripheral sympathetic nerve terminals. We have investigated the ability of NCC blockade to prevent lethal arrhythmias associated with heart failure. We compared the effects of cilnidipine, a dual N- and L-type Ca(2+) channel blocker, with those of nitrendipine, a selective L-type Ca(2+) channel blocker, in transgenic mice expressing a cardiac-specific, dominant-negative form of neuron-restrictive silencer factor (dnNRSF-Tg). In this mouse model of dilated cardiomyopathy leading to sudden arrhythmic death, cardiac structure and function did not significantly differ among the control, cilnidipine, and nitrendipine groups. However, cilnidipine dramatically reduced arrhythmias in dnNRSF-Tg mice, significantly improving their survival rate and correcting the imbalance between cardiac sympathetic and parasympathetic nervous system activity. A β-blocker, bisoprolol, showed similar effects in these mice. Genetic titration of NCCs, achieved by crossing dnNRSF-Tg mice with mice lacking CACNA1B, which encodes the α1 subunit of NCCs, improved the survival rate. With restoration of cardiac autonomic balance, dnNRSF-Tg;CACNA1B(+/-) mice showed fewer malignant arrhythmias than dnNRSF-Tg;CACNA1B(+/+) mice. Both pharmacological blockade of NCCs and their genetic titration improved cardiac autonomic balance and prevented lethal arrhythmias in a mouse model of dilated cardiomyopathy and sudden arrhythmic death. Our findings suggest that NCC blockade is a potentially useful approach to preventing sudden death in patients with heart failure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

Correlates of Exercise Self-efficacy in a Randomized Trial of Mind-Body Exercise in Patients With Chronic Heart Failure.

Science.gov (United States)

Yeh, Gloria Y; Mu, Lin; Davis, Roger B; Wayne, Peter M

2016-01-01

Exercise self-efficacy is one of the strongest predictors of physical activity behavior. Prior literature suggests that tai chi, a mind-body exercise, may increase self-efficacy; however, this is not extensively studied. Little is known about the factors associated with development of exercise self-efficacy in a population with heart failure. We utilized data from a randomized controlled trial of 12 weeks of group tai chi classes versus education in patients with chronic heart failure (n = 100). Multivariable linear regression was used to explore possible correlates of change in exercise self-efficacy in the entire sample and in the subgroup who received tai chi (n = 50). Covariates included baseline quality of life, social support, functional parameters, physical activity, serum biomarkers, sociodemographics, and clinical heart failure parameters. Baseline 6-minute walk (β=-0.0003, SE = 0.0001, P = .02) and fatigue score (β= 0.03, SE = 0.01, P = .004) were significantly associated with change in self-efficacy, with those in the lowest tertile for 6-minute walk and higher tertiles for fatigue score experiencing the greatest change. Intervention group assignment was highly significant, with self-efficacy significantly improved in the tai chi group compared to the education control over 12 weeks (β= 0.39, SE = 0.11, P heart failure who are deconditioned, with lower functional status and mood.

Mutations in calmodulin cause ventricular tachycardia and sudden cardiac death

DEFF Research Database (Denmark)

Nyegaard, Mette; Overgaard, Michael Toft; Sondergaard, M.T.

2012-01-01

a substantial part of sudden cardiac deaths in young individuals. Mutations in RYR2, encoding the cardiac sarcoplasmic calcium channel, have been identified as causative in approximately half of all dominantly inherited CPVT cases. Applying a genome-wide linkage analysis in a large Swedish family with a severe......Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a devastating inherited disorder characterized by episodic syncope and/or sudden cardiac arrest during exercise or acute emotion in individuals without structural cardiac abnormalities. Although rare, CPVT is suspected to cause...... calmodulin-binding-domain peptide at low calcium concentrations. We conclude that calmodulin mutations can cause severe cardiac arrhythmia and that the calmodulin genes are candidates for genetic screening of individual cases and families with idiopathic ventricular tachycardia and unexplained sudden cardiac...

Sudden entanglement death, and ways to avoid it

International Nuclear Information System (INIS)

Eberly, J.H.; Ting Yu

2005-01-01

We report that non-communicating but entangled qubit pairs are almost universally liable to sudden entanglement death. In the presence of minor and purely local environmental noises their mixed-state entanglement may abruptly become zero long before the noises are able to destroy the local qubit coherence. Despite the inability of unitary transformations to alter entanglement, for example of Werner states, unitary transformations have been found to delay or defeat the sudden death event. These results upset the conventional understanding that entanglement lifetime can be estimated from qubit lifetime. This is not even approximately or qualitatively true. (author)

Classification of sudden and arrhythmic death

DEFF Research Database (Denmark)

Torp-Pedersen, C; Køber, L; Elming, H

1997-01-01

was nearly abolished by the implantable defibrillator, indicating that arrhythmic death by this classification is meaningful, at least in the population studied. For future investigations, a call is made for committees to present data in a way that allows the reader to examine the quality of the data used......Since all death is (eventually) sudden and associated with cardiac arrhythmias, the concept of sudden death is only meaningful if it is unexpected, while arrhythmic death is only meaningful if life could have continued had the arrhythmia been prevented or treated. Current classifications of death...... or autopsy) are available in only a few percent of cases. A main problem in using classifications is the lack of validation data. This situation has, with the MADIT trial, changed in the case of the Thaler and Hinkle classification of arrhythmic death. The MADIT trial demonstrated that arrhythmic death...

Sudden unexpected death in children with a previously diagnosed cardiovascular disorder

NARCIS (Netherlands)

Polderman, Florens N.; Cohen, Joeri; Blom, Nico A.; Delhaas, Tammo; Helbing, Wim A.; Lam, Jan; Sobotka-Plojhar, Marta A.; Temmerman, Arno M.; Sreeram, Narayanswani

2004-01-01

BACKGROUND: It is known that children with previously diagnosed heart defects die suddenly. The causes of death are often unknown. OBJECTIVE: The aim of the study was to identify all infants and children within the Netherlands with previously diagnosed heart disease who had a sudden unexpected death

Sudden unexpected death in children with a previously diagnosed cardiovascular disorder

NARCIS (Netherlands)

Polderman, F.N.; Cohen, Joeri; Blom, N.A.; Delhaas, T.; Helbing, W.A.; Lam, J.; Sobotka-Plojhar, M.A.; Temmerman, Arno M.; Sreeram, N.

2004-01-01

Background: It is known that children with previously diagnosed heart defects die suddenly. The causes of death are often unknown. Objective: The aim of the study was to identify all infants and children within the Netherlands with previously diagnosed heart disease who had a sudden unexpected death

Sudden oak death and Phytophthora ramorum: a summary of the literature

Science.gov (United States)

John T. Kliejunas

2010-01-01

Sudden oak death and Phytophthora ramorum, both first recognized about a decade ago, have been the subject of hundreds of scientific and popular press articles. This document presents a comprehensive, concise summary of sudden oak death and P. ramorum research findings and management activities. Topics covered include...

Comparison of Sprint Fidelis and Riata defibrillator lead failure rates.

Science.gov (United States)

Fazal, Iftikhar A; Shepherd, Ewen J; Tynan, Margaret; Plummer, Christopher J; McComb, Janet M

2013-09-30

Sprint Fidelis and Riata defibrillator leads are prone to early failure. Few data exist on the comparative failure rates and mortality related to lead failure. The aims of this study were to determine the failure rate of Sprint Fidelis and Riata leads, and to compare failure rates and mortality rates in both groups. Patients implanted with Sprint Fidelis leads and Riata leads at a single centre were identified and in July 2012, records were reviewed to ascertain lead failures, deaths, and relationship to device/lead problems. 113 patients had Sprint Fidelis leads implanted between June 2005 and September 2007; Riata leads were implanted in 106 patients between January 2003 and February 2008. During 53.0 ± 22.3 months of follow-up there were 13 Sprint Fidelis lead failures (11.5%, 2.60% per year) and 25 deaths. Mean time to failure was 45.1 ± 15.5 months. In the Riata lead cohort there were 32 deaths, and 13 lead failures (11.3%, 2.71% per year) over 54.8 ± 26.3 months follow-up with a mean time to failure of 53.5 ± 24.5 months. There were no significant differences in the lead failure-free Kaplan-Meier survival curve (p=0.77), deaths overall (p=0.17), or deaths categorised as sudden/cause unknown (p=0.54). Sprint Fidelis and Riata leads have a significant but comparable failure rate at 2.60% per year and 2.71% per year of follow-up respectively. The number of deaths in both groups is similar and no deaths have been identified as being related to lead failure in either cohort. Copyright © 2012. Published by Elsevier Ireland Ltd.

The effect of various adhesives, enamel etching, and base treatment on the failure frequency of customized lingual brackets: a randomized clinical trial.

Science.gov (United States)

Mavreas, Dimitrios; Cuzin, Jean-François; Boonen, Guillaume; Vande Vannet, Bart

2018-05-25

The aim of this paper was to compare failure differences in precious metal customized lingual brackets bonded with three adhesive systems. Also, differences in failure of non-precious metal brackets with and without a silicatized base layer bonded with the same adhesive, as well as the influence of enamel etching prior to using a self-etching dual cure resin were explored. Five different groups were defined in a semi-randomized approach. Group 1 (IME): Maxcem Elite with 378 Incognito brackets and etched teeth, Group 2 (IMNE): Maxcem Elite with 193 Incognito brackets on non-etched teeth, Group 3 (INE): Nexus+Excite with 385 Incognito brackets, Group 4 (IRE): Relyx with 162 Incognito brackets, Group 5 (HRME) and Group 6 (HNRME): Maxcem Elite with 182 Harmony brackets with silicatized and non-slicatized bases respectively. Bracket failures were recorded over a 12-month period. The number of failures during the observation period was small in the various adhesives types of groups, as well as in HRME and HNRME groups, and the comparisons among those groups were non-significant (P > 0.05). A statistically significant difference (P brackets failure frequencies (rates) are not different for the three adhesive materials tested. 2. Eliminating the etching stage when using self-etch/self-adhesive adhesives, may lead to a dramatic increase in the failure rates. 3. Silicoating of stainless steel customized lingual brackets does not seem to influence the failure of the bonds.

The molecular autopsy: an indispensable step following sudden cardiac death in the young?

Science.gov (United States)

Boczek, Nicole J.; Tester, David J.; Ackerman, Michael J.

2013-01-01

Annually thousands of sudden deaths involving young individuals (autopsy. In fact, epidemiological studies have estimated that over half of sudden deaths involving previously healthy young individuals have no morphological abnormalities identifiable at autopsy. Cardiac channelopathies associated with structurally normal hearts such as long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and Brugada syndrome (BrS), leave no evidence to be found at autopsy, leaving investigators to only speculate that a lethal arrhythmia might lie at the heart of a sudden unexplained death (SUD). In cases of autopsy-negative SUD, continued investigation, through the use of a cardiological and genetic evaluation of first- or second-degree relatives and/or a molecular autopsy, may pinpoint the underlying mechanism attributing to the sudden death and allow for the identification of living family members with the pathogenic substrate that renders them vulnerable to an increased risk for cardiac events, including sudden death. PMID:22993115

Effectiveness of an interactive platform, and the ESC/HFA heartfailurematters.org website in patients with heart failure: design of the multicentre randomized e-Vita heart failure trial.

Science.gov (United States)

Wagenaar, Kim P; Broekhuizen, Berna D L; Dickstein, Kenneth; Jaarsma, Tiny; Hoes, Arno W; Rutten, Frans H

2015-12-01

Electronic health support (e-health) may improve self-care of patients with heart failure (HF). We aim to assess whether an adjusted care pathway with replacement of routine consultations by e-health improves self-care as compared with usual care. In addition, we will determine whether the ESC/HFA (European Society of Cardiology/Heart Failure Association) website heartfailurematters.org (HFM website) improves self-care when added to usual care. Finally, we aim to evaluate the cost-effectiveness of these interventions. A three-arm parallel randomized trial will be conducted. Arm 1 consists of usual care; arm 2 consists of usual care plus the HFM website; and arm 3 is the adjusted care pathway with an interactive platform for disease management (e-Vita platform), with a link to the HFM website, which replaces routine consultations with HF nurses at the outpatient clinic. In total, 414 patients managed in 10 Dutch HF outpatient clinics or in general practice will be included and followed for 12 months. Participants are included if they have had an established diagnosis of HF for at least 3 months. The primary outcome is self-care as measured by the European Heart Failure Self-care Behaviour scale (EHFScB scale). Secondary outcomes are quality of life, cardiovascular- and HF-related mortality, hospitalization, and its duration as captured by hospital and general practitioner registries, use of and user satisfaction with the HFM website, and cost-effectiveness. This study will provide important prospective data on the impact and cost-effectiveness of an interactive platform for disease management and the HFM website. unique identifier: NCT01755988. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

Efficacy of carvedilol in pediatric heart failure

DEFF Research Database (Denmark)

Christensen, Alex Hørby; Fatkin, Diane

2013-01-01

Evaluation of: Huang M, Zhang X, Chen S et al. The effect of carvedilol treatment on chronic heart failure in pediatric patients with dilated cardiomyopathy: a prospective, randomized-controlled study. Pediatr. Cardiol. 34, 680-685 (2013). A role for β-blockers in children with heart failure has...

The effect of endometrial scratch injury on pregnancy outcome in women with previous intrauterine insemination failure: A randomized clinical trial.

Science.gov (United States)

Ashrafi, Mahnaz; Tehraninejad, Ensieh Shahrokh; Haghiri, Mansooreh; Masomi, Masoumeh; Sadatmahalleh, Shahideh Jahanian; Arabipoor, Arezoo

2017-09-01

Endometrial scratch injury (ESI) has been recently proposed to enhance the implantation rate in assisted reproductive technology cycles. The present study was conducted to determine the effect of ESI on pregnancy rate in women with intrauterine insemination (IUI) failure. This prospective randomized controlled study was carried out in Imam-Khomeini Hospital and Royan Institute, Tehran, during a 12-month period from January 2013 to January 2014. After assessment, 169 patients who had IUI failure twice or more (no chemical or clinical pregnancy) with normal uterine anatomy and hysterosalpingography, were enrolled. They were randomly assigned into two groups. In the experimental group, all patients underwent ESI at day 8 or 9 of stimulation phase in the present IUI cycle, whereas no intervention was performed on the control group. IUI outcome was then compared between the two groups. A total of 150 patients completed the IUI cycle during the study. The chemical pregnancy rate was 10.7% and 2.7% in the experimental and control groups, respectively, without significant difference (P = 0.09). Also no significant differences were detected in terms of clinical pregnancy and miscarriage rates between the two groups (P > 0.05). No significant beneficial effect of ESI on fertility outcome in patients with repeated IUI failure was detected when it was carried out on day 8 or 9 of the same IUI stimulation cycle. Also, however, no negative impact secondary to ESI was observed. Therefore, confirmation or refutation of this hypothesis requires further studies with a larger sample size. IRCT201507271141N19. © 2017 Japan Society of Obstetrics and Gynecology.

Sudden infant death syndrome, childhood thrombosis, and presence of genetic risk factors for thrombosis

DEFF Research Database (Denmark)

Larsen, TB; Nørgaard-Pedersen, B; Lundemose, JB

2000-01-01

in the child. This prompted us to investigate these genetic markers of thromboembolic disease in 121 cases of sudden infant death syndrome and in relevant controls, in the expectation of a more frequent occurrence of these markers if thrombosis is an etiological factor in sudden infant death syndrome...... or unknown risk factors for thrombosis as possible etiological factors for sudden infant death syndrome. It is likely that we must continuously employ the exclusion principle on possible etiological causes in genetic material from a large group of victims of sudden infant death syndrome if the phenomenon...

Sudden death due to inhalant abuse in youth: Case report

Directory of Open Access Journals (Sweden)

Ramazan Akcan

2010-06-01

Full Text Available Intentional inhalation or abuse of volatile substances is a common public health problem all over the world. As these substances generate euphoria frequency of use among adolescents and young adults is increasing steadily. In cases using inhalants to achieve a euphoric state -without knowing possible consequences- sudden death may occurdue to acute cardio-pulmonary dysfunction.Here we present a case of sudden death of a nineteen-year-old female due to inhalation of volatile from butane containing lighter gas tube, with the findings of autopsy and death scene investigation.In the context of this case; it was aimed to draw attention to the risk of sudden death and steady increase of frequencyof volatile substance abuse among adolescents and young adults due to various psycho-social factors.

Initial conditions and entanglement sudden death

International Nuclear Information System (INIS)

Qian, Xiao-Feng; Eberly, J.H.

2012-01-01

We report results bearing on the behavior of non-local decoherence and its potential for being managed or even controlled. The decoherence process known as entanglement sudden death (ESD) can drive prepared entanglement to zero at the same time that local coherences and fidelity remain non-zero. For a generic ESD-susceptible Bell superposition state, we provide rules restricting the occurrence and timing of ESD, amounting to management tools over a continuous variation of initial conditions. These depend on only three parameters: initial purity, entanglement and excitation. Knowledge or control of initial phases is not needed. -- Highlights: ► We study the possibility of managing disentanglement through initial conditions. ► The initial parameters are the amount of entanglement, excitation, and purity. ► Entanglement sudden death (ESD) free and ESD susceptible phases are identified. ► ESD onset time is also presented in the ESD susceptible phase. ► Our results may guide experiments to prepare ESD free or delayed ESD states.

How sudden is a compelling desire to void? An observational cystometric study on the suddenness of this sensation.

Science.gov (United States)

De Wachter, Stefan; Wyndaele, Jean-Jacques

2008-04-01

To evaluate whether a compelling desire to void (CDV) is always perceived suddenly, or whether it can result from the gradual build-up of bladder-filling sensations. The pattern of filling sensations was evaluated during standard cystometric bladder filling in 75 patients who complained of urgency and showed detrusor overactivity during cystometry. Cystometric filling ended when a CDV was reported. The 'warning volume' is defined as the difference in volume between the first perception of filling and the volume at CDV. Different patterns of bladder-filling sensations were reported. A CDV occurred suddenly, without a preceding sensation in 13% of the patients, whereas 66% reported at least two normal preceding filling sensations before a CDV. The bladder volume at the CDV was significantly smaller in patients that reported no or just one preceding sensation compared with those that reported the normal pattern of two or three sensations (P perception was reported was not different regardless of whether it was described as a first sensation of filling, a first desire or a CDV (P = 0.42). The warning volumes were not different between patients with one or no standardized filling sensations (P = 0.7), but they were significantly smaller than in patients with two or three filling sensations (P = 0.85). A CDV can occur suddenly if normal filling sensation is disturbed, but also gradually if normal filling sensation is preserved. In cases of disturbed filling sensation, the volume at CDV and the warning volume are significantly lower.

Crack phantoms: localized damage correlations and failure in network models of disordered materials

International Nuclear Information System (INIS)

Zaiser, M; Moretti, P; Lennartz-Sassinek, S

2015-01-01

We study the initiation of failure in network models of disordered materials such as random fuse and spring models, which serve as idealized representations of fracture processes in quasi-two-dimensional, disordered material systems. We consider two different geometries, namely rupture of thin sheets and delamination of thin films, and demonstrate that irrespective of geometry and implementation of the disorder (random failure thresholds versus dilution disorder) failure initiation is associated with the emergence of typical localized correlation structures in the damage patterns. These structures (‘crack phantoms’) exhibit well-defined characteristic lengths, which relate to the failure stress by scaling relations that are typical for critical crack nuclei in disorder-free materials. We discuss our findings in view of the fundamental nature of failure processes in materials with random microstructural heterogeneity. (paper)

Relationship between sudden natural death and abdominal fat evaluated on postmortem CT scans.

Science.gov (United States)

Kaichi, Y; Sakane, H; Higashibori, H; Honda, Y; Tatsugami, F; Baba, Y; Iida, M; Awai, K

2017-06-01

This study examined the association between sudden natural death and abdominal fat using postmortem computed tomography (CT) scans. Postmortem CT images at the umbilical level of 241 subjects were used to measure abdominal areas of subcutaneous- and visceral fat, the rate of visceral fat and the waist circumference. Of the study subjects, 174 died of sudden natural death (130 men and 44 women), and 67 died of different causes (46 men and 21 women). All were between 40 and 75 years of age. Logistic regression analysis was performed to identify independent abdominal parameters associated with sudden natural death. By univariate analysis, the areas of subcutaneous and visceral fat were significantly larger in sudden natural death than who died of different causes (subcutaneous fat, odds ratio [OR] = 1.004, 95% confidence interval [CI] = 1.000-1.007, p  = 0.03; visceral fat, OR = 1.008, 95% CI = 1.003-1.013, p  fat was an independent factor associated with the risk of sudden natural death (OR = 1.008, 95% CI = 1.002-1.015, p  = 0.02). Postmortem CT revealed that sudden natural death was related to abdominal fat deposits.

An Experimental Study on Flow Boiling Critical Heat Flux Characteristics of Suddenly Expanded Region

Energy Technology Data Exchange (ETDEWEB)

Kim, Yong Jin; Song, Sub Lee; Chang, Soon Heung [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of); Moon, Sang Ki [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2014-05-15

In this experiment, test section has been designed to simulate sudden flow path change due to deformation of cladding. It was tended to simulate cladding deformation that has discontinuous diameter change so coolant flow path changes suddenly. Experiments are in progress. Experiments on test section that simulate deformed flow path which contains sudden contraction and sudden expansion part have been done. Location of CHF has been varied by different condition of experiment. CHF at the outlet of test section fits well into the Macbeth's correlation and data of reference experiment, which was held on plain test section that had same diameter with inlet diameter of deformed test section. CHF at sudden expansion part was in churn flow regime and CHF was very low compared to expectation. It is discussed that liquid film separation from wall or bubble accumulation by backflow might be the reason of this result. For future work, experiments for two additional blockage ratio conditions will be carried out. Also, discussion and model development for deformed channel with sudden expand flow path will be held on.

Definition of Sudden Infant Death and Sudden Intrauterine Unexpected Death Syndromes (SIDS and SIUDS with Regard to the Anatomo-Pathological Examination

Directory of Open Access Journals (Sweden)

Giulia Ottaviani

2016-09-01

Full Text Available Crib death, or sudden infant death syndrome (SIDS, is the most frequent form of death in the first year of life, striking one baby in every 1,700–2,000. Yet despite advances in maternal-infant care, sudden intrauterine unexplained/unexpected death syndrome (SIUDS, has a six-eightfold greater incidence than that of SIDS. Frequent congenital abnormalities, likely morphological substrates for SIDS-SIUDS, were detected, mainly represented by alterations of the cardiac conduction system, such as accessory pathways and abnormal resorptive degeneration, and hypoplasia/agenesis of the vital brainstem structures. On the basis of these considerations, the new common definition of the SIDS-SIUDS complex is The sudden death of a fetus after the 25th gestational week or infant under one year of age which is unexpected by history and remains unexplained after a thorough case investigation, including examination of the death scene, performance of a general autopsy and examination of the fetal adnexa. Therefore, given that the general autopsy does not disclose any cause of death, a more in-depth histopathological analysis of the cardiac conduction system and autonomic nervous system by specialized pathologists will become necessary.

Failure rate analysis using GLIMMIX

International Nuclear Information System (INIS)

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

1998-01-01

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

Sudden death amongst people practicing competitive sports (Review Article

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Bartłomiej Wrzesiński

2018-02-01

Full Text Available Sudden cardiac death is and unexpected cardiac arrest that may occur both during exercise and also an hour after its completion. It most often occurs in young sportsmen under 35 years of age and is usually associated with improperly performed physical activity proceeded by lack of specialized medical examination and research. Natural and cardiac causes are two basic phenomena that lead to cardiac death. As confirmed by Framingham Heart Study, conducted in the eighties of the twentieth century on the population of Americans, natural causes accounted for 13% while cardiac causes accounted for 88% off all. The statistics of the largest centers of sport medicine are presented as follows: Germany – 1 death per 200,000 people practicing sports (total while United States of America – 1 death per 80,000 people per year. The problem of of sudden deaths is and important topic worthy of a broader and more specific analysis. It should be noted that physical exertion is not is not a direct cause of sudden deaths. Currently the most research concerns professional athletes who have extensive support and knowledge about the exercise they perform. The main problem concerning subject of sudden deaths are not diagnosed hearth defects. Additional topic of interest is rarity of medical tests performed by amateur athletes and athletes at the lower levels of competition. Such athletes do not  have as extensive knowledge as their experienced idols, which may bring tragic consequences.

Steroid Treatments Equally Effective Against Sudden Deafness

Science.gov (United States)

... NIGMS NIMH NIMHD NINDS NINR NLM CC CIT CSR FIC NCATS NCCIH OD About NIH Who We ... with sudden deafness should discuss the risks and benefits of both treatments with their doctor.” Related Links ...

Laryngeal dystonia gravidarum: sudden onset of adductor spasmodic dysphonia in pregnancy.

Science.gov (United States)

Ankola, Ashish; Sulica, Lucian; Murry, Thomas

2013-12-01

The purpose of this study was to identify the presence or absence of known factors related to onset of adductor spasmodic dysphonia (ADSD) in a population with sudden onset during or after pregnancy. Retrospective review. A review of 350 patient records identified five patients with sudden onset of ADSD related to pregnancy. An age-matched group with sudden onset of ADSD not related to pregnancy served as controls. All subjects completed a 20-question survey of risk factors relevant to ADSD. The average age of onset in both groups was 31 years. Three had onset of ADSD in the postpartum period, the other two during pregnancy. Significantly increased avocational voice use was found in the pregnant group compared to the control group. There was a significant difference in the two groups regarding cumulative risk factors traditionally associated with ADSD. Sudden onset of ADSD can occur in pregnancy in women with clinical profiles that differ from traditional ADSD patients. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Bilateral sudden sensorineural hearing loss as a first symptom of infective endocarditis: two case reports.

Science.gov (United States)

Chroni, M; Prappa, E; Kokkevi, I

2018-04-01

Septic emboli are an unusual cause of sudden sensorineural hearing loss, for which few reports exist in the literature. This paper presents two cases of sudden sensorineural hearing loss, initially considered as idiopathic, but which were caused by septic emboli. Hearing loss in these cases was bilateral, sequential and total. The first patient had mild fever one week prior to their presentation with sudden sensorineural hearing loss; the other patient had no additional symptoms at presentation. These patients were later diagnosed with infective endocarditis, at two and seven months following the sudden sensorineural hearing loss respectively, showing that septic emboli had been the cause of sudden sensorineural hearing loss. Septic emboli should be considered as a possible cause of sudden sensorineural hearing loss in cases of total hearing loss. This form of hearing loss should prompt the otolaryngologist to further investigate for infective endocarditis.

Sudden death in young persons with uncontrolled asthma--a nationwide cohort study in Denmark

DEFF Research Database (Denmark)

Gullach, Anders Juul; Risgaard, Bjarke; Lynge, Thomas Hadberg

2015-01-01

BACKGROUND: Asthma is a common chronic disease among young adults, and several studies have reported increased mortality rates in patients with asthma. However, no study has described sudden unexpected death in a nationwide setting in patients with uncontrolled asthma. We defined uncontrolled...... in preventing sudden unexpected deaths. We therefore aimed to describe clinical characteristics, symptoms, causes of death, and contact with the healthcare system prior to sudden unexpected death in young persons with uncontrolled asthma. METHODS: Through the review of death certificates, we found 625 sudden...... individuals who suffered from uncontrolled asthma. This corresponds to an incidence rate of 0.32 per 100,000 person-years. The cause of death in 31 cases (63%) was sudden cardiac death, and in 13 cases (27%), it was a fatal asthma attack. Symptoms (chest pain, dyspnea, seizures, general malaise, syncope...

An 88-Year-Old Man with Sudden Onset Abdominal Pain

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Mohammad Manouchehrifar

2015-07-01

Full Text Available An 88-year-old man presented to the emergency department with sudden onset of abdominal pain since 6 hours before. He was a known case of chronic renal failure that underwent hemodialysis three times a week. He also suffered from hypertension and benign prostatic hyperplasia. The patients’ on-arrival vital signs were as follows: systolic blood pressure: 100/60 mmHg, pulse rate: 88/minute, respiratory rate: 25/minute, oral temperature: 36◦C, oxygen saturation 93% in room air.  He had severely ill appearance on admission. Distended abdomen was considerable but had normal bowel sound and clearly, pain was disproportionate to physical examination. His electrocardiogram showed sinus rhythm and venous blood gas analysis revealed the following: pH=6.96, PaCO2=49 mmHg, HCO3=11 mEq/L, Base excess= -20.  The bedside ultrasonography showed echogenic particles in hepatic parenchyma and same findings that were passing through the portal vein. Chest and abdominal X-rays were reported as normal. The patient underwent abdominal and pelvic computed tomography (CT scan with oral contrast.What is your diagnosis?

Laparoscopic ovarian diathermy after clomiphene failure in polycystic ovary syndrome: is it worthwhile? A randomized controlled trial.

Science.gov (United States)

Abu Hashim, Hatem; Foda, Osama; Ghayaty, Essam; Elawa, Ahmed

2011-11-01

Laparoscopic ovarian diathermy (LOD) represents a successful treatment option for women with clomiphene citrate (CC)-resistant polycystic ovary syndrome (PCOS). However, in case of CC failure PCOS, LOD offers several theoretical advantages. This study was conducted to compare the efficacy of LOD versus continuation of CC up to six further cycles in PCOS patients who failed to achieve pregnancy despite the previous successful CC induced ovulation. One hundred and seventy six infertile women with CC failure PCOS were selected in this randomized controlled trial. Patients (n = 87) underwent LOD with 6 months follow-up or received CC (n = 89) up to six cycles. Outcome measures were; clinical pregnancy rate, midcycle endometrial thickness, cycle length, miscarriage and live birth rates. The clinical pregnancy rate per patient and the cumulative pregnancy rate after six cycles were comparable in both groups (39 vs. 33.7% and 47 vs. 39.2%, respectively). Four twin pregnancies occurred in CC group and none in LOD group and the difference was statistically significant (p < 0.05). No significant difference in midcycle endometrial thickness was observed (8.8 ± 1.2 mm vs. 7.7 ± 1.1 mm). Improvement in cycle length, miscarriage and live birth rates were comparable in both groups. No cases of ovarian hyperstimulation syndrome occurred in either group. LOD during the 6 months follow-up period and CC for up to six further cycles are equally effective for achieving pregnancy in CC failure PCOS patients.

Investigation of neutrophil-to-lymphocyte ratio and mean platelet volume in sudden hearing loss,

Directory of Open Access Journals (Sweden)

Rauf Oguzhan Kum

2015-12-01

Full Text Available ABSTRACT INTRODUCTION: Several theories attempt to explain the pathophysiology of sudden hearing loss. OBJECTIVE: The objective of this study was to investigate the possible role of inflammation and atherothrombosis in sudden hearing loss patients through the neutrophil-to-lymphocyte ratio and mean platelet volume. METHODS: Study design - retrospective cross-sectional historical cohort. This study was conducted on two groups: one with 59 individuals diagnosed with sudden hearing loss, and other with 59 healthy individuals with the same characteristics of gender and age distribution, neutrophil-to-lymphocyte ratio and mean platelet volume levels were measured in patients diagnosed with sudden hearing loss as well as in the control group, and it was verified whether these results interfered for a better or worse prognosis with treatment of sudden deafness. RESULTS: Neutrophil-to-lymphocyte ratio levels are much higher in patients diagnosed with sudden hearing loss compared to the control group. Similarly, mean levels of neutrophil-to-lymphocyte ratio are higher in non-recovered versus recovered patients (p = 0.001. However, we could not find a correlation with mean platelet volume levels (p > 0.05. CONCLUSION: Neutrophil-to-lymphocyte ratio is a quick and reliable indicator regarding diagnosis and prognosis of sudden hearing loss; on the other hand, mean platelet volume may be considered a less important indicator in this aspect.

Cardiac symptoms before sudden cardiac death caused by coronary artery disease

DEFF Research Database (Denmark)

Jabbari, Reza; Risgaard, Bjarke; Holst, Anders G

2013-01-01

The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD).......The aim of this nationwide case-control study was to identify and characterise symptoms before sudden death of young persons who had died due to coronary artery disease (CAD)....

Analysis of non simultaneous common mode failures. Application to the reliability assessment of the decay heat removal of the RNR 1500 project

International Nuclear Information System (INIS)

Natta, M.; Bloch, M.

1991-01-01

The experience with the LMFBR PHENIX has shown many cases of failures on identical and redundant components, which were close in time but not simultaneous and due to the same causes such as a design error, an unappropriate material, corrosion, ... Since the decay heat removal (DHR) must be assured for a long period after shutdown of the reactor, the overall reliability of the DHR system depends much on this type of successive failures by common mode causes, for which the usual β factor methods are not appropriate since they imply that the several failures are simultaneous. In this communication, two methods will be presented. The first one was used to assess the reliability of the DHR system of the RNR 1500 project. In this method, one modelize the occurrence of successive failures on n identical files by a sudden jump of the failure rate from the value λ attributed to the first failure to the value λ' attributed to the (n-1) still available files. This method leads to a quite natural quantification of the interest of diversity for highly redundant systems. For the RNR 1500 project where, in case of the loss of normal DHR path through the steam generators, the decay heat is removed by four separated sodium loops of 26 MW unit capacity in forced convection, the probabilistic assessment shows that it is necessary to diversify the sodium-sodium heat exchanger in order to fullfil the upper limit of 10 -7 /year for the probability of failure of DHR. A separate assessment for the main sequence leading to DHR loss was performed using a different method in which the successive failures are interpreted as a premature end of life, the lifetimes being directly used as random variables. This Monte-Carlo type method, which can be applied to any type of lifetime distribution, leads to results consistent to those obtained with the first one

Delayed Repolarization Underlies Ventricular Arrhythmias in Rats With Heart Failure and Preserved Ejection Fraction.

Science.gov (United States)

Cho, Jae Hyung; Zhang, Rui; Kilfoil, Peter J; Gallet, Romain; de Couto, Geoffrey; Bresee, Catherine; Goldhaber, Joshua I; Marbán, Eduardo; Cingolani, Eugenio

2017-11-21

Heart failure with preserved ejection fraction (HFpEF) represents approximately half of heart failure, and its incidence continues to increase. The leading cause of mortality in HFpEF is sudden death, but little is known about the underlying mechanisms. Dahl salt-sensitive rats were fed a high-salt diet (8% NaCl) from 7 weeks of age to induce HFpEF (n=38). Rats fed a normal-salt diet (0.3% NaCl) served as controls (n=13). Echocardiograms were performed to assess systolic and diastolic function from 14 weeks of age. HFpEF-verified and control rats underwent programmed electrical stimulation. Corrected QT interval was measured by surface ECG. The mechanisms of ventricular arrhythmias (VA) were probed by optical mapping, whole-cell patch clamp to measure action potential duration and ionic currents, and quantitative polymerase chain reaction and Western blotting to investigate changes in ion channel expression. After 7 weeks of a high-salt diet, 31 of 38 rats showed diastolic dysfunction and preserved ejection fraction along with signs of heart failure and hence were diagnosed with HFpEF. Programmed electric stimulation demonstrated increased susceptibility to VA in HFpEF rats ( P hearts demonstrated prolonged action potentials ( P hearts. Susceptibility to VA was markedly increased in rats with HFpEF. Underlying abnormalities include QT prolongation, delayed repolarization from downregulation of potassium currents, and multiple reentry circuits during VA. Our findings are consistent with the hypothesis that potassium current downregulation leads to abnormal repolarization in HFpEF, which in turn predisposes to VA and sudden cardiac death. © 2017 American Heart Association, Inc.

Numerical Investigation of Pressure Losses in Axisymmetric Sudden Expansion with a Chamfer

Energy Technology Data Exchange (ETDEWEB)

Bae, Youngmin; Kim, Youngin; Kim, Keung Koo [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2014-05-15

In this paper, the pressure losses through axisymmetric sudden expansions with a chamfer are analyzed by means of numerical simulation, with an emphasis on the effect of the Reynolds number. In this study, we investigate numerically the turbulent flow in axisymmetric sudden expansions having a slight chamfer on the edge. With the aim of investigating the impact of Reynolds number on the expansion losses in a time-averaged sense, an extensive set of simulations is carried out. On the basis of numerical results, we also propose a general correlation to estimate the local loss coefficient in sudden expansions with a chamfer.

Numerical Investigation of Pressure Losses in Axisymmetric Sudden Expansion with a Chamfer

International Nuclear Information System (INIS)

Bae, Youngmin; Kim, Youngin; Kim, Keung Koo

2014-01-01

In this paper, the pressure losses through axisymmetric sudden expansions with a chamfer are analyzed by means of numerical simulation, with an emphasis on the effect of the Reynolds number. In this study, we investigate numerically the turbulent flow in axisymmetric sudden expansions having a slight chamfer on the edge. With the aim of investigating the impact of Reynolds number on the expansion losses in a time-averaged sense, an extensive set of simulations is carried out. On the basis of numerical results, we also propose a general correlation to estimate the local loss coefficient in sudden expansions with a chamfer

F-MARC: promoting the prevention and management of sudden cardiac arrest in football.

Science.gov (United States)

Kramer, Efraim Benjamin; Dvorak, J; Schmied, C; Meyer, T

2015-05-01

Sudden cardiac death is the most common cause of unnatural death in football. To prevent and urgently manage sudden cardiac arrest on the football field-of-play, F-MARC (FIFA Medical and Research Centre) has been fully committed to a programme of research, education, standardisation and practical implementation. This strategy has detected football players at medical risk during mandatory precompetition medical assessments. Additionally, FIFA has (1) sponsored internationally accepted guidelines for the interpretation of an athlete's ECG, (2) developed field-of-play-specific protocols for the recognition, response, resuscitation and removal of a football player having sudden cardiac arrest and (3) introduced and distributed the FIFA medical emergency bag which has already resulted in the successful resuscitation of a football player who had a sudden cardiac arrest on the field-of-play. Recently FIFA, in association with the Institute of Sports and Preventive Medicine in Saarbrücken, Germany, established a worldwide Sudden Death Registry with a view to documenting fatal events on the football field-of-play. These activities by F-MARC are testimony to FIFA's continued commitment to minimising sudden cardiac arrest while playing football. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Sudden infant death syndrome, childhood thrombosis, and presence of genetic risk factors for thrombosis

DEFF Research Database (Denmark)

Larsen, T B; Nørgaard-Pedersen, B; Banner, Jytte

2000-01-01

in the child. This prompted us to investigate these genetic markers of thromboembolic disease in 121 cases of sudden infant death syndrome and in relevant controls, in the expectation of a more frequent occurrence of these markers if thrombosis is an etiological factor in sudden infant death syndrome......Sudden infant death syndrome or "cot death" has until the late eighties been a significant cause of death in children between the ages of 1 month and 1 year. Approximately two per 1000 children born alive dies of sudden infant death syndrome each year in Western Europe, North America, and Australia....... The vulnerability of the infant brain stem to ischemia has been suggested to be a conceivable cause of sudden infant death syndrome. This is compatible with a hypothesis that genetic risk factors for cerebral thrombosis could cause microinfarction in the brain stem during the first month of life, affecting vital...

Evaluation of Bearing Capacity of Strip Footing Using Random Layers Concept

Directory of Open Access Journals (Sweden)

Kawa Marek

2015-09-01

Full Text Available The paper deals with evaluation of bearing capacity of strip foundation on random purely cohesive soil. The approach proposed combines random field theory in the form of random layers with classical limit analysis and Monte Carlo simulation. For given realization of random the bearing capacity of strip footing is evaluated by employing the kinematic approach of yield design theory. The results in the form of histograms for both bearing capacity of footing as well as optimal depth of failure mechanism are obtained for different thickness of random layers. For zero and infinite thickness of random layer the values of depth of failure mechanism as well as bearing capacity assessment are derived in a closed form. Finally based on a sequence of Monte Carlo simulations the bearing capacity of strip footing corresponding to a certain probability of failure is estimated. While the mean value of the foundation bearing capacity increases with the thickness of the random layers, the ultimate load corresponding to a certain probability of failure appears to be a decreasing function of random layers thickness.

Stripper foil failure modes and cures at the Oak Ridge Spallation Neutron Source

Directory of Open Access Journals (Sweden)

M. A. Plum

2011-03-01

Full Text Available The Oak Ridge Spallation Neutron Source comprises a 1 GeV, 1.5 MW linear accelerator followed by an accumulator ring and a liquid mercury target. To manage the beam loss caused by the H^{0} excited states created during the H^{-} charge-exchange injection into the accumulator ring, the stripper foil is located inside one of the chicane dipoles. This has some interesting consequences that were not fully appreciated until the beam power reached about 840 kW. One consequence was sudden failure of the stripper foil system due to convoy electrons stripped from the incoming H^{-} beam, which circled around to strike the foil bracket and cause bracket failure. Another consequence is that convoy electrons can reflect back up from the electron catcher and strike the foil and bracket. An additional contributor to foil system failure is vacuum breakdown due to the charge developed on the foil by secondary electron emission. In this paper we detail these and other interesting failure mechanisms and describe the improvements we have made to mitigate them.

Sudden unexplained death in childhood. An audit of the quality of Autopsy reporting

LENUS (Irish Health Repository)

Treacy, A

2013-03-01

Cases of sudden unexplained death in childhood (SUDC) in Ireland in children aged >1year and <5 years were examined in order to assess the quality of autopsy reporting. All SUDC cases are notified to and documented by the National Sudden Infant Death Register (NSIDR) in Ireland along with all cases of sudden infant death syndrome (SIDS) referring to sudden infant deaths less than one year of age. The database of the NSIDR in Ireland was interrogated and cases of SIDS and SUDC were compared over a fifteen-year period (1995-2009). SIDS cases whose autopsies were conducted in the same hospital in the same year as the index SUDC case were used for comparison. The autopsy report for each case was examined and modified Rushton(MR) scores 1\\r\

BDD-based reliability evaluation of phased-mission systems with internal/external common-cause failures

International Nuclear Information System (INIS)

Xing, Liudong; Levitin, Gregory

2013-01-01

Phased-mission systems (PMS) are systems in which multiple non-overlapping phases of operations (or tasks) are accomplished in sequence for a successful mission. Examples of PMS abound in applications such as aerospace, nuclear power, and airborne weapon systems. Reliability analysis of a PMS must consider statistical dependence across different phases as well as dynamics in system configuration, failure criteria, and component behavior. This paper proposes a binary decision diagrams (BDD) based method for the reliability evaluation of non-repairable binary-state PMS with common-cause failures (CCF). CCF are simultaneous failure of multiple system elements, which can be caused by some external factors (e.g., lightning strikes, sudden changes in environment) or by propagated failures originating from some elements within the system. Both the external and internal CCF is considered in this paper. The proposed method is combinatorial, exact, and is applicable to PMS with arbitrary system structures and component failure distributions. An example with different CCF scenarios is analyzed to illustrate the application and advantages of the proposed method. -- Highlights: ► Non-repairable phased-mission systems with common-cause failures are analyzed. ► Common-cause failures caused by internal or external factors are considered. ► A combinatorial algorithm based on binary decision diagrams is suggested

The most common cause of sudden cardiac death in athletes

Directory of Open Access Journals (Sweden)

Topalović Nikola

2016-01-01

Full Text Available The positive impact of exercise on cardiovascular health is well known. Athletes, who are constantly physically active, are considered to be the healthiest members of our society. That is why their sudden death, during the training or competition, attracts the attention of the general public. Rarely, tragic events of sudden cardiac death (SCD are the reason for questioning if by many positive there are also negative impact of physical exercise. The first case of SCD is recorded as far back as the year 490 BC, when the Greek soldier Pheidippides died after he conveyed news of the great victory of the Greeks over the Persians. Risk of SCD is recognized in the middle of the twentieth century. In our region, discussion about this issue began after the World Basketball Championship, which was held in Ljubljana in 1970, because of the sudden death of the national team member Trajko Rajkovic. One of the important goals of modern sports medicine is to reduce the risk of SCD in athletes to 'inevitable rarity'. Definition of SCD is considered to be any unexpected death due to sudden cardiac arrest. Pedo (Pedoe has divided all causes of SCD in the sport into three categories: Commotio cordis (agitation of the heart, which results from blunt impact to the athletes chest with consequent fatal disorder of heart rhythm; SCD of athletes under the age of 35 because of structural, congenital and inflammatory heart disease, which includes hypertrophic cardiomyopathy as the most important cause of sudden cardiac death, congenital anomalies of the coronary arteries, arrhythmogenic right ventricular cardiomyopathy, myocarditis and other; SCD of athletes older than 35 years which is most common due coronary artery disease - atherosclerosis (the dominant risk in the marathon and half-marathon. .

A 23-year review of sudden natural death autopsies in the Niger ...

African Journals Online (AJOL)

Background: Death occurring suddenly especially when the victim was active and recently fit, call for attention and thorough investigation to rule out secret homicide. Aim: To study the pattern of sudden natural death in the Niger Delta region of Nigeria. Methodology: The coroner's autopsy reports and hospital autopsy ...

Sudden death in the first 2 years of life following immunization in the Republic of Korea.

Science.gov (United States)

Choe, Young June; Kim, Jong-Hee; Son, Hyun Jin; Bae, Geun-Ryang; Lee, Duk-hyoung

2012-12-01

Because the peak age for incidence of sudden deaths in infancy temporally coincides with the age of infant primary immunization, some have raised the question as to whether immunization is a risk factor for sudden death in infancy. Recent occurrence of two sudden deaths in infants in Korea has renewed concerns about the causal association between immunization and sudden deaths in infants. We carried out a retrospective review of data from the Korea Centers for Disease Control and Prevention Adverse Events Following Immunization Surveillance System and Vaccine Compensation programs. From 1994 to 2011, a total of 45 cases of sudden deaths in the first 2 years of life following immunization were reported in Korea. The causes of death were classified as follows: infectious diseases (n= 13); accidental injuries (n= 7); congenital abnormalities (n= 2); and malignancy (n= 1). Of 20 sudden deaths in infancy, nine deaths met Brighton Collaboration case definition level I and II, and therefore were classified as possible sudden infant death syndrome cases. Hepatitis B vaccine (n= 13) was the most frequent vaccine with temporal association with sudden deaths in the first 2 years of life. Few sudden deaths in the first 2 years of life following immunization have been reported, despite the use of universal immunization in Korea. The majority of deaths in infancy did not meet case definition for sudden infant death syndrome. Encouraging investigators to perform thorough investigation, including postmortem autopsy and death scene examination, may promote data comparability and provide guidance on decision-making in the vaccine-safety monitoring and response system in Korea. © 2012 The Authors. Pediatrics International © 2012 Japan Pediatric Society.

Drug Concentration Thresholds Predictive of Therapy Failure and Death in Children With Tuberculosis: Bread Crumb Trails in Random Forests.

Science.gov (United States)

Swaminathan, Soumya; Pasipanodya, Jotam G; Ramachandran, Geetha; Hemanth Kumar, A K; Srivastava, Shashikant; Deshpande, Devyani; Nuermberger, Eric; Gumbo, Tawanda

2016-11-01

 The role of drug concentrations in clinical outcomes in children with tuberculosis is unclear. Target concentrations for dose optimization are unknown.  Plasma drug concentrations measured in Indian children with tuberculosis were modeled using compartmental pharmacokinetic analyses. The children were followed until end of therapy to ascertain therapy failure or death. An ensemble of artificial intelligence algorithms, including random forests, was used to identify predictors of clinical outcome from among 30 clinical, laboratory, and pharmacokinetic variables.  Among the 143 children with known outcomes, there was high between-child variability of isoniazid, rifampin, and pyrazinamide concentrations: 110 (77%) completed therapy, 24 (17%) failed therapy, and 9 (6%) died. The main predictors of therapy failure or death were a pyrazinamide peak concentration <38.10 mg/L and rifampin peak concentration <3.01 mg/L. The relative risk of these poor outcomes below these peak concentration thresholds was 3.64 (95% confidence interval [CI], 2.28-5.83). Isoniazid had concentration-dependent antagonism with rifampin and pyrazinamide, with an adjusted odds ratio for therapy failure of 3.00 (95% CI, 2.08-4.33) in antagonism concentration range. In regard to death alone as an outcome, the same drug concentrations, plus z scores (indicators of malnutrition), and age <3 years, were highly ranked predictors. In children <3 years old, isoniazid 0- to 24-hour area under the concentration-time curve <11.95 mg/L × hour and/or rifampin peak <3.10 mg/L were the best predictors of therapy failure, with relative risk of 3.43 (95% CI, .99-11.82).  We have identified new antibiotic target concentrations, which are potential biomarkers associated with treatment failure and death in children with tuberculosis. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Genetic mutation in Korean patients of sudden cardiac arrest as a surrogating marker of idiopathic ventricular arrhythmia.

Science.gov (United States)

Son, Myoung Kyun; Ki, Chang-Seok; Park, Seung-Jung; Huh, June; Kim, June Soo; On, Young Keun

2013-07-01

Mutation or common intronic variants in cardiac ion channel genes have been suggested to be associated with sudden cardiac death caused by idiopathic ventricular tachyarrhythmia. This study aimed to find mutations in cardiac ion channel genes of Korean sudden cardiac arrest patients with structurally normal heart and to verify association between common genetic variation in cardiac ion channel and sudden cardiac arrest by idiopathic ventricular tachyarrhythmia in Koreans. Study participants were Korean survivors of sudden cardiac arrest caused by idiopathic ventricular tachycardia or fibrillation. All coding exons of the SCN5A, KCNQ1, and KCNH2 genes were analyzed by Sanger sequencing. Fifteen survivors of sudden cardiac arrest were included. Three male patients had mutations in SCN5A gene and none in KCNQ1 and KCNH2 genes. Intronic variant (rs2283222) in KCNQ1 gene showed significant association with sudden cardiac arrest (OR 4.05). Four male sudden cardiac arrest survivors had intronic variant (rs11720524) in SCN5A gene. None of female survivors of sudden cardiac arrest had SCN5A gene mutations despite similar frequencies of intronic variants between males and females in 55 normal controls. Common intronic variant in KCNQ1 gene is associated with sudden cardiac arrest caused by idiopathic ventricular tachyarrhythmia in Koreans.

Tympanotomy and sealing of the round window for treatment of sudden deafness

DEFF Research Database (Denmark)

Ul-Mulk, Jamshaid; Friis, Søren; Hahn, Christoffer Holst

2011-01-01

The objective of this study was to evaluate the effectiveness of explorative tympanotomy and sealing of the round window in patients diagnosed with sudden deafness.......The objective of this study was to evaluate the effectiveness of explorative tympanotomy and sealing of the round window in patients diagnosed with sudden deafness....

Systematic review of the incidence of sudden cardiac death in the United States.

Science.gov (United States)

Kong, Melissa H; Fonarow, Gregg C; Peterson, Eric D; Curtis, Anne B; Hernandez, Adrian F; Sanders, Gillian D; Thomas, Kevin L; Hayes, David L; Al-Khatib, Sana M

2011-02-15

The need for consistent and current data describing the true incidence of sudden cardiac arrest (SCA) and/or sudden cardiac death (SCD) was highlighted during the most recent Sudden Cardiac Arrest Thought Leadership Alliance's (SCATLA) Think Tank meeting of national experts with broad representation of key stakeholders, including thought leaders and representatives from the American College of Cardiology, American Heart Association, and the Heart Rhythm Society. As such, to evaluate the true magnitude of this public health problem, we performed a systematic literature search in MEDLINE using the MeSH headings, "death, sudden" OR the terms "sudden cardiac death" OR "sudden cardiac arrest" OR "cardiac arrest" OR "cardiac death" OR "sudden death" OR "arrhythmic death." Study selection criteria included peer-reviewed publications of primary data used to estimate SCD incidence in the U.S. We used Web of Science's Cited Reference Search to evaluate the impact of each primary estimate on the medical literature by determining the number of times each "primary source" has been cited. The estimated U.S. annual incidence of SCD varied widely from 180,000 to >450,000 among 6 included studies. These different estimates were in part due to different data sources (with data age ranging from 1980 to 2007), definitions of SCD, case ascertainment criteria, methods of estimation/extrapolation, and sources of case ascertainment. The true incidence of SCA and/or SCD in the U.S. remains unclear, with a wide range in the available estimates that are badly dated. As reliable estimates of SCD incidence are important for improving risk stratification and prevention, future efforts are clearly needed to establish uniform definitions of SCA and SCD and then to prospectively and precisely capture cases of SCA and SCD in the overall U.S. population. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Compounds from multilayer plastic bags cause reproductive failures in artificial insemination.

Science.gov (United States)

Nerin, C; Ubeda, J L; Alfaro, P; Dahmani, Y; Aznar, M; Canellas, E; Ausejo, R

2014-05-09

High levels of reproductive failure were detected in some Spanish sow farms in the Spring of 2010. Regular returns to estrus and variable reductions in litter size were observed. The problem started suddenly and did not appear to be related to the quality of the ejaculates, disease, alterations of body condition or any other apparent reasons. Subsequent studies determined that the problem was the origin of the plastic bags used for semen storage. Chemical analysis of the suspicious bags identified unexpected compounds such as BADGE, a cyclic lactone and an unknown phthalate that leached into the semen at concentrations of 0.2 to 2.5 mg/L. Spermatozoa preserved in these bags passed all of the routine quality control tests, and no differences were observed between storage in the control and suspicious bags (p > 0.05). In vitro fecundation tests and endocrine profiler panel analysis (EPP) did not show any alterations, whereas the in vivo tests confirmed the described failure. This is the first described relationship between reproductive failure and toxic compounds released from plastic bags.

Compounds from multilayer plastic bags cause reproductive failures in artificial insemination

Science.gov (United States)

Nerin, C.; Ubeda, J. L.; Alfaro, P.; Dahmani, Y.; Aznar, M.; Canellas, E.; Ausejo, R.

2014-05-01

High levels of reproductive failure were detected in some Spanish sow farms in the Spring of 2010. Regular returns to estrus and variable reductions in litter size were observed. The problem started suddenly and did not appear to be related to the quality of the ejaculates, disease, alterations of body condition or any other apparent reasons. Subsequent studies determined that the problem was the origin of the plastic bags used for semen storage. Chemical analysis of the suspicious bags identified unexpected compounds such as BADGE, a cyclic lactone and an unknown phthalate that leached into the semen at concentrations of 0.2 to 2.5 mg/L. Spermatozoa preserved in these bags passed all of the routine quality control tests, and no differences were observed between storage in the control and suspicious bags (p > 0.05). In vitro fecundation tests and endocrine profiler panel analysis (EPP) did not show any alterations, whereas the in vivo tests confirmed the described failure. This is the first described relationship between reproductive failure and toxic compounds released from plastic bags.

Sudden Oak Death - Eastern (Pest Alert)

Science.gov (United States)

Joseph O' Brien; Manfred Mielke; Steve Oak; Bruce Moltzan

2002-01-01

A phenomenon known as Sudden Oak Death was first reported in 1995 in central coastal California. Since then, tens of thousands of tanoaks (Lithocarpus densiflorus), coast live oaks (Quercus agrifolia), and California black oaks (Quercus kelloggii) have been killed by a newly identified fungus, Phytophthora ramorum. On these hosts, the fungus causes a bleeding canker on...

Nationwide survey of rotavirus-associated encephalopathy and sudden unexpected death in Japan.

Science.gov (United States)

Kawamura, Yoshiki; Ohashi, Masahiro; Ihira, Masaru; Hashimoto, Shuji; Taniguchi, Koki; Yoshikawa, Tetsushi

2014-08-01

Rotavirus can cause severe complications such as encephalopathy/encephalitis and sudden unexpected death. The incidence of rotavirus-associated encephalopathy/encephalitis or sudden unexpected death remains unknown. To clarify the clinical features of rotavirus-associated encephalitis/encephalopathy and sudden unexpected death, we conducted a nationwide survey in Japan. A two-part questionnaire was designed to determine the number of the cases and the clinical features of severe cases of rotavirus infection, including encephalitis/encephalopathy and sudden unexpected death, between 2009 and 2011. Of the 1365 questionnaires sent to hospitals, 963 (70.5%) were returned and eligible for analysis. We determined 58 cases of rotavirus-associated encephalitis/encephalopathy and 7 cases of sudden unexpected death. These patients were diagnosed with rotavirus infection by immunochromatography. Although 36/58 (62.1%) encephalitis/encephalopathy patients had no sequelae, 15/58 (25.9%) patients had neurological sequelae, and 7/58 (12.1%) patients had fatal outcomes. Pleocytosis was observed in 9/40 (22.5%) patients and cerebrospinal fluid protein levels were elevated in only 4/40 (10%) patients. Elevated lactate dehydrogenase (LDH) (>500 IU/L) or acidemia (pHdeath were 44.0 and 4.9 cases in Japan, respectively. Elevated LDH (>500 IU/L) or acidemia (pH<7.15) were related to a poor prognosis of the encephalitis/encephalopathy. Copyright © 2013 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Is there an association between depression and cardiovascular mortality or sudden death?

Science.gov (United States)

Alboni, Paolo; Favaron, Elisa; Paparella, Nelly; Sciammarella, Massimo; Pedaci, Mario

2008-04-01

The results of many studies and recent meta-analyses strongly suggest that depression is a risk factor for total and cardiovascular mortality, both in the general population and in patients with known heart disease. By contrast, the association between depression and sudden death or cardiac arrest has received little attention. This issue has been investigated in three recent studies; two were carried out in the general population and showed depression to be a independent risk factor for sudden death. The other study was carried out in patients with acute myocardial infarction (AMI); the adjusted relative risk (RR) of sudden death was significantly increased in depressed patients but, after adjustment for dyspnea/fatigue (a common symptom for heart disease and depression), the RR was no longer statistically significant. However, when the cognitive-affective depressive symptoms were examined separately from the somatic ones (dyspnea/fatigue, etc.), there was a clear trend for an association between cognitive-affective symptoms and sudden death. Because a risk factor can be defined as 'independent' only in a multivariate analysis in which variables are dichotomized, the presence of common symptoms between heart disease and depression represents a very difficult problem. However, taken together, the results of studies carried out in the general population and in patients with AMI strongly suggest that depression is a significant risk factor for sudden death.

The hot (invisible?) hand: can time sequence patterns of success/failure in sports be modeled as repeated random independent trials?

Science.gov (United States)

Yaari, Gur; Eisenmann, Shmuel

2011-01-01

The long lasting debate initiated by Gilovich, Vallone and Tversky in [Formula: see text] is revisited: does a "hot hand" phenomenon exist in sports? Hereby we come back to one of the cases analyzed by the original study, but with a much larger data set: all free throws taken during five regular seasons ([Formula: see text]) of the National Basketball Association (NBA). Evidence supporting the existence of the "hot hand" phenomenon is provided. However, while statistical traces of this phenomenon are observed in the data, an open question still remains: are these non random patterns a result of "success breeds success" and "failure breeds failure" mechanisms or simply "better" and "worse" periods? Although free throws data is not adequate to answer this question in a definite way, we speculate based on it, that the latter is the dominant cause behind the appearance of the "hot hand" phenomenon in the data.

[Ultrafiltration versus intravenous diuretics in decompensated heart failure: a meta-analysis of randomized controlled trials].

Science.gov (United States)

Zhao, Yu-liang; Zhang, Ling; Yang, Ying-ying; Tang, Yi; Liu, Fang; Fu, Ping

2013-08-13

To explore whether ultrafiltration is superior to intravenous diuretics in ameliorating fluid overload and preserving renal functions in decompensated heart failure patients. By searching in Pubmed, Cochrane Library, Embase, Springer, WanFang, CQVIP, CNKI and CBM database as well as related Chinese journals, qualified randomized controlled trials (RCTs) were included for meta-analysis by Revman 5.0 and STATA 10.0. Six RCTs were included with 241 patients in ultrafiltration group and 240 patients in intravenous diuretics group. Pooled analyses demonstrated ultrafiltration was superior to intravenous diuretics in the aspects of weight loss (WMD = 1.44 kg, 95%CI:0.33-2.55 kg, P = 0.01) and fluid removal (WMD = 1.23 kg, 95%CI:0.63-1.82 kg, P diuretics in mitigating fluid overload. No intergroup difference was observed in renal function preservation, mortality or rehospitalization.

Sudden viscous dissipation in compressing plasma turbulence

Science.gov (United States)

Davidovits, Seth; Fisch, Nathaniel

2015-11-01

Compression of a turbulent plasma or fluid can cause amplification of the turbulent kinetic energy, if the compression is fast compared to the turnover and viscous dissipation times of the turbulent eddies. The consideration of compressing turbulent flows in inviscid fluids has been motivated by the suggestion that amplification of turbulent kinetic energy occurred on experiments at the Weizmann Institute of Science Z-Pinch. We demonstrate a sudden viscous dissipation mechanism whereby this amplified turbulent kinetic energy is rapidly converted into thermal energy, which further increases the temperature, feeding back to further enhance the dissipation. Application of this mechanism in compression experiments may be advantageous, if the plasma can be kept comparatively cold during much of the compression, reducing radiation and conduction losses, until the plasma suddenly becomes hot. This work was supported by DOE through contract 67350-9960 (Prime # DOE DE-NA0001836) and by the DTRA.

How far is it to a sudden future singularity of pressure?

International Nuclear Information System (INIS)

DaPbrowski, Mariusz P.; Denkiewicz, Tomasz; Hendry, Martin A.

2007-01-01

We discuss the constraints coming from current observations of type Ia supernovae on cosmological models which allow sudden future singularities of pressure (with the scale factor and the energy density regular). We show that such a sudden singularity may happen in the very near future (e.g. within 10x10 6 years) and its prediction at the present moment of cosmic evolution cannot be distinguished, with current observational data, from the prediction given by the standard quintessence scenario of future evolution. Fortunately, sudden future singularities are characterized by a momentary peak of infinite tidal forces only; there is no geodesic incompleteness, which means that the evolution of the universe may eventually be continued throughout until another 'more serious' singularity such as a big crunch or big rip

Sudden unexpected death due to Graves' disease during physical altercation.

Science.gov (United States)

Wei, Dengming; Yuan, Xiaogang; Yang, Tiantong; Chang, Lin; Zhang, Xiang; Burke, Allen; Fowler, David; Li, Ling

2013-09-01

We report a case of a 30-year-old woman who suddenly collapsed after having a physical altercation with her husband. Despite immediate resuscitation, she died on arrival at the hospital. The victim's parents requested an autopsy because they believed that their daughter was killed by her husband. Postmortem examination revealed that the victim had a diffusely enlarged thyroid gland and cardiomegaly with left ventricular hypertrophy. There was no evidence of significant trauma on the body. Further postmortem thyroid function tests and review of her medical history indicated that her death was due to Graves' disease. To the best of our knowledge, this is the first case reported of sudden death due to cardiac arrhythmia from Graves' disease induced by physical and emotional stress associated with the criminal activity of another person. The autopsy findings are described. In addition, the literature is reviewed and the significance of postmortem evaluation of thyroid hormones in the cases of sudden death is discussed. © 2013 American Academy of Forensic Sciences.

Cardiac Channelopathies and Sudden Death: Recent Clinical and Genetic Advances.

Science.gov (United States)

Fernández-Falgueras, Anna; Sarquella-Brugada, Georgia; Brugada, Josep; Brugada, Ramon; Campuzano, Oscar

2017-01-29

Sudden cardiac death poses a unique challenge to clinicians because it may be the only symptom of an inherited heart condition. Indeed, inherited heart diseases can cause sudden cardiac death in older and younger individuals. Two groups of familial diseases are responsible for sudden cardiac death: cardiomyopathies (mainly hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic cardiomyopathy) and channelopathies (mainly long QT syndrome, Brugada syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia). This review focuses on cardiac channelopathies, which are characterized by lethal arrhythmias in the structurally normal heart, incomplete penetrance, and variable expressivity. Arrhythmias in these diseases result from pathogenic variants in genes encoding cardiac ion channels or associated proteins. Due to a lack of gross structural changes in the heart, channelopathies are often considered as potential causes of death in otherwise unexplained forensic autopsies. The asymptomatic nature of channelopathies is cause for concern in family members who may be carrying genetic risk factors, making the identification of these genetic factors of significant clinical importance.

Effect of random edge failure on the average path length

Energy Technology Data Exchange (ETDEWEB)

Guo Dongchao; Liang Mangui; Li Dandan; Jiang Zhongyuan, E-mail: mgliang58@gmail.com, E-mail: 08112070@bjtu.edu.cn [Institute of Information Science, Beijing Jiaotong University, 100044, Beijing (China)

2011-10-14

We study the effect of random removal of edges on the average path length (APL) in a large class of uncorrelated random networks in which vertices are characterized by hidden variables controlling the attachment of edges between pairs of vertices. A formula for approximating the APL of networks suffering random edge removal is derived first. Then, the formula is confirmed by simulations for classical ER (Erdoes and Renyi) random graphs, BA (Barabasi and Albert) networks, networks with exponential degree distributions as well as random networks with asymptotic power-law degree distributions with exponent {alpha} > 2. (paper)

[Sudden death from hypoglycemia].

Science.gov (United States)

Asmundo, A; Aragona, M; Gualniera, P; Aragona, F

1995-12-01

The sudden death by hypoglycemia is an aspect of the forensic pathology frequently neglected. Authors initially described the pathogenesis of different hypoglycemia forms, distinguishing the primary ones due to hyperinsulinism and the secondary ones due to functional insufficiency of other organs (hypophysis, thyroid, adrenal gland, liver); after that Authors described three cases of sudden death induced hypoglycemia by hyperinsulinism: two were unweaned with nesidioblastosis and one adolescent. In any form of hypoglycemia the central nervous system damage is present with evident neuronal degenerative-necrotic phenomena, widespread edema with microhemorrhage, swollen and dissociation of myelin sheath, glial cells hyperplasia. Death caused by primary hypoglycemia is histopathologically different from the secondary one because of the maintenance of hepatic glycogen content in the former, that increase in striated muscles, including the heart, in spite of the constant secretion of catecholamine from the adrenal medulla. Glycogen is depleted in secondary hypoglycemia. In the primary form, behind the adrenal medulla hyperfunction, the increased functional activity of the adrenal cortex is moderate, contrasting with the seriousness of the syndrome, due prevalently to inhibit the gluconeogenesis response conditioned by the persistence of stored glycogen in the liver, heart and striated muscles. The rare anoxic processes coming with resynthesis of hepatic glycogen have to be considered in the differential diagnosis. The primary hypoglycemic death, especially in unweaned, is frequently promoted by other processes inducing hypoxia (fetal asphyxia outcome, pneumonia, etc.) or worsening the hypoglycemia (hypothyroidism, etc.). The secondary hypoglycemias are characterized by the normality of exocrine pancreas and by organic alterations that cause glycogen depletion from the liver.

Towards Better Understanding of the Pathogenesis of Neuronal Respiratory Network in Sudden Perinatal Death

Directory of Open Access Journals (Sweden)

Riffat Mehboob

2017-07-01

Full Text Available Sudden perinatal death that includes the victims of sudden infant death syndrome, sudden intrauterine death syndrome, and stillbirth are heartbreaking events in the life of parents. Most of the studies about sudden perinatal death were reported from Italy, highlighting two main etiological factors: prone sleeping position and smoking. Other probable contributory factors are prematurity, male gender, lack of breastfeeding, respiratory tract infections, use of pacifiers, infant botulism, extensive use of pesticides and insecticides, etc. However, extensive studies across the world are required to establish the role of these factors in a different subset of populations. Previous studies confirmed the widely accepted hypothesis that neuropathology of the brainstem is one of the main cause of sudden perinatal death. This study is an effort to summarize the neuropathological evaluation of the brainstems and their association to sudden perinatal death. Brainstem nuclei in vulnerable infants undergo certain changes that may alter the sleep arousal cycle, cardiorespiratory control, and ultimately culminate in death. This review focuses on the roles of different brainstem nuclei, their pathologies, and the established facts in this regard in terms of it’s link to such deaths. This study will also help to understand the role of brainstem nuclei in controlling the cardiorespiratory cycles in sudden perinatal death and may provide a better understanding to resolve the mystery of these deaths in future. It is also found that a global initiative to deal with perinatal death is required to facilitate the diagnosis and prevention in developed and as well as developing countries.

Failure Prediction for Autonomous Driving

OpenAIRE

Hecker, Simon; Dai, Dengxin; Van Gool, Luc

2018-01-01

The primary focus of autonomous driving research is to improve driving accuracy. While great progress has been made, state-of-the-art algorithms still fail at times. Such failures may have catastrophic consequences. It therefore is important that automated cars foresee problems ahead as early as possible. This is also of paramount importance if the driver will be asked to take over. We conjecture that failures do not occur randomly. For instance, driving models may fail more likely at places ...

Utility of Post-Mortem Genetic Testing in Cases of Sudden Arrhythmic Death Syndrome

DEFF Research Database (Denmark)

Lahrouchi, Najim; Raju, Hariharan; Lodder, Elisabeth M

2017-01-01

BACKGROUND: Sudden arrhythmic death syndrome (SADS) describes a sudden death with negative autopsy and toxicological analysis. Cardiac genetic disease is a likely etiology. OBJECTIVES: This study investigated the clinical utility and combined yield of post-mortem genetic testing (molecular autopsy...

Prolonged QTc interval and risk of sudden cardiac death in a population of older adults

DEFF Research Database (Denmark)

Straus, Sabine M J M; Kors, Jan A; De Bruin, Marie L

2006-01-01

OBJECTIVES: This study sought to investigate whether prolongation of the heart rate-corrected QT (QTc) interval is a risk factor for sudden cardiac death in the general population. BACKGROUND: In developed countries, sudden cardiac death is a major cause of cardiovascular mortality. Prolongation...... of the QTc interval has been associated with ventricular arrhythmias, but in most population-based studies no consistent association was found between QTc prolongation and total or cardiovascular mortality. Only very few of these studies specifically addressed sudden cardiac death. METHODS: This study......). The association between a prolonged QTc interval and sudden cardiac death was estimated using Cox proportional hazards analysis. RESULTS: During an average follow-up period of 6.7 years (standard deviation, 2.3 years) 125 patients died of sudden cardiac death. An abnormally prolonged QTc interval (>450 ms in men...

Current state of the problem sudden infant death at home

OpenAIRE

Berlay Margarita Vasilievna; Kopylov Anatoliy Vasilievich; Karpov Sergey Mikhailovich

2017-01-01

The “Sudden Infant Death Syndrome” stands for unexpected nonviolent death of apparently healthy chest age child when there is no history or pathomorphological features which can be adequate explanations for death reasons. In Russian Federation, the death rate from this syndrome in the range of 0,06 to 2,8 per 1000 live births. In Stavropol region, average figures are equal to 0,36 per 1000 live births in the period of 2005–2014. Rates of incidence sudden infant death syndrome are similar to t...

[Idiopathic sudden deafness: a report of 96 patients].

Science.gov (United States)

Gabanou, F; Bera, G; Vincent, C

2012-01-01

Evaluation of the management of idiopathic sudden deafness indicating the usefulness of biological assessments and the pronostic factors of hearing recovery. This is a retrospective study of 96 patients with idiopathic sudden deafness referred to a tertiary centre between 2005 and 2009 treated with corticosteroids intravenously at a daily dose of 1 mg/kg. Mean tonal thresholds were assessed (PTA = [500 Hz + 1000 Hz + 2000 Hz + 4000 Hz]/4). Each audiogram was classified as five classes according to its frequency profile. The hearing recovery is significant between D0-D5 and D5-M1 for the frequencies 0.5, 1 and 2 kHz. For 4 kHz, the recovery is significant between 0 and J5. There is no statistically significant correlation between the presence of associated signs (tinnitus, vertigo) and hearing recovery. Hearing recovery according to the five types of audiograms has the same evolution in the follow-up time but with audiograms type E (cophosis or subcophosis) often associated with an hyporeactivity at the videonystagmography. The presence of cardiovascular disease is a predictor of poor hearing recovery. The usefullness of systematic extensive blood tests is low. In sudden deafness, the maximum hearing recovery takes place in the month following the onset of symptoms. The predictors of poor hearing recovery are an initial mean threshold > 70 dB, the existence of an associated cardiovascular disease.

Utility of Post-Mortem Genetic Testing in Cases of Sudden Arrhythmic Death Syndrome

NARCIS (Netherlands)

Lahrouchi, Najim; Raju, Hariharan; Lodder, Elisabeth M.; Papatheodorou, Efstathios; Ware, James S.; Papadakis, Michael; Tadros, Rafik; Cole, Della; Skinner, Jonathan R.; Crawford, Jackie; Love, Donald R.; Pua, Chee J.; Soh, Bee Y.; Bhalshankar, Jaydutt D.; Govind, Risha; Tfelt-Hansen, Jacob; Winkel, Bo G.; van der Werf, Christian; Wijeyeratne, Yanushi D.; Mellor, Greg; Till, Jan; Cohen, Marta C.; Tome-Esteban, Maria; Sharma, Sanjay; Wilde, Arthur A. M.; Cook, Stuart A.; Bezzina, Connie R.; Sheppard, Mary N.; Behr, Elijah R.

2017-01-01

Sudden arrhythmic death syndrome (SADS) describes a sudden death with negative autopsy and toxicological analysis. Cardiac genetic disease is a likely etiology. This study investigated the clinical utility and combined yield of post-mortem genetic testing (molecular autopsy) in cases of SADS and

Acute otitis media associated bilateral sudden hearing loss: case report and literature review.

Science.gov (United States)

Smith, A; Gutteridge, I; Elliott, D; Cronin, M

2017-07-01

Sudden sensorineural hearing loss is a rare otological condition with potential for dire outcomes including permanent hearing loss. Although the majority of cases are deemed idiopathic, bilateral sudden sensorineural hearing loss represents a rare subset typically related to systemic conditions, with higher morbidity and mortality. A controversial association with acute otitis media has been reported, with few bilateral cases published in the literature. A very rare case of bilateral sudden sensorineural hearing loss associated with acute otitis media is described, with a review of the literature. The limited evidence available suggests that acute otitis media with tinnitus and/or bacterial pathology may have an increased risk of sudden sensorineural hearing loss, which is consistent with the case described. Although there is no sufficiently powered published evidence to provide definitive treatment guidelines, the literature reviewed suggests that early myringotomy and antibiotics may greatly improve treatment outcomes.

Survival and sudden cardiac death after septal ablation for hypertrophic obstructive cardiomyopathy

DEFF Research Database (Denmark)

Jensen, Morten Kvistholm; Havndrup, Ole; Hassager, Christian

2011-01-01

Reports of long-term survival and the risk of sudden cardiac death (SCD) after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are sparse.......Reports of long-term survival and the risk of sudden cardiac death (SCD) after percutaneous transluminal septal myocardial ablation (PTSMA) in patients with hypertrophic obstructive cardiomyopathy (HOCM) are sparse....

Damage Detection on Sudden Stiffness Reduction Based on Discrete Wavelet Transform

Directory of Open Access Journals (Sweden)

Bo Chen

2014-01-01

Full Text Available The sudden stiffness reduction in a structure may cause the signal discontinuity in the acceleration responses close to the damage location at the damage time instant. To this end, the damage detection on sudden stiffness reduction of building structures has been actively investigated in this study. The signal discontinuity of the structural acceleration responses of an example building is extracted based on the discrete wavelet transform. It is proved that the variation of the first level detail coefficients of the wavelet transform at damage instant is linearly proportional to the magnitude of the stiffness reduction. A new damage index is proposed and implemented to detect the damage time instant, location, and severity of a structure due to a sudden change of structural stiffness. Numerical simulation using a five-story shear building under different types of excitation is carried out to assess the effectiveness and reliability of the proposed damage index for the building at different damage levels. The sensitivity of the damage index to the intensity and frequency range of measurement noise is also investigated. The made observations demonstrate that the proposed damage index can accurately identify the sudden damage events if the noise intensity is limited.

Completion report : Effect of Comprehensive Yogic Breathing program on type 2 diabetes: A randomized control trial

Directory of Open Access Journals (Sweden)

V P Jyotsna

2014-01-01

Full Text Available Background: Yoga has been shown to be benefi cial in diabetes in many studies, though randomized control trials are few. The aim of this randomized control trial was to see the effect of Sudarshan Kriya and related practices (comprehensive yogic breathing program on quality of life, glycemic control, and cardiac autonomic functions in diabetes. Diabetes mellitus is a risk factor for sudden cardiac death. Cardiac autonomic neuropathy has been implicated in the causation of sudden cardiac death. Therefore, a maneuver to prevent progression of cardiac autonomic neuropathy holds signifi cance. Materials and Methods: A total of 120 patients of diabetes on oral medication and diet and exercise advice were randomized into two groups: (1 Continued to receive standard treatment for diabetes. (2 Patients administered comprehensive yogic breathing program and monitored to regularly practice yoga in addition to standard treatment of diabetes. At 6 months, quality of life and postprandial plasma glucose signifi cantly improved in the group practicing yoga compared to baseline, but there was no significant improvement in the fasting plasma glucose and glycated hemoglobin. Results: On per protocol analysis, sympathetic cardiac autonomic functions signifi cantly improved from baseline in the group practicing comprehensive yogic breathing. Conclusion: This randomized control trial points towards the beneficial effect of yogic breathing program in preventing progression of cardiac neuropathy. This has important implications as cardiac autonomic neuropathy has been considered as one of the factors for sudden cardiac deaths.Keywords: comprehensive yogic breathing program, diabetes mellitus, cardiac autonomic function

Back muscle response to sudden trunk loading can be modified by training among healthcare workers

DEFF Research Database (Denmark)

Pedersen, Mogens Theisen; Essendrop, Morten; Skotte, Jørgen H.

2007-01-01

Study Design. Experimental study of the effect of physical training on the reaction to sudden back loading. Objective. To investigate the effect and sustainability of "on the job training" on the reaction to sudden back loading among employees at a geriatric ward. Summary of Background Data...... of the trunk (stopping time). Data on the possibilities of a training-induced improvement in the reflex response among workers exposed to sudden trunk loading on the job are, however, nonexistent, and there is no evidence of long-term benefits, i.e., the sustainability of a positive training effect. Methods....... Available data suggest that a delayed muscle reflex response to sudden trunk loading may increase the risk of low back injuries. We have previously shown that training may alter the response to sudden trunk loading in healthy subjects and decrease the time elapsed until stopping of the forward movement...

Febrile seizures prior to sudden cardiac death

DEFF Research Database (Denmark)

Stampe, Niels Kjær; Glinge, Charlotte; Jabbari, Reza

2018-01-01

Aims: Febrile seizure (FS) is a common disorder affecting 2-5% of children up to 5 years of age. The aim of this study was to determine whether FS in early childhood are over-represented in young adults dying from sudden cardiac death (SCD). Methods and results: We included all deaths (n = 4595...... with FS was sudden arrhythmic death syndrome (5/8; 62.5%). Conclusion: In conclusion, this study demonstrates a significantly two-fold increase in the frequency of FS prior to death in young SCD cases compared with the two control groups, suggesting that FS could potentially contribute in a risk......) nationwide and through review of all death certificates, we identified 245 SCD in Danes aged 1-30 years in 2000-09. Through the usage of nationwide registries, we identified all persons admitted with first FS among SCD cases (14/245; 5.7%) and in the corresponding living Danish population (71 027/2 369 785...

Cardiovascular Risk Factors in Primary Relatives of Sudden Cardiac Death Victims

Science.gov (United States)

1991-01-01

hypertriglyceridemia and hypertension as risk factors in relatives of sudden death victims. The sample for both studies will be the same. 5 Chapter II The...provided most of the research information on SCD. Pathology of Sudden Cardiac Death There appear to be several different pathologic scenarios which render a...had severe two or three vessel disease. By comparison, 100 age matched controls who died of other causes, had a combined 27% incidence of two and

The hot (invisible? hand: can time sequence patterns of success/failure in sports be modeled as repeated random independent trials?

Directory of Open Access Journals (Sweden)

Gur Yaari

Full Text Available The long lasting debate initiated by Gilovich, Vallone and Tversky in [Formula: see text] is revisited: does a "hot hand" phenomenon exist in sports? Hereby we come back to one of the cases analyzed by the original study, but with a much larger data set: all free throws taken during five regular seasons ([Formula: see text] of the National Basketball Association (NBA. Evidence supporting the existence of the "hot hand" phenomenon is provided. However, while statistical traces of this phenomenon are observed in the data, an open question still remains: are these non random patterns a result of "success breeds success" and "failure breeds failure" mechanisms or simply "better" and "worse" periods? Although free throws data is not adequate to answer this question in a definite way, we speculate based on it, that the latter is the dominant cause behind the appearance of the "hot hand" phenomenon in the data.

Sudden infant death syndrome (SIDS): a time lag factor.

Science.gov (United States)

Reid, G M

1991-02-01

A time lag factor of about five days has been identified in an increased incidence of SIDS in relation to a cold day. Sudden exposure to chilling appeared to trigger skeletal muscle weakness and renal failure about five days later in a man found to have only 25% of normal carnitine palmitoyl transferase (CPT) activity in biopsied skeletal muscle. White Muscle Disease is a muscular dystrophy in young ruminants which appears about five days after turnout to pasture in the weaned ruminant raised on a diet deficient in vitamin E and selenium (VESD). Pasture has high levels of linoleic and linolenic acid (high PUFA diet) which are modified by developing rumen bacteria. Corbucci investigated the effects of circulatory shock (cardiogenic) on skeletal muscle mitochondrial activity in humans. Cytochrome oxidase activity fell markedly and, in particular, the capacity to oxidase palmitoyl carnitine was greatly reduced. He considered a consequence of this disorder was sequestration of carnitine as acyl carnitine which could not be recycled. Unusual acyl carnitines have been identified in six out of 13 SIDS victims in a USA group. In Finland, researchers identified a rise in SIDS incidence (mostly found in the prone position) after great and rapid temperature changes. Foster found a relationship between 1984 SIDS incidence and the incidence of goitre in World War I troops.

Sudden Gains during Therapy of Social Phobia

Science.gov (United States)

Hofmann, Stefan G.; Schultz, Stefan M.; Meuret, Alicia E.; Moscovitch, David A.; Suvak, Michael

2006-01-01

The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive-behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967…

Febrile convulsions and sudden infant death syndrome

DEFF Research Database (Denmark)

Vestergaard, Mogens; Basso, Olga; Henriksen, Tine Brink

2002-01-01

It has been suggested that sudden infant death syndrome (SIDS) and febrile convulsions are related aetiologically. We compared the risk of SIDS in 9877 siblings of children who had had febrile convulsions with that of 20.177 siblings of children who had never had febrile convulsions. We found...

Sudden (reversible) sensorineural hearing loss in pregnancy.

LENUS (Irish Health Repository)

Kenny, R

2011-03-01

Sudden hearing loss directly associated with pregnancy or birth is a little known and rare occurrence. The temporary, unilateral, low-frequency sensorineural hearing loss in this case was reported after the birth of the patient\\'s first child, and again during the third trimester of her second pregnancy.

Case of sudden death following rupture of thoracic aortic aneurysm during “a manual therapy” procedure in the spinal area

Directory of Open Access Journals (Sweden)

Aleksandra Kaczorowska

2015-03-01

Full Text Available The reported case concerns the rupture of an aneurysm located in the descending part of the thoracic aorta during the procedure of the so-called “spinal adjustment” performed by a chiropractor. A 45-year-old patient with no significant medical history of cardiovascular diseases visited, along with his wife, one of “manual therapy” practices because of back pain. During the procedure, the patient suddenly lost consciousness. Despite cardiopulmonary resuscitation and emergency assistance given by an ambulance team, the patient died. An autopsy revealed that the cause of death was increasing cardiorespiratory failure secondary to bleeding into the lumen of the left pleural cavity following the rupture of pathologically altered thoracic aortic wall.

Wave vector modification of the infinite order sudden approximation

International Nuclear Information System (INIS)

Sachs, J.G.; Bowman, J.M.

1980-01-01

A simple method is proposed to modify the infinite order sudden approximation (IOS) in order to extend its region of quantitative validity. The method involves modifying the phase of the IOS scattering matrix to include a part calculated at the outgoing relative kinetic energy as well as a part calculated at the incoming kinetic energy. An immediate advantage of this modification is that the resulting S matrix is symmetric. We also present a closely related method in which the relative kinetic energies used in the calculation of the phase are determined from quasiclassical trajectory calculations. A set of trajectories is run with the initial state being the incoming state, and another set is run with the initial state being the outgoing state, and the average final relative kinetic energy of each set is obtained. One part of the S-operator phase is then calculated at each of these kinetic energies. We apply these methods to vibrationally inelastic collinear collisions of an atom and a harmonic oscillator, and calculate transition probabilities P/sub n/1→nf for three model systems. For systems which are sudden, or nearly so, the agreement with exact quantum close-coupling calculations is substantially improved over standard IOS ones when Δn=such thatub f/-n/sub i/ is large, and the corresponding transition probability is small, i.e., less than 0.1. However, the modifications we propose will not improve the accuracy of the IOS transition probabilities for any collisional system unless the standard form of IOS already gives at least qualitative agreement with exact quantal calculations. We also suggest comparisons between some classical quantities and sudden predictions which should help in determining the validity of the sudden approximation. This is useful when exact quantal data is not available for comparison

Wave vector modification of the infinite order sudden approximation

Science.gov (United States)

Sachs, Judith Grobe; Bowman, Joel M.

1980-10-01

A simple method is proposed to modify the infinite order sudden approximation (IOS) in order to extend its region of quantitative validity. The method involves modifying the phase of the IOS scattering matrix to include a part calculated at the outgoing relative kinetic energy as well as a part calculated at the incoming kinetic energy. An immediate advantage of this modification is that the resulting S matrix is symmetric. We also present a closely related method in which the relative kinetic energies used in the calculation of the phase are determined from quasiclassical trajectory calculations. A set of trajectories is run with the initial state being the incoming state, and another set is run with the initial state being the outgoing state, and the average final relative kinetic energy of each set is obtained. One part of the S-operator phase is then calculated at each of these kinetic energies. We apply these methods to vibrationally inelastic collinear collisions of an atom and a harmonic oscillator, and calculate transition probabilities Pn1→nf for three model systems. For systems which are sudden, or nearly so, the agreement with exact quantum close-coupling calculations is substantially improved over standard IOS ones when Δn=‖nf-ni‖ is large, and the corresponding transition probability is small, i.e., less than 0.1. However, the modifications we propose will not improve the accuracy of the IOS transition probabilities for any collisional system unless the standard form of IOS already gives at least qualitative agreement with exact quantal calculations. We also suggest comparisons between some classical quantities and sudden predictions which should help in determining the validity of the sudden approximation. This is useful when exact quantal data is not available for comparison.

Porting Initiation and Failure into Linked CHEETAH

Science.gov (United States)

Souers, Clark; Vitello, Peter

2007-06-01

Linked CHEETAH is a thermo-chemical code coupled to a 2-D hydrocode. Initially, a quadratic-pressure dependent kinetic rate was used, which worked well in modeling prompt detonation of explosives of large size, but does not work on other aspects of explosive behavior. The variable-pressure Tarantula reactive flow rate model was developed with JWL++ in order to also describe failure and initiation, and we have moved this model into Linked CHEETAH. The model works by turning on only above a pressure threshold, where a slow turn-on creates initiation. At a higher pressure, the rate suddenly leaps to a large value over a small pressure range. A slowly failing cylinder will see a rapidly declining rate, which pushes it quickly into failure. At a high pressure, the detonation rate is constant. A sequential validation procedure is used, which includes metal-confined cylinders, rate-sticks, corner-turning, initiation and threshold, gap tests and air gaps. The size (diameter) effect is central to the calibration. This work was performed under the auspices of the U.S. Department of Energy by the University of California Lawrence Livermore National Laboratory under contract No. W-7405-Eng-48.

Temporal-varying failures of nodes in networks

Science.gov (United States)

Knight, Georgie; Cristadoro, Giampaolo; Altmann, Eduardo G.

2015-08-01

We consider networks in which random walkers are removed because of the failure of specific nodes. We interpret the rate of loss as a measure of the importance of nodes, a notion we denote as failure centrality. We show that the degree of the node is not sufficient to determine this measure and that, in a first approximation, the shortest loops through the node have to be taken into account. We propose approximations of the failure centrality which are valid for temporal-varying failures, and we dwell on the possibility of externally changing the relative importance of nodes in a given network by exploiting the interference between the loops of a node and the cycles of the temporal pattern of failures. In the limit of long failure cycles we show analytically that the escape in a node is larger than the one estimated from a stochastic failure with the same failure probability. We test our general formalism in two real-world networks (air-transportation and e-mail users) and show how communities lead to deviations from predictions for failures in hubs.

Sudden cardiac death in young athletes

Directory of Open Access Journals (Sweden)

Östman-Smith I

2011-07-01

Full Text Available Ingegerd Östman-SmithDivision of Paediatric Cardiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, SwedenAbstract: Athletic activity is associated with an increased risk of sudden death for individuals with some congenital or acquired heart disorders. This review considers in particular the causes of death affecting athletes below 35 years of age. In this age group the largest proportion of deaths are caused by diseases with autosomal dominant inheritance such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, long QT-syndrome, and Marfan’s syndrome. A policy of early cascade-screening of all first-degree relatives of patients with these disorders will therefore detect a substantial number of individuals at risk. A strictly regulated system with preparticipation screening of all athletes following a protocol pioneered in Italy, including school-age children, can also detect cases caused by sporadic new mutations and has been shown to reduce excess mortality among athletes substantially. Recommendations for screening procedure are reviewed. It is concluded that ECG screening ought to be part of preparticipation screening, but using criteria that do not cause too many false positives among athletes. One such suggested protocol will show positive in approximately 5% of screened individuals, among whom many will be screened for these diseases. On this point further research is needed to define what kind of false-positive and false-negative rate these new criteria result in. A less formal system based on cascade-screening of relatives, education of coaches about suspicious symptoms, and preparticipation questionnaires used by athletic clubs, has been associated over time with a sizeable reduction in sudden cardiac deaths among Swedish athletes, and thus appears to be worth implementing even for junior athletes not recommended for formal preparticipation screening. It is strongly argued

Sickle cell trait and sudden death--bringing it home.

Science.gov (United States)

Mitchell, Bruce L.

2007-01-01

Sickle cell trait continues to be the leading cause of sudden death for young African Americans in military basic training and civilian organized sports. The syndrome may have caused the death of up to 10 college football players since 1974 and, as recently as 2000, was suspected as the cause of death of three U.S. Army recruits. The penal military-style boot camps in the United States and the recent death of two teenagers with sickle cell trait merits renewed vigor in the education of athletic instructors, the military and the public about conditions associated with sudden death in individuals with sickle cell trait. Images Figure 1 Figure 2 PMID:17393956

The initial phase of sudden releases of superheated liquid

International Nuclear Information System (INIS)

Schmidli, J.

1994-04-01

The catastrophic failure of a pressure vessel containing a liquefied substance, leading to an instantaneous release of its whole contents is considered as one of the major technological hazards. Due to the rapid depressurization caused by vessel failure, the fluid becomes superheated and unstable. Part of the fluid will evaporate using its internal energy and the two-phase mixture forming will be accelerated. This flashing process can be very violent, as experiments and incidents actually happened have shown. In the past, a number of dispersion models were developed to predict the history of an instantaneous release. In most of these models the source term is considered to be a gas volume at rest and not a rapidly expanding aerosol, as could be observed. Furthermore, it is usually assumed that all of the remaining fluid is entrained into the expanding cloud and nothing is deposited on the ground to form a pool. This work concentrates on the initial phase of the sudden release of superheated liquids with the aim to gain a better understanding of the flashing process and of the physical mechanisms involved, leading to a reliable prediction of the source term. Therefore, more than 400 experiments with propane, butane, refrigerant 12 and 114 were conducted. The experiments were initiated by shattering spherical glass flasks of different sizes. The main parameters varied were the liquid superheat and the filling level of the vessel. Using high-speed video and movie recordings and very fast responding measurement devices, it was possible to study the initial phase of such releases during which gravity plays no role. For sufficiently large released internal energy, the initial evolution of the release was always spherical with a constant radial expansion velocity during he first milliseconds until instabilities appeared at the surface of the droplet/vapor cloud that was formed. For all the experimental conditions, the fraction of the initial liquid falling on the ground

Cardiac channelopathies and sudden infant death syndrome

DEFF Research Database (Denmark)

Tfelt-Hansen, Jacob; Winkel, Bo Gregers; Grunnet, Morten

2011-01-01

Sudden infant death syndrome (SIDS) is always a devastating and unexpected occurrence. SIDS is the leading cause of death in the first 6 months after birth in the industrialized world. Since the discovery in 1998 of long QT syndrome as an underlying substrate for SIDS, around 10-20% of SIDS cases...

Sudden death syndrome of soybean in Argentina

Science.gov (United States)

Sudden death syndrome (SDS) is one of the most common and widely spread root disease affecting soybean [Glycine max (L.) Merr.] in Argentina where it is an economically important crop. This disease was first discovered in this country in 1992 in the Pampas Region, and the following year in Northwest...

2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant.

Science.gov (United States)

Subirana, M Teresa; Barón-Esquivias, Gonzalo; Manito, Nicolás; Oliver, José M; Ripoll, Tomás; Lambert, Jose Luis; Zunzunegui, José L; Bover, Ramon; García-Pinilla, José Manuel

2014-03-01

This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

Compressive failure with interacting cracks

International Nuclear Information System (INIS)

Yang Guoping; Liu Xila

1993-01-01

The failure processes in concrete and other brittle materials are just the results of the propagation, coalescence and interaction of many preexisting microcracks or voids. To understand the real behaviour of the brittle materials, it is necessary to bridge the gap from the relatively matured one crack behaviour to the stochastically distributed imperfections, that is, to concern the crack propagation and interaction of microscopic mechanism with macroscopic parameters of brittle materials. Brittle failure in compression has been studied theoretically by Horii and Nemat-Nasser (1986), in which a closed solution was obtained for a preexisting flaw or some special regular flaws. Zaitsev and Wittmann (1981) published a paper on crack propagation in compression, which is so-called numerical concrete, but they did not take account of the interaction among the microcracks. As for the modelling of the influence of crack interaction on fracture parameters, many studies have also been reported. Up till now, some researcher are working on crack interaction considering the ratios of SIFs with and without consideration of the interaction influences, there exist amplifying or shielding effects of crack interaction which are depending on the relative positions of these microcracks. The present paper attempts to simulate the whole failure process of brittle specimen in compression, which includes the complicated coupling effects between the interaction and propagation of randomly distributed or other typical microcrack configurations step by step. The lengths, orientations and positions of microcracks are all taken as random variables. The crack interaction among many preexisting random microcracks is evaluated with the help of a simple interaction matrix (Yang and Liu, 1991). For the subcritically stable propagation of microcracks in mixed mode fracture, fairly known maximum hoop stress criterion is adopted to compute branching lengths and directions at each tip of the crack

Risk factors and causes of sudden noncardiac death: A nationwide cohort study in Denmark.

Science.gov (United States)

Risgaard, Bjarke; Lynge, Thomas Hadberg; Wissenberg, Mads; Jabbari, Reza; Glinge, Charlotte; Gislason, Gunnar Hilmar; Haunsø, Stig; Winkel, Bo Gregers; Tfelt-Hansen, Jacob

2015-05-01

On the performance of an autopsy, sudden deaths may be divided into 2 classifications: (1) sudden cardiac deaths and (2) sudden noncardiac deaths (SNCDs). Families of SNCD victims should not be followed up as a means of searching for cardiac disease. The purpose of this study was to report the risk factors and causes of SNCD. We conducted a retrospective, nationwide study including all deaths between 2000 and 2006 of individuals aged 1-35 years and all deaths between 2007 and 2009 of individuals aged 1-49 years. Two physicians identified all sudden death cases through review of death certificates. Autopsy reports were collected. A multivariable logistic regression model was used to identify both clinical characteristics and risk factors associated with SNCD. We identified 1039 autopsied cases of sudden death, of which 286 (28%) were classified as SNCD. The median age in the SNCD death population was 32 years. Increasing age was inversely associated with SNCD (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.87-0.98). Female sex, in-hospital location, and the absence of cardiac comorbidities were positively associated with SNCD (OR 1.7, 95% CI 1.3-2.3; OR 3.0, 95% CI 2.0-4.4; and OR 4.3, 95% CI 2.5-7.4, respectively). The most common cause of SNCD was pulmonary disease (n = 115 [40%]). Sudden death among individuals aged caused by noncardiac diseases in 28% of cases. Risk factors were female sex, age, and the absence of cardiac comorbidities. These data may guide future strategies for the follow-up of family members of nonautopsied sudden death victims, improve risk stratification, and influence public health strategies. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Is age a factor in the success or failure of remote monitoring in heart failure? Telemonitoring and structured telephone support in elderly heart failure patients.

Science.gov (United States)

Inglis, Sally C; Conway, Aaron; Cleland, John Gf; Clark, Robyn A

2015-06-01

There are few data regarding the effectiveness of remote monitoring for older people with heart failure. We conducted a post-hoc sub-analysis of a previously published large Cochrane systematic review and meta-analysis of relevant randomized controlled trials to determine whether structured telephone support and telemonitoring were effective in this population. A post hoc sub-analysis of a systematic review and meta-analysis that applied the Cochrane methodology was conducted. Meta-analyses of all-cause mortality, all-cause hospitalizations and heart failure-related hospitalizations were performed for studies where the mean or median age of participants was 70 or more years. The mean or median age of participants was 70 or more years in eight of the 16 (n=2659/5613; 47%) structured telephone support studies and four of the 11 (n=894/2710; 33%) telemonitoring studies. Structured telephone support (RR 0.80; 95% CI=0.63-1.00) and telemonitoring (RR 0.56; 95% CI=0.41-0.76) interventions reduced mortality. Structured telephone support interventions reduced heart failure-related hospitalizations (RR 0.81; 95% CI=0.67-0.99). Despite a systematic bias towards recruitment of individuals younger than the epidemiological average into the randomized controlled trials, older people with heart failure did benefit from structured telephone support and telemonitoring. These post-hoc sub-analysis results were similar to overall effects observed in the main meta-analysis. While further research is required to confirm these observational findings, the evidence at hand indicates that discrimination by age alone may be not be appropriate when inviting participation in a remote monitoring service for heart failure. © The European Society of Cardiology 2014.

The randomly renewed general item and the randomly inspected item with exponential life distribution

International Nuclear Information System (INIS)

Schneeweiss, W.G.

1979-01-01

For a randomly renewed item the probability distributions of the time to failure and of the duration of down time and the expectations of these random variables are determined. Moreover, it is shown that the same theory applies to randomly checked items with exponential probability distribution of life such as electronic items. The case of periodic renewals is treated as an example. (orig.) [de

Regenerative braking failures in battery electric vehicles and their impact on the driver.

Science.gov (United States)

Cocron, Peter; Neumann, Isabel; Kreußlein, Maria; Wanner, Daniel; Bierbach, Maxim; Krems, Josef F

2018-09-01

A unique feature of battery electric vehicles (BEV) is their regenerative braking system (RBS) to recapture kinetic energy in deceleration maneuvers. If such a system is triggered via gas pedal, most deceleration maneuvers can be executed by just using this pedal. This impacts the driving task as different deceleration strategies can be applied. Previous research has indicated that a RBS failure leading to a sudden reduced deceleration represents an adverse event for BEV drivers. In the present study, we investigated such a failure's impact on the driver's evaluation and behavior. We conducted an experiment on a closed-off test track using a modified BEV that could temporarily switch off the RBS. One half of the 44 participants in the study received information about an upcoming RBS failure whereas the other half did not. While 91% of the drivers receiving prior information noticed the RBS failure, only 48% recognized it in the "uniformed" group. In general, the failure and the perception of its occurrence influenced the driver's evaluation and behavior more than receiving prior information. Nevertheless, under the tested conditions, drivers kept control and were able to compensate for the RBS failure. As the participants drove quite simple maneuvers in our experiment, further studies are needed to validate our findings using more complex driving settings. Given that RBS failures could have severe consequences, appropriate information and warning strategies for drivers are necessary. Copyright © 2018 Elsevier Ltd. All rights reserved.

Bridging the gap in heart failure prevention: rationale and design of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study

DEFF Research Database (Denmark)

Carrington, Melinda J; Stewart, Simon; de Courten, Barbora

2010-01-01

AIMS: The primary objective of the Nurse-led Intervention for Less Chronic Heart Failure (NIL-CHF) Study is to develop a programme of care that cost-effectively prevents the development of chronic heart failure (CHF). Methods NIL-CHF is a randomized controlled trial of a hybrid, home- and clinic-...

Pilates in heart failure patients: a randomized controlled pilot trial.

Science.gov (United States)

Guimarães, Guilherme Veiga; Carvalho, Vitor Oliveira; Bocchi, Edimar Alcides; d'Avila, Veridiana Moraes

2012-12-01

Conventional cardiac rehabilitation program consist of 15 min of warm-up, 30 min of aerobic exercise and followed by 15 min calisthenics exercise. The Pilates method has been increasingly applied for its therapeutic benefits, however little scientific evidence supports or rebukes its use as a treatment in patients with heart failure (HF). Investigate the effects of Pilates on exercise capacity variables in HF. Sixteen pts with HF, left ventricular ejection fraction 27 ± 14%, NYHA class I-II were randomly assigned to conventional cardiac rehabilitation program (n = 8) or mat Pilates training (n = 8) for 16 weeks of 30 min of aerobic exercise followed by 20 min of the specific program. At 16 weeks, pts in the mat Pilates group and conventional group showed significantly increase on exercise time 11.9 ± 2.5 to 17.8 ± 4 and 11.7 ± 3.9 to 14.2 ± 4 min, respectively. However, only the Pilates group increased significantly the ventilation (from 56 ± 20 to 69 ± 17 L/min, P = 0.02), peak VO(2) (from 20.9 ± 6 to 24.8 ± 6 mL/kg/min, P = 0.01), and O(2) pulse (from 11.9 ± 2 to 13.8 ± 3 mL/bpm, P = 0.003). The Pilates group showed significantly increase in peak VO(2) when compared with conventional group (24.8 ± 6 vs. 18.3 ± 4, P = 0.02). The result suggests that the Pilates method may be a beneficial adjunctive treatment that enhances functional capacity in patients with HF who are already receiving standard medical therapy. © 2011 Blackwell Publishing Ltd.

Metabolic Syndrome Increases the Risk of Sudden Sensorineural Hearing Loss in Taiwan: A Case-Control Study.

Science.gov (United States)

Chien, Chen-Yu; Tai, Shu-Yu; Wang, Ling-Feng; Hsi, Edward; Chang, Ning-Chia; Wu, Ming-Tsang; Ho, Kuen-Yao

2015-07-01

Sudden sensorineural hearing loss has been reported to be associated with diabetes mellitus, hypertension, and hyperlipidemia in previous studies. The aim of this study was to examine whether metabolic syndrome increases the risk of sudden sensorineural hearing loss in Taiwan. A case-control study. Tertiary university hospital. We retrospectively investigated 181 cases of sudden sensorineural hearing loss and 181 controls from the Department of Otorhinolaryngology, Kaohsiung Medical University Hospital, in southern Taiwan from 2010 to 2012, comparing their clinical variables. We analyzed the relationship between metabolic syndrome and sudden sensorineural hearing loss. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III with Asian modifications. The demographic and clinical characteristics, audiometry results, and outcome were reviewed. Subjects with metabolic syndrome had a 3.54-fold increased risk (95% confidence interval [CI] = 2.00-6.43, P diabetes mellitus, hypertension, and hyperlipidemia. With increases in the number of metabolic syndrome components, the risk of sudden sensorineural hearing loss increased (P for trend Vertigo was associated with a poor outcome (P = .02; 95% CI = 1.13~5.13, adjusted odds ratio = 2.39). The hearing loss pattern may influence the outcome of sudden sensorineural hearing loss (P Vertigo and total hearing loss were indicators of a poor outcome in sudden sensorineural hearing loss. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

The effect of sudden server breakdown on the performance of a disassembly line

Science.gov (United States)

Udomsawat, Gun; Gupta, Surendra M.

2005-11-01

Product and material recovery relies on the disassembly process to separate target components or materials from the end-of-life (EOL) products. Disassembly line is especially effective when products in large quantity are disassembled. Unlike an assembly line, a disassembly line is more complex and is subjected to numerous uncertainties including stochastic and multi-level arrivals of component demands, stochastic arrival times for EOL products, and process interruption due to equipment failure. These factors seriously impair the control mechanism in the disassembly line. A common production control mechanism is the traditional push system (TPS). TPS responds to the aforementioned complications by carrying substantial amounts of inventories. An alternative control mechanism is a newly developed multi-kanban pull system (MKS) that relies on dynamic routing of kanbans, which tends to minimize the system's inventories while maintaining demand serviceability. In this paper we explore the impact of sudden breakdown of server on the performance of a disassembly line. We compare the overall performances of the TPS and MKS by considering two scenarios. We present the solution procedure and results for these cases.

Ependymal alterations in sudden intrauterine unexplained death and sudden infant death syndrome: possible primary consequence of prenatal exposure to cigarette smoking

Directory of Open Access Journals (Sweden)

Matturri Luigi

2010-07-01

Full Text Available Abstract Background The ependyma, the lining providing a protective barrier and filtration system separating brain parenchyma from cerebrospinal fluid, is still inadequately understood in humans. In this study we aimed to define, by morphological and immunohistochemical methods, the sequence of developmental steps of the human ependyma in the brainstem (ventricular ependyma and thoracic spinal cord (central canal ependyma of a large sample of fetal and infant death victims, aged from 17 gestational weeks to 8 postnatal months. Additionally, we investigated a possible link between alterations of this structure, sudden unexplained fetal and infant death and maternal smoking. Results Our results demonstrate that in early fetal life the human ependyma shows a pseudostratified cytoarchitecture including many tanycytes and ciliated cells together with numerous apoptotic and reactive astrocytes in the subependymal layer. The ependyma is fully differentiated, with a monolayer of uniform cells, after 32 to 34 gestational weeks. We observed a wide spectrum of ependymal pathological changes in sudden death victims, such as desquamation, clusters of ependymal cells in the subventricular zone, radial glial cells, and the unusual presence of neurons within and over the ependymal lining. These alterations were significantly related to maternal smoking in pregnancy. Conclusions We conclude that in smoking mothers, nicotine and its derivatives easily reach the cerebrospinal fluid in the fetus, immediately causing ependymal damage. Consequently, we suggest that the ependyma should be examined in-depth first in victims of sudden fetal or infant death with mothers who smoke.

The epidemiology of sudden oak death in Oregon forests

Science.gov (United States)

Ebba K. Peterson

2011-01-01

The phytopathogen Phytophthora ramorum (Werres, DeCock & Man in't Veld), causal agent of Sudden Oak Death (SOD) of oaks (Quercus spp.) and tanoaks (Notholithocarpus densiflorus syn. Lithocarpus densiflorus...

Prone positioning in hypoxemic respiratory failure: meta-analysis of randomized controlled trials.

Science.gov (United States)

Kopterides, Petros; Siempos, Ilias I; Armaganidis, Apostolos

2009-03-01

Prone positioning is used to improve oxygenation in patients with hypoxemic respiratory failure (HRF). However, its role in clinical practice is not yet clearly defined. The aim of this meta-analysis was to assess the effect of prone positioning on relevant clinical outcomes, such as intensive care unit (ICU) and hospital mortality, days of mechanical ventilation, length of stay, incidence of ventilator-associated pneumonia (VAP) and pneumothorax, and associated complications. We used literature search of MEDLINE, Current Contents, and Cochrane Central Register of Controlled Trials. We focused only on randomized controlled trials reporting clinical outcomes in adult patients with HRF. Four trials met our inclusion criteria, including 662 patients randomized to prone ventilation and 609 patients to supine ventilation. The pooled odds ratio (OR) for the ICU mortality in the intention-to-treat analysis was 0.97 (95% confidence interval [CI], 0.77-1.22), for the comparison between prone and supine ventilated patients. Interestingly, the pooled OR for the ICU mortality in the selected group of the more severely ill patients favored prone positioning (OR, 0.34; 95% CI, 0.18-0.66). The duration of mechanical ventilation and the incidence of pneumothorax were not different between the 2 groups. The incidence of VAP was lower but not statistically significant in patients treated with prone positioning (OR, 0.81; 95% CI, 0.61-1.10). However, prone positioning was associated with a higher risk of pressure sores (OR, 1.49; 95% CI, 1.17-1.89) and a trend for more complications related to the endotracheal tube (OR, 1.30; 95% CI, 0.94-1.80). Despite the inherent limitations of the meta-analytic approach, it seems that prone positioning has no discernible effect on mortality in patients with HRF. It may decrease the incidence of VAP at the expense of more pressure sores and complications related to the endotracheal tube. However, a subgroup of the most severely ill patients may

Heat transfer in oscillating flows with sudden change in cross section

Science.gov (United States)

Ibrahim, Mounir; Hashim, Waqar; Tew, Roy C.; Dudenhoefer, James E.

1992-01-01

Oscillating fluid flow (zero mean) with heat transfer, between two parallel plates with a sudden change in cross section, was examined computationally. Over 30 different cases were examined; these cases cover wide ranges of Re sub max (187.5 to 30,000), Va (1 to 350), expansion ratio (1:2, 1:4, 1:8, and 1:12) and A sub r (0.68 to 4). Three different geometric cases were considered (asymmetric expansion and/or contraction, symmetric expansion/contraction, and symmetric blunt body). The heat transfer cases were based on constant wall temperature at higher (heating) or lower (cooling) value than the inflow fluid temperature. As a result of the oscillating flow, the fluid undergoes sudden expansion in one half of the cycle and sudden contraction in the other half. Instantaneous friction factors and heat transfer coefficients, for some ranges of Re sub max and Va, deviated substantially from those predicted with steady state correlations.

Magnetic resonance imaging in sudden deafness; Ressonancia magnetica em surdez subita

Energy Technology Data Exchange (ETDEWEB)

Ramos, Hugo Valter Lisboa; Barros, Flavia Alencar; Penido, Norma de Oliveira; Souza, Ana Claudia Valerio de; Yamaoka, Wellington Yugo [Sao Paulo Univ., SP (Brazil). Dept. de Otorinolaringologia e Cirurgia da Cabeca e Pescoco; Yamashita, Helio [Sao Paulo Univ., SP (Brazil). Dept. de Imagem e Diagnostico]. E-mail: hvlramos@gmail.com

2005-07-15

The etiology of sudden deafness can remain undetermined despite extensive investigation. This study addresses the value of magnetic resonance imaging in the analysis of sudden deafness patients.Study Design: transversal cohort.Material And Method: In a prospective study, 49 patients attended at otolaryngology emergency room of Federal University of Sao Paulo - Escola Paulista de Medicina, from April 2001 to May 2003, were submitted to magnetic resonance imaging.Results: Magnetic Resonance abnormalities were seen in 23 (46.9%) patients and revealed two tumors suggestive of meningioma, three vestibular schwannomas, thirteen microangiopathic changes of the brain and five (21.7%) pathological conditions of the labyrinth.Conclusion: Sudden deafness should be approached as a symptom common to different diseases. The presence of cerebellopontine angle tumors in 10.2% of our cases, among other treatable causes, justifies the recommendation of gadolinium-enhanced magnetic resonance use, not only to study the auditory peripheral pathway, but to study the whole auditory pathway including the brain. (author)

Systems with randomly failing repairable components

DEFF Research Database (Denmark)

Der Kiureghian, Armen; Ditlevsen, Ove Dalager; Song, Junho

2005-01-01

Closed-form expressions are derived for the steady-state availability, mean rate of failure, mean duration of downtime and reliability of a general system with randomly and independently failing repairable components. Component failures are assumed to be homogeneous Poisson events in time and rep...

Relationship between late ventricular potentials and myocardial 123I-metaiodobenzylguanidine scintigraphy in patients with dilated cardiomyopathy with mild to moderate heart failure: results of a prospective study of sudden death events

International Nuclear Information System (INIS)

Kasama, Shu; Toyama, Takuji; Kaneko, Yoshiaki; Kurabayashi, Masahiko; Iwasaki, Toshiya; Sumino, Hiroyuki; Kumakura, Hisao; Minami, Kazutomo; Ichikawa, Shuichi; Matsumoto, Naoya; Sato, Yuichi

2012-01-01

Late ventricular potentials (LPs) are considered to be useful for identifying patients with heart failure at risk of developing ventricular arrhythmias. 123 I-metaiodobenzylguanidine (MIBG) scintigraphy, which is used to evaluate cardiac sympathetic activity, has demonstrated cardiac sympathetic denervation in patients with malignant ventricular tachyarrhythmias. This study was undertaken to clarify the relationship between LPs and 123 I-MIBG scintigraphy findings in patients with dilated cardiomyopathy (DCM). A total of 56 patients with DCM were divided into an LP-positive group (n = 24) and an LP-negative group (n = 32). During the compensated period, the delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from 123 I-MIBG images and plasma brain natriuretic peptide (BNP) concentrations were measured. Left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) were simultaneously determined by echocardiography. LVEDV, LVESV, LVEF and plasma BNP concentrations were similar in the two groups. However, TDS was significantly higher (35 ± 8 vs. 28 ± 6, p 123 I-MIBG scintigraphic parameters were worse in LP-positive DCM patients than in LP-negative DCM patients. Furthermore, in LP-positive DCM patients with a high WR, the incidence of sudden death events was higher than that in other subgroups of DCM patients. (orig.)

Perinatal Fluoxetine Exposure Impairs the CO2 Chemoreflex. Implications for Sudden Infant Death Syndrome.

Science.gov (United States)

Bravo, Karina; Eugenín, Jaime L; Llona, Isabel

2016-09-01

High serotonin levels during pregnancy affect central nervous system development. Whether a commonly used antidepressant such as fluoxetine (a selective serotonin reuptake inhibitor) taken during pregnancy may adversely affect respiratory control in offspring has not been determined. The objective was to determine the effect of prenatal-perinatal fluoxetine exposure on the respiratory neural network in offspring, particularly on central chemoreception. Osmotic minipumps implanted into CF-1 mice on Days 5-7 of pregnancy delivered 7 milligrams per kilogram per day of fluoxetine, achieving plasma levels within the range found in patients. Ventilation was assessed in offspring at postnatal Days 0-40 using head-out body plethysmography. Neuronal activation was evaluated in the raphe nuclei and in the nucleus tractus solitarius by c-Fos immunohistochemistry during normoxic eucapnia and hypercapnia (10% CO2). Respiratory responses to acidosis were evaluated in brainstem slices. Prenatal-perinatal fluoxetine did not affect litter size, birth weight, or the postnatal growth curve. Ventilation under eucapnic normoxic conditions was similar to that of control offspring. Fluoxetine exposure reduced ventilatory responses to hypercapnia at P8-P40 (P Fluoxetine applied acutely on control slices did not modify their respiratory response to acidosis. We concluded that prenatal-perinatal fluoxetine treatment impairs central respiratory chemoreception during postnatal life. These results are relevant in understanding the pathogenesis of respiratory failures, such as sudden infant death syndrome, associated with brainstem serotonin abnormalities and the failure of respiratory chemoreflexes.

Rapid decompression and desorption induced energetic failure in coal

Directory of Open Access Journals (Sweden)

Shugang Wang

2015-06-01

Full Text Available In this study, laboratory experiments are conducted to investigate the rapid decompression and desorption induced energetic failure in coal using a shock tube apparatus. Coal specimens are recovered from Colorado at a depth of 610 m. The coal specimens are saturated with the strong sorbing gas CO2 for a certain period and then the rupture disc is suddenly broken on top of the shock tube to generate a shock wave propagating upwards and a rarefaction wave propagating downwards through the specimen. This rapid decompression and desorption has the potential to cause energetic fragmentation in coal. Three types of behaviors in coal after rapid decompression are found, i.e. degassing without fragmentation, horizontal fragmentation, and vertical fragmentation. We speculate that the characteristics of fracture network (e.g. aperture, spacing, orientation and stiffness and gas desorption play a role in this dynamic event as coal can be considered as a dual porosity, dual permeability, dual stiffness sorbing medium. This study has important implications in understanding energetic failure process in underground coal mines such as coal gas outbursts.

Otolaryngological aspects of sudden infant death syndrome.

Science.gov (United States)

Marom, Tal; Cinamon, Udi; Castellanos, Paul F; Cohen, Marta C

2012-03-01

Sudden infant death syndrome (SIDS) is characterized by the sudden death of an apparently otherwise healthy infant, typically during sleep, and with no obvious case after a thorough post-mortem and scene death examination. To address the problem from the otolaryngologist's perspective, describe relevant pathologies, discuss controversies and suggest preventive measures in high-risk populations. A MEDLINE search and hand search were conducted to identify reports published between 1969 and 2011 in the English language on the pathophysiology of SIDS related to the head and neck organs. Search terms included SIDS (MeSH term), SIDS and pathophysiology (text words), and SIDS and autopsy (text words). A growing number of reports suggested head and neck organs involvement in SIDS autopsies. Laryngeal, oropharyngeal, maxillofacial, otologic, cervical vascular abnormalities and infectious etiologies, were recognized and discussed. Otolaryngologists should be aware of relevant pathologies, as some are treatable, if identified early enough in infancy. A proactive risk-management approach is warranted in infants presenting with certain abnormalities reviewed here. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Therapeutic Approach to Patients with Heart Failure with Reduced Ejection Fraction and End-stage Renal Disease.

Science.gov (United States)

Inampudi, Chakradhari; Alvarez, Paulino; Asleh, Rabea; Briasoulis, Alexandros

2018-03-14

Several risk factors including Ischemic heart disease, uncontrolled hypertension, high output Heart Failure (HF) from shunting through vascular hemodialysis access, and anemia, contribute to development of HF in patients with End-Stage Renal Disease (ESRD). Guidelinedirected medical and device therapy for Heart Failure with Reduced Ejection Fraction (HFrEF) has not been extensively studied and may have limited safety and efficacy in patients with ESRD. Maintenance of interdialytic and intradialytic euvolemia is a key component of HF management in these patients but often difficult to achieve. Beta-blockers, especially carvedilol which is poorly dialyzed is associated with cardiovascular benefit in this population. Despite paucity of data, Angiotensin-converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARBs) when appropriately adjusted by dose and with close monitoring of serum potassium can also be administered to these patients who tolerate beta-blockers. Mineralocorticoid receptors in patients with HFrEF and ESRD have been shown to reduce mortality in a large randomized controlled trial without any significantly increased risk of hyperkalemia. Implantable Cardiac-defibrillators (ICDs) should be considered for primary prevention of sudden cardiac death in patients with HFrEF and ESRD who meet the implant indications. Furthermore in anemic iron-deficient patients, intravenous iron infusion may improve functional status. Finally, mechanical circulatory support with leftventricular assist devices may be related to increased mortality risk and the presence of ESRD poses a relative contraindication to further evaluation of these devices. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Utility based maintenance analysis using a Random Sign censoring model

International Nuclear Information System (INIS)

Andres Christen, J.; Ruggeri, Fabrizio; Villa, Enrique

2011-01-01

Industrial systems subject to failures are usually inspected when there are evident signs of an imminent failure. Maintenance is therefore performed at a random time, somehow dependent on the failure mechanism. A competing risk model, namely a Random Sign model, is considered to relate failure and maintenance times. We propose a novel Bayesian analysis of the model and apply it to actual data from a water pump in an oil refinery. The design of an optimal maintenance policy is then discussed under a formal decision theoretic approach, analyzing the goodness of the current maintenance policy and making decisions about the optimal maintenance time.

Addition of non-invasive ventilatory support to combined aerobic and resistance training improves dyspnea and quality of life in heart failure patients: a randomized controlled trial.

Science.gov (United States)

Bittencourt, Hugo Souza; Cruz, Cristiano Gonçalves; David, Bruno Costa; Rodrigues, Erenaldo; Abade, Camille Magalhães; Junior, Roque Aras; Carvalho, Vitor Oliveira; Dos Reis, Francisco Borges Faria; Gomes Neto, Mansueto

2017-11-01

To test the hypothesis that combined aerobic and resistance training and non-invasive ventilatory support result in additional benefits compared with combined aerobic and resistance training alone in heart failure patients. A randomized, single-blind, controlled study. Cardiac rehabilitation center. A total of 46 patients with New York Heart Association class II/III heart failure were randomly assigned to a 10-week program of combined aerobic and resistance training, plus non-invasive ventilatory support ( n = 23) or combined aerobic and resistance training alone ( n = 23). Before and after intervention, results for the following were obtained: 6-minute walk test, forced vital capacity, forced expiratory volume at one second, maximal inspiratory muscle pressure, and maximal expiratory muscle pressure, with evaluation of dyspnea by the London Chest Activity of Daily Living scale, and quality of life with the Minnesota Living With Heart Failure questionnaire. Of the 46 included patients, 40 completed the protocol. The combined aerobic and resistance training plus non-invasive ventilatory support, as compared with combined aerobic and resistance training alone, resulted in significantly greater benefit for dyspnea (mean change: 4.8 vs. 1.3, p = 0.004), and quality of life (mean change: 19.3 vs. 6.8, p = 0.017 ). In both groups, the 6-minute walk test improved significantly (mean change: 45.7 vs. 44.1, p = 0.924), but without a statistically significant difference. Non-invasive ventilatory support combined with combined aerobic and resistance training provides additional benefits for dyspnea and quality of life in moderate heart failure patients. ClinicalTrials.gov identifier: NCT02384798. Registered 03 April 2015.

Qt interval prolongation and ventricular arrhythmias in patients with chronic heart failure

International Nuclear Information System (INIS)

Sarwar, M.; Majeed, S.M.I.; Khan, M.A.; Majeed, S.M.

2014-01-01

To determine the association of QTc interval prolongation with ventricular arrhythmias in patients with chronic heart failure. Study Design: Descriptive study. Place and Duration of Study: This study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi, Pakistan from April 2013 to August 2013. Patients and Methods: Fifty three heart failure patients were monitored for 48 hours using ambulatory holter electrocardiography recorders. Digital ECG data was analyzed for QTc interval along with frequency and severity of arrhythmias. Association of prolonged QTc interval with ventricular arrhythmias and severity of arrhythmias was analyzed. Results: Cardiac arrhythmias were observed in 79.2% patients. QT analysis revealed that 69.8% patients had prolonged QTc interval, 86.4% patients with prolonged QTc had ventricular arrhythmias. Of these 66% patients were found to have severe ventricular arrhythmias. Comparison of mean QTc interval of our study population with a reference value showed significantly higher QTc interval of our study group than the test value. Conclusion: Arrhythmia frequency and severity significantly increases with an increase in QTc interval in heart failure demonstrating association of prolonged QTc interval with high risk of severe ventricular arrhythmias and sudden cardiac death in chronic heart failure. (author)

Sudden Cardiac Death of a Body Packer Due to Cocaine Cardiotoxicity

Directory of Open Access Journals (Sweden)

Parthasarathi Pramanik

2016-01-01

Full Text Available This article presents a case of sudden cardiac death due to the effects of cocaine concealed in the body of a male drug smuggler in his 40s, a so-called body packer. A total of 57 body packets filled with cocaine powder were discovered in his body cavities. The detailed autopsy examination, including histopathology and toxicology findings, is discussed with the aim of describing the mechanism of cocaine intoxication in the body packer and an analysis of cocaine-induced cardiotoxicity and sudden death.

Clinical and psychological impact of prophylactic implantable cardioverter-defibrillators in a community heart failure population.

LENUS (Irish Health Repository)

Arnous, S

2012-02-01

AIMS: ICD implantation for primary prevention of sudden cardiac death in patients with left ventricular systolic dysfunction (ejection fraction <\\/= 35%) has increased since the publication of the SCD-HEFT and MADIT-II data. The aim of this study is to examine the effectiveness and safety of prophylactic ICD use in a community heart failure population and to assess the impact on patient\\'s quality of life. METHODS AND RESULTS: Seventy-one ICDs were inserted between the years 2002 and 2006. The mean follow-up from time of insertion was 24 +\\/- 11 months. Eighteen patients (25%) had potentially life-saving therapy. Seven (10%) patients received inappropriate shocks. Complications were encountered in five patients (7%). CONCLUSION: In a community heart failure population, prophylactic ICD implantation is associated with a high incidence of life-saving therapy, a low complication rate and a high level of tolerability. These data indicate translation of clinical trial benefits to the general heart failure population.

Brugada Syndrome in a Patient with Vascular Ehlers-Danlos Syndrome: Sudden Death Risk Amplified.

Science.gov (United States)

D'Souza, Jason; Malhotra, Divyanshu; Goud, Aditya; Dahagam, Chanukya; Everett, George

2017-04-19

The vast majority of sudden cardiac arrests occur in patients with structural heart disease and in approximately 10% of the cases, it can occur in those with structurally normal hearts. Brugada syndrome is an autosomal dominant sodium channelopathy that has been implicated in sudden deaths. Given their low prevalence, our knowledge about Brugada syndrome is still evolving. Apart from schizophrenia, there have been no reports of associated medical conditions. We recently encountered a patient with vascular Ehlers-Danlos syndrome who was also found to have Brugada syndrome. Both these conditions share some common clinical presentations including a propensity for sudden death.

Familial Atrial Septal Defect and Sudden Cardiac Death

DEFF Research Database (Denmark)

Ellesøe, Sabrina Gade; Johansen, Morten Munk; Bjerre, Jesper Vandborg

2016-01-01

OBJECTIVE: Atrial septal defect (ASD) is the second most common congenital heart defect (CHD) and is observed in families as an autosomal dominant trait as well as in nonfamilial CHD. Mutations in the NKX2-5 gene, located on chromosome 5, are associated with ASD, often combined with conduction...... disturbances, cardiomyopathies, complex CHD, and sudden cardiac death as well. Here, we show that NKX2-5 mutations primarily occur in ASD patients with conduction disturbances and heritable ASD. Furthermore, these families are at increased risk of sudden cardiac death. RESULTS: We screened 39 probands...... with familial CHD for mutations in NKX2-5 and discovered a novel mutation in one family (2.5%) with ASD and atrioventricular block. A review of the literature revealed 59 different NKX2-5 mutations in 202 patients. Mutations were significantly more common in familial cases compared to nonfamilial cases (P = 7...

An Abrupt Transition to an Intergranular Failure Mode in the Near-Threshold Fatigue Crack Growth Regime in Ni-Based Superalloys

Science.gov (United States)

Telesman, J.; Smith, T. M.; Gabb, T. P.; Ring, A. J.

2018-06-01

Cyclic near-threshold fatigue crack growth (FCG) behavior of two disk superalloys was evaluated and was shown to exhibit an unexpected sudden failure mode transition from a mostly transgranular failure mode at higher stress intensity factor ranges to an almost completely intergranular failure mode in the threshold regime. The change in failure modes was associated with a crossover of FCG resistance curves in which the conditions that produced higher FCG rates in the Paris regime resulted in lower FCG rates and increased ΔK th values in the threshold region. High-resolution scanning and transmission electron microscopy were used to carefully characterize the crack tips at these near-threshold conditions. Formation of stable Al-oxide followed by Cr-oxide and Ti-oxides was found to occur at the crack tip prior to formation of unstable oxides. To contrast with the threshold failure mode regime, a quantitative assessment of the role that the intergranular failure mode has on cyclic FCG behavior in the Paris regime was also performed. It was demonstrated that even a very limited intergranular failure content dominates the FCG response under mixed mode failure conditions.

Bone marrow-derived mesenchymal stromal cell treatment in patients with severe ischaemic heart failure

DEFF Research Database (Denmark)

Mathiasen, Anders Bruun; Qayyum, Abbas Ali; Jørgensen, Erik

2015-01-01

AIMS: Regenerative treatment with mesenchymal stromal cells (MSCs) has been promising in patients with ischaemic heart failure but needs confirmation in larger randomized trials. We aimed to study effects of intra-myocardial autologous bone marrow-derived MSC treatment in patients with severe isc...... identified. CONCLUSION: Intra-myocardial injections of autologous culture expanded MSCs were safe and improved myocardial function in patients with severe ischaemic heart failure. STUDY REGISTRATION NUMBER: NCT00644410 (ClinicalTrials.gov)....... ischaemic heart failure. METHODS AND RESULTS: The MSC-HF trial is a randomized, double-blind, placebo-controlled trial. Patients were randomized 2 : 1 to intra-myocardial injections of MSC or placebo, respectively. The primary endpoint was change in left ventricular end-systolic volume (LVESV), measured...

Approximations of time-dependent phenomena in quantum mechanics: adiabatic versus sudden processes

International Nuclear Information System (INIS)

Melnichuk, S V; Dijk, W van; Nogami, Y

2005-01-01

By means of a one-dimensional model of a particle in an infinite square-well potential with one wall moving at a constant speed, we examine aspects of time-dependent phenomena in quantum mechanics such as adiabatic and sudden processes. The particle is assumed to be initially in the ground state of the potential with its initial width. The time dependence of the wavefunction of the particle in the well is generally more complicated when the potential well is compressed than when it is expanded. We are particularly interested in the case in which the potential well is suddenly compressed. The so-called sudden approximation is not applicable in this case. We also study the energy of the particle in the changing well as a function of time for expansion and contraction as well as for expansion followed by contraction and vice versa

Left Ventricular Aneurysm: Sudden Unexpected Deaths in a 29-Year-Old Man.

Science.gov (United States)

Srettabunjong, Supawon

2018-05-01

Left ventricular aneurysm (LVA) is an abnormal dilated heart structure, either congenital or acquired. LVA is a rare cardiac condition with no symptoms in most cases, thus occasionally diagnosed during investigations of other diseases. Its association with certain cardiac complications and sudden cardiac deaths has been reported. However, its role as a cause of sudden unexpected death is rare. The author reported a sudden cardiac death in a 29-year-old man with LVA. Without a significant coronary artery disease and known etiologies of LVA, such an abnormal heart structure in the present case was considered congenital LVA. As no other possible mechanisms of death could be identified other than LVA with its associated pathologic lesions, mural thrombi, and dilated cardiomegaly, his death was attributable to fatal cardiac arrhythmia (most commonly ventricular tachycardia) secondary to LVA. © 2017 American Academy of Forensic Sciences.

Sudden hearing loss after an explosion

Directory of Open Access Journals (Sweden)

Irfan Mohamad

2013-12-01

Full Text Available An 18-year-old man presented with a sudden onset of bilateral hearing loss after a home-made firework exploded near the right side of his scalp. The hearing loss was associated with tinnitus. Examination revealed an area of skin loss on the right pinna. There was mild bleeding from the right pinna and scalp at the mastoid region, which spontaneously resolved. An otoscopic examination is shown in Figure 1.

Epilepsy and risk of death and sudden unexpected death in the young

DEFF Research Database (Denmark)

Holst, Anders Gaarsdal; Winkel, Bo Gregers; Risgaard, Bjarke

2013-01-01

Patients with epilepsy are at increased risk of premature death from all causes and likely also from sudden unexplained death (SUD). Many patients with epilepsy have significant comorbidity, and it is unclear how much of the increased risk can be explained by epilepsy itself. We aimed to chart...... the incidence of sudden unexpected death in epilepsy (SUDEP) and estimate the risk of death from all causes and SUD conferred by epilepsy independently....

Landing performance by low-time private pilots after the sudden loss of binocular vision - Cyclops II

Science.gov (United States)

Lewis, C. E., Jr.; Swaroop, R.; Mcmurty, T. C.; Blakeley, W. R.; Masters, R. L.

1973-01-01

Study of low-time general aviation pilots, who, in a series of spot landings, were suddenly deprived of binocular vision by patching either eye on the downwind leg of a standard, closed traffic pattern. Data collected during these landings were compared with control data from landings flown with normal vision during the same flight. The sequence of patching and the mix of control and monocular landings were randomized to minimize the effect of learning. No decrease in performance was observed during landings with vision restricted to one eye, in fact, performance improved. This observation is reported at a high level of confidence (p less than 0.001). These findings confirm the previous work of Lewis and Krier and have important implications with regard to aeromedical certification standards.

Guidelines for autopsy investigation of sudden cardiac death

NARCIS (Netherlands)

Basso, Cristina; Burke, Margaret; Fornes, Paul; Gallagher, Patrick J.; de Gouveia, Rosa Henriques; Sheppard, Mary; Thiene, Gaetano; van der Wal, Allard

2010-01-01

Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed, and the accurate diagnosis of

Guidelines for autopsy investigation of sudden cardiac death

NARCIS (Netherlands)

Basso, C.; Burke, M.; Fornes, P.; Gallagher, P. J.; de Gouveia, R. H.; Sheppard, M.; Thiene, G.; van der Wal, A.

2010-01-01

Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of

Guidelines for autopsy investigation of sudden cardiac death

NARCIS (Netherlands)

Basso, Cristina; Burke, Margaret; Fornes, Paul; Gallagher, Patrick J.; de Gouveia, Rosa Henriques; Sheppard, Mary; Thiene, Gaetano; van der Wal, Allard

2008-01-01

Although sudden cardiac death is one of the most important mode of death in Western Countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed, and the accurate diagnosis of

Numerical simulation of the transport phenomena due to sudden heating in porous media

Energy Technology Data Exchange (ETDEWEB)

Lei, S.Y.; Zheng, G.Y.; Wang, B.X.; Yang, R.G.; Xia, C.M.

1997-07-01

Such process as wet porous media suddenly heated by hot fluids frequently occurs in nature and in industrial applications. The three-variable simulation model was developed to predict violent transport phenomena due to sudden heating in porous media. Two sets of independent variables were applied to different regions in porous media in the simulation. For the wet zone, temperature, wet saturation and air pressure were used as the independent variables. For the dry zone, the independent variables were temperature, vapor pressure and air pressure. The model simulated two complicated transport processes in wet unsaturated porous media which is suddenly heated by melting metal or boiling water. The effect of the gas pressure is also investigated on the overall transport phenomena.

Inhaled PGE1 in neonates with hypoxemic respiratory failure: two pilot feasibility randomized clinical trials.

Science.gov (United States)

Sood, Beena G; Keszler, Martin; Garg, Meena; Klein, Jonathan M; Ohls, Robin; Ambalavanan, Namasivayam; Cotten, C Michael; Malian, Monica; Sanchez, Pablo J; Lakshminrusimha, Satyan; Nelin, Leif D; Van Meurs, Krisa P; Bara, Rebecca; Saha, Shampa; Das, Abhik; Wallace, Dennis; Higgins, Rosemary D; Shankaran, Seetha

2014-12-12

Inhaled nitric oxide (INO), a selective pulmonary vasodilator, has revolutionized the treatment of neonatal hypoxemic respiratory failure (NHRF). However, there is lack of sustained improvement in 30 to 46% of infants. Aerosolized prostaglandins I2 (PGI2) and E1 (PGE1) have been reported to be effective selective pulmonary vasodilators. The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of inhaled PGE1 (IPGE1) in NHRF. Two pilot multicenter phase II RCTs are included in this report. In the first pilot, late preterm and term neonates with NHRF, who had an oxygenation index (OI) of ≥15 and <25 on two arterial blood gases and had not previously received INO, were randomly assigned to receive two doses of IPGE1 (300 and 150 ng/kg/min) or placebo. The primary outcome was the enrollment of 50 infants in six to nine months at 10 sites. The first pilot was halted after four months for failure to enroll a single infant. The most common cause for non-enrollment was prior initiation of INO. In a re-designed second pilot, co-administration of IPGE1 and INO was permitted. Infants with suboptimal response to INO received either aerosolized saline or IPGE1 at a low (150 ng/kg/min) or high dose (300 ng/kg/min) for a maximum duration of 72 hours. The primary outcome was the recruitment of an adequate number of patients (n = 50) in a nine-month-period, with fewer than 20% protocol violations. No infants were enrolled in the first pilot. Seven patients were enrolled in the second pilot; three in the control, two in the low-dose IPGE1, and two in the high-dose IPGE1 groups. The study was halted for recruitment futility after approximately six months as enrollment targets were not met. No serious adverse events, one minor protocol deviation and one pharmacy protocol violation were reported. These two pilot RCTs failed to recruit adequate eligible newborns with NHRF. Complex management RCTs of novel therapies for persistent pulmonary

Contrast-enhanced MR imaging of the endolymphatic sac in patients with sudden hearing loss

International Nuclear Information System (INIS)

Naganawa, Shinji; Koshikawa, Tokiko; Fukatsu, Hiroshi; Ishigaki, Takeo; Nakashima, Tsutomu; Ichinose, Nobuyasu

2002-01-01

Our objective was to evaluate the frequency of contrast enhancement of the endolymphatic sac in patients with sudden hearing loss. Forty consecutive patients with sudden sensorineural hearing loss (20 males and 20 females; age range 11-82 years), 40 age-matched control subjects, and 5 patients with Meniere's disease were examined using the same imaging protocol on a 1.5-T MR system. Pre- and post-contrast-enhanced T1-weighted 3D spoiled gradient-echo sequence (3D SPGR; TR/TE=23/10 ms, no. of excitations=1, flip angle=30 ) images were obtained using a voxel size of 0.6 x 0.7 x 0.8 mm 3 . Contrast enhancement in the area of the endolymphatic sac was assessed by two radiologists, and the frequency of contrast enhancement was compared between the three study groups. Enhancement of the ipsilateral endolymphatic sac was observed in 30 of the 40 patients with sudden hearing loss (75%). Twenty of these 30 patients also showed enhancement on the contralateral side, and 1 patient showed enhancement only on the contralateral side. Only 1 of the 5 patients with Meniere's disease showed enhancement. Nine of the 40 control subjects (22.5%) showed enhancement (bilateral enhancement in 5 subjects, unilateral in 4). The frequency of enhancement in patients with sudden hearing loss was significantly higher than that in control subjects (P<0.0001) or patients with Meniere's disease (P<0.05). The frequency of contrast enhancement of the endolymphatic sac is significantly increased in patients with sudden hearing loss, but further study is necessary to clarify the relationship between this finding and the pathophysiology of sudden hearing loss. (orig.)

Repairable system analysis in presence of covariates and random effects

International Nuclear Information System (INIS)

Giorgio, M.; Guida, M.; Pulcini, G.

2014-01-01

This paper aims to model the failure pattern of repairable systems in presence of explained and unexplained heterogeneity. The failure pattern of each system is described by a Power Law Process. Part of the heterogeneity among the patterns is explained through the use of a covariate, and the residual unexplained heterogeneity (random effects) is modeled via a joint probability distribution on the PLP parameters. The proposed approach is applied to a real set of failure time data of powertrain systems mounted on 33 buses employed in urban and suburban routes. Moreover, the joint probability distribution on the PLP parameters estimated from the data is used as an informative prior to make Bayesian inference on the future failure process of a generic system belonging to the same population and employed in an urban or suburban route under randomly chosen working conditions. - Highlights: • We describe the failure process of buses powertrain system subject to heterogeneity. • Heterogeneity due to different service types is explained by a covariate. • Random effect is modeled through a joint pdf on failure process parameters. • The powertrain reliability under new future operating conditions is estimated

Guidelines for autopsy investigation of sudden cardiac death

DEFF Research Database (Denmark)

Basso, Cristina; Aguilera, Beatriz; Banner, Jytte

2017-01-01

diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular...

Recent advances in understanding and prevention of sudden cardiac death [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Jamie I. Vandenberg

2017-08-01

Full Text Available There have been tremendous advances in the diagnosis and treatment of heart disease over the last 50 years. Nevertheless, it remains the number one cause of death. About half of heart-related deaths occur suddenly, and in about half of these cases the person was unaware that they had underlying heart disease. Genetic heart disease accounts for only approximately 2% of sudden cardiac deaths, but as it typically occurs in younger people it has been a particular focus of activity in our quest to not only understand the underlying mechanisms of cardiac arrhythmogenesis but also develop better strategies for earlier detection and prevention. In this brief review, we will highlight trends in the recent literature focused on sudden cardiac death in genetic heart diseases and how these studies are contributing to a broader understanding of sudden death in the community.

About a cocaine-associated sudden death casework.

Science.gov (United States)

Pileggi, P; Teatino, A; La Marca, A; Barbaro, A

2004-12-02

A man 24-year-old died suddenly while he was doing shopping. It was supposed that the death was caused by ictus or by cardiac pathology. During the autopsy, some biological samples were taken (hair, urine, blood and lachrymal liquid) for the toxicological analysis and also the heart, some fragments from the liver, lungs, spleen, and kidneys for the histo-pathological analysis.

Elastic lattice in a random potential

Energy Technology Data Exchange (ETDEWEB)

Chudnovsky, E.M.; Dickman, R. [Department of Physics and Astronomy, Lehman College, CUNY, Bedford Park Boulevard West, Bronx, New York 10468-1589 (United States)

1998-02-01

Using Monte Carlo simulations, we study the properties of an elastic triangular lattice subject to a random background potential. As the cooling rate is reduced, we observe a rather sudden crossover between two different glass phases, with exponential decay of translational correlations, the other with power-law decay. Contrary to predictions derived for continuum models, no evidence of a crossover in the mean-square displacement B(r) from the quadratic growth at small r to the logarithmic growth at large r is found. {copyright} {ital 1998} {ital The American Physical Society}

Elastic lattice in a random potential

International Nuclear Information System (INIS)

Chudnovsky, E.M.; Dickman, R.

1998-01-01

Using Monte Carlo simulations, we study the properties of an elastic triangular lattice subject to a random background potential. As the cooling rate is reduced, we observe a rather sudden crossover between two different glass phases, with exponential decay of translational correlations, the other with power-law decay. Contrary to predictions derived for continuum models, no evidence of a crossover in the mean-square displacement B(r) from the quadratic growth at small r to the logarithmic growth at large r is found. copyright 1998 The American Physical Society

Cerebral Paragonimiasis Presenting with Sudden Death.

Science.gov (United States)

Amaro, Deirdre E; Cowell, Annie; Tuohy, Marion J; Procop, Gary W; Morhaime, Jacquelyn; Reed, Sharon L

2016-12-07

A 58-year-old Korean-born woman with a history of seizures and psychiatric issues was found dead at home. Autopsy was notable for large, calcified nodules that had nearly replaced her right temporal lobe. Histologic examination revealed the presence of Paragonimus eggs. This case demonstrates a rare manifestation of an aberrantly migrated lung fluke that resulted in epilepsy and sudden death years after the initial infection. © The American Society of Tropical Medicine and Hygiene.

Sudden behavior change in a cat.

Science.gov (United States)

Gelberg, H B

2013-11-01

A 5-year-old, spayed female, domestic short-haired cat had a 10-day history of sudden behavioral changes followed by seizures. Blood parameters were in the reference ranges, and radiographs failed to detect a mass lesion in the brain. Euthanasia was followed by rabies testing, which was negative. Gross lesions were absent. Histologic changes were present only in the brain and consisted of foci of hippocampal pyramidal cell loss, mild gliosis, pallor of the associated neuropil, and neovascularization.

Sudden death in paediatrics as a traumatic experience for critical care nurses.

Science.gov (United States)

Lima, Lígia; Gonçalves, Sandra; Pinto, Cândida

2018-01-01

Research shows that nurses working in critical care units and in particular, paediatric units, are at risk of developing symptoms of secondary traumatic stress (STS). However, little attention has been given to this phenomenon when associated with situations of sudden death in paediatrics. This study aimed to examine the impact of sudden death in paediatrics on nurses working in paediatrics critical care units and to explore nurses' experiences of this event. This study used a mixed-methods design. The Impact of Event Scale - Revised was used for investigating the presence of STS symptoms. In addition, an interview was conducted with six nurses. Fifty-seven percent of nurses responded to the surveys and six nurses were interviewed. The results showed that the sudden death of children and adolescents is an event that elicits symptoms of STS in nurses. The quantitative assessment, revealed that 19·4% presented total scores indicating high impact. The participants interviewed described experiences of subjective distress, such as intrusive thoughts, avoidance and hyperarousal. Other factors were also reported as influencing the experience of the sudden death of a child/adolescent, namely, the child's age, the cause of death and the family's reaction to the loss. According to the participants, the emotional impact was also determined by parenthood, previous training and professional experience. Sudden death in paediatric critical care units is one of the most difficult situations in nursing practice and elicits STS symptoms, which may severely impact the physical and psychological health of nurses and ultimately affect the quality of the provided care. This study emphasizes the need for promoting better conditions for professional practice, namely, with regard to emotional support, as well as training programmes for skills development in the area of management of traumatic situations and of communication with clients. © 2017 British Association of Critical Care

Prevention of sudden cardiac death in young athletes: controversies and conundrums.

Science.gov (United States)

Rowland, Thomas

2011-01-01

Strategies for preventing sudden cardiac death in young athletes are predicated on the assumption that: (1) these events reflect pre-existing, clinically silent heart disease, and (2) means for detecting these abnormalities on the pre-participation evaluation are both feasible and accurate. Recent controversy has surrounded both of these presumptions. Some evidence suggests that the myocardial hypertrophy accompanying sports training itself might serve as a substrate for fatal arrhythmias. As well, vigorous debate has arisen over the optimal content of the pre-participation evaluation, particularly regarding the inclusion of routine screening electrocardiograms. As the rarity of these fatal events does not lend itself to an experimental approach, such disagreements are not easily resolved. Consequently, it is expected that decisions regarding approaches to prevention of sudden death in athletes will be dictated largely by region-specific financial, political, and cultural factors. This chapter examines the aetiologies of sudden cardiac death in young athletes as well as the controversies surrounding the prevention of these tragedies. Copyright © 2011 S. Karger AG, Basel.

Determination of the failure probability in the weld region of ap-600 vessel for transient condition

International Nuclear Information System (INIS)

Wahyono, I.P.

1997-01-01

Failure probability in the weld region of AP-600 vessel was determined for transient condition scenario. The type of transient is increase of the heat removal from primary cooling system due to sudden opening of safety valves or steam relief valves on the secondary cooling system or the steam generator. Temperature and pressure in the vessel was considered as the base of deterministic calculation of the stress intensity factor. Calculation of film coefficient of the convective heat transfers is a function of the transient time and water parameter. Pressure, material temperature, flaw depth and transient time are variables for the stress intensity factor. Failure probability consideration was done by using the above information in regard with the flaw and probability distributions of Octavia II and Marshall. Calculation of the failure probability by probability fracture mechanic simulation is applied on the weld region. Failure of the vessel is assumed as a failure of the weld material with one crack which stress intensity factor applied is higher than the critical stress intensity factor. VISA II code (Vessel Integrity Simulation Analysis II) was used for deterministic calculation and simulation. Failure probability of the material is 1.E-5 for Octavia II distribution and 4E-6 for marshall distribution for each transient event postulated. The failure occurred at the 1.7th menit of the initial transient under 12.53 ksi of the pressure

Adaptation to sudden unexpected loading of the low back - the effects of repeated trials

DEFF Research Database (Denmark)

Skotte, J.H.; Fallentin, N.; Pedersen, Mogens Theisen

2004-01-01

The purpose of this study was to investigate short-term changes in reactions to sudden unexpected loading of the low back. The study utilized a set-up where a horizontal force of 58 N pointing forward suddenly was applied to the upper part of the subject's trunk. EMG activity from the erector...

Failure of the pressure bulkhead of a passenger aircraft - a Case Study

International Nuclear Information System (INIS)

Salam, I.; Khan, A.N.; Farooque, M.

2011-01-01

The pressure bulkhead of a passenger aircraft ruptured when the aircraft was cruising at a height of 28,000 ft. Because of the sudden rupture, the rear toilets disintegrated and things like toilet rolls, tissue papers, towels, were sucked into the stabilizer compartment, where the entire tail control system was located. The debris damaged the green hydraulic system, ruptured fuel line and jammed the control cables. The damage resulted in the aircraft going into pitch-up mode (take-off position) and almost approached stalling position. The failed part was located near the toilets. Water from the toilets reached in this region due to leakage and penetrated inside the sheets and corrosion started in the presence of stagnant water. This was supplemented by the stresses present on the structure during flight. Stress corrosion started from inner sheet and led to initiation of fatigue. The combined effect of stress corrosion cracking and fatigue resulted in the failure of this sheet. No third stage (catastrophic) failure was observed in the fracture. The absence of catastrophic failure mode in the fractured sheet showed that it stood up to last stage. (author)

Point Estimation Method of Electromagnetic Flowmeters Life Based on Randomly Censored Failure Data

Directory of Open Access Journals (Sweden)

Zhen Zhou

2014-08-01

Full Text Available This paper analyzes the characteristics of the enterprise after-sale service records for field failure data, and summarizes the types of field data. Maximum likelihood estimation method and the least squares method are presented for the complexity and difficulty of field failure data processing, and Monte Carlo simulation method is proposed. Monte Carlo simulation, the relatively simple calculation method, is an effective method, whose result is closed to that of the other two methods. Through the after-sale service records analysis of a specific electromagnetic flowmeter enterprises, this paper illustrates the effectiveness of field failure data processing methods.

Effects of systematic prone positioning in hypoxemic acute respiratory failure: a randomized controlled trial.

Science.gov (United States)

Guerin, Claude; Gaillard, Sandrine; Lemasson, Stephane; Ayzac, Louis; Girard, Raphaele; Beuret, Pascal; Palmier, Bruno; Le, Quoc Viet; Sirodot, Michel; Rosselli, Sylvaine; Cadiergue, Vincent; Sainty, Jean-Marie; Barbe, Philippe; Combourieu, Emmanuel; Debatty, Daniel; Rouffineau, Jean; Ezingeard, Eric; Millet, Olivier; Guelon, Dominique; Rodriguez, Luc; Martin, Olivier; Renault, Anne; Sibille, Jean-Paul; Kaidomar, Michel

2004-11-17

A recent trial showed that placing patients with acute lung injury in the prone position did not increase survival; however, whether those results hold true for patients with hypoxemic acute respiratory failure (ARF) is unclear. To determine whether prone positioning improves mortality in ARF patients. Prospective, unblinded, multicenter controlled trial of 791 ARF patients in 21 general intensive care units in France using concealed randomization conducted from December 14, 1998, through December 31, 2002. To be included, patients had to be at least 18 years, hemodynamically stable, receiving mechanical ventilation, and intubated and had to have a partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FIO2) ratio of 300 or less and no contraindications to lying prone. Patients were randomly assigned to prone position placement (n = 413), applied as early as possible for at least 8 hours per day on standard beds, or to supine position placement (n = 378). The primary end point was 28-day mortality; secondary end points were 90-day mortality, duration of mechanical ventilation, incidence of ventilator-associated pneumonia (VAP), and oxygenation. The 2 groups were comparable at randomization. The 28-day mortality rate was 32.4% for the prone group and 31.5% for the supine group (relative risk [RR], 0.97; 95% confidence interval [CI], 0.79-1.19; P = .77). Ninety-day mortality for the prone group was 43.3% vs 42.2% for the supine group (RR, 0.98; 95% CI, 0.84-1.13; P = .74). The mean (SD) duration of mechanical ventilation was 13.7 (7.8) days for the prone group vs 14.1 (8.6) days for the supine group (P = .93) and the VAP incidence was 1.66 vs 2.14 episodes per 100-patients days of intubation, respectively (P = .045). The PaO2/FIO2 ratio was significantly higher in the prone group during the 28-day follow-up. However, pressure sores, selective intubation, and endotracheal tube obstruction incidences were higher in the prone group. This trial

Research on a Sudden Explosion and its Environmental Impact

Science.gov (United States)

Ye, Maosheng; Ma, Hui; Ni, Qingwei

2017-12-01

A sudden blast was chosen as the studied topic. Also, one computer based virtual experimentation was used to estimate the dimensional impact of initial pollutant plume from blasts. Self-made method using Mathcad code was used to generate the output for the period of the first tenth of a second (1deci-second) to 1minute (60s) of the blast at the point source. It also depicted long-range air pollution travel within the first 1 to 10 minutes. In the case study, it assumed an average directional diffusivity of 1720 m2s-1 which is about 25 per cent of the average generated speed of common explosives. The newly developed model revealed a plume cloud impact of 6.8×107µgm-3 in the first 1millisecond (0.01s) which decayed suddenly to a value of 1.7×107µgm-3 in the first 1decisecond (0.1s). The impact concentration at the point source by the end of the first second (1.0s) was 3.2×105µgm-3 which implied a 99.5% sudden decay when compared to 0.01s concentration value at the emission point source. Computerized experiments observed that air pollutants release from explosives/blasts were dispersed into the atmosphere in the first few seconds by forceful injection instead of by gradual dispersion as is the case with normal air pollutants plume releases.

Thyroid gland and cerebella lesions: New risk factors for sudden cardiac death in schizophrenia?

Science.gov (United States)

Scorza, Fulvio A; Cavalheiro, Esper A; de Albuquerque, Marly; de Albuquerque, Juliana; Cysneiros, Roberta M; Terra, Vera C; Arida, Ricardo M

2011-02-01

People with schizophrenia show a two to threefold increased risk to die prematurely than those without schizophrenia. Patients' life style, suicide, premature development of cardiovascular disease, high prevalence of metabolic syndrome and sudden cardiac death are well-known causes of the excess mortality. The exact pathophysiological cause of sudden death in schizophrenia is unknown, but it is likely that cardiac arrhythmia and respiratory abnormalities play potential role. Some antipsychotics may be associated with cardiovascular adverse events (e.g., QT interval prolongation) and lesions in specific brain regions, such as cerebella may be associated with respiratory abnormalities, suggesting that metabolic and brain dysfunction could lead to sudden cardiac death in patients with schizophrenia. However, exact knowledge regarding the association of these findings and schizophrenia is lacking. As subclinical hyperthyroidism has been linked with increased risk of cardiovascular disease and cerebella progressive atrophy has been observed in patients with schizophrenia, we propose in this paper that subclinical thyroid dysfunction and cerebella volume loss could be considered as new risk factor for sudden cardiac death in schizophrenia. Copyright © 2010 Elsevier Ltd. All rights reserved.

Next of kin’s experiences of sudden and unexpected death from stroke - a study of narratives

Science.gov (United States)

2013-01-01

Background Death always evokes feelings in those close to the afflicted person. When death comes suddenly the time for preparation is minimal and the next of kin have to cope with the situation despite their own sorrow. The suddenness is found to be stressful for the next of kin and communication both with healthcare professionals and information about what has happened has been found helpful. The aim of this study was to illuminate the experiences of next of kin from the sudden and unexpected death of a relative from acute stroke. Methods Data was collected over a 12-month period in 2009–2010. Twelve next of kin of patients cared for in stroke units who died suddenly and unexpectedly from stroke were interviewed using a narrative method. The narratives were analyzed using narrative thematic analysis. Results Three themes emerged showing facets of next of kin’s experiences of a relative’s sudden and unexpected death from stroke: Divided feelings about the sudden and unexpected death; Perception of time and directed attention when keeping vigil; Contradictions and arbitrary memories when searching for understanding. Conclusions To have to live in the aftermath of severe stroke is absolute horror in people’s imagination and death is seen as the lesser of two evils. The sudden and unexpected death totally pervades the next of kin’s life, directs their attention to the dying person and even causes them to forget themselves and their own needs, and leads to difficulties in information intake. It is a challenge for the healthcare professionals to be able to identify the individual needs of the next of kin in this situation. PMID:23590246

Nationwide study of sudden cardiac death in persons aged 1-35 years

DEFF Research Database (Denmark)

Winkel, Bo Gregers; Holst, Anders Gaarsdal; Theilade, Juliane

2011-01-01

Aims The aim of this investigation was to study the incidence of sudden cardiac death (SCD) in persons aged 1-35 years in a nationwide setting (5.38 million people) by systematic evaluation of all deaths. Methods and results All deaths in persons aged 1-35 years in Denmark in 2000-06 were included....... Death certificates were read independently by two physicians. The National Patient Registry was used to retrieve information on prior medical history. All autopsy reports were read and the cause of death was revised based on autopsy findings. We identified 625 cases of sudden unexpected death (10......% of all deaths), of which 156 (25%) were not autopsied. Of the 469 autopsied cases, 314 (67%) were SCD. The most common cardiac cause of death was ischaemic heart disease (13%); 29% of autopsied sudden unexpected death cases were unexplained. In 45% of SCD cases, the death was witnessed; 34% died during...

Congenital and hereditary causes of sudden cardiac death in young adults: diagnosis, differential diagnosis, and risk stratification.

Science.gov (United States)

Stojanovska, Jadranka; Garg, Anubhav; Patel, Smita; Melville, David M; Kazerooni, Ella A; Mueller, Gisela C

2013-01-01

Sudden cardiac death is defined as death from unexpected circulatory arrest-usually a result of cardiac arrhythmia-that occurs within 1 hour of the onset of symptoms. Proper and timely identification of individuals at risk for sudden cardiac death and the diagnosis of its predisposing conditions are vital. A careful history and physical examination, in addition to electrocardiography and cardiac imaging, are essential to identify conditions associated with sudden cardiac death. Among young adults (18-35 years), sudden cardiac death most commonly results from a previously undiagnosed congenital or hereditary condition, such as coronary artery anomalies and inherited cardiomyopathies (eg, hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy [ARVC], dilated cardiomyopathy, and noncompaction cardiomyopathy). Overall, the most common causes of sudden cardiac death in young adults are, in descending order of frequency, hypertrophic cardiomyopathy, coronary artery anomalies with an interarterial or intramural course, and ARVC. Often, sudden cardiac death is precipitated by ventricular tachycardia or fibrillation and may be prevented with an implantable cardioverter defibrillator (ICD). Risk stratification to determine the need for an ICD is challenging and involves imaging, particularly echocardiography and cardiac magnetic resonance (MR) imaging. Coronary artery anomalies, a diverse group of congenital disorders with a variable manifestation, may be depicted at coronary computed tomographic angiography or MR angiography. A thorough understanding of clinical risk stratification, imaging features, and complementary diagnostic tools for the evaluation of cardiac disorders that may lead to sudden cardiac death is essential to effectively use imaging to guide diagnosis and therapy.

Canonical failure modes of real-time control systems: insights from cognitive theory

Science.gov (United States)

Wallace, Rodrick

2016-04-01

Newly developed necessary conditions statistical models from cognitive theory are applied to generalisation of the data-rate theorem for real-time control systems. Rather than graceful degradation under stress, automatons and man/machine cockpits appear prone to characteristic sudden failure under demanding fog-of-war conditions. Critical dysfunctions span a spectrum of phase transition analogues, ranging from a ground state of 'all targets are enemies' to more standard data-rate instabilities. Insidious pathologies also appear possible, akin to inattentional blindness consequent on overfocus on an expected pattern. Via no-free-lunch constraints, different equivalence classes of systems, having structure and function determined by 'market pressures', in a large sense, will be inherently unreliable under different but characteristic canonical stress landscapes, suggesting that deliberate induction of failure may often be relatively straightforward. Focusing on two recent military case histories, these results provide a caveat emptor against blind faith in the current path-dependent evolutionary trajectory of automation for critical real-time processes.

Cryotherapy does not affect peroneal reaction following sudden inversion.

Science.gov (United States)

Berg, Christine L; Hart, Joseph M; Palmieri-Smith, Riann; Cross, Kevin M; Ingersoll, Christopher D

2007-11-01

If ankle joint cryotherapy impairs the ability of the ankle musculature to counteract potentially injurious forces, the ankle is left vulnerable to injury. To compare peroneal reaction to sudden inversion following ankle joint cryotherapy. Repeated measures design with independent variables, treatment (cryotherapy and control), and time (baseline, immediately post treatment, 15 minutes post treatment, and 30 minutes post treatment). University research laboratory. Twenty-seven healthy volunteers. An ice bag was secured to the lateral ankle joint for 20 minutes. The onset and average root mean square amplitude of EMG activity in the peroneal muscles was calculated following the release of a trap door mechanism causing inversion. There was no statistically significant change from baseline for peroneal reaction time or average peroneal muscle activity at any post treatment time. Cryotherapy does not affect peroneal muscle reaction following sudden inversion perturbation.

Probabilistic analysis of ''common mode failures''

International Nuclear Information System (INIS)

Easterling, R.G.

1978-01-01

Common mode failure is a topic of considerable interest in reliability and safety analyses of nuclear reactors. Common mode failures are often discussed in terms of examples: two systems fail simultaneously due to an external event such as an earthquake; two components in redundant channels fail because of a common manufacturing defect; two systems fail because a component common to both fails; the failure of one system increases the stress on other systems and they fail. The common thread running through these is a dependence of some sort--statistical or physical--among multiple failure events. However, the nature of the dependence is not the same in all these examples. An attempt is made to model situations, such as the above examples, which have been termed ''common mode failures.'' In doing so, it is found that standard probability concepts and terms, such as statistically dependent and independent events, and conditional and unconditional probabilities, suffice. Thus, it is proposed that the term ''common mode failures'' be dropped, at least from technical discussions of these problems. A corollary is that the complementary term, ''random failures,'' should also be dropped. The mathematical model presented may not cover all situations which have been termed ''common mode failures,'' but provides insight into the difficulty of obtaining estimates of the probabilities of these events

F-MARC: promoting the prevention and management of sudden cardiac arrest in football

OpenAIRE

Kramer, Efraim Benjamin; Dvorak, J; Schmied, C; Meyer, T

2015-01-01

Sudden cardiac death is the most common cause of unnatural death in football. To prevent and urgently manage sudden cardiac arrest on the football field-of-play, F-MARC (FIFA Medical and Research Centre) has been fully committed to a programme of research, education, standardisation and practical implementation. This strategy has detected football players at medical risk during mandatory precompetition medical assessments. Additionally, FIFA has (1) sponsored internationally accepted guidelin...

Failure probability under parameter uncertainty.

Science.gov (United States)

Gerrard, R; Tsanakas, A

2011-05-01

In many problems of risk analysis, failure is equivalent to the event of a random risk factor exceeding a given threshold. Failure probabilities can be controlled if a decisionmaker is able to set the threshold at an appropriate level. This abstract situation applies, for example, to environmental risks with infrastructure controls; to supply chain risks with inventory controls; and to insurance solvency risks with capital controls. However, uncertainty around the distribution of the risk factor implies that parameter error will be present and the measures taken to control failure probabilities may not be effective. We show that parameter uncertainty increases the probability (understood as expected frequency) of failures. For a large class of loss distributions, arising from increasing transformations of location-scale families (including the log-normal, Weibull, and Pareto distributions), the article shows that failure probabilities can be exactly calculated, as they are independent of the true (but unknown) parameters. Hence it is possible to obtain an explicit measure of the effect of parameter uncertainty on failure probability. Failure probability can be controlled in two different ways: (1) by reducing the nominal required failure probability, depending on the size of the available data set, and (2) by modifying of the distribution itself that is used to calculate the risk control. Approach (1) corresponds to a frequentist/regulatory view of probability, while approach (2) is consistent with a Bayesian/personalistic view. We furthermore show that the two approaches are consistent in achieving the required failure probability. Finally, we briefly discuss the effects of data pooling and its systemic risk implications. © 2010 Society for Risk Analysis.

Sudden unilateral deafness with endolymphatic sac adenocarcinoma: MRI

International Nuclear Information System (INIS)

Gaeta, M.; Blandino, A.; Minutoli, F.; Pandolfo, I.

1999-01-01

A 30-year-old man presented with sudden left deafness and vertigo. CT showed an osteolytic retrolabyrinthine tumour of the left temporal bone. High signal from the tumour and labyrinth was seen on fat-suppressed T 1-weighted images. At surgery, a haemorrhagic papillary-cystic adenocarcinoma of the endolymphatic sac was found. (orig.)

Sudden unilateral deafness with endolymphatic sac adenocarcinoma: MRI

Energy Technology Data Exchange (ETDEWEB)

Gaeta, M.; Blandino, A.; Minutoli, F.; Pandolfo, I. [Inst. of Radiological Sciences, Univ. of Messina (Italy)

1999-10-01

A 30-year-old man presented with sudden left deafness and vertigo. CT showed an osteolytic retrolabyrinthine tumour of the left temporal bone. High signal from the tumour and labyrinth was seen on fat-suppressed T 1-weighted images. At surgery, a haemorrhagic papillary-cystic adenocarcinoma of the endolymphatic sac was found. (orig.)

Temporal epidemiology of sudden oak death in Oregon

Science.gov (United States)

Ebba K. Peterson; Everett M. Hansen; Alan Kanaskie

2015-01-01

An effort to eradicate Phytophthora ramorum, causal agent of sudden oak death, has been underway since its discovery in Oregon forests. Using an information-theoretical approach, we sought to model yearly variation in the size of newly infested areas and dispersal distance. Maximum dispersal distances were best modeled by spring and winter...

Relationship between coronary atherosclerosis and 'sudden cardiac death'

International Nuclear Information System (INIS)

Lundholm, C.E.; Sundbom, L.; Lundholm, L.

1989-01-01

Coronary arteriosclerosis in mini-pigs was produced by combination of hypercholesterolemia and twofold X irradiation of the cardiac region. 15-21 weeks following irradiation 40% of the adult animals and 58% of the juvenils died of 'sudden cardiac death'. The mortality rate decreased significantly after application of the calcium-channel blocking agent nifedipine

Sudden Cardiac Arrest due to Brugada Syndrome: a Case Report and Literature Review

Directory of Open Access Journals (Sweden)

R Soleimanirad

2013-04-01

Full Text Available Brugada Syndrome is a rare cause of sudden cardiac arrest and has a unique ECG pattern. In fact, with ST-segment elevation down sloping in the right precordial leads (v1-v3, RBBB pattern in lateral leads and J-point elevation is revealed. We must notice and avoid trigger factors of this syndrome during general anesthesia. Patient is a 39 old man who attended to emergency department with sudden cardiac arrest and resuscitate. He was transferred to ICU for management of hypoxic ischemic encephalopathy. Complementary studies concluded the diagnosis of Brugada syndrome. We must consider Brugada syndrome within patients with family history of sudden cardiac arrest. Moreover, we must avoid trigger factors of this syndrome such as fever, bradicardia and electrolyte abnormality (specialy Na, Ca abnormalities during general anesthesia and if they appear, we should treat them.

Anti-HERG activity and the risk of drug-induced arrhythmias and sudden death

DEFF Research Database (Denmark)

De Bruin, M L; Pettersson, M; Meyboom, R H B

2005-01-01

AIMS: Drug-induced QTc-prolongation, resulting from inhibition of HERG potassium channels may lead to serious ventricular arrhythmias and sudden death. We studied the quantitative anti-HERG activity of pro-arrhythmic drugs as a risk factor for this outcome in day-to-day practice. METHODS...... defined as reports of cardiac arrest, sudden death, torsade de pointes, ventricular fibrillation, and ventricular tachycardia (n = 5591), and compared with non-cases regarding the anti-HERG activity, defined as the effective therapeutic plasma concentration (ETCPunbound) divided by the HERG IC50 value......, of suspected drugs. We identified a significant association of 1.93 (95% CI: 1.89-1.98) between the anti-HERG activity of drugs, measured as log10 (ETCPunbound/IC50), and reporting of serious ventricular arrhythmias and sudden death to the WHO-UMC database. CONCLUSION: Anti-HERG activity is associated...

Incidence and causes of sudden death in U.S. college athletes.

Science.gov (United States)

Maron, Barry J; Haas, Tammy S; Murphy, Caleb J; Ahluwalia, Aneesha; Rutten-Ramos, Stephanie

2014-04-29

The goal of this study was to reliably define the incidence and causes of sudden death in college student-athletes. The frequency with which cardiovascular-related sudden death occurs in competitive athletes importantly influences considerations for pre-participation screening strategies. We assessed databases (including autopsy reports) from both the U.S. National Registry of Sudden Death in Athletes and the National Collegiate Athletic Association (2002 to 2011). Over the 10-year study period, 182 sudden deaths occurred (age 20 ± 1.7 years; 85% male; 64% white), 52 resulting from suicide (n = 31) or drug abuse (n = 21) and 64 probably or likely attributable to cardiovascular causes (6/year). Of these 64 athletes, 47 had a confirmed post-mortem diagnosis; the most common were hypertrophic cardiomyopathy in 21 and congenital coronary anomalies in 8. The 4,052,369 athlete participations (in 30 sports over 10 years) incurred mortality risks as follows: suicide and drugs combined, 1.3/100,000 athlete participation-years (5 deaths/year); and documented cardiovascular disease, 1.2/100,000 athlete participation-years (4 deaths/year). Notably, cardiovascular deaths were 5-fold more common in African-American athletes than in white athletes (3.8 vs. 0.7/100,000 athlete participation-years; p death due to cardiovascular disease is relatively low, with mortality rates similar to suicide and drug abuse, but less than expected in the general population, although highest in African-American athletes. A substantial minority of confirmed cardiovascular deaths would not likely have been reliably detected by pre-participation screening with 12-lead electrocardiograms. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Pulmonary thromboembolism and sudden death in psychiatric patients: Two cases reports

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Marinković Nadica

2017-01-01

Full Text Available Introduction. Pulmonary thromboembolism occurs usually by running a thrombus from the deep veins of the legs rarely periprostatic or periuteric veins. Virchow's triad of necessary conditions for the occurrence of thrombosis involves disruption of blood flow, disruption of blood chemistry and damage to the vessel wall. Venous thrombosis is often associated with the implementation of antipsychotic therapy. Case report. We reported two cases of sudden death of psychiatric patients who were in both cases fixed during hospitalization. The first case was a 26-year-old woman treated a year with the diagnose of postpartum reactive psychosis. She was hospitalized because of mental state worsening with a dominant depressed mood, visual and auditory hallucinations. Her therapy was determined by diazepam, clozapine, haloperidol and lamotrigine. Suddenly, the patient died on the fifth day of hospitalization. The autopsy showed massive thromboembolism of the pulmonary artery branches. Toxicological analysis revealed the presence of therapeutic doses of antipsychotics. The second case was a-45-yearold men, a long-time alcoholic. On admission, the diagnosis of delirium tremens was established, and diazepam and haloperidol were administered. On the fifth day of hospitalization, he suddenly died. The autopsy showed thromboembolism of the branch of the pulmonary artery. Toxicological analysis established the presence of nordiazepam in urine (0.06 mg/L. Both patients were fixed during hospitalization. Conclusion. Both presented psychiatric patients were younger than 50 years, were not overweight, did not have changes of the venous blood vessels. Nowadays, when the issue of medical responsibility often arises in these and similar cases of sudden death in patients treated in psychiatric clinics, the questions on medical malpractice could be expected.

Dynamic stability under sudden loads

International Nuclear Information System (INIS)

Simitses, G.J.

1998-01-01

The concept of dynamic stability of elastic structures subjected to sudden (step) loads is discussed. The various criteria and related methodologies for estimating critical conditions are presented with the emphasis on their similarities and differences. These are demonstrated by employing a simple mechanical model. Several structural configurations are analyzed, for demonstration purposes, with the intention of comparing critical dynamic loads to critical static loads. These configurations include shallow arches and shallow spherical caps, two bar frames, and imperfect cylindrical shells of metallic as well as laminated composite construction. In the demonstration examples, the effect of static pre loading on the dynamic critical load is presented

Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study.

Science.gov (United States)

Varvarigou, Vasileia; Farioli, Andrea; Korre, Maria; Sato, Sho; Dahabreh, Issa J; Kales, Stefanos N

2014-11-18

To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. Case distribution study (case series with survey information on referent exposures). United States law enforcement. Summaries of deaths of over 4500 US police officers provided by the National Law Enforcement Officers Memorial Fund and the Officer Down Memorial Page from 1984 to 2010. Observed and expected sudden cardiac death counts and relative risks for sudden cardiac death events during specific strenuous duties versus routine/non-emergency activities. Independent estimates of the proportion of time that police officers spend across various law enforcement duties obtained from surveys of police chiefs and front line officers. Impact of varying exposure assessments, covariates, and missing cases in sensitivity and stability analyses. 441 sudden cardiac deaths were observed during the study period. Sudden cardiac death was associated with restraints/altercations (25%, n=108), physical training (20%, n=88), pursuits of suspects (12%, n=53), medical/rescue operations (8%, n=34), routine duties (23%, n=101), and other activities (11%, n=57). Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34-69 times higher during restraints/altercations, 32-51 times higher during pursuits, 20-23 times higher during physical training, and 6-9 times higher during medical/rescue operations. Results were robust to all sensitivity and stability analyses. Stressful law enforcement duties are associated with a risk of sudden cardiac death that is markedly higher than the risk during routine/non-emergency duties. Restraints/altercations and pursuits are associated with the greatest risk. Our findings have public health implications and suggest that primary and secondary cardiovascular prevention efforts are needed among law enforcement officers. © Varvarigou et al 2014.

The analysis of Sudden Infant Death Syndrome in Poland

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Anna Lewandowska

2017-05-01

Full Text Available Introduction: Sudden Infant Death Syndrome is defined in literature similarly as a sudden and unexpected death of an infant occurring during sleep and, at the same time, causes of which cannot be explained based on anamnesis, circumstances of death or comprehensive post-mortem examinations. Sudden Infant Death Syndrome is considered to be the most frequent cause of death among infants in the developed countries. Incidence of SIDS in the whole world ranges from about 0.1 to 6.0/1,000 live births. As much as 90% concerns deaths in the first year of life of a child, whereas 70% stands for deaths for which the cause remains unknown. In SIDS, about 90% of cases concern children under 1 year old and, in particular, at the age of between 2 and 4 months. The aim: The aim of the study was to present the most significant aspects of SIDS as well as description and analysis of risk factors for occurrence of sudden infant death syndrome based on statistical data. Materials and methods: For the purpose of the study, the secondary data analysis and desk research technique have been applied. The analysis is based on statistical data from the time period 2009-2014 released by the Central Statistical Office of Poland. Results: In 2009-2014, the highest number of deaths of infants and new-borns was reported in 2009 with the number being as high as 2,327. In the following years, the number of deaths of new-borns and infants systematically decreased. In 2010 it was 2,057 and in 2011 – 1,836, in 2012 – 1,791, in 2013 – 1,684, and in 2014 – 1,583. The highest number of deaths of boys was reported in 2009 – 1,298, while the number of deaths of girls in that year, although it was the highest in the analysed period, was lower – 1,029. Conclusions: cases of death were more frequent among boys rather than girls. The highest number of deaths was reported among infants under the age of one month and the number decreased with an increasing infants’ age. More

Sudden Oak Death, Phytophthora ramorum: A Persistent Threat to Oaks and Other Tree Species

Science.gov (United States)

S.J. Frankel; K.M. Palmieri

2014-01-01

This paper reviews the status and management of sudden oak death and “sudden larch death” in the urban and wildland forests of California, Oregon, and the UK. The causal pathogen, Phytophthora ramorum, was discovered in all three locations over a decade ago; however, efforts to contain and eliminate infestations have been unsuccessful. These less...

Picture quiz: a case of sudden severe chest pain.

Science.gov (United States)

Rabia, Mustafa Abu; Sullivan, P; Stivaros, Stavros M

2007-01-01

An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting.

The Astringency of the GP Algorithm for Forecasting Software Failure Data Series

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Yong-qiang Zhang

2007-05-01

Full Text Available The forecasting of software failure data series by Genetic Programming (GP can be realized without any assumptions before modeling. This discovery has transformed traditional statistical modeling methods as well as improved consistency for model applicability. The individuals' different characteristics during the evolution of generations, which are randomly changeable, are treated as Markov random processes. This paper also proposes that a GP algorithm with "optimal individuals reserved strategy" is the best solution to this problem, and therefore the adaptive individuals finally will be evolved. This will allow practical applications in software reliability modeling analysis and forecasting for failure behaviors. Moreover it can verify the feasibility and availability of the GP algorithm, which is applied to software failure data series forecasting on a theoretical basis. The results show that the GP algorithm is the best solution for software failure behaviors in a variety of disciplines.

[Three good reasons to perform a postmortem examination in all cases of juvenile sudden death].

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d'Amati, Giulia; di Gioia, Cira R T; Silenzi, Paola F; Gallo, Pietro

2009-04-01

The aim of this review is to underline the reasons why a post-mortem examination has to be performed in all cases of juvenile sudden death. Sudden death in children and young adults can be caused by potentially heritable cardiovascular disorders and fatal outcome is often the first symptom in apparently healthy subjects. In these cases, a careful autopsy, performed according to a standardized protocol, becomes the sole diagnostic tool to guide clinical and molecular genetic family screening and to adopt the proper therapeutic and preventive strategies. Thus, a post-mortem examination is a fundamental part of a multidisciplinary approach to the issue of juvenile sudden death.

Infinite-order-sudden method for light--heavy--light reactions: Application to D+HCl→DCl+H

International Nuclear Information System (INIS)

Clary, D.C.; Drolshagen, G.

1982-01-01

An infinite-order-sudden (IOS) theory for light-heavy-light reactions is applied to the D+HCl(v = 0, j)→DCl(v'< or =1, j')+H reaction. The results are compared with those obtained using a more accurate quantum-dynamical technique, the ESA--CSA method, in which the energy sudden approximation is used for the entrance channel, while the centrifugal sudden approximation is employed for the exit channel. The computations have been performed using LEPS and DIM potential energy surfaces. We obtain good agreement between the IOS and ESA--CSA results, not only for averaged quantities such as rate coefficients, but also for detailed vibrational-rotational reactive cross sections

Initiating sacubitril/valsartan (LCZ696) in heart failure: results of TITRATION, a double-blind, randomized comparison of two uptitration regimens.

Science.gov (United States)

Senni, Michele; McMurray, John J V; Wachter, Rolf; McIntyre, Hugh F; Reyes, Antonio; Majercak, Ivan; Andreka, Peter; Shehova-Yankova, Nina; Anand, Inder; Yilmaz, Mehmet B; Gogia, Harinder; Martinez-Selles, Manuel; Fischer, Steffen; Zilahi, Zsolt; Cosmi, Franco; Gelev, Valeri; Galve, Enrique; Gómez-Doblas, Juanjo J; Nociar, Jan; Radomska, Maria; Sokolova, Beata; Volterrani, Maurizio; Sarkar, Arnab; Reimund, Bernard; Chen, Fabian; Charney, Alan

2016-09-01

To assess the tolerability of initiating/uptitrating sacubitril/valsartan (LCZ696) from 50 to 200 mg twice daily (target dose) over 3 and 6 weeks in heart failure (HF) patients (ejection fraction ≤35%). A 5-day open-label run-in (sacubitril/valsartan 50 mg twice daily) preceded an 11-week, double-blind, randomization period [100 mg twice daily for 2 weeks followed by 200 mg twice daily ('condensed' regimen) vs. 50 mg twice daily for 2 weeks, 100 mg twice daily for 3 weeks, followed by 200 mg twice daily ('conservative' regimen)]. Patients were stratified by pre-study dose of angiotensin-converting enzyme inhibitor/angiotensin-receptor blocker (ACEI/ARB; low-dose stratum included ACEI/ARB-naïve patients). Of 540 patients entering run-in, 498 (92%) were randomized and 429 (86.1% of randomized) completed the study. Pre-defined tolerability criteria were hypotension, renal dysfunction and hyperkalaemia; and adjudicated angioedema, which occurred in ('condensed' vs. 'conservative') 9.7% vs. 8.4% (P = 0.570), 7.3% vs. 7.6% (P = 0.990), 7.7% vs. 4.4% (P = 0.114), and 0.0% vs. 0.8% of patients, respectively. Corresponding proportions for pre-defined systolic blood pressure 5.5 mmol/L, and serum creatinine >3.0 mg/dL were 8.9% vs. 5.2% (P = 0.102), 7.3% vs. 4.0% (P = 0.097), and 0.4% vs. 0%, respectively. In total, 378 (76%) patients achieved and maintained sacubitril/valsartan 200 mg twice daily without dose interruption/down-titration over 12 weeks (77.8% vs. 84.3% for 'condensed' vs. 'conservative'; P = 0.078). Rates by ACEI/ARB pre-study dose stratification were 82.6% vs. 83.8% (P = 0.783) for high-dose/'condensed' vs. high-dose/'conservative' and 84.9% vs. 73.6% (P = 0.030) for low-dose/'conservative' vs. low-dose/'condensed'. Initiation/uptitration of sacubitril/valsartan from 50 to 200 mg twice daily over 3 or 6 weeks had a tolerability profile in line with other HF treatments. More gradual initiation/uptitration maximized attainment of target dose in the low

Discordance in investigator-reported and adjudicated sudden death in TIOSPIR

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Robert A. Wise

2017-03-01

Full Text Available Accurate and consistent determination of cause of death is challenging in chronic obstructive pulmonary disease (COPD patients. TIOSPIR (N=17 135 compared the safety and efficacy of tiotropium Respimat 5/2.5 µg with HandiHaler 18 µg in COPD patients. All-cause mortality was a primary end-point. A mortality adjudication committee (MAC assessed all deaths. We aimed to investigate causes of discordance in investigator-reported and MAC-adjudicated causes of death and their impact on results, especially cardiac and sudden death. The MAC provided independent, blinded assessment of investigator-reported deaths (n=1302 and assigned underlying cause of death. Discordance between causes of death was assessed descriptively (shift tables. There was agreement between investigator-reported and MAC-adjudicated deaths in 69.4% of cases at the system organ class level. Differences were mainly observed for cardiac deaths (16.4% investigator, 5.1% MAC and deaths assigned to general disorders including sudden death (17.4% investigator, 24.6% MAC. Reasons for discrepancies included investigator attribution to the immediate (e.g. myocardial infarction (MI over the underlying cause of death (e.g. COPD and insufficient information for a definitive cause. Cause-specific mortality varies in COPD, depending on the method of assignment. Sudden death, witnessed and unwitnessed, is common in COPD and often attributed to MI without supporting evidence.

Effects of yoga versus hydrotherapy training on health-related quality of life and exercise capacity in patients with heart failure: A randomized controlled study.

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Hägglund, Ewa; Hagerman, Inger; Dencker, Kerstin; Strömberg, Anna

2017-06-01

The aims of this study were to determine whether yoga and hydrotherapy training had an equal effect on the health-related quality of life in patients with heart failure and to compare the effects on exercise capacity, clinical outcomes, and symptoms of anxiety and depression between and within the two groups. The design was a randomized controlled non-inferiority study. A total of 40 patients, 30% women (mean±SD age 64.9±8.9 years) with heart failure were randomized to an intervention of 12 weeks, either performing yoga or training with hydrotherapy for 45-60 minutes twice a week. Evaluation at baseline and after 12 weeks included self-reported health-related quality of life, a six-minute walk test, a sit-to-stand test, clinical variables, and symptoms of anxiety and depression. Yoga and hydrotherapy had an equal impact on quality of life, exercise capacity, clinical outcomes, and symptoms of anxiety and depression. Within both groups, exercise capacity significantly improved (hydrotherapy p=0.02; yoga p=0.008) and symptoms of anxiety decreased (hydrotherapy p=0.03; yoga p=0.01). Patients in the yoga group significantly improved their health as rated by EQ-VAS ( p=0.004) and disease-specific quality of life in the domains symptom frequency ( p=0.03), self-efficacy ( p=0.01), clinical summary as a combined measure of symptoms and social factors ( p=0.05), and overall summary score ( p=0.04). Symptoms of depression were decreased in this group ( p=0.005). In the hydrotherapy group, lower limb muscle strength improved significantly ( p=0.01). Yoga may be an alternative or complementary option to established forms of exercise training such as hydrotherapy for improvement in health-related quality of life and may decrease depressive symptoms in patients with heart failure.

[Expression of proBNP and NT-proBNP in Sudden Death of Coronary Heart Disease].

Science.gov (United States)

Zeng, Q; Sun, R F; Li, Z; Zhai, L Q; Liu, M Z; Guo, X J; Gao, C R

2017-10-01

To study the expression change of pro-brain natriuretic peptide （proBNP） and N-terminal pro-brain natriuretic peptide （NT-proBNP） in sudden death of coronary atherosclerotic heart disease, and to explore its application in forensic diagnosis. Myocardial and blood samples were collected from normal control group, sudden death of coronary atherosclerotic heart disease group and single coronary stenosis group （20 cases in each group）. The expression of proBNP in myocardial samples were detected by immunohistochemical staining and Western blotting, and that of BNP mRNA were detected by reverse transcription PCR （RT-PCR）. The content of NT-proBNP in plasma were detected by ELISA. Immunohistochemical staining showed positive expression of proBNP in both sudden death of coronary atherosclerotic heart disease group and single coronary stenosis group. There was no positive expression in normal control group. For sudden death of coronary atherosclerotic heart disease group and single coronary stenosis group, the relative expression of proBNP protein and BNP mRNA in myocardial tissue and the NT-proBNP content in plasma were higher than that of normal control group （ P heart disease group was higher than that of single coronary stenosis group （ P heart disease and determine whether the sudden death due to coronary atherosclerotic heart disease. Copyright© by the Editorial Department of Journal of Forensic Medicine

The role of levosimendan in acute heart failure complicating acute coronary syndrome

DEFF Research Database (Denmark)

Nieminen, Markku S; Buerke, M.; Cohen-Solal, A.

2016-01-01

Acute heart failure and/or cardiogenic shock are frequently triggered by ischemic coronary events. Yet, there is a paucity of randomized data on the management of patients with heart failure complicating acute coronary syndrome, as acute coronary syndrome and cardiogenic shock have frequently bee...

The initial phase of sudden releases of superheated liquid

International Nuclear Information System (INIS)

Schmidli, J.; Yadigaroglu, G.

1994-01-01

Series of experiments were conducted with refrigerants-114, -12, propane and butane to investigate the initial phase of sudden releases of superheated liquids due to the catastrophic failure of the vessel containing them. The experiments were initiated by shattering spherical flasks of 100 to 2000 ml containing the liquefied, pressurized gases. The variable parameters were the initial superheat, the filling level, the height of the flask above ground, and the relative humidity of the surrounding air. It was found that the initial flashing process is not determined by homogeneous nucleation, but rather by surface instabilities which lead to an evaporation wave traveling from the initial surface towards the center of the released mass. Cloud shape and expansion velocity could be determined from high speed recordings covering the initial stage of the release during which gravity has no influence. When the internal energy was sufficient, it was observed that the expanding droplet/vapor cloud initially propagated spherically with a constant expansion velocity, until Rayleigh-Taylor type instabilities appeared at its surface. Information about the pool which can be formed on the ground, the pressure decay within the flask, the droplet size, and the cloud temperature was collected. The experimental findings for the expansion velocity, as well as for the pool fraction, were the base for a nondimensional analysis leading to correlations which describe the initial phase of such releases and can be used to define the ''source term'' for turbulent dispersion models. (author) 5 figs., 1 tab., 15 refs

Sudden infant death syndrome (SIDS)--standardised investigations and classification

DEFF Research Database (Denmark)

Bajanowski, Thomas; Vege, Ashild; Byard, Roger W

2007-01-01

Sudden infant death syndrome (SIDS) still accounts for considerable numbers of unexpected infant deaths in many countries. While numerous theories have been advanced to explain these events, it is increasingly clear that this group of infant deaths results from the complex interaction of a variet...

Enhanced Psychosocial Support for Caregiver Burden for Patients With Chronic Kidney Failure Choosing Not to Be Treated by Dialysis or Transplantation: A Pilot Randomized Controlled Trial.

Science.gov (United States)

Chan, Kwok Ying; Yip, Terence; Yap, Desmond Y H; Sham, Mau Kwong; Wong, Yim Chi; Lau, Vikki Wai Kee; Li, Cho Wing; Cheng, Benjamin Hon Wai; Lo, Wai Kei; Chan, Tak Mao

2016-04-01

Family caregivers of patients with chronic kidney failure have increased burden, as reflected by their high frequency of physical and mental disturbances. The impact of enhanced psychosocial support to caregivers of patients with chronic kidney failure remains unclear. Open-label randomized controlled trial. All new patients referred to the renal palliative clinic were screened. Caregivers of patients who met the following criteria were recruited: (1) chronic kidney failure as defined by creatinine clearance renal care (control). Enhanced psychosocial support included counseling and psychosocial interventions by an on-site palliative care nurse and designated social worker. Each caregiver was followed up at 2- to 4-week intervals for up to 6 months. Zarit Burden Inventory (ZBI) and Hospital Anxiety and Depression Scale (HADS) in caregivers and McGill Quality of Life scores in patients of both groups were compared. 29 pairs of family caregivers/patients with chronic kidney failure were randomly assigned (intervention, n=14; control, n=15). Mean ages of patients and caregivers were 81.6 ± 5.1 and 59.8 ± 14.2 (SD) years, respectively. The intervention group showed significantly lower ZBI scores than the control group at 1 and 3 months (22.0 ± 5.3 vs 31.6 ± 9.5 and 21.3 ± 6.6 vs 33.4 ± 7.2; P=0.006 and P=0.009, respectively). HADS anxiety scores of caregivers who received the intervention were significantly lower than those of controls at 1 and 3 months (7.1 ± 3.2 vs 10.1 ± 2.2 and 6.5 ± 4.5 vs 11.0 ± 3.1; P=0.01 and P=0.03, respectively). Insignificant reductions in ZBI and HADS scores were found at 6 months. 19 patients died (intervention, n=10; control, n=9) during the study period. The study is limited by a relatively small sample size and short duration. Enhanced psychosocial support program in patients with chronic kidney failure and caregivers resulted in an early significant reduction in caregiver burden and anxiety. Copyright © 2016 National Kidney

Symptoms Before Sudden Arrhythmic Death Syndrome

DEFF Research Database (Denmark)

Glinge, Charlotte; Jabbari, Reza; Risgaard, Bjarke

2015-01-01

INTRODUCTION: No studies in an unselected and nationwide setting have characterized the symptoms and medical history of patients with sudden arrhythmic death syndrome (SADS). The aim of this study was to identify and describe the symptoms and medical history of patients before the presentation......%), palpitations (n = 2, 1%), presyncope/syncope (n = 23, 17%), and aborted SCD (n = 2, 1%). In addition, seizures (n = 25, 18%) were prevalent. In 61 (45%) SADS cases, no previous medical history were recorded. CONCLUSION: In this unselected, nationwide study of 136 young SADS patients, 35% had experienced...

Sudden cardiac death in hemodialysis patients: an in-depth review.

Science.gov (United States)

Green, Darren; Roberts, Paul R; New, David I; Kalra, Philip A

2011-06-01

Sudden cardiac death (SCD) is the leading cause of death in hemodialysis patients, accounting for death in up to one-quarter of this population. Unlike in the general population, coronary artery disease and heart failure often are not the underlying pathologic processes for SCD; accordingly, current risk stratification tools are inadequate when assessing these patients. Factors assuming greater importance in hemodialysis patients may include left ventricular hypertrophy, electrolyte shift, and vascular calcification. Knowledge regarding SCD in hemodialysis patients is insufficient, in part reflecting the lack of an agreed-on definition of SCD in this population, although epidemiologic studies suggest the most common times for SCD to occur are toward the end of the long 72-hour weekend interval between dialysis sessions and in the 12 hours immediately after hemodialysis. Accordingly, it is hypothesized that the dialysis procedure itself may have important implications for SCD. Supporting this is recognition that hemodialysis is associated with both ventricular arrhythmias and dynamic electrocardiographic changes. Importantly, echocardiography and electrocardiography may show changes that are modifiable by alterations to dialysis prescription. The most effective preventative strategy in the general population, implanted cardioverter-defibrillator devices, are less effective in the presence of chronic kidney disease and have not been studied adequately in dialysis patients. Last, many dialysis patients experience SCD despite not fulfilling current criteria for implantation, making appropriate allocation of defibrillators uncertain. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Medico legal investigations into sudden sniffing deaths linked with trichloroethylene.

Science.gov (United States)

Da Broi, Ugo; Colatutto, Antonio; Sala, Pierguido; Desinan, Lorenzo

2015-08-01

Sudden deaths attributed to sniffing trichloroethylene are caused by the abuse of this solvent which produces pleasant inebriating effects with rapid dissipation. In the event of repeated cycles of inhalation, a dangerous and uncontrolled systemic accumulation of trichloroethylene may occur, followed by central nervous system depression, coma and lethal cardiorespiratory arrest. Sometimes death occurs outside the hospital environment, without medical intervention or witnesses and without specific necroscopic signs. Medico legal investigations into sudden sniffing deaths associated with trichloroethylene demand careful analysis of the death scene and related circumstances, a detailed understanding of the deceased's medical history and background of substance abuse and an accurate evaluation of all autopsy and laboratory data, with close cooperation between the judiciary, coroners and toxicologists. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

QUASI-RANDOM TESTING OF COMPUTER SYSTEMS

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S. V. Yarmolik

2013-01-01

Full Text Available Various modified random testing approaches have been proposed for computer system testing in the black box environment. Their effectiveness has been evaluated on the typical failure patterns by employing three measures, namely, P-measure, E-measure and F-measure. A quasi-random testing, being a modified version of the random testing, has been proposed and analyzed. The quasi-random Sobol sequences and modified Sobol sequences are used as the test patterns. Some new methods for Sobol sequence generation have been proposed and analyzed.

Sudden headache, third nerve palsy and visual deficit: thinking outside the subarachnoid haemorrhage box.

Science.gov (United States)

Ní Chróinín, Danielle; Lambert, John

2013-11-01

A 75-year-old lady presented with sudden severe headache and vomiting. Examination was normal, and CT and lumbar puncture not convincing for subarachnoid haemorrhage. Shortly thereafter, she developed painless diplopia. Examination confirmed right third cranial nerve palsy plus homonymous left inferior quadrantanopia. Urgent cerebral MRI with angiography was requested to assess for a possible posterior communicating artery aneurysm, but revealed an unsuspected pituitary mass. Pituitary adenoma with pituitary apoplexy was diagnosed. Pituitary apopolexy is a syndrome comprising sudden headache, meningism, visual and/or oculomotor deficits, with an intrasellar mass. It is commonly due to haemorrhage or infarction within a pituitary adenoma. Treatment includes prompt steroid administration, and potentially surgical decompression. While subarachnoid haemorrhage is an important, well-recognised cause of sudden severe headache, other aetiologies, including pituitary apoplexy, should be considered and sought.

Geographic differences in heart failure trials.

Science.gov (United States)

Ferreira, João Pedro; Girerd, Nicolas; Rossignol, Patrick; Zannad, Faiez

2015-09-01

Randomized controlled trials (RCTs) are essential to develop advances in heart failure (HF). The need for increasing numbers of patients (without substantial cost increase) and generalization of results led to the disappearance of international boundaries in large RCTs. The significant geographic differences in patients' characteristics, outcomes, and, most importantly, treatment effect observed in HF trials have recently been highlighted. Whether the observed regional discrepancies in HF trials are due to trial-specific issues, patient heterogeneity, structural differences in countries, or a complex interaction between factors are the questions we propose to debate in this review. To do so, we will analyse and review data from HF trials conducted in different world regions, from heart failure with preserved ejection fraction (HF-PEF), heart failure with reduced ejection fraction (HF-REF), and acute heart failure (AHF). Finally, we will suggest objective and actionable measures in order to mitigate regional discrepancies in future trials, particularly in HF-PEF where prognostic modifying treatments are urgently needed and in which trials are more prone to selection bias, due to a larger patient heterogeneity. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

Sudden oak death disease progression in oaks and tanoaks

Science.gov (United States)

Brice A. McPherson; Sylvia R. Mori; David L. Wood; Andrew J. Storer; Pavel Svihra; N. Maggi Kelly; Richard B. Standiford

2006-01-01

In March 2000, we established twenty disease progression plots in Marin County to monitor the progress of sudden oak death symptoms in coast live oak (Quercus agrifolia), California black oak (Q. kelloggii), and tanoak (Lithocarpus densiflorus) (McPherson and others 2005). Plots were located to encompass a...

Sudden aortic death-proposal for a comprehensive diagnostic approach in forensic and in clinical pathology practice

NARCIS (Netherlands)

de Boer, Hans H.; Dedouit, Fabrice; Chappex, Nina; van der Wal, Allard C.; Michaud, Katarzyna

2017-01-01

Backgrounds Aortic rupture or dissection as immediate cause of sudden death is encountered in forensic and clinical autopsy practice. Despite a common denominator of 'sudden aortic death' (SAD), we expect that in both settings the diagnostic workup, being either primarily legal or primarily disease

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

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Ensieh Shahrokh-Tehraninejad

2016-12-01

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

Excess sudden cardiac deaths after short-term clarithromycin administration in the CLARICOR trial

DEFF Research Database (Denmark)

Winkel, Per; Hilden, J; Hansen, Jørgen Fischer

2011-01-01

Objectives: To elucidate potential mechanisms for the clarithromycin-induced excess mortality observed in the CLARICOR trial during 2.6 year follow-up of patients with stable coronary artery disease. Methods: Cox analyses using out-of-hospital death as a proxy for sudden death compared to in-hospital...... CV death in patients not on statins at trial entry (HR: 2.61, 95% CI: 1.69–4.05, p administration was significantly associated with increased risk of sudden CV death in stable...

Catatonia Secondary to Sudden Clozapine Withdrawal: A Case with Three Repeated Episodes and a Literature Review

Directory of Open Access Journals (Sweden)

John Bilbily

2017-01-01

Full Text Available A literature search identified 9 previously published cases that were considered as possible cases of catatonia secondary to sudden clozapine withdrawal. Two of these 9 cases did not provide enough information to make a diagnosis of catatonia according to the Diagnostic and Statistical Manual, 5th Edition (DSM-5. The Liverpool Adverse Drug Reaction (ADR Causality Scale was modified to assess ADRs secondary to drug withdrawal. From the 7 published cases which met DSM-5 catatonia criteria, using the modified scale, we established that 3 were definitive and 4 were probable cases of catatonia secondary to clozapine withdrawal. A new definitive case is described with three catatonic episodes which (1 occurred after sudden discontinuation of clozapine in the context of decades of follow-up, (2 had ≥3 of 12 DSM-5 catatonic symptoms and serum creatinine kinase elevation, and (3 required medical hospitalization and intravenous fluids. Clozapine may be a gamma-aminobutyric acid (GABA receptor agonist; sudden clozapine withdrawal may explain a sudden decrease in GABA activity that may contribute to the development of catatonic symptoms in vulnerable patients. Based on the limited information from these cases, the pharmacological treatment for catatonia secondary to sudden clozapine withdrawal can include benzodiazepines and/or restarting clozapine.

Constraint-induced sound therapy for sudden sensorineural hearing loss – behavioral and neurophysiological outcomes

OpenAIRE

Hidehiko Okamoto; Munehisa Fukushima; Henning Teismann; Lothar Lagemann; Tadashi Kitahara; Hidenori Inohara; Ryusuke Kakigi; Christo Pantev

2014-01-01

Sudden sensorineural hearing loss is characterized by acute, idiopathic hearing deterioration. We report here the development and evaluation of “constraint-induced sound therapy”, which is based on a well-established neuro-rehabilitation approach, and which is characterized by the plugging of the intact ear (“constraint”) and the simultaneous, extensive stimulation of the affected ear with music. The sudden sensorineural hearing loss patients who received the constraint-induced sound therapy ...

Osteopathic manual therapy in heart failure patients: A randomized clinical trial.

Science.gov (United States)

Thomaz, Sergio R; Teixeira, Felipe A; de Lima, Alexandra C G B; Cipriano Júnior, Gerson; Formiga, Magno F; Cahalin, Lawrence Patrick

2018-04-01

Heart Failure (HF) patients usually present with increased arterial resistance and reduced blood pressure (BP) leading to an impaired functional capacity. Osteopathic Manual Therapy (OMT) focused on myofascial release techniques (MRT) and in the balancing of diaphragmatic tensions, has been shown to improve blood flow in individuals using the resistive index (RI). However, its effects in HF patients have not been examined. To evaluate the acute response of selected osteopathic techniques on RI, heart rate (HR), and BP in patients with HF. Randomized-controlled clinical trial of HF patients assigned to MRT (six different techniques with three aimed at the pelvis, two at the thorax, and one at the neck for 15 min) or Control group (subjects in supine position for 15 min without intervention). The RI of the femoral, brachial and carotid arteries was measured via doppler ultrasound while HR and BP were measured via sphygmomanometry before and after a single MRT or control intervention. Twenty-two HF patients equally distributed (50% male, mean age 53 years; range 32-69 years) (ejection fraction = 35.6%, VO 2peak : 12.9 mL/kg -1 min -1 ) were evaluated. We found no intra or inter group differences in RI of the carotid (Δ MRT : 0.07% vs Δ Control :11.8%), brachial (Δ MRT :0.17% vs Δ Control : 2.9%), or femoral arteries (Δ MRT :1.65% vs Δ Control : 0.97%) (P > 0.05) and no difference in HR or BP (Δ MRT :0.6% vs Δ Control : 3%), (P > 0.05). A single MRT session did not significantly change the RI, HR, or BP of HF patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparative study of turbulence model performance for axisymmetric sudden expansion flow

International Nuclear Information System (INIS)

Bae, Youngmin; Kim, Young In; Kim, Keung Koo; Yoon, Juhyeon

2013-01-01

In this study, the performance of turbulence models in predicting the turbulent flow in an axisymmetric sudden expansion with an expansion ratio of 4 is assessed for a Reynolds number of 5.6 Χ 10 4 . The comparisons show that the standard k-ε and RSM models provide the best agreement with the experimental data, whereas the standard k-ω model gives poor predictions. Owing to its computational efficiency, the Reynolds Averaged Navier-Stokes (RANS) approach has been widely used for the prediction of turbulent flows and associated pressure losses in a variety of internal flow systems such as a diffuser, orifice, converging nozzle, and pipes with sudden expansion. However, the lack of a general turbulence model often leads to limited applications of a RANS approach, i. e., the accuracy and validity of solutions obtained from RANS equations vary with the turbulence model, flow regime, near-wall treatment, and configuration of the problem. In light of the foregoing, a large amount of turbulence research has been conducted to assess the performance of existing turbulence models for different flow fields. In this paper, the turbulent flow in an axisymmetric sudden expansion is numerically investigated for a Reynolds number of 5.6 Χ 10 4 , with the aim of examining the performance of several turbulence models

Mechanical failure of anodized aluminum under three and four-point bending tests

International Nuclear Information System (INIS)

Bargui, M.; Bensalah, W.; Elleuch, K.; Ayedi, H.F.

2013-01-01

Highlights: • We study the flexural behavior of anodic oxide layers formed on aluminum. • Three and four-point bending tests were used as techniques. • Changing the beam configuration will change the flexural response. - Abstract: In this work, three and four-point bending tests were adopted as methods for characterizing anodized aluminum beams in a sulfuric acid bath. The failure behavior of sandwich beams having aluminum oxide face sheets and aluminum core were tested. In so doing, many configurations were adopted by anodizing aluminum beams on one and both sides to investigate faces in place of tension and compression. Bending tests showed different behaviors. When the oxide was only on the top side of the beam (working in compression) a slight sudden decrease of the load was observed. This fact was absent on beams with oxide layers working in tensile. The bending behavior of sandwich beams was similar to those with oxide on top sides but with much higher loads. The mechanical failure of the oxide was mainly caused by its failure when it is placed in compression beneath the loading rollers. Finally, a morphological study of the aluminum oxide layers after bending tests was conducted by optical microscopy

Immunization safety review: vaccinations and sudden unexpected death in infancy

National Research Council Canada - National Science Library

Institute of Medicine (U.S.). Immunization Safety Review Committee; Stratton, Kathleen R

2003-01-01

...), and neonatal death (infant death, whether sudden or not, during the first 4 weeks of life). Based on this review, the committee concluded that the evidence favors rejection of a causal relationship between some vaccines and SIDS...

Chiasma failures and chromosome association in Rhoeo spathacea var. variegata.

Science.gov (United States)

Lin, Y J

1982-01-01

In Rhoeo spathacea var. variegata (2n = 2x = 12), the most frequent meiotic configuration was the chain-of-12 chromosomes (36%) and the second most frequent was the ring-of-12 chromosomes (25.6%). All six possible two-chain situations and eleven of the twelve possible three-chain situations were observed. A maximum of five chains was observed in four cells. The size of chains ranged from on through twelve chromosomes. The mean number of chiasma failures was 1.36 +/- 0.07 per cell and 0.1133 per pair of chromosome arms. Because the observed frequencies of various configurations agree with the expected, which were calculated under the assumption that chiasma failure is equally likely at each of the twelve positions around the ring, it was concluded that chiasma failures occurred at random among the arm-positions. Due to the lengths of arm-pairs in the ring vary considerably, the randomness may mean that chiasma formation was restricted to small terminal regions on all chromosomes.

The Consequences of Service Encounter Failure in Shopping Centers: A Study with Visually Impaired Consumers

Directory of Open Access Journals (Sweden)

Pedro Felipe da Costa Coelho

2017-06-01

Full Text Available The advent of the Brazilian Law on the Inclusion of People with Disabilities, in 2015, has brought a series of implications for marketing researchers, since it concerns the rights to include people with disabilities in public and private consumption spaces, such as shopping malls. Despite the growth of these consumer spaces in Brazil, several failures in service encounters are frequent, especially when consumers are visually impaired. Therefore, this study aims to understand the consequences of service encounters failures in shopping malls for the consumer with visual disabilities. To reach this goal, we used a qualitative approach of phenomenological nature. Data were collected through direct and naturalistic observations and conduct of nine face-to-face interviews with visually impaired consumers. Through content analysis of the results, we concluded that there is a diversity of failures occurred in service encounters, such as excessive piety of sellers to consumers, contempt and the sudden change in the service script. For this reason, the consequences of service encounter failure were from the verbal confrontation and the withdrawal of the transaction to the word-of-mouth and negative expressions of frustration in virtual social networks. This article also presents managerial and academic contributions for marketing researchers.

Sarcomeric gene mutations in sudden infant death syndrome (SIDS).

Science.gov (United States)

Brion, Maria; Allegue, Catarina; Santori, Montserrat; Gil, Rocio; Blanco-Verea, Alejandro; Haas, Cordula; Bartsch, Christine; Poster, Simone; Madea, Burkhard; Campuzano, Oscar; Brugada, Ramon; Carracedo, Angel

2012-06-10

In developed countries, sudden infant death syndrome (SIDS) represents the most prevalent cause of death in children between 1 month and 1 year of age. SIDS is a diagnosis of exclusion, a negative autopsy which requires the absence of structural organ disease. Although investigators have confirmed that a significant percentage of SIDS cases are actually channelopathies, no data have been made available as to whether other sudden cardiac death-associated diseases, such as hypertrophic cardiomyopathy (HCM), could be responsible for some cases of SIDS. The presence of a genetic mutation in the sarcomeric protein usually affects the force of contraction of the myocyte, whose weakness is compensated with progressive hypertrophy and disarray. However, it is unclear whether in the most incipient forms, that is, first years of life, the lack of these phenotypes still confers a risk of arrhythmogenesis. The main goal of the present study is to wonder whether genetic defects in the sarcomeric proteins, previously associated with HCM, could be responsible for SIDS. We have analysed 286 SIDS cases for the most common genes implicated in HCM in adults. A total of 680 mutations localised in 16 genes were analysed by semi-automated matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDITOF-MS) using the Sequenom MassARRAY(®) System. Ten subjects with completely normal hearts showed mutated alleles at nine of the genetic variants analysed, and one additional novel mutation was detected by conventional sequencing. Therefore, a genetic mutation associated with HCM may cause sudden cardiac death in the absence of an identifiable phenotype. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Coronary atherosclerosis in sudden cardiac death: An autopsy study

Directory of Open Access Journals (Sweden)

Sudha M

2009-10-01

Full Text Available Background: The incidence of ischemic heart disease (IHD has markedly increased in India over the past few years. Considering the variations in racial, dietary and lifestyle patterns in our population, it is essential to study the biology of coronary atherosclerosis in our patients. Vulnerable plaques have a large number of foam cells, extracellular lipid, thin fibrous caps and clusters of inflammatory cells and are more prone to rupture. These plaques are nourished by the microvessels arising from the vasa vasorum of the blood vessels and by lumen-derived microvessels through the fibrous cap. This autopsy study was designed to analyse the coronary arterial tree in cases of sudden cardiac death, classify coronary atherosclerotic plaques and to assess the factors contributing to vulnerability of the plaques including inflammation, calcification and microvascular density. Materials and Methods: Seven cases of sudden cardiac death were included in the study. The hearts were perfusion-fixed and the coronary arteries along with their main branches were dissected and studied. The location of the plaques, type of plaques, presence of inflammation and calcification were assessed. The cap thickness and microvessel density per 1000um 2 were assessed. The statistical significance was estimated. Results and Conclusions: Extensive high-grade coronary atherosclerotic disease was seen in all sudden cardiac death cases. Majority of the plaques were vulnerable. High-grade inflammation was seen in most of the vulnerable and ruptured plaques. All the ruptured plaques were uncalcified indicating that calcification probably stabilizes the plaques and protects against rupture. Increased microvessel density was noted in ruptured plaques compared to vulnerable plaques. However, it was not statistically significant.

Sudden death related to advanced coronary atherosclerosis in mini-pigs

International Nuclear Information System (INIS)

Jacobsson, L.; Lundholm, L.; Wingren, G.

1984-01-01

Advanced coronary atherosclerosis was produced in 30 mini-pigs by a combination of a hypercholesterolaemic diet and X-irradiation to the precordial region. Within 11-25 weeks after the irradiation, 13 of the 30 animals died a sudden death probably caused by coronary atherosclerosis. The contents of free and ester-bound cholesterol in the right coronary artery were significantly higher in the animals which died spontaneously than in surviving animals. In an untreated group of 12 animals 7 died whereas in a group treated with β-pyridylcarbinol only 1 out of 5 died. In the coronary arteries, the contents of both free and ester-bound cholesterol were significantly lower in the β-pyridylcarbinol-treated animals. In a sulfinpyrazontreated group 3 out of 8, and in a metoprolol-treated group 2 out of 5 animals died. None of these drugs reduced the accumulation of cholesterol in the coronary arteries. The rate of sudden death was 26 +- 6% (P<0.05) lower in the combined group of treated animals than in the untreated ones. By regular ECG recordings, signs which could predict the fatal outcome of the experiment were looked for. Although depressed ST segments were present before death in a few animals, this was not a regular phenomenon. It is concluded that advanced coronary atherosclerosis in mini-pigs often leads to sudden death and that this animal model seems suitable for testing the potential therapeutic effects of drugs. (author)

Sudden post-traumatic sciatica caused by a thoracic spinal meningioma.

Science.gov (United States)

Mariniello, Giuseppe; Malacario, Francesca; Dones, Flavia; Severino, Rocco; Ugga, Lorenzo; Russo, Camilla; Elefante, Andrea; Maiuri, Francesco

2016-10-01

Spinal meningiomas usually present with slowly progressive symptoms of cord and root compression, while a sudden clinical onset is very rare. A 35-year-old previously symptom-free woman presented sudden right sciatica and weakness of her right leg following a fall with impact to her left foot. A neurological examination showed paresis of the right quadriceps, tibial and sural muscles, increased bilateral knee and ankle reflexes and positive Babinski sign. Magnetic resonance imaging (MRI) revealed the presence of a spinal T11 meningioma in the left postero-lateral compartment of the spinal canal; at this level, the spinal cord was displaced to the contralateral side with the conus in the normal position. At surgery, a meningioma with dural attachment of the left postero-lateral dural surface was removed. The intervention resulted in rapid remission of both pain and neurological deficits. Spinal meningiomas may exceptionally present with sudden pain and neurological deficits as result of tumour bleeding or post-traumatic injury of the already compressed nervous structures, both in normal patients and in those with conus displacement or tethered cord. In this case, the traumatic impact of the left foot was transmitted to the spine, resulting in stretching of the already compressed cord and of the contralateral lombosacral roots. This case suggests that low thoracic cord compression should be suspected in patients with post-traumatic radicular leg pain with normal lumbar spine MRI. © The Author(s) 2016.

An engineering approach to common mode failure analysis

International Nuclear Information System (INIS)

Gangloff, W.C.; Franke, T.H.

1975-01-01

Safety systems for nuclear reactors can be designed using standard reliability engineering techniques such that system failure due to random component faults is extremely unlikely. However, the common-mode failure where several components fail together from a common cause is not susceptible to prevention by the usual tactics. In systems where a high degree of redundancy has been employed, the actual reliability of the system in service may be limited by common-mode failures. A methodical and thorough procedure for evaluation of system vulnerability to common-mode failures is presented. This procedure was developed for use in nuclear reactor safety systems and has been applied specifically to reactor protection. The method offers a qualitative assessment of a system whereby weak points can be identified and the resistance to common-mode failure can be judged. It takes into account all factors influencing system performance including design, manufacturing, installation, operation, testing, and maintenance. It is not a guarantee or sure solution, but rather a practical tool which can provide good assurance that the probability of common-mode protection failure has been made acceptably low. (author)

A method to assign failure rates for piping reliability assessments

International Nuclear Information System (INIS)

Gamble, R.M.; Tagart, S.W. Jr.

1991-01-01

This paper reports on a simplified method that has been developed to assign failure rates that can be used in reliability and risk studies of piping. The method can be applied on a line-by-line basis by identifying line and location specific attributes that can lead to piping unreliability from in-service degradation mechanisms and random events. A survey of service experience for nuclear piping reliability also was performed. The data from this survey provides a basis for identifying in-service failure attributes and assigning failure rates for risk and reliability studies

Resolving epidemic network failures through differentiated repair times

DEFF Research Database (Denmark)

Fagertun, Anna Manolova; Ruepp, Sarah Renée; Manzano, Marc

2015-01-01

In this study, the authors investigate epidemic failure spreading in large-scale transport networks under generalisedmulti-protocol label switching control plane. By evaluating the effect of the epidemic failure spreading on the network,they design several strategies for cost-effective network pe...... assigninglower repair times among the network nodes. They believe that the event-driven simulation model can be highly beneficialfor network providers, since it could be used during the network planning process for facilitating cost-effective networksurvivability design.......In this study, the authors investigate epidemic failure spreading in large-scale transport networks under generalisedmulti-protocol label switching control plane. By evaluating the effect of the epidemic failure spreading on the network,they design several strategies for cost-effective network...... performance improvement via differentiated repair times. First, theyidentify the most vulnerable and the most strategic nodes in the network. Then, via extensive event-driven simulations theyshow that strategic placement of resources for improved failure recovery has better performance than randomly...

Sudden infant death syndrome: an unrecognized killer in developing countries

Directory of Open Access Journals (Sweden)

Ndu IK

2016-02-01

Full Text Available Ikenna Kingsley Ndu Department of Paediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: Sudden infant death syndrome (SIDS is defined as the sudden unexpected death of an infant <1 year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy and review of the circumstances of death and the clinical history. SIDS contributes to infant mortality and resulted in ~15,000 deaths globally in 2013. Most of the risk factors of SIDS are common in developing countries; yet, there has been little interest in SIDS by researchers in Africa. This review looks at the extent of the attention given to SIDS in a developing country like Nigeria, and factors responsible for the scarce data concerning this significant cause of mortality. Keywords: SIDS, mortality, Nigeria

Sudden cardiac death and acute pathology of coronary arteries

NARCIS (Netherlands)

van Dantzig, J. M.; Becker, A. E.

1986-01-01

The pathology of sudden cardiac death still is a matter of controversy, particularly with respect to the state of the coronary arteries. A recent study has shown a high incidence of acute lesions and suggests a causal relationship. The present study has been designed to verify whether or not acute

Wind park control system to support grid stability in case of failure; Windparkregelung zur Unterstuetzung der Netzstabilitaet im Fehlerfall

Energy Technology Data Exchange (ETDEWEB)

Michalke, Gabriele; Scheuermann, Garvin; Hartkopf, Thomas [Technische Univ. Darmstadt (Germany). Fachgebiet Regenerative Energien; Hansen, Anca Daniela [Research Establishment Risoe, Roskilde (Denmark)

2007-07-01

A control strategy for wind power plants is presented which involves PMSG synchronous generators for management of grid failure and for voltage maintenance in case of sudden voltage drops. A dynamic simulation model of the concept is established using the DIgSILENT software. Simulation results so far proved the effectiveness of the new control strategy. It was shown that PMSG wind power plants equipeed with such a control strategy can manage fault ride-through also for neighbouring ocnventional wind power plants. (orig.)

Effects of carvedilol in heart failure due to dilated cardiomyopathy. Results of a double-blind randomized placebo-controlled study (CARIBE study

Directory of Open Access Journals (Sweden)

Paulo Roberto Chizzola

2000-03-01

Full Text Available OBJECTIVE: To assess the effects of carvedilol in patients with idiopathic dilated cardiomyopathy. METHODS: In a double-blind randomized placebo-controlled study, 30 patients (7 women with functional class II and III heart failure were assessed. Their ages ranged from 28 to 66 years (mean of 43±9 years, and their left ventricular ejection fraction varied from 8% to 35%. Carvedilol was added to the usual therapy of 20 patients; placebo was added to the usual therapy of 10 patients. The initial dose of carvedilol was 12.5 mg, which was increased weekly until it reached 75 mg/day, according to the patient's tolerance. Clinical assessment, electrocardiogram, echocardiogram, and radionuclide ventriculography were performed in the pretreatment phase, being repeated after 2 and 6 months of medication use. RESULTS: A reduction in heart rate (p=0.016 as well as an increase in left ventricular shortening fraction (p=0.02 and in left ventricular ejection fraction (p=0.017 occurred in the group using carvedilol as compared with that using placebo. CONCLUSION: Carvedilol added to the usual therapy for heart failure resulted in better heart function.

Strong, sudden cooling alleviates the inflammatory responses in heat-stressed dairy cows based on iTRAQ proteomic analysis

Science.gov (United States)

Cheng, Jianbo; Min, Li; Zheng, Nan; Fan, Caiyun; Zhao, Shengguo; Zhang, Yangdong; Wang, Jiaqi

2018-02-01

This study was designed to investigate the effects of sudden cooling on the physiological responses of 12 heat-stressed Holstein dairy cows using an isobaric tags for relative and absolute quantification (iTRAQ) labeling approach. Plasma samples were collected from these cows during heat stress (HS), and after strong, sudden cooling in the summer (16 days later). We compared plasma proteomic data before and after sudden cooling to identify the differentially abundant proteins. The results showed that sudden cooling in summer effectively alleviated the negative consequences of HS on body temperature and production variables. Expressions of plasma hemoglobin alpha and hemoglobin beta were upregulated, whereas lipopolysaccharide-binding protein (LBP) and haptoglobin were downregulated in this process. The increase of hemoglobin after cooling may improve oxygen transport and alleviate the rise in respiration rates in heat-stressed dairy cows. The decrease of LBP and haptoglobin suggests that the inflammatory responses caused by HS are relieved after cooling. Our findings provide new insight into the physiological changes that occur when heat-stressed dairy cows experience strong, sudden cooling.

Age replacement policy based on imperfect repair with random probability

International Nuclear Information System (INIS)

Lim, J.H.; Qu, Jian; Zuo, Ming J.

2016-01-01

In most of literatures of age replacement policy, failures before planned replacement age can be either minimally repaired or perfectly repaired based on the types of failures, cost for repairs and so on. In this paper, we propose age replacement policy based on imperfect repair with random probability. The proposed policy incorporates the case that such intermittent failure can be either minimally repaired or perfectly repaired with random probabilities. The mathematical formulas of the expected cost rate per unit time are derived for both the infinite-horizon case and the one-replacement-cycle case. For each case, we show that the optimal replacement age exists and is finite. - Highlights: • We propose a new age replacement policy with random probability of perfect repair. • We develop the expected cost per unit time. • We discuss the optimal age for replacement minimizing the expected cost rate.

Reading Success and Failure among Chinese Children.

Science.gov (United States)

Hsu, Chen-chin

Drawing on a cross-national study of children's reading, a study examined the correlates of reading success and failure in Taiwan. Subjects, 240 randomly selected Taipei fifth graders, were administered a reading test, cognitive test, and mathematics achievement test. A structured interview with each child's mother and classroom behavior…

Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial.

Science.gov (United States)

Freedman, Stephen B; Willan, Andrew R; Boutis, Kathy; Schuh, Suzanne

2016-05-10

Gastroenteritis is a common pediatric illness. Electrolyte maintenance solution is recommended to treat and prevent dehydration. Its advantage in minimally dehydrated children is unproven. To determine if oral hydration with dilute apple juice/preferred fluids is noninferior to electrolyte maintenance solution in children with mild gastroenteritis. Randomized, single-blind noninferiority trial conducted between the months of October and April during the years 2010 to 2015 in a tertiary care pediatric emergency department in Toronto, Ontario, Canada. Study participants were children aged 6 to 60 months with gastroenteritis and minimal dehydration. Participants were randomly assigned to receive color-matched half-strength apple juice/preferred fluids (n=323) or apple-flavored electrolyte maintenance solution (n=324). Oral rehydration therapy followed institutional protocols. After discharge, the half-strength apple juice/preferred fluids group was administered fluids as desired; the electrolyte maintenance solution group replaced losses with electrolyte maintenance solution. The primary outcome was a composite of treatment failure defined by any of the following occurring within 7 days of enrollment: intravenous rehydration, hospitalization, subsequent unscheduled physician encounter, protracted symptoms, crossover, and 3% or more weight loss or significant dehydration at in-person follow-up. Secondary outcomes included intravenous rehydration, hospitalization, and frequency of diarrhea and vomiting. The noninferiority margin was defined as a difference between groups of 7.5% for the primary outcome and was assessed with a 1-sided α=.025. If noninferiority was established, a 1-sided test for superiority was conducted. Among 647 randomized children (mean age, 28.3 months; 331 boys [51.1%]; 441 (68.2%) without evidence of dehydration), 644 (99.5%) completed follow-up. Children who were administered dilute apple juice experienced treatment failure less often than those

[Effect of benazepril on cardiac function in Chinese patients with chronic heart failure: a meta-analysis of randomized controlled trials].

Science.gov (United States)

Yan, Xiaowei; Xu, Dingli; Huang, Jun

2014-10-14

To evaluate the efficacy and tolerability of benazepril in Chinese patients with chronic systolic heart failure. We searched the databases of Cochrane, PubMed, EMbase, CBM and CNKI from January 1989 to November 2010 for the relevant studies. Two investigators identified randomized controlled trials (RCTs) independently according to the predefined inclusion and exclusion criteria. Statistical data analysis was performed with the Stata 11 software. A total of 15 studies with 1 355 Chinese patients of chronic systolic heart failure fulfilled the inclusion criteria. Among them, 546 received benazepril monotherapy. The dose range of benazepril was 5 to 40 mg daily. And it was similar to angiotensin II receptor blockers (ARBs) in improving left ventricular ejection fraction (LVEF)(P = 0.674), reducing LVEDD (P = 0.511) and improving cardiac output (P = 0.363). The combination therapy of benazepril and ARB was superior to ARB monotherapy in reducing left ventricular end-diastolic diameter (LVEDD) (P = 0.001). However, LVEF was comparable between patients with ACEI/ARB combination therapy and those with ARB monotherapy (P = 0.105). Compared with blank control, benazepril treatment was associated with a significant improvement in LVEF from baseline to follow-up (WMD = 6.5%; 95% CI: 0.9%, 12.0%; P = 0.022). Compared with baseline, benazepril treatment significantly increased LVEF (WMD = 10.4%; 95% confidence interval [CI]:7.1%, 13.8%; P benazepril group. As the most common side effect after benazepril treatment, cough had a prevalence of 11.6%. Other side effects were rare. Benazepril is both efficacious and safe in the management of Chinese patients with chronic heart failure.

Determinants of occurrence and survival after sudden cardiac arrest-A European perspective

DEFF Research Database (Denmark)

Empana, Jean-Philippe; Blom, Marieke T; Bӧttiger, Bernd W

2018-01-01

AIMS: The ESCAPE-NET project ("European Sudden Cardiac Arrest network- towards Prevention, Education and New Effective Treatments") aims to study: (1) risk factors and mechanisms for the occurrence of sudden cardiac arrest (SCA) in the population, and (2) risk factors and treatment strategies...... for survival after SCA on a European scale. METHODS: This is an Horizon2020 funded program of the European Union, performed by a European public-private consortium of 16 partners across 10 EU countries. There are 11 deep-phenotyped SCA cohorts for the study of risk factors and treatment strategies for survival...... ongoing efforts on SCA outside Europe and within Europe including the EuReCa project....

Short-term Effects of High-Dose Caffeine on Cardiac Arrhythmias in Patients With Heart Failure: A Randomized Clinical Trial.

Science.gov (United States)

Zuchinali, Priccila; Souza, Gabriela C; Pimentel, Maurício; Chemello, Diego; Zimerman, André; Giaretta, Vanessa; Salamoni, Joyce; Fracasso, Bianca; Zimerman, Leandro I; Rohde, Luis E

2016-12-01

The presumed proarrhythmic action of caffeine is controversial. Few studies have assessed the effect of high doses of caffeine in patients with heart failure due to left ventricular systolic dysfunction at high risk for ventricular arrhythmias. To compare the effect of high-dose caffeine or placebo on the frequency of supraventricular and ventricular arrhythmias, both at rest and during a symptom-limited exercise test. Double-blinded randomized clinical trial with a crossover design conducted at the heart failure and cardiac transplant clinic of a tertiary-care university hospital. The trial included patients with chronic heart failure with moderate-to-severe systolic dysfunction (left ventricular ejection fraction capsules, in addition to 5 doses of 100 mL decaffeinated coffee at 1-hour intervals, for a total of 500 mg of caffeine or placebo during a 5-hour protocol. After a 1-week washout period, the protocol was repeated. Number and percentage of ventricular and supraventricular premature beats assessed by continuous electrocardiographic monitoring. We enrolled 51 patients (37 [74%] male; mean [SD] age, 60.6 [10.9] years) with predominantly moderate-to-severe left ventricular systolic dysfunction (mean [SD] left ventricular ejection fraction, 29% [7%]); 31 [61%] had an implantable cardioverter-defibrillator device. No significant differences between the caffeine and placebo groups were observed in the number of ventricular (185 vs 239 beats, respectively; P = .47) and supraventricular premature beats (6 vs 6 beats, respectively; P = .44), as well as in couplets, bigeminal cycles, or nonsustained tachycardia during continuous electrocardiographic monitoring. Exercise test-derived variables, such as ventricular and supraventricular premature beats, duration of exercise, estimated peak oxygen consumption, and heart rate, were not influenced by caffeine ingestion. We observed no increases in ventricular premature beats (91 vs 223 vs 207 beats, respectively

Can complexity decrease in congestive heart failure?

Science.gov (United States)

Mukherjee, Sayan; Palit, Sanjay Kumar; Banerjee, Santo; Ariffin, M. R. K.; Rondoni, Lamberto; Bhattacharya, D. K.

2015-12-01

The complexity of a signal can be measured by the Recurrence period density entropy (RPDE) from the reconstructed phase space. We have chosen a window based RPDE method for the classification of signals, as RPDE is an average entropic measure of the whole phase space. We have observed the changes in the complexity in cardiac signals of normal healthy person (NHP) and congestive heart failure patients (CHFP). The results show that the cardiac dynamics of a healthy subject is more complex and random compare to the same for a heart failure patient, whose dynamics is more deterministic. We have constructed a general threshold to distinguish the border line between a healthy and a congestive heart failure dynamics. The results may be useful for wide range for physiological and biomedical analysis.

Effective cross-over to granisetron after failure to ondansetron, a randomized double blind study in patients failing ondansetron plus dexamethasone during the first 24 hours following highly emetogenic chemotherapy

Science.gov (United States)

de Wit, R; de Boer, A C; vd Linden, G H M; Stoter, G; Sparreboom, A; Verweij, J

2001-01-01

In view of the similarity in chemical structure of the available 5HT3-receptor antagonists it is assumed, whilst these agents all act at the same receptor, that failure to one agent would predict subsequent failure to all 5HT3-receptor antagonists. We conducted a randomized double blind trial of granisetron 3 mg plus dexamethasone 10 mg versus continued treatment with ondansetron 8 mg plus dexamethasone 10 mg in patients with protection failure on ondansetron 8 mg plus dexamethasone 10 mg during the first 24 hours following highly emetogenic chemotherapy. Of 40 eligible patients, 21 received ondansetron + dexamethasone and 19 received granisetron + dexamethasone. We found a significant benefit from crossing-over to granisetron after failure on ondansetron. Of the 19 patients who crossed over to granisetron, 9 patients obtained complete protection, whereas this was observed in 1 of the 21 patients continuing ondansetron, P = 0.005. These results indicate that there is no complete cross-resistance between 5HT3-receptor antagonists, and that patients who have acute protection failure on one 5HT3-receptor antagonist should be offered cross-over to another 5HT3-receptor antagonist. © 2001 Cancer Research Campaign  http://www.bjcancer.com PMID:11710819

Screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy

DEFF Research Database (Denmark)

Proclemer, Alessandro; Lewalter, Thorsten; Bongiorni, Maria Grazia

2013-01-01

The purpose of this EHRA survey was to examine the current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy with a focus on selection of candidates for implantable cardioverter-defibrillator (ICD) therapy, timing of ICD...... implantation, and use of non-invasive and invasive diagnostic tests across Europe. A systematic screening programme for sudden cardiac death existed in 19 out of 31 centres (61.3%). Implantation of ICDs according to the inclusion criteria of MADIT-II and SCD-HeFT trials was reported in 30 and 29% of centres......, respectively, followed by MADIT-CRT (18%), COMPANION (16%), and combined MADIT and MUSTT (7%) indications. In patients with severe renal impairment, ICD implantation for primary prevention of sudden death was always avoided in 8 centres (33.3%), was not used only if creatinine level was >2.5 mg/dL in 10...

Development of a subway operation incident delay model using accelerated failure time approaches.

Science.gov (United States)

Weng, Jinxian; Zheng, Yang; Yan, Xuedong; Meng, Qiang

2014-12-01

This study aims to develop a subway operational incident delay model using the parametric accelerated time failure (AFT) approach. Six parametric AFT models including the log-logistic, lognormal and Weibull models, with fixed and random parameters are built based on the Hong Kong subway operation incident data from 2005 to 2012, respectively. In addition, the Weibull model with gamma heterogeneity is also considered to compare the model performance. The goodness-of-fit test results show that the log-logistic AFT model with random parameters is most suitable for estimating the subway incident delay. First, the results show that a longer subway operation incident delay is highly correlated with the following factors: power cable failure, signal cable failure, turnout communication disruption and crashes involving a casualty. Vehicle failure makes the least impact on the increment of subway operation incident delay. According to these results, several possible measures, such as the use of short-distance and wireless communication technology (e.g., Wifi and Zigbee) are suggested to shorten the delay caused by subway operation incidents. Finally, the temporal transferability test results show that the developed log-logistic AFT model with random parameters is stable over time. Copyright © 2014 Elsevier Ltd. All rights reserved.

REVIVE Trial: Retrograde Delivery of Autologous Bone Marrow in Patients With Heart Failure.

Science.gov (United States)

Patel, Amit N; Mittal, Sanjay; Turan, Goekmen; Winters, Amalia A; Henry, Timothy D; Ince, Hueseyin; Trehan, Naresh

2015-09-01

Cell therapy is an evolving option for patients with end-stage heart failure and ongoing symptoms despite optimal medical therapy. Our goal was to evaluate retrograde bone marrow cell delivery in patients with either ischemic heart failure (IHF) or nonischemic heart failure (NIHF). This was a prospective randomized, multicenter, open-label study of the safety and feasibility of bone marrow aspirate concentrate (BMAC) infused retrograde into the coronary sinus. Sixty patients were stratified by IHF and NIHF and randomized to receive either BMAC infusion or control (standard heart failure care) in a 4:1 ratio. Accordingly, 24 subjects were randomized to the ischemic BMAC group and 6 to the ischemic control group. Similarly, 24 subjects were randomized to the nonischemic BMAC group and 6 to the nonischemic control group. All 60 patients were successfully enrolled in the study. The treatment groups received BMAC infusion without complications. The left ventricular ejection fraction in the patients receiving BMAC demonstrated significant improvement compared with baseline, from 25.1% at screening to 31.1% at 12 months (p=.007) in the NIHF group and from 26.3% to 31.1% in the IHF group (p=.035). The end-systolic diameter decreased significantly in the nonischemic BMAC group from 55.6 to 50.9 mm (p=.020). Retrograde BMAC delivery is safe. All patients receiving BMAC experienced improvements in left ventricular ejection fraction, but only those with NIHF showed improvements in left ventricular end-systolic diameter and B-type natriuretic peptide. These results provide the basis for a larger clinical trial in HF patients. This work is the first prospective randomized clinical trial using high-dose cell therapy delivered via a retrograde coronary sinus infusion in patients with heart failure. This was a multinational, multicenter study, and it is novel, translatable, and scalable. On the basis of this trial and the safety of retrograde coronary sinus infusion, there are

Gender and survival in patients with heart failure

DEFF Research Database (Denmark)

Martínez-Sellés, Manuel; Doughty, Robert N; Poppe, Katrina

2012-01-01

The aim of this study was to investigate the relationship between gender and survival of patients with heart failure, using data from both randomized trials and observational studies, and the relative contribution of age, left ventricular systolic function, aetiology, and diabetes to differences...

A Zebrafish Heart Failure Model for Assessing Therapeutic Agents.

Science.gov (United States)

Zhu, Xiao-Yu; Wu, Si-Qi; Guo, Sheng-Ya; Yang, Hua; Xia, Bo; Li, Ping; Li, Chun-Qi

2018-03-20

Heart failure is a leading cause of death and the development of effective and safe therapeutic agents for heart failure has been proven challenging. In this study, taking advantage of larval zebrafish, we developed a zebrafish heart failure model for drug screening and efficacy assessment. Zebrafish at 2 dpf (days postfertilization) were treated with verapamil at a concentration of 200 μM for 30 min, which were determined as optimum conditions for model development. Tested drugs were administered into zebrafish either by direct soaking or circulation microinjection. After treatment, zebrafish were randomly selected and subjected to either visual observation and image acquisition or record videos under a Zebralab Blood Flow System. The therapeutic effects of drugs on zebrafish heart failure were quantified by calculating the efficiency of heart dilatation, venous congestion, cardiac output, and blood flow dynamics. All 8 human heart failure therapeutic drugs (LCZ696, digoxin, irbesartan, metoprolol, qiliqiangxin capsule, enalapril, shenmai injection, and hydrochlorothiazide) showed significant preventive and therapeutic effects on zebrafish heart failure (p failure model developed and validated in this study could be used for in vivo heart failure studies and for rapid screening and efficacy assessment of preventive and therapeutic drugs.

Diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture

DEFF Research Database (Denmark)

Ring-Larsen, H; Henriksen, Jens Henrik Sahl; Wilken, C

1986-01-01

The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. After fasting overnight in bed the patients received bumetanide 1 mg intravenously and were then immediately randomly assigned to either bed rest in the sup......The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. After fasting overnight in bed the patients received bumetanide 1 mg intravenously and were then immediately randomly assigned to either bed rest...... in the supine position or normal daily activity in the upright position for the next six hours. Two days later the procedure was repeated, the patients being assigned to the other posture. The diuretic response was similar in patients with heart failure and cirrhosis, and was significantly greater in the supine...

Debonding failure and size effects in micro reinforced composites

DEFF Research Database (Denmark)

Legarth, Brian Nyvang; Niordson, Christian Frithiof

2010-01-01

-plastic formulation. Bi-axially loaded unit cells are used and failure is modeled using a cohesive zone at the reinforcement interface. During debonding a sudden stress drop in the overall average stress–strain response is observed. Adaptive higher-order boundary conditions are imposed at the reinforcement interface...... for realistically modeling the restrictions on moving dislocations as debonding occurs. It is found that the influence of the imposed higher-order boundary conditions at the interface is minor. If strain-gradient effects are accounted for a void with a smooth shape develops at the reinforcement interface while...... a smaller void having a sharp tip nucleates if strain-gradient effects are excluded. Using orthogonalization of the plastic strain gradient with three corresponding material length scales it is found that, the first length scale dominates the evaluated overall average stress–strain response, the second one...

Sudden disruption of the cross-tail current in the magnetotail

International Nuclear Information System (INIS)

Ma, Z. W.

2008-01-01

A Hall magnetohydrodynamic simulation is used to study current dynamic processes with realistic magnetotail geometry. The simulation results indicate that sudden disruption of cross-tail current at the near Earth region inside 15R E is triggered by fast magnetic reconnection with the reconnection rate ∼0.15. The cross-tail current density exhibits an impulsive intensification in the late growth phase. The magnitude of the current increases more than one order within a few minutes. After the reconnection onset, the cross-tail current is suddenly disrupted in a few Alfven times, which is in good agreement with that from the satellite observations. Associated with the current disruption, the tail-like geometry becomes a dipolarlike structure with an impulsive enhancement of the magnetic field B z . Large increases of the electric field and Earthward bulk flow in this simulation are observed immediately after the reconnection onset

Comparative study of turbulence model performance for axisymmetric sudden expansion flow

Energy Technology Data Exchange (ETDEWEB)

Bae, Youngmin; Kim, Young In; Kim, Keung Koo; Yoon, Juhyeon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2013-10-15

In this study, the performance of turbulence models in predicting the turbulent flow in an axisymmetric sudden expansion with an expansion ratio of 4 is assessed for a Reynolds number of 5.6 Χ 10{sup 4}. The comparisons show that the standard k-ε and RSM models provide the best agreement with the experimental data, whereas the standard k-ω model gives poor predictions. Owing to its computational efficiency, the Reynolds Averaged Navier-Stokes (RANS) approach has been widely used for the prediction of turbulent flows and associated pressure losses in a variety of internal flow systems such as a diffuser, orifice, converging nozzle, and pipes with sudden expansion. However, the lack of a general turbulence model often leads to limited applications of a RANS approach, i. e., the accuracy and validity of solutions obtained from RANS equations vary with the turbulence model, flow regime, near-wall treatment, and configuration of the problem. In light of the foregoing, a large amount of turbulence research has been conducted to assess the performance of existing turbulence models for different flow fields. In this paper, the turbulent flow in an axisymmetric sudden expansion is numerically investigated for a Reynolds number of 5.6 Χ 10{sup 4}, with the aim of examining the performance of several turbulence models.

Reporting a sudden death due to accidental gasoline inhalation.

Science.gov (United States)

Martínez, María Antonia; Ballesteros, Salomé; Alcaraz, Rafael

2012-02-10

The investigation of uncertain fatalities requires accurate determination of the cause of death, with assessment of all factors that may have contributed to it. Gasoline is a complex and highly variable mixture of aliphatic and aromatic hydrocarbons that can lead to cardiac arrhythmias due to sensitization of the myocardium to catecholamines or acts as a simple asphyxiant if the vapors displace sufficient oxygen from the breathing atmosphere. This work describes a sudden occupational fatality involving gasoline. The importance of this petroleum distillate detection and its quantitative toxicological significance is discussed using a validated analytical method. A 51 year-old Caucasian healthy man without significant medical history was supervising the repairs of the telephone lines in a manhole near to a gas station. He died suddenly after inhaling gasoline vapors from an accidental leak. Extensive blistering and peeling of skin were observed on the skin of the face, neck, anterior chest, upper and lower extremities, and back. The internal examination showed a strong odor of gasoline, specially detected in the respiratory tract. The toxicological screening and quantitation of gasoline was performed by means of gas chromatography with flame ionization detector and confirmation was performed using gas chromatography-mass spectrometry. Disposition of gasoline in different tissues was as follows: heart blood, 35.7 mg/L; urine, not detected; vitreous humor, 1.9 mg/L; liver, 194.7 mg/kg; lung, 147.6 mg/kg; and gastric content, 116,6 mg/L (2.7 mg total). Based upon the toxicological data along with the autopsy findings, the cause of death was determined to be gasoline poisoning and the manner of death was accidental. We would like to alert on the importance of testing for gasoline, and in general for volatile hydrocarbons, in work-related sudden deaths involving inhalation of hydrocarbon vapors and/or exhaust fumes. Copyright © 2011 Elsevier Ireland Ltd. All rights

Oscillating flow and heat transfer in a channel with sudden cross section change

Science.gov (United States)

Ibrahim, Mounir; Hashim, Waqar

1993-01-01

We have computationally examined oscillating flow (zero mean) between two parallel plates with a sudden change in cross section. The flow was assumed to be laminar incompressible with the inflow velocity uniform over the channel cross section but varying sinusoidally with time. The cases studied cover wide ranges of Re(sub max) (from 187.5 to 2000), Va (from 1 to 10.66), the expansion ratio (1:2 and 1:4) and A(sub r) (2 and 4). Also, three different geometric cases were discussed: (1) asymmetric expansion/contraction; (2) symmetric expansion/contraction; and (3) symmetric blunt body. For these oscillating flow conditions, the fluid undergoes sudden expansion in one-half of the cycle and sudden contraction inthe other half. The instantaneous friction factor, for some ranges of Re(sub max) and Va, deviated substantially from the steady-state friction factor for the same flow parameters. A region has been identified below which the flow is laminar quasi-steady. A videotape showing computer simulations of the oscillating flow demonstrates the usefulness of the current analyses in providing information on the transient hydraulic phenomena.

Chronic heart failure modifies respiratory mechanics in rats: a randomized controlled trial

Directory of Open Access Journals (Sweden)

Deise M. Pacheco

2016-01-01

Full Text Available ABSTRACT Objective To analyze respiratory mechanics and hemodynamic alterations in an experimental model of chronic heart failure (CHF following myocardial infarction. Method Twenty-seven male adult Wistar rats were randomized to CHF group (n=12 or Sham group (n=15. Ten weeks after coronary ligation or sham surgery, the animals were anesthetized and submitted to respiratory mechanics and hemodynamic measurements. Pulmonary edema as well as cardiac remodeling were measured. Results The CHF rats showed pulmonary edema 26% higher than the Sham group. The respiratory system compliance (Crs and the total lung capacity (TLC were lower (40% and 27%, respectively in the CHF rats when compared to the Sham group (P<0.01. There was also an increase in tissue resistance (Gti and elastance (Hti (28% and 45%, respectively in the CHF group. Moreover, left ventricular end-diastolic pressure was higher (32 mmHg vs 4 mmHg, P<0.01, while the left ventricular systolic pressure was lower (118 mmHg vs 130 mmHg, P=0.02 in the CHF group when compared to the control. Pearson’s correlation coefficient showed a negative association between pulmonary edema and Crs (r=–0.70, P=0.0001 and between pulmonary edema and TLC (r=–0.67,P=0.0034. Pulmonary edema correlated positively with Gti (r=0.68, P=0.001 and Hti (r=0.68, P=0.001. Finally, there was a strong positive relationship between pulmonary edema and heart weight (r=0.80, P=0.001. Conclusion Rats with CHF present important changes in hemodynamic and respiratory mechanics, which may be associated with alterations in cardiopulmonary interactions.

Effect of Workplace- versus Home-Based Physical Exercise on Muscle Response to Sudden Trunk Perturbation among Healthcare Workers

DEFF Research Database (Denmark)

Jakobsen, Markus D; Sundstrup, Emil; Brandt, Mikkel

2015-01-01

Objectives. The present study investigates the effect of workplace- versus home-based physical exercise on muscle reflex response to sudden trunk perturbation among healthcare workers. Methods. Two hundred female healthcare workers (age: 42 [SD 11], BMI: 24 [SD 4], and pain intensity: 3.1 [SD 2.......2] on a scale of 0-10) from 18 departments at three hospitals were randomized at the cluster level to 10 weeks of (1) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise...... perturbation. Furthermore, EMG preactivation of the erector spinae and fear avoidance were reduced more following WORK than HOME (95% CI -2.7--0.7 (P training sessions per week, respectively...

Coupled catastrophes: sudden shifts cascade and hop among interdependent systems

Science.gov (United States)

Barnett, George; D'Souza, Raissa M.

2015-01-01

An important challenge in several disciplines is to understand how sudden changes can propagate among coupled systems. Examples include the synchronization of business cycles, population collapse in patchy ecosystems, markets shifting to a new technology platform, collapses in prices and in confidence in financial markets, and protests erupting in multiple countries. A number of mathematical models of these phenomena have multiple equilibria separated by saddle-node bifurcations. We study this behaviour in its normal form as fast–slow ordinary differential equations. In our model, a system consists of multiple subsystems, such as countries in the global economy or patches of an ecosystem. Each subsystem is described by a scalar quantity, such as economic output or population, that undergoes sudden changes via saddle-node bifurcations. The subsystems are coupled via their scalar quantity (e.g. trade couples economic output; diffusion couples populations); that coupling moves the locations of their bifurcations. The model demonstrates two ways in which sudden changes can propagate: they can cascade (one causing the next), or they can hop over subsystems. The latter is absent from classic models of cascades. For an application, we study the Arab Spring protests. After connecting the model to sociological theories that have bistability, we use socioeconomic data to estimate relative proximities to tipping points and Facebook data to estimate couplings among countries. We find that although protests tend to spread locally, they also seem to ‘hop' over countries, like in the stylized model; this result highlights a new class of temporal motifs in longitudinal network datasets. PMID:26559684

A vortex dynamics perspective on stratospheric sudden warmings

OpenAIRE

Matthewman, N. J.

2009-01-01

A vortex dynamics approach is used to study the underlying mechanisms leading to polar vortex breakdown during stratospheric sudden warmings (SSWs). Observational data are used in chapter 2 to construct climatologies of the Arctic polar vortex structure during vortex-splitting and vortex-displacement SSWs occurring between 1958 and 2002. During vortex-splitting SSWs, polar vortex breakdown is shown to be typically independent of height (barotropic), whereas breakdown during vor...

Pseudo Random Coins Show More Heads Than Tails

OpenAIRE

Bauke, Heiko; Mertens, Stephan

2003-01-01

Tossing a coin is the most elementary Monte Carlo experiment. In a computer the coin is replaced by a pseudo random number generator. It can be shown analytically and by exact enumerations that popular random number generators are not capable of imitating a fair coin: pseudo random coins show more heads than tails. This bias explains the empirically observed failure of some random number generators in random walk experiments. It can be traced down to the special role of the value zero in the ...

Successful management of diastolic heart failure in a patient with restrictive cardiomyopathy following an anterior communicating artery aneurysm clipping

Directory of Open Access Journals (Sweden)

Rajasekar Arumugam

2017-01-01

Full Text Available Perioperative management of neurosurgical patients with an underlying myocardial dysfunction poses a unique challenge to the neuroanaesthesiologist and the neurointensivist. Sudden catecholamine surge during the aneurysmal subarachnoid haemorrhage (SAH can cause severe cardiac dysfunction such as myocardial ischaemia and cardiomyopathy. SAH in a patient with restrictive cardiomyopathy could be hazardous to the myocardium leading to severe cardiac morbidity. We report the successful management of an acute post-operative diastolic heart failure with a milrinone infusion in a patient with restrictive cardiomyopathy, following anterior communicating artery aneurysm clipping. We have discussed the 'dual beneficial' role of milrinone on the heart and the brain in this clinical setting. In addition, the importance of peri-operative utilisation of transoesophageal echocardiography and transthoracic echocardiography for the successful management of diastolic heart failure is highlighted.

Network Performance Improvement under Epidemic Failures in Optical Transport Networks

DEFF Research Database (Denmark)

Fagertun, Anna Manolova; Ruepp, Sarah Renée

2013-01-01

In this paper we investigate epidemic failure spreading in large- scale GMPLS-controlled transport networks. By evaluating the effect of the epidemic failure spreading on the network, we design several strategies for cost-effective network performance improvement via differentiated repair times....... First we identify the most vulnerable and the most strategic nodes in the network. Then, via extensive simulations we show that strategic placement of resources for improved failure recovery has better performance than randomly assigning lower repair times among the network nodes. Our OPNET simulation...... model can be used during the network planning process for facilitating cost- effective network survivability design....

Circumvention of suddenly appearing obstacles in young and older adults

NARCIS (Netherlands)

Pijnappels, M.; Kingma, I.; Van Dieën, J. H.

2010-01-01

Reduced ability to circumvent an obstacle, which is noticed only shortly before collision, could be a cause of falls and injury, especially in older adults. In this study, we investigated differences in strategies and their characteristics between young and older adults when circumventing a suddenly

Epidemiology of heart failure with preserved ejection fraction

DEFF Research Database (Denmark)

Andersson, Charlotte; Vasan, Ramachandran S

2014-01-01

Heart failure with preserved ejection fraction (HFPEF) is a common condition, and the prevalence is projected to increase further. Studies differ in the reported incidence and mortality associated with this condition, although there is agreement that between a third and one-half of all patients...... with heart failure have HFPEF. Although several consensus statements and guidelines have been published, some recent randomized clinical trials have reported low mortality, raising doubts about whether all patients diagnosed with HFPEF have HFPEF or whether the condition is heterogeneous in its cause...

Effect of passenger position on fear of danger experienced during sudden bus stops.

Science.gov (United States)

Aoki, Takeo; Uetake, Teruo; Shimoda, Masahiro

2009-06-01

The purpose of this study was to identify the effect of bus passengers' positions on their fear of danger when a bus stopped suddenly. A temporary bus running course with one bus stop was set up on the campus of the Tokyo University of Agriculture and Technology (TUAT). The bus ran the course 14 times with the bus stopping twice during the course, once at the bus stop and again just after re-starting from the bus stop. The driver was asked to brake more strongly than usual when stopping. Sixteen students (15 males and 1 female) between the ages of 18 and 21 years participated. In turn, all participants were asked to take 14 different postures in the bus. Participants were also asked to report their level of fear on a rating scale each time the bus stopped. The study showed that (1) passengers' fear of danger at the first sudden stop was typically higher than that at the second stop, (2) standing passengers who held hand straps experienced more fear than those who held fixed safety devices, (3) bus passengers sitting on the centre of the rear seat had a great risk of injury if the bus stopped suddenly, and (4) when passengers faced the window and stood transversely with respect to from the moving direction of the bus and the bus stopped suddenly, passengers' fear of danger was affected by the side of the bus on which they stood as well as which hand they used to grasp a safety device.

A new reliability measure based on specified minimum distances before the locations of random variables in a finite interval

International Nuclear Information System (INIS)

Todinov, M.T.

2004-01-01

A new reliability measure is proposed and equations are derived which determine the probability of existence of a specified set of minimum gaps between random variables following a homogeneous Poisson process in a finite interval. Using the derived equations, a method is proposed for specifying the upper bound of the random variables' number density which guarantees that the probability of clustering of two or more random variables in a finite interval remains below a maximum acceptable level. It is demonstrated that even for moderate number densities the probability of clustering is substantial and should not be neglected in reliability calculations. In the important special case where the random variables are failure times, models have been proposed for determining the upper bound of the hazard rate which guarantees a set of minimum failure-free operating intervals before the random failures, with a specified probability. A model has also been proposed for determining the upper bound of the hazard rate which guarantees a minimum availability target. Using the models proposed, a new strategy, models and reliability tools have been developed for setting quantitative reliability requirements which consist of determining the intersection of the hazard rate envelopes (hazard rate upper bounds) which deliver a minimum failure-free operating period before random failures, a risk of premature failure below a maximum acceptable level and a minimum required availability. It is demonstrated that setting reliability requirements solely based on an availability target does not necessarily mean a low risk of premature failure. Even at a high availability level, the probability of premature failure can be substantial. For industries characterised by a high cost of failure, the reliability requirements should involve a hazard rate envelope limiting the risk of failure below a maximum acceptable level

Health-related quality of life in a multicenter randomized controlled comparison of telephonic disease management and automated home monitoring in patients recently hospitalized with heart failure: SPAN-CHF II trial.

Science.gov (United States)

Konstam, Varda; Gregory, Douglas; Chen, Jie; Weintraub, Andrew; Patel, Ayan; Levine, Daniel; Venesy, David; Perry, Kathleen; Delano, Christine; Konstam, Marvin A

2011-02-01

Although disease management programs have been shown to provide a number of clinical benefits to patients with heart failure (HF), the incremental impact of an automated home monitoring (AHM) system on health-related quality of life (HRQL) is unknown. We performed a prospective randomized investigation, examining the additive value of AHM to a previously described nurse-directed HF disease management program (SPAN-CHF), with attention to HRQL, in patients with a recent history of decompensated HF. A total of 188 patients were randomized to receive the SPAN-CHF intervention for 90 days, either with (AHM group) or without (NAHM, standard-care group) AHM, with a 1:1 randomization ratio after HF-related hospitalization. HRQL, measured by the Minnesota Living With Heart Failure Questionnaire (MLHFQ) (Physical, Emotional, and Total scores on MLHFQ) was assessed at 3 time points: baseline, 45 days, and 90 days. Although both treatments (AHM and NAHM) improved HRQL at 45 and 90 days compared with baseline with respect to Physical, Emotional, and Total domain scales, no significant difference emerged between AHM and NAHM groups. AHM and NAHM treatments demonstrated improved HRQL scores at 45 and 90 days after baseline assessment. When comparing 2 state-of the-art disease management programs regarding HRQL outcomes, our results did not support the added value of AHM. Copyright © 2011. Published by Elsevier Inc.

Solar flare effects and storm sudden commencement even in ...

African Journals Online (AJOL)

1998-05-08

Variations in the three components of geomagnetic field were observed at the twenty-two geomagnetic Euro-African Observatories during the solar flare that occurred on the 6 May, 1998 at 0080UT and storm sudden commencement that took place on May 8, 1998 at 15.00 UT. The geomagnetic field on 6 May, 1998 was ...

Linking sudden oak death with spatial economic value transfer

Science.gov (United States)

Tom Holmes; Bill Smith

2008-01-01

Sudden oak death (caused by Phytophthora ramorum) is currently having a dramatic impact on the flow of ecosystem services provided by trees and forests in California. Timber species in California are not thought to be at risk of mortality from this pathogen and, consequently, economic impacts accrue to non-market values of trees such as aesthetics,...

Cardiomyopathies as a Cause of Sudden Cardiac Death (SCD in Egypt: Recognition and Preventive Strategies Needed

Directory of Open Access Journals (Sweden)

Nora Fnon

2016-06-01

Full Text Available This study aimed at evaluating the epidemiological characteristics and pathological features of different types of cardiomyopathies in Egypt, highlighting the role of the forensic pathologist in identifying cases of cardiomyopathies and initiating for their families a possible genetic study aiming at prevention of sudden death. All cases with sudden cardiac death (SCD due to cardiomyopathies during the period from the beginning of January 2010 until the end of December 2014 (5 years were included in this study. All hearts underwent detailed gross and histological examination. Circumstances of death, medical history, and post-mortem pathological findings were thoroughly  investigated. Out of 535 cases of sudden cardiac death, there were 22 cases (4.1% diagnosed as having cardiomyopathies; sudden death was their first presentation. Eighteen cases (81.8% were male, with the 4th decade (11 cases, 50% being the most affected age; severe physical activity and exertion were evident in death circumstances of 14 cases (63.6%; pathological evaluation revealed that hypertrophic cardiomyopathy was the most frequent type, being diagnosed in 10 cases (45%. Cardiomyopathies are an infrequent cause of sudden cardiac death. Most deaths are in children and adults, so cases are of high social impact that demands multidisciplinary research and resources. In all cases of SCD, forensic autopsy should be done. Forensic study is the key to identifying an affected family and the starting point regarding assessing them.

Is human failure a stochastic process?

International Nuclear Information System (INIS)

Dougherty, Ed M.

1997-01-01

Human performance results in failure events that occur with a risk-significant frequency. System analysts have taken for granted the random (stochastic) nature of these events in engineering assessments such as risk assessment. However, cognitive scientists and error technologists, at least those who have interest in human reliability, have, over the recent years, claimed that human error does not need this stochastic framework. Yet they still use the language appropriate to stochastic processes. This paper examines the potential for the stochastic nature of human failure production as the basis for human reliability analysis. It distinguishes and leaves to others, however, the epistemic uncertainties over the possible probability models for the real variability of human performance

Effect of a multidisciplinary supportive program for family caregivers of patients with heart failure on caregiver burden, quality of life, and depression: A randomized controlled study.

Science.gov (United States)

Hu, Xiaolin; Dolansky, Mary A; Su, Yonglin; Hu, Xiuying; Qu, Moying; Zhou, Lingjuan

2016-10-01

Caregivers of patients with heart failure experience burden and negative health outcomes. Adequate support for family caregivers improves their well-being and the quality of care provided to the patients. However, little is known about the benefits of interventions for caregivers of patients with heart failure in China. To test the effects of a multidisciplinary supportive program for family caregivers on caregiver burden, quality of life, and depression. A randomized controlled design with repeated measures was used in this study. A total of 118 participants were randomized into experimental (n=59) and control groups (n=59) from May to December 2014 in one hospital in Chengdu, People's Republic of China. Participants in the experimental group received a 3-month multidisciplinary supportive program, consisting of three 60-min sessions of group classes, three 30-min peer support groups, and regular telephone follow-ups and consultations, while participants in the control group received usual care only. Outcomes were caregiver burden, quality of life, and depression. Data were collected at baseline, post-test (3 months after discharge), and 3 months after post-test (6 months after discharge). The repeated measures analysis of variance was used to examine the effects of groups, changes over time, and time-group interaction on outcome variables. There were significant improvements in caregiver burden, mental health, and depression after post-test and 3 months after post-test in the experimental group. However, there was no significant improvement in caregivers' physical health at either 3 or 6 months following discharge. A multidisciplinary supportive program for caregivers of heart failure patients had positive effects and provides a unique perspective of an intervention considering Chinese culture and customs. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Sudden death in Versailles: A review of a cardiovascular treatrise by Dionis (1710)].

Science.gov (United States)

Charlier, P

2018-02-01

In 1710, the surgeon Pierre Dionis publishes a Dissertation on sudden death. Echoing and expanding the work of his Roman colleague Jean Marie Lancisi, he describes and analyzes dozens of cases of sudden death observed by him. A large number of cases was followed by autopsies allowing clinicopathological confrontation. Are proposed causes of death (pulmonary embolism, myocardial infarction, hemorrhagic stroke, arterial rupture, etc.), pathophysiological mechanisms based on the ancient theory of humors, and preventive actions to avoid these unexpected deaths. In this article, we oppose these old data to those of current literature. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Prevention of sudden cardiac death in athletes, sportspersons and marathoners in India

Directory of Open Access Journals (Sweden)

Amit Vora

2018-01-01

Full Text Available The annual incidence of sudden cardiac death (SCD in athletes is significantly lower than the general population. However, when SCD occurs in an athlete during sporting event or training, it sends shockwaves in the society and raises questions about cardiovascular effects of sports and exercise. This document reviews the causes and mechanism of SCD in sports and exercise in young and older athletes. In the Indian context, we suggest a ‘pre-participation screening’ of young and older athletes and consider a ‘supervised, graded exercise regime’ for the uninitiated, older sports participant. Finally, the document proposes medical infrastructure required to successfully revive a victim of sudden cardiac arrest during a sporting event.

Towards sensor array materials: can failure be delayed?

Science.gov (United States)

Mekid, Samir; Saheb, Nouari; Khan, Shafique M. A.; Qureshi, Khurram K.

2015-06-01

Further to prior development in enhancing structural health using smart materials, an innovative class of materials characterized by the ability to feel senses like humans, i.e. ‘nervous materials’, is discussed. Designed at all scales, these materials will enhance personnel and public safety, and secure greater reliability of products. Materials may fail suddenly, but any system wishes that failure is known in good time and delayed until safe conditions are reached. Nervous materials are expected to be the solution to this statement. This new class of materials is based on the novel concept of materials capable of feeling multiple structural and external stimuli, e.g. stress, force, pressure and temperature, while feeding information back to a controller for appropriate real-time action. The strain-stress state is developed in real time with the identified and characterized source of stimulus, with optimized time response to retrieve initial specified conditions, e.g. shape and strength. Sensors are volumetrically embedded and distributed, emulating the human nervous system. Immediate applications are in aircraft, cars, nuclear energy and robotics. Such materials will reduce maintenance costs, detect initial failures and delay them with self-healing. This article reviews the common aspects and challenges surrounding this new class of materials with types of sensors to be embedded seamlessly or inherently, including appropriate embedding manufacturing techniques with modeling and simulation methods.

Fragmentation of suddenly heated liquids

International Nuclear Information System (INIS)

Blink, J.A.

1985-03-01

Fragmentation of free liquids in Inertial Confinement Fusion reactors could determine the upper bound on reactor pulse rate. The x-ray ablated materials must cool and recondense to allow driver beam propagation. The increased surface area caused by fragmentation will enhance the cooling and condensation rates. Relaxation from the suddenly heated state will move a liquid into the negative pressure region under the liquid-vapor P-V dome. The lithium equation of state was used to demonstrate that neutron-induced vaporization uses only a minor fraction of the added heat, much less than would be required to drive the expansion. A 77% expansion of the lithium is required before the rapid vaporization process of spinodal decomposition could begin, and nucleation and growth are too slow to contribute to the expansion

Left ventricular cardiac myxoma and sudden death in a dog

NARCIS (Netherlands)

de Nijs, M.I.; Vink, Aryan; Bergmann, W.; Szatmári, V.

2016-01-01

Background: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. Case presentation: A previously healthy 12-year-old male West Highland white terrier was found dead

Left ventricular cardiac myxoma and sudden death in a dog

NARCIS (Netherlands)

de Nijs, Maria Irene; Vink, Aryan; Bergmann, Wilhelmina; Szatmári, Viktor

2016-01-01

BACKGROUND: Myxoma is a very rare benign cardiac tumor in dogs. This is the first description of a cardiac myxoma originating from the left ventricular outflow tract, presumably causing sudden death. CASE PRESENTATION: A previously healthy 12-year-old male West Highland white terrier was found dead

Rationale and design of the SERVE-HF study: treatment of sleep-disordered breathing with predominant central sleep apnoea with adaptive servo-ventilation in patients with chronic heart failure.

Science.gov (United States)

Cowie, Martin R; Woehrle, Holger; Wegscheider, Karl; Angermann, Christiane; d'Ortho, Marie-Pia; Erdmann, Erland; Levy, Patrick; Simonds, Anita; Somers, Virend K; Zannad, Faiez; Teschler, Helmut

2013-08-01

Central sleep apnoea/Cheyne-Stokes respiration (CSA/CSR) is a risk factor for increased mortality and morbidity in heart failure (HF). Adaptive servo-ventilation (ASV) is a non-invasive ventilation modality for the treatment of CSA/CSR in patients with HF. SERVE-HF is a multinational, multicentre, randomized, parallel trial designed to assess the effects of addition of ASV (PaceWave, AutoSet CS; ResMed) to optimal medical management compared with medical management alone (control group) in patients with symptomatic chronic HF, LVEF ≤45%, and predominant CSA. The trial is based on an event-driven group sequential design, and the final analysis will be performed when 651 events have been observed or the study is terminated at one of the two interim analyses. The aim is to randomize ∼1200 patients to be followed for a minimum of 2 years. Patients are to stay in the trial up to study termination. The first patient was randomized in February 2008 and the study is expected to end mid 2015. The primary combined endpoint is the time to first event of all-cause death, unplanned hospitalization (or unplanned prolongation of a planned hospitalization) for worsening (chronic) HF, cardiac transplantation, resuscitation of sudden cardiac arrest, or appropriate life-saving shock for ventricular fibrillation or fast ventricular tachycardia in implantable cardioverter defibrillator patients. The SERVE-HF study is a randomized study that will provide important data on the effect of treatment with ASV on morbidity and mortality, as well as the cost-effectiveness of this therapy, in patients with chronic HF and predominantly CSA/CSR. ISRCTN19572887.

Sudden acquired retinal degeneration syndrome in western Canada: 93 cases.

Science.gov (United States)

Leis, Marina L; Lucyshyn, Danica; Bauer, Bianca S; Grahn, Bruce H; Sandmeyer, Lynne S

2017-11-01

This study reviewed clinical data from dogs diagnosed with sudden acquired retinal degeneration syndrome (SARDS) in western Canada. Medical records from the Western College of Veterinary Medicine from 2002 to 2016 showed that 93 cases of SARDS were diagnosed based on presentation for sudden blindness and a bilaterally extinguished electroretinogram. The most common pure breeds were the miniature schnauzer, dachshund, and pug. The mean age at diagnosis was 8.1 years and males and females were equally affected. Most of the dogs were presented with normal non-chromatic, but abnormal chromatic pupillary light reflexes. The incidence of retinal degeneration as detected via ophthalmoscopy increased over time after SARDS diagnosis. Polyuria, polydipsia, polyphagia, weight gain, elevated liver enzyme values, isosthenuria, and proteinuria were common clinical and laboratory findings. Chromatic pupillary light reflex testing may be more valuable than non-chromatic pupillary light testing in detecting pupil response abnormalities in dogs with SARDS, although electroretinography remains the definitive diagnostic test.

Sudden death and paroxysmal autonomic dysfunction in stiff-man syndrome.

Science.gov (United States)

Mitsumoto, H; Schwartzman, M J; Estes, M L; Chou, S M; La Franchise, E F; De Camilli, P; Solimena, M

1991-04-01

Two women with typical stiff-man syndrome (SMS) developed increasingly frequent attacks of muscle spasms with severe paroxysmal autonomic dysfunctions such as transient hyperpyrexia, diaphoresis, tachypnea, tachycardia, pupillary dilation, and arterial hypertension. Autoantibodies to GABA-ergic neurons were identified in the serum of both patients and in the cerebrospinal fluid of one. Both died suddenly and unexpectedly. General autopsy did not reveal the cause of death. Neuropathological studies revealed perivascular gliosis in the spinal cord and brain stem of one patient and lymphocytic perivascular infiltration in the spinal cord, brain stem, and basal ganglia of the other. The occurrence of a chronic inflammatory reaction in one of the two patients supports the idea that an autoimmune disease against GABA-ergic neurons may be involved in SMS. A review of the literature indicates that functional impairment in SMS is severe and prognosis is unpredictable because of the potential for sudden and unexpected death. Both muscular abnormalities and autonomic dysfunctions may result from autoimmunity directed against GABA-ergic neurons.

Sudden acquired retinal degeneration syndrome in western Canada: 93 cases

Science.gov (United States)

Leis, Marina L.; Lucyshyn, Danica; Bauer, Bianca S.; Grahn, Bruce H.; Sandmeyer, Lynne S.

2017-01-01

This study reviewed clinical data from dogs diagnosed with sudden acquired retinal degeneration syndrome (SARDS) in western Canada. Medical records from the Western College of Veterinary Medicine from 2002 to 2016 showed that 93 cases of SARDS were diagnosed based on presentation for sudden blindness and a bilaterally extinguished electroretinogram. The most common pure breeds were the miniature schnauzer, dachshund, and pug. The mean age at diagnosis was 8.1 years and males and females were equally affected. Most of the dogs were presented with normal non-chromatic, but abnormal chromatic pupillary light reflexes. The incidence of retinal degeneration as detected via ophthalmoscopy increased over time after SARDS diagnosis. Polyuria, polydipsia, polyphagia, weight gain, elevated liver enzyme values, isosthenuria, and proteinuria were common clinical and laboratory findings. Chromatic pupillary light reflex testing may be more valuable than non-chromatic pupillary light testing in detecting pupil response abnormalities in dogs with SARDS, although electroretinography remains the definitive diagnostic test. PMID:29089658

Replacement and inspection policies for products with random life cycle

International Nuclear Information System (INIS)

Yun, Won Young; Nakagawa, Toshio

2010-01-01

In this paper, we consider maintenance policies for products in which the economical life cycle of products is a random variable. First, we study a periodic replacement policy with minimal repair. The system is minimally repaired at failure and is replaced by new one at age T (periodic replacement policy with minimal repair of Barlow and Hunter). The expected present value of total maintenance cost of products with random life cycle is obtained and the optimal replacement interval minimizing the cost is found. Second, we consider an inspection policy for products with random life cycle to detect the system failure. The expected total cost is obtained and the optimal inspection interval is found. Numerical examples are also included.

Disease management in the treatment of patients with chronic heart failure who have universal access to health care: a randomized controlled trial.

Science.gov (United States)

Kalter-Leibovici, Ofra; Freimark, Dov; Freedman, Laurence S; Kaufman, Galit; Ziv, Arnona; Murad, Havi; Benderly, Michal; Silverman, Barbara G; Friedman, Nurit; Cukierman-Yaffe, Tali; Asher, Elad; Grupper, Avishay; Goldman, Dorit; Amitai, Miriam; Matetzky, Shlomi; Shani, Mordechai; Silber, Haim

2017-05-01

The efficacy of disease management programs in improving the outcome of heart failure patients remains uncertain and may vary across health systems. This study explores whether a countrywide disease management program is superior to usual care in reducing adverse health outcomes and improving well-being among community-dwelling adult patients with moderate-to-severe chronic heart failure who have universal access to advanced health-care services and technologies. In this multicenter open-label trial, 1,360 patients recruited after hospitalization for heart failure exacerbation (38%) or from the community (62%) were randomly assigned to either disease management or usual care. Disease management, delivered by multi-disciplinary teams, included coordination of care, patient education, monitoring disease symptoms and patient adherence to medication regimen, titration of drug therapy, and home tele-monitoring of body weight, blood pressure and heart rate. Patients assigned to usual care were treated by primary care practitioners and consultant cardiologists. The primary composite endpoint was the time elapsed till first hospital admission for heart failure exacerbation or death from any cause. Secondary endpoints included the number of all hospital admissions, health-related quality of life and depression during follow-up. Intention-to-treat comparisons between treatments were adjusted for baseline patient data and study center. During the follow-up, 388 (56.9%) patients assigned to disease management and 387 (57.1%) assigned to usual care had a primary endpoint event. The median (range) time elapsed until the primary endpoint event or end of study was 2.0 (0-5.0) years among patients assigned to disease management, and 1.8 (0-5.0) years among patients assigned to usual care (adjusted hazard ratio, 0.908; 95% confidence interval, 0.788 to 1.047). Hospital admissions were mostly (70%) unrelated to heart failure. Patients assigned to disease management had a better

Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study.

Science.gov (United States)

Fleming, P J; Gilbert, R; Azaz, Y; Berry, P J; Rudd, P T; Stewart, A; Hall, E

1990-01-01

OBJECTIVE--To determine the relation between sleeping position and quantity of bedding and the risk of sudden unexpected infant death. DESIGN--A study of all infants dying suddenly and unexpectedly and of two controls matched for age and date with each index case. The parents of control infants were interviewed within 72 hours of the index infant's death. Information was collected on bedding, sleeping position, heating, and recent signs of illness for index and control infants. SETTING--A defined geographical area comprising most of the county of Avon and part of Somerset. SUBJECTS--72 Infants who had died suddenly and unexpectedly (of whom 67 had died from the sudden infant death syndrome) and 144 control infants. RESULTS--Compared with the control infants the infants who had died from the sudden infant death syndrome were more likely to have been sleeping prone (relative risk 8.8; 95% confidence interval 7.0 to 11.0; p less than 0.001), to have been more heavily wrapped (relative risk 1.14 per tog above 8 tog; 1.03 to 1.28; p less than 0.05), and to have had the heating on all night (relative risk 2.7; 1.4 to 5.2; p less than 0.01). These differences were less pronounced in the younger infants (less than 70 days) than the older ones. The risk of sudden unexpected death among infants older than 70 days, nursed prone, and with clothing and bedding of total thermal resistance greater than 10 tog was increased by factors of 15.1 (2.6 to 89.6) and 25.2 (3.7 to 169.0) respectively compared with the risk in infants of the same age nursed supine or on their side and under less than 6 tog of bedding. CONCLUSIONS--Overheating and the prone position are independently associated with an increased risk of sudden unexpected infant death, particularly in infants aged more than 70 days. Educating parents about appropriate thermal care and sleeping position of infants may help to reduce the incidence of the sudden infant death syndrome. PMID:2390588

Analysis on Invulnerability of Wireless Sensor Network towards Cascading Failures Based on Coupled Map Lattice

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Xiuwen Fu

2018-01-01

Full Text Available Previous research of wireless sensor networks (WSNs invulnerability mainly focuses on the static topology, while ignoring the cascading process of the network caused by the dynamic changes of load. Therefore, given the realistic features of WSNs, in this paper we research the invulnerability of WSNs with respect to cascading failures based on the coupled map lattice (CML. The invulnerability and the cascading process of four types of network topologies (i.e., random network, small-world network, homogenous scale-free network, and heterogeneous scale-free network under various attack schemes (i.e., random attack, max-degree attack, and max-status attack are investigated, respectively. The simulation results demonstrate that the rise of interference R and coupling coefficient ε will increase the risks of cascading failures. Cascading threshold values Rc and εc exist, where cascading failures will spread to the entire network when R>Rc or ε>εc. When facing a random attack or max-status attack, the network with higher heterogeneity tends to have a stronger invulnerability towards cascading failures. Conversely, when facing a max-degree attack, the network with higher uniformity tends to have a better performance. Besides that, we have also proved that the spreading speed of cascading failures is inversely proportional to the average path length of the network and the increase of average degree k can improve the network invulnerability.

Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure

DEFF Research Database (Denmark)

Køber, Lars; Thune, Jens J; Nielsen, Jens C

2016-01-01

Background The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due...... to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT). Methods In a randomized, controlled trial, 556 patients with symptomatic systolic heart.......6%) in the control group (P=0.29). Conclusions In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic...

Therapeutic effect of Intra-Tympanic Dexamethasone–Hyaluronic Acid Combination in Sudden Sensorineural Hearing Loss

Directory of Open Access Journals (Sweden)

Mehrdad Rogha

2017-09-01

Full Text Available Introduction: Hearing loss is fairly a common disorder which is usually treated with corticosteroids via systemic administration and/or intra-tympanic injection. This study aimed to compare the effectiveness of intra-tympanic injections of dexamethasone with its combination with hyaluronic acid in patients with sudden sensorineural hearing loss.   Materials and Methods: In this clinical trial, 40 patients were randomly assigned to two groups; in the first group, 20 patients received 2.4 mg intra-tympanic dexamethasone, while in the second group patients received injections of 2.4 mg of dexamethasone plus 2 mg of hyaluronic acid in combination. Patients in both groups were injected every other day to a total of three injections. The hearing status of patients was evaluated by pure tone audiometry (bone conduction threshold before and 2 weeks after the intervention.   Results: Assessment of hearing threshold before and after treatment in the two groups showed a significant difference between hearing thresholds at frequencies of 4,000 to 8,000 Hz (P

Control of trunk motion following sudden stop perturbations during cart pushing.

Science.gov (United States)

Lee, Yun-Ju; Hoozemans, Marco J M; van Dieën, Jaap H

2011-01-04

External perturbations during pushing tasks have been suggested to be a risk factor for low-back symptoms. An experiment was designed to investigate whether self-induced and externally induced sudden stops while pushing a high inertia cart influence trunk motions, and how flexor and extensor muscles counteract these perturbations. Twelve healthy male participants pushed a 200 kg cart at shoulder height and hip height. Pushing while walking was compared to situations in which participants had to stop the cart suddenly (self-induced stop) or in which the wheels of the cart were unexpectedly blocked (externally induced stop). For the perturbed conditions, the peak values and the maximum changes from the reference condition (pushing while walking) of the external moment at L5/S1, trunk inclination and electromyographic amplitudes of trunk muscles were determined. In the self-induced stop, a voluntary trunk extension occurred. Initial responses in both stops consisted of flexor and extensor muscle cocontraction. In self-induced stops this was followed by sustained extensor activity. In the externally induced stops, an external extension moment caused a decrease in trunk inclination. The opposite directions of the internal moment and trunk motion in the externally induced stop while pushing at shoulder height may indicate insufficient active control of trunk posture. Consequently, sudden blocking of the wheels in pushing at shoulder height may put the low back at risk of mechanical injury. Copyright © 2010 Elsevier Ltd. All rights reserved.

Vasculopathic Cranial Ocular Motor Neuropathy Following Sudden Emotional Stress

OpenAIRE

Purvin, Valerie

2010-01-01

We describe three patients who experienced onset of a microvascular ocular motor nerve palsy in the setting of sudden emotional stress. Such emotional states are accompanied by a marked increase in sympathetic tone in some individuals. Mechanisms by which these autonomic changes might produce an ischemic cranial nerve palsy include intra-cranial vasoconstriction and transient systemic hypotension due to alterations in cardiac function.

Adaptive servo-ventilation therapy for patients with chronic heart failure in a confirmatory, multicenter, randomized, controlled study.

Science.gov (United States)

Momomura, Shin-Ichi; Seino, Yoshihiko; Kihara, Yasuki; Adachi, Hitoshi; Yasumura, Yoshio; Yokoyama, Hiroyuki; Wada, Hiroshi; Ise, Takayuki; Tanaka, Koichi

2015-01-01

Adaptive servo-ventilation (ASV) therapy is expected to be novel nonpharmacotherapy with hemodynamic effects on patients with chronic heart failure (CHF), but sufficient evidence has not been obtained. A 24-week, open-label, randomized, controlled study was performed to confirm the cardiac function-improving effect of ASV therapy on CHF patients. At 39 institutions, 213 outpatients with CHF, whose left ventricular ejection fraction (LVEF) was control group], respectively. The primary endpoint was LVEF, and the secondary endpoints were HF deterioration, B-type natriuretic peptide (BNP), and clinical composite response (CCR: NYHA class+HF deterioration). LVEF and BNP improved significantly at completion against the baseline values in the 2 groups. However, no significant difference was found between these groups. HF deterioration tended to be suppressed. The ASV group showed a significant improvement in CCR corroborated by significant improvements in NYHA class and ADL against the control group. Under the present study's conditions, ASV therapy was not superior to GDMT in the cardiac function-improving effect but showed a clinical status-improving effect, thus indicating a given level of clinical benefit.

Innovation and dedication underpin management of sudden oak death (Phytophthora ramorum) in California and Oregon forests

Science.gov (United States)

Susan J. Frankel

2017-01-01

This special issue of Forest Phytophthoras serves as part of the proceedings from the Sixth Sudden Oak Death Science Symposium held June 21 -23, 2016 at Fort Mason Center in San Francisco, CA, USA. The symposium marked almost 16 years to the day that David Rizzo (UC Davis) and Matteo Garbelotto (UC Berkeley) identified the cause of sudden oak death to be a previously...

A study of common-mode failures

International Nuclear Information System (INIS)

Edwards, G.T.; Watson, I.A.

1979-07-01

The purpose of the report is to investigate problems of the identification of the common failure mode (CFM) the reliability models used and the data required for their solution, particularly with regard to automatic protection systems for nuclear reactors. The available literature which was surveyed during the study is quoted and used as a basis for the main work of the study. The type of redundancy system under consideration is initially described and the types of CFM to which these systems are prone are identified before a general definition of the term 'common mode failure' is proposed. The definition and proposed classification system for CMF are based on the common cause of failure, so identifying the primary events. Defences against CFM are included and proposals for an overall strategy and detailed recommendations for design and operation are made. Common mode failures in US nuclear reactor systems, aircraft systems, and other sources including chemical plant systems are surveyed. The data indicates the importance of the human error problem in the causes of CMF in design, maintenance and operation. From a study of the collected data a redundancy sub-system model for CMF is developed which identifies three main categories of failure, non-recurrent engineering design errors, maintenance and test errors, and random interest events. The model proposed allows for the improvement in sub-system reliability where appropriate defences are applied. (author)

Hypertrophic Cardiomyopathy Mimicking Acute Anterior Myocardial Infarction Associated with Sudden Cardiac Death

Directory of Open Access Journals (Sweden)

Y. Daralammouri

2012-01-01

Full Text Available Hypertrophic cardiomyopathy is the most common genetic disease of the heart. We report a rare case of hypertrophic obstructive cardiomyopathy mimicking an acute anterior myocardial infarction associated with sudden cardiac death. The patient presented with acute ST elevation myocardial infarction and significant elevation of cardiac enzymes. Cardiac catheterization showed some atherosclerotic coronary artery disease, without significant stenosis. Echocardiography showed left ventricular hypertrophy with a left ventricular outflow tract obstruction; the pressure gradient at rest was 20 mmHg and became severe with the Valsalva maneuver (100 mmHg. There was no family history of sudden cardiac death. Six days later, the patient suffered a syncope on his way to magnetic resonance imaging. He was successfully resuscitated by ventricular fibrillation.

January 2015 Phoenix pulmonary journal club: noninvasive ventilation in acute respiratory failure

Directory of Open Access Journals (Sweden)

Mathew M

2015-01-01

Full Text Available No abstract available. Article truncated after 150 words. Noninvasive positive pressure ventilation has expanded its role in the treatment of both chronic and acute respiratory failure. Its initial use in conditions such as obstructive sleep apnea, neuromuscular disease and tracheobronchomalacia, have been shown to improve quality of life and reduce mortality. Over the past 20 years studies have looked at using noninvasive ventilation in the management of acute respiratory failure from pulmonary edema, asthma and COPD exacerbations. During this month's journal club we reviewed 3 articles evaluating the efficacy of noninvasive ventilation in acute respiratory failure. Gupta D, Nath A, Agarwal R, Behera D. A prospective randomized controlled trial on the efficacy of noninvasive ventilation in severe acute asthma. Respir Care. 2010;55(5:536-43. [PubMed] This was a small unblinded randomized controlled trial (RCT looking at the efficacy using noninvasive ventilation (NIV in acute asthma. A total of 53 patients were included and divided into 2 groups of 28 patients ...

Ventricular arrhythmia and sudden cardiac death in Fabry disease: a systematic review of risk factors in clinical practice.

Science.gov (United States)

Baig, Shanat; Edward, Nicky C; Kotecha, Dipak; Liu, Boyang; Nordin, Sabrina; Kozor, Rebecca; Moon, James C; Geberhiwot, Tarekegn; Steeds, Richard P

2017-10-17

Fabry disease (FD) is an X-linked lysosomal storage disorder caused by deficiency of α-galactosidase A enzyme. Cardiovascular (CV) disease is a common cause of mortality in FD, in particular as a result of heart failure and arrhythmia, with a significant proportion of events categorized as sudden. There are no clear models for risk prediction in FD. This systematic review aims to identify the risk factors for ventricular arrhythmia (VA) and sudden cardiac deaths (SCD) in FD. A systematic search was performed following PRISMA guidelines of EMBASE, Medline, PubMed, Web of Science, and Cochrane from inception to August 2016, focusing on identification of risk factors for the development of VA or SCD. Thirteen studies were included in the review (n = 4185 patients) from 1189 articles, with follow-up of 1.2-10 years. Weighted average age was 37.6 years, and 50% were male. Death from any cause was reported in 8.3%. Of these, 75% was due to CV problems, with the majority being SCD events (62% of reported deaths). Ventricular tachycardia was reported in 7 studies, with an average prevalence of 15.3%. Risk factors associated with SCD events were age, male gender, left ventricular hypertrophy, late gadolinium enhancement on CV magnetic resonance imaging, and non-sustained ventricular tachycardia. Although a multi-system disease, FD is a predominantly cardiac disease from a mortality perspective, with death mainly from SCD events. Limited evidence highlights the importance of clinical and imaging risk factors that could contribute to improved decision-making in the management of FD. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For Permissions, please email: journals.permissions@oup.com.

Heart failure and sudden cardiac death in heritable thoracic aortic disease caused by pathogenic variants in the SMAD3 gene.

Science.gov (United States)

Backer, Julie De; Braverman, Alan C

2018-05-01

Predominant cardiovascular manifestations in the spectrum of Heritable Thoracic Aortic Disease include by default aortic root aneurysms- and dissections, which may be associated with aortic valve disease. Mitral- and tricuspid valve prolapse are other commonly recognized features. Myocardial disease, characterized by heart failure and/or malignant arrhythmias has been reported in humans and in animal models harboring pathogenic variants in the Fibrillin1 gene. Description of clinical history of three cases from one family in Ghent (Belgium) and one family in St. Louis (US). We report on three cases from two families presenting end-stage heart failure (in two) and lethal arrhythmias associated with moderate left ventricular dilatation (in one). All three cases harbor a pathogenic variant in the SMAD3 gene, known to cause aneurysm osteoarthritis syndrome, Loeys-Dietz syndrome type 3 or isolated Heritable Thoracic Aortic Disease. These unusual presentations warrant awareness for myocardial disease in patients harboring pathogenic variants in genes causing Heritable Thoracic Aortic Disease and indicate the need for prospective studies in larger cohorts. © 2018 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.

Optimal Lot Sizing with Scrap and Random Breakdown Occurring in Backorder Replenishing Period

OpenAIRE

Ting, Chia-Kuan; Chiu, Yuan-Shyi; Chan, Chu-Chai

2011-01-01

This paper is concerned with determination of optimal lot size for an economic production quantity model with scrap and random breakdown occurring in backorder replenishing period. In most real-life manufacturing systems, generation of defective items and random breakdown of production equipment are inevitable. To deal with the stochastic machine failures, production planners practically calculate the mean time between failures (MTBF) and establish the robust plan accordingly, in terms of opt...

Sudden oak death effects on the dynamics of dead wood

Science.gov (United States)

Richard C. Cobb; Jo& atilde; o Filipe A.N.; Margaret R. Metz; Ross K. Meentemeyer; David M. Rizzo

2013-01-01

Sudden oak death has impacted forests notable for high-fire risk and contiguous host communities in California and Oregon coastal forest ecosystems. The disease continues to emerge in stands and landscapes with a large biomass of tanoak (Notholithocarpus densiflorus (Hook.&Arn.) Manos, Cannon & S.H.Oh), and we show that woody debris also...

Local measurement and numerical calculation on turbulent two-phase flow in a vertical pipe with sudden expansion

International Nuclear Information System (INIS)

Kondo, Koichi; Yoshida, Kenji; Okawa, Tomio; Kataoka, Isao

2004-01-01

Experiment and numerical calculation were carried out for upward, turbulent bubbly two-phase flow in a vertical pipe with an axisymmetric sudden expansion, which is one of the typical multi-dimensional channel geometries. The void fraction, the liquid velocity and turbulent intensity along the flow direction below and the above the sudden expansion point were measured for various turbulent flow conditions by using a point-electrode resistivity probe and a hot-film anemometry probe. They showed quite complicated behaviors depending upon flow rates of gas and liquid phases and bubble size. In particular, the geometry of sudden expansion affected on the bubble behaviors in multi-dimensional two-phase flow, such as the bubble-stagnation, the bubble-deformation, the enhancement and suppression effects due to the two-phase turbulence etc. Through the measurements, fundamental parameters of the two-phase flow were clarified for the sudden expansion channel. Moreover, a three-dimensional one-way bubble tracking simulation of a single bubble behavior in turbulent flow field along the downstream of the sudden expansion was also demonstrated where equation of motion of bubble was solved by assuming appropriate constitutive models and turbulence model. Based on the trajectories of large number of bubbles, the void fraction distribution was predicted in this calculation. It concretely revealed that the lift force and the two-phase turbulence model were the most important parameters in determining the multi-dimensional void fraction distribution and the calculation should be considered by using the measured experimental data. (author)

Phenotype-driven molecular autopsy for sudden cardiac death.

Science.gov (United States)

Cann, F; Corbett, M; O'Sullivan, D; Tennant, S; Hailey, H; Grieve, J H K; Broadhurst, P; Rankin, R; Dean, J C S

2017-01-01

A phenotype-driven approach to molecular autopsy based in a multidisciplinary team comprising clinical and laboratory genetics, forensic medicine and cardiology is described. Over a 13 year period, molecular autopsy was undertaken in 96 sudden cardiac death cases. A total of 46 cases aged 1-40 years had normal hearts and suspected arrhythmic death. Seven (15%) had likely pathogenic variants in ion channelopathy genes [KCNQ1 (1), KCNH2 (4), SCN5A (1), RyR2(1)]. Fifty cases aged between 2 and 67 had a cardiomyopathy. Twenty-five had arrhythmogenic right ventricular cardiomyopathy (ARVC), 10 dilated cardiomyopathy (DCM) and 15 hypertrophic cardiomyopathy (HCM). Likely pathogenic variants were found in three ARVC cases (12%) in PKP2, DSC2 or DSP, two DCM cases (20%) in MYH7, and four HCM cases (27%) in MYBPC3 (3) or MYH7 (1). Uptake of cascade screening in relatives was higher when a molecular diagnosis was made at autopsy. In three families, variants previously published as pathogenic were detected, but clinical investigation revealed no abnormalities in carrier relatives. With a conservative approach to defining pathogenicity of sequence variants incorporating family phenotype information and population genomic data, a molecular diagnosis was made in 15% of sudden arrhythmic deaths and 18% of cardiomyopathy deaths. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Syncope and the risk of sudden cardiac death: Evaluation, management, and prevention

Directory of Open Access Journals (Sweden)

Ryan J. Koene, MD

2017-12-01

Full Text Available Syncope is a clinical syndrome defined as a relatively brief self-limited transient loss of consciousness (TLOC caused by a period of inadequate cerebral nutrient flow. Most often the trigger is an abrupt drop of systemic blood pressure. True syncope must be distinguished from other common non-syncope conditions in which real or apparent TLOC may occur such as seizures, concussions, or accidental falls. The causes of syncope are diverse, but in most instances, are relatively benign (e.g., reflex and orthostatic faints with the main risks being accidents and/or injury. However, in some instances, syncope may be due to more worrisome conditions (particularly those associated with cardiac structural disease or channelopathies; in such circumstances, syncope may be an indicator of increased morbidity and mortality risk, including sudden cardiac death (SCD. Establishing an accurate basis for the etiology of syncope is crucial in order to initiate effective therapy. In this review, we focus primarily on the causes of syncope that are associated with increased SCD risk (i.e., sudden arrhythmic cardiac death, and the management of these patients. In addition, we discuss the limitations of our understanding of SCD in relation to syncope, and propose future studies that may ultimately address how to improve outcomes of syncope patients and reduce SCD risk. Keywords: Syncope, Sudden cardiac death, Risk assessment

Management of Sleep Disordered Breathing in Patients with Heart Failure.

Science.gov (United States)

Oates, Connor P; Ananthram, Manjula; Gottlieb, Stephen S

2018-04-03

This paper reviews treatment options for sleep disordered breathing (SDB) in patients with heart failure. We sought to identify therapies for SDB with the best evidence for long-term use in patients with heart failure and to minimize uncertainties in clinical practice by examining frequently discussed questions: what is the role of continuous positive airway pressure (CPAP) in patients with heart failure? Is adaptive servo-ventilation (ASV) safe in patients with heart failure? To what extent is SDB a modifiable risk factor? Consistent evidence has demonstrated that the development of SDB in patients with heart failure is a poor prognostic indicator and a risk factor for cardiovascular mortality. However, despite numerous available interventions for obstructive sleep apnea and central sleep apnea, it remains unclear what effect these therapies have on patients with heart failure. To date, all major randomized clinical trials have failed to demonstrate a survival benefit with SDB therapy and one major study investigating the use of adaptive servo-ventilation demonstrated harm. Significant questions persist regarding the management of SDB in patients with heart failure. Until appropriately powered trials identify a treatment modality that increases cardiovascular survival in patients with SDB and heart failure, a patient's heart failure management should remain the priority of medical care.

On the Question of the Diagnosis of Sudden Infant Death Syndrome

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L. L. Nisevich

2015-01-01

Full Text Available Sudden Infant Death Syndrome (SIDS is one of the leading causes of postneonatal mortality of infants in most developed countries. This paper presents data on terminology and on the study of SIDS in developed countries, and also examines problems of SIDS diagnostic inRussia in comparison with the results of own researches, analyzes risk factors, which are universal as for SIDS, and also for perinatal and infant death in general. The large variability of SIDS diagnosis in Russia suggests that this diagnosis often does not comply with international standard: post-mortem examination of community-acquired sudden death cases is often carried out by a forensic expert, but not by a children's pathologist, and they do not use virological and microbiological methods of investigation. In some cases, there is no infant's record or case record from children's polyclinic.

Rationale and design of the Pan-African Sudden Cardiac Death survey

DEFF Research Database (Denmark)

Bonny, Aimé; Ngantcha, Marcus; Amougou, Sylvie Ndongo

2014-01-01

BACKGROUND: The estimated rate of sudden cardiac death (SCD) in Western countries ranges from 300,000 to 400,000 annually, which represents 0.36 to 1.28 per 1 000 inhabitants in Europe and the United States. The burden of SCD in Africa is unknown. Our aim is to assess the epidemiology of SCD...... of districts of interest will be checked for past medical history, circumstances of death, and autopsy report (if possible). We will also analyse the employment of resuscitation attempts during the time frame of sudden cardiac arrest (SCA) in various patient populations throughout African countries. CONCLUSION...... in Africa. METHODS: The Pan-Africa SCD study is a prospective, multicentre, community-based registry monitoring all cases of cardiac arrest occurring in victims over 15 years old. We will use the definition of SCD as 'witnessed natural death occurring within one hour of the onset of symptoms...

Tissue specific responses alter the biomass accumulation in wheat under gradual and sudden salt stress

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Yumurtaci A.

2012-11-01

Full Text Available Salinity is one the major limiting environmental factors which has negative side effects on crop production. The purpose of this study was to investigate the differences between the gradual and sudden salt stress effects on biomass accumulation associated with whole plant development in three different tissues of two wheat species ( Triticum aestivum and Triticum durum under hydroponic conditions in the long term. Considering the effects of sudden and gradual stress for biomass accumulation, while importance of salinity x genotype interaction for fresh weights was 5%, association for salinity x tissue type was found as 1% important. Interestingly, root branching and development of lateral roots were much more negatively affected by gradual stress rather than sudden salt application. Our results demonstrated that root and leaf were both critical tissues to test the salt tolerance by physiologically but sheath tissue might be used as an alternative source of variation for solving the interactions between root and leaves in wheat.

Cause of Sudden Cardiac Deaths on Autopsy Findings; a Four-Year Report

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Dinesh Rao

2014-03-01

Full Text Available Introduction: Incidence of sudden cardiac death (SCD has been steadily increasing all over the world. While knowing the cause of SCD is one of the favorites of the physicians involved with these cases, it is very difficult and challenging task for the forensic physician. The present report is a prospective study regarding cause of SCDs on autopsy examination in four-year period, Bangalore, India. Methods: The present prospective study is based on autopsy observations, carried out for four-year period from 2008 to 2011, and analyzed for cause of SCDs. The cases were chosen as per the definition of sudden death and autopsied. The material was divided into natural and unnatural groups. Finally, on histopathology, gross examination, hospital details, circumstantial, and police reports the cause of death was inferred. Results: A total of 2449 autopsy was conducted of which 204 cases were due to SCD. The highest SCDs were reported in 50-60 years age group (62.24%; n-127, followed closely by the age group 60-69 (28.43%; n-58. Male to female ratio was around 10:1. The maximum number of deaths (n=78 was within few hours (6 hours after the onset of signs and symptoms. In 24 (11.8% cases major narrowing was noted in both the main coronaries, in 87 (42.6% cases in the left anterior descending coronary artery (LAD, and in 18 (51.5% cases in the right coronary artery (RCA. The major cardiac pathology resulting in sudden death was coronary artery disease (n-116; 56.86% and myocardial infarction (n-104; 50.9%. most of the SCDs occurred in the place of residence (n-80; 39.2% followed closely by death in hospital (n-49; 24.01%. Conclusion: Coronary occlusion was the major contributory cause of sudden death with cardiac origin and the highest number of deaths were reported in the age 50-59 years with male to female ratio of 10:1. 

47. A cardiac center experience with Brugada syndrome who survived sudden cardiac death

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I. Suliman

2016-07-01

Full Text Available Brugada syndrome is a heritable arrhythmia syndrome that is characterized by an electrocardiographic pattern consisting of coved-type ST-segment elevation (2 mm followed by a negative T wave in the right precordial leads, V1 through V3 (often referred to as type 1 Brugada electrocardiographic pattern, here we describe 3 cases of Brugada who survived sudden cardiac death (SCD cardiac center experience with survived Brugada syndrome patients – case series. First Case: The Father 45 years old male, presented in 2005 after involvement in unprovoked motor vehicle accident, the patient was the driver who lost consciousness and rushed to the hospital. On arrival to our ER and putting the patient on the bed, the ER doctor observed a brief episode of VF on the monitor. The patient was taken to the catheterization Lab , his coronaries were normal. The diagnosis of Brugada was established and the patient received a defibrillator. At That Time all family members were screened and were negative. Second Case: The Son of the first patient 5 years later his 23 years old male rushed to our ER after he lost consciousness, he was passenger in the car of his friend. Third Case: The pilot A military pilot aged a male 35 years old was in very good health when he lost consciousness and brought to the hospital after resuscitation in 2005. He had full invasive cardiac evaluation, subsequently he received a defibrillator in the same admission period, till 2015 he is doing fine. Brugada syndrome is associated with high tendency for sudden cardiac death. In our three cases the first clinical presentation was survived sudden cardiac death (SCD and all three male patients survived. We did not encounter a female patient who survived sudden cardiac death.

Takayasu Arteritis of the Coronary Arteries Presenting as Sudden Death in a White Teenager.

Science.gov (United States)

Hlavaty, Leigh; Diaz, Francisco; Sung, LokMan

2015-09-01

Takayasu arteritis is a rare disease that expresses chronic, large vessel inflammation. The etiology remains unclear and its presentation depends on the affected arteries. With coronary artery involvement, manifestations range from chest pain and shortness of breath to sudden death. We report a case of a 15-year-old white girl who presented with syncope immediately before passing. On autopsy, all 3 major coronary arteries grossly contained multiple proximal lesions that were consistent with Takayasu arteritis, microscopically. Takayasu arteritis solely affecting multiple coronary arteries is exceedingly rare. This report discusses the significance of coronary involvement in Takayasu arteritis at autopsy and sudden death.

On a fine structure of a primary impulse of a magnetic storm sudden commencement

International Nuclear Information System (INIS)

Parkhomov, V.A.

1985-01-01

A fine structure of a primary reverse impulse of a sudden commencement (SSC*) of a magnetic storm is analyzed. 200 cases of SSC* recorded in 1965-79 have been chosen for the investigation. It is shown that the preliminary impulse of the sudden copmencement of magnetic storms has a fine structure in the form of the train of damped oscillations in Pc2-3 range of < or approximately 2 min durations. The excitation of oscillations is related with the propagation of the fast magnetoacoustic wave which is generated during interaction of the interplanetary shock wave with the earth magnetosphere

Probabilistic physics-of-failure models for component reliabilities using Monte Carlo simulation and Weibull analysis: a parametric study

International Nuclear Information System (INIS)

Hall, P.L.; Strutt, J.E.

2003-01-01

In reliability engineering, component failures are generally classified in one of three ways: (1) early life failures; (2) failures having random onset times; and (3) late life or 'wear out' failures. When the time-distribution of failures of a population of components is analysed in terms of a Weibull distribution, these failure types may be associated with shape parameters β having values 1 respectively. Early life failures are frequently attributed to poor design (e.g. poor materials selection) or problems associated with manufacturing or assembly processes. We describe a methodology for the implementation of physics-of-failure models of component lifetimes in the presence of parameter and model uncertainties. This treats uncertain parameters as random variables described by some appropriate statistical distribution, which may be sampled using Monte Carlo methods. The number of simulations required depends upon the desired accuracy of the predicted lifetime. Provided that the number of sampled variables is relatively small, an accuracy of 1-2% can be obtained using typically 1000 simulations. The resulting collection of times-to-failure are then sorted into ascending order and fitted to a Weibull distribution to obtain a shape factor β and a characteristic life-time η. Examples are given of the results obtained using three different models: (1) the Eyring-Peck (EP) model for corrosion of printed circuit boards; (2) a power-law corrosion growth (PCG) model which represents the progressive deterioration of oil and gas pipelines; and (3) a random shock-loading model of mechanical failure. It is shown that for any specific model the values of the Weibull shape parameters obtained may be strongly dependent on the degree of uncertainty of the underlying input parameters. Both the EP and PCG models can yield a wide range of values of β, from β>1, characteristic of wear-out behaviour, to β<1, characteristic of early-life failure, depending on the degree of

Risk factors for sudden cardiac death among patients with schizophrenia.

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Hou, Ping-Yi; Hung, Galen Chin-Lun; Jhong, Jia-Rong; Tsai, Shang-Ying; Chen, Chiao-Chicy; Kuo, Chian-Jue

2015-10-01

Patients with schizophrenia suffer from excessive premature mortality, and sudden cardiac death (SCD) is receiving growing attention as a potential cause. The present study investigated the incidence of SCD and its risk factors in a large schizophrenia cohort. We enrolled a consecutive series of 8264 patients diagnosed with schizophrenia (according to DSM-III-R and DSM-IV criteria) who were admitted to a psychiatric center in northern Taiwan from January 1, 1985 through December 31, 2008. By linking with national mortality database, 64 cases of SCD were identified. The standardized mortality ratio (SMR) for SCD was estimated. The cases were matched with controls randomly selected using risk-set sampling in a 1:2 ratio. A standardized chart review process was used to collect socio-demographic and clinical characteristics and the prescribed drugs for each study subject. Multivariate conditional logistic regression analysis was used to identify correlates of SCD at the index admission and the latest admission. The SMR for SCD was 4.5. For the clinical profiles at the index admission, physical disease (adjusted risk ratio [aRR]=2.91, Prisk of SCD. Regarding the latest admission, electrocardiographic abnormalities (aRR=5.46, Prisk for SCD. Consistently, aggressive behaviors (aRR=3.26, Prisk as well. Apart from cardiovascular profiles and antipsychotics, physical aggression is a crucial risk factor that deserves ongoing work for clarifying the mechanisms mediating SCD in schizophrenia. Copyright © 2015 Elsevier B.V. All rights reserved.

Nonseizure SUDEP: Sudden unexpected death in epilepsy without preceding epileptic seizures.

Science.gov (United States)

Lhatoo, Samden D; Nei, Maromi; Raghavan, Manoj; Sperling, Michael; Zonjy, Bilal; Lacuey, Nuria; Devinsky, Orrin

2016-07-01

To describe the phenomenology of monitored sudden unexpected death in epilepsy (SUDEP) occurring in the interictal period where death occurs without a seizure preceding it. We report a case series of monitored definite and probable SUDEP where no electroclinical evidence of underlying seizures was found preceding death. Three patients (two definite and one probable) had SUDEP. They had a typical high SUDEP risk profile with longstanding intractable epilepsy and frequent generalized tonic-clonic seizures (GTCS). All patients had varying patterns of respiratory and bradyarrhythmic cardiac dysfunction with profound electroencephalography (EEG) suppression. In two patients, patterns of cardiorespiratory failure were similar to those seen in some patients in the Mortality in Epilepsy Monitoring Units Study (MORTEMUS). SUDEP almost always occur postictally, after GTCS and less commonly after a partial seizure. Monitored SUDEP or near-SUDEP cases without a seizure have not yet been reported in literature. When nonmonitored SUDEP occurs in an ambulatory setting without an overt seizure, the absence of EEG information prevents the exclusion of a subtle seizure. These cases confirm the existence of nonseizure SUDEP; such deaths may not be prevented by seizure detection-based devices. SUDEP risk in patients with epilepsy may constitute a spectrum of susceptibility wherein some are relatively immune, death occurs in others with frequent GTCS with one episode of seizure ultimately proving fatal, while in others still, death may occur even in the absence of a seizure. We emphasize the heterogeneity of SUDEP phenomena. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

Contribution of inherited heart disease to sudden cardiac death in childhood

NARCIS (Netherlands)

Hofman, Nynke; Tan, Hanno L.; Clur, Sally-Ann; Alders, Mariel; van Langen, Irene M.; Wilde, Arthur A. M.

2007-01-01

BACKGROUND. In children aged 1 to 18 years, the causes of sudden cardiac death may remain unresolved when autopsy results are negative. Because inherited cardiac diseases are likely, cardiologic and genetic investigations of relatives may still yield the diagnosis in these cases. Moreover, these

Sudden rotation reactive scattering: Theory and application to 3-D H+H2

International Nuclear Information System (INIS)

Bowman, J.M.; Lee, K.T.

1980-01-01

An approximate quantum mechanical theory of reactive scattering is presented and applied to the H+H 2 reaction in three dimensions. Centrifugal sudden and rotational sudden approximations are made in each arrangement channel, however, vibrational states are treated in a fully coupled manner. Matching of arrangement channel wave functions is done where the arrangement channel centrifugal potentials are equal. This matching is particularly appropriate for collinearly favored reactions. Integral and differential cross sections are calculated for the H+H 2 reaction for H 2 in the ground and first excited vibrational states. These calculations employ the Porter--Karplus potential energy surface mainly to allow for comparisons with previous accurate and approximate quantal and quasiclassical calculations

Keeping kids in care: virological failure in a paediatric antiretroviral ...

African Journals Online (AJOL)

A retrospective file audit determined the cumulative virological failure rate, that is, the sum of all ... Interviews were conducted with a purposive sample of 12 staff members and a random sample of 21 caregivers and 4 children attending care.

Sudden Cardiac Death in Young Adults With Previous Hospital-Based Psychiatric Inpatient and Outpatient Treatment

DEFF Research Database (Denmark)

Risgaard, Bjarke; Waagstein, Kristine; Winkel, Bo Gregers

2015-01-01

Introduction: Psychiatric patients have premature mortality compared to the general population. The incidence of sudden cardiac death (SCD) in psychiatric patients is unknown in a nationwide setting. The aim of this study was to compare nationwide SCD incidence rates in young individuals with and......Introduction: Psychiatric patients have premature mortality compared to the general population. The incidence of sudden cardiac death (SCD) in psychiatric patients is unknown in a nationwide setting. The aim of this study was to compare nationwide SCD incidence rates in young individuals...

Statistical inferences for bearings life using sudden death test

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Morariu Cristin-Olimpiu

2017-01-01

Full Text Available In this paper we propose a calculus method for reliability indicators estimation and a complete statistical inferences for three parameters Weibull distribution of bearings life. Using experimental values regarding the durability of bearings tested on stands by the sudden death tests involves a series of particularities of the estimation using maximum likelihood method and statistical inference accomplishment. The paper detailing these features and also provides an example calculation.

[Forensic Analysis of 6 Cases of Sudden Death due to Hyperthyroid Heart Disease].

Science.gov (United States)

Zhang, M Z; Li, B X; Zhao, R; Guan, D W; Zhang, G H; Wu, X; Zhu, B L; Li, R B

2017-10-01

To analyse the cases of sudden death due to hyperthyroid heart disease, and explore the general information of deaths and the forensic pathological characteristics to provide reference evidence for forensic identification of such cases. Six cases of sudden death due to hyperthyroid heart disease between 2001 and 2016 were selected from School of Forensic Medicine, China Medical University. The general information （gender and age）, clinical manifestations, medical history, anatomical and histopathological findings, biochemical parameters and cause of death were analysed retrospectively. Most of the 6 patients had definite history of hyperthyroidism, and they all showed certain degrees of symptoms of cardiovascular disease; had obvious incentive factors of death; histopathological examination of thyroid conformed to the performances of diffuse toxic goiter; with increase of cardiac weight, dilatation of cardiac chambers, myocardial hypertrophy and focal necrosis; postmortem biochemical analyses of pericardial fluid could be used as an additional method for diagnostic of sudden death due to hyperthyroid heart disease. The identification of death due to hyperthyroid heart disease should be based on the clinical history and the results of autopsy, histopathological examination, postmortem toxicology tests. The postmortem biochemical detection of thyroid and cardiac function should be performed if necessary. Copyright© by the Editorial Department of Journal of Forensic Medicine

The sudden success of prose

DEFF Research Database (Denmark)

Mortensen, Lars Boje

2017-01-01

The article presents a new model for understanding the sudden success of prose in four literatures: Greek, Latin, French and Old Norse. Through comparison and quantitative observations, and by focusing on the success of prose rather than its invention, it is shown that in all four cases two...... reading aloud) has been underplayed in previous scholarship mostly focused on authorial choices and invention. For two of the literatures (Greek, French) the fast dynamics of the rise of prose has already been identified and discussed, but for the two others (Latin, Old Norse), the observation is new....... It is also suggested that the exactly contemporary rise of French and Old Norse prose (c. 1200-1230) most probably is connected. The four literatures are each shown in chronological charts so as to visualize the timeline and the relation between poetic and prosaic works. The article furthermore reflects...

System reliability analysis using dominant failure modes identified by selective searching technique

International Nuclear Information System (INIS)

Kim, Dong-Seok; Ok, Seung-Yong; Song, Junho; Koh, Hyun-Moo

2013-01-01

The failure of a redundant structural system is often described by innumerable system failure modes such as combinations or sequences of local failures. An efficient approach is proposed to identify dominant failure modes in the space of random variables, and then perform system reliability analysis to compute the system failure probability. To identify dominant failure modes in the decreasing order of their contributions to the system failure probability, a new simulation-based selective searching technique is developed using a genetic algorithm. The system failure probability is computed by a multi-scale matrix-based system reliability (MSR) method. Lower-scale MSR analyses evaluate the probabilities of the identified failure modes and their statistical dependence. A higher-scale MSR analysis evaluates the system failure probability based on the results of the lower-scale analyses. Three illustrative examples demonstrate the efficiency and accuracy of the approach through comparison with existing methods and Monte Carlo simulations. The results show that the proposed method skillfully identifies the dominant failure modes, including those neglected by existing approaches. The multi-scale MSR method accurately evaluates the system failure probability with statistical dependence fully considered. The decoupling between the failure mode identification and the system reliability evaluation allows for effective applications to larger structural systems

Sudden cardiac death in the young

Science.gov (United States)

Ackerman, Michael; Atkins, Dianne L; Triedman, John K

2016-01-01

Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and post-mortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD victims. Institution of a national registry of SCD in the young will provide data that will help to answer these questions. PMID:26951821

The relationship between serum lipids and sudden sensorineural hearing loss: a systematic review and meta-analysis.

Directory of Open Access Journals (Sweden)

I Jen Chang

Full Text Available Sudden sensorineural hearing loss (SSNHL is a relatively common condition that is usually of unknown etiology. A number of individual studies have investigated the association between various serum lipids and SSNHL; however, the findings have been inconsistent. In an attempt to obtain more definitive information on the relationship between serum lipids and SSNHL, we carried out a systematic review and meta-analysis.Medline, the Cochrane Library, and EMBASE were searched using the following key words: lipid, cholesterol, triglyceride, fat, serum, blood, sudden hearing loss, hearing loss, hearing disorders. Randomized controlled trials, prospective cohort studies, and retrospective case-control studies involving patients with SSNHL and healthy controls that examined the relationship (reported as odds ratios [OR] between lipid profiles and SSNHL were included. Primary outcomes were total cholesterol and low-density lipoprotein cholesterol (LDL-C concentrations. Secondary outcomes were triglyceride, high-density lipoprotein cholesterol, and lipoprotein(a concentrations.A total of 6 case-control studies were included in this systematic review/meta-analysis. The total number of participants ranged from 30 to 250 in the case group and from 43 to 271 in the control group. Meta-analysis revealed no significant difference in total cholesterol levels between the case and control groups (pooled OR = 1.79, 95% confidence interval [CI] = 0.98 to 3.26, P = 0.057. Likewise, meta-analysis revealed no significant difference in LDL-C concentrations between the case and control groups (pooled OR = 1.15, 95% CI = 0.64 to 2.07, P = 0.639. Since there were an insufficient number of studies reporting data for the secondary outcomes, meta-analysis was not possible.Our results do not provide evidence for serum lipids being associated with SSNHL, nor do they definitively rule out such an association. Additional studies are needed to ascertain the relationship, or lack

Bayesian reliability demonstration for failure-free periods

Energy Technology Data Exchange (ETDEWEB)

Coolen, F.P.A. [Department of Mathematical Sciences, Science Laboratories, University of Durham, South Road, Durham, DH1 3LE (United Kingdom)]. E-mail: frank.coolen@durham.ac.uk; Coolen-Schrijner, P. [Department of Mathematical Sciences, Science Laboratories, University of Durham, South Road, Durham, DH1 3LE (United Kingdom); Rahrouh, M. [Department of Mathematical Sciences, Science Laboratories, University of Durham, South Road, Durham, DH1 3LE (United Kingdom)

2005-04-01

We study sample sizes for testing as required for Bayesian reliability demonstration in terms of failure-free periods after testing, under the assumption that tests lead to zero failures. For the process after testing, we consider both deterministic and random numbers of tasks, including tasks arriving as Poisson processes. It turns out that the deterministic case is worst in the sense that it requires most tasks to be tested. We consider such reliability demonstration for a single type of task, as well as for multiple types of tasks to be performed by one system. We also consider the situation, where tests of different types of tasks may have different costs, aiming at minimal expected total costs, assuming that failure in the process would be catastrophic, in the sense that the process would be discontinued. Generally, these inferences are very sensitive to the choice of prior distribution, so one must be very careful with interpretation of non-informativeness of priors.

Bayesian reliability demonstration for failure-free periods

International Nuclear Information System (INIS)

Coolen, F.P.A.; Coolen-Schrijner, P.; Rahrouh, M.

2005-01-01

We study sample sizes for testing as required for Bayesian reliability demonstration in terms of failure-free periods after testing, under the assumption that tests lead to zero failures. For the process after testing, we consider both deterministic and random numbers of tasks, including tasks arriving as Poisson processes. It turns out that the deterministic case is worst in the sense that it requires most tasks to be tested. We consider such reliability demonstration for a single type of task, as well as for multiple types of tasks to be performed by one system. We also consider the situation, where tests of different types of tasks may have different costs, aiming at minimal expected total costs, assuming that failure in the process would be catastrophic, in the sense that the process would be discontinued. Generally, these inferences are very sensitive to the choice of prior distribution, so one must be very careful with interpretation of non-informativeness of priors

Instrument Failure, Stress, and Spatial Disorientation Leading to a Fatal Crash With a Large Aircraft.

Science.gov (United States)

Tribukait, Arne; Eiken, Ola

2017-11-01

An aircraft's orientation relative to the ground cannot be perceived via the sense of balance or the somatosensory system. When devoid of external visual references, the pilot must rely on instruments. A sudden unexpected instrument indication is a challenge to the pilot, who might have to question the instrument instead of responding with the controls. In this case report we analyze, from a human-factors perspective, how a limited instrument failure led to a fatal accident. During straight-ahead level flight in darkness, at 33,000 ft, the commander of a civil cargo airplane was suddenly confronted by an erroneous pitch-up indication on his primary flight display. He responded by pushing the control column forward, making a bunt maneuver with reduced/negative Gz during approximately 15 s. The pilots did not communicate rationally or cross-check instruments. Recordings of elevator and aileron positions suggest that the commander made intense efforts to correct for several extreme and erroneous roll and pitch indications. Gz displayed an increasing trend with rapid fluctuations and peaks of approximately 3 G. After 50 s the aircraft entered a turn with decreasing radius and finally hit the ground in an inverted attitude. A precipitate maneuvring response can, even if occurring in a large aircraft at high altitude, result in a seemingly inexorable course of events, ending with a crash. In the present case both pilots were probably incapacitated by acute psychological stress and spatial disorientation. Intense variations in Gz may have impaired the copilot's reading of the functioning primary flight display.Tribukait A, Eiken O. Instrument failure, stress, and spatial disorientation leading to a fatal crash with a large aircraft. Aerosp Med Hum Perform. 2017; 88(11):1043-1048.

Sudden Cardiac arrest Risk profile in a group of amateur level ...

African Journals Online (AJOL)

... males and females in this group of university basketball players showed varying signs of SCA risk, with the overall risk being reasonably low, albeit abnormalities were highlighted in some and Marfanoid characteristics were clearly evident in others. Key words: Sudden cardiac arrest; Basketball players, Marfan syndrome; ...

The failure rate dynamics in heterogeneous populations

International Nuclear Information System (INIS)

Cha, Ji Hwan; Finkelstein, Maxim

2013-01-01

Most populations encountered in real world are heterogeneous. In reliability applications, the mixture (observed) failure rate, obviously, can be considered as a measure of ‘average’ quality in these populations. However, in addition to this average measure, some variability characteristics for failure rates can be very helpful in describing the time-dependent changes in quality of heterogeneous populations. In this paper, we discuss variance and the coefficient of variation of the corresponding random failure rate as variability measures for items in heterogeneous populations. Furthermore, there is often a risk that items of poor quality are selected for important missions. Therefore, along with the ‘average quality’ of a population, more ‘conservative’ quality measures should be also defined and studied. For this purpose, we propose the percentile and the tail-mixture of the failure rates as the corresponding conservative measures. Some illustrative examples are given. -- Highlights: ► This paper provides the insight on the variability measures in heterogeneous populations. ► The conservative quality measures in heterogeneous populations are defined. ► The utility of these measures is illustrated by meaningful examples. ► This paper provides a better understanding of the dynamics in heterogeneous populations

Cascading Failures and Recovery in Networks of Networks

Science.gov (United States)

Havlin, Shlomo

Network science have been focused on the properties of a single isolated network that does not interact or depends on other networks. In reality, many real-networks, such as power grids, transportation and communication infrastructures interact and depend on other networks. I will present a framework for studying the vulnerability and the recovery of networks of interdependent networks. In interdependent networks, when nodes in one network fail, they cause dependent nodes in other networks to also fail. This is also the case when some nodes like certain locations play a role in two networks -multiplex. This may happen recursively and can lead to a cascade of failures and to a sudden fragmentation of the system. I will present analytical solutions for the critical threshold and the giant component of a network of n interdependent networks. I will show, that the general theory has many novel features that are not present in the classical network theory. When recovery of components is possible global spontaneous recovery of the networks and hysteresis phenomena occur and the theory suggests an optimal repairing strategy of system of systems. I will also show that interdependent networks embedded in space are significantly more vulnerable compared to non embedded networks. In particular, small localized attacks may lead to cascading failures and catastrophic consequences.Thus, analyzing data of real network of networks is highly required to understand the system vulnerability. DTRA, ONR, Israel Science Foundation.

Sudden fetal death due to dualism of the sino-atrial node.

Science.gov (United States)

Pusiol, Teresa; Roncati, Luca; Lavezzi, Anna Maria; Taddei, Fabrizio; Piscioli, Francesco; Ottaviani, Giulia

2016-01-01

First, we report a sudden fetal death at 33(+3)weeks due to sino-atrial node dualism. The female stillborn was delivered by induced labor. The postmortem examination of the cardiac conduction system revealed a dualism of the sino-atrial node, associated with fragmentation of the atrio-ventricular node and His bundle. These abnormalities of the cardiac conduction system represent the morphological substrate for the development of malignant arrhythmias. In particular, the dualism of the sino-atrial node can cause the dissociation of the longitudinal nodal impulse into two distinct ways of different pulse generation, resulting in supraventricular tachyarrhythmias. This observation suggests new avenues of research on the pathogenesis of the sudden unexpected fetal death. Moreover, our findings confirm the need for an accurate postmortem examination, including serial sectioning of the cardiac conduction system, in every case of unexplained fetal death, following standardized autoptic protocols. Copyright © 2016 Elsevier Inc. All rights reserved.

Sudden and unexpected childhood deaths investigated at the Pretoria Medico-Legal Laboratory, South Africa, 2007 - 2011.

Science.gov (United States)

Van Deventer, B S; Rossouw, S H; Du Toit-Prinsloo, L

2016-09-06

 Sudden and unexpected death is well known to occur in infants, and although sudden deaths are less frequent after the first birthday, they still account for a significant proportion of childhood deaths. In 2009, 1.9% of the total deaths in the USA were childhood deaths. In South Africa (SA) this proportion was much higher at 11.85%. According to the law, sudden and unexpected deaths are generally investigated as unnatural deaths. Establishing an exact underlying anatomical cause of death will depend on available resources and can be difficult in a substantial proportion of cases.  A retrospective descriptive case audit was conducted at the Pretoria Medico-Legal Laboratory (PMLL), SA, from 1 January 2007 through to 31 December 2011. All children aged 1 - 18 years who died suddenly and unexpectedly were included.  Ninety-eight cases were identified, which constituted nearly 1% of total admissions to the PMLL. The majority of the deaths were of children aged 1 - 5 years, and the male/female ratio was 1.04:1. In the largest proportion of cases (n=28, 28.6%), the medicolegal investigation, including autopsy and ancillary investigations, did not establish an underlying anatomical cause of death. In the cases where a cause of death was established, pneumonia was the most common diagnosis (n=22, 22.4%).  The fact that the cause of the largest proportion of deaths could not be ascertained emphasises the need for consideration of additional investigative techniques, such as molecular/genetic screening, which have provided an underlying cause of death in a significant number of cases in other countries. There is a lack of published research on the causes and incidence of sudden unexpected deaths in children in SA, and further research in this area is needed.

New relationships among the sudden oak death pathogen, bark and ambrosia beetles, and fungi colonizing coast live oaks

Science.gov (United States)

Nadir Erbilgin; Brice A. McPherson; Pierluigi Bonello; David L. Wood; Andrew J. Nelson

2008-01-01

Sudden oak death (SOD) has had devastating effects on several oak species in many California coastal forests. Phytophthora ramorum has been identified as the primary causal agent of sudden oak death. While the pathogen may be capable of killing mature trees, it is likely that in nature opportunistic organisms play significant roles in the decline and...

Effect of edaravone on acute brainstem-cerebellar infarction with vertigo and sudden hearing loss.

Science.gov (United States)

Inoue, Yuta; Yabe, Takao; Okada, Kazunari; Nakamura, Yuka

2014-06-01

We report 2 cases with acute brainstem and brainstem-cerebellar infarction showed improvement of their signs and symptoms after administration of edaravone. Case 1, a 74-year-old woman who experienced sudden vertigo, also had dysarthria and left hemiplegia. Magnetic resonance imaging (MRI) showed an abnormal region in the right ventrolateral medulla oblongata. The patient's vertigo and hemiplegia improved completely after treatment. Case 2, a 50-year-old man who experienced sudden vertigo and sensorineural hearing loss (SNHL), developed dysarthria after admission. MRI revealed acute infarction in the right cerebellar hemisphere. Magnetic resonance angiography revealed dissection of the basilar artery and occlusion of the right anterior inferior cerebellar artery. The patient's vertigo and hearing remarkably improved. We have described 2 patients whose early symptoms were vertigo and sudden SNHL, but who were later shown to have ischemic lesions of the central nervous system. Edaravone is neuroprotective drug with free radical-scavenging actions. Free radicals in the ear are responsible for ischemic damage. Edaravone, a free radical scavenger, may be useful in the treatment of vertigo and SNHL. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Effect of workplace- versus home-based physical exercise on muscle response to sudden trunk perturbation among healthcare workers

DEFF Research Database (Denmark)

Jakobsen, Markus D.; Sundstrup, Emil; Brandt, Mikkel

2015-01-01

.2] on a scale of 0-10) from 18 departments at three hospitals were randomized at the cluster level to 10 weeks of (1) workplace physical exercise (WORK) performed in groups during working hours for 5 × 10 minutes per week and up to 5 group-based coaching sessions on motivation for regular physical exercise...... perturbation. Furthermore, EMG preactivation of the erector spinae and fear avoidance were reduced more following WORK than HOME (95% CI -2.7--0.7 (P WORK and HOME performed 2.2 (SD: 1.1) and 1.0 (SD: 1.2) training sessions per week, respectively......Objectives. The present study investigates the effect of workplace- versus home-based physical exercise on muscle reflex response to sudden trunk perturbation among healthcare workers. Methods. Two hundred female healthcare workers (age: 42 [SD 11], BMI: 24 [SD 4], and pain intensity: 3.1 [SD 2...

Restorations in abrasion/erosion cervical lesions: 8-year results of a triple blind randomized controlled trial.

Science.gov (United States)

Dall'Orologio, Giovanni Dondi; Lorenzi, Roberta

2014-10-01

An equivalence randomized controlled trial within the subject was organized to evaluate the clinical long-term success of a new 2-step etch & rinse adhesive and a new nano-filled ormocer. 50 subjects, 21 males and 29 females aged between 21 and 65, were randomized to receive 150 restorations, 100 with the new restorative material, 50 with the composite as control, placed in non-carious cervical lesions with the same bonding system. The main outcome measure was the cause of failure at 8 years. Randomization was number table-generated, with allocation concealment by opaque sequentially numbered sealed and stapled envelopes. Subjects, examiner, and analyst were blinded to group assignment. Two interim analyses were performed. Data were analyzed by ANOVA and Cox test (P failures in the experimental group and four failures in the control group. The cumulative loss rate was 7% for both restorative materials, with the annual failure lower than 1%, without any statistically significant difference. There were two key elements of failure: the presence of sclerotic dentin and the relationship between lesion and gingival margin.

Worsening Renal Function during Management for Chronic Heart Failure with Reduced Ejection Fraction: Results From the Pro-BNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study.

Science.gov (United States)

Ibrahim, Nasrien E; Gaggin, Hanna K; Rabideau, Dustin J; Gandhi, Parul U; Mallick, Aditi; Januzzi, James L

2017-02-01

To assess prognostic meaning of worsening renal failure (WRF) occurring during management of chronic heart failure (HF) with reduced ejection fraction. When WRF develops during titration of HF medical therapy, it commonly leads to less aggressive care. A total of 151 patients enrolled in a prospective, randomized study of standard of care (SOC) HF therapy versus SOC plus a goal N-terminal pro-B type natriuretic peptide (NT-proBNP) renal function. Copyright © 2016 Elsevier Inc. All rights reserved.

Load to Failure and Stiffness

Science.gov (United States)

Esquivel, Amanda O.; Duncan, Douglas D.; Dobrasevic, Nikola; Marsh, Stephanie M.; Lemos, Stephen E.

2015-01-01

Background: Rotator cuff tendinopathy is a frequent cause of shoulder pain that can lead to decreased strength and range of motion. Failures after using the single-row technique of rotator cuff repair have led to the development of the double-row technique, which is said to allow for more anatomical restoration of the footprint. Purpose: To compare 5 different types of suture patterns while maintaining equality in number of anchors. The hypothesis was that the Mason-Allen–crossed cruciform transosseous-equivalent technique is superior to other suture configurations while maintaining equality in suture limbs and anchors. Study Design: Controlled laboratory study. Methods: A total of 25 fresh-frozen cadaveric shoulders were randomized into 5 suture configuration groups: single-row repair with simple stitch technique; single-row repair with modified Mason-Allen technique; double-row Mason-Allen technique; double-row cross-bridge technique; and double-row suture bridge technique. Load and displacement were recorded at 100 Hz until failure. Stiffness and bone mineral density were also measured. Results: There was no significant difference in peak load at failure, stiffness, maximum displacement at failure, or mean bone mineral density among the 5 suture configuration groups (P row rotator cuff repair to be superior to the single-row repair; however, clinical research does not necessarily support this. This study found no difference when comparing 5 different repair methods, supporting research that suggests the number of sutures and not the pattern can affect biomechanical properties. PMID:26665053

Determination of bounds on failure probability in the presence of ...

Indian Academy of Sciences (India)

In particular, fuzzy set theory provides a more rational framework for ..... indicating that the random variations inT andO2 do not affect failure probability significantly. ... The upper-bound for PF shown in figure 6 can be used in decision-making.

Effect of Nesiritide in Patients with Acute Decompensated Heart Failure