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Sample records for stable unit treatment

  1. Treatment of stable COPD: antioxidants

    Directory of Open Access Journals (Sweden)

    W. MacNee

    2005-09-01

    Full Text Available There is considerable evidence that an increased oxidative burden occurs in the lungs of patients with chronic obstructive pulmonary disease (COPD and this results in an imbalance between oxidants/antioxidants or oxidative stress, which may play a role in many of the processes involved in the pathogenesis of COPD. These include enhanced proteolytic activity, mucus hypersecretion and the enhanced inflammatory response in the lungs to inhaling tobacco smoke, which is characteristic of COPD. COPD is now recognised to have multiple systemic consequences, such as weight loss and skeletal muscle dysfunction. It is now thought that oxidative stress may extend beyond the lungs and is involved in these systemic effects. Antioxidant therapy therefore would seem to be a logical therapeutic approach in chronic obstructive pulmonary disease. There is a need for more potent antioxidant therapies to test the hypothesis that antioxidant drugs may be a new therapeutic strategy for the prevention and treatment of chronic obstructive pulmonary disease.

  2. Unit of stable isotopic N15 analysis

    International Nuclear Information System (INIS)

    Cabrera de Bisbal, Evelin; Paredes U, Maria

    1997-01-01

    active roots. The location of areas with higher density of absorbent roots and the way as they vary with the stations. The inorganic fertilizers can be substituted, in certain measure, by other sources of nutriments that are available in the town or that are less expensive. As well as the leguminous and other families, in symbiosis with the appropriate microorganisms can use the atmospheric N 2 directly. The N 1 5 isotopic techniques are really reliable to obtain quantitative and integrated fixed nitrogen values, either in natural or agricultural systems. Besides the supply of nutriments, the water is one of the main restrictive factors for the domestic agricultural production. The application of radiation techniques using neutron probe and gamma densitometers allows the development of methods to handle rain waters under agricultural drought conditions or to improve the efficiency of the irrigation use of water. The Stable Isotopes N 1 5 Analysis Laboratory, of the Laboratory Unit of the Agroecologic Resources Investigations Institute (IIRA), of CENIAP, provides from its foundation, a valuable service support to the investigation of nitrogen fertilization, aswell as alternative nitrogen sources (biological fixation), and in the development of water handling methods. The laboratory was installed in 1989, with the collaboration of the International Atomic Energy Agency. This laboratory is in capacity to analyze N 1 5 in water, land and vegetable tissue. The number of samples analyzed through these eight years of activities is 2000, being beneficiaries of this service diverse national agricultural research institutions (UCV, IVIC, LUZ and FONAIAP). The projects that have been assisted by the laboratory cover the areas previously mentioned, promoting the generation and deepening of knowledge, which helps to obtain a maximum efficiency in the use of nitrogen fertilizers and water, in the main domestic cropping systems [es

  3. Waste Water Treatment Unit

    International Nuclear Information System (INIS)

    Ramadan, A.E.K.

    2004-01-01

    A wastewater treatment plant to treat both the sanitary and industrial effluent originated from process, utilities and off site units of the refinery is described. The purpose is to obtain at the end of the treatment plant, a water quality that is in compliance with contractual requirements and relevant environmental regulations. first treatment (pretreatment). Primary de-oiling, Equalization, Neutralization, Secondary de-oiling. Second treatment (Biological), The mechanism of BOD removal, Biological flocculation, Nutrient requirements, Nitrification, De-nitrification, Effect of temperature, Effect of ph, Toxicity

  4. Selection of medical treatment in stable angina pectoris

    DEFF Research Database (Denmark)

    Ardissino, D; Savonitto, S; Egstrup, K

    1995-01-01

    pectoris. BACKGROUND: The characteristics of anginal symptoms and the results of exercise testing are considered of great importance for selecting medical treatment in patients with chronic stable angina pectoris. However, little information is available on how this first evaluation may be used to select......, the patients were randomly allocated to double-blind treatment for 6 weeks with either metoprolol (Controlled Release, 200 mg once daily) or nifedipine (Retard, 20 mg twice daily) according to a parallel group design. At the end of this period, exercise tests were repeated 1 to 4 h after drug intake. RESULTS....... CONCLUSIONS: The results of a baseline exercise test, but not the characteristics of anginal symptoms, may offer useful information for selecting medical treatment in stable angina pectoris....

  5. NEBIVOLOL IN TREATMENT OF STABLE EXERTIONAL ANGINA PECTORIS

    Directory of Open Access Journals (Sweden)

    Y. V. Gavrilov

    2015-12-01

    Full Text Available Aim. To evaluate antianginal and antiischemic efficiency of nebivolol in patients with stable angina pectoris.Material and methods. 100 patients with ischemic heart disease showing stable exertional angina pectoris and having no contraindications to beta-blockers were studied. After 5-7 days of control period 50 randomly selected patients began to take nebivolol in initial dose of 5mg once daily and 50 patients started to take metoprolol in initial dose of 50 mg twice daily. Duration of treatment was 8 weeks. Efficiency of treatment was assessed according to the results of control treadmill assessment and control daily ECG monitoring.Results. 56-day therapy with nebivolol at a dose of 7,5 mg per day results in increase in duration of treadmill test before angina or ST depression (p<0.05. Antianginal and antiischemic effect of nebivolol 7.5 mg once daily is rather similar with that of metoprolol in average daily dose of 175 mg. Nebivolol compared to metoprolol significantly (p<0.05 more effectively reduces the number of silent myocardial ischemia.Conclusion. Nebivolol is an efficient antianginal and antiischemic drug for patients with stable exertional angina pectoris.

  6. NEBIVOLOL IN TREATMENT OF STABLE EXERTIONAL ANGINA PECTORIS

    Directory of Open Access Journals (Sweden)

    Y. V. Gavrilov

    2007-01-01

    Full Text Available Aim. To evaluate antianginal and antiischemic efficiency of nebivolol in patients with stable angina pectoris.Material and methods. 100 patients with ischemic heart disease showing stable exertional angina pectoris and having no contraindications to beta-blockers were studied. After 5-7 days of control period 50 randomly selected patients began to take nebivolol in initial dose of 5mg once daily and 50 patients started to take metoprolol in initial dose of 50 mg twice daily. Duration of treatment was 8 weeks. Efficiency of treatment was assessed according to the results of control treadmill assessment and control daily ECG monitoring.Results. 56-day therapy with nebivolol at a dose of 7,5 mg per day results in increase in duration of treadmill test before angina or ST depression (p<0.05. Antianginal and antiischemic effect of nebivolol 7.5 mg once daily is rather similar with that of metoprolol in average daily dose of 175 mg. Nebivolol compared to metoprolol significantly (p<0.05 more effectively reduces the number of silent myocardial ischemia.Conclusion. Nebivolol is an efficient antianginal and antiischemic drug for patients with stable exertional angina pectoris.

  7. Development of shelf stable, processed, low acid food products using heat-irradiation combination treatments

    International Nuclear Information System (INIS)

    Minnaar, A.

    1998-01-01

    The amount of ionizing irradiation needed to sterilize low acid vegetable and starch products (with and without sauces) commercially impairs their sensorial and nutritive qualities, and use of thermal processes for the same purpose may also have an adverse effect on the product quality. A systematic approach to the establishment of optimized combination parameters was developed for heat-irradiation processing to produce high quality, shelf stable, low acid food products. The effects of selected heat, heat-irradiation combination and irradiation treatments on the quality of shelf stable mushrooms in brine and rice, stored at ambient temperature, were studied. From a quality viewpoint, use of heat-irradiation combination treatments favouring low irradiation dose levels offered a feasible alternative to thermally processed or radappertized mushrooms in brine. However, shelf stable rice produced by heat-irradiation combination treatments offered a feasible alternative only to radappertized rice from the standpoint of quality. The technical requirements for the heat and irradiation processing of a long grain rice cultivar from the United States of America oppose each other directly, thereby reducing the feasibility of using heat-irradiation combination processing to produce shelf stable rice. The stability of starch thickened white sauces was found to be affected severely during high dose irradiation and subsequent storage at ambient temperature. However, use of pea protein isolate as a thickener in white sauces was found to have the potential to maintain the viscosity of sauces for irradiated meat and sauce products throughout processing and storage. (author)

  8. Stable Isotope Identification of Nitrogen Sources for United States (U.S.) Pacific Coast Estuaries

    Science.gov (United States)

    Brown, C. A.; Kaldy, J. E.; Fong, P.; Fong, C.; Mochon Collura, T.; Clinton, P.

    2016-02-01

    Nutrients are the leading cause of water quality impairments in the United States, and as a result tools are needed to identify the sources of nutrients. We used natural abundance stable isotope data to evaluate nitrogen sources to U.S. west coast estuaries. We collected macroalgae and analyzed these samples for natural abundance of stable isotopes (δ15N) and supplemented this with available data from the literature for estuaries from Mexico to Alaska. Stable isotope ratios of green macroalgae were compared to δ15N of dissolved inorganic nitrogen of oceanic and watershed end members. There was a latitudinal gradient in δ15N of macroalgae with southern estuaries being 7 per mil heavier than northern estuaries. Gradients in isotope data were compared to nitrogen sources estimated by the USGS using the SPARROW model. In California estuaries, the elevation of isotope data appeared to be related to anthropogenic nitrogen sources. In Oregon systems, the nitrogen levels of streams flowing into the estuaries are related to forest cover, rather than to developed land classes. In Oregon estuaries, the δ15N of macroalgae suggested that the ocean and nitrogen-fixing trees in the watersheds were the dominant nitrogen sources with heavier sites located near the estuary mouth. In California estuaries, the gradient was reversed with heavier sites located upriver. In some Oregon estuaries, there was an elevation an elevation of δ15N above marine end members in the vicinity of wastewater treatment facility discharge locations, suggesting isotopes may be useful for distinguishing inputs along an estuarine gradient.

  9. Design of automated oil sludge treatment unit

    Science.gov (United States)

    Chukhareva, N.; Korotchenko, T.; Yurkin, A.

    2015-11-01

    The article provides the feasibility study of contemporary oil sludge treatment methods. The basic parameters of a new resource-efficient oil sludge treatment unit that allows extracting as much oil as possible and disposing other components in efficient way have been outlined. Based on the calculation results, it has been revealed that in order to reduce the cost of the treatment unit and the expenses related to sludge disposal, it is essential to apply various combinations of the existing treatment methods.

  10. Design of automated oil sludge treatment unit

    OpenAIRE

    Chukhareva, Natalia Vyacheslavovna; Korotchenko, Tatiana Valerievna; Yurkin, A.

    2015-01-01

    The article provides the feasibility study of contemporary oil sludge treatment methods. The basic parameters of a new resource-efficient oil sludge treatment unit that allows extracting as much oil as possible and disposing other components in efficient way have been outlined. Based on the calculation results, it has been revealed that in order to reduce the cost of the treatment unit and the expenses related to sludge disposal, it is essential to apply various combinations of the existing t...

  11. Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

    OpenAIRE

    Sandeep Gurung; Dipendra KC; Roshni Khatri

    2016-01-01

    Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37), were treated with elastic stable intramedul...

  12. Control technique for enhancing the stable operation of distributed generation units within a microgrid

    International Nuclear Information System (INIS)

    Mehrasa, Majid; Pouresmaeil, Edris; Mehrjerdi, Hasan; Jørgensen, Bo Nørregaard; Catalão, João P.S.

    2015-01-01

    Highlights: • A control technique for enhancing the stable operation of distributed generation units is proposed. • Passivity-based control technique is considered to analyze the dynamic and steady-state behaviors. • The compensation of instantaneous variations in the reference current components is considered. • Simulation results confirm the performance of the control scheme within the microgrid. - Abstract: This paper describes a control technique for enhancing the stable operation of distributed generation (DG) units based on renewable energy sources, during islanding and grid-connected modes. The Passivity-based control technique is considered to analyze the dynamic and steady-state behaviors of DG units during integration and power sharing with loads and/or power grid, which is an appropriate tool to analyze and define a stable operating condition for DG units in microgrid technology. The compensation of instantaneous variations in the reference current components of DG units in ac-side, and dc-link voltage variations in dc-side of interfaced converters, are considered properly in the control loop of DG units, which is the main contribution and novelty of this control technique over other control strategies. By using the proposed control technique, DG units can provide the continuous injection of active power from DG sources to the local loads and/or utility grid. Moreover, by setting appropriate reference current components in the control loop of DG units, reactive power and harmonic current components of loads can be supplied during the islanding and grid-connected modes with a fast dynamic response. Simulation results confirm the performance of the control scheme within the microgrid during dynamic and steady-state operating conditions

  13. Modified yupingfeng formula for the treatment of stable chronic ...

    African Journals Online (AJOL)

    The following outcomes were evaluated: (1) lung function; (2) 6-minute walk distance (6MWD); (3) effective rate; (4) serum levels of IgA, IgG and IgE; and (5) adverse ... when combined with Western medications can provide more benefits for patients with stable COPD, without any serious adverse reactions being identified.

  14. Study on the Effect of the Separating Unit Optimization on the Economy of Stable Isotope Separation

    Directory of Open Access Journals (Sweden)

    YANG Kun

    2015-01-01

    Full Text Available An economic criterion called as yearly net profit of single separating unit (YNPSSU was presented to evaluate the influence of structure optimization on the economy. Using YNPSSU as a criterion, economic analysis was carried out for the structure optimization of separating unit in the case of separating SiF4 to obtain the 28Si and 29Si isotope. YNPSSU was calculated and compared with that before optimization. The results showed that YNPSSU was increased by 12.3% by the structure optimization. Therefore, the structure optimization could increase the economy of the stable isotope separation effectively.

  15. Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures

    Directory of Open Access Journals (Sweden)

    Sandeep Gurung

    2016-06-01

    Full Text Available Introduction: Tibia fractures in the skeletally immature patient can usually be treated with above knee cast or patellar tendon bearing cast. The purpose of our study was to evaluate epidemiology and outcome of Elastic stable intramedullary nailing fixation of pediatric tibial shaft fractures treated at our institution. Methods: Over a period of one year, fifty pediatric patients of tibial shaft fractures, with average age of 9.68 yr (SD=2.37, were treated with elastic stable intramedullary nail. Demographic data, union and complication rate were evaluated. Results: There were 36 closed and 14 open fractures. The average time to union was 11.6 weeks  (SD=2.65 for close and  14.3 weeks (SD=2.62 for open fracture. There were no instances of growth arrest, remanipulations, or refracture. Conclusion: We conclude that flexible intramedullary fixation is an easy and effective method of management of both open and closed unstable fractures of the tibia in children.

  16. Study the Stability of a Wastewater Treatment Unit using LABVIEW

    Directory of Open Access Journals (Sweden)

    Ghainm M. Alwan

    2013-05-01

    Full Text Available This study was devoted to limit the stability conditions of the wastewater treatment unit.       LABVIEW was a powerful and versatile graphical programming language in automation control and date acquisition of the system. The on-line show that accurate and stable control responses were obtained in the present work. The actual phase plane proved to a better technique to limit the regions of the non-linear system stability compared to other theoretical techniques. Limit cycle did not appear in the present system. 

  17. Target-ion source unit ionization efficiency measurement by method of stable ion beam implantation

    CERN Document Server

    Panteleev, V.N; Fedorov, D.V; Moroz, F.V; Orlov, S.Yu; Volkov, Yu.M

    The ionization efficiency is one of the most important parameters of an on-line used target-ion source system exploited for production of exotic radioactive beams. The ionization efficiency value determination as a characteristic of a target-ion source unit in the stage of its normalizing before on-line use is a very important step in the course of the preparation for an on-line experiment. At the IRIS facility (Petersburg Nuclear Physics Institute, Gatchina) a reliable and rather precise method of the target-ion source unit ionization efficiency measurement by the method of stable beam implantation has been developed. The method worked out exploits an off-line mass-separator for the implantation of the ion beams of selected stable isotopes of different elements into a tantalum foil placed inside the Faraday cup in the focal plane of the mass-separator. The amount of implanted ions has been measured with a high accuracy by the current integrator connected to the Faraday cup. After the implantation of needed a...

  18. Addiction treatment and stable housing among a cohort of injection drug users.

    Directory of Open Access Journals (Sweden)

    Anita Palepu

    Full Text Available Unstable housing and homelessness is prevalent among injection drug users (IDU. We sought to examine whether accessing addiction treatment was associated with attaining stable housing in a prospective cohort of IDU in Vancouver, Canada.We used data collected via the Vancouver Injection Drug User Study (VIDUS between December 2005 and April 2010. Attaining stable housing was defined as two consecutive "stable housing" designations (i.e., living in an apartment or house during the follow-up period. We assessed exposure to addiction treatment in the interview prior to the attainment of stable housing among participants who were homeless or living in single room occupancy (SRO hotels at baseline. Bivariate and multivariate associations between the baseline and time-updated characteristics and attaining stable housing were examined using Cox proportional hazard regression models.Of the 992 IDU eligible for this analysis, 495 (49.9% reported being homeless, 497 (50.1% resided in SRO hotels, and 380 (38.3% were enrolled in addiction treatment at the baseline interview. Only 211 (21.3% attained stable housing during the follow-up period and of this group, 69 (32.7% had addiction treatment exposure prior to achieving stable housing. Addiction treatment was inversely associated with attaining stable housing in a multivariate model (adjusted hazard ratio [AHR]=0.71; 95% CI: 0.52-0.96. Being in a partnered relationship was positively associated with the primary outcome (AHR=1.39; 95% CI: 1.02-1.88. Receipt of income assistance (AHR=0.65; 95% CI: 0.44-0.96, daily crack use (AHR=0.69; 95% CI: 0.51-0.93 and daily heroin use (AHR=0.63; 95% CI: 0.43-0.92 were negatively associated with attaining stable housing.Exposure to addiction treatment in our study was negatively associated with attaining stable housing and may have represented a marker of instability among this sample of IDU. Efforts to stably house this vulnerable group may be occurring in contexts

  19. Revascularisation versus medical treatment in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Windecker, Stephan; Stortecky, Stefan; Stefanini, Giulio G

    2014-01-01

    OBJECTIVE: To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN: Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials...... while maintaining randomisation. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: A strategy of initial medical treatment compared with revascularisation by coronary artery bypass grafting or Food and Drug Administration approved techniques for percutaneous revascularization: balloon angioplasty, bare metal...

  20. Fractional CO2lasers contribute to the treatment of stable non-segmental vitiligo.

    Science.gov (United States)

    Yuan, Jinping; Chen, Hongqiang; Yan, Ru; Cui, Shaoshan; Li, Yuan-Hong; Wu, Yan; Gao, Xing-Hua; Chen, Hong-Duo

    2016-12-01

    Stable non-segmental vitiligo is often resistant to conventional therapies. The purpose of this study was to investigate the effect of three types of fractional lasers in the treatment of stable non-segmental vitiligo. Twenty patients were enrolled in the study. The vitiligo lesions of each patient were divided into four treatment parts, and all parts were treated with narrowband ultraviolet-B (NB-UVB). Three of the four parts were respectively treated with three types of fractional lasers (two ablative 10,600-nm CO 2 lasers and one non-ablative 1,565-nm laser), followed by topical betamethasone solution application. The treatment period lasted six months. Efficacy and satisfaction were respectively assessed by dermatologists and patients. The ablative CO 2 lasers, in combination with topical betamethasone solution and NB-UVB, achieved marked to excellent improvement on white patches assessed by dermatologists. Patients showed high satisfaction scores for the treatments. The non-ablative 1,565-nm fractional laser did not provide any further benefit in the treatment of vitiligo. No severe adverse events developed for any of the treatments. The treatment protocol with ablative CO 2 lasers, in combination with topical betamethasone solution and NB-UVB, was suitable for stable non-segmental vitiligo. For vitiligo, the ablative fractional CO 2 laser is more effective than the non-ablative fractional laser.

  1. Stable isotope ratiometer-multiple ion detector (SIRMID) unit for quantitative and qualitative stable isotope studies by gas chromatography-mass spectrometry

    International Nuclear Information System (INIS)

    Klein, P.D.; Haumann, J.R.; Hachey, D.L.

    1975-01-01

    A stable isotope ratiometer-multiple ion detector (SIRMID) unit which can drive existing gas chromatograph-quadrupole or magnetic sector mass spectrometers to monitor up to six ions in turn is described. Each of the three pairs of ions can be selected for quantitation; thus three different or successive components can be analyzed in a single GC run. A background subtraction option permits the ion intensity in the absence of sample to be subtracted automatically during sample measurement. Displays of accumulated counts and isotope ratio are updated twice per second during the measurement and can be printed out at its conclusion. All six ions can be monitored in the analog mode by parallel outputs to a multipen recorder. Experience gained in the construction of this prototype indicates that SIRMID units could be commercially available for $10K, or about 1 / 3 rd to 1 / 6 th of the cost of even an inexpensive computer system. (U.S.)

  2. Paraoxonase-1 and Simvastatin Treatment in Patients with Stable Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Rafał Januszek

    2016-01-01

    Full Text Available Background. Paraoxonase-1 (PON1 is the crucial antioxidant marker of high-density lipoproteins. The present study is aimed at assessing the effect of simvastatin treatment on PON1 activity and its relationship to Q192R and M55L polymorphisms in subjects with stable coronary artery disease (CAD. Methods. The patient group was composed of 53 individuals with stable CAD, and the control group included 53 sex-matched police officers without CAD. CAD patients were treated with simvastatin 40mg/day for 12 months. Respectively, flow mediated dilatation (FMD, serum hs-CRP and TNF-α levels, urinary 8-iso-PGF2α concentrations, and PON1 activity were evaluated in definitive intervals. Results. There was no effect of simvastatin treatment on urinary 8-iso-PGF2α. Simvastatin treatment significantly increased FMD value, decreased CRP and TNF-α concentration. After adjusting for PON1 genotypes, significantly higher PON1 activity was noted in the 192R allele carriers, in both groups. Regardless of genotype, PON1 activity remained stable after simvastatin treatment. Conclusions. The present study confirms a positive effect of simvastatin therapy on endothelial function and inflammatory markers in secondary prevention. Simvastatin treatment shows no effects on PON1 activity and 8-isoprostanes level. The effect of simvastatin therapy on PON1 activity is not modulated by Q192R and M55L polymorphisms.

  3. Functionally Stable and Phylogenetically Diverse Microbial Enrichments from Microbial Fuel Cells during Wastewater Treatment

    OpenAIRE

    Ishii, Shun'ichi; Suzuki, Shino; Norden-Krichmar, Trina M.; Nealson, Kenneth H.; Sekiguchi, Yuji; Gorby, Yuri A.; Bretschger, Orianna

    2012-01-01

    Microbial fuel cells (MFCs) are devices that exploit microorganisms as biocatalysts to recover energy from organic matter in the form of electricity. One of the goals of MFC research is to develop the technology for cost-effective wastewater treatment. However, before practical MFC applications are implemented it is important to gain fundamental knowledge about long-term system performance, reproducibility, and the formation and maintenance of functionally-stable microbial communities. Here w...

  4. Warm Parenting Associated with Decreasing or Stable Child BMI during Treatment.

    Science.gov (United States)

    Rhee, Kyung E; Jelalian, Elissa; Boutelle, Kerri; Dickstein, Susan; Seifer, Ronald; Wing, Rena

    2016-04-01

    While authoritative parenting, which includes high levels of warmth and behavioral control, has been associated with lower risk of obesity, little is known about how general parenting impacts child weight loss during treatment. Our goal was to examine the relationship between several general parenting dimensions and 'decreasing /stable' child BMI during a 16-week family-based behavioral weight control program. Forty-four overweight parent-child dyads (child age 8 to 12 years) enrolled in the program. Families were videotaped at baseline eating dinner in their home. Using the General Parenting Observational Scale (GPOS), meals were coded for several general parenting dimensions. Primary outcome was percent of children whose BMI 'decreased or stayed the same.' Multivariable logistic regression was used to determine the relationship between general parenting and decreasing/stable child BMI. Forty families (91%) completed the program. Children had a mean BMI change of -0.40 (SD 1.57), which corresponds to a -0.15 (SD 0.20) change in BMI z-score (BMI-Z); 75% of children had decreasing/stable BMI. In the unadjusted models, lower parent BMI, higher parent education, and higher levels of parental warmth were significantly associated with decreasing/stable child BMI. In the multivariable model, only higher level of warmth was associated with increased odds of decreasing/stable child BMI (OR = 1.28; 95% CI, 1.01, 1.62). Baseline parental warmth may influence a child's ability to lower/maintain BMI during a standard family-based behavioral weight control program. Efforts to increase parent displays of warmth and emotional support towards their overweight child may help to increase the likelihood of treatment success.

  5. Experimental investigations on prototype heat storage units utilizing stable supercooling of sodium acetate trihydrate mixtures

    DEFF Research Database (Denmark)

    Dannemand, Mark; Dragsted, Janne; Fan, Jianhua

    2016-01-01

    was filled with 220 kg SAT mixture thickened with 1% carboxymethyl cellulose. The heat exchange capacity rate during the charging of the unit with the extra water was significantly higher than for the unit with the thickening agent due to the different levels of convection. The SAT mixtures in the units were...

  6. Gynaecomastia in two men on stable antiretroviral therapy who commenced treatment for tuberculosis.

    Science.gov (United States)

    Kratz, Jeremy D; El-Shazly, Ahmad Y; Mambuque, Santos G; Demetria, Elpidio; Veldkamp, Peter; Anderson, Timothy S

    2016-12-01

    Gynaecomastia is a common clinical presentation that varies from benign presentations in stages of human development to hormonal pathology, mainly due to hepatic dysfunction, malignancy, and adverse pharmacologic effects. We describe the development of significant bilateral gynaecomastia after starting treatment for pulmonary tuberculosis (TB) in two males with WHO stage III Human Immunodeficiency Virus (HIV) infection on stable antiretroviral regimens. Emerging reports suggest that distinct hepatic impairment in efavirenz metabolism modulates oestrogenic activity, which may be potentiated by anti-tuberculosis therapy. Clinical application includes early recognition of efavirenz-induced gynaecomastia, especially after commencing tuberculosis treatment. To avoid decreased adherence resulting from the distressing side effect of gynecomastia, transition to an alternative ART regimen over the course of tuberculosis treatment should be considered.

  7. Development of a stable cation modified graphene oxide membrane for water treatment

    Science.gov (United States)

    Yu, Wenzheng; (Yet Yu, Tong; Graham, Nigel

    2017-12-01

    Membranes prepared from layers of graphene oxide (GO) offer substantial advantages over conventional materials for water treatment (e.g. greater flux), but the stability of GO membranes in water has not been achieved until now. In this study the behavior of GO membranes prepared with different quantities and species of cations has been investigated to establish the feasibility of their application in water treatment. A range of cation-modified GO membranes were prepared and exposed to aqueous solutions containing specific chemical constituents. In pure water, unmodified and Na-modified GO membranes were highly unstable, while GO membranes modified with multivalent cations were stable provided there were sufficient quantities of cations present; their relative capability to achieve GO stability was as follows: Al3+  >  Ca2+  >  Mg2+  >  Na+. It is believed that the mechanism of cross-linking, and membrane stability, is via metal-carboxylate chelates and cation-graphite surface interactions (cation-π interaction), and that the latter appears to increase with increasing cation valency. The instability of cation (Ca or Al)-modified GO membranes by NaCl solutions during permeation occurred as Na+ exchanged with the incorporated multivalent cations, but a high content of Al3+ in the GO membrane impeded Al3+/Na+ exchange and thus retained membrane stability. In solutions containing biopolymers representative of surface waters or seawater (protein and polysaccharide solutions), Ca-GO membranes (even with high Ca2+ content) were not stable, while Al-GO membranes were stable if the Al3+ content was sufficiently high; Al-formed membranes also had a greater flux than Ca-GO membranes.

  8. Long-term L-Triiodothyronine (T3) treatment in stable systolic heart failure patients

    DEFF Research Database (Denmark)

    Holmager, Pernille; Schmidt, Ulla; Mark, Peter

    2015-01-01

    BACKGROUND: Chronic heart failure (HF) is characterized by reduced serum T3 levels and increased activity of the T3 degrading enzyme deiodinase D3. This may result in an intracellular composition of the cardiomyocyte mimicking that of hypothyroidism. Short-term T3-administration to systolic HF...... during T3-treatment and neither did the neurohormonal profile. There were no side-effects in terms of cardiac arrhythmias and no change in resting heart rate. CONCLUSIONS: This study does not support the hypothesis that oral T3 treatment might be beneficial to patients with chronic, stable systolic HF...... with a modest degree of reduced LVEF and low-normal serum T3 concentrations. The study included both functional studies of heart contractility as well as measures of the neurohormonal activation....

  9. Unit for continuous heat treatment of molasses

    Energy Technology Data Exchange (ETDEWEB)

    Shvets, V.N.; Savchuk, M.Ya.; Egorov, A.A.

    1981-01-01

    An apparatus is described for continuous heat treatment of molasses for alcohol fermentation. Repeated short-term heating of molasses at 120 degrees followed by cooling in vacuo results in the removal of 25% volatile fatty acids, stabilization of yeast during fermentation, and increase of alcohol yield by 0.33%.

  10. Functionally stable and phylogenetically diverse microbial enrichments from microbial fuel cells during wastewater treatment.

    Science.gov (United States)

    Ishii, Shun'ichi; Suzuki, Shino; Norden-Krichmar, Trina M; Nealson, Kenneth H; Sekiguchi, Yuji; Gorby, Yuri A; Bretschger, Orianna

    2012-01-01

    Microbial fuel cells (MFCs) are devices that exploit microorganisms as biocatalysts to recover energy from organic matter in the form of electricity. One of the goals of MFC research is to develop the technology for cost-effective wastewater treatment. However, before practical MFC applications are implemented it is important to gain fundamental knowledge about long-term system performance, reproducibility, and the formation and maintenance of functionally-stable microbial communities. Here we report findings from a MFC operated for over 300 days using only primary clarifier effluent collected from a municipal wastewater treatment plant as the microbial resource and substrate. The system was operated in a repeat-batch mode, where the reactor solution was replaced once every two weeks with new primary effluent that consisted of different microbial and chemical compositions with every batch exchange. The turbidity of the primary clarifier effluent solution notably decreased, and 97% of biological oxygen demand (BOD) was removed after an 8-13 day residence time for each batch cycle. On average, the limiting current density was 1000 mA/m(2), the maximum power density was 13 mW/m(2), and coulombic efficiency was 25%. Interestingly, the electrochemical performance and BOD removal rates were very reproducible throughout MFC operation regardless of the sample variability associated with each wastewater exchange. While MFC performance was very reproducible, the phylogenetic analyses of anode-associated electricity-generating biofilms showed that the microbial populations temporally fluctuated and maintained a high biodiversity throughout the year-long experiment. These results suggest that MFC communities are both self-selecting and self-optimizing, thereby able to develop and maintain functional stability regardless of fluctuations in carbon source(s) and regular introduction of microbial competitors. These results contribute significantly toward the practical application

  11. Short-term topical bevacizumab in the treatment of stable corneal neovascularization.

    Science.gov (United States)

    Cheng, Sheng-Fu; Dastjerdi, Mohammad H; Ferrari, Giulio; Okanobo, Andre; Bower, Kraig S; Ryan, Denise S; Amparo, Francisco; Stevenson, William; Hamrah, Pedram; Nallasamy, Nambi; Dana, Reza

    2012-12-01

    To evaluate the safety and efficacy of topical bevacizumab in the treatment of corneal neovascularization. Prospective, nonrandomized, interventional case series. setting: Institutional, multicenter clinical trial. study population: Twenty eyes from 20 patients with stable corneal neovascularization. intervention procedures: Patients were treated with topical 1.0% bevacizumab for 3 weeks and were monitored for a total of 24 weeks. main outcome measures: Primary outcome measures included: neovascular area, defined as the area of the corneal vessels themselves; vessel caliber, defined as the mean corneal vessel diameter; and invasion area, defined as the fraction of the total cornea into which the vessels extended. The occurrence of ocular and systemic adverse events was monitored closely. As compared with the baseline visit, patients exhibited a statistically significant improvement in neovascular area by week 6 (P = .007) and in vessel caliber by week 12 (P = .006). At the final visit, neovascular area, vessel caliber, and invasion area were reduced by 47.5%, 36.2%, and 20%, respectively. The decreases in neovascular area and vessel caliber were statistically significant (P < .001 and P = .003, respectively); however, the reduction in invasion area did not reach statistical significance (P = .06). There were no significant changes in the secondary outcomes, and there were no adverse events. Short-term topical bevacizumab treatment reduced the extent of stable corneal neovascularization as measured by neovascular area and vessel caliber with no associated adverse events. Interestingly, the degree of treatment efficacy was inversely proportional to the baseline invasion area. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Functionally stable and phylogenetically diverse microbial enrichments from microbial fuel cells during wastewater treatment.

    Directory of Open Access Journals (Sweden)

    Shun'ichi Ishii

    Full Text Available Microbial fuel cells (MFCs are devices that exploit microorganisms as biocatalysts to recover energy from organic matter in the form of electricity. One of the goals of MFC research is to develop the technology for cost-effective wastewater treatment. However, before practical MFC applications are implemented it is important to gain fundamental knowledge about long-term system performance, reproducibility, and the formation and maintenance of functionally-stable microbial communities. Here we report findings from a MFC operated for over 300 days using only primary clarifier effluent collected from a municipal wastewater treatment plant as the microbial resource and substrate. The system was operated in a repeat-batch mode, where the reactor solution was replaced once every two weeks with new primary effluent that consisted of different microbial and chemical compositions with every batch exchange. The turbidity of the primary clarifier effluent solution notably decreased, and 97% of biological oxygen demand (BOD was removed after an 8-13 day residence time for each batch cycle. On average, the limiting current density was 1000 mA/m(2, the maximum power density was 13 mW/m(2, and coulombic efficiency was 25%. Interestingly, the electrochemical performance and BOD removal rates were very reproducible throughout MFC operation regardless of the sample variability associated with each wastewater exchange. While MFC performance was very reproducible, the phylogenetic analyses of anode-associated electricity-generating biofilms showed that the microbial populations temporally fluctuated and maintained a high biodiversity throughout the year-long experiment. These results suggest that MFC communities are both self-selecting and self-optimizing, thereby able to develop and maintain functional stability regardless of fluctuations in carbon source(s and regular introduction of microbial competitors. These results contribute significantly toward the

  13. Preliminary investigation into the zone of support influence and stable span between support units.

    CSIR Research Space (South Africa)

    Daehnke, A

    1999-10-01

    Full Text Available ).........................................................................................................31 Figure 2.2.12Graph showing the effect of clamping stresses on the factor of safety of wedge- shaped blocks (after Daehnke et al., 1998).......................................................31 Figure 2.3.1(a) Joint with in... support unit (b = 1,0 m, j = 40o, F = 200 kN, w = 0,5 m).. ........................66 Figure 4.3.2 Maximum extent of the zone of support influence governed by bedding plane friction angle, ϕ, and bedding plane height, b...

  14. Treatment for stable HIV patients in England: can we increase efficiency and improve patient care?

    Science.gov (United States)

    Adams, Elisabeth; Ogden, David; Ehrlich, Alice; Hay, Phillip

    2014-07-01

    To estimate the costs and potential efficiency gains of changing the frequency of clinic appointments and drug dispensing arrangements for stable HIV patients compared to the costs of hospital pharmacy dispensing and home delivery. We estimated the annual costs per patient (HIV clinic visits and either first-line treatment or a common second-line regimen, with some patients switching to a second-line regimen during the year). The cost of three-, four- and six-monthly clinic appointments and drug supply was estimated assuming hospital dispensing (incurring value-added tax) and home delivery. Three-monthly appointments and hospital drug dispensing (baseline) were compared to other strategies. The baseline was the most costly option (£10,587 if first-line treatment and no switch to second-line regimen). Moving to six-monthly appointments and home delivery yielded savings of £1883 per patient annually. Assuming patients start on different regimens and may switch to second-line therapies, six-monthly appointments and three-monthly home delivery of drugs is the least expensive option and could result in nearly £2000 savings per patient. This translates to annual cost reduction of about £8 million for the estimated 4000 eligible patients not currently on home delivery in London, England. Different appointment schedules and drug supply options should be considered for stable HIV patients based on efficiency gains. However, this should be assessed for individual patients to meet their needs, especially around adherence and patient support. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  15. Revascularisation versus medical treatment in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Windecker, Stephan; Stortecky, Stefan; Stefanini, Giulio G

    2014-01-01

    stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. DATA SOURCES: Medline and Embase from 1980.......80, 95% credibility interval 0.70 to 0.91) compared with medical treatment. New generation drug eluting stents (everolimus: 0.75, 0.59 to 0.96; zotarolimus (Resolute): 0.65, 0.42 to 1.00) but not balloon angioplasty (0.85, 0.68 to 1.04), bare metal stents (0.92, 0.79 to 1.05), or early generation drug...... eluting stents (paclitaxel: 0.92, 0.75 to 1.12; sirolimus: 0.91, 0.75 to 1.10; zotarolimus (Endeavor): 0.88, 0.69 to 1.10) were associated with improved survival compared with medical treatment. Coronary artery bypass grafting reduced the risk of myocardial infarction compared with medical treatment (0...

  16. Accurate, stable and efficient Navier-Stokes solvers based on explicit treatment of the pressure term

    International Nuclear Information System (INIS)

    Johnston, Hans; Liu Jianguo

    2004-01-01

    We present numerical schemes for the incompressible Navier-Stokes equations based on a primitive variable formulation in which the incompressibility constraint has been replaced by a pressure Poisson equation. The pressure is treated explicitly in time, completely decoupling the computation of the momentum and kinematic equations. The result is a class of extremely efficient Navier-Stokes solvers. Full time accuracy is achieved for all flow variables. The key to the schemes is a Neumann boundary condition for the pressure Poisson equation which enforces the incompressibility condition for the velocity field. Irrespective of explicit or implicit time discretization of the viscous term in the momentum equation the explicit time discretization of the pressure term does not affect the time step constraint. Indeed, we prove unconditional stability of the new formulation for the Stokes equation with explicit treatment of the pressure term and first or second order implicit treatment of the viscous term. Systematic numerical experiments for the full Navier-Stokes equations indicate that a second order implicit time discretization of the viscous term, with the pressure and convective terms treated explicitly, is stable under the standard CFL condition. Additionally, various numerical examples are presented, including both implicit and explicit time discretizations, using spectral and finite difference spatial discretizations, demonstrating the accuracy, flexibility and efficiency of this class of schemes. In particular, a Galerkin formulation is presented requiring only C 0 elements to implement

  17. Social Pre-treatment Modulates Attention Allocation to Transient and Stable Object Properties

    Directory of Open Access Journals (Sweden)

    Katalin Oláh

    2016-10-01

    Full Text Available Increasing evidence suggests that ostensive-communicative signals in social learning situations enable observers to focus their attention on the intrinsic features of an object (e.g. color at the expense of ignoring transient object properties (e.g. location. Here we investigated whether off-line social cues, presented as social primes, have the same power to modulate attention allocation to stable and transient object properties as on-line ostensive-communicative cues. The first part of the experiment consisted of a pre-treatment phase, where adult male participants either received intensive social stimulation or were asked to perform non-social actions. Then, they participated in a change detection test, where they watched pairs of pictures depicting an array of five objects. On the second picture, a change occurred compared to the first picture. One object changed either its location (moving forward or backward or was replaced by another object, and participants were required to indicate where the change had happened. We found that participants detected the change more successfully if it had happened in the location of the object; however, this difference was reduced following a socially intense pre-treatment phase. The results are discussed in relation to the claims of the natural pedagogy theory.

  18. Stable single-unit-cell nanosheets of zeolite MFI as active and long-lived catalysts.

    Science.gov (United States)

    Choi, Minkee; Na, Kyungsu; Kim, Jeongnam; Sakamoto, Yasuhiro; Terasaki, Osamu; Ryoo, Ryong

    2009-09-10

    Zeolites-microporous crystalline aluminosilicates-are widely used in petrochemistry and fine-chemical synthesis because strong acid sites within their uniform micropores enable size- and shape-selective catalysis. But the very presence of the micropores, with aperture diameters below 1 nm, often goes hand-in-hand with diffusion limitations that adversely affect catalytic activity. The problem can be overcome by reducing the thickness of the zeolite crystals, which reduces diffusion path lengths and thus improves molecular diffusion. This has been realized by synthesizing zeolite nanocrystals, by exfoliating layered zeolites, and by introducing mesopores in the microporous material through templating strategies or demetallation processes. But except for the exfoliation, none of these strategies has produced 'ultrathin' zeolites with thicknesses below 5 nm. Here we show that appropriately designed bifunctional surfactants can direct the formation of zeolite structures on the mesoporous and microporous length scales simultaneously and thus yield MFI (ZSM-5, one of the most important catalysts in the petrochemical industry) zeolite nanosheets that are only 2 nm thick, which corresponds to the b-axis dimension of a single MFI unit cell. The large number of acid sites on the external surface of these zeolites renders them highly active for the catalytic conversion of large organic molecules, and the reduced crystal thickness facilitates diffusion and thereby dramatically suppresses catalyst deactivation through coke deposition during methanol-to-gasoline conversion. We expect that our synthesis approach could be applied to other zeolites to improve their performance in a range of important catalytic applications.

  19. Water uptake in woody riparian phreatophytes of the southwestern United States: a stable isotope study

    International Nuclear Information System (INIS)

    Busch, D.E.; Ingraham, N.L.; Smith, S.D.

    1992-01-01

    Alluvial forest associations are often dominated by woody phreatophytes, plants that are tightly linked to aquifers for water uptake. Anthropogenic hydrological alterations (e.g., water impoundment or diversion) are of clear importance to riparian ecosystem function. Because decreased frequency of flooding and depression of water tables may, in effect, sever riparian plants from their natural water sources, research was undertaken to determine water uptake patterns for the dominant native and introduced woody taxa of riparian plant communities of the southwestern United States. At floodplain study sites along the Bill Williams and lower Colorado Rivers (Arizona, USA), naturally occurring D and 18 O were used to distinguish among potential water sources. Isotopic ratios from potential uptake locations were compared to water extracted from the dominant woody taxa of the study area (Populus fremontii, Salix gooddingii, and Tamarix ramosissima) to elucidate patterns of water absorption. Isotopic composition of water obtained from sapwood cores did not differ significantly from heartwood or branch water, suggesting that heartwood water exchange, stem capacitance, and phloem sap mixing may be inconsequential in actively transpiring Salix and Populus. There was evidence for close hydrologic linkage of river, ground, and soil water during the early part of the growing season. Surface soils exhibited D enrichment due to cumulative exposure to evaporation as the growing season progressed. Isotopic ratios of water extracted from Populus and Salix did not exhibit isotopic enrichment and were not significantly different from groundwater or saturated soil water sources, indicating a phreatophytic uptake pattern. Associations of isotopic ratios with water relations parameters indicated high levels of canopy evaporation and possible use of moisture from unsaturated alluvial soils in addition to groundwater in Tamarix. (author)

  20. Healing predictors of stable juvenile osteochondritis dissecans knee lesions after 6 and 12 months of nonoperative treatment.

    Science.gov (United States)

    Krause, Matthias; Hapfelmeier, Alexander; Möller, Melanie; Amling, Michael; Bohndorf, Klaus; Meenen, Norbert M

    2013-10-01

    Nonoperative treatment of stable juvenile osteochondritis dissecans (JOCD) lesions of the knee fails in up to 50% of cases. Healing predictors are needed to identify potential failures and thus determine treatment options. A predictive model for healing potential after 6 and 12 months of nonoperative treatment of stable JOCD lesions based on sensitive magnetic resonance imagining (MRI) follow-up measurements was developed. Cohort study (diagnosis); Level of evidence, 2. A retrospective cross-sectional study was conducted to analyze 62 white patients (76 stable JOCD lesions) who were initially treated by restriction of activity until they were free of pain. The primary end point was healing investigated on MRI with follow-up measurements after 6 and 12 months of nonoperative treatment. Multivariate logistic regression was used to determine the influence of age, sex, JOCD lesion size, clinical symptoms, and the occurrence of cystlike lesions (CLLs) on healing potential. Additionally, optimal prognostic cutoffs were defined to differentiate failures from nonfailures. After 6 months of nonoperative treatment, 51 (67%) of 76 stable JOCD lesions showed no progression toward healing or showed signs of instability. Normalized lesion width and area and CLL occurrence differed significantly between failures and nonfailures (P treatment with or without casting might be appropriate if the healing potential is >48%. A 12-month period of nonoperative treatment may be successful if the CLL is <1.3 mm in length as assessed on MRI.

  1. Combined coagulation flocculation pre treatment unit for municipal wastewater

    Directory of Open Access Journals (Sweden)

    Ibrahim M. Ismail

    2012-10-01

    Full Text Available The potentials of using the hydraulic technique in combined unit for municipal wastewater treatment were studied. A combined unit in which processes of coagulation, flocculation and sedimentation, has been designed utilizing hydraulic mixing instead of mechanical mixing. A jar test treatability study has been conducted to locate the optimum dose of the coagulants to be used. Alum, ferrous sulfate, ferric sulfate, a mixture of ferric and ferrous sulfates, and mixture of lime and ferrous sulfate were all tested. A pilot unit was constructed in the existing wastewater treatment plant at El Mansoura governorate located in north Egypt. The optimum dose of coagulants used in the combined unit gives removal efficiencies for COD, BOD, and total phosphorous as 65%, 55%, and 83%, respectively.

  2. Efficacy and safety of febuxostat in the treatment of hyperuricemia in stable kidney transplant recipients

    Directory of Open Access Journals (Sweden)

    Sofue T

    2014-02-01

    Full Text Available Tadashi Sofue,1 Masashi Inui,2 Taiga Hara,1 Yoko Nishijima,1 Kumiko Moriwaki,1 Yushi Hayashida,3 Nobufumi Ueda,3 Akira Nishiyama,4 Yoshiyuki Kakehi,3 Masakazu Kohno1 1Division of Nephrology and Dialysis, Department of Cardiorenal and Cerebrovascular Medicine, Kagawa University, Kagawa, 2Department of Urology, Tokyo Women's Medical University, Tokyo, 3Department of Urology, 4Department of Pharmacology, Kagawa University, Kagawa, Japan Background: Post-transplant hyperuricemia (PTHU, defined as serum uric acid concentration ≥7.0 mg/dL or need for treatment with allopurinol or benzbromarone, reduces long-term allograft survival in kidney transplant recipients. Febuxostat, a new nonpurine selective xanthine oxidase inhibitor, is well tolerated in patients with moderate renal impairment. However, its efficacy and safety in kidney recipients with PTHU is unclear. We therefore assessed the efficacy and safety of febuxostat in stable kidney transplant recipients with PTHU. Methods: Of 93 stable adult kidney transplant recipients, 51 were diagnosed with PTHU (PTHU group and 42 were not (NPTHU group. Of the 51 patients with PTHU, 26 were treated with febuxostat (FX group and 25 were not (NFX group, at the discretion of each attending physician. One-year changes in serum uric acid concentrations, rates of achievement of target uric acid (<6.0 mg/dL, estimated glomerular filtration rates in allografts, and adverse events were retrospectively analyzed in the FX, NFX, and NPTHU groups. Results: The FX group showed significantly greater decreases in serum uric acid (-2.0±1.1 mg/dL versus 0.0±0.8 mg/dL per year, P<0.01 and tended to show a higher rate of achieving target uric acid levels (50% versus 24%; odds ratio 3.17 [95% confidence interval 0.96–10.5], P=0.08 than the NFX group. Although baseline allograft estimated glomerular filtration rates tended to be lower in the FX group than in the NFX group (40±14 mL/min/1.73 m2 versus 47±19 mL/min/1.73 m2

  3. Effect of Dietary Intake of Stable Iodine on Dose-per-unit-intake Factors for 99Tc

    Energy Technology Data Exchange (ETDEWEB)

    Strom, Daniel J.

    2003-09-30

    of stable iodine in the diet on the dose per unit intake factors for 99Tc without developing an improved biokinetic model for technetium. Specific experiments should be designed to quantitatively evaluate 99TcO4? metabolism, excretion, and secretion, as well as to evaluate its chemical toxicity It is recommended that the ICRP reexamine its biokinetics models for Tc based on nuclear medicine data that have accumulated over the years. In particular, the ICRP ignores the lactation pathway, the enhanced concentration of Tc in breast and breast milk, and enhanced concentration of Tc (and I) in the salivary glands as well as in the thyroid. The ICRP should also explicitly incorporate the effect of stable iodine in the diet into both its models for iodine and technetium. The effect of concentration of Tc in breast milk needs further study for dosimetric implications to nursing infants whose mothers may ingest 99TcO4? from groundwater sources. The ICRP should also investigate the possibility of enhanced concentration of both I and Tc in the non-lactating female breast. To do these re-evaluations of biokinetic models, new experiments designed specifically to evaluate these questions concerning the biokinetics of Tc and I are needed.

  4. Who benefits from treatment and rehabilitation in a stroke Unit?

    DEFF Research Database (Denmark)

    Jorgensen, H S; Kammersgaard, L P; Houth, J

    2000-01-01

    The beneficial effects of treatment and rehabilitation of patients with acute stroke in a dedicated stroke unit (SU) are well established. We wanted to examine if these effects are limited to certain groups of patients or if they apply to all patients independent of age, sex, comorbidity, and ini...

  5. Who benefits from treatment and rehabilitation in a stroke Unit?

    DEFF Research Database (Denmark)

    Jorgensen, H S; Kammersgaard, L P; Houth, J

    2000-01-01

    The beneficial effects of treatment and rehabilitation of patients with acute stroke in a dedicated stroke unit (SU) are well established. We wanted to examine if these effects are limited to certain groups of patients or if they apply to all patients independent of age, sex, comorbidity......, and initial stroke severity....

  6. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P. van den Heuvel; F. Unger (Felix); R. Beyar; W.K. Lindeboom (Wietze); V. de Valk (Vincent); S. Milo; R. Simon (Rudiger); G.F.O. Tyers (Frank); D. Regensburger; P.A. Crean (Peter); I.M. Penn (Ian); E. McGovern; C. van Cauwelaert; P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the

  7. Stroke treatment outcomes in hospitals with and without Stroke Units.

    Science.gov (United States)

    Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

    2017-10-23

    Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Stable Isotope and Isotopomeric Constraints on Nitrous Oxide Production in a Wastewater Treatment Plant

    Science.gov (United States)

    Bellucci, F.; Gonzalez-Meler, M. A.; Sturchio, N. C.; Bohlke, J. K.; Ostrom, N. E.; Kozak, J. A.

    2011-12-01

    Estimates of US anthropogenic greenhouse gas emissions by USEPA (Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1990-2009; 2011) indicate that wastewater treatment plants are the 7th highest contributor to atmospheric nitrous oxide. This unregulated gas has an estimated global warming potential (GWP) 310 times that of carbon dioxide on a per mol basis. There is general agreement that, within wastewater treatment plants, the vast majority of the nitrous oxide emissions occur in the aerobic zones for biological ammonia oxidation and/or downstream from anoxic zones used in biological nitrogen removal. However, the exact mechanism of production is not well understood, as both incomplete nitrification and denitrification might contribute to the overall nitrous oxide emissions. Determining the dominant biological pathways responsible for these emissions is important for the development of improved treatment systems that can reduce nitrous oxide greenhouse gas emissions to the atmosphere. In this study, we determined the total nitrous oxide flux from a single tank of one of the aeration basins from a large metropolitan wastewater treatment plant in Stickney, Illinois. Furthermore, we analyzed the changes in nitrogen and oxigen stable isotopic composition for ammonium, nitrate, and nitrous oxide, as well as the intramolecular site preference (SP) for δ15N within the linear N-N-O molecule, along the 520 meter wastewater flow path within the tank. Assuming the measured tank was representative of the 32 tanks constituting the 4 aeration basins of the plant, we estimate the combined annual nitrous oxide flux from this source to be approximately 230 metric ton/y. The δ15N values for ammonium ranged between +19.9% and +6.4%, those for nitrate ranged between +20.4% and +5.3%, and those for nitrous oxide ranged between -34.4% and 0.4%. The nitrous oxide SP ranged between +11.7% and -4.5%. The concentrations and δ15N values of ammonium and nitrate showed trends along the

  9. Evaluation of treatment response to autologous transplantation of noncultured melanocyte/keratinocyte cell suspension in patients with stable vitiligo.

    Science.gov (United States)

    Ramos, Mariana Gontijo; Ramos, Daniel Gontijo; Ramos, Camila Gontijo

    2017-01-01

    Vitiligo is a chronic disease characterized by the appearance of achromic macules caused by melanocyte destruction. Surgical treatments with melanocyte transplantation can be used for stable vitiligo cases. To evaluate treatment response to the autologous transplantation of noncultured epidermal cell suspension in patients with stable vitiligo. Case series study in patients with stable vitiligo submitted to noncultured epidermal cell suspension transplantation and evaluated at least once, between 3 and 6 months after the procedure, to observe repigmentation and possible adverse effects. The maximum follow-up period for some patients was 24 months. Of the 20 patients who underwent 24 procedures, 25% showed an excellent rate of repigmentation, 50% good repigmentation, 15% regular, and 10% poor response. The best results were observed in face and neck lesions, while the worst in extremity lesions (88% and 33% of satisfactory responses, respectively). Patients with segmental vitiligo had a better response (84%) compared to non-segmental ones (63%). As side effects were observed hyperpigmentation of the treated area and the appearance of Koebner phenomenon in the donor area. Some limitations of the study included the small number of patients, a subjective evaluation, and the lack of long-term follow-up on the results. CONCLUSION: Noncultured epidermal cell suspension transplantation is efficient and well tolerated for stable vitiligo treatment, especially for segmental vitiligo on the face and neck.

  10. Statin treatment prevents increased cardiovascular and all-cause mortality associated with clarithromycin in patients with stable coronary heart disease

    DEFF Research Database (Denmark)

    Jensen, Gorm B; Hilden, Jørgen; Als-Nielsen, Bodil

    2010-01-01

    In the CLARICOR trial, significantly increased cardiovascular (CV) and all-cause mortality in stable patients with coronary heart disease were observed after a short course of clarithromycin. We report on the impact of statin treatment at entry on the CV and all-cause mortality. The multicenter...... CLARICOR trial randomized patients to oral clarithromycin (500 mg daily; n = 2172) versus matching placebo (daily; n = 2201) for 2 weeks. Patients were followed through public databases. In the 41% patients on statin treatment at entry, no significant effect of clarithromycin was observed on CV (hazard.......0003; statin-clarithromycin interaction P = 0.0029) and all-cause mortality (HR, 1.33; 95% CI, 1.05-1.67; P = 0.016; statin-clarithromycin interaction P = 0.41). Multivariate analysis and 6-year follow up confirmed these results. Concomitant statin treatment in stable patients with coronary heart disease...

  11. Study on the Development of Household Wastewater Treatment Unit

    Directory of Open Access Journals (Sweden)

    Ali Hadi Ghawi

    2018-03-01

    Full Text Available The cities of Iraq in general and the city of Al Diwaniyah in particular are characterized by the fact that the majority of households use septic tank to dispose of sewage, leading to contamination of ground and surface water and a disturbance to the environment. The objective of this study is to protect the water and soil sources from the risk of pollution, eliminate the process of perfusion and thus, reduce costs, maintain public health, as well as design and implement the proposed purification unit for domestic wastewater treatment. A domestic wastewater treatment unit has been improved to meet the standard specifications for the quality of the effluent wastewater. In this study, a compact non-electric sewage treatment unit was improved and implemented. Treatment is based on an effective modern biological purification process. Experimental verification and analysis of results were performed to demonstrate the improvement of physical and chemical parameters. The performance of the septic tanks-bioreactor gave satisfactory results. The removal efficiencies of Total Biochemical Oxygen Demand (BOD, Total Chemical Oxygen Demand (COD, NH4-N, Total Nitrogen and Total Suspended Solid (TSS were 96.9%, 84.6%, 78.8%, 79.9% and 95.3%, respectively.

  12. Meta-analysis of acupuncture therapy for the treatment of stable angina pectoris.

    Science.gov (United States)

    Zhang, Ze; Chen, Min; Zhang, Li; Zhang, Zhe; Wu, Wensheng; Liu, Jun; Yan, Jun; Yang, Guanlin

    2015-01-01

    Angina pectoris is a common symptom imperiling patients' life quality. The aim of this study is to evaluate the efficacy and safety of acupuncture for stable angina pectoris. Clinical randomized-controlled trials (RCTs) comparing the efficacy of acupuncture to conventional drugs in patients with stable angina pectoris were searched using the following database of PubMed, Medline, Wanfang and CNKI. Overall odds ratio (ORs) and weighted mean difference (MD) with their 95% confidence intervals (CI) were calculated by using fixed- or random-effect models depending on the heterogeneity of the included trials. Total 8 RCTs, including 640 angina pectoris cases with 372 patients received acupuncture therapy and 268 patients received conventional drugs, were included. Overall, our result showed that acupuncture significantly increased the clinical curative effects in the relief of angina symptoms (OR=2.89, 95% CI=1.87-4.47, Pacupuncture therapy was superior to conventional drugs. Although there was no significant difference in overall effective rate relating reduction of nitroglycerin between two groups (OR=2.13, 95% CI=0.90-5.07, P=0.09), a significant reduction on nitroglycerin consumption in acupuncture group was found (MD=-0.44, 95% CI=-0.64, -0.24, Pacupuncture therapy than for traditional medicines (MD=2.44, 95% CI=1.64-3.24, Pacupuncture therapy were found. Acupuncture may be an effective therapy for stable angina pectoris. More clinical trials are needed to systematically assess the role of acupuncture in angina pectoris.

  13. Surface treatment of silica nanoparticles for stable and charge-controlled colloidal silica

    Science.gov (United States)

    Kim, Kyoung-Min; Kim, Hye Min; Lee, Won-Jae; Lee, Chang-Woo; Kim, Tae-il; Lee, Jong-Kwon; Jeong, Jayoung; Paek, Seung-Min; Oh, Jae-Min

    2014-01-01

    An attempt was made to control the surface charge of colloidal silica nanoparticles with 20 nm and 100 nm diameters. Untreated silica nanoparticles were determined to be highly negatively charged and have stable hydrodynamic sizes in a wide pH range. To change the surface to a positively charged form, various coating agents, such as amine containing molecules, multivalent metal cation, or amino acids, were used to treat the colloidal silica nanoparticles. Molecules with chelating amine sites were determined to have high affinity with the silica surface to make agglomerations or gel-like networks. Amino acid coatings resulted in relatively stable silica colloids with a modified surface charge. Three amino acid moiety coatings (L-serine, L-histidine, and L-arginine) exhibited surface charge modifying efficacy of L-histidine > L-arginine > L-serine and hydrodynamic size preservation efficacy of L-serine > L-arginine > L-histidine. The time dependent change in L-arginine coated colloidal silica was investigated by measuring the pattern of the backscattered light in a Turbiscan™. The results indicated that both the 20 nm and 100 nm L-arginine coated silica samples were fairly stable in terms of colloidal homogeneity, showing only slight coalescence and sedimentation. PMID:25565824

  14. [Elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm fractures in the child: about 87 cases].

    Science.gov (United States)

    Andaloussi, Saad; Amine Oukhouya, Mohamed; Alaoui, Othmane; Atarraf, Karima; Chater, Lamiae; Afifi, My Abderrahmane

    2017-01-01

    This study aims to describe the complications of elastic stable intramedullary nailing (ESIN) in the treatment of both-bone forearm diaphyseal fractures in the child. Between January 2009 and December 2013, 87 children with both-bone forearm diaphyseal fractures were treated by elastic stable intramedullary nailing with Métaizeau nails. 76 boys and 11 girls, with an average age of 12 years, were enrolled in the study. Nailing was promptly performed in 50 cases and after secondary displacement during plaster-cast treatment in the other cases. Both bones were nailed in all cases. All patients underwent systematic plaster immobilization for a period of about one month. On average, nails were removed after about 6 months. Functional outcomes were studied over a mean follow-up period of 10 months. Complications were marked by 14 superficial infections (14 cases), osteitis associated with material (2 cases), refracture (3 cases), pseudarthrosis (3 cases), delayed fracture consolidation (2 cases) and proximal radioulnar synostosis (1 case). Although intramedullary nailing ideally is an osteosynthesis technique suitable for the treatment of fractures in children, it is more invasive than orthopaedic treatment.Indications for treatment should remain within well-established limits.

  15. Outcome with invasive versus medical treatment of stable coronary artery disease

    DEFF Research Database (Denmark)

    Simonsen, Jane A; Johansen, Allan; Gerke, Oke

    2016-01-01

    AIMS: Our aim was to address the combined influence of myocardial perfusion defects and left ventricular ejection fraction (LVEF) on outcome with coronary revascularisation in stable CAD patients. METHODS AND RESULTS: Of 527 patients with ischaemia by myocardial perfusion scintigraphy, 343 had...... the effect of large compared to small/moderate defects vanished when adjusted for LVEF and ischaemia (HR=1.01, p=0.99). Considering the outcome difference as a function of both LVEF and ischaemia, we found no advantage or even a disadvantage of revascularisation in patients with mild/moderate ischaemia...

  16. Treatment of stable and recalcitrant depigmented skin conditions by autologous punch grafting

    Directory of Open Access Journals (Sweden)

    Lahiri Koushik

    1997-01-01

    Full Text Available Sixty cases of stable and refractory depigmented skin conditions which include local vitiligo, segmental vitiligo, chemical leucoderma, vitiligo vulgaris, post-burn depigmentation etc constitute the study group. 39 of them were female and 21 male. Age ranged between 6 and 67 years. 1057 grafts were placed over 114 lesions and the cases were followed up to a period of 18 months. 70% to 100% repigmentation was observed in 56 lesions of 31 patients. Rate and extent of perigraft pigment spread was noted. Patients under PUVASOL showed a distinctly better response. Sequelae like cobble-stoning and polka-dotting were found to be disappearing with time or interference.

  17. Cost-of-treatment of clinically stable severe mental lilnesses in India

    Directory of Open Access Journals (Sweden)

    Siddharth Sarkar

    2017-01-01

    Full Text Available Background and Aims: The cost-of-treatment studies can help to make informed decisions while planning health-care services. This study is aimed to assess direct costs of outpatient treatment of four common chronic severe mental illnesses in a tertiary care hospital in South India. Methods: The patients with ICD-10 diagnoses of schizophrenia, unspecified nonorganic psychosis, bipolar disorder, and recurrent depression were recruited by purposive sampling from a government teaching hospital in South India. The total cost-of-treatment to the patient and the hospital was computed for each disorder as a percentage of the per-capita income of an individual patient. Results: The study comprised a total of 140 patients. The average monthly total cost-of-treatment was Indian Rupees (INR 770 (95% confidence interval of 725 to 815, or approximately US$ 12.8. The monthly total cost-of-treatment was INR 720 for schizophrenia, INR 750 for unspecified nonorganic psychosis, INR 830 for bipolar disorder, and INR 790 for recurrent depression, with no significant differences between groups. On an average, 22.8% of total cost-of-treatment was borne by the patient, and the rest by the hospital. The patients spent a median of 12% of their per-capita income on treatment related to direct costs. Conclusions: Despite substantial government subsidies, patients do incur some expenses in treatment of chronic psychiatric illnesses. The attempts to reduce treatment and travel costs can facilitate psychiatric care to larger number of individuals.

  18. Impact of contamination and pre-treatment on stable carbon and nitrogen isotopic composition of charred plant remains.

    Science.gov (United States)

    Vaiglova, Petra; Snoeck, Christophe; Nitsch, Erika; Bogaard, Amy; Lee-Thorp, Julia

    2014-12-15

    Stable isotope analysis of archaeological charred plants has become a useful tool for interpreting past agricultural practices and refining ancient dietary reconstruction. Charred material that lay buried in soil for millennia, however, is susceptible to various kinds of contamination, whose impact on the grain/seed isotopic composition is poorly understood. Pre-treatment protocols have been adapted in distinct forms from radiocarbon dating, but insufficient research has been carried out on evaluating their effectiveness and necessity for stable carbon and nitrogen isotope analysis. The effects of previously used pre-treatment protocols on the isotopic composition of archaeological and modern sets of samples were investigated. An archaeological sample was also artificially contaminated with carbonates, nitrates and humic acid and subjected to treatment aimed at removing the introduced contamination. The presence and removal of the contamination were investigated using Fourier transform infrared spectroscopy (FTIR) and δ(13)C and δ(15)N values. The results show a ca 1‰ decrease in the δ(15)N values of archaeological charred plant material caused by harsh acid treatments and ultra-sonication. This change is interpreted as being caused by mechanical distortion of the grains/seeds rather than by the removal of contamination. Furthermore, specific infrared peaks have been identified that can be used to detect the three types of contaminants studied. We argue that it is not necessary to try to remove humic acid contamination for stable isotope analysis. The advantages and disadvantages of crushing the grains/seeds before pre-treatment are discussed. We recommend the use of an acid-only procedure (0.5 M HCl for 30 min at 80 °C followed by three rinses in distilled water) for cleaning charred plant remains. This study fills an important gap in plant stable isotope research that will enable future researchers to evaluate potential sources of isotopic change and pre

  19. Analysis and Design of a Permanent Magnet Bi-Stable Electro-Magnetic Clutch Unit for In-Wheel Electric Vehicle Drives

    OpenAIRE

    Wanli Cai; Chenglin Gu; Xiaodong Hu

    2015-01-01

    Clutches have been used in internal combustion vehicles and concentrated electric vehicles (EVs) to smoothen impulsion while starting and shifting. This paper proposes a permanent magnet bi-stable electromagnetic clutch unit (PMBECU) which is specially introduced into in-wheel EVs to make the rigid connection between hub and wheel more flexible. Firstly, the operation principle of the PMBECU is illustrated. Then, the basic magnetic circuit model is presented and analyzed, followed by optimal ...

  20. Treatment of symptomatic macromastia in a breast unit

    Directory of Open Access Journals (Sweden)

    Schneider José

    2010-11-01

    Full Text Available Abstract Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28% presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy

  1. Treatment of symptomatic macromastia in a breast unit

    Science.gov (United States)

    2010-01-01

    Background Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. Methods A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. Results Eight patients (14.28%) presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. Conclusion Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it posssible to perform oncoplastic breast conserving surgery. In our opinion, this management policy could bring clear advantages

  2. Eye injury treatment in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    L. K. Moshetova

    2015-01-01

    Full Text Available Aim. To describe eye injuries in intensive care unit (ICU patients with multitrauma, to study conjunctival microflora in these patients, and to develop etiologically and pathogenically targeted treatment and prevention of wound complications.Materials and methods. Study group included 50 patients (54 eyes with combined mechanical cerebral and eye injury. All patients underwent possible ophthalmological examination (biomicroscopy, ophthalmoscopy and ocular fundus photographing with portative fundus camera, tonometry, cranial CT and MRT, and bacteriological study of conjunctival smears. Results. Modern methods of ophthalmological examination of ICU patients provided correct diagnosis and prediction of wound healing. Eye injury treatment schedule provided maximum possible results in all ICU patients. Hospitalacquired infection results in asymptomatic dissemination of pathogenic microbes on ocular surface. Conclusions. 14-day topical treatment with antimicrobials, steroids, and NSAIDs reduces posttraumatic inflammation caused by mechanical eye injuries in ICU patients. Bacteriological studies of conjunctival smears demonstrate the presence of pathogenic flora in ICU patients. In these patients, the most effective antibacterial agents are third-generation fluoroquinolones. 

  3. Enhancing the ecological and operational characteristics of water treatment units at TPPs based on baromembrane technologies

    Science.gov (United States)

    Chichirova, N. D.; Chichirov, A. A.; Filimonova, A. A.; Saitov, S. R.

    2017-12-01

    The innovative baromembrane technologies for water demineralization were introduced at Russian TPPs more than 25 years ago. While being used in the power engineering industry of Russia, these technologies demonstrated certain advantages over the traditional ion-exchange and thermal technologies of makeup water treatment for steam boilers. Water treatment units based on the baromembrane technology are compact, easy to operate, and highly automated. The experience gained from the use of these units shows that their reliability depends directly on preliminary water treatment. The popular water pretreatment technology with coagulation by aluminum oxychloride proved to be inefficient during the seasonal changes of source water quality that occurs at some stations. The use of aluminum coagulant at pH 8 and higher does not ensure the stable and qualitative pretreatment regime: soluble aluminum forms slip on membranes of the ultrafiltration unit, thereby causing pollution and intoxication as well as leading to structural damages or worsening of mechanical properties of the membranes. The problem of increased pH and seasonal changes of the source water quality can be solved by substitution of the traditional coagulant into a new one. To find the most successful coagulant for water pretreatment, experiments have been performed on both qualitative and quantitative analysis of the content of natural organic matters in the Volga water and their structure. We have developed a software program and measured the concentrations of soluble aluminum and iron salts at different pH values of the source water. The analysis of the obtained results has indicated that iron sulfate at pH 6.0-10.2, in contrast to aluminum oxychloride, is not characterized by increased solubility. Thus, the basic process diagrams of water pretreatment based on baromembrane technologies with pretreatment through coagulation by iron salts and wastewater amount reducing from 60-40 to 5-2% have been introduced for

  4. Displaced Tibial Shaft Fractures With Intact Fibula in Children: Nonoperative Management Versus Operative Treatment With Elastic Stable Intramedullary Nailing.

    Science.gov (United States)

    Canavese, Federico; Botnari, Alexei; Andreacchio, Antonio; Marengo, Lorenza; Samba, Antoine; Dimeglio, Alain; Pereira, Bruno; Mansour, Mounira; Rousset, Marie

    2016-01-01

    The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced tibial shaft fractures with intact fibula in children after nonoperative management and operative treatment by elastic stable intramedullary nailing. A study was performed on 80 consecutive children, 56 males, 24 females from 2 Institutions, with displaced and closed tibial shaft fracture with intact fibula. All patients underwent regular clinical and radiographic follow-up visits for at least 2 years after injury. In total, 26 patients (group A-Institution I) were treated surgically by elastic stable intramedullary nailing and 54 patients (18 patients from group B-Institution I and 36 patients from group C-Institution II) were treated nonoperatively with closed reduction and casting. groups A, B, and C did not significantly differ on sex (P=0.37), side (P=0.54), and fracture site (P=0.14).Valgus deformity was significantly controlled in group A patients only (P=0.001); during follow-up in group B patients (P=0.017), and showed no significant change between pretreatment images and last follow-up in group C patients (P=0.71). Procurvatum deformity was significantly controlled in group A patients only (P=0.001); it showed no significant improvement after conservative treatment in group B (P=0.73) and C patients (P=0.8). Recurvatum was significantly improved in group A (Pfracture of tibial diaphysis without associated fibula fracture.On the basis of the findings reported here, it is not contraindicated to operate skeletally immature patients with displaced fracture of tibial diaphysis without associated fibula fracture. However, results were essentially the same and either method is a satisfactory choice for pediatric tibia shaft fractures with an intact fibula. In particular, we found that conservative treatment was as efficacious as surgical treatment apart from the length of time for immobilization. Level III.

  5. Chip Scale Ultra-Stable Clocks: Miniaturized Phonon Trap Timing Units for PNT of CubeSats

    Science.gov (United States)

    Rais-Zadeh, Mina; Altunc, Serhat; Hunter, Roger C.; Petro, Andrew

    2016-01-01

    The Chip Scale Ultra-Stable Clocks (CSUSC) project aims to provide a superior alternative to current solutions for low size, weight, and power timing devices. Currently available quartz-based clocks have problems adjusting to the high temperature and extreme acceleration found in space applications, especially when scaled down to match small spacecraft size, weight, and power requirements. The CSUSC project aims to utilize dual-mode resonators on an ovenized platform to achieve the exceptional temperature stability required for these systems. The dual-mode architecture utilizes a temperature sensitive and temperature stable mode simultaneously driven on the same device volume to eliminate ovenization error while maintaining extremely high performance. Using this technology it is possible to achieve parts-per-billion (ppb) levels of temperature stability with multiple orders of magnitude smaller size, weight, and power.

  6. [Treatment of Tibial Shaft Fractures with the Stable Angle Tibial Nail Targon TX].

    Science.gov (United States)

    Chmielnicki, M; Prokop, A

    2016-10-01

    Tibial shaft fractures are among the most common long bone fractures in humans. The incidence is 1-2 per 100,000. The gold standard of treatment for AO type 42 A-C fractures is a locking intramedullary nail. The development of new implants has extended the indications for this minimally invasive technique, so that now AO types 41 and 43 can also be treated with special nails. Fixed-angle screw anchors increase primary stability and supplemental locking devices located proximally and distally extend the spectrum of use to metaphyseal fractures. The cannulated Targon TX titanium nail can be introduced, either with or without reaming. Using an operative video, the treatment of a tibial fracture with an intramedullary nail is demonstrated in stages and the operative steps further illustrated on artificial bone. Georg Thieme Verlag KG Stuttgart · New York.

  7. Integrated Waste Treatment Unit GFSI Risk Management Plan

    Energy Technology Data Exchange (ETDEWEB)

    W. A. Owca

    2007-06-21

    This GFSI Risk Management Plan (RMP) describes the strategy for assessing and managing project risks for the Integrated Waste Treatment Unit (IWTU) that are specifically within the control and purview of the U.S. Department of Energy (DOE), and identifies the risks that formed the basis for the DOE contingency included in the performance baseline. DOE-held contingency is required to cover cost and schedule impacts of DOE activities. Prior to approval of the performance baseline (Critical Decision-2) project cost contingency was evaluated during a joint meeting of the Contractor Management Team and the Integrated Project Team for both contractor and DOE risks to schedule and cost. At that time, the contractor cost and schedule risk value was $41.3M and the DOE cost and schedule risk contingency value is $39.0M. The contractor cost and schedule risk value of $41.3M was retained in the performance baseline as the contractor's management reserve for risk contingency. The DOE cost and schedule risk value of $39.0M has been retained in the performance baseline as the DOE Contingency. The performance baseline for the project was approved in December 2006 (Garman 2006). The project will continue to manage to the performance baseline and change control thresholds identified in PLN-1963, ''Idaho Cleanup Project Sodium-Bearing Waste Treatment Project Execution Plan'' (PEP).

  8. Integrated Waste Treatment Unit GFSI Risk Management Plan

    International Nuclear Information System (INIS)

    W. A. Owca

    2007-01-01

    This GFSI Risk Management Plan (RMP) describes the strategy for assessing and managing project risks for the Integrated Waste Treatment Unit (IWTU) that are specifically within the control and purview of the U.S. Department of Energy (DOE), and identifies the risks that formed the basis for the DOE contingency included in the performance baseline. DOE-held contingency is required to cover cost and schedule impacts of DOE activities. Prior to approval of the performance baseline (Critical Decision-2) project cost contingency was evaluated during a joint meeting of the Contractor Management Team and the Integrated Project Team for both contractor and DOE risks to schedule and cost. At that time, the contractor cost and schedule risk value was $41.3M and the DOE cost and schedule risk contingency value is $39.0M. The contractor cost and schedule risk value of $41.3M was retained in the performance baseline as the contractor's management reserve for risk contingency. The DOE cost and schedule risk value of $39.0M has been retained in the performance baseline as the DOE Contingency. The performance baseline for the project was approved in December 2006 (Garman 2006). The project will continue to manage to the performance baseline and change control thresholds identified in PLN-1963, ''Idaho Cleanup Project Sodium-Bearing Waste Treatment Project Execution Plan'' (PEP)

  9. Acute ethanol treatment upregulates th1, th2 and hdc in larval zebrafish in stable networks

    Directory of Open Access Journals (Sweden)

    Henri ePuttonen

    2013-05-01

    Full Text Available Earlier studies in zebrafish have revealed that acutely given ethanol has a stimulatory effect on locomotion in fish larvae but the mechanism of this effect has not been revealed. We studied the effects of ethanol concentrations between 0.75% and 3.00% on 7-day-old larval zebrafish (Danio rerio of the Turku strain. At 0.75-3% concentrations ethanol increased swimming speed during the first minute. At 3% the swimming speed decreased rapidly after the first minute, whereas at 0.75 and 1.5% a prolonged increase in swimming speed was seen. At the highest ethanol concentration dopamine levels decreased significantly after a 10-min treatment. We found that ethanol upregulates key genes involved in the biosynthesis of histamine (hdc and dopamine (th1 and th2 following a short 10-min ethanol treatment, measured by qPCR. Using in situ hybridisation and immunohistochemistry, we further discovered that the morphology of the histaminergic and dopaminergic neurons and networks in the larval zebrafish brain was unaffected by both the 10-min and a longer 30-min treatment. The results suggest that acute ethanol rapidly decreases dopamine levels, and activates both forms or th to replenish the dopamine stores within 30 minutes. The dynamic changes in histaminergic and dopaminergic system enzymes occured in the same cells which normally express the transcripts. As both dopamine and histamine are known to be involved in the behavioural effects of ethanol and locomotor stimulation, these results suggest that rapid adaptations of these networks are associated with altered locomotor activity.

  10. Metabolic therapy in the comprehensive treatment of patients with comorbidity of chronic pancreatitis and stable coronary artery disease

    Directory of Open Access Journals (Sweden)

    L.S. Babinets

    2017-02-01

    Full Text Available Metabolic therapy is one of the few ways to restore normal functions of all the vital organs and systems. The goal of the research was to explore the effectiveness of a course of treatment using metabolic drug Vazonat (meldonium dihydrate to correct prooxidant-antioxidant and trophological disorders in patients with comorbid course of chronic pancreatitis (CP and stable coronary artery disease (SCAD. The study included 90 patients with CP in combination with SCAD, who were divided into two groups (depending on the treatment program: I group (45 patients received conventional treatment (CT; group II (45 patients in addition to CT received Vazonat as follows: 5 ml intravenous bolus injection 1 time a day for 10 days followed by administration of 1 capsule (250 mg, 2 times per day for one month. It has been shown that the addition of Vazonat to the treatment of patients with comorbidity of CP and SCAD is more conducive to improving the performance and trophological prooxidant-antioxidant status than the standard basic therapy.

  11. Fan the flame: trazodone-induced mania in a unipolar depressed patient with stable sertraline treatment

    Directory of Open Access Journals (Sweden)

    Hu JB

    2017-08-01

    Full Text Available Jianbo Hu,1,2,* Jianbo Lai,1,2,* Hanzhi Zheng,3 Shaohua Hu,1,2 Yi Xu1,2 1Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; 2The Key Laboratory of Mental Disorder’s Management in Zhejiang Province, Hangzhou, China; 3Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China *These authors contributed equally to this work Abstract: Depressed patients often complain of sleep disturbance. Routine antidepressive strategies sometimes fail to deal with this intractable issue. Indeed, the supplementation of sleep promoting antidepressants (eg, trazodone, mirtazapine, and agomelatine is prevalent in clinical practice. However, the combination of different antidepressants may increase the affective lability. Herein, we document a patient with unipolar depression who was compliant with sertraline treatment and who dramatically switched to mania after adding trazodone as a sleeping aid. This case extended our understanding of the potential manic-switching risk when trazodone is used to promote sleep. Keywords: trazodone, sertraline, depression, mania

  12. THE ROLE OF FOLLICULAR UNIT GRAFTING IN TREATMENT ALOPECIA

    Directory of Open Access Journals (Sweden)

    Duhita Ayuningtyas

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Alopecia is usually treatable and self-limited, but it may be permanent. Careful diagnosis of the type of hair loss will aid in selecting effective treatment. Many drugs used to treat alopecia, but in many people not satisfied with the result. One of the treatment currently used to treat alopecia is hair transplantation with follicular unit grafting (FUG. The advantages of hair transplantation is to create a natural appearance, one that mimics natural hair growth both in terms of numbers and pattern /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  13. Interprosthetic femoral fractures: Treatment with a lateral angular-stable plate.

    Science.gov (United States)

    Albareda, J; Gómez, J; Ezquerra, L; Blanco, N

    To study the causes and outcomes of patients with interprosthetic femoral fractures. A retrospective review conducted on 7 patients treated between 2010 and 2013. The knee arthroplasties had been implanted for at least 5 years, and those of the hip less than a year. They were bipolar cemented in 6 patients and totally non-cemented in one patient, all of them implanted due to a displaced femoral neck fracture. They were treated using osteosynthesis with angular stability plate covering the whole interprosthetic femoral segment. Except for one patient, all have been reviewed at least 12 months. The patients included 6 women and one man, with a mean age of 84.7. The fracture, always by low energy, occurred between 2 and 8 months after that of the hip without the implants being mobilized. Four of them were located at diaphyseal level, and 3 at supracondylar level, and unrelated to the type of knee implant. There was consolidation in all patients at a mean of 4.5 months, without a re-operation in any of them, and with no mortality during the follow-up period. All patients walked independently at the time of the fracture, and all of them have managed to return to walking independently, having lost as average 20° of knee flexion in cases of supracondylar fracture. The most important factors in our patients regarding the producing of the fracture have been the changes in the ability to walk after knee replacement and bone fragility. Angular stability plates give good results in the treatment of interprosthetic femoral fractures. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. [Treatment of complex hand injuries by stable osteosynthesis using a "multiple pinning" technique].

    Science.gov (United States)

    Le Nen, D; Hu, W; Genestet, M; Liot, M; Tran Quan, J; Dos Remédios, C; Mener, G

    2004-04-01

    The multiple pinning technique has been reported by the authors as an effective method for the treatment of comminuted osteo-articular fractures of the digits. This procedure can be performed rapidly, offers good stability and thereby allows early post-operative physiotherapy. The aim of this type of management is to offer the patient recovery of thumb to digit pinch by restoring two functional joints (MCP, PIP) or at least one functional joint (MCP), particularly as far as the radial digits are concerned. After performing reduction, very small diameter pins are introduced and the bone fragments are reconstructed like a puzzle. The very small calibre of the pins allows multiple pinning and simultaneously permits them to be easily orientated. The pins being multiple, and parallel or diverging are responsible for the stability of the construct. The ends of the pins are either bent over or more frequently, just cut flush with the surface of the bone. Comminuted fractures, even the most severe, respond very nicely to this management. The multiple pinning technique offers remarkable stability, allowing early post-operative physiotherapy. This technique is particularly effective when faced with the difficulties of treating open fractures of the metacarpals and phalanges. Moreover, this technique avoids performing an extensive skin incision. The stability of this multiple pinning technique could be related to the following factors: the shortness of the pins offering more rigidity and less flexibility, the proper fixation of the pins within the cortical bone, especially in the diaphysis and the large number of pins offering more strength. The disadvantage of this technique is the possibility of pin migration.

  15. Transport of Pathogen Surrogates in Soil Treatment Units: Numerical Modeling

    Directory of Open Access Journals (Sweden)

    Ivan Morales

    2014-04-01

    Full Text Available Segmented mesocosms (n = 3 packed with sand, sandy loam or clay loam soil were used to determine the effect of soil texture and depth on transport of two septic tank effluent (STE-borne microbial pathogen surrogates—green fluorescent protein-labeled E. coli (GFPE and MS-2 coliphage—in soil treatment units. HYDRUS 2D/3D software was used to model the transport of these microbes from the infiltrative surface. Mesocosms were spiked with GFPE and MS-2 coliphage at 105 cfu/mL STE and 105–106 pfu/mL STE, respectively. In all soils, removal rates were >99.99% at 25 cm. The transport simulation compared (1 optimization; and (2 trial-and-error modeling approaches. Only slight differences between the transport parameters were observed between these approaches. Treating both the die-off rates and attachment/detachment rates as variables resulted in an overall better model fit, particularly for the tailing phase of the experiments. Independent of the fitting procedure, attachment rates computed by the model were higher in sandy and sandy loam soils than clay, which was attributed to unsaturated flow conditions at lower water content in the coarser-textured soils. Early breakthrough of the bacteria and virus indicated the presence of preferential flow in the system in the structured clay loam soil, resulting in faster movement of water and microbes through the soil relative to a conservative tracer (bromide.

  16. Cervical vertebrae maturation, dentoalveolar, head postural and respiratory parameters in predicting the stable outcome of face-mask treatment.

    Science.gov (United States)

    Lee, Kwang-Min; Chung, Dong-Hwa; Lee, Jin-Woo; Lee, Sang-Min

    2015-06-01

    To select predictors related to cervical vertebrae maturation (CVM), dentoalveolar adaptation, head posture, and respiration on outcome of face-mask treatment. Forty-six patients (24 boys and 22 girls) with skeletal Class III pattern whose CVM stages ranged from I to IV at pretreatment were selected. The observation period was 2.87 ± 1.77 years from the end of treatment. Negative overjet and overbite was regarded as unstable. CVM, 10 skeletal variables, 6 dental adaptation variables, 4 alveolar housing variables, an airway variable, and 2 head posture variables were chosen for discriminant analysis of initial characteristics between stable and unstable groups. Measurements exhibiting strong correlations were distance from lower incisor to Nasion, B point (NB), Frankfort horizontal plane to Mandibular incisor Angle (FMIA), incisor overbite, body to anterior cranial base. We missed muscle-related variables, which cannot be identified in a cephalogram. Presence of non-skeletal cephalometric factors more closely associated with stability of face-mask treatment rather than skeletal cephalometric factors at the initial stage are confirmed. © The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  17. Long-Term Stable Surface Treatments on CdTe and CdZnTe Radiation Detectors

    Science.gov (United States)

    Pekarek, Jakub; Belas, Eduard; Zazvorka, Jakub

    2017-04-01

    The spectral resolution and charge collection efficiency (CCE) of cadmium telluride (CdTe) and cadmium zinc telluride (CZT) room-temperature x-ray and gamma-ray detectors are often limited by high surface leakage current due to conducting surface species created during detector fabrication. Surface treatments play a major role in reduction of this surface leakage current. The effect of various types of surface etching and passivation on the leakage current and thereby the spectral energy resolution, CCE, and internal electric field profile of CdTe/CZT detectors has been studied. The main aim of this work is preparation of long-term stable detectors with strongly reduced leakage current. The time stability of the current-voltage characteristic and spectral resolution was investigated during 21 days and 1 year, respectively, after performing surface treatments. Our results suggest that the optimal detector preparation method is chemomechanical polishing in bromine-ethylene glycol solution followed by chemical etching in bromine-methanol solution then surface passivation in potassium hydroxide or ammonium fluoride (NH4F/H2O2). Detectors prepared using this optimal treatment exhibited low leakage current, high spectral resolution, and long-term stability compared with those subjected to other surface preparation methods.

  18. Using stable isotopes to determine seasonal variations in water uptake of summer maize under different fertilization treatments

    Energy Technology Data Exchange (ETDEWEB)

    Ma, Ying, E-mail: maying@igsnrr.ac.cn [Key Laboratory of Water Cycle and Related Land Surface Processes, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, 100101 Beijing (China); State Key Laboratory of Soil and Sustainable Agriculture, Institute of Soil Science, Chinese Academy of Sciences, 210008 Nanjing (China); Song, Xianfang [Key Laboratory of Water Cycle and Related Land Surface Processes, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, 100101 Beijing (China)

    2016-04-15

    Fertilization and water both affect root water uptake in the nutrient and water cycle of the Soil-Plant-Atmosphere-Continuum (SPAC). In this study, dual stable isotopes (D and {sup 18}O) were used to determine seasonal variations in water uptake patterns of summer maize under different fertilization treatments in Beijing, China during 2013–2014. The contributions of soil water at different depths to water uptake were quantified by the MixSIAR Bayesian mixing model. Water uptake was mainly sourced from soil water in the 0–20 cm depth at the seeding (67.7%), jointing (60.5%), tasseling (47.5%), dough (41.4%), and harvest (43.9%) stages, and the 20–50 cm depth at the milk stage (32.8%). Different levels of fertilization application led to considerable differences in the proportional contribution of soil water at 0–20 cm (6.0–58.5%) and 20–50 cm (6.1–26.3%). There was little difference of contributions in the deep layers (50–200 cm) among treatments in 2013, whereas differences were observed in 50–90 cm at the milk stage and 50–200 cm at the dough stage during 2014. The main water uptake depth was concentrated in the upper soil layers (0–50 cm) during the wet season (2013), whereas a seasonal drought in 2014 promoted the contribution of soil water in deep layers. The contribution of soil water was significantly and positively correlated with the proportions of root length (r = 0.753, p < 0.01). The changes of soil water distribution were consistent with the seasonal variation in water uptake patterns. The present study identified water sources for summer maize under varying fertilization treatments and provided scientific implications for fertilization and irrigation management. - Highlights: • Dual stable isotopes and MixSIAR were coupled to quantify water uptake of maize. • Maize mainly used soil water in 20–50 cm at milk stage and 0–20 cm at other stages. • Fertilization treatments led to distinct water uptake pattern at 0–50 cm

  19. Using stable isotopes to determine seasonal variations in water uptake of summer maize under different fertilization treatments

    International Nuclear Information System (INIS)

    Ma, Ying; Song, Xianfang

    2016-01-01

    Fertilization and water both affect root water uptake in the nutrient and water cycle of the Soil-Plant-Atmosphere-Continuum (SPAC). In this study, dual stable isotopes (D and 18 O) were used to determine seasonal variations in water uptake patterns of summer maize under different fertilization treatments in Beijing, China during 2013–2014. The contributions of soil water at different depths to water uptake were quantified by the MixSIAR Bayesian mixing model. Water uptake was mainly sourced from soil water in the 0–20 cm depth at the seeding (67.7%), jointing (60.5%), tasseling (47.5%), dough (41.4%), and harvest (43.9%) stages, and the 20–50 cm depth at the milk stage (32.8%). Different levels of fertilization application led to considerable differences in the proportional contribution of soil water at 0–20 cm (6.0–58.5%) and 20–50 cm (6.1–26.3%). There was little difference of contributions in the deep layers (50–200 cm) among treatments in 2013, whereas differences were observed in 50–90 cm at the milk stage and 50–200 cm at the dough stage during 2014. The main water uptake depth was concentrated in the upper soil layers (0–50 cm) during the wet season (2013), whereas a seasonal drought in 2014 promoted the contribution of soil water in deep layers. The contribution of soil water was significantly and positively correlated with the proportions of root length (r = 0.753, p < 0.01). The changes of soil water distribution were consistent with the seasonal variation in water uptake patterns. The present study identified water sources for summer maize under varying fertilization treatments and provided scientific implications for fertilization and irrigation management. - Highlights: • Dual stable isotopes and MixSIAR were coupled to quantify water uptake of maize. • Maize mainly used soil water in 20–50 cm at milk stage and 0–20 cm at other stages. • Fertilization treatments led to distinct water uptake pattern at 0–50 cm depth.

  20. Cross-market cost-effectiveness analysis of erlotinib as first-line maintenance treatment for patients with stable non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Vergnenègre A

    2012-01-01

    Full Text Available Alain Vergnenègre1, Joshua A Ray2, Christos Chouaid3, Francesco Grossi4, Helge G Bischoff5, David F Heigener6, Stefan Walzer21Department of Pneumology, Hôpital du Cluzeau, Limoges, France; 2Global Health Economics and Strategic Pricing, F Hoffmann-La Roche Ltd, Basel, Switzerland; 3Respiratory Service, Hôpital Saint Antoine, Paris, France; 4Lung Cancer Unit, National Institute for Cancer Research, Genoa, Italy; 5Thoracic Oncology, Onkologie Thoraxklinik Heidelberg, Heidelberg, Germany; 6Department of Thoracic Oncology, Krankenhaus Großhansdorf, Großhansdorf, GermanyBackground: Platinum-doublet, first-line treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC is limited to 4–6 cycles. An alternative strategy used to prolong the duration of first-line treatment and extend survival in metastatic NSCLC is first-line maintenance therapy. Erlotinib was approved for first-line maintenance in a stable disease population following results from a randomized, controlled Phase III trial comparing erlotinib with best supportive care. We aimed to estimate the incremental cost-effectiveness of erlotinib 150 mg/day versus best supportive care when used as first-line maintenance therapy for patients with locally advanced or metastatic NSCLC and stable disease.Methods: An economic decision model was developed using patient-level data for progression-free survival and overall survival from the SATURN (SequentiAl Tarceva in UnResectable NSCLC study. An area under the curve model was developed; all patients entered the model in the progression-free survival health state and, after each month, moved to progression or death. A time horizon of 5 years was used. The model was conducted from the perspective of national health care payers in France, Germany, and Italy. Probabilistic sensitivity analyses were performed.Results: Treatment with erlotinib in first-line maintenance resulted in a mean life expectancy of 1.39 years in all countries

  1. 77 FR 58470 - Irradiation Treatment; Location of Facilities in the Southern United States; Technical Amendment

    Science.gov (United States)

    2012-09-21

    .... APHIS-2009-0100] RIN 0579-AD35 Irradiation Treatment; Location of Facilities in the Southern United... things, allow for irradiation treatment of mangoes from India upon arrival in the mainland United States... 20, 2012, we amended the regulations in Sec. 319.56-46 to allow for irradiation treatment of mangoes...

  2. 77 FR 42621 - Irradiation Treatment; Location of Facilities in the Southern United States

    Science.gov (United States)

    2012-07-20

    .... APHIS-2009-0100] RIN 0579-AD35 Irradiation Treatment; Location of Facilities in the Southern United... amending the phytosanitary treatment regulations to provide generic criteria for new irradiation treatment facilities in the Southern States of the United States. This action will allow irradiation facilities to be...

  3. Reverse total shoulder versus angular stable plate treatment for proximal humeral fractures in over 65 years old patients.

    Science.gov (United States)

    Giardella, Antonio; Ascione, Francesco; Mocchi, Mattia; Berlusconi, Marco; Romano, Alfonso Maria; Oliva, Francesco; Maradei, Leonardo

    2017-01-01

    Treatment for displaced proximal humeral fractures is still under debate. Poor rotator cuff status and non-union of the tubercles in elderly patients has caused reversed total shoulder prosthesis growing popularity and showed promising results, even in comparison to angular stable plates fixation.The purpose of this study is to report clinical and radiological results of proximal humerus fractures treated with rTSA or ORIF in elderly. The study has investigated retrospectively a consecutive series of 73 patients over 65 years old (range 65-91) with proximal humeral three- and four- parts fractures, operated from January 2009 to June 2014 with a reversed total shoulder prosthetic replacement or open reduction and internal fixation using an angular stable plate, with at least 1 year follow-up. Participants are admitted in our hospital with a displaced proximal humeral fracture according to AO-OTA type 11-B2 or 11-C2.The primary outcomes are active ROM and shoulder function (Constant score). Secondary outcomes have been patient self-assessment form (Simple shoulder test) and radiographical details. Follow-up takes place at the moment of clinical observation with rx control. We analyzed a group of 23 patients treated by plate and screws and 21 patients treated by rTSA with these average results. ORIF: Flexion 112.8°, Abduction 99.6°, External rotation at 90° 47.4°, modal Internal rotation hand at Sacroiliac joint, Constant Score 52.9 and Simple Shoulder Test 8.0. RSA: Flexion 133.3°, Abduction 101.4°, External rotation at 90° of abduction 35.5°, modal Internal rotation hand at waist (L3), Constant Score 65.9 and Simple Shoulder Test 9.2. No nerve injuries were reported. No cases of pseudoarthrosis or plate fractures. No arthroplasty implant loosening, infection or dislocation was documented and revision required. Our study shows good clinical outcomes and fewer complications in both treatment options. Better clinical and daily living results are reported in RSA

  4. Physical activity in treatment units for eating disorders: clinical practice and attitudes.

    Science.gov (United States)

    Bratland-Sanda, S; Rosenvinge, J H; Vrabel, K A R; Norring, C; Sundgot-Borgen, J; Rø, Ø; Martinsen, E W

    2009-01-01

    Physical activity (PA) in eating disorders (ED) may be harmful, but in a therapeutic setting also beneficial. The purpose of this survey was to examine these contradictory aspects of PA in ED specialist treatment settings. We examined whether 1) PA is assessed by the unit, 2) the units have guidelines for managing excessive PA, 3) the units have staff with higher education and special competence in PA and exercise science, 4) how units regard PA in ED, 5) whether regular PA is integrated in the treatment programs, and 6) how the units rate the role of PA in the treatment of ED compared with other mental disorders. Of the 49 units located in Scandinavia and the United Kingdom, 41 (84%) responded to a questionnaire. In 28 units (68%) PA was assessed regularly. Excessive PA was considered a harmful symptom in ED, and most units reported guidelines to manage excessive PA. Thirty-two units included PA in their treatment programmes. Clinicians found PA most relevant in the treatment of obesity and, except for binge eating, less for ED. PA was more commonly integrated in treatment compared to previous studies. Future research should address how to manage excessive PA, and the potential beneficial role of PA in the treatment of ED.

  5. Evaluation of Complience to Treatment and Frequency of Comorbidities in Patients with Stable Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Sami Deniz

    2016-01-01

    Full Text Available Aim: It%u2019s recommended that comorbidities should be treated properly due to effecting on severity of COPD. Purpose: In this study, we aimed to evaluate comorbidity frequencies and compliance to treatment of co-morbid diseases in COPD patients according to their self reported medical history. Material and Method: 339 patients with stable COPD from five different centers were included in the study. Spirometry was performed to all the patients. Body Mass Index (BMI, modified Medical Research Council Dyspnea Score (mMRC and COPD Assessment Tool (CAT were calculated. Patients were questioned about their smoking habit and medical history, including comorbidities as diabetes mellitus (DM, hypertension (HT, and coronary artery disease (CAD. Results: Average age of the study population was 67,5 ± 10,5. Patients were separated into 4 stages of COPD according to predicted forced expiratory volume in one second (FEV1 value and two groups were obtained by combining stage 1 and 2 (group 1; and stage 3 and 4 (group 2. There was statistically significant difference between groups with respect to age (p=0.01. There was not any positive correlation between the frequency of DM, CAD and the stage of COPD, while patients with HT were higher in group 2. Patients were categorized 3 groups in terms of BMI (Group A:

  6. HIV co-receptor tropism prediction remains stable over time in treatment-naïve patients.

    Science.gov (United States)

    Philip, Keir Ej; Macartney, Malcolm J; Conibear, Tim Cr; Smith, Colette J; Marshall, Neal; Johnson, Margaret A; Haque, Tanzina; Webster, Daniel P

    2016-06-01

    HIV co-receptor tropism determination is essential before prescribing the CCR5 antagonist maraviroc. British HIV Association guidelines suggest tropism testing may remain valid for only 90 days in antiretroviral-naïve patients. We aimed to determine the accuracy of this figure. Tropism was assessed in 26 antiretroviral-naïve patients with ongoing viral replication, sampled yearly from first clinic visit. The V3 region of HIV-1 was sequenced in triplicate, then tropism predicted using the Geno2Pheno system. Baseline tropism prediction remained valid for a median of 52 months (range 7-81). For 19/26 individuals baseline tropism remained unchanged throughout a median of 54 months follow-up; 18 R5 tropic and 1 X4 tropic. In seven patients (27%) baseline tropism switched at least once (range 1-4 switches) during follow-up; however, their baseline tropism prediction remained valid for a median of 45 months. Co-receptor tropism in treatment-naïve patients with ongoing viral replication appears highly stable over time, suggesting that baseline genotypic tropism prediction may be valid for a longer duration in patients delaying ART initiation. In this study, baseline tropism prediction remained valid for a median of 52 months, suggesting current guidelines recommending repeat testing after 90 days may be excessively conservative in their assessment of tropism stability. © The Author(s) 2015.

  7. Geochemical and stable isotopic constraints on the generation and passive treatment of acidic, Fe-SO4 rich waters.

    Science.gov (United States)

    Matthies, Romy; Aplin, Andrew C; Boyce, Adrian J; Jarvis, Adam P

    2012-03-15

    Reducing and Alkalinity Producing Systems (RAPS) remediate net-acidic metalliferous mine drainage by creating anoxic conditions in which bacterial sulfate reduction (BSR) raises alkalinity and drives the precipitation of iron and other chalcophilic elements as sulfides. We report chemical and stable isotopic data from a study monitoring the biogeochemical processes involved in the generation of mine waters and their remediation by two RAPS. Sulfur isotopes show that sulfate in all mine waters has a common source (pyrite oxidation), whilst oxygen isotopes show that oxidation of pyritic sulfur is mediated by Fe(III)(aq). The isotopic composition of dissolved sulfide, combined with the sulfur and oxygen isotopic composition of sulfate in RAPS effluents, proves BSR and details its dual isotope systematics. The occurrence and isotopic composition of solid phase iron sulfides indicate the removal of reduced sulfur within the RAPS, with significant amounts of elemental sulfur indicating reoxidation steps. However, only 0 to 9% of solid phase iron occurs as Fe sulfides, with approximately 70% of the removed iron occurs as Fe(III) (hydr)oxides. Some of the (hydr)oxide is supplied to the wetland as solids and is simply filtered by the wetland substrate, playing no role in alkalinity generation or proton removal. However, the majority of iron is supplied as dissolved Fe(II), indicating that acid generating oxidation and hydrolysis reactions dominate iron removal. The overall contribution of BSR to the sulfur geochemistry in the RAPS is limited and sulfate retention is dominated by sulfate precipitation, comparable to aerobic treatment systems, and show that the proton acidity resulting from iron oxidation and hydrolysis must be subsequently neutralised by calcite dissolution and/or BSR deeper in the RAPS sediments. BSR is not as important as previously thought for metal removal in RAPS. The results have practical consequences for the design, treatment performance and long

  8. Stable gastric pentadecapeptide BPC 157 in the treatment of colitis and ischemia and reperfusion in rats: New insights.

    Science.gov (United States)

    Duzel, Antonija; Vlainic, Josipa; Antunovic, Marko; Malekinusic, Dominik; Vrdoljak, Borna; Samara, Mariam; Gojkovic, Slaven; Krezic, Ivan; Vidovic, Tinka; Bilic, Zdenko; Knezevic, Mario; Sever, Marko; Lojo, Nermin; Kokot, Antonio; Kolovrat, Marijan; Drmic, Domagoj; Vukojevic, Jaksa; Kralj, Tamara; Kasnik, Katarina; Siroglavic, Marko; Seiwerth, Sven; Sikiric, Predrag

    2017-12-28

    To provide new insights in treatment of colitis and ischemia and reperfusion in rats using stable gastric pentadecapeptide BPC 157. Medication [BPC 157, L-NAME, L-arginine (alone/combined), saline] was bath at the blood deprived colon segment. During reperfusion, medication was BPC 157 or saline. We recorded (USB microscope camera) vessel presentation through next 15 min of ischemic colitis (IC-rats) or reperfusion (removed ligations) (IC + RL-rats); oxidative stress as MDA (increased (IC- and IC + RL-rats)) and NO levels (decreased (IC-rats); increased (IC + RL-rats)) in colon tissue. IC + OB-rats [IC-rats had additional colon obstruction (OB)] for 3 d (IC + OB-rats), then received BPC 157 bath. Commonly, in colon segment (25 mm, 2 ligations on left colic artery and vein, 3 arcade vessels within ligated segment), in IC-, IC + RL-, IC + OB-rats, BPC 157 (10 μg/kg) bath (1 mL/rat) increased vessel presentation, inside/outside arcade interconnections quickly reappeared, mucosal folds were preserved and the pale areas were small and markedly reduced. BPC 157 counteracted worsening effects induced by L-NAME (5 mg) and L-arginine (100 mg). MDA- and NO-levels were normal in BPC 157 treated IC-rats and IC + RL-rats. In addition, on day 10, BPC 157-treated IC + OB-rats presented almost completely spared mucosa with very small pale areas and no gross mucosal defects; the treated colon segment was of normal diameter, and only small adhesions were present. BPC 157 is a fundamental treatment that quickly restores blood supply to the ischemically injured area and rapidly activates collaterals. This effect involves the NO system.

  9. How Outpatient Substance Abuse Treatment Unit Director Activities May Affect Provision of Community Outreach Services

    Science.gov (United States)

    Chuang, Emmeline; Wells, Rebecca; Alexander, Jeffrey; Green, Sherri

    2013-01-01

    Aims: Community outreach services play an important role in infectious disease prevention and engaging drug users not currently in treatment. However, fewer than half of US substance abuse treatment units provide these services and many have little financial incentive to do so. Unit directors generally have latitude about scope of services,…

  10. Shock treatment in a cohort of Scandinavian intensive care units in 2014

    DEFF Research Database (Denmark)

    Kollind, M; Wickbom, F; Wilkman, E

    2016-01-01

    BACKGROUND: Shock is common in intensive care units, and treatment includes fluids, vasopressor and/or inotropic drugs, guided by hemodynamic monitoring. The aim of this study was to identify current practice for treatment of shock in Scandinavian intensive care units. METHODS: Seven-day inceptio...

  11. Analysis and Design of a Permanent Magnet Bi-Stable Electro-Magnetic Clutch Unit for In-Wheel Electric Vehicle Drives

    Directory of Open Access Journals (Sweden)

    Wanli Cai

    2015-06-01

    Full Text Available Clutches have been used in internal combustion vehicles and concentrated electric vehicles (EVs to smoothen impulsion while starting and shifting. This paper proposes a permanent magnet bi-stable electromagnetic clutch unit (PMBECU which is specially introduced into in-wheel EVs to make the rigid connection between hub and wheel more flexible. Firstly, the operation principle of the PMBECU is illustrated. Then, the basic magnetic circuit model is presented and analyzed, followed by optimal design of the main structural parameters by investigating the PM leakage flux coefficient. Further, according to the basic electromagnetic characteristics of the PMBECU, the current pulse supply is put forward, and the minimum pulse width which enables the operation of the PMBECU and its dynamic characteristics are analyzed by an improved finite element method. Finally, a prototype machine is manufactured and tested to validate all the analysis results.

  12. Present and Future Developments in Radiotherapy Treatment Units.

    Science.gov (United States)

    Boyer

    1995-04-01

    Technical advances in the design of medical accelerators are making possible the exploration of new treatment techniques. Technology currently available to the radiation oncologist allows the use of internal and dynamic wedges. Multileaf collimators can be used for static treatment ports, and dynamic field shaping and beam modulation using multileaf collimators has been shown to be feasible. Computer interfaces are necessary to transfer the complex treatment sequences that are possible with these devices. Such network interfaces also provide for more efficient conventional treatments. New machines such as X-band linear accelerators and advanced proton accelerators are being developed for applications such as boron neutron capture therapy and proton conformal therapy.

  13. Enhanced external counterpulsation for the treatment of stable angina and heart failure: a systematic review and economic analysis.

    Science.gov (United States)

    McKenna, C; McDaid, C; Suekarran, S; Hawkins, N; Claxton, K; Light, K; Chester, M; Cleland, J; Woolacott, N; Sculpher, M

    2009-04-01

    To determine the clinical effectiveness and cost-effectiveness of enhanced external counterpulsation (EECP) compared with usual care and placebo for refractory stable angina and heart failure, and to undertake analyses of the expected value of information to assess the potential value of future research on EECP. Major electronic databases were searched between November 2007 and March 2008. A systematic review of the literature was undertaken and a decision model developed to compare EECP treatment with no treatment in adults with chronic stable angina. Five studies were included in the review. In the Multicenter Study of Enhanced External Counterpulsation (MUST-EECP), time to greater than or equal to 1-mm ST segment depression (exercise-induced ischaemia) was statistically significantly improved in the EECP group compared with the control group (sham EECP), mean difference (MD) 41 seconds [95% confidence interval (CI) 9.10-73.90]. However, there was no statistically significant difference between the EECP and control groups in the change in exercise duration from baseline to end of treatment, self-reported angina episodes or daily nitroglycerin use, and the clinical significance of the limited benefits was unclear. There was also a lack of data on long-term outcomes. There were more withdrawals due to adverse events in the EECP group than in the control group, as well as a greater proportion of patients with adverse events [relative risk (RR) 2.13, 95% CI 1.35-3.38]. The three non-randomised studies compared EECP with elective percutaneous coronary intervention (PCI) and usual care. There was a high risk of selection bias in all three studies and the results should be treated with considerable caution. The study comparing an EECP registry with a PCI registry reported similar 1-year all-cause mortality in both groups. In the Prospective Evaluation of EECP in Congestive Heart Failure (PEECH) trial, patients with heart failure were randomised to EECP or to usual care

  14. Bioremediation of pesticides in surface soil treatment unit using ...

    African Journals Online (AJOL)

    The manufacturing and use of pesticides has been rising tremendously in India. The waste generated by the pesticide industry has become an environmental problem due to the present insufficient and ineffective waste treatment technology involving physico-chemical and biological treatment. The available data indicates ...

  15. Infertility Evaluation and Treatment among Women in the United States

    Science.gov (United States)

    Kessler, Lawrence M.; Craig, Benjamin M.; Plosker, Shayne M.; Reed, Damon R.; Quinn, Gwendolyn P.

    2013-01-01

    Objective To examine the characteristics of women seeking infertility evaluation and treatment. Design Cross-sectional survey based on in-person interviews, followed by two-step hurdle analysis. Participants 4,558 married or cohabitating women ages 25–44 Setting U.S. household population of women based on the 2006–2010 National Survey of Family Growth Intervention None Main Outcome Measure(s) Likelihood of seeking preliminary infertility evaluation. Likelihood of seeking infertility treatment once evaluated. Treatment type provided. Results 623 women (13.7%) reported seeking infertility evaluation, of which 328 reported undergoing subsequent infertility treatment. Age at marriage, marital status, education, health insurance status, race/ethnicity, and religion were associated with the likelihood of seeking infertility evaluation. For example, the predicted probability that a non-White woman who married at 25 will seek evaluation was 12%. This probability increased to 34% for White women with a graduate degree who married at age 30. Among women who are evaluated, income, employment status, and ethnicity correlated strongly with the likelihood of seeking infertility treatment. Infertility drug therapy was the most frequent treatment used. Reproductive surgery and in vitro fertilization (IVF) were used the least. Conclusions The use of infertility services is not random and understanding the socio-demographic factors correlated with use may assist new couples with family planning. Roughly 50% of the women evaluated for infertility progressed to treatment, and only a small proportion were treated with more advanced assisted reproductive technologies (ARTs) such as IVF therapy. Future research aimed at improving access to effective healthcare treatments within the boundaries of affordability is warranted. PMID:23849845

  16. Source identification of N2O produced during simulated wastewater treatment under different oxygen conditions using stable isotopic analysis

    Directory of Open Access Journals (Sweden)

    T Azzaya

    2014-12-01

    Full Text Available Nitrous oxide (N2O, a potent greenhouse gas which is important in climate change, is predicted to be the most dominant ozone depleting substance. It is mainly produced by oxidation of hydroxylamine (NH2OH or reduction of nitrite (NO2- during microbiological processes such as nitrification and denitrification. Wastewater treatment plant (WWTP is one of the anthropogenic N2O sources because inorganic and organic nitrogen compounds are converted to nitrate (NO3-, in the case of standard system or N2 (in the case of advanced system by bacterial nitrification and denitrification in WWTP. We investigated the N2O production mechanisms during batch experiments that simulate wastewater treatment with activated sludge under various dissolved oxygen (DO concentrations by stable isotope analysis. About 125mL of water was sampled from 30L incubation chamber for several times during the incubation, and concentration and isotopomer ratios of N2O and N-containing species were measured using gas chromatography/isotope ratio mass spectrometry (GC/IRMS. Ammonium (NH4+ consumption was accompanied by increment of nitrite (NO2-, and at the same time dissolved N2O concentration gradually increased to 4850 and 5650 nmol kg-1, respectively, during the four-hour incubation when DO concentrations were 0.2 and 0.5 mg L-1. Observed low SP values (0.2-8.9‰ at DO-0.2 mg L-1, -5.3-6.3‰ at DO-0.5 mg L-1, -1.0-8.3‰ at DO-0.8 mg L-1 in N2O and relationship of nitrogen isotope ratios between N2O and its potential substrates (NH4+, NO3- suggested that N2O produced under the aerobic condition derived mainly from NO2- reduction by ammonia-oxidizing bacteria (nitrifier–denitrification.DOI: http://doi.dx.org/10.5564/mjc.v15i0.313Mongolian Journal of Chemistry  15 (41, 2014, p4-10  

  17. Stable isotopes

    International Nuclear Information System (INIS)

    Evans, D.K.

    1986-01-01

    Seventy-five percent of the world's stable isotope supply comes from one producer, Oak Ridge Nuclear Laboratory (ORNL) in the US. Canadian concern is that foreign needs will be met only after domestic needs, thus creating a shortage of stable isotopes in Canada. This article describes the present situation in Canada (availability and cost) of stable isotopes, the isotope enrichment techniques, and related research programs at Chalk River Nuclear Laboratories (CRNL)

  18. More Than Just a Break from Treatment: How Substance Use Disorder Patients Experience the Stable Environment in Horse-Assisted Therapy.

    Science.gov (United States)

    Kern-Godal, Ann; Brenna, Ida Halvorsen; Arnevik, Espen Ajo; Ravndal, Edle

    2016-01-01

    Inclusion of horse-assisted therapy (HAT) in substance use disorder (SUD) treatment is rarely reported. Our previous studies show improved treatment retention and the importance of the patient-horse relationship. This qualitative study used thematic analysis, within a social constructionist framework, to explore how eight patients experienced contextual aspects of HAT's contribution to their SUD treatment. Participants described HAT as a "break from usual treatment". However, four interrelated aspects of this experience, namely "change of focus", "activity", "identity", and "motivation," suggest HAT is more than just a break from usual SUD treatment. The stable environment is portrayed as a context where participants could construct a positive self: one which is useful, responsible, and accepted; more fundamentally, a different self from the "patient/self" receiving treatment for a problem. The implications extend well beyond animal-assisted or other adjunct therapies. Their relevance to broader SUD policy and treatment practices warrants further study.

  19. Comparison of monitor units calculated by radiotherapy treatment planning system and an independent monitor unit verification software.

    Science.gov (United States)

    Sellakumar, P; Arun, C; Sanjay, S S; Ramesh, S B

    2011-01-01

    In radiation therapy, the monitor units (MU) needed to deliver a treatment plan are calculated by treatment planning systems (TPS). The essential part of quality assurance is to verify the MU with independent monitor unit calculation to correct any potential errors prior to the start of treatment. In this study, we have compared the MU calculated by TPS and by independent MU verification software. The MU verification software was commissioned and tested for the data integrity to ensure that the correct beam data was considered for MU calculations. The accuracy of the calculations was tested by creating a series of test plans and comparing them with ion chamber measurements. The results show that there is good agreement between the two. The MU difference (MUdiff) between the monitor unit calculations of TPS and independent MU verification system was calculated for 623 fields from 245 patients and was analyzed by treatment site for head & neck, thorax, breast, abdomen and pelvis. The mean MUdiff of -0.838% with a standard deviation of 3.04% was observed for all 623 fields. The site specific standard deviation of MUdiff was as follows: abdomen and pelvis (<1.75%), head & neck (2.5%), thorax (2.32%) and breast (6.01%). The disparities were analyzed and different correction methods were used to reduce the disparity. © 2010 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  20. Treatment of corneal astigmatism with the new small-incision lenticule extraction (SMILE) laser technique: Is treatment of high degree astigmatism equally accurate, stable and safe as treatment of low degree astigmatism?

    DEFF Research Database (Denmark)

    Hansen, Rasmus Søgaard; Grauslund, Jakob; Lyhne, Niels

    Field: Ophthalmology Introduction: SMILE has proven effective in treatment of myopia and low degrees of astigmatism (less than 2 dioptres (D)), but there are no studies on treatment of high degrees of astigmatism (2 or more D). The aim of this study was to compare results after SMILE treatment...... for low or high degrees of astigmatism concerning accuracy, stability, and safety. Methods: Retrospective study of 1017 eyes treated with SMILE for myopia with low astigmatism or myopia with high astigmatism from 2011-2013 at the Department of Ophthalmology, Odense University Hospital, Denmark. Inclusion.......6%) treated for low astigmatism and four eyes (3.2%) treated for high astigmatism (P=0.02) had lost two or more lines of BSCVA after three months. Conclusion: This study is the first of its kind, and our results indicate that SMILE treatment of high degree astigmatism is equally accurate and stable...

  1. Ranolazine for the treatment of chronic stable angina: a cost-effectiveness analysis from the UK perspective

    OpenAIRE

    Coleman, Craig I; Freemantle, Nick; Kohn, Christine G

    2015-01-01

    Objectives To estimate the cost-effectiveness of ranolazine when added to standard-of-care (SoC) antianginals compared with SoC alone in patients with stable coronary disease experiencing ?3 attacks/week. Setting An economic model utilising a UK health system perspective, a 1-month cycle-length and a 1-year time horizon. Participants Patients with stable coronary disease experiencing ?3 attacks/week starting in 1 of 4 angina frequency health states based on Seattle Angina Questionnaire Angina...

  2. The antiplatelet effect of clopidogrel is not attenuated by statin treatment in stable patients with ischemic heart disease

    DEFF Research Database (Denmark)

    Vinholt, Pernille Just; Poulsen, Tina Svenstrup; Korsholm, Lars

    2005-01-01

    Recent studies suggest that cytochrome P450 (CYP) 3A4 metabolized statins attenuate the antiaggregatory effect of clopidogrel. We evaluated how CYP3A4 metabolized statins and non-CYP3A4 metabolized statins influence platelet aggregation when given concomitantly with clopidogrel. Sixty-six stable ...

  3. ENEA`s mobile treatment units for specific waters; Impianti mobili ENEA di trattamento / smaltimento rifiuti

    Energy Technology Data Exchange (ETDEWEB)

    Beone, G.; Barni, E.; Coronidi, M. [ENEA, Centro Ricerche Casaccia, Rome (Italy). Dipt. Ambiente; Bortone, G.; Gambaro, L.; Zanetti, P. [ENEA, Centro Ricerche `Ezio Clementel, Bologna (Italy). Dipt. Ambiente; Liccione, G. [ENEA, Centro Ricerche Trisaia, Matera (Italy). Dipt. Ambiente; Zanin, E.

    1997-11-01

    Solid waste production in turistic places is characterized by a large increase, up to 80 % for few months during the year. Generally a waste treatment plant is designed for a mean production and can support increases that non exceed 10 %. Treatment plants with higher capacity are not economically convenient and the excedent production is landfilled. An answer to this problem are mobile treatment units that could be used to support resident plants when higher treatment capacity is requested. Mobile units are very useful for other uses like as treatment of specific wastes (agricultural plastic bags and sheets contaminated by antiparasitics and herbicides) infective wastes from hospital and laboratories and leaches from landfills. Mobile units flexibility is also important for environmental protection actions, either scheduled on in an emergency, like as reclamation of contaminated soils, asbestos contaminated site and every time when waste transport is characterized by high cost or safety and sanitary problems.

  4. Plutonium Finishing Plant (PFP) Treatment and Storage Unit Waste Analysis Plan

    International Nuclear Information System (INIS)

    PRIGNANO, A.L.

    2000-01-01

    The purpose of this waste analysis plan (WAP) is to document waste analysis activities associated with the Plutonium Finishing Plant Treatment and Storage Unit (PFP Treatment and Storage Unit) to comply with Washington Administrative Code (WAC) 173-303-300(1), (2), (4)(a) and (5). The PFP Treatment and Storage Unit is an interim status container management unit for plutonium bearing mixed waste radiologically managed as transuranic (TRU) waste. TRU mixed (TRUM) waste managed at the PFP Treatment and Storage Unit is destined for the Waste Isolation Pilot Plant (WIPP) and therefore is not subject to land disposal restrictions [WAC 173-303-140 and 40 CFR 268]. The PFP Treatment and Storage Unit is located in the 200 West Area of the Hanford Facility, Richland Washington (Figure 1). Because dangerous waste does not include source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of this documentation. The information on radionuclides is provided only for general knowledge

  5. Interim Status Closure Plan Open Burning Treatment Unit Technical Area 16-399 Burn Tray

    Energy Technology Data Exchange (ETDEWEB)

    Vigil-Holterman, Luciana R. [Los Alamos National Laboratory

    2012-05-07

    This closure plan describes the activities necessary to close one of the interim status hazardous waste open burning treatment units at Technical Area (TA) 16 at the Los Alamos National Laboratory (LANL or the Facility), hereinafter referred to as the 'TA-16-399 Burn Tray' or 'the unit'. The information provided in this closure plan addresses the closure requirements specified in the Code of Federal Regulations (CFR), Title 40, Part 265, Subparts G and P for the thermal treatment units operated at the Facility under the Resource Conservation and Recovery Act (RCRA) and the New Mexico Hazardous Waste Act. Closure of the open burning treatment unit will be completed in accordance with Section 4.1 of this closure plan.

  6. Withdrawing life-support treatment in the intensive care unit: The ...

    African Journals Online (AJOL)

    Critically ill patients admitted to the intensive care units (ICUs) require treatment methods to support their vital functions of respiration and circulation by means of modalities such as mechanical ventilation and inotropic support. However, when these treatment options are maximised and the patient's condition remains ...

  7. Evaluation of the effectiveness of an urban stormwater treatment unit in Madison, Wisconsin, 1996-97

    Science.gov (United States)

    Waschbusch, Robert J.

    1999-01-01

    An urban stormwater treatment unit was tested as part of an ongoing program of urban nonpoint- pollution research in Madison, Wis. Flow measurements were made and water samples were collected at the inlet to, outlet from, and bypass around the treatment chamber of the device that was installed to collect the runoff from a city maintenance yard.

  8. Plutonium Finishing Plant Treatment and Storage Unit Dangerous Waste Training Plan

    International Nuclear Information System (INIS)

    ENTROP, G.E.

    2000-01-01

    The training program for personnel performing waste management duties pertaining to the Plutonium Finishing Plant (PFP) Treatment and Storage Unit is governed by the general requirements established in the Plutonium Finishing Plant Dangerous Waste Training Plan (PFP DWTP). The PFP Treatment and Storage Unit DWTP presented below incorporates all of the components of the PFP DWTP by reference. The discussion presented in this document identifies aspects of the training program specific to the PFP Treatment and Storage Unit. The training program includes specifications for personnel instruction through both classroom and on-the-job training. Training is developed specific to waste management duties. Hanford Facility personnel directly involved with the PFP Treatment and Storage Unit will receive training to container management practices, spill response, and emergency response. These will include, for example, training in the cementation process and training pertaining to applicable elements of WAC 173-303-330(1)(d). Applicable elements from WAC 173-303-330(1)(d) for the PFP Treatment and Storage Unit include: procedures for inspecting, repairing, and replacing facility emergency and monitoring equipment; communications and alarm systems; response to fires or explosions; and shutdown of operations

  9. Tracking the inorganic suspended solids through biological treatment units of wastewater treatment plants.

    Science.gov (United States)

    Ekama, G A; Wentzel, M C; Sötemann, S W

    2006-11-01

    From an experimental and theoretical investigation of the continuity of influent inorganic suspended solids (ISS) along the links connecting the primary settling tank (PST), fully aerobic or N removal activated sludge (AS) and anaerobic and aerobic digestion (AerD) unit operations, it was found that (i) the influent wastewater (fixed) ISS concentration is conserved through primary sludge anaerobic digestion, and AS and AerD unit operations. However, the measured ISS flux at different stages through a series of WWTP unit operations is not equal to the influent ISS flux because the ordinary heterotrophic organisms (OHO) biomass contributes to the ISS flux by differing amounts depending on the OHO (active) fraction of the VSS solids at that stage.

  10. Treatment of long bone osteomyelitis with a mechanically stable intramedullar antibiotic dispenser: nineteen consecutive cases with a minimum of 12 months follow-up.

    Science.gov (United States)

    Sancineto, Carlos Federico; Barla, Jorge Daniel

    2008-12-01

    Antibiotic cement beads are the most common system of local antibiotic delivery. Unfortunately, bead strings do not give mechanical support to the fracture site, stability being fundamental in osteomyelitis treatment. Local treatment associated with bone stability should improve the results in posttraumatic osteomyelitis. The objective of this article is to present our experience in the treatment of long bone osteomyelitis using an intramedullary, mechanically stable antibiotic dispenser. We present a retrospective review of a consecutive series of patients with a long bone osteomyelitis treated using an intramedullary, mechanically stable antibiotic dispenser. The dispenser used with a T-95 chest tube filled with poly(methyl methacrylate) + antibiotic (vancomycin, gentamycin, or both, tobramycin or imipenem; depending on culture results) and with a metal center (Ender nail). Fifteen patients were men and three were women, with an average age of 37 years (range, 18-52 years). In four cases, treatment involved the femur and in 15 the tibia. Positive cultures were obtained from each patient. Methicillin-resistant Staphylococcus aureus was isolated in 17 cases. The intramedullary dispenser was removed between 6 and 76 weeks after surgery. Success was defined as negative cultures after dispenser removal. Follow-up period was between 10 and 54 months. Negative cultures were obtained from intramedullary reaming after dispenser removal in all but one patient who could not finish treatment because of local intolerance to antibiotic treatment. None of the 17 patients presented an infection recurrence. The combination of local antibiotic treatment with bone segment stability showed acceptable results in our short series of patients. Further investigation on locked intramedullary antibiotic dispensers providing improved stability will help us learn about this difficult clinical scenario.

  11. Insights from a national survey into why substance abuse treatment units add prevention and outreach services

    Directory of Open Access Journals (Sweden)

    Lemak Christy

    2006-08-01

    Full Text Available Abstract Background Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1 environmental, (2 unit-level, and (3 unit leadership. Results A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period. Conclusion Findings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care

  12. Long-term trends in restoration and associated land treatments in the southwestern United States

    Science.gov (United States)

    Copeland, Stella M.; Munson, Seth M.; Pilliod, David S.; Welty, Justin L.; Bradford, John B.; Butterfield, Bradley J.

    2018-01-01

    Restoration treatments, such as revegetation with seeding or invasive species removal, have been applied on U.S. public lands for decades. Temporal trends in these management actions have not been extensively summarized previously, particularly in the southwestern United States where invasive plant species, drought, and fire have altered dryland ecosystems. We assessed long-term (1940–2010) trends in restoration using approximately 4,000 vegetation treatments conducted on Bureau of Land Management lands across the southwestern United States. We found that since 1940, the proportions of seeding and vegetation/soil manipulation (e.g. vegetation removal or plowing) treatments have declined, while the proportions of prescribed burn and invasive species treatments have increased. Treatments in pinyon-juniper and big sagebrush communities declined in comparison to treatments in desert scrub, creosote bush, and riparian woodland communities. Restoration-focused treatment objectives increased relative to resource extraction objectives. Species richness and proportion of native species used in seeding treatments also increased. Inflation-adjusted costs per area rose 750% for vegetation/soil manipulation, 600% for seeding, and 400% for prescribed burn treatments in the decades from 1981 to 2010. Seeding treatments were implemented in warmer and drier years when compared to the climate conditions of the entire study period and warmer and wetter years relative to several years before and after the treatment. These results suggest that treatments over a 70-year period on public lands in the southwestern United States are shifting toward restoration practices that are increasingly large, expensive, and related to fire and invasive species control.

  13. Effects of ceftiofur treatment on the susceptibility of commensal porcine E.coli--comparison between treated and untreated animals housed in the same stable.

    Science.gov (United States)

    Beyer, Anne; Baumann, Sven; Scherz, Gesine; Stahl, Jessica; von Bergen, Martin; Friese, Anika; Roesler, Uwe; Kietzmann, Manfred; Honscha, Walther

    2015-10-15

    Healthy farm animals have been found to act as a reservoir of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli). Therefore, the objective of the study was to determine the input of antimicrobial active ceftiofur metabolites in the stable via faeces and urine after intramuscular administration of the drug to pigs and the elucidation of the Escherichia coli ESBL resistance pattern of treated and untreated pigs housed in the same barn during therapy. For determination of the minimal inhibitory concentration (MIC) the method of microdilutionaccording to the recommended procedure of the Clinical and Laboratory Standards Institute was used. Inaddition to that, a qualitative determination was performed by agar dilution. Unsusceptible E. coli speciesselected via agar dilution with cefotaxime were confirmed by MALDI-TOF and ESBL encoding genes wereidentified by PCR. The amounts of ceftiofur measured as desfuroylceftiofur (DFC) in the different probes (plasma, urine, faeces and dust) were analysed by UPLC-MS/MS. In a first experiment two groups of pigs (6 animals per group) were housed in the same barn in two separated boxes. One group (group B) were treated with ceftiofur according to the licence (3 mg/kg administered intramuscularly (i.m.) on three consecutive days, day 1-3). During a second treatment period (day 29-31) an increased rate of ESBL resistant E. coli was detectable in these treated pigs and in the air of the stable. Moreover, the second group of animals (group A) formerly untreated but housed for the whole period in the same stable as the treated animals revealed increased resistance rates during their first treatment (day 45-47) with ceftiofur. In order to investigate the environmental input of ceftiofur during therapy and to simulate oral uptake of ceftiofur residues from the air of the stable a second set of experiments were performed. Pigs (6 animals) were treated with an interval of 2 weeks for 3 days with different doses of

  14. Does less frequent routine monitoring of patients on a stable, fully suppressed cART regimen lead to an increased risk of treatment failure?

    DEFF Research Database (Denmark)

    Reekie, Joanne; Mocroft, Amanda; Sambatakou, Helen

    2008-01-01

    SIDA study who maintained a stable and fully suppressed cART regimen for 1 year were included in the analysis. METHODS: Risk of treatment failure, defined by viral rebound, fall in CD4 cell count, development of new AIDS-defining illness, serious opportunistic infection or death, in the 12 months following...... interval (CI) 0.1-0.5], 2.2% (95% CI 1.6-2.8) and 6.0% (95% CI 5.0-7.0) risk of treatment failure, respectively. Patients who spent more than 80% of their time on cART with fully suppressed viraemia prior to baseline had a 38% reduced risk of treatment failure, hazard ratio 0.62 (95% CI 0.42-0.90, P = 0...

  15. Stable particles

    International Nuclear Information System (INIS)

    Samios, N.P.

    1994-01-01

    I have been asked to review the subject of stable particles, essentially the particles that eventually comprised the meson and baryon octets, with a few more additions - with an emphasis on the contributions made by experiments utilizing the bubble chamber technique. In this activity, much work had been done by the photographic emulsion technique and cloud chambers - exposed to cosmic rays as well as accelerator based beams. In fact, many if not most of the stable particles were found by these latter two techniques, however, the foree of the bubble chamber (coupled with the newer and more powerful accelerators) was to verify, and reinforce with large statistics, the existence of these states, to find some of the more difficult ones, mainly neutrals and further to elucidate their properties, i.e., spin, parity, lifetimes, decay parameters, etc. (orig.)

  16. Stable particles

    International Nuclear Information System (INIS)

    Samios, N.P.

    1993-01-01

    I have been asked to review the subject of stable particles, essentially the particles that eventually comprised the meson and baryon octets. with a few more additions -- with an emphasis on the contributions made by experiments utilizing the bubble chamber technique. In this activity, much work had been done by the photographic emulsion technique and cloud chambers-exposed to cosmic rays as well as accelerator based beams. In fact, many if not most of the stable particles were found by these latter two techniques, however, the forte of the bubble chamber (coupled with the newer and more powerful accelerators) was to verify, and reinforce with large statistics, the existence of these states, to find some of the more difficult ones, mainly neutrals and further to elucidate their properties, i.e., spin, parity, lifetimes, decay parameters, etc

  17. Characterization of suspended bacteria from processing units in an advanced drinking water treatment plant of China.

    Science.gov (United States)

    Wang, Feng; Li, Weiying; Zhang, Junpeng; Qi, Wanqi; Zhou, Yanyan; Xiang, Yuan; Shi, Nuo

    2017-05-01

    For the drinking water treatment plant (DWTP), the organic pollutant removal was the primary focus, while the suspended bacterial was always neglected. In this study, the suspended bacteria from each processing unit in a DWTP employing an ozone-biological activated carbon process was mainly characterized by using heterotrophic plate counts (HPCs), a flow cytometer, and 454-pyrosequencing methods. The results showed that an adverse changing tendency of HPC and total cell counts was observed in the sand filtration tank (SFT), where the cultivability of suspended bacteria increased to 34%. However, the cultivability level of other units stayed below 3% except for ozone contact tank (OCT, 13.5%) and activated carbon filtration tank (ACFT, 34.39%). It meant that filtration processes promoted the increase in cultivability of suspended bacteria remarkably, which indicated biodegrading capability. In the unit of OCT, microbial diversity indexes declined drastically, and the dominant bacteria were affiliated to Proteobacteria phylum (99.9%) and Betaproteobacteria class (86.3%), which were also the dominant bacteria in the effluent of other units. Besides, the primary genus was Limnohabitans in the effluents of SFT (17.4%) as well as ACFT (25.6%), which was inferred to be the crucial contributors for the biodegradable function in the filtration units. Overall, this paper provided an overview of community composition of each processing units in a DWTP as well as reference for better developing microbial function for drinking water treatment in the future.

  18. Ranolazine for the treatment of chronic stable angina: a cost-effectiveness analysis from the UK perspective.

    Science.gov (United States)

    Coleman, Craig I; Freemantle, Nick; Kohn, Christine G

    2015-11-06

    To estimate the cost-effectiveness of ranolazine when added to standard-of-care (SoC) antianginals compared with SoC alone in patients with stable coronary disease experiencing ≥3 attacks/week. An economic model utilising a UK health system perspective, a 1-month cycle-length and a 1-year time horizon. Patients with stable coronary disease experiencing ≥3 attacks/week starting in 1 of 4 angina frequency health states based on Seattle Angina Questionnaire Angina Frequency (SAQAF) scores (100=no; 61-99=monthly; 31-60=weekly; 0-30=daily angina). Ranolazine added to SoC or SoC alone. Patients were allowed to transition between SAQAF states (first cycle only) or death (any cycle) based on probabilities derived from the randomised, controlled Efficacy of Ranolazine in Chronic Angina trial and other studies. Patients not responding to ranolazine in month 1 (not improving ≥1 SAQAF health state) discontinued ranolazine and were assumed to behave like SoC patients. Costs (£2014) and quality-adjusted life-years (QALYs) for patients receiving and not receiving ranolazine. Ranolazine patients lived a mean of 0.701 QALYs at a cost of £5208. Those not receiving ranolazine lived 0.662 QALYs at a cost of £5318. The addition of ranolazine to SoC was therefore a dominant economic strategy. The incremental cost-effectiveness ratio was sensitive to ranolazine cost; exceeding £20,000/QALY when ranolazine's cost was >£203/month. Ranolazine remained a dominant strategy when indirect costs were included and mortality rates were assumed to increase with worsening severity of SAQAF health states. Monte Carlo simulation found ranolazine to be a dominant strategy in ∼71% of 10,000 iterations. Although UK-specific data on ranolazine's efficacy and safety are lacking, our analysis suggest ranolazine added to SoC in patients with weekly or daily angina is likely cost-effective from a UK health system perspective. Published by the BMJ Publishing Group Limited. For permission to use

  19. Plutonium Finishing Plan (PFP) Treatment and Storage Unit Interim Status Closure Plan

    International Nuclear Information System (INIS)

    PRIGNANO, A.L.

    2000-01-01

    This document describes the planned activities and performance standards for closing the Plutonium Finishing Plant (PFP) Treatment and Storage Unit. The PFP Treatment and Storage Unit is located within the 234-52 Building in the 200 West Area of the Hanford Facility. Although this document is prepared based upon Title 40 Code of Federal Regulations (CFR), Part 265, Subpart G requirements, closure of the unit will comply with Washington Administrative Code (WAC) 173-303-610 regulations pursuant to Section 5.3 of the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) Action Plan (Ecology et al. 1996). Because the PFP Treatment and Storage Unit manages transuranic mixed (TRUM) waste, there are many controls placed on management of the waste. Based on the many controls placed on management of TRUM waste, releases of TRUM waste are not anticipated to occur in the PFP Treatment and Storage Unit. Because the intention is to clean close the PFP Treatment and Storage Unit, postclosure activities are not applicable to this closure plan. To clean close the unit, it will be demonstrated that dangerous waste has not been left onsite at levels above the closure performance standard for removal and decontamination. If it is determined that clean closure is not possible or is environmentally impractical, the closure plan will be modified to address required postclosure activities. The PFP Treatment and Storage Unit will be operated to immobilize and/or repackage plutonium-bearing waste in a glovebox process. The waste to be processed is in a solid physical state (chunks and coarse powder) and will be sealed into and out of the glovebox in closed containers. The containers of immobilized waste will be stored in the glovebox and in additional permitted storage locations at PFP. The waste will be managed to minimize the potential for spills outside the glovebox, and to preclude spills from reaching soil. Containment surfaces will be maintained to ensure

  20. Thermal treatment of solid residues from WtE units: A review

    International Nuclear Information System (INIS)

    Lindberg, Daniel; Molin, Camilla; Hupa, Mikko

    2015-01-01

    Highlights: • We review the thermal treatment methods for ashes and residues from WtE plants. • We review the results from extensive laboratory work on vitrification, melting and vaporization of ash. • We analyze the results from the extensive patent literature on thermal treatment. • We review industrial concepts for thermal treatment of ash. - Abstract: Thermal treatment methods of bottom ash, fly ash and various types of APC (air pollution control) residues from waste-to-energy plants can be used to obtain environmentally stable material. The thermal treatment processes are meant to reduce the leachability of harmful residue constituents, destroy toxic organic compounds, reduce residue volume, and produce material suitable for utilization. Fly ash and APC residues often have high levels of soluble salts, particularly chlorides, metals such as cadmium, lead, copper and zinc, and trace levels of organic pollutants such as dioxins and furans. Different thermal treatment methods can be used to either decompose or stabilize harmful elements and compounds in the ash, or separate them from the ash to get a material that can be safely stored or used as products or raw materials. In the present paper, thermal treatment methods, such as sintering, vitrification, and melting have been reviewed. In addition to a review of the scientific literature, a survey has been made of the extensive patent literature in the field

  1. Thermal treatment of solid residues from WtE units: A review

    Energy Technology Data Exchange (ETDEWEB)

    Lindberg, Daniel, E-mail: daniel.lindberg@abo.fi; Molin, Camilla, E-mail: camilla.molin@abo.fi; Hupa, Mikko, E-mail: mikko.hupa@abo.fi

    2015-03-15

    Highlights: • We review the thermal treatment methods for ashes and residues from WtE plants. • We review the results from extensive laboratory work on vitrification, melting and vaporization of ash. • We analyze the results from the extensive patent literature on thermal treatment. • We review industrial concepts for thermal treatment of ash. - Abstract: Thermal treatment methods of bottom ash, fly ash and various types of APC (air pollution control) residues from waste-to-energy plants can be used to obtain environmentally stable material. The thermal treatment processes are meant to reduce the leachability of harmful residue constituents, destroy toxic organic compounds, reduce residue volume, and produce material suitable for utilization. Fly ash and APC residues often have high levels of soluble salts, particularly chlorides, metals such as cadmium, lead, copper and zinc, and trace levels of organic pollutants such as dioxins and furans. Different thermal treatment methods can be used to either decompose or stabilize harmful elements and compounds in the ash, or separate them from the ash to get a material that can be safely stored or used as products or raw materials. In the present paper, thermal treatment methods, such as sintering, vitrification, and melting have been reviewed. In addition to a review of the scientific literature, a survey has been made of the extensive patent literature in the field.

  2. Official Satire in Propaganda: The Treatment of the United States in the GDR's "Eulenspiegel."

    Science.gov (United States)

    Bytwerk, Randall L.

    1989-01-01

    Examines 102 issues (published in 1985 and 1986) of the "Eulenspiegel," the only magazine in the German Democratic Republic (GDR) devoted to humor and satire. Focuses on the "Eulenspiegel's" treatment of the United States to determine the nature of that satire, its purposes, and its effectiveness. (MM)

  3. Application for verification of monitor units of the treatment planning system

    International Nuclear Information System (INIS)

    Suero Rodrigo, M. A.; Marques Fraguela, E.

    2011-01-01

    Current estimates algorithms achieve acceptable degree of accuracy. However, operate on the basis of un intuitive models. It is therefore necessary to verify the calculation of monitor units of the treatment planning system (TPS) with those obtained by other independent formalisms. To this end, we have developed an application based on factorization formalism that automates the calculation of dose.

  4. The Interactive Seminar: An Educational Approach for Voluntary HIV Testing in a Drug Dependence Treatment Unit.

    Science.gov (United States)

    Sedhom, Laila; And Others

    1994-01-01

    A survey of 118 male patients in a drug dependence treatment unit before and after an interactive seminar with a nonjudgmental professional showed that seminar participants, especially intravenous drug users, had higher rates of voluntary HIV testing than nonparticipants. Drug users who completed detoxification and attended the seminar also had…

  5. Treatment and rehabilitation on a stroke unit improves 5-year survival. A community-based study

    DEFF Research Database (Denmark)

    Jørgensen, H S; Kammersgaard, L P; Nakayama, H

    1999-01-01

    We have previously reported a marked reduction in mortality up to 1 year after treatment and rehabilitation on a stroke unit versus on general neurological and medical wards in unselected stroke patients. In the present study we wanted to test the hypothesis that this mortality-reducing effect...

  6. Checks for quality control of wedge dynamics in treatment units and the planning system

    International Nuclear Information System (INIS)

    Mateos Salvador, P.; Rodriguez Lopez, B.; Font Gelabert, J.; Hernandez Rodriguez, J.; Arino Gil, A.

    2013-01-01

    The objective of this study is to verify the implementation of enhanced dynamic wedge (EDW) vary in the Eclipse planning system and the experimental determination of the parameters that define the dosimetry characteristics of enhanced dynamic wedge of our treatment units. (Author)

  7. [Technical aspects of treatments with single- and multi-unit fixed dental prostheses

    NARCIS (Netherlands)

    Wiersema, E.J.; Kreulen, C.M.; Latzke, P.; Witter, D.J.; Creugers, N.H.J.

    2014-01-01

    For the manufacture of single- and multi-unit fixed dental prostheses, effective communication between dentist and dental technician is required. Mutual insight concerning the (im)possibilities of available treatments and technical options is prerequisitefor this communication. The manufacture of

  8. Prevalence and treatment of eating disorders among Hispanics/Latino Americans in the United States

    NARCIS (Netherlands)

    Perez, Marisol; Ohrt, Tara K.; Hoek, Hans W.

    2016-01-01

    Purpose of reviewWe reviewed the recent literature on prevalence rates, and application of evidence-based treatments for eating disorders among Hispanics/Latinos residing in the United States.Recent findingsLifetime prevalence rates of anorexia nervosa are lower among Hispanic/Latinos than

  9. More than Just a Break from Treatment: How Substance Use Disorder Patients Experience the Stable Environment in Horse-Assisted Therapy

    Directory of Open Access Journals (Sweden)

    Ann Kern-Godal

    2016-01-01

    Full Text Available Inclusion of horse-assisted therapy (HAT in substance use disorder (SUD treatment is rarely reported. Our previous studies show improved treatment retention and the importance of the patient–horse relationship. This qualitative study used thematic analysis, within a social constructionist framework, to explore how eight patients experienced contextual aspects of HAT's contribution to their SUD treatment. Participants described HAT as a “break from usual treatment”. However, four interrelated aspects of this experience, namely “change of focus”, “activity”, “identity”, and “motivation,” suggest HAT is more than just a break from usual SUD treatment. The stable environment is portrayed as a context where participants could construct a positive self: one which is useful, responsible, and accepted; more fundamentally, a different self from the “patient/self” receiving treatment for a problem. The implications extend well beyond animal-assisted or other adjunct therapies. Their relevance to broader SUD policy and treatment practices warrants further study.

  10. The case for SAR as the major component of a hyperthermia treatment unit

    International Nuclear Information System (INIS)

    Scott, R.S.

    1985-01-01

    A major problem facing clinical hyperthermia is the lack of a useful unit of treatment. Most attempts at a treatment unit have utilized some function of temperature and time. Having accepted the validity of such a hypothetical units, one is faced with the formidable problem of obtaining a three dimensional temperature profile so that thermal dose can be determined. A corollary is the desirability of obtaining uniform temperature in the treatment volume. Various studies suggest that a uniform SAR is a more desirable goal when radiotherapy is to be used in combination with hyperthermia. The synergy between radiation and hyperthermia is maximized in low pH regions of tumor which are presumably also hypoxic. These regions are poorly perfused, likely to heat readily, and are resistant to the cytotoxic effects of radiation alone. On the other hand, well perfused regions of tumor are likely sensitive to radiation, and benefit less from the combination treatment. Other studies have definitely shown that tissue temperatures in the range normally associated with desirable hyperthermia treatment result in severe vascular damage. This damage could be expected to unnecessarily compromise the effectiveness of radiotherapy. Models in the literature can be combined to verify these observations

  11. Distribution and abundance of natural parasitoid (Hymenoptera: Pteromalidae) populations of house flies and stable flies (Diptera: Muscidae) at the University of Florida Dairy Research Unit

    OpenAIRE

    Romero, Alvaro; Hogsette, Jerome A; Coronado, Alfredo

    2010-01-01

    From September 2001 through September 2002, house fly and stable fly pupae were collected weekly from three fly habitats at the University of Florida Research dairy in northcentral Florida and evaluated for parasitism. Varying parasitism percentages were observed throughout the study but they were not affected by temperature, precipitation or fly abundance. Of the 6,222 house fly pupae and 1,660 stable fly pupae that produced either a host fly or a parasitoid, 26.9% and 26.7% were parasitized...

  12. Effects of Hydrogen Peroxide on Dental Unit Biofilms and Treatment Water Contamination

    Science.gov (United States)

    Lin, Shih-Ming; Svoboda, Kathy K.H.; Giletto, Anthony; Seibert, Jeff; Puttaiah, Raghunath

    2011-01-01

    Objectives: To study effects of various concentrations of hydrogen peroxide on mature waterline biofilms and in controlling planktonic (free-floating) organisms in simulated dental treatment water systems; and to study in vitro the effects of 2%, 3%, and 7% hydrogen peroxide on the removal of mature biofilms and inorganic compounds in dental waterlines. Methods: Four units of an automated dental unit water system simulation device was used for 12 weeks. All units were initially cleaned to control biofilms and inorganic deposits. H2O2 at concentrations of 1%, 2%, 3% was used weekly for periodic cleaning in three treatment group units (units 1, 2 & 3), with 0.05%, 0.15% and 0.25% H2O2 in municipal water used as irrigant respectively. The control unit (unit 4) did not have weekly cleanings and used municipal water as irrigant. Laser Scanning Confocal Microscopy and Scanning Electron Microscopy were used to study deposits on lines, and weekly heterotrophic plate counts done to study effluent water contamination. A 24 hour in vitro challenge test with 7%, 3% and 2% H2O2 on mature biofilms was conducted using harvested waterlines to study biofilm and inorganic deposit removal. Results: Heterotrophic plate counts of effluent water showed that the control unit reached contamination levels in excess of 400,000 CFU/mL while all treatment units showed contamination levels biofilm and inorganic deposit control in this short 12 week study. The in vitro challenge test showed although there was biofilm control, there was no eradication even when 7% H2O2 was used for 24 hours. Conclusions: 2% H2O2 used as a periodic cleaner, and diluted to 0.05% in municipal water for irrigation was beneficial in controlling biofilm and planktonic contamination in dental unit water systems. However, to remove well established biofilms, it may take more than 2 months when initial and multiple periodic cleanings are performed using H2O2. PMID:21228956

  13. Thymidylate synthase protein expression levels remain stable during paclitaxel and carboplatin treatment in non-small cell lung cancer

    DEFF Research Database (Denmark)

    Jakobsen, Jan Nyrop; Santoni-Rugiu, Eric; Sørensen, Jens Benn

    2014-01-01

    BACKGROUND: Thymidylate synthase (TS) is a potential predictive marker for efficacy of treatment with pemetrexed. The current study aimed at investigating whether TS expression changes during non-pemetrexed chemotherapy of non-small cell lung cancer (NSCLC), thus making rebiopsy necessary...... for deciding on pemetrexed second-line treatment. MATERIALS AND METHODS: TS immunohistochemístry was performed on biopsies and available resection specimens from 65 NSCLC patients stage T1-3N0-2 treated with preoperative carboplatin and paclitaxel [neoadjuvant chemotherapy (NAC)-group] and from 53 NSCLC...... in primary tumors remained unchanged, and new biopsies for deciding on second-line pemetrexed does not seem warranted based on the current results....

  14. Salmeterol/fluticasone stable-dose treatment compared with formoterol/budesonide adjustable maintenance dosing: impact on health-related quality of life

    Directory of Open Access Journals (Sweden)

    Williams Angela E

    2007-07-01

    Full Text Available Abstract Background Improving patients' health-related quality of life (HRQoL is recognized as a fundamental part of asthma management. The aims of this study were to evaluate the long-term efficacy (including symptom-free days and exacerbations and impact on HRQoL of a stable-dose regimen of salmeterol/fluticasone propionate (SAL/FP and an adjustable maintenance dosing (AMD regimen of formoterol/budesonide (FOR/BUD where treatment is adjusted based on symptoms [SAM40056]. Methods A total of 688 outpatients with asthma receiving regular low-dose inhaled corticosteroids (ICS plus a long-acting β2-agonist, or medium dose ICS alone participated in this randomized, double-blind, double-dummy, parallel-group, 1-year trial, which was conducted in 91 centers in 15 countries. Patients were randomized to receive 1 inhalation of SAL/FP 50/250 μg BID or 2 inhalations of FOR/BUD 6/200 μg BID during Weeks 1–4. For Weeks 5–52, patients meeting strict continuation criteria for stable asthma at Week 4 received AMD with FOR/BUD or stable-dose SAL/FP. Results The percentage of symptom-free days was significantly greater (58.8% vs 52.1%; p = 0.034 and the annual exacerbation rate was significantly lower (47%; p = 0.008 with stable-dose SAL/FP compared with FOR/BUD AMD. A total of 568 patients completed the Asthma Quality of Life Questionnaire (AQLQ at least once during the study. The mean change from baseline in AQLQ overall score was numerically greater with SAL/FP than FOR/BUD at week 28 and week 52, but did not reach statistical significance (p = 0.121 at Week 52. However, in a post hoc logistic regression analyses for any AQLQ improvement, significant benefits with SAL/FP were seen at both time points (p = 0.038 and p = 0.009, respectively. The minimally important difference of ≥ 0.5-point improvement in AQLQ overall score was achieved by a significantly greater number of patients receiving SAL/FP at Week 28 (68% vs 60%; p = 0.049; a trend for this

  15. Stable beams

    CERN Multimedia

    2015-01-01

    Stable beams: two simple words that carry so much meaning at CERN. When LHC page one switched from "squeeze" to "stable beams" at 10.40 a.m. on Wednesday, 3 June, it triggered scenes of jubilation in control rooms around the CERN sites, as the LHC experiments started to record physics data for the first time in 27 months. This is what CERN is here for, and it’s great to be back in business after such a long period of preparation for the next stage in the LHC adventure.   I’ve said it before, but I’ll say it again. This was a great achievement, and testimony to the hard and dedicated work of so many people in the global CERN community. I could start to list the teams that have contributed, but that would be a mistake. Instead, I’d simply like to say that an achievement as impressive as running the LHC – a machine of superlatives in every respect – takes the combined effort and enthusiasm of everyone ...

  16. Treatment utilization among persons with opioid use disorder in the United States.

    Science.gov (United States)

    Wu, Li-Tzy; Zhu, He; Swartz, Marvin S

    2016-12-01

    The United States is experiencing an opioid overdose epidemic. Treatment use data from diverse racial/ethnic groups with opioid use disorder (OUD) are needed to inform treatment expansion efforts. We examined demographic characteristics and behavioral health of persons aged ≥12 years that met criteria for past-year OUD (n=6,125) in the 2005-2013 National Surveys on Drug Use and Health (N=503,101). We determined the prevalence and correlates of past-year use of alcohol/drug use treatment and opioid-specific treatment to inform efforts for improving OUD treatment. Among persons with OUD, 81.93% had prescription (Rx) OUD only, 9.75% had heroin use disorder (HUD) only, and 8.32% had Rx OUD+HUD. Persons with Rx OUD+HUD tended to be white, adults aged 18-49, males, or uninsured. The majority (80.09%) of persons with OUD had another substance use disorder (SUD), and major depressive episode (MDE) was common (28.74%). Of persons with OUD, 26.19% used any alcohol or drug use treatment, and 19.44% used opioid-specific treatment. Adolescents, the uninsured, blacks, native-Hawaiians/Pacific-Islanders/Asian-Americans, persons with Rx OUD only, and persons without MDE or SUD particularly underutilized opioid-specific treatment. Among alcohol/drug use treatment users, self-help group and outpatient rehabilitation treatment were commonly used services. Most people with OUD report no use of OUD treatment. Multifaceted interventions, including efforts to access insurance coverage, are required to change attitudes and knowledge towards addiction treatment in order to develop a supportive culture and infrastructure to enable treatment-seeking. Outreach efforts could target adolescents, minority groups, and the uninsured to improve access to treatment. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  17. Stable isotope estimates of evaporation: inflow and water residence time for lakes across the United States as a tool for national lake water quality assessments

    Science.gov (United States)

    Stable isotope ratios of water (delta18O and delta2H) can be very useful in large-scale monitoring programs because water samples are easy to collect and isotope ratios integrate information about basic hydrologic processes such as evaporation as a percentage of inflow (E/I) and ...

  18. Population-level differences in revascularization treatment and outcomes among various United States subpopulations.

    Science.gov (United States)

    Graham, Garth; Xiao, Yang-Yu Karen; Rappoport, Dan; Siddiqi, Saima

    2016-01-26

    Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to

  19. Comparison of the safety and efficacy of ivabradine and nebivolol mono- and combination therapies in the treatment of stable angina pectoris patients with left ventricular dysfunction

    Directory of Open Access Journals (Sweden)

    Rasim Kutlu

    2013-08-01

    Full Text Available We aimed to investigate the pharmacoeconomic efficacy of ivabradine and nebivolol in treatment of stable angina pectoris patients with left ventricular dysfunction prospectively. Pharmacoeconomic analysis was performed by using cost minimization analysis, and cost effectiveness analysis. After 6 months’ treatment LVEF for the nebivolol group (17 patients, 50% improved by (38 ± 6.5 to (41 ± 3.2, (p>0.05 and for the ivabradine group (17 patients, 50% (37 ± 5.4 to (41 ± 2.3, (p>0.05, mean MET value in the nebivolol group increased from (3.7 ± 1.2 to (5.5 ± 1.6, (p>0.05, versus from (3.6 ± 1.5 to (5.5 ± 1.4, (p>0.05 in the ivabradine group, cost minimization analysis results showed a difference in the total cost of treatment was US$ 5288.7 in favor of nebivolol. The findings suggest that nebivolol is more cost-effective than ivabradine in the treatment of patients with left ventricular dysfunction.

  20. Case report: treatment of medulloblastoma using a computer-controlled tracking cobalt unit

    International Nuclear Information System (INIS)

    Tate, T.; Brace, J.A.; Davy, T.J.; Morgan, H.M.; Skeggs, D.B.L.; Tookman, A.J.

    1985-01-01

    Radiation therapy of the length of the spinal column presents various clinical and physical problems. The completed plan may be complicated to set up, be time-consuming and require daily variation to achieve reasonable dose homogeneity. A case of medulloblastoma is used to illustrate the steps in producing a plan for dynamic treatment using a computer-controlled tracking cobalt unit. After definition by computed tomography, the target is considered in segments in order to develop a plan which keeps the spinal cord constantly positioned at the beam isocentre. The main computer is used to develop the patient treatment file and information is transferred to a second computer which controls and monitors the safe functioning of the cobalt unit. The cranial fields are treated separately in a conventional way. Good and consistent control of the dose distribution is achieved along the entire target volume. This technique is a marked improvement over all existing methods of treating the spinal axis. (author)

  1. The effect of statin treatment on the prevention of stent mediated flow limited edge dissections during PCI in patients with stable angina.

    Science.gov (United States)

    Oksuz, Fatih; Yarlioglues, Mikail; Yayla, Cagrı; Canpolat, Ugur; Murat, Sani Namık; Aydogdu, Sinan

    2016-10-01

    The effect of statin therapy before PCI with direct stenting may reduce the development of flow limited edge dissections (ED) in patients with stable angina. Flow limited ED after PCI is associated with an increased risk of major adverse cardiovascular events. Statin therapy induces important changes in the plaque composition which have been previously identified as strong predictors of ED. 100 patients complicated with flow limited ED and 100 control patients with successful procedure were enrolled into the study. EDs were described as the 5-mm regions that were immediately adjacent to the stent borders, both distally and proximally on the coronary angiography. Rate of statin use and duration of statin use were significantly higher in patients with non-ED group (63%) versus ED group (25%) (p<0.001). In addition, patients in ED group had significantly higher levels of C-reactive protein (CRP) at admission (9.9mg/dL (5.89-16.45) vs. 4.40mg/dL (3.5-7.09), respectively, p=0.014). Our findings suggested that maintenance statin treatment before PCI with direct stenting may reduce the development of flow limited ED in patients with stable angina. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Flexible and stable heat energy recovery from municipal wastewater treatment plants using a fixed-inverter hybrid heat pump system

    International Nuclear Information System (INIS)

    Chae, Kyu-Jung; Ren, Xianghao

    2016-01-01

    Highlights: • Specially designed fixed-inverter hybrid heat pump system was developed. • Hybrid operation performed better at part loads than single inverter operation. • The applied heat pump can work stably over a wide range of heat load variations. • Heat energy potential of treated effluent was better than influent. • The heat pump’s COP from the field test was 4.06 for heating and 3.64 for cooling. - Abstract: Among many options to improve energy self-sufficiency in sewage treatment plants, heat extraction using a heat pump holds great promise, since wastewater contains considerable amounts of thermal energy. The actual heat energy demand at municipal wastewater treatment plants (WWTPs) varies widely with time; however, the heat pumps typically installed in WWTPs are of the on/off controlled fixed-speed type, thus mostly run intermittently at severe part-load conditions with poor efficiency. To solve this mismatch, a specially designed, fixed-inverter hybrid heat pump system incorporating a fixed-speed compressor and an inverter-driven, variable-speed compressor was developed and tested in a real WWTP. In this hybrid configuration, to improve load response and energy efficiency, the base-heat load was covered by the fixed-speed compressor consuming relatively less energy than the variable-speed type at nominal power, and the remaining varying load was handled by the inverter compressor which exhibits a high load-match function while consuming relatively greater energy. The heat pump system developed reliably extracted heat from the treated effluent as a heat source for heating and cooling purposes throughout the year, and actively responded to the load changes with a high measured coefficient of performance (COP) of 4.06 for heating and 3.64 for cooling. Moreover, this hybrid operation yielded a performance up to 15.04% better on part loads than the single inverter operation, suggesting its effectiveness for improving annual energy saving when

  3. Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010

    Directory of Open Access Journals (Sweden)

    João Maurício Castaldelli-Maia

    2013-12-01

    Full Text Available Objective: To analyze the predictors of smoking cessation treatment outcomes in a sample with a high rate of medical and psychiatric disorders and addictions. Methods: Analysis of predictors of success of a 6-week treatment provided by an addiction care unit (CAPS-AD to 367 smokers in Brazil from 2007 to 2010. Forty variables were collected at baseline. Success was defined as abstinence from smoking for a period of at least 14 consecutive days, including the last day of treatment. Twenty variables were selected for the logistic regression model. Results: The only condition correlated with successful treatment after logistic regression was smoking one's first cigarette 5 minutes or more after waking (beta = 1.85, 95% confidence interval [95%CI] = 1.11-3.10, p = 0.018. Subjects with hypertension and alcohol use disorders and those who were undergoing psychiatric treatment showed success rates comparable to or greater than the average success rate of the sample (34.2-44.4%. Conclusions: These findings support the importance of the variable time to first cigarette in treatment outcomes for a sample with a high rate of clinical and psychiatric disorders. Good success rates were observed for pharmacological treatment, which was combined with group therapy based on cognitive-behavioral concepts and integrated into ongoing treatment of other addictions and psychiatric disorders.

  4. Hanford facility dangerous waste permit application, 325 hazardous waste treatment units. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-07-01

    This report contains the Hanford Facility Dangerous Waste Permit Application for the 325 Hazardous Waste Treatment Units (325 HWTUs) which consist of the Shielded Analytical Laboratory, the 325 Building, and the 325 Collection/Loadout Station Tank. The 325 HWTUs receive, store, and treat dangerous waste generated by Hanford Facility programs. Routine dangerous and/or mixed waste treatment that will be conducted in the 325 HWTUs will include pH adjustment, ion exchange, carbon absorption, oxidation, reduction, waste concentration by evaporation, precipitation, filtration, solvent extraction, solids washing, phase separation, catalytic destruction, and solidification/stabilization.

  5. Hanford facility dangerous waste permit application, 325 hazardous waste treatment units. Revision 1

    International Nuclear Information System (INIS)

    1997-07-01

    This report contains the Hanford Facility Dangerous Waste Permit Application for the 325 Hazardous Waste Treatment Units (325 HWTUs) which consist of the Shielded Analytical Laboratory, the 325 Building, and the 325 Collection/Loadout Station Tank. The 325 HWTUs receive, store, and treat dangerous waste generated by Hanford Facility programs. Routine dangerous and/or mixed waste treatment that will be conducted in the 325 HWTUs will include pH adjustment, ion exchange, carbon absorption, oxidation, reduction, waste concentration by evaporation, precipitation, filtration, solvent extraction, solids washing, phase separation, catalytic destruction, and solidification/stabilization

  6. Tuberculosis Diagnosis Delaying Treatment of Cancer: Experience From a New Oncology Unit in Blantyre, Malawi.

    Science.gov (United States)

    Masamba, Leo Peter Lockie; Jere, Yankho; Brown, Ewan Russell Stewart; Gorman, Dermot Robert

    2016-02-01

    Malawi is a low-income country in sub-Saharan Africa with limited health care infrastructure and high prevalance of HIV and tuberculosis. This study aims to determine the characteristics of patients presenting to Queen Elizabeth Central Hospital Oncology Unit, Blantyre, Malawi, who had been treated for tuberculosis before they were diagnosed with cancer. Clinical data on all patients presenting to the oncology unit at Queen Elizabeth Central Hospital from 2010 to 2014 after a prior diagnosis of tuberculosis were prospectively recorded, and a descriptive analysis was undertaken. Thirty-four patients who had been treated for tuberculosis before being diagnosed with cancer were identified between 2010 and 2014, which represents approximately 1% of new referrals to the oncology unit. Forty-one percent of patients were HIV positive. Mean duration of tuberculosis treatment before presentation to the oncology unit was 3.6 months. The most common clinical presentation was a neck mass or generalized lymphadenopathy. Lymphoma was the most common malignancy that was subsequently diagnosed in 23 patients. Misdiagnosis of cancer as tuberculosis is a significant clinical problem in Malawi. This study underlines the importance of closely monitoring the response to tuberculosis treatment, being aware of the possibility of a cancer diagnosis, and seeking a biopsy early if cancer is suspected.

  7. Trends in the United States in the treatment of distal radial fractures in the elderly.

    Science.gov (United States)

    Chung, Kevin C; Shauver, Melissa J; Birkmeyer, John D

    2009-08-01

    Traditionally, distal radial fractures in the elderly have been treated nonoperatively with casting. However, since the introduction of the volar locking plating system in 2000, there has been an interest in the use of more aggressive treatment methods. The purpose of the present study was to assess changing trends in the treatment of distal radial fractures in elderly patients in the United States. We evaluated a 5% sample of Medicare data from 1996 to 1997 and a 20% sample from 1998 to 2005. Information on four treatment methods (closed treatment, percutaneous pin fixation, internal fixation, and external fixation) was extracted from the dataset. Other available data were diagnosis, physician specialty, and patient age, sex, and race. We calculated frequencies and rates to compare the utilization of different treatments over time. Over the ten-year time period examined, the rate of internal fixation of distal radial fractures in the elderly increased fivefold, from 3% in 1996 to 16% in 2005. Closed treatment, however, remained the predominant method (used for 82% of the fractures in 1996 and 70% in 2005). Fractures in patients with an age of eighty-five years or more were significantly more likely to be treated in a closed fashion (p < 0.0001). There was a large variation among physician specialties with regard to the fixation methods that were used. Orthopaedic surgeons were significantly more likely to use closed treatment than hand surgeons were, whereas hand surgeons were significantly more likely to use internal fixation than orthopaedic surgeons were. Since 2000, although the majority of distal radial fractures are still treated nonoperatively, there has been an increase in the use of internal fixation and a concurrent decrease in the rate of closed treatment of distal radial fractures in the elderly in the United States.

  8. CONCEPTUAL BASES OF THE ENERGY EFFICIENT SYSTEM OF MANAGEMENT OF COMBINED UNITS OF WASTEWATER TREATMENT

    Directory of Open Access Journals (Sweden)

    V. N. Shtepa

    2016-01-01

    Full Text Available A critical analysis of the shortcomings of the existing water purification systems is conducted. In order to ensure environmental safety and energy savings it is proposed to use the combined units, including physical, chemical, physical-and-chemical and biological methods. The attention is driven to the fact that the most effective way to maintain current water purification is an adaptive control system. The shortcomings of the management of water treatment units were revealed and it was proposed to produce their synthesis based on the mathematical apparatus of artificial intelligence systems. Taking into account the requirements of the environmental safety and the need in the energy savings, the energy efficiency criteria of combined system functioning has been developed. At an industrial plant (slaughterhouse wastewater treatment the compliance of the production conditions of the criterion has been undertaken that confirmed the criterion relevance and usefulness as applied to the synthesis of energy-efficient control systems. A synthetic control system combined the water treatment plants. Having based on the preliminary research and analysis of the current work in the subject area the architecture of a control system of combined water treatment units that use intelligent technology was developed. The key functional of the unit – information-analytical subsystem of the formation control actions including: multilayer perceptrons self-organization Kohonen network, fuzzy cognitive map. The basic difference between the developed design and its analogues is the ability to adjust the settings of equipment adaptively on the basis of processing sensor data, information on the price of consumables, volley discharges of pollutants, a sudden change in the flow and other force majeure. Adjustment of the parameters of the control system is carried out with the use of experimental and analytical data stored in the knowledge base of technological

  9. Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States

    OpenAIRE

    Fryer, Gary; Morse, Christopher M; Johnson, Jane C

    2009-01-01

    Background Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States. Methods A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests w...

  10. Single motor unit firing rate after stroke is higher on the less-affected side during stable low-level voluntary contractions

    Directory of Open Access Journals (Sweden)

    Penelope A Mcnulty

    2014-07-01

    Full Text Available Muscle weakness is the most common outcome after stroke and a leading cause of adult-acquired motor disability. Single motor unit properties provide insight into the mechanisms of post-stroke motor impairment. Motor units on the more-affected side are reported to have lower peak firing rates, reduced discharge variability and a more compressed dynamic range than healthy subjects. The activity of 169 motor units was discriminated from surface EMG in 28 stroke patients during sustained voluntary contractions 10% of maximal and compared to 110 units recorded from 16 healthy subjects. Motor units were recorded in three series: ankle dorsiflexion, wrist flexion and elbow flexion. Mean firing rates after stroke were significantly lower on the more-affected than the less-affected side (p< 0.001 with no between-side differences for controls. When data were combined, firing rates on the less-affected side were significantly higher than those either on the more-affected side or healthy subjects (p< 0.001. Motor unit mean firing rate was higher in the upper-limb than the lower-limb (p< 0.05. The coefficient of variation of motor unit discharge rate was lower for motor units after stroke compared to controls for wrist flexion (p< 0.05 but not ankle dorsiflexion. However, the dynamic range of motor units was compressed only for motor units on the more-affected side during wrist flexion. Our results show that the pathological change in motor unit firing rate occurs on the less-affected side after stroke and not the more-affected side as previously reported, and suggest that motor unit behavior recorded in a single muscle after stroke cannot be generalized to muscles acting on other joints even within the same limb. These data emphasize that the less-affected side does not provide a valid control for physiological studies on the more-affected side after stroke and that both sides should be compared to data from age- and sex-matched healthy subjects.

  11. A Thermally Stable Form of Bacterial Cocaine Esterase: A Potential Therapeutic Agent for Treatment of Cocaine Abuse

    Energy Technology Data Exchange (ETDEWEB)

    Brim, Remy L.; Nance, Mark R.; Youngstrom, Daniel W.; Narasimhan, Diwahar; Zhan, Chang-Guo; Tesmer, John J.G.; Sunahara, Roger K.; Woods, James H. (Michigan); (Michigan-Med); (Kentucky)

    2010-09-03

    Rhodococcal cocaine esterase (CocE) is an attractive potential treatment for both cocaine overdose and cocaine addiction. CocE directly degrades cocaine into inactive products, whereas traditional small-molecule approaches require blockade of the inhibitory action of cocaine on a diverse array of monoamine transporters and ion channels. The usefulness of wild-type (wt) cocaine esterase is hampered by its inactivation at 37 C. Herein, we characterize the most thermostable form of this enzyme to date, CocE-L169K/G173Q. In vitro kinetic analyses reveal that CocE-L169K/G173Q displays a half-life of 2.9 days at 37 C, which represents a 340-fold improvement over wt and is 15-fold greater than previously reported mutants. Crystallographic analyses of CocE-L169K/G173Q, determined at 1.6-{angstrom} resolution, suggest that stabilization involves enhanced domain-domain interactions involving van der Waals interactions and hydrogen bonding. In vivo rodent studies reveal that intravenous pretreatment with CocE-L169K/G173Q in mice provides protection from cocaine-induced lethality for longer time periods before cocaine administration than wt CocE. Furthermore, intravenous administration (pretreatment) of CocE-L169K/G173Q prevents self-administration of cocaine in a time-dependent manner. Termination of the in vivo effects of CoCE seems to be dependent on, but not proportional to, its clearance from plasma as its half-life is approximately 2.3 h and similar to that of wt CocE (2.2 h). Taken together these data suggest that CocE-L169K/G173Q possesses many of the properties of a biological therapeutic for treating cocaine abuse but requires additional development to improve its serum half-life.

  12. On the unit rupture work of metals and alloys

    International Nuclear Information System (INIS)

    Verkhoturov, A.D.; Kovalenko, V.S.; Dyatel, V.P.

    1980-01-01

    Studied is the effect of the nature of the treated material treatment regimes on their unit rupture work at laser treatment in the regime of quasistationary evaporation. It is shown that the unit rupture work changes its values depending on the treatment regimes, coincidences between experimental and calculation values of unit rupture work are not being observed, especially for refractory metals of the 6th group and for solid alloys. Established are optimum regimes for determination of stable values of unit rupture work

  13. [Characteristics of Adolescents with Gender Dysphoria Referred to the Gender Identity Treatment Unit].

    Science.gov (United States)

    Fernández Rodríguez, María; Guerra Mora, Patricia; Martín Sánchez, Eloya

    2017-02-01

    The demand for treatment among people with gender dys-phoria has increased during the last years. The aim of the present research was to carry out an analysis of the demand of the teenagers that requested consultation at the UTIGPA (Gender Identity Treatment Unit of Principality of Asturias) as they presented complains of gender dysphoria. The sample included 20 minors that were treated between March 2007 and December 2015. The clinical history was made to collect informa-tion. It was made descriptive analysis and the reason sex/gender was used. The 20 teenagers represented the 14,6% of the whole sample (of 137 demands). The age average was 15,20 years (SD=1,473) and the range of years was between 12-17. The reason sex/gender was 1/1 (10 into the man to woman group and 10 into the woman to man group). At the arrival at the Treatment Unit, 100% of the individuals lived with their nuclear or extended family and in the 60% of the cases, their parents were separated. 70% of the cases were referred from mental health services. 10% hadn´t got any past medical history and 35% had never received any prescription for a psychopharmacological treatment. 95% hadn't done any hormonal self-treatment. 100% defined themselves as heterosexual. 25% requested exclusively for psychological interventions and 75% asked for medical treatments. The profile of the minor was a teenager of approximately 15 years old that was referred from mental health services. Contrary to the fin-dings of other national and international researches, the rate sex/gender was equated in our research. The minor had got a past medical history and their prio-rity request was for medical treatments, both hormonal and surgical therapies.

  14. Application of an EPID for fast daily dosimetric quality control of a fully computer-controlled treatment unit

    Energy Technology Data Exchange (ETDEWEB)

    Dirkx, M.L.P.; Kroonwijk, M.; De Boer, J.C.J.; Heijmen, B.J.M. [Nederlands Kanker Inst. `Antoni van Leeuwenhoekhuis`, Amsterdam (Netherlands)

    1995-12-01

    The MM50 Racetrack Microtron, suited for sophisticated three-dimensional computer-controlled conformal radiotherapy techniques, is a complex treatment unit in various respects. Therefore, for a number of gantry angles, daily quality control of the absolute output and the profiles of the scanned photon beams in mandatory. A fast method for these daily checks, based on dosimetric measurements with the Philips SRI-100 Electronic Portal Imaging Device, has been developed and tested. Open beams are checked for four different gantry angles; for gantry angle 0, a wedged field is checked as well. The fields are set up one after another under full computer control. Performing and analyzing the measurements takes about ten minutes. The applied EPID has favourable characteristics for dosimetric quality control measurements: absolute measurements reproduce within 0.5% (1 SD) and the reproducibility of a relative (2-D) fluence profile is 0.2% (1 SD). The day-to-day sensitivity stability over a period of a month is 0.6% (1 SD). EPID-signals are within 0.2% linear with the applied dose. The 2-D fluence profile of the 25 MV photon beam of the MM50 is very stable in time: during a period of one year, a maximum fluctuation of 2.6% was observed. Once, a deviation in the cGy/MU-value of 6% was detected. Only because of the performed morning quality control checks with the EPID, erroneous dose delivery to patients could be avoided; there is no interlock in the MM50-system that would have prevented patient treatment. Based on our experiences and on clinical requirements regarding the acceptability of deviations of beam characteristics, a protocol has been developed including action levels for additional investigations. Studies on the application of the SRI-100 for in vivo dosimetry on the MM50 have been started.

  15. Toward treatment with respect and dignity in the intensive care unit.

    Science.gov (United States)

    Sugarman, Jeremy

    2015-01-01

    Despite concern that patients in the intensive care unit (ICU) may not be treated with respect and dignity, there is not conceptual clarity regarding what constitutes such treatment. In addition, measures specific to treatment with respect and dignity in the ICU are unavailable. Accordingly, a multidisciplinary group developed a conceptual model for treatment with respect and dignity in the ICU and used mixed methods to gather data on this issue. This effort included interviews with patients and families, focus groups with health care professionals, and direct observations. These data were then compared and contrasted to synthesize what was learned. Finally, pilot quantitative patient and family survey data were collected and analyzed. Each of these approaches, which comprise the papers in this supplement to Narrative Inquiry in Bioethics, is briefly described in this article.

  16. MOBIL CONTAINER UNIT FOR SEWAGE SLUDGE UTILIZATION FROM SMALL AND MEDIUM WASTWATER TREATMENT PLANTS

    Directory of Open Access Journals (Sweden)

    Stanisław Ledakowicz

    2016-06-01

    Full Text Available The most wastewater treatment plants in Poland are small and medium plants of flow capacity below 1000 m3/d. These plants are not able to build sludge incineration plants and the transportation costs to the nearest plants increase the total costs of wastewater treatment. Polish company Metal Expert together with the French company ETIA and Lodz University of Technology proposed mobile unit for integrated drying and pyrolysis of sewage sludge in a pilot bench scale with capacity of 100 kg/h of dewatered sludge. The pilot plant was mounted in a typical mobile container which could provide service to small and medium wastewater treatment plants offering thermal processing of sewage sludge. This unit consists of KENKI contact dryer and „Spirajoule”® pyrolyser supplied with electricity utilizing the Joule effect, and a boiler, wherein the pyrolysis gases and volatile products are burned producing steam sent to the contact dryer. The bio-char produced during sludge pyrolysis could be utilized for agriculture purposes. During preliminary experiments and short-term exploitation of the unit at Elbląg Wastewater Treatment Plant the obtained results allowed us to make a mass and energy balance depended on the process conditions in the pyrolysis temperature range of 400÷800 °C. Based on the obtained results a calculator was created in the Excel , which enables assessment of pyrolysis products content and making mass and energy balances depended on process parameters such as initial moisture of sludge, pyrolysis temperature and installation output.

  17. Design of chemical treatment unit for radioactive liquid wastes in Serpong nuclear facilities

    International Nuclear Information System (INIS)

    Salimin, Z.; Walman, E.; Santoso, P.; Purnomo, S.; Sugito; Suwardiyono; Wintono

    1996-01-01

    The chemical treatment unit for radioactive liquid wastes arising from nuclear fuel fabrication, radioisotopes production and radiometallurgy facility has been designed. The design of chemical processing unit is based on the characteristics of liquid wastes containing fluors from uranium fluoride conversion process to ammonium uranyl carbonate on the fuel fabrication. The chemical treatment has the following process steps: coagulation-precipitation of fluoride ion by calcium hydroxide coagulant, separation of supernatant solution from sludge, coagulation of remaining fluoride on the supernatant solution by alum, separation of supernatant from sludge, and than precipitation of fluors on the supernatant by polymer resin WWS 116. The processing unit is composed of 3 storage tanks for raw liquid wastes (capacity 1 m 3 per tank), 5 storage tanks for chemicals (capacity 0.5 m 3 per tank), 2 mixing reactors (capacity 0.5 m 3 per reactor), 1 storage tank for supernatant solution (capacity 1 m 3 ), and 1 storage tank for sludge (capacity 1 m 3 )

  18. Current trends in endodontic treatment by general dental practitioners: report of a United States national survey.

    Science.gov (United States)

    Savani, Gina M; Sabbah, Wael; Sedgley, Christine M; Whitten, Brian

    2014-05-01

    In the United States almost 70% of root canal treatment (RCT) is performed by general dentists (GPs), yet little is known about their treatment protocols. A paper survey was mailed to 2000 United States GPs with questions about the types of endodontic cases treated, routine treatment protocols, use of newer technologies, and endodontic continuing education (CE). Completed surveys were returned by 479 respondents (24%). GPs who perform RCT (84%) reported providing anterior (99%), bicuspid (95%), and molar (62%) RCT and retreatment (18%). Rubber dam was used always (60%), usually (16%), sometimes (13%), and never (11%). Newer technologies used by GPs included digital radiography (72%), magnification (80%), electronic apex locator (70%), and nickel-titanium rotary instrumentation (74%). Compared with GPs with >20 years of experience, those in practice for ≤10 years were more likely to use rubber dam (P 20 years were more likely to perform retreatments (P retreatment or molar RCT (both P 5 hours of CE were more likely to use rotary instrumentation (P retreatment (P 20 years. More experienced GPs were more likely to take on complicated cases than those with fewer years of practice. There was no association between hours of CE and compliance with rubber dam usage. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  19. Design of Biochemical Oxidation Process Engineering Unit for Treatment of Organic Radioactive Liquid Waste

    International Nuclear Information System (INIS)

    Zainus Salimin; Endang Nuraeni; Mirawaty; Tarigan, Cerdas

    2010-01-01

    Organic radioactive liquid waste from nuclear industry consist of detergent waste from nuclear laundry, 30% TBP-kerosene solvent waste from purification or recovery of uranium from process failure of nuclear fuel fabrication, and solvent waste containing D 2 EHPA, TOPO, and kerosene from purification of phosphoric acid. The waste is dangerous and toxic matter having low pH, high COD and BOD, and also low radioactivity. Biochemical oxidation process is the effective method for detoxification of organic waste and decontamination of radionuclide by bio sorption. The result process are sludges and non radioactive supernatant. The existing treatment facilities radioactive waste in Serpong can not use for treatment of that’s organics waste. Dio chemical oxidation process engineering unit for continuous treatment of organic radioactive liquid waste on the capacity of 1.6 L/h has been designed and constructed the equipment of process unit consist of storage tank of 100 L capacity for nutrition solution, 2 storage tanks of 100 L capacity per each for liquid waste, reactor oxidation of 120 L, settling tank of 50 L capacity storage tank of 55 L capacity for sludge, storage tank of 50 capacity for supernatant. Solution on the reactor R-01 are added by bacteria, nutrition and aeration using two difference aerators until biochemical oxidation occurs. The sludge from reactor of R-01 are recirculated to the settling tank of R-02 and on the its reverse operation biological sludge will be settled, and supernatant will be overflow. (author)

  20. Community unit performance: factors associated with childhood diarrhea and appropriate treatment in Nyanza Province, Kenya.

    Science.gov (United States)

    Kawakatsu, Yoshito; Tanaka, Junichi; Ogawa, Kazuya; Ogendo, Kenneth; Honda, Sumihisa

    2017-02-16

    The government of Kenya launched its community health strategy in 2006 to improve certain aspects of its community health program. Under the strategy, community units (CUs) were established as level one of the Kenyan health system. A core member at this level is the community health worker (CHW). The objective of this study was to assess the relationship among the performance of the CUs, the prevalence of childhood diarrhea and appropriate treatment for it by controlling individual and community-level factors. The main dataset used in this study was the 2011 Nyanza Province county-based Multiple Indicator Cluster Survey (MICS). In addition, based on the list of community units in Nyanza Province, Kenya, we identified the area's CUs and their performance. MICS data and data on CUs were merged using sub-location names. There were 17 individual and two community-level independent variables in this study. Bivariate analysis and a multilevel logistic regression were performed. Factors significantly associated with a lower prevalence of diarrhea among children under five were the child's increasing age, middle-aged household heads, children who received more attention, water treatment and rural versus urban area residence, while male children and highly performing CUs were significantly associated with a higher prevalence of diarrhea. In addition, middle wealth index, severity of diarrhea and middle- and high-CU performance were significantly associated with appropriate treatment for childhood diarrhea. Although this study found that children living in areas of high CU performance were more likely to have diarrhea, these areas would have been identified as being more at risk for diarrhea prevalence and other health concerns, prioritized for the establishment of a CU and allocated more resources to improve the performance of CUs. A higher CU performance was significantly associated with the appropriate treatment. It was suggested that CHWs could have a positive effect on

  1. Pre-treatment analysis of woody vegetation composition and structure on the hardwood ecosystem experiment research units

    Science.gov (United States)

    Michael R. Saunders; Justin E. Arseneault

    2013-01-01

    In long-term, large-scale forest management studies, documentation of pre-treatment differences among and variability within experimental units is critical for drawing the proper inferences from imposed treatments. We compared pre-treatment overstory and large shrub communities (diameters at breast height >1.5 cm) for the 9 research cores with the Hardwood Ecosystem...

  2. Resource Conservation and Recovery Act (RCRA) closure sumamry for the Uranium Treatment Unit

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-05-01

    This closure summary has been prepared for the Uranium Treatment Unit (UTU) located at the Y-12 Plant in Oak Ridge, Tennessee. The actions required to achieve closure of the UTU area are outlined in the Closure Plan, submitted to and approved by the Tennessee Department of Environmental and Conservation staff, respectively. The UTU was used to store and treat waste materials that are regulated by the Resource Conservation and Recovery Act. This closure summary details all steps that were performed to close the UTU in accordance with the approved plan.

  3. Resource Conservation and Recovery Act (RCRA) closure sumamry for the Uranium Treatment Unit

    International Nuclear Information System (INIS)

    1996-05-01

    This closure summary has been prepared for the Uranium Treatment Unit (UTU) located at the Y-12 Plant in Oak Ridge, Tennessee. The actions required to achieve closure of the UTU area are outlined in the Closure Plan, submitted to and approved by the Tennessee Department of Environmental and Conservation staff, respectively. The UTU was used to store and treat waste materials that are regulated by the Resource Conservation and Recovery Act. This closure summary details all steps that were performed to close the UTU in accordance with the approved plan

  4. Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis: A retrospective case-control study.

    Science.gov (United States)

    Sun, Yapeng; Zhang, Wei; Qie, Suhui; Zhang, Nan; Ding, Wenyuan; Shen, Yong

    2017-07-01

    The study was to comprehensively compare the postoperative outcome and imaging parameter characters in a short/middle period between the percutaneous endoscopic lumbar discectomy (PELD) and the internal fixation of bone graft fusion (the most common form is posterior lumbar interbody fusion [PLIF]) for the treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis after a previous lumbar internal fixation surgery.In this retrospective case-control study, we collected the medical records from 11 patients who received PELD operation (defined as PELD group) for and from 13 patients who received the internal fixation of bone graft fusion of lumbar posterior vertebral lamina decompression (defined as control group) for the treatment of the lumbar disc prolapse combined with stable retrolisthesis at Department of Spine Surgery, the Third Hospital of Hebei Medical University (Shijiazhuang, China) from May 2010 to December 2015. The operation time, the bleeding volume of perioperation, and the rehabilitation days of postoperation were compared between 2 groups. Before and after surgery at different time points, ODI, VAS index, and imaging parameters (including Taillard index, inter-vertebral height, sagittal dislocation, and forward bending angle of lumbar vertebrae) were compared.The average operation time, the blooding volume, and the rehabilitation days of postoperation were significantly less in PELD than in control group. The ODI and VAS index in PELD group showed a significantly immediate improving on the same day after the surgery. However, Taillard index, intervertebral height, sagittal dislocation in control group showed an immediate improving after surgery, but no changes in PELD group till 12-month after surgery. The forward bending angle of lumbar vertebrae was significantly increased and decreased in PELD and in control group, respectively.PELD operation was superior in terms of operation time, bleeding volume, recovery period, and financial

  5. Comprehensive comparing percutaneous endoscopic lumbar discectomy with posterior lumbar internal fixation for treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis

    Science.gov (United States)

    Sun, Yapeng; Zhang, Wei; Qie, Suhui; Zhang, Nan; Ding, Wenyuan; Shen, Yong

    2017-01-01

    Abstract The study was to comprehensively compare the postoperative outcome and imaging parameter characters in a short/middle period between the percutaneous endoscopic lumbar discectomy (PELD) and the internal fixation of bone graft fusion (the most common form is posterior lumbar interbody fusion [PLIF]) for the treatment of adjacent segment lumbar disc prolapse with stable retrolisthesis after a previous lumbar internal fixation surgery. In this retrospective case-control study, we collected the medical records from 11 patients who received PELD operation (defined as PELD group) for and from 13 patients who received the internal fixation of bone graft fusion of lumbar posterior vertebral lamina decompression (defined as control group) for the treatment of the lumbar disc prolapse combined with stable retrolisthesis at Department of Spine Surgery, the Third Hospital of Hebei Medical University (Shijiazhuang, China) from May 2010 to December 2015. The operation time, the bleeding volume of perioperation, and the rehabilitation days of postoperation were compared between 2 groups. Before and after surgery at different time points, ODI, VAS index, and imaging parameters (including Taillard index, inter-vertebral height, sagittal dislocation, and forward bending angle of lumbar vertebrae) were compared. The average operation time, the blooding volume, and the rehabilitation days of postoperation were significantly less in PELD than in control group. The ODI and VAS index in PELD group showed a significantly immediate improving on the same day after the surgery. However, Taillard index, intervertebral height, sagittal dislocation in control group showed an immediate improving after surgery, but no changes in PELD group till 12-month after surgery. The forward bending angle of lumbar vertebrae was significantly increased and decreased in PELD and in control group, respectively. PELD operation was superior in terms of operation time, bleeding volume, recovery period

  6. Study of the uses of Information and Communication Technologies by Pain Treatment Unit Physicians.

    Science.gov (United States)

    Muriel Fernandez, Jorge; Sánchez Ledesma, María José; López Millan, Manuel; García Cenador, María Begoña

    2017-05-01

    Adequate use of Information and Communication Technologies (ICTs) in health has been shown to save the patient and caregiver time, improve access to the health system, improve diagnosis and control of disease or treatment. All this results in cost savings, and more importantly, they help improve the quality of service and the lives of patients. The purpose of this study is to analyse the differences in the uses of this ICTs between those physicians that belong to Pain Treatment Units (PU) and other physicians that work in pain not linked to these PUs. An online survey, generated by Netquest online survey tool, was sent to both groups of professionals and the data collected was statistical analysed through a logistic regression methodology which is the Logit binomial model. Our results show that those physicians that belong to PUs use ICTs more frequently and consider it more relevant to their clinical practice.

  7. Treatment of skin and soft tissue infections in a pediatric observation unit.

    Science.gov (United States)

    Lane, Roni D; Sandweiss, David R; Corneli, Howard M

    2014-05-01

    To report the success rate of observation unit (OU) treatment of pediatric skin and soft tissue infections (SSTIs) and to see if we could identify variables at the time of initial evaluation that predicted successful OU treatment. A retrospective review of children less than 18 years of age admitted for SSTI treatment to our OU from the emergency department between January 2003 and June 2009. On records review, 853 patients matched eligibility criteria; median age was 5.2 years (interquartile range = 2.5-9 years). Of the 853 patients, 597 (70.0%) met the primary outcome criteria of successful OU discharge within 26 hours. Secondary analysis revealed that 82% of the patients achieved successful discharge from the OU within 48 hours. Although some laboratory variables demonstrated statistical association with success, none achieved a combination of high sensitivity and specificity to predict OU failure. OU success rates varied by location. Dental and face infections and those of the extremities or multiple sites demonstrated OU success rates higher than 65%, while infection of the groin, buttocks, trunk, or neck had success rates between 24% (neck) and 60% (groin). In multivariate analysis, only 3 variables remained significant. Unfavorable location was most strongly associated with OU failure, followed by C-reactive protein > 4 and then by erythrocyte sedimentation rate > 20. Our findings suggest that successful OU treatment is possible in a large group of patients needing hospitalization for SSTIs. Consideration of infection location may assist the emergency department clinician in determining the most appropriate unit for admission.

  8. Development and status of the AL Mixed Waste Treatment Plan or I love that mobile unit of mine

    International Nuclear Information System (INIS)

    Bounini, L.; Williams, M.; Zygmunt, S.

    1995-01-01

    Nine Department of Energy (DOE) sites reporting to the Albuquerque Office (AL) have mixed waste that is chemically hazardous and radioactive. The hazardous waste regulations require the chemical portion of mixed waste to be to be treated to certain standards. The total volume of low-level mixed waste at the nine sites is equivalent to 7,000 drums, with individual site volumes ranging from 1 gallon of waste at the Pinellas Plant to 4,500 drums at Los Alamos National Laboratory. Nearly all the sites have a diversity of wastes requiring a diversity of treatment processes. Treatment capacity does not exist for much of this waste, and it would be expensive for each site to build the diversity of treatment processes needed to treat its own wastes. DOE-AL assembled a team that developed the AL Mixed Waste Treatment Plan that uses the resources of the nine sites to treat the waste at the sites. Work on the plan started in October 1993, and the plan was finalized in March 1994. The plan uses commercial treatment, treatability studies, and mobile treatment units. The plan specifies treatment technologies that will be built as mobile treatment units to be moved from site to site. Mobile units include bench-top units for very small volumes and treatability studies, drum-size units that treat one drum per day, and skid-size units that handle multiple drum volumes. After the tools needed to treat the wastes were determined, the sites were assigned to provide part of the treatment capacity using their own resources and expertise. The sites are making progress on treatability studies, commercial treatment, and mobile treatment design and fabrication. To date, this is the only plan for treating waste that brings the resources of several DOE sites together to treat mixed waste. It is the only program actively planning to use mobile treatment coordinated between DOE sites

  9. Delivery Unit Costs for Antiretroviral Treatment and Prevention of Mother-to-Child-Transmission of HIV

    Science.gov (United States)

    Galárraga, Omar; Wirtz, Veronika J.; Figueroa-Lara, Alejandro; Santa-Ana-Tellez, Yared; Coulibaly, Ibrahima; Viisainen, Kirsi; Medina-Lara, Antonieta; Korenromp, Eline L.

    2013-01-01

    Background As antiretroviral treatment (ART) for HIV/AIDS is scaled-up globally, information on per-person costs is critical to improve efficiency in service delivery and maximize coverage and health impact. Objective To review studies on delivery unit costs for adult and pediatric ART provision per-patient-year, and prevention of mother-to-child transmission (PMTCT) interventions per mother-infant pair screened or treated, in low- and middle-income countries. Methods Systematic review of English, French and Spanish publications from 2001 to 2009, reporting empirical costing that accounted for at least antiretroviral (ARV) medicines, laboratory testing and personnel. Expenditures were analyzed by country income level and cost component. All costs were standardized to 2009 US dollars. Results Analyses covered 29 eligible, comprehensive costing studies. In the base case, in low-income countries (LIC), median, ART cost per patient-year was $792 (mean: $839, range: $682-$1089); for lower-middle-income countries (LMIC), the median was $932 (mean: $1246, range: $156-$3904); and for upper-middle-income countries (UMIC) the median was $1454 (mean: $2783, range: $1230-$5667). ARV drugs were largest component of overall ART cost in all settings (62%, 50% and 47% in LIC, LMIC and UMIC respectively). Out of 26 ART studies, 14 report which drug regimes were used, and only one study explicitly reported second line treatment costs. The second cost driver was laboratory cost in LIC and LMIC (14% and 19.5%) whereas it was personnel costs in UMIC (26%). Two studies specified the types of laboratory tests costed, and three studies specifically included above-facility-level personnel costs. Three studies reported detailed PMTCT costs, and two studies reported on pediatric ART. Conclusions There is a paucity of data on the full ART and PMTCT delivery unit costs, in particular for low-and middle-income countries. Heterogeneity in activities costed and insufficient detail regarding

  10. Drip-and-ship thrombolytic treatment paradigm among acute ischemic stroke patients in the United States.

    Science.gov (United States)

    Tekle, Wondwossen G; Chaudhry, Saqib A; Hassan, Ameer E; Rodriguez, Gustavo J; Suri, M Fareed K; Qureshi, Adnan I

    2012-07-01

    To provide a national assessment of thrombolytic administration using drip-and-ship treatment paradigm. Patients treated with the drip-and-ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment were identified within the Nationwide Inpatient Sample. Thrombolytic utilization, patterns of referral, comparative in-hospital outcomes, and hospitalization charges related to drip-and-ship paradigm were determined. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate analysis. Of the 22 243 ischemic stroke patients who received thrombolytic treatment, 4474 patients (17%) were treated using drip-and-ship paradigm. Of these 4474 patients, 81% were referred to urban teaching hospitals for additional care, and 7% of them received follow-up endovascular treatment. States with a higher proportion of patients treated using the drip-and-ship paradigm had higher rates of overall thrombolytic utilization (5.4% versus 3.3%; Pcare was significantly higher in patients treated with drip-and-ship paradigm compared with those who received thrombolytics through primary emergency department arrival in the multivariate analysis (OR, 1.198; 95% CI, 1.019-1.409; P=0.0286). One of every 6 thrombolytic-treated patients in United States is treated using drip-and-ship paradigm. States with the highest proportion of drip-and-ship cases were also the states with the highest thrombolytic utilization.

  11. Land Application of Treated Sewage Sludge in the United States: Regulatory Considerations for Risk Reduction and Determining Treatment Process Equivalency

    Science.gov (United States)

    In the United States, municipal wastewater includes discharges from households, commercial businesses and various industries. Microorganisms associated with these wastes can be concentrated in the solids (sludge) which are removed during treatment operations. Beneficial reuse a...

  12. Surgical treatment using The Unit Rod in children with neuromuscular scoliosis.

    Science.gov (United States)

    Nedelcu, T; Georgescu, I; Leroux, J; Lechevallier, J; Barbilian, A; Tuhar, I

    2016-01-01

    The article represents a retrospective clinical and radiological study. Objective. To assess the safety and the stability in time of the Unit Rod instrumentation in the treatment of severe neuromuscular scoliosis in children and adolescents. Summary. The treatment of patients with neuromuscular scoliosis always represents a challenge. The patients are debilitated and usual interventions are very long with great loss of blood. Serious complications can compromise the result of the surgery. The technique we used (the Unit Rod) is worldwide recognized, is simple, and gives excellent stability with a low rate of complications. Methods. We conducted a clinical and radiological retrospective study with a follow-up of at least 4 years in 58 patients with serious neuromuscular conditions, most of them being non-walkers. They were surgically treated by using mostly the Unit Rod technique, in the department of Paediatric Orthopaedics of the Rouen University Hospital, France, between 2000 and 2008. The back fusion was generally from T2 to pelvis. We used the Galveston technique for the patients who needed a pelvic fixation. Results. The mean Cobb angle correction was of 67% immediately after surgery; the correction of the curve decreased in time only in 4% of the cases. Pelvic obliquity was also very well corrected: 73% immediately and 70% at the last radiological follow-up. The mean operative time was of 175 minutes compared to 269 minutes for screws and hooks instrumentation. The most common complication for our technique was the radiolucent halo that appeared around the pelvic inserts. There was no significant degradation in time of the correction obtained. Conclusions. The use of this technique is safe, gives excellent results, achieving significant improvements in the postoperative functional status of the patients. The intra- and postoperative complications were minor. The advantage of using this method is the low cost of the material and technical simplicity, the

  13. Somatic mutation frequencies in the stamen hairs of stable and mutable clones of Tradescantia after acute gamma-ray treatments with small doses

    International Nuclear Information System (INIS)

    Ichikawa, Sadao; Takahashi, C.S.

    1977-01-01

    Young inflorescences of two different Tradescantia clones heterozygous for flower and stamen-hair color, one stable (KU 9) and the other spontaneously mutable (KU 20), were irradiated acutely with small doses (approx. 3 to 50 R) of 60 Co gamma-rays. Somatic mutation frequencies from blue to pink in the stamen hairs scored on post-irradiation days 10 to 16 increased essentially linearly with increasing gamma-ray dose in both clones. Despite about a 5-fold difference in spontaneous mutation frequency per hair found between the two clones, the dose-response curves of pink mutations determined were similar to each other, giving average mutation frequencies of 1.51 and 1.41 pink-mutant events per 1000 hairs per R for KU 9 and KU 20, respectively. These frequencies are comparable to earlier results obtained from acute irradiation treatments of other clones with higher doses. The doubling dose of pink mutation (the radiation dose making the mutation frequency double the spontaneous level) was calculated to be 2.09 R for KU 9, and this low doubling dose must be given full attention. On the other hand, the doubling dose for KU 20 (calculated to be 10.4 R) is of questionable value, being greatly subject to change because of the diversely variable spontaneous mutation frequency of this clone

  14. Multibeam tomotherapy: A new treatment unit devised for multileaf collimation, intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Achterberg, Nils; Mueller, Reinhold G.

    2007-01-01

    A fully integrated system for treatment planning, application, and verification for automated multileaf collimator (MLC) based, intensity-modulated, image-guided, and adaptive radiation therapy (IMRT, IGRT and ART, respectively) is proposed. Patient comfort, which was the major development goal, will be achieved through a new unit design and short treatment times. Our device for photon beam therapy will consist of a new dual energy linac with five fixed treatment heads positioned evenly along one plane but one electron beam generator only. A minimum of moving parts increases technical reliability and reduces motion times to a minimum. Motion is allowed solely for the MLCs, the robotic patient table, and the small angle gantry rotation of ±36 deg. . Besides sophisticated electron beam guidance, this compact setup can be built using existing modules. The flattening-filter-free treatment heads are characterized by reduced beam-on time and contain apertures restricted in one dimension to the area of maximum primary fluence output. In the case of longer targets, this leads to a topographic intensity modulation, thanks to the combination of ''step and shoot'' MLC delivery and discrete patient couch motion. Owing to the limited number of beam directions, this multislice cone beam serial tomotherapy is referred to as ''multibeam tomotherapy.'' Every patient slice is irradiated by one treatment head at any given moment but for one subfield only. The electron beam is then guided to the next head ready for delivery, while the other heads are preparing their leaves for the next segment. The ''Multifocal MLC-positioning'' algorithm was programmed to enable treatment planning and optimize treatment time. We developed an overlap strategy for the longitudinally adjacent fields of every beam direction, in doing so minimizing the field match problem and the effects of possible table step errors. Clinical case studies show for the same or better planning target volume coverage

  15. Independent calculation of the monitor units and times of treatment in radiotherapy

    International Nuclear Information System (INIS)

    Mueller, Marcio Rogerio

    2005-01-01

    In this work, an independent verification system of calculations in radiotherapy was developed and applied, using Visual Basic TM programming language. The computational program performs calculations of monitor units and treatment time, based on the algorithm of manual calculation. The calculations executed for the independent system had initially been compared with the manual calculations performed by the medical physicists of the Institute of Radiotherapy of the Hospital das Clinicas da Universidade de Sao Paulo. In this step, the results found for more than two hundred fields studied were similar to those found in the literature; deviations larger than +- 1% were found only in five cases involving errors in manual calculation. The application of the independent system, in this stage, could have identified errors up to +- 2,4%. Based on these data, the system was validated for use in clinical routine. In a second step, calculations were compared with calculations realized by the treatment computerized planning system CadPIan TM . When, again, the results were similar to those published in other works allowing to obtain levels of acceptance of the discrepancies between the calculations executed for the independent system and the calculations developed from the planning system, separated by anatomical region, as recommended according by the recent literature. For beams of 6 MV, the levels of acceptance for deviations between the calculations of monitor units, separated by treatment region were the following; breast +- 1.7%, head and neck +2%; hypophysis +- 2.2%; pelvis +- 4 . 1% and thorax +- 1.5%. For beams of 15 MV, the level suggested for pelvis was of +- 4.5%. (author)

  16. Study of the efficiency of some water treatment unit that present in houses in Erbil city-Iraq

    Science.gov (United States)

    Toma, Janan. Jabbar.; Hanna, Aveen. Matti.

    2017-09-01

    Many people in Erbil city started more than two decade to put special treatment units in their houses to purified water to become safer for drinking uses. The aim of this study was determine the efficiency of six kind water treatment units which include (two replicate of Crystal Water Purifier, So-Safe Water Filter, R O Water Purifier, Kontec Water Purified and Al-Kawther Purified Water). Water samples were collected in two sites one before and other after treatment unit. Each sample was collect with three replication during May to October-2016. Analyzed for Major cations concentration (calcium, magnesium, sodium and potassium), anions concentration (nitrate and chloride) and hydrogen ion concentration (pH), electrical conductivity (EC), total dissolved solids (TDS), alkalinity and total hardness by using standard methods. The water quality index values for all raw water sample befor and after treatment was good and excellent respectively for drinking purposes. Efficiency of So-Safe Water Filter was 66.32% it means was more efficiency than others special water treatment units while in RO Water Purifier was 27.14%, means less efficiency than other water purifier water under this study. Values for major cations, anions and others chemicals characteristics in the water samples after treatment became lower concentrations than befor treatment, likely an indication that these were removed by treatment. According to guideline of world health organization all of variables except total hardness befor treatment are safe and suitable for drinking purposes.

  17. Performance assessment of the BEBIG MultiSource® high dose rate brachytherapy treatment unit

    Science.gov (United States)

    Palmer, Antony; Mzenda, Bongile

    2009-12-01

    A comprehensive system characterisation was performed of the Eckert & Ziegler BEBIG GmbH MultiSource® High Dose Rate (HDR) brachytherapy treatment unit with an 192Ir source. The unit is relatively new to the UK market, with the first installation in the country having been made in the summer of 2009. A detailed commissioning programme was devised and is reported including checks of the fundamental parameters of source positioning, dwell timing, transit doses and absolute dosimetry of the source. Well chamber measurements, autoradiography and video camera analysis techniques were all employed. The absolute dosimetry was verified by the National Physical Laboratory, UK, and compared to a measurement based on a calibration from PTB, Germany, and the supplied source certificate, as well as an independent assessment by a visiting UK centre. The use of the 'Krieger' dosimetry phantom has also been evaluated. Users of the BEBIG HDR system should take care to avoid any significant bend in the transfer tube, as this will lead to positioning errors of the source, of up to 1.0 mm for slight bends, 2.0 mm for moderate bends and 5.0 mm for extreme curvature (depending on applicators and transfer tube used) for the situations reported in this study. The reason for these errors and the potential clinical impact are discussed. Users should also note the methodology employed by the system for correction of transit doses, and that no correction is made for the initial and final transit doses. The results of this investigation found that the uncorrected transit doses lead to small errors in the delivered dose at the first dwell position, of up to 2.5 cGy at 2 cm (5.6 cGy at 1 cm) from a 10 Ci source, but the transit dose correction for other dwells was accurate within 0.2 cGy. The unit has been mechanically reliable, and source positioning accuracy and dwell timing have been reproducible, with overall performance similar to other existing HDR equipment. The unit is capable of high

  18. A biofilter integrated with gas membrane separation unit for the treatment of fluctuating styrene loads.

    Science.gov (United States)

    Li, Lin; Lian, Jing; Han, Yunping; Liu, Junxin

    2012-05-01

    Biofiltration for volatile organic compound control in waste gas streams is best operated at steady contaminant loadings. To provide long-term stable operation of a biofilter under adverse contaminant feeding conditions, an integrated bioreactor system with a gas separation membrane module installed after a biofilter was proposed for styrene treatment. Styrene was treated effectively, with average styrene effluent concentrations maintained at less than 50 mg m(-3) and a total removal efficiency of over 96% achieved when the biofiltration column faced fluctuating loads. The maximum elimination capacity of the integrated bioreactor system was 93.8 g m(-3)h(-1), which was higher than that obtained with the biofiltration column alone. The combination of these two processes (microbial and chemical) led to more efficient elimination of styrene and buffering of the fluctuating loads. The factors on gas membrane separation, microbial characteristics in the integrated bioreactor and membrane fouling were also investigated in this study. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Sexual orientation and substance abuse treatment utilization in the United States: results from a national survey.

    Science.gov (United States)

    McCabe, Sean Esteban; West, Brady T; Hughes, Tonda L; Boyd, Carol J

    2013-01-01

    This study examined substance abuse treatment utilization across three dimensions of sexual orientation (identity, attraction, and behavior) in a large national sample of adults in the United States. Prevalence estimates were based on data collected from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions. The sample consisted of 34,653 adults 20 years and older, and represented a population that was 52% women, 71% White, 12% Hispanic, 11% African American, 4% Asian, and 2% other race/ethnicities. An estimated 2% of the target population self-identified as lesbian, gay or bisexual; 4% reported same-sex sexual behavior, and 6% reported same-sex sexual attraction. Sexual minorities, especially women, had a greater likelihood of lifetime substance use disorders and earlier age of drinking onset. The majority of respondents with substance use disorders were untreated and lifetime substance abuse treatment utilization differed based on sexual orientation. Sexual minorities were found to have more extensive family histories of substance abuse problems. The findings indicate the underutilization of substance abuse treatment among all adults, and highlight some important factors to consider when working with sexual minorities. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Sexual Orientation and Substance Abuse Treatment Utilization in the United States: Results from a National Survey

    Science.gov (United States)

    McCabe, Sean Esteban; West, Brady T.; Hughes, Tonda L.; Boyd, Carol J.

    2012-01-01

    This study examined substance abuse treatment utilization across three dimensions of sexual orientation (identity, attraction, behavior) in a large national sample of adults in the United States. Prevalence estimates were based on data collected from the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions. The sample consisted of 34,653 adults aged 20 years and older: 52% women, 71% White, 12% Hispanic, 11% African American, 4% Asian, and 2% other race/ethnicities. Approximately 2% of the sample self-identified as lesbian, gay or bisexual; 4% reported same-sex sexual behavior, and 6% reported same-sex sexual attraction. Sexual minorities, especially women, had a greater likelihood of lifetime substance use disorders and earlier age of drinking onset. The majority of respondents with substance use disorders were untreated and lifetime substance abuse treatment utilization differed based on sexual orientation. Sexual minorities were found to have more extensive family history of substance abuse problems. The findings indicate the underutilization of substance abuse treatment among all adults, and highlight some important factors to consider when working with sexual minorities. PMID:22444421

  1. Ceftaroline fosamil for the treatment of community-acquired bacterial pneumonia in the intensive care unit.

    Science.gov (United States)

    Maggiore, Christy; Vazquez, Jose A; Guervil, David J; Ramani, Ananthakrishnan; Jandourek, Alena; Cole, Phillip; Friedland, H David

    2015-01-01

    The Clinical Assessment Program and Teflaro(®) Utilization Registry (CAPTURE) is a multicenter study evaluating the clinical use of ceftaroline fosamil in patients with community-acquired bacterial pneumonia (CABP) or acute bacterial skin and skin structure infection. Data were collected between August 2011 and February 2013, from 398 evaluable patients receiving treatment at 33 sites in the USA. This manuscript presents data collected from patients with CABP who received care in an intensive care unit (ICU) or in general medical wards (35% and 64% of evaluable patients, respectively). The majority of ICU and general medical ward patients had underlying comorbidities (78% and 74%, respectively), with structural lung disease being the most common (42% in the ICU and 40% in general medical wards). Patients admitted to the ICU had a longer duration of stay, a longer duration of symptoms before treatment, and a longer duration of ceftaroline fosamil therapy than did general medical ward patients. Most patients treated in the ICU and in general medical wards were given ceftaroline fosamil as second-line therapy (87% and 80%, respectively). The overall rate of clinical success for patients treated with ceftaroline fosamil was 68% in the ICU and 85% in the general medical wards. Clinical success for patients receiving ceftaroline fosamil as a second-line agent was 84% in the ICU and 86% in general medical wards. These findings indicate that ceftaroline fosamil is a viable treatment option for CABP, both in the ICU and in general medical wards.

  2. The management and treatment of children with Fabry disease: A United States-based perspective.

    Science.gov (United States)

    Hopkin, Robert J; Jefferies, John L; Laney, Dawn A; Lawson, Victoria H; Mauer, Michael; Taylor, Matthew R; Wilcox, William R

    2016-02-01

    Fabry disease is an inherited X-linked disorder that presents during childhood in male and female patients. Young patients may initially experience pain, hypohidrosis, and gastrointestinal symptoms. Other manifestations of Fabry disease, such as renal and cardiac disease, manifest later in adolescence or adulthood. In the pediatric population, renal damage is typically subclinical and identifiable only through biopsy. Specialists from the United States with expertise in Fabry disease convened during 2013-2014 in order to develop these consensus guidelines about the management and treatment of children with Fabry disease. The presence of symptoms in boys and girls of any age is an indication to begin therapy. Early treatment before the onset of potentially irreversible vital organ pathology is ideal. Asymptomatic children with Fabry mutations should be followed closely for the development of renal, cardiac, neurological, or gastrointestinal signs, symptoms, or laboratory changes, which would warrant treatment initiation. A comprehensive care plan should be implemented by the treating physicians to guide the management of children with Fabry disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. United States-based practice patterns and resource utilization in advanced neuroendocrine tumor treatment.

    Science.gov (United States)

    Strosberg, Jonathan; Casciano, Roman; Stern, Lee; Parikh, Rohan; Chulikavit, Maruit; Willet, Jacob; Liu, Zhimei; Wang, Xufang; Grzegorzewski, Krzysztof J

    2013-04-21

    To assess advanced neuroendocrine tumor (NET) treatment patterns and resource utilization by tumor progression stage and tumor site in the United States. United States Physicians meeting eligibility criteria were provided with online data extraction forms to collect patient chart data on recent NET patients. Resource utilization and treatment pattern data were collected over a baseline period (after diagnosis and before tumor progression), as well as initial and secondary progression periods, with progression defined according to measureable radiographic evidence of tumor progression. Resource categories used in the analysis include: Treatments (e.g., surgery, chemotherapy, radiotherapy, targeted therapies), hospitalizations and physician visits, diagnostic tests (biomarkers, imaging, laboratory tests). Comparisons between categories of resource utilization and tumor progression status were examined using univariate (by tumor site) and multivariate analyses (across all tumor sites). Fifty-five physicians were included in the study and completed online data extraction forms using the charts of 110 patients. The physician sample showed a relatively even distribution for those affiliated with academic versus community hospitals (46% vs 55%). Forty (36.3%) patients were reported to have pancreatic NET (pNET), while 70 (63.6%) patients had gastrointestinal tract (GI)/Lung as the primary NET site. Univariate analysis showed the proportion of patients hospitalized increased from 32.7% during baseline to 42.1% in the progression stages. While surgeries were performed at similar proportions overall at baseline and progression, pNET patients, were more likely than GI/Lung NET patients to have undergone surgery during the baseline (33.3% vs 25.0%) and any progression periods (26.7% vs 23.4%). While peptide-receptor radionuclide and targeted therapy utilization was low across NET types and tumor stages, GI/Lung types exhibited greater utilization of these technologies compared

  4. Attitudes of dermatologists in the southeastern United States regarding treatment of alopecia areata: a cross-sectional survey study

    Directory of Open Access Journals (Sweden)

    Stewart Paul W

    2009-11-01

    Full Text Available Abstract Background Little evidence exists to guide treatment of alopecia areata (AA. The current practices in treatment of children compared to adults and of progressive stages of hair loss are unknown. The objective of this study was to examine the current practices of southeastern United States dermatologists for the treatment of AA. Methods Dermatologists were sent anonymous questionnaires regarding their treatment practices by mail. Respondents' frequencies of treatment in children compared to adults and in patchy hair loss compared to widespread hair loss were compared with Wilcoxon signed-ranks tests and Friedman tests. As a secondary source, the National Alopecia Areata Registry (NAAR database was analyzed for patients' treatment histories. Results Survey results suggested that dermatologists recommend treatment less frequently for children than adults and for more advanced hair loss. NAAR data confirmed that offering no treatment for AA is relatively common. Conclusion Dermatologists' treatment of AA is inconsistent. A stronger evidence base will provide more consistent treatment options.

  5. Grand Junction projects office mixed-waste treatment program, VAC*TRAX mobile treatment unit process hazards analysis

    International Nuclear Information System (INIS)

    Bloom, R.R.

    1996-04-01

    The objective of this report is to demonstrate that a thorough assessment of the risks associated with the operation of the Rust Geotech patented VAC*TRAX mobile treatment unit (MTU) has been performed and documented. The MTU was developed to treat mixed wastes at the US Department of Energy (DOE) Albuquerque Operations Office sites. The MTU uses an indirectly heated, batch vacuum dryer to thermally desorb organic compounds from mixed wastes. This process hazards analysis evaluated 102 potential hazards. The three significant hazards identified involved the inclusion of oxygen in a process that also included an ignition source and fuel. Changes to the design of the MTU were made concurrent with the hazard identification and analysis; all hazards with initial risk rankings of 1 or 2 were reduced to acceptable risk rankings of 3 or 4. The overall risk to any population group from operation of the MTU was determined to be very low; the MTU is classified as a Radiological Facility with low hazards

  6. United Nations Office on Drugs and Crime International Network of Drug Dependence Treatment and Rehabilitation Resource Centres: Treatnet

    Science.gov (United States)

    Tomas-Rossello, Juana; Rawson, Richard A.; Zarza, Maria J.; Bellows, Anne; Busse, Anja; Saenz, Elizabeth; Freese, Thomas; Shawkey, Mansour; Carise, Deni; Ali, Robert; Ling, Walter

    2010-01-01

    Key to the dissemination of evidence-based addiction treatments is the exchange of experiences and mutual support among treatment practitioners, as well as the availability of accurate addiction training materials and effective trainers. To address the shortage of such resources, the United Nations Office on Drugs and Crime (UNODC) created…

  7. Guide to fuel treatments in dry forests of the Western United States: assessing forest structure and fire hazard.

    Science.gov (United States)

    Morris C. Johnson; David L. Peterson; Crystal L. Raymond

    2007-01-01

    Guide to Fuel Treatments analyzes a range of fuel treatments for representative dry forest stands in the Western United States with overstories dominated by ponderosa pine (Pinus ponderosa), Douglas-fir (Pseudotsuga menziesii), and pinyon pine (Pinus edulis). Six silvicultural options (no thinning; thinning...

  8. Combining Follicular Unit Extraction and Scalp Micropigmentation for the Cosmetic Treatment of Alopecias

    Directory of Open Access Journals (Sweden)

    William Rassman, MD

    2017-11-01

    Full Text Available Two relatively new modalities, follicular unit extraction (FUE and scalp micropigmentation have changed the treatment of hair loss, to reduce the number of procedures and the total costs of the hair restoration process. These 2 modalities augment each other when treating patients with thinning hair and balding. The explosion of FUE procedures (which reflected 52.6% of the hair transplant procedures performed in 2016, up from 48.5% and the appearance of more and more new physicians offering hair restoration technologies employing FUE have caused a 20% annual growth in this industry over the past few years. This article reviews the use of FUE and scalp micropigmentation when used in combination.

  9. Fuzzy dynamic modelling and predictive control of a coagulation chemical dosing unit for water treatment plants

    Directory of Open Access Journals (Sweden)

    Oladipupo Bello

    2014-09-01

    Full Text Available In this paper, a fuzzy model predictive control (FMPC strategy is proposed to regulate the output variables of a coagulation chemical dosing unit. A multiple-input, multiple-output (MIMO process model in form of a linearised Takagi–Sugeno (T–S fuzzy model is derived. The process model is obtained through subtractive clustering from the plant's data set. The MIMO model is described by a set of coupled multiple-input, single-output models (MISO. In the controller design, the T–S fuzzy model is applied in combination with the nonlinear model predictive control (MPC algorithm. The results show that the proposed controller has good set-point tracking when compared with nonlinear MPC and adequate disturbance rejection ability required for efficient coagulation control and process optimisation in water treatment operations.

  10. Case study: evaluation of the performance of water treatment units by the use of tracer techniques

    International Nuclear Information System (INIS)

    Sebastian, C.; Maghella, G.; Mamani, E.

    2000-12-01

    Very often, water treatment systems do not reach the expected performance due to disturbances of hydraulic order, which cause malfunctioning in the flow through such systems. Tracer techniques have proved to be very useful to obtain information on the system or a part of it, by means of observation of the released tracer or observation of the released tracer during its progress into the system or at the output of the same. This paper is a report of the behavior of a set of both sand settlement unit and hydraulic flocculators in a potable water plant, through the analysis of radiotracers response curves or residence time distribution curves. The tracers released into the system consists in an aqueous solution of Iodine-131 with very low activity, in order to get a dynamic behave similar to the one of the fluid under investigation

  11. Radionuclides release to three rivers by ore treatment unit at Caldas, Minas Gerais - Brazil

    International Nuclear Information System (INIS)

    Pereira, W.S.; Carmo, R.F. do; Py Junior, D.A.

    2013-01-01

    The Ore Treatment Unit (OTU) is a uranium mining and milling plant, situated at Caldas city, Minas Gerais, Brazil that was disabled in the mid 90's. This unit releases controlled effluents to three rivers: Ribeirao das Antas (at point 014, influenced by the waste pile), Ribeirao Soberbo (point 025, influenced by the waste pond) and Corrego da Consulta (at point 076, influenced by the open pit mine). Water samples collected at these points were analyzed for U nat , 226 Ra, 210 Pb, 232 Th and 228 Ra content in the particulate and soluble fractions, and the behavior of radionuclide releases and their fractions was investigated. U nat and 228 Ra showed identical behaviors at these three points. U nat at point 014 (waste pile) behaved different from described in recent literature data. The isotopes of Ra should exhibit the same behavior at each point, but this was not observed at point 025 (waste pond). 232 Th release showed equal activity concentration near the waste pile (point 014) and near the waste pond (point 025), whilst near the open pit mine (point 076) the soluble fraction showed a concentration of activity greater than the particulate fraction. Finally, 210 Pb showed a different behavior at each point. Due to the great differences in behaviors of each radionuclide, it was not possible to establish a temporal pattern of release which requires assessment over a longer period of time. (author)

  12. Prolonged glucocorticoid treatment in ARDS: impact on intensive care unit acquired weakness.

    Directory of Open Access Journals (Sweden)

    Gianfranco Umberto Meduri

    2016-08-01

    Full Text Available AbstractSystemic inflammation and duration of immobilization are strong independent risk factors for development of intensive care unit- acquired weakness (ICUAW. Activation of the pro-inflammatory transcription factor nuclear factor-κB (NF-κB results in muscle wasting during disuse-induced skeletal muscle atrophy (ICU bed rest and septic shock. In addition, NF-κB-mediated signaling plays a significant role in mechanical ventilation-induced diaphragmatic atrophy and contractile dysfunction. Older trials investigating high dose glucocorticoid treatment reported a lack of a sustained anti-inflammatory effects and an association with ICUAW. However, prolonged low-to-moderate dose glucocorticoid treatment of sepsis and ARDS is associated with a reduction in NF-κB DNA-binding, decreased transcription of inflammatory cytokines, enhanced resolution of systemic and pulmonary inflammation, leading to fewer days of mechanical ventilation, and lower mortality. Importantly, meta-analyses of a large number of randomized controlled trials (RCTs investigating low-to-moderate glucocorticoid treatment in severe sepsis and ARDS found no increase in ICUAW. Furthermore, while the ARDS network trial investigating methylprednisolone treatment in persistent ARDS is frequently cited to support an association with ICUAW, a re-analysis of the data showed a similar incidence with the control group. Our review concludes that in patients with sepsis and ARDS any potential direct harmful neuromuscular effect of glucocorticoids appears outweighed by the overall clinical improvement and reduced duration of organ failure, in particular ventilator dependency and associated immobilization, which are key risk factors for ICUAW. Acknowledgements: The NHLBI ARDSnetwork graciously provided and assisted with the ARDSnet02 Dataset on the Efficacy of Corticosteroids as Rescue Therapy for the Late Phase of Acute Respiratory Distress Syndrome (LaSRS.

  13. Trends in osteoporosis treatment with oral and intravenous bisphosphonates in the United States, 2002-2012.

    Science.gov (United States)

    Wysowski, Diane K; Greene, Patty

    2013-12-01

    Bisphosphonates have been widely prescribed to postmenopausal women for treatment and prevention of osteoporosis. Given a background of reports of recent safety problems, questions about optimal duration of use, and the patent expiration of Fosamax in February 2008, we accessed data from pharmaceutical marketing research databases to describe trends in dispensed prescriptions and sales of oral bisphosphonates, characteristics of patients and prescribers, and sales of intravenous bisphosphonates for osteoporosis treatment. An estimated 21.3million prescriptions for oral bisphosphonates were dispensed in U.S. retail pharmacies in 2002 that increased 46% to a peak of 31.0million in 2007 and 2008, and declined by 53% in a four year-period to 14.7million in 2012. Sales data (number of packages sold in all settings of care) showed parallel trends (66% increase from 2002 through 2007 and 51% decrease from 2007 through 2012). Similarly, intravenous bisphosphonate sales for osteoporosis treatment grew 3.8-fold from 149.5 thousand packages in 2007 to 561.6 thousand in 2010, followed by a 22% decrease in 2012. Data from an ongoing monthly office-based survey indicated physicians mentioned oral bisphosphonates primarily in visits of older aged Caucasian women with lower body mass for osteoporosis. Frequencies of oral bisphosphonate mentions increased between 2002 and 2012 in visits of Asians and for osteopenia diagnoses. These data indicate a substantial decline in prescriptions and sales of oral (since 2007-2008) and intravenous (since 2010) bisphosphonates for osteoporosis treatment in the United States. Reasons for, and implications of, the decline should be considered for future research. © 2013.

  14. Removal of trace organic chemicals in onsite wastewater soil treatment units: a laboratory experiment.

    Science.gov (United States)

    Teerlink, Jennifer; Martínez-Hernández, Virtudes; Higgins, Christopher P; Drewes, Jörg E

    2012-10-15

    Onsite wastewater treatment is used by 20% of residences in the United States. The ability of these systems, specifically soil treatment units (STUs), to attenuate trace organic chemicals (TOrCs) is not well understood. TOrCs released by STUs pose a potential risk to downstream groundwater and hydraulically-connected surface water that may be used as a drinking water source. A series of bench-scale experiments were conducted using sand columns to represent STUs and to evaluate the efficacy of TOrC attenuation as a function of hydraulic loading rate (1, 4, 8, 12, and 30 cm/day). Each hydraulic loading rate was examined using triplicate experimental columns. Columns were initially seeded with raw wastewater to establish a microbial community, after which they were fed with synthetic wastewater and spiked with 17 TOrCs, in four equal doses per day, to provide a consistent influent water quality. After an initial start-up phase, effluent from all columns consistently demonstrated >90% reductions in dissolved organic carbon and nearly complete (>85%) oxidation of ammonia to nitrate, comparable to the performance of field STUs. The results of this study suggest STUs are capable of attenuating many TOrCs present in domestic wastewater, but attenuation is compound-specific. A subset of TOrCs exhibited an inverse relationship with hydraulic loading rate and attenuation efficiency. Atenolol, cimetidine, and TCPP were more effectively attenuated over time in each experiment, suggesting that the microbial community evolved to a stage where these TOrCs were more effectively biotransformed. Aerobic conditions as compared to anaerobic conditions resulted in more efficient attenuation of acetaminophen and cimetidine. Copyright © 2012. Published by Elsevier Ltd.

  15. ICEMENERG technologies of water treatment applied at Cernavoda NPP Unit 1

    International Nuclear Information System (INIS)

    Stanca, Angela; Bolma, Aurelia; Serbanescu, Agnes; Raducanu, Alice

    2002-01-01

    The paper presents the ICEMENERG technologies for water treatment applied at Cernavoda Unit 1, the treatment of the additional water for power steam generators and the chemical treatment of cooling system water. The requirements for quality of water totally demineralized as imposed by the AECL-ANSALDO consortium are as following: electrical conductivity, < 0.2 mS/cm; total silicon, <0.02 mg/L; ionic silicon, <0.01 mg/L; sodium, < 0.05 mg/L; TOC, <0.300 mg/L. These requirements raise rather difficult problems to be solved because the raw water source in case of Cernavoda NPP is Danube River which presents a raising trend of organic and inorganic contamination. Accordingly, experiments at laboratory scale reproducing the entire technological flow were conducted. The following operations were studied: pretreatment with limewash, ferric chloride (with and without coagulation additives); demineralization with ion exchangers of Purolite and Amberlite types. The system consisted of a cationic stage, formed of an strongly acid step with countercurrent recovery and an anionic stage formed of two steps, namely, a weakly basic step and a strongly basic step with recovery inserted; finishing on mixed bed. The paper presents also the chemical treatment/conditioning of the cooling loop of turbine condenser. The Cernavoda NPP cooling system is an open system with a single flow of cooling water comprising two systems, namely, the circulation water system ensuring the steam condenser cooling and the servicing water system ensuring the cooling of heat exchangers in the recirculated water circuit (RCWS), the turbine oil coolants, the coolants of auxiliary steam as well as the emergency core cooling system. Studies were conducted to ensure the chemical conditioning of the raw water from Danube River, particularly, to destroy and remove the shells, the algae and other components. Finally, the following four steps of conditioning the water of the cooling system are summarized: 1

  16. Spinal and sacroiliac assessment and treatment techniques used by osteopathic physicians in the United States

    Science.gov (United States)

    Fryer, Gary; Morse, Christopher M; Johnson, Jane C

    2009-01-01

    Background Osteopathic manipulative medicine texts and educators advocate a range of approaches for physical assessment and treatment, but little is known about their use by osteopathic physicians in the United States. Methods A web-based survey using a 5-point Likert scale was developed and e-mailed to 777 practicing osteopathic physician members of the American Academy of Osteopathy. Responses in the "frequently" and "always" categories were combined for reporting purposes. Friedman tests were used to analyze the reported usage of each item. The effect of gender was analyzed using Mann-Whitney tests. Results One hundred seventy-one osteopathic physicians completed the survey (22%). For the assessment of spinal somatic dysfunction, paraspinal tissue texture (98%), transverse process asymmetry (89%), and tenderness (85%) were most commonly reported. Myofascial release (78%), soft tissue technique (77%), and patient self-stretches (71%) were most commonly used for treatment of the spine. For assessment of pelvic landmark asymmetry, the anterior superior iliac spine (ASIS, 87%), sacral base (82%), posterior superior iliac spine (81%), sacral sulci (78%), iliac crests (77%), and inferior lateral angle of the sacrum (74%) were commonly palpated. For assessment of sacroiliac joint motion, ASIS compression (68%) was most commonly used. Sacroiliac pain provocation tests were also employed although their use was less common than asymmetry or motion tests. Muscle energy (70%), myofascial release (67%), patient self-stretches (66%), osteopathy in the cranial field (59%), muscle strengthening exercises (58%), soft tissue technique (58%), and articulatory technique (53%) were most commonly used for treatment of the pelvis and sacroiliac. The effect of gender was significant for many of the treatment procedures, with females using more soft tissue and muscle energy and males more high-velocity techniques. The majority of respondents document the types of osteopathic

  17. Stable Isotope Data

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Tissue samples (skin, bone, blood, muscle) are analyzed for stable carbon, stable nitrogen, and stable sulfur analysis. Many samples are used in their entirety for...

  18. Sorption-reagent treatment of brines produced by reverse osmosis unit for liquid radioactive waste management

    International Nuclear Information System (INIS)

    Avramenko, V. A.; Zheleznov, V. V.; Sergienko, V. I.; Chizhevsky, I. Yu

    2003-01-01

    The results of the pilot plant tests (2002-2003) of the sorption-reagent decontamination of high salinity radioactive waste (brines) remaining after the low-salinity liquid radioactive waste (LRW) treatment in the reverse-osmosis unit from long-lived radionuclides are presented. The sorption-reagent materials used in this work were developed in the Institute of Chemistry FEDRAS. They enable one to decontaminate brines with total salt content up to 50 g/l from long-lived radionuclides of Cs, Sr and Co. At joint application of the reverse-osmosis and sorption-reagent technologies total volume of solid radioactive waste (SRW) decreases up to 100-fold as compared to the technology of cementation of reverse osmosis brines. In this case total cost of LRW treatment and SRW disposal decreases more than 10-fold. Brines decontaminated from radionuclides are then diluted down to the ecologically safe total salts content in water to be disposed of. Tests were performed to compare the efficiency of technologies including evaporation of brines remaining after reverse osmosis process and their decontamination by means of the sorption-reagent method. It was shown that, as compared to evaporation, the sorption-reagent technology provides substantial advantages as in regard to radioactive waste total volume reduction as in view of total cost of the waste management

  19. Investigation of Accelerated Partial Breast Patient Alignment and Treatment With Helical Tomotherapy Unit

    International Nuclear Information System (INIS)

    Langen, Katja M.; Buchholz, Daniel J.; Burch, Doug R. C.; Burkavage, Rob C.; Limaye, Arti U.; Meeks, Sanford L.; Kupelian, Patrick A.; Ruchala, Kenneth J.; Haimerl, Jason; Henderson, Doug; Olivera, Gustavo H.

    2008-01-01

    Purpose: To determine the precision of megavoltage computed tomography (MVCT)-based alignment of the seroma cavity for patients undergoing partial breast irradiation; and to determine whether accelerated partial breast irradiation (APBI) plans can be generated for TomoTherapy deliveries that meet the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 protocol guidelines for target coverage and normal tissue dose limitations. Methods and Materials: We obtained 50 MVCT images from 10 patients. An interuser study was designed to assess the alignment precision. Using a standard helical and a fixed beam prototype ('topotherapy') optimizer, two APBI plans for each patient were developed. Results: The precision of the MVCT-based seroma cavity alignment was better than 2 mm if averaged over the patient population. Both treatment techniques could be used to generate acceptable APBI plans for patients that fulfilled the recommended NSABP B-39/RTOG-0413 selection criteria. For plans of comparable treatment time, the conformation of the prescription dose to the target was greater for helical deliveries, while the ipsilateral lung dose was significantly reduced for the topotherapy plans. Conclusions: The inherent volumetric imaging capabilities of a TomoTherapy Hi-Art unit allow for alignment of patients undergoing partial breast irradiation that is determined from the visibility of the seroma cavity on the MVCT image. The precision of the MVCT-based alignment was better than 2 mm (± standard deviation) when averaged over the patient population. Using the NSABP B-39/RTOG-0413 guidelines, acceptable APBI treatment plans can be generated using helical- or topotherapy-based delivery techniques

  20. Ceftaroline fosamil for the treatment of community-acquired bacterial pneumonia in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Maggiore C

    2015-04-01

    Full Text Available Christy Maggiore,1 Jose A Vazquez,2 David J Guervil,3 Ananthakrishnan Ramani,4 Alena Jandourek,5 Phillip Cole,5 H David Friedland5 1Gulf Coast Medical Center, Panama City, FL, USA; 2Medical College of Georgia, Georgia Regents University, Augusta, GA, USA; 3Memorial Hermann-Texas Medical Center, Houston, TX, USA; 4Mountain View Medical Practice (Columbia Memorial Hospital, Catskill, NY, USA; 5Cerexa, Inc., Oakland, CA, USA Abstract: The Clinical Assessment Program and Teflaro® Utilization Registry (CAPTURE is a multicenter study evaluating the clinical use of ceftaroline fosamil in patients with community-acquired bacterial pneumonia (CABP or acute bacterial skin and skin structure infection. Data were collected between August 2011 and February 2013, from 398 evaluable patients receiving treatment at 33 sites in the USA. This manuscript presents data collected from patients with CABP who received care in an intensive care unit (ICU or in general medical wards (35% and 64% of evaluable patients, respectively. The majority of ICU and general medical ward patients had underlying comorbidities (78% and 74%, respectively, with structural lung disease being the most common (42% in the ICU and 40% in general medical wards. Patients admitted to the ICU had a longer duration of stay, a longer duration of symptoms before treatment, and a longer duration of ceftaroline fosamil therapy than did general medical ward patients. Most patients treated in the ICU and in general medical wards were given ceftaroline fosamil as second-line therapy (87% and 80%, respectively. The overall rate of clinical success for patients treated with ceftaroline fosamil was 68% in the ICU and 85% in the general medical wards. Clinical success for patients receiving ceftaroline fosamil as a second-line agent was 84% in the ICU and 86% in general medical wards. These findings indicate that ceftaroline fosamil is a viable treatment option for CABP, both in the ICU and in general

  1. Independent verification of monitor unit calculation for radiation treatment planning system.

    Science.gov (United States)

    Chen, Li; Chen, Li-Xin; Huang, Shao-Min; Sun, Wen-Zhao; Sun, Hong-Qiang; Deng, Xiao-Wu

    2010-02-01

    To ensure the accuracy of dose calculation for radiation treatment plans is an important part of quality assurance (QA) procedures for radiotherapy. This study evaluated the Monitor Units (MU) calculation accuracy of a third-party QA software and a 3-dimensional treatment planning system (3D TPS), to investigate the feasibility and reliability of independent verification for radiation treatment planning. Test plans in a homogenous phantom were designed with 3-D TPS, according to the International Atomic Energy Agency (IAEA) Technical Report No. 430, including open, blocked, wedge, and multileaf collimator (MLC) fields. Test plans were delivered and measured in the phantom. The delivered doses were input to the QA software and the independent calculated MUs were compared with delivery. All test plans were verified with independent calculation and phantom measurements separately, and the differences of the two kinds of verification were then compared. The deviation of the independent calculation to the measurements was (0.1 +/- 0.9)%, the biggest difference fell onto the plans that used block and wedge fields (2.0%). The mean MU difference between the TPS and the QA software was (0.6 +/- 1.0)%, ranging from -0.8% to 2.8%. The deviation in dose of the TPS calculation compared to the measurements was (-0.2 +/- 1.7)%, ranging from -3.9% to 2.9%. MU accuracy of the third-party QA software is clinically acceptable. Similar results were achieved with the independent calculations and the phantom measurements for all test plans. The tested independent calculation software can be used as an efficient tool for TPS plan verification.

  2. Characterizing Treatment Utilization Patterns for Trigeminal Neuralgia in the United States.

    Science.gov (United States)

    Zakrzewska, Joanna M; Wu, Ning; Lee, John Y K; Werneburg, Brian; Hoffman, Deborah; Liu, Ying

    2018-02-19

    Trigeminal neuralgia (TN) is a rare orofacial disorder characterized by severe unilateral paroxysmal pain in the region of the fifth cranial nerve. Clinical guidelines recommend carbamazepine (only US Food and Drug Administration-approved drug for TN) and oxcarbazepine as first-line therapies. We utilized the US Truven Health MarketScan database to examine treatment patterns among patients with TN. Included patients were aged ≥18 years, newly diagnosed with TN (≥2 TN diagnoses ≥14 days apart; no diagnosis in the prior year), continuously enrolled 1 year pre-index, with ≥3 years' follow-up post-index. We assessed utilization of selected pharmacotherapies (carbamazepine, oxcarbazepine, pregabalin, gabapentin, baclofen, duloxetine, topiramate), surgery (posterior fossa, radiosurgery), and injections (peripheral anesthetic injections, Gasserian ganglion procedures) for TN. 3685 patients were included (2425 commercial, 1260 Medicare; 71.8% female; mean[SD] age, 59 [15] years). Overall, 72.5% of patients received at least 1 studied medication, most commonly carbamazepine (51.7%) or gabapentin (48.6%). Sixty-five percent of pharmacologically treated patients had ≥2 treatment episodes; 41.6% had ≥3 (defined by a change in pharmacotherapy [monotherapy/combination] regimen). Overall, 12.3% had surgery and 7.3% injections; 42.9% received opioids for TN. In the 3 years after diagnosis, patients with TN in the United States receive a variety of pharmacological treatments, including opioids, despite carbamazepine being the only approved medication. A notable proportion utilize surgeries/injections. A high proportion of pharmacologically treated patients receive multiple treatment episodes, suggesting frequent therapy switching, perhaps due to suboptimal efficacy/tolerability. Our data suggest a high burden of illness associated with TN.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License

  3. Incidence and treatment patterns in males presenting with lower urinary tract symptoms to the emergency department in the United States.

    Science.gov (United States)

    Roghmann, Florian; Ghani, Khurshid R; Kowalczyk, Keith J; Bhojani, Naeem; Sammon, Jesse D; Gandaglia, Giorgio; Trudeau, Vincent; Becker, Andreas; Sukumar, Shyam; Menon, Mani; Zorn, Kevin C; Karakiewicz, Pierre; Sun, Maxine; Noldus, Joachim; Trinh, Quoc-Dien

    2013-11-01

    Due to varying clinical definitions of lower urinary tract symptoms, it has been difficult to determine comparable prevalence and incidence rates of lower urinary tract symptoms and their treatment modalities. We assessed the incidence of emergency department visits in men with lower urinary tract symptoms who presented to emergency departments in the United States and factors associated with an increased likelihood of hospitalization. Emergency department visits from 2006 to 2009 associated with a primary diagnosis of lower urinary tract symptoms using established criteria were abstracted from the Nationwide Emergency Department Sample. Age adjusted incidence rates of emergency department visits and charges were calculated. We performed multivariable analysis to examine patient and hospital characteristics of those hospitalized and those with benign prostatic hyperplasia related adverse events. A weighted estimate of 1,178,423 emergency department visits for lower urinary tract symptoms was recorded with a national incidence of 197.6/100,000 males per year. A total of 112,288 visits (9.5%) resulted in hospitalization. Adverse events were identified in 734,269 patients (62.3%). The most common adverse events were catheterization in 44.6% of cases, infection in 17.4%, hematuria in 9.6%, bladder stones in 1.7%, hydronephrosis in 1.2% and acute renal failure in 0.1%. On multivariable analysis independent predictors of hospital admission included comorbidities, socioeconomic status, hospital characteristics and adverse events such as sepsis, acute renal failure and hydronephrosis. Independent predictors of adverse events included patient age, year of visit, socioeconomic status, hospital characteristics and concomitant neurological disease. In 2009 total emergency department charges for lower urinary tract symptoms were $494,981,922. The number of men with lower urinary tract symptoms who visit the emergency department has remained stable, while emergency

  4. Oral midodrine treatment accelerates the liberation of intensive care unit patients from intravenous vasopressor infusions.

    Science.gov (United States)

    Levine, Alexander R; Meyer, Matthew J; Bittner, Edward A; Berg, Sheri; Kalman, Rebecca; Stanislaus, Anne B; Ryan, Cheryl; Ball, Stephanie A; Eikermann, Matthias

    2013-10-01

    Persistent low-level hypotension represents a barrier to discharging patients from the intensive care unit (ICU). Midodrine may be an effective adjunct to wean intravenous (IV) vasopressors and permit ICU discharge. We tested the hypothesis that midodrine, given to patients on IV vasopressors who otherwise met ICU discharge criteria, increased the magnitude of change in IV vasopressor rate. This was a prospective, observational study in 20 adult surgical ICU patients who met ICU discharge criteria except for an IV vasopressor requirement. We compared the change in phenylephrine equivalent rates during the day before midodrine to the change in phenylephrine equivalent rates after midodrine initiation and analyzed changes in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count during this period. Patients received 41.0±33.4 μg/min of phenylephrine equivalents and the change in IV vasopressor rate (slope) decreased significantly from -0.62 μg/min per hour of phenylephrine equivalents before midodrine to -2.20 μg/min per hour following the initiation of midodrine treatment (P=.012). Change in total body fluid balance, heart rate, mean arterial pressure, and white blood cell count did not correlate with change in IV vasopressor rate. Midodrine treatment was associated with an increase in the magnitude of decline of the IV vasopressor rate. Oral midodrine may facilitate liberation of surgical ICU patients from an IV vasopressor infusion, and this may affect discharge readiness of patients from the ICU. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Firewater Storage, Treatment, Recycling and Management: New Perspectives Based on Experiences from the United Kingdom

    Directory of Open Access Journals (Sweden)

    Miklas Scholz

    2014-02-01

    Full Text Available Smart firewater management and recycling helps reduce water use and protect the environment from pollution. However, contamination of recycled water may pose a health risk to fire fighters. This review assesses international literature to identify best practices, and to recommend new technologies and methods on firewater management and recycling. The literature assessment indicates that this is a new research area where insufficient findings have been published in Web of Science-referenced journals. Therefore, informally published materials (a.k.a. grey literature were also assessed. Findings indicate the need for practical decision support tools to estimate consumption rates, predict “bottlenecks” and bund capacity, assess water quality and determine pump requirements. This article recommends that cost-efficient and rapid on-site treatment methods, such as compact and mobile filtration units for firewater recycling should be researched in the future. The filters should be based on compartments with different media. The empty pore space should decrease from inflow to outflow. A light plastic media should be positioned near the inflow to retain large particles, such as a grid. Activated carbon media could be placed near the outlet to remove fine suspended solids and dissolved contaminants. This should address concerns by fire fighters dealing with contaminated water, spray and foam.

  6. Formulating and improving care while mitigating risk in a military Ebola virus disease treatment unit.

    Science.gov (United States)

    Lamb, Lucy Em; Cox, A T; Fletcher, T; McCourt, A L

    2017-02-01

    This paper describes the development of the UK military's Ebola Virus Disease Treatment Unit (EVD TU) that was deployed to Sierra Leone as part of the UK response to the West African Ebola virus disease (EVD) epidemic in 2014 and 2015. It highlights specific challenges faced within this unique Field Hospital environment. The military EVD TU was initially established to provide confidence to international healthcare workers coming to Sierra Leone to assist in the international response to the EVD epidemic and formed a key part of the action plan by the UK's Department for International Development. It was designed and staffed to provide a high level of care to those admitted with suspected or confirmed EVD and was prepared to admit the first patient within 6 weeks of the original activation order by the Ministry of Defence. This article outlines the main hazards perceived at the outset of the operation and the methods used to mitigate the risk to the healthcare workers at the EVD TU. The article examines the mechanisms that enabled the hospital to respond positively to challenges that emerged during the deployment, while simultaneously reducing the risk to the healthcare workers involved in care delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. Neonatal circumcision in severe haemophilia: a survey of paediatric haematologists at United States Hemophilia Treatment Centers.

    Science.gov (United States)

    Kearney, S; Sharathkumar, A; Rodriguez, V; Chitlur, M; Valentino, L; Boggio, L; Gill, J

    2015-01-01

    Neonatal circumcision in patients with severe haemophilia has not been well studied. We performed a survey of paediatric haematologists from Hemophilia Treatment Centers (HTC) across the United States to better understand the attitudes toward and management of neonatal circumcision in haemophilia patients. Response rate to our survey was 40% (n = 64/159). Thirty-eight percent of respondents (n = 24) said that they would allow this procedure in the newborn period but in many cases this was against medical advice. The most reported concern regarding neonatal circumcision in haemophilia patients was the risk of development of an inhibitor (n = 25; 39%) followed by the concern for bleeding (n = 22; 34%) and issues related to vascular access in the neonate (n = 11; 17%). All respondents recommended at least one preprocedure dose of factor replacement. Twenty-two percent (n = 14) of respondents did not use more than one dose of factor replacement but 32% (n = 21) used 1-2 postoperative doses. The remainder of paediatric haematologists surveyed recommended between 3-5 (16%; n = 10) and 6-10 (3%, n = 2) additional days postoperatively. There was wide variation in both techniques of circumcision as well as adjuvant haemostatic agents used. Only 22% of respondents said that they had an established protocol for management of circumcision in the newborn haemophilia patient. These survey results highlight the need for evidence-based guidelines regarding the optimal management of circumcision in neonates with severe haemophilia. © 2014 John Wiley & Sons Ltd.

  8. Responding to secondary traumatic stress: a pilot study of torture treatment programs in the United States.

    Science.gov (United States)

    Akinsulure-Smith, Adeyinka M; Keatley, Eva; Rasmussen, Andrew

    2012-04-01

    Providers who care for torture survivors may be at risk for secondary traumatic stress, yet there has been little documentation of the effects of repeated exposure to traumatic issues on their emotional health or exploration of the support systems and resources available to address their emotional needs. This study assessed the secondary stress experiences of service providers (N = 43) within the National Consortium of Torture Treatment Programs in the United States and examined the supports offered by their organizations. The study found a significant correlation between rates of anxiety and depression among providers, r(34) = .49, p = .003. Although these participants reported that their work with survivors of torture was stressful, 91% indicated that their organizations offered a variety of stress-reduction activities. Overall, participants reported that their own personal activities were the most-effective stress reducers. The results are discussed in light of challenges that professionals who work with this population face and the effectiveness of support systems available to support their work. Copyright © 2012 International Society for Traumatic Stress Studies.

  9. Dose in sensitive organs during the prostate treatment with a 60Co unit

    International Nuclear Information System (INIS)

    Vega C, H. R.; Navarro B, J. A.; Perez A, M. L.; Perez L, L. H.

    2012-10-01

    The absorbed dose by the bladder, the rectum and the gland thyroid was measured during a treatment applied for prostate cancer by means of a Cobalt 60 unit. The dose was measured using thermoluminescent dosimeters of the type TLD 100, with the values of the absorbed the values of the effective dose were calculated and was determined the probability of the development of a secondary cancer. Because these measurements cannot be made -in vivo- a phantom or mannequin was built with water that represents the hip and part of the torso of the human body and to represent the neck was used polyethylene. The study was carried out in the Instituto Zacatecano del Tumor that has a -cobalt bomb- which is used to treat oncology patients, during the phantom irradiation a dose of 200 c Gy was applied of this dose the bladder received 96.7%, the rectum 100.8% and the gland thyroid 0.3%. The dose received by the rectum and the bladder is due to the therapeutic beam while the dose received by the thyroid is due to the dispersed radiation by the phantom. The probability that in these organs a new neoplasm is developed is of 0.033% for the bladder, 0.157% for the rectum and 7.8 x 10 -5 % for the thyroid case. (Author)

  10. Stroke treatment in Stroke Unit: from scientific evidences to clinical practice

    Directory of Open Access Journals (Sweden)

    Michele Stornello

    2013-04-01

    Full Text Available Background: In themanagement of stroke disease, evidences fromthe literature demonstrate that the introduction of stroke units, hospital wards with dedicated beds providing intensive care within 48 hours of symptoms’ onset, produced a real improvement in the outcome, reducing in-hospital fatality cases and increasing the proportion of patients independently living in long term follow-up. Discussion: The article focuses on stroke disease-management, suggesting a stroke integrated approach for the admission of patients on dedicated beds, in order to extend the ‘‘stroke care’’ approach outcomes to as many hospitals as possible in Italy. This approach implies the set up of a stroke network for an effective patients’ stratification according to the severity of the illness at debut; the set up of an integrated team of specialists in hospital management of the acute phase (first 48 hours and a timely rehabilitation treatment. Ultimately the hospital should be organized according to department’s semi-intensive areas in order to assure to the patients, in the early stage of the disease, a timely high intensity care aimed to improve the long term outcome.

  11. State parity laws and access to treatment for substance use disorder in the United States: implications for federal parity legislation.

    Science.gov (United States)

    Wen, Hefei; Cummings, Janet R; Hockenberry, Jason M; Gaydos, Laura M; Druss, Benjamin G

    2013-12-01

    The passage of the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act incorporated parity for substance use disorder (SUD) treatment into federal legislation. However, prior research provides us with scant evidence as to whether federal parity legislation will hold the potential for improving access to SUD treatment. To examine the effect of state-level SUD parity laws on state-aggregate SUD treatment rates and to shed light on the impact of the recent federal SUD parity legislation. We conducted a quasi-experimental study using a 2-way (state and year) fixed-effect method. We included all known specialty SUD treatment facilities in the United States and examined treatment rates from October 1, 2000, through March 31, 2008. Our main source of data was the National Survey of Substance Abuse Treatment Services, which provides facility-level information on specialty SUD treatment. State-level SUD parity laws during the study period. State-aggregate SUD treatment rates in (1) all specialty SUD treatment facilities and (2) specialty SUD treatment facilities accepting private insurance. The implementation of any SUD parity law increased the treatment rate by 9% (P legislation on access to specialty SUD treatment. Furthermore, the positive association is more pronounced in states with more comprehensive parity laws. Our findings suggest that federal parity legislation holds the potential to improve access to SUD treatment.

  12. Stable convergence and stable limit theorems

    CERN Document Server

    Häusler, Erich

    2015-01-01

    The authors present a concise but complete exposition of the mathematical theory of stable convergence and give various applications in different areas of probability theory and mathematical statistics to illustrate the usefulness of this concept. Stable convergence holds in many limit theorems of probability theory and statistics – such as the classical central limit theorem – which are usually formulated in terms of convergence in distribution. Originated by Alfred Rényi, the notion of stable convergence is stronger than the classical weak convergence of probability measures. A variety of methods is described which can be used to establish this stronger stable convergence in many limit theorems which were originally formulated only in terms of weak convergence. Naturally, these stronger limit theorems have new and stronger consequences which should not be missed by neglecting the notion of stable convergence. The presentation will be accessible to researchers and advanced students at the master's level...

  13. Expert Statement on the Single-Agent Use of Inhaled Bronchodilator in the Treatment of Stable Mild-Moderate Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Riesco Miranda, Juan Antonio; Alcázar, Bernardino; Alfageme, Inmaculada; Casanova, Ciro; Celli, Bartolomé; de-Torres, Juan P; Jiménez Ruiz, Carlos A

    2017-10-01

    To describe the evidence- and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD). Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from1 (total disagreement) to10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Centre for Evidence-based Medicine levels. A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed. These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States

    OpenAIRE

    Bhattacharjee, Sandipan; Goldstone, Lisa; Ip, Queeny; Warholak, Terri

    2017-01-01

    Background. There is little information regarding depression treatment patterns among adults with MS and depression in ambulatory settings at national level in the United States (US). Objectives. The objectives of this study were to identify patterns and predictors of depression treatment in ambulatory settings in US among adults with MS and depression. Methods. A cross-sectional study was conducted by pooling multiple years (2005–2011) of National Ambulatory Medical Care Survey and the outpa...

  15. Processes for CO2 capture. Context of thermal waste treatment units. State of the art. Extended abstract

    International Nuclear Information System (INIS)

    Lopez, A.; Roizard, D.; Favre, E.; Dufour, A.

    2013-01-01

    For most of industrial sectors, Greenhouse Gases (GHG) such as carbon dioxide (CO 2 ) are considered as serious pollutants and have to be controlled and treated. The thermal waste treatment units are part of industrial CO 2 emitters, even if they represent a small part of emissions (2,5 % of GHG emissions in France) compared to power plants (13 % of GHG emissions in France, one third of worldwide GHG emissions) or shaper industries (20 % of GHG emissions in France). Carbon Capture and Storage (CCS) can be a solution to reduce CO 2 emissions from industries (power plants, steel and cement industries...). The issues of CCS applied to thermal waste treatment units are quite similar to those related to power plants (CO 2 flow, flue gas temperature and pressure conditions). The problem is to know if the CO 2 produced by waste treatment plants can be captured thanks to the processes already available on the market or that should be available by 2020. It seems technically possible to adapt CCS post-combustion methods to the waste treatment sector. But on the whole, CCS is complex and costly for a waste treatment unit offering small economies of scale. However, regulations concerning impurities for CO 2 transport and storage are not clearly defined at the moment. Consequently, specific studies must be achieved in order to check the technical feasibility of CCS in waste treatment context and clearly define its cost. (authors)

  16. 75 FR 9102 - Recovery of Cost of Hospital and Medical Care and Treatment Furnished by the United States...

    Science.gov (United States)

    2010-03-01

    ... Medical Care and Treatment Furnished by the United States; Delegation of Authority AGENCY: Department of... responsible for the furnishing of hospital, medical, surgical, or dental care. This change responds to the... furnishing of hospital, medical, surgical, or dental care. During the intervening period, the cost of medical...

  17. An Analysis of the Treatment of Corporate Influence on Government by United States History and American Government High School Textbooks

    Science.gov (United States)

    Neumann, Richard

    2014-01-01

    This article reports on an investigation to explore the possibility that ideology might be expressed in the treatment of corporate influence on federal government by social studies textbooks. Two textbooks were examined in the study--United States history and American government. Corporate influence involves activities that affect election and…

  18. Supply of essential drugs in units specialized in the treatment of chronic diseases in Mexico in 2012

    Directory of Open Access Journals (Sweden)

    David Contreras-Loya

    2013-11-01

    Full Text Available Objective. To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC in Mexico. Materials and methods. The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. Results. Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. Conclusion. UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.

  19. Predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime cannabis use disorder in the United States.

    Science.gov (United States)

    Kerridge, Bradley T; Mauro, Pia M; Chou, S Patricia; Saha, Tulshi D; Pickering, Roger P; Fan, Amy Z; Grant, Bridget F; Hasin, Deborah S

    2017-12-01

    To present information on predictors of treatment utilization and barriers to treatment utilization among individuals with lifetime DSM-5 cannabis use disorder (CUD). Face-to-face survey of a representative sample of the adult US general population (n=36,309). Treatment rates for CUD were low in this general population survey (13.7%). Severity of CUD and comorbidity of other lifetime drug use disorders were significant predictors of lifetime treatment utilization for CUD. Preference for self-reliance, minimizing problems, fear of stigma, and financial and structural issues were among the most frequently endorsed reasons for respondents not seeking treatment when they perceived the need for treatment among individuals with lifetime CUD, regardless of whether they eventually utilized treatment at some time in their lives. Given the rising prevalence of CUD in the US over the past decade and currently low treatment rates for CUD, increased provision for services for CUD appears critically needed, especially those that screen for and treat, when present, other drug use disorders. Programs to reduce stigma and financial barriers are needed, as well as programs to increase awareness among the general public, health care professionals about the nature and seriousness of CUD, and the availability and effectiveness of treatment for this disorder. Copyright © 2017. Published by Elsevier B.V.

  20. Study of technical and economical feasibility for implementation of a movable unit for treatment of industrial effluents with electron beam

    International Nuclear Information System (INIS)

    Rela, Carolina Sciamarelli

    2006-01-01

    The treatment of industrial effluents is a practice that is disseminating in accelerated rhythm, of contributing to reinforce the public image, through the combat of the pollution, it brings economical advantages allowing the companies the reuse of the treated water in their own processes. The liquid effluent treatment technique studied in the present work is the one that uses the chemical oxidation/reduction standing out the use of the electron beam (e.b.) radiation. This technique uses an advanced oxidation process, generating radicals highly reagents that provoke the oxidation, reduction, dissociation and degradation in composed organic and exercising lethal effect in general in the microorganisms and parasites. In this work a conceptual and basic project of a movable unit of effluents treatment using electron beam radiation process was developed, in order that the unit moves until the treatment point, where the effluent is produced, facilitating the logistics. A technical and economical feasibility study was also elaborated allowing data on the capacity and cost of effluents processing to consolidate the values of the necessary investments to be presented to foundations organs for the construction of a movable unit. The results of the studies demonstrated that it is technically viable attending the pertinent legislation of Brazil, in the aspects of Radiation Protection and transport limit capacity. The unitary cost of the e.b. radiation processing in the movable unit was shown more expensive than in the fixed unit, the reason is the decrease of the efficiency of the interaction of the incident electrons in the effluent, due to the reduction of electron energy operation time of the unit. (author)

  1. Treatment of Young People With Antipsychotic Medications in the United States.

    Science.gov (United States)

    Olfson, Mark; King, Marissa; Schoenbaum, Michael

    2015-09-01

    Despite concerns about rising treatment of young people with antipsychotic medications, little is known about trends and patterns of their use in the United States. To describe antipsychotic prescription patterns among young people in the United States, focusing on age and sex. A retrospective descriptive analysis of antipsychotic prescriptions among patients aged 1 to 24 years was performed with data from calendar years 2006 (n = 765,829), 2008 (n = 858,216), and 2010 (n = 851,874), including a subset from calendar year 2009 with service claims data (n = 53,896). Data were retrieved from the IMS LifeLink LRx Longitudinal Prescription database, which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. The percentage of young people filling 1 or more antipsychotic prescriptions during the study year by sex and age group (younger children, 1-6 years; older children, 7-12 years; adolescents, 13-18 years; and young adults, 19-24 years) was calculated. Among young people with antipsychotic use, percentages with specific clinical psychiatric diagnoses and 1 or more antipsychotic prescriptions from a psychiatrist and from a child and adolescent psychiatrist were also determined. The percentages of young people using antipsychotics in 2006 and 2010, respectively, were 0.14% and 0.11% for younger children, 0.85% and 0.80% for older children, 1.10% and 1.19% for adolescents, and 0.69% and 0.84% for young adults. In 2010, males were more likely than females to use antipsychotics, especially during childhood and adolescence: 0.16% vs 0.06% for younger children, 1.20% vs 0.44% for older children, 1.42% vs 0.95% for adolescents, and 0.88% vs 0.81% for young adults. Among young people treated with antipsychotics in 2010, receiving a prescription from a psychiatrist was less common among younger children (57.9%) than among other age groups (range, 70.4%-77.9%). Approximately 29.3% of

  2. Radiation-stable polyolefin compositions

    International Nuclear Information System (INIS)

    Rekers, J.W.

    1986-01-01

    This invention relates to compositions of olefinic polymers suitable for high energy radiation treatment. In particular, the invention relates to olefinic polymer compositions that are stable to sterilizing dosages of high energy radiation such as a gamma radiation. Stabilizers are described that include benzhydrol and benzhydrol derivatives; these stabilizers may be used alone or in combination with secondary antioxidants or synergists

  3. Surface interactions between nanoscale iron and organic material: Potential uses in water treatment process units

    Science.gov (United States)

    Storms, Max

    Membrane systems are among the primary emergent technologies in water treatment process units due to their ease of use, small physical footprint, and high physical rejection. Membrane fouling, the phenomena by which membranes become clogged or generally soiled, is an inhibitor to optimal efficiency in membrane systems. Novel, composite, and modified surface materials must be investigated to determine their efficacy in improving fouling behavior. Ceramic membranes derived from iron oxide nanoparticles called ferroxanes were coated with a superhydrophillic, zwitterionic polymer called poly (sulfobetaine methacrylate) (polySBMA) to form a composite ceramic-polymeric membrane. Membrane samples with and without polySBMA coating were subjected to fouling with a bovine serum albumin solution and fouling was observed by measuring permeate flux at 10 mL intervals. Loss of polySBMA was measured using total organic carbon analysis, and membrane samples were characterized using x-ray diffraction, scanning electron microscopy, and optical profilometry. The coated membrane samples decreased initial fouling rate by 27% and secondary fouling rate by 24%. Similarly, they displayed a 30% decrease in irreversible fouling during the initial fouling stage, and a 27% decrease in irreversible fouling in the secondary fouling stage; however, retention of polySBMA sufficient for improved performance was not conclusive. The addition of chemical disinfectants into drinking water treatment processes results in the formation of compounds called disinfection by-products (DBPs). The formation of DBPs occurs when common chemical disinfectants (i.e. chlorine) react with organic material. The harmful effects of DBP exposure require that they be monitored and controlled for public safety. This work investigated the ability of nanostructured hematite derived from ferroxane nanoparticles to remove organic precursors to DBPs in the form of humic acid via adsorption processes. The results show that p

  4. Clinical characteristics and methods of treatment of patients with stable coronary heart disease in the primary care settings--the results of the Polish, Multicentre Angina Treatment Pattern (ATP) study.

    Science.gov (United States)

    Ruzyllo, W; Ponikowski, P; Wilkins, A

    2004-12-01

    For further improvement of coronary heart disease (CHD) management large epidemiological studies are required to characterise the real population of patients with CHD, treated in the primary care settings, and to evaluate how the guidelines are implemented in the everyday clinical practice. The aim of the Angina Treatment Pattern (ATP) survey was to characterise (i) the population of patients, treated by the primary care physicians for stable CHD, (ii) the methods applied by the primary care physicians to establish diagnosis of CHD and (iii) the pharmacological therapies for CHD. Across Poland, 397 primary care physicians were randomly selected. They recruited 7420 patients (49% men; mean age, 62 +/- 10 years; range: 25-93 years), treated for stable CHD. The duration of CHD was 7.4 +/- 6.6 years (range: 6 months-50 years), 2750 (37%) patients had myocardial infarction. The following risk factors of CHD were present: arterial hypertension in 58%, dyslipidaemia in 52%, smoking in 40%, family history of CHD in 56% and obesity or overweight in 73% of patients. Primary care physicians based a diagnosis of CHD predominantly on a history of anginal pain (in 33% patients), accompanied either by abnormal resting ECG or positive exercise test (in additional 31% patients). Only in 5% of patients, coronary angiography was applied to diagnose CAD. The following groups of drugs have been used: long-acting nitrates in 90%, anti-platelet drugs or anti-coagulants in 71% (aspirin in 65%), angiotensin-converting enzyme inhibitors in 51%, beta-blockers in 48%, calcium antagonists 31%, hypolipaemic drugs in 23% (statins in 10%) and metabolic agents in 16% of patients. Despite an extensive use of classical anti-anginal drugs (including at least one of the following: long-acting nitrates, beta-blockers, calcium antagonists in 95% of patients), 85% of patients still complained of anginal symptoms. Neither prevalence of angina among patients nor nitroglycerin intake depended on the number

  5. Developing an efficient scheduling template of a chemotherapy treatment unit: A case study.

    Science.gov (United States)

    Ahmed, Z; Elmekkawy, Ty; Bates, S

    2011-01-01

    This study was undertaken to improve the performance of a Chemotherapy Treatment Unit by increasing the throughput and reducing the average patient's waiting time. In order to achieve this objective, a scheduling template has been built. The scheduling template is a simple tool that can be used to schedule patients' arrival to the clinic. A simulation model of this system was built and several scenarios, that target match the arrival pattern of the patients and resources availability, were designed and evaluated. After performing detailed analysis, one scenario provide the best system's performance. A scheduling template has been developed based on this scenario. After implementing the new scheduling template, 22.5% more patients can be served. 1. CancerCare Manitoba is a provincially mandated cancer care agency. It is dedicated to provide quality care to those who have been diagnosed and are living with cancer. MacCharles Chemotherapy unit is specially built to provide chemotherapy treatment to the cancer patients of Winnipeg. In order to maintain an excellent service, it tries to ensure that patients get their treatment in a timely manner. It is challenging to maintain that goal because of the lack of a proper roster, the workload distribution and inefficient resource allotment. In order to maintain the satisfaction of the patients and the healthcare providers, by serving the maximum number of patients in a timely manner, it is necessary to develop an efficient scheduling template that matches the required demand with the availability of resources. This goal can be reached using simulation modelling. Simulation has proven to be an excellent modelling tool. It can be defined as building computer models that represent real world or hypothetical systems, and hence experimenting with these models to study system behaviour under different scenarios.1, 2 A study was undertaken at the Children's Hospital of Eastern Ontario to identify the issues behind the long waiting

  6. stableGP

    Data.gov (United States)

    National Aeronautics and Space Administration — The code in the stableGP package implements Gaussian process calculations using efficient and numerically stable algorithms. Description of the algorithms is in the...

  7. Short-term effects of fuel reduction treatments on herpetofauna from the southeastern United States

    Science.gov (United States)

    Eran S. Kilpatrick; Thomas A. Waldrop; Joseph D. Lanham; Cathryn H. Greenberg; Tom H. Contreras

    2010-01-01

    Path analysis of fuel reduction treatments on herpetofauna across four southeastern sites of the National Fire and Fire Surrogate Study provided quantitative evidence relating changes in vegetation and fuels to herpetofauna response. Fuel reduction treatments included prescribed burning (B), a mechanical treatment (M), mechanical treatment followed by prescribed...

  8. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2015-2017.

    Science.gov (United States)

    DiGiulio, Anne; Jump, Zach; Yu, Annie; Babb, Stephen; Schecter, Anna; Williams, Kisha-Ann S; Yembra, Debbie; Armour, Brian S

    2018-04-06

    Cigarette smoking prevalence among Medicaid enrollees (25.3%) is approximately twice that of privately insured Americans (11.8%), placing Medicaid enrollees at increased risk for smoking-related disease and death (1). Medicaid spends approximately $39 billion annually on treating smoking-related diseases (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications* are effective in helping tobacco users quit (3). Although state Medicaid coverage of tobacco cessation treatments improved during 2014-2015, coverage was still limited in most states (4). To monitor recent changes in state Medicaid cessation coverage for traditional (i.e., nonexpansion) Medicaid enrollees, the American Lung Association collected data on coverage of a total of nine cessation treatments: individual counseling, group counseling, and seven FDA-approved cessation medications † in state Medicaid programs during July 1, 2015-June 30, 2017. The American Lung Association also collected data on seven barriers to accessing covered treatments, such as copayments and prior authorization. As of June 30, 2017, 10 states covered all nine of these treatments for all enrollees, up from nine states as of June 30, 2015; of these 10 states, Missouri was the only state to have removed all seven barriers to accessing these cessation treatments. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers would be expected to reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures (5-7).

  9. Upgrading of Alum Preparation and Dosing Unit for Sharq Dijla Water Treatment Plant by Using Programmable Logic Controller System

    Directory of Open Access Journals (Sweden)

    Aumar Al-Nakeeb

    2018-02-01

    Full Text Available One of the important units in Sharq Dijla Water Treatment Plant (WTP first and second extensions are the alum solution preparation and dosing unit. The existing operation of this unit accomplished manually starting from unloading the powder alum in the preparation basin and ending by controlling the alum dosage addition through the dosing pumps to the flash mix chambers. Because of the modern trend of monitoring and control the automatic operation of WTPs due to the great benefits that could be gain from optimum equipment operation, reducing the operating costs and human errors. This study deals with how to transform the conventional operation to an automatic monitoring and controlling system depending on a Programmable Logic Controller (PLC and online sensors for alum preparation and dosing unit in Sharq Dijla WTP. PLC system will receive, analyze transmitting data, compare them with preset points then automatically orders the operational equipment (such as pumps, valves, and mixers in a way that guarantees the safe and appropriate operation of the unit. As a result of Process and Instrumentation Diagrams (PID that were prepared in this study, these units can be fully operating and manage by using Supervisory Control and Data Acquisition (SCADA system.

  10. The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study

    Science.gov (United States)

    Boone, M. Dustin; Massa, Jennifer; Mueller, Ariel; Jinadasa, Sayuri P; Lee, Joon; Kothari, Rishi; Scott, Daniel J.; Callahan, Julie; Celi, Leo Anthony; Hacker, Michele R.

    2016-01-01

    Purpose Prior studies report that weekend admission to an intensive care unit is associated with increased mortality, potentially attributed to the organizational structure of the unit. This study aims to determine whether treatment of hypotension, a risk factor for mortality, differs according to level of staffing. Methods Using the Multiparameter Intelligent Monitoring in Intensive Care database, we conducted a retrospective study of patients admitted to an intensive care unit at Beth Israel Deaconess Medical Center who experienced one or more episodes of hypotension. Episode(s) were categorized according to the staffing level, defined as high during weekday daytime (7am–7pm) and low during weekends or nighttime (7pm–7am). Results Patients with a hypotensive event on a weekend were less likely to be treated compared to those that occurred during the weekday daytime (p=0.02). No association between weekday daytime versus weekday nighttime staffing levels and treatment of hypotension was found (RR 1.02; 95% CI 0.98–1.07). Conclusion Patients with a hypotensive event on a weekend were less likely to be treated than patients with an event during high-staffing periods. No association between weekday nighttime staffing and hypotension treatment was observed. We conclude that treatment of a hypotensive episode relies on more than solely staffing levels. PMID:26975737

  11. The Treatment of the Architectural Unit above Openings of the Mamluk and Ottoman Facades in Cairo

    Directory of Open Access Journals (Sweden)

    Heba Mahmoud Saad Abdel Naby

    2014-09-01

    Full Text Available The facades of the Mamluk buildings have a common characteristic feature which is the use of lintels, nafis and relieving arches above doors and windows. The three elements together formed a unit with an important architectural function on the façades. This unit was also treated as a focal point of the façade. Therefore, it was richly decorated with floral and geometric decorations and was usually made of colored marble, joggles voussoirs or carved stones. As a result, that unit attracted the attention of pedestrians and added to the beauty of the façade. During the Ottoman period the same unit was used on facades, however, due to financial and political reasons, the materials used differed and the decorations became modest. Nonetheless, the decoration of the lintel, nafis and relieving arch managed to mark the Ottoman facades with a different identity.

  12. Treatment with triple combination of atorvastatin, perindopril, and amlodipine in patients with stable coronary artery disease: A subgroup analysis from the PAPA-CAD study.

    Science.gov (United States)

    Dézsi, Csaba András

    2018-01-01

    Background In patients with stable coronary artery disease, aspirin, a statin, and an angiotensin-converting enzyme inhibitor are recommended as first-line agents for secondary prevention. Subgroup analyses of the previously published Hungarian Perindopril plus Amlodipine in PAtients with Coronary Artery Disease (PAPA-CAD) non-interventional trial demonstrated that the addition of the metabolically beneficial, fixed combination of perindopril + amlodipine to atorvastatin further improves the patient's lipid profile. Methods The PAPA-CAD study, a 6-month open-label, prospective, multicenter, observational/non-interventional survey evaluated data accumulated from patients with hypertensive patients with stable coronary artery disease. The herein-reported subgroup analysis was conducted using the findings from those 1130 patients, who were taking atorvastatin in addition to the fixed combination of perindopril + amlodipine at the time of all four study visits (i.e., at baseline and 1, 3, and 6 months later). Results In the subgroup of patients taking atorvastatin as an add-on agent, 82.5% reached the target blood pressure of 140/90 mmHg compared with 78.8% of those not taking a statin. The addition of atorvastatin to the fixed combination of perindopril + amlodipine resulted in further significant improvements of key metabolic parameters. Conclusion This subgroup analysis confirmed that favorable synergism exists among perindopril, amlodipine, and atorvastatin.

  13. Laboratory evaluation of novaluron as a development site treatment for controlling larval horn flies, house flies, and stable flies (Diptera: Muscidae).

    Science.gov (United States)

    Lohmeyer, K H; Pound, J M

    2012-05-01

    A granular formulation of novaluron (Novaluron 0.2G, 0.2% [AI]), a newer benzoylphenyl urea insecticide, was evaluated for its efficacy in controlling the larval stage of horn flies, Haematobia irritans (L.); house flies, Musca domestica L.; and stable flies, Stomoxys calcitrans (L.), in cow manure. Various rates and insecticide placement locations (top, middle, and bottom of manure) were evaluated in this study and all combinations of these variables reduced adult emergence of all three species when compared with the untreated controls. The presence of deformed pupae indicated that novaluron had an insect growth regulator effect on the developing fly larvae. Top, middle, or bottom application rates of 0.125, 0.195, 0.25, and 0.375 g novaluron onto manure samples, reduced adult horn fly emergence by > 90%. Middle and bottom application rates of 0.195, 0.25, and 0.375 g novaluron reduced adult house fly emergence >93%. All rates and placement combinations resulted in >98% reduction of adult stable fly emergence. The level of control efficacy observed against these three fly species along with the ease of use of a granular formulation, make this product an ideal candidate for use in an integrated livestock pest management program.

  14. Neglected infections of poverty in Texas and the rest of the United States: management and treatment options.

    Science.gov (United States)

    Barry, M A; Bezek, S; Serpa, J A; Hotez, P J; Woc-Colburn, L

    2012-08-01

    In the poorest regions of the United States, especially along the Gulf Coast and in South Texas, are a group of endemic parasitic and related infections known as the neglected infections of poverty. Such infections are characterized by their chronicity, disabling features, and disproportionate impact on the estimated 46 million people who live below the U.S. poverty line. Today more Americans live in poverty than ever before in the half-century that the Census Bureau has been recording poverty rates. In association with that poverty, a group of major neglected infections of poverty have emerged in the United States. Here we describe the major neglected infections of poverty in the United States, with a brief overview of their significant epidemiological features, their links with poverty, and our approaches to their diagnosis, management, and treatment.

  15. Trends in the Quality of Treatment for Patients With Intact Cervical Cancer in the United States, 1999 Through 2011

    International Nuclear Information System (INIS)

    Smith, Grace L.; Jiang, Jing; Giordano, Sharon H.; Meyer, Larissa A.; Eifel, Patricia J.

    2015-01-01

    Purpose: High-quality treatment for intact cervical cancer requires external radiation therapy, brachytherapy, and chemotherapy, carefully sequenced and completed without delays. We sought to determine how frequently current treatment meets quality benchmarks and whether new technologies have influenced patterns of care. Methods and Materials: By searching diagnosis and procedure claims in MarketScan, an employment-based health care claims database, we identified 1508 patients with nonmetastatic, intact cervical cancer treated from 1999 to 2011, who were <65 years of age and received >10 fractions of radiation. Treatments received were identified using procedure codes and compared with 3 quality benchmarks: receipt of brachytherapy, receipt of chemotherapy, and radiation treatment duration not exceeding 63 days. The Cochran-Armitage test was used to evaluate temporal trends. Results: Seventy-eight percent of patients (n=1182) received brachytherapy, with brachytherapy receipt stable over time (Cochran-Armitage P trend =.15). Among patients who received brachytherapy, 66% had high–dose rate and 34% had low–dose rate treatment, although use of high–dose rate brachytherapy steadily increased to 75% by 2011 (P trend <.001). Eighteen percent of patients (n=278) received intensity modulated radiation therapy (IMRT), and IMRT receipt increased to 37% by 2011 (P trend <.001). Only 2.5% of patients (n=38) received IMRT in the setting of brachytherapy omission. Overall, 79% of patients (n=1185) received chemotherapy, and chemotherapy receipt increased to 84% by 2011 (P trend <.001). Median radiation treatment duration was 56 days (interquartile range, 47-65 days); however, duration exceeded 63 days in 36% of patients (n=543). Although 98% of patients received at least 1 benchmark treatment, only 44% received treatment that met all 3 benchmarks. With more stringent indicators (brachytherapy, ≥4 chemotherapy cycles, and duration not exceeding 56 days), only 25

  16. Trends in the Quality of Treatment for Patients With Intact Cervical Cancer in the United States, 1999 Through 2011

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Grace L. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Jiang, Jing [Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Giordano, Sharon H. [Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Meyer, Larissa A. [Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Gynecologic Oncology and Reproductive Medicine (LAM), The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Eifel, Patricia J., E-mail: peifel@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2015-06-01

    Purpose: High-quality treatment for intact cervical cancer requires external radiation therapy, brachytherapy, and chemotherapy, carefully sequenced and completed without delays. We sought to determine how frequently current treatment meets quality benchmarks and whether new technologies have influenced patterns of care. Methods and Materials: By searching diagnosis and procedure claims in MarketScan, an employment-based health care claims database, we identified 1508 patients with nonmetastatic, intact cervical cancer treated from 1999 to 2011, who were <65 years of age and received >10 fractions of radiation. Treatments received were identified using procedure codes and compared with 3 quality benchmarks: receipt of brachytherapy, receipt of chemotherapy, and radiation treatment duration not exceeding 63 days. The Cochran-Armitage test was used to evaluate temporal trends. Results: Seventy-eight percent of patients (n=1182) received brachytherapy, with brachytherapy receipt stable over time (Cochran-Armitage P{sub trend}=.15). Among patients who received brachytherapy, 66% had high–dose rate and 34% had low–dose rate treatment, although use of high–dose rate brachytherapy steadily increased to 75% by 2011 (P{sub trend}<.001). Eighteen percent of patients (n=278) received intensity modulated radiation therapy (IMRT), and IMRT receipt increased to 37% by 2011 (P{sub trend}<.001). Only 2.5% of patients (n=38) received IMRT in the setting of brachytherapy omission. Overall, 79% of patients (n=1185) received chemotherapy, and chemotherapy receipt increased to 84% by 2011 (P{sub trend}<.001). Median radiation treatment duration was 56 days (interquartile range, 47-65 days); however, duration exceeded 63 days in 36% of patients (n=543). Although 98% of patients received at least 1 benchmark treatment, only 44% received treatment that met all 3 benchmarks. With more stringent indicators (brachytherapy, ≥4 chemotherapy cycles, and duration not exceeding 56

  17. Psychological Distress among Ebola Survivors Discharged from an Ebola Treatment Unit in Monrovia, Liberia ? A Qualitative Study

    OpenAIRE

    Rabelo, Ionara; Lee, Virginia; Fallah, Mosoka P.; Massaquoi, Moses; Evlampidou, Iro; Crestani, Rosa; Decroo, Tom; Van den Bergh, Rafael; Severy, Nathalie

    2016-01-01

    Introduction A consequence of the West Africa Ebola outbreak 2014–2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community. Methods Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited t...

  18. Predictors of New Onset Sleep Medication and Treatment Utilization Among Older Adults in the United States.

    Science.gov (United States)

    Leggett, Amanda; Pepin, Renee; Sonnega, Amanda; Assari, Shervin

    2016-07-01

    Sleep disturbances are common among older adults resulting in frequent sleep medication utilization, though these drugs are associated with a number of risks. We examine rates and predictors of new prescription sleep medications and sleep treatments, as well as sleep treatments without a doctor's recommendation. Participants were 8,417 adults aged 50 and older from two waves of the nationally representative Health and Retirement Study (HRS) who were not using a sleep medication or treatment at baseline (2006). Logistic regression analyses are run with sociodemographic, health, and mental health factors as predictors of three outcomes: new prescription medication use, sleep treatment use, and sleep treatment out of a doctor's recommendation in 2010. New sleep medication prescriptions were started by 7.68%, 12.62% started using a new sleep treatment, and 31.93% were using the treatment outside of their doctor's recommendation. Common predictors included greater severity of insomnia, worsening insomnia, older age, and use of psychiatric medications. New prescription medication use was also associated with poorer mental and physical health, whereas new sleep treatment was associated with being White, higher educated, and drinking less alcohol. Starting a new prescription sleep medication may reflect poorer health and higher health care utilization, whereas beginning a sleep treatment may reflect an individual's awareness of treatments and determination to treat their problem. Clinicians should be aware of predictors of new sleep medication and treatment users and discuss various forms of treatment or behavioral changes to help patients best manage sleep disturbance. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. Integrated Waste Treatment Unit (IWTU) Input Coal Analyses and Off-Gass Filter (OGF) Content Analyses

    Energy Technology Data Exchange (ETDEWEB)

    Jantzen, Carol M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Missimer, David M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Guenther, Chris P. [National Energy Technology Lab. (NETL), Morgantown, WV (United States); Shekhawat, Dushyant [National Energy Technology Lab. (NETL), Morgantown, WV (United States); VanEssendelft, Dirk T. [National Energy Technology Lab. (NETL), Morgantown, WV (United States); Means, Nicholas C. [AECOM Technology Corp., Oak Ridge, TN (United States)

    2015-04-23

    A full engineering scale Fluidized Bed Steam Reformer (FBSR) system is being used at the Idaho Nuclear Technology and Engineering Center (INTEC) to stabilize acidic Low Activity Waste (LAW) known as Sodium Bearing Waste (SBW). The INTEC facility, known as the Integrated Waste Treatment Unit (IWTU), underwent an Operational Readiness Review (ORR) and a Technology Readiness Assessment (TRA) in March 2014. The IWTU began non-radioactive simulant processing in late 2014 and by January, 2015 ; the IWTU had processed 62,000 gallons of simulant. The facility is currently in a planned outage for inspection of the equipment and will resume processing simulated waste feed before commencing to process 900,000 gallons of radioactive SBW. The SBW acidic waste will be made into a granular FBSR product (carbonate based) for disposal in the Waste Isolation Pilot Plant (WIPP). In the FBSR process calcined coal is used to create a CO2 fugacity to force the waste species to convert to carbonate species. The quality of the coal, which is a feed input, is important because the reactivity, moisture, and volatiles (C,H,N,O, and S) in the coal impact the reactions and control of the mineralizing process in the primary steam reforming vessel, the Denitration and Mineralizing Reformer (DMR). Too much moisture in the coal can require that additional coal be used. However since moisture in the coal is only a small fraction of the moisture from the fluidizing steam this can be self-correcting. If the coal reactivity or heating value is too low then the coal feedrate needs to be adjusted to achieve the desired heat generation. Too little coal and autothermal heat generation in the DMR cannot be sustained and/or the carbon dioxide fugacity will be too low to create the desired carbonate mineral species. Too much coal and excess S and hydroxide species can form. Excess sulfur from coal that (1) is too rich in sulfur or (2) from overfeeding coal can promote wall scale and contribute to corrosion

  20. The Economic Model of Retinopathy of Prematurity (EcROP) Screening and Treatment: Mexico and the United States.

    Science.gov (United States)

    Rothschild, Michael I; Russ, Rebecca; Brennan, Kathryn A; Williams, Christopher J; Berrones, David; Patel, Bhavesh; Martinez-Castellanos, Maria Ana; Fernandes, Alcides; Hubbard, G Baker; Chan, R V Paul; Yang, Zhou; Olsen, Timothy W

    2016-08-01

    To describe an economic (Ec) model for estimating the impact of screening and treatment for retinopathy of prematurity (ROP). EcROP is a cost-effectiveness, cost-utility, and cost-benefit analysis. We surveyed caregivers of 52 children at schools for the blind or pediatric eye clinics in Atlanta, Georgia and 43 in Mexico City. A decision analytic model with sensitivity analysis determined the incremental cost-effectiveness (primary outcome) and incremental monetary benefit (secondary outcome) of an ideal (100% screening) national ROP program as compared to estimates of current practice. Direct costs included screening and treatment expenditures. Indirect costs estimated lost productivity of caretaker(s) and blind individuals as determined by face-to-face surveys. Utility and effectiveness were measured in quality-adjusted life years and benefit in US dollars. EcROP includes a sensitivity analysis to assesses the incremental cost-effectiveness and societal impact of ROP screening and treatment within a country or economic region. Estimates are based on evidence-based clinical data and region-specific economic data acquired from direct field survey. In both Mexico and the United States, an ideal national ROP screening and treatment program was highly cost-saving. The incremental net benefit of an ideal ROP program over current practice is $5556 per child ($206 574 333 annually) and $3628 per child ($205 906 959 annually) in Mexico and the United States, respectively. EcROP demonstrates that ROP screening and treatment is highly beneficial for quality of life, cost saving, and cost-effectiveness in the United States and Mexico. EcROP can be applied to any country or region to provide data for informed allocation of limited health care resources. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Alternative national guidelines for treating attention and depression problems in children: comparison of treatment approaches and prescribing rates in the United Kingdom and United States.

    Science.gov (United States)

    Murphy, J Michael; McCarthy, Alyssa E; Baer, Lee; Zima, Bonnie T; Jellinek, Michael S

    2014-01-01

    The use of psychotropic medications for children and adolescents with attention and depression problems continues to generate both attention in the news media and controversy within the field. Given that the United Kingdom has recently issued guidelines for its national health service that differ substantially from those in the United States, the time is ripe to reexamine the evidence. The purpose of this article is to describe the UK's new "stepped care" guidelines for treating attention and depression problems in children and to compare them to the US guidelines issued by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. Our findings are that, despite many similarities, the UK guidelines are generally more conservative in their recommendations for medication use, especially for children experiencing only moderate impairment. Our article also compares prescription and diagnosis rates in the UK and the US, and reports evidence for lower rates of prescribing in the UK, despite some evidence that the rates of problems may not differ substantially. We conclude by noting that the existence of an alternative standard provides validation for clinicians or families who prefer to take a more conservative approach to medication use. The two different approaches to care also provide a valuable opportunity for research to determine whether the approaches result in different treatment outcomes.

  2. Hemiarthroplasty versus angle-stable locking compression plate osteosynthesis in the treatment of three- and four-part fractures of the proximal humerus in the elderly: design of a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Verbeek Paul A

    2012-02-01

    Full Text Available Abstract Background The optimal surgical management of dislocated three- and four-part fractures of the proximal humerus in elderly patients remains unclear. Most used techniques are hemiarthroplasty and angle-stable locking compression plate osteosynthesis. In the current literature there is no evidence available presenting superior results between hemiarthroplasty and angle-stable locking compression plate osteosynthesis in terms of speed of recovery, pain, patient satisfaction, functional outcome, quality of life or complications. Methods/Design A randomized controlled multicenter trial will be conducted. Patients older than 60 years of age with a dislocated three- or four-part fracture of the proximal humerus as diagnosed by X-rays and CT-scans will be included. Exclusion criteria are a fracture older than 14 days, multiple comorbidity, multitrauma, a pathological fracture, previous surgery on the injured shoulder, severely deranged function caused by a previous disease, "head-split" proximal humerus fracture and unwillingness or inability to follow instructions. Participants will be randomized between surgical treatment with hemiarthroplasty and angle-stable locking compression plate osteosynthesis. Measurements will take place preoperatively and 3 months, 6 months, 9 months, 12 months and 24 months postoperatively. Primary outcome measure is speed of recovery of functional capacity of the affected upper limb using the Disabilities of Arm, Shoulder and Hand score (DASH. Secondary outcome measures are pain, patient satisfaction, shoulder function, quality of life, radiological evaluation and complications. Data will be analyzed on an intention-to-treat basis, using univariate and multivariate analyses. Discussion Both hemiarthroplasty and angle-stable locking compression plate osteosynthesis are used in the current treatment of dislocated three-and four-part fractures of the proximal humerus. There is a lack of level-1 studies comparing

  3. Effects of forest fuel-reduction treatments in the United States

    Science.gov (United States)

    Scott L. Stephens; James D. McIver; Ralph E.J. Boerner; Christopher J. Fettig; Joseph B. Fontaine; Bruce R. Hartsough; Patricia L. Kennedy; Dylan W. Schwilk

    2012-01-01

    The current conditions of many seasonally dry forests in the western and southern United States, especially those that once experienced low- to moderate-intensity fire regimes, leave them uncharacteristically susceptible to high-severity wildfire. Both prescribed fire and its mechanical surrogates are generally successful in meeting short-term fuel-reduction objectives...

  4. Greywater turns to gold: Treatment units to help low-income ...

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

    2011-02-08

    Feb 8, 2011 ... With no new sources to tap, Jordanians must find ways to reduce their demand and make better use of existing supplies. One of option ... At the Ministry of Planning and International Cooperation, officials approved the installation of greywater units in more than 700 households in 90 metropolitan areas.

  5. Impaired intravascular triglyceride lipolysis constitutes a marker of clinical outcome in patients with stable angina undergoing secondary prevention treatment: a long-term follow-up study.

    Science.gov (United States)

    Sposito, Andrei C; Lemos, Pedro A; Santos, Raul D; Hueb, Whady; Vinagre, Carmen G C; Quintella, Edgard; Carneiro, Otavio; Chapman, M John; Ramires, Jose A F; Maranhão, Raul C

    2004-06-16

    We sought to verify whether the intravascular metabolism of chylomicron-like emulsion may predict the clinical evolution of patients with coronary artery disease (CAD) undergoing secondary prevention therapy of CAD. Case-control studies have suggested an association between impaired intravascular catabolism of triglyceride (TG)-rich lipoproteins and CAD. However, evidence is lacking with respect to the potential clinical relevance of this metabolic disorder in CAD patients. During a period of 4.5 +/- 0.9 years, we followed up 63 stable CAD patients (mean age 60 +/- 10 years) undergoing secondary prevention therapy (low-density lipoprotein cholesterol <100 mg/dl) in whom kinetic studies of the in vivo catabolism of chylomicron-like emulsions were performed. At enrollment into the study, fasting patients were injected intravenously with a chylomicron-like emulsion labeled with radioactive triglyceride (3H-TG) and cholesteryl esters (14C-CE) to evaluate the efficacy of intravascular TG lipolysis. At baseline, CAD patients displayed a diminished fractional clearance rate (FCR) for 3H-TG (-26%; p = 0.027), for 14C-CE (-37%; p = 0.015), and for delipidation index (DI) (-26%; p = 0.02) as compared with 35 control subjects. During follow-up of secondary prevention therapy, 33% of CAD patients (n = 21) presented with clinically refractory angina and aggravated coronary angiographic severity. The FCR for 3H-TG (-44%; p = 0.005) and DI (-41%; p = 0.006) in those patients with refractory angina was significantly lower than that observed in those with stable evolution. Moreover, in a Cox multivariate regression analysis, the presence of a DI less than the median value was an independent predictor of an unfavorable clinical evolution (adjusted hazard ratio 3.32; 95% confidence interval 1.21 to 9.14; p = 0.020). The current study establishes that delayed intravascular TG lipolysis is a strong and independent predictor of evolution to severe angina among patients undergoing

  6. Prevalence and correlates of treatment utilization among adults with cannabis use disorder in the United States.

    Science.gov (United States)

    Wu, Li-Tzy; Zhu, He; Mannelli, Paolo; Swartz, Marvin S

    2017-08-01

    The increase in cannabis potency may have treatment implications for cannabis use disorder (CUD). Given the reported increase in prevalence of cannabis use among adults, there is a need to understand substance use treatment needs for CUD. We examined demographics and behavioral health indicators of adults aged ≥18 years that met criteria for past-year CUD (n=10,943) in the 2005-2013 National Surveys on Drug Use and Health. We determined prevalence and correlates of past-year treatment use for alcohol/drug, any drug, and cannabis use related problems, to inform treatment efforts for CUD. The majority of adults with past-year CUD were young adults aged 18-25 or men, had low income, and did not attend college. Two-thirds of adults with CUD met criteria for cannabis dependence, which was comparatively common among younger adults, women, low-income or publicly insured adults, and college-educated adults. Nicotine dependence (40.92%) and alcohol (44.07%) or other drug use disorder (19.70%) were prevalent among adults with CUD. Overall, less than 13% of adults with CUD had received alcohol/drug use treatment the past year; only 7.8% received cannabis-specific treatment. There was no significant yearly variation in treatment use prevalence over 9 years. In particular, Asian-Americans, women, and college-educated adults underutilized cannabis-specific treatment. This large sample of adults with CUD reveals pervasive underutilization of cannabis-related treatment, especially in women, married adults, and those with college education, despite a high proportion of comorbid behavioral health problems. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

  7. Stable isotopes labelled compounds

    International Nuclear Information System (INIS)

    1982-09-01

    The catalogue on stable isotopes labelled compounds offers deuterium, nitrogen-15, and multiply labelled compounds. It includes: (1) conditions of sale and delivery, (2) the application of stable isotopes, (3) technical information, (4) product specifications, and (5) the complete delivery programme

  8. Stable Boundary Layer Issues

    NARCIS (Netherlands)

    Steeneveld, G.J.

    2012-01-01

    Understanding and prediction of the stable atmospheric boundary layer is a challenging task. Many physical processes are relevant in the stable boundary layer, i.e. turbulence, radiation, land surface coupling, orographic turbulent and gravity wave drag, and land surface heterogeneity. The

  9. Evolutionary Stable Strategy

    Indian Academy of Sciences (India)

    IAS Admin

    After Maynard-Smith and Price [1] mathematically derived why a given behaviour or strategy was adopted by a certain proportion of the population at a given time, it was shown that a strategy which is currently stable in a population need not be stable in evolutionary time (across generations). Additionally it was sug-.

  10. Mobile unit for treatment of oil emulsions (taladrines); Unidad movil de tratamiento de taladrinas

    Energy Technology Data Exchange (ETDEWEB)

    Ortiz, S.

    1995-06-01

    The environmental problems of water in oil emulsions (taladrines), produced because of an uncontrolled pouring in the sewage system, is the problem caused for the sewage sludge water treatment plants because they have oils, emulgents and heavy metals. (Author)

  11. Current Status of Treatment of Radiation Injury in the United States

    National Research Council Canada - National Science Library

    Jarrett, D. G; Sedlak, R. G; Dickerson, W. E

    2005-01-01

    ... on i) historical data, ii) animal research, and iii) human results derived from present medical treatment such as the care provided to cancer patients undergoing radiation therapy or chemotherapy...

  12. An examination of periodontal treatment, dental care, and pregnancy outcomes in an insured population in the United States.

    Science.gov (United States)

    Albert, David A; Begg, Melissa D; Andrews, Howard F; Williams, Sharifa Z; Ward, Angela; Conicella, Mary Lee; Rauh, Virginia; Thomson, Janet L; Papapanou, Panos N

    2011-01-01

    We examined whether periodontal treatment or other dental care is associated with adverse birth outcomes within a medical and dental insurance database. In a retrospective cohort study, we examined the records of 23,441 women enrolled in a national insurance plan who delivered live births from singleton pregnancies in the United States between January 1, 2003, and September 30, 2006, for adverse birth outcomes on the basis of dental treatment received. We compared rates of low birthweight and preterm birth among 5 groups, specifying the relative timing and type of dental treatment received. We used logistic regression analysis to compare outcome rates across treatment groups while adjusting for duration of continuous dental coverage, maternal age, pregnancy complications, neighborhood-level income, and race/ethnicity. Analyses showed that women who received preventive dental care had better birth outcomes than did those who received no treatment (P periodontal treatment. For women with medical and dental insurance, preventive care is associated with a lower incidence of adverse birth outcomes.

  13. Analysis and relevant treatment of diametral tolerance of exciter shaft in unit 2

    International Nuclear Information System (INIS)

    Liu Qiang

    2012-01-01

    The generator and exciter unit has three support in Qinshan Nuclear Power Plant Phase Ⅱ, there are two bearings for the generator rotor and one for the exciter, this structure results in that it is difficult to achieve the standard when checking the exciter bearing's diametral tolerance. In the fifth outage of unit 2 in Qinshan Nuclear Power Plant Phase Ⅱ, the diametral tolerance failed to achieve the standard, there were several reasons for this, such as the alignment of generator and exciter coupling, the angular moment of generator and exciter coupling bolt. the end surface condition of generator and exciter coupling, the fitting dimension of the coupling bolt hole and the sleeve in it. After the analysis of all reasons one by one, it was confirmed that the radical reason was the abnormal condition of the generator coupling end surface, the problem was solved by machining it. (author)

  14. Tuberculosis Treatment Completion in a United States/Mexico Binational Context

    Directory of Open Access Journals (Sweden)

    Celina I. Valencia

    2017-05-01

    Full Text Available BackgroundTuberculosis (TB remains a salient public health issue along the U.S./Mexico border. This study seeks to identify the social and structural factors, which are associated with TB disease burden in the binational geographic region. Identification of barriers of treatment completion provides the necessary framework for developing evidence-based interventions that are culturally relevant and context specific for the U.S./Mexico border region.MethodsRetrospective study of data extracted from medical charts (n = 439 from Yuma County Health Department (YCHD (n = 160 and Centro de Salud San Luis Río Colorado (n = 279. Patients currently accessing TB treatment at either facility were excluded from the study. Chi-square, unadjusted odds ratios, and logistic regression were utilized to identify characteristics associated with successful TB treatment in this population.FindingsThe study population was predominantly male (n = 327. Females were more likely to complete TB treatment (OR = 3.71. The absence of drug use and/or the absence of an HIV positive diagnosis were found to be predictors of TB treatment completion across both clinical sites. Forty-four percent (43.59% (n = 85 TB patients treated at CDS San Luis did not complete treatment versus 40.35% (n = 49 of TB patients who did not complete treatment at YCHD. Moving from the area or being deported was the highest category (20.78% for incomplete TB treatment in the population (n = 64 across both clinical sites.

  15. Cost-effectiveness model comparing olanzapine and other oral atypical antipsychotics in the treatment of schizophrenia in the United States

    Directory of Open Access Journals (Sweden)

    Smolen Lee J

    2009-04-01

    Full Text Available Abstract Background Schizophrenia is often a persistent and costly illness that requires continued treatment with antipsychotics. Differences among antipsychotics on efficacy, safety, tolerability, adherence, and cost have cost-effectiveness implications for treating schizophrenia. This study compares the cost-effectiveness of oral olanzapine, oral risperidone (at generic cost, primary comparator, quetiapine, ziprasidone, and aripiprazole in the treatment of patients with schizophrenia from the perspective of third-party payers in the U.S. health care system. Methods A 1-year microsimulation economic decision model, with quarterly cycles, was developed to simulate the dynamic nature of usual care of schizophrenia patients who switch, continue, discontinue, and restart their medications. The model captures clinical and cost parameters including adherence levels, relapse with and without hospitalization, quality-adjusted life years (QALYs, treatment discontinuation by reason, treatment-emergent adverse events, suicide, health care resource utilization, and direct medical care costs. Published medical literature and a clinical expert panel were used to develop baseline model assumptions. Key model outcomes included mean annual total direct cost per treatment, cost per stable patient, and incremental cost-effectiveness values per QALY gained. Results The results of the microsimulation model indicated that olanzapine had the lowest mean annual direct health care cost ($8,544 followed by generic risperidone ($9,080. In addition, olanzapine resulted in more QALYs than risperidone (0.733 vs. 0.719. The base case and multiple sensitivity analyses found olanzapine to be the dominant choice in terms of incremental cost-effectiveness per QALY gained. Conclusion The utilization of olanzapine is predicted in this model to result in better clinical outcomes and lower total direct health care costs compared to generic risperidone, quetiapine, ziprasidone, and

  16. Psychiatric treatment and research unit for adolescent intensive care: the first adolescent forensic psychiatric service in Finland.

    Science.gov (United States)

    Kahila, K; Kilkku, N; Kaltiala-Heino, R

    2004-04-01

    Finland does not have a history of providing forensic adolescent psychiatric units although the need for this kind of service has been established. According to legislation patients who are minors have to be treated separately from adults, however, this has not been possible in practice. Also, adolescent psychiatric wards have not always been able to admit the most severely ill patients, those with impulsive and aggressive behaviours, because of lack of staff resources, problems associated with protecting other vulnerable patients and a shortage of secure environments. A previous report demonstrated the significant increase in adolescent's involuntary treatment within adult psychiatric wards. Data from this report were acknowledged as an important starting point in the planning process for the psychiatric treatment and research unit for adolescent intensive care. This paper describes the background, development process, plan of action, tailor-made education programme and supporting evidence for the first Finnish adolescent forensic service opened in April 2003 in the Department of Psychiatry, Tampere University Hospital. The tool used for planning the unit's activities and staff education programme was the Balanced Score Card approach, the structure and development of which is also outlined within the paper.

  17. The effectiveness and cost-effectiveness of 3- vs. 6-monthly dispensing of antiretroviral treatment (ART) for stable HIV patients in community ART-refill groups in Zimbabwe: study protocol for a pragmatic, cluster-randomized trial.

    Science.gov (United States)

    Fatti, Geoffrey; Ngorima-Mabhena, Nicoletta; Chirowa, Frank; Chirwa, Benson; Takarinda, Kudakwashe; Tafuma, Taurayi A; Mahachi, Nyikadzino; Chikodzore, Rudo; Nyadundu, Simon; Ajayi, Charles A; Mutasa-Apollo, Tsitsi; Mugurungi, Owen; Mothibi, Eula; Hoffman, Risa M; Grimwood, Ashraf

    2018-01-29

    Sub-Saharan Africa is the world region with the greatest number of people eligible to receive antiretroviral treatment (ART). Less frequent dispensing of ART and community-based ART-delivery models are potential strategies to reduce the load on overburdened healthcare facilities and reduce the barriers for patients to access treatment. However, no large-scale trials have been conducted investigating patient outcomes or evaluating the cost-effectiveness of extended ART-dispensing intervals within community ART-delivery models. This trial will assess the clinical effectiveness, cost-effectiveness and acceptability of providing ART refills on a 3 vs. a 6-monthly basis within community ART-refill groups (CARGs) for stable patients in Zimbabwe. In this pragmatic, three-arm, parallel, unblinded, cluster-randomized non-inferiority trial, 30 clusters (healthcare facilities and associated CARGs) are allocated using stratified randomization in a 1:1:1 ratio to either (1) ART refills supplied 3-monthly from the health facility (control arm), (2) ART refills supplied 3-monthly within CARGs, or (3) ART refills supplied 6-monthly within CARGs. A CARG consists of 6-12 stable patients who meet in the community to receive ART refills and who provide support to one another. Stable adult ART patients with a baseline viral load alive and retained in care 12 months after enrollment. Secondary outcomes (measured at 12 and 24 months) are the proportions achieving virological suppression, average provider cost per participant, provider cost per participant retained, cost per participant retained with virological suppression, and average patient-level costs to access treatment. Qualitative research will assess the acceptability of extended ART-dispensing intervals within CARGs to both providers and patients, and indicators of potential facility-level decongestion due to the interventions will be assessed. Cost-effective health system models that sustain high levels of patient retention

  18. The Effects of Silvicultural Treatment on Sirex noctilio Attacks and Tree Health in Northeastern United States

    Directory of Open Access Journals (Sweden)

    Kevin J. Dodds

    2014-11-01

    Full Text Available The invasive woodwasp Sirex noctilio (Hymenoptera: Siricidae is established in east-central North America. A replicated case study testing the effectiveness of silvicultural treatments for reducing the number of S. noctilio attacked trees in a stand was conducted in New York, USA. Silvicultural treatments reduced S. noctilio attacked trees by approximately 75% over the course of the study. There was no tree growth response to silvicultural treatments in the four years after thinning, but targeted removal of weakened trees removed potential S. noctilio habitat from treated stands. Two spectral vegetation indices were used to determine tree health in each treatment and potentially provide guidance for detection efforts. Silvicultural treatment significantly influenced the Red Edge Inflection Point, a strong indicator of chlorophyll content, and the Moisture Stress Index, a reflectance measurement sensitive to changes in foliar leaf water content, with the greatest differences occurring between control and treated blocks. Vegetation indices showed promise as a tool for aiding in stand prioritization for S. noctilio surveys or management activities.

  19. The potential impact of reducing indoor tanning on melanoma prevention and treatment costs in the United States: An economic analysis.

    Science.gov (United States)

    Guy, Gery P; Zhang, Yuanhui; Ekwueme, Donatus U; Rim, Sun Hee; Watson, Meg

    2017-02-01

    Indoor tanning is associated with an increased risk of melanoma. The US Food and Drug Administration proposed prohibiting indoor tanning among minors younger than 18 years. We sought to estimate the health and economic benefits of reducing indoor tanning in the United States. We used a Markov model to estimate the expected number of melanoma cases and deaths averted, life-years saved, and melanoma treatment costs saved by reducing indoor tanning. We examined 5 scenarios: restricting indoor tanning among minors younger than 18 years, and reducing the prevalence by 20%, 50%, 80%, and 100%. Restricting indoor tanning among minors younger than 18 years was estimated to prevent 61,839 melanoma cases, prevent 6735 melanoma deaths, and save $342.9 million in treatment costs over the lifetime of the 61.2 million youth age 14 years or younger in the United States. The estimated health and economic benefits increased as indoor tanning was further reduced. Limitations include the reliance on available data and not examining compliance to indoor tanning laws. Reducing indoor tanning has the potential to reduce melanoma incidence, mortality, and treatment costs. These findings help quantify and underscore the importance of continued efforts to reduce indoor tanning and prevent melanoma. Published by Elsevier Inc.

  20. TITRATION: A Randomized Study to Assess 2 Treatment Algorithms with New Insulin Glargine 300 units/mL.

    Science.gov (United States)

    Yale, Jean-François; Berard, Lori; Groleau, Mélanie; Javadi, Pasha; Stewart, John; Harris, Stewart B

    2017-10-01

    It was uncertain whether an algorithm that involves increasing insulin dosages by 1 unit/day may cause more hypoglycemia with the longer-acting insulin glargine 300 units/mL (GLA-300). The objective of this study was to compare safety and efficacy of 2 titration algorithms, INSIGHT and EDITION, for GLA-300 in people with uncontrolled type 2 diabetes mellitus, mainly in a primary care setting. This was a 12-week, open-label, randomized, multicentre pilot study. Participants were randomly assigned to 1 of 2 algorithms: they either increased their dosage by 1 unit/day (INSIGHT, n=108) or the dose was adjusted by the investigator at least once weekly, but no more often than every 3 days (EDITION, n=104). The target fasting self-monitored blood glucose was in the range of 4.4 to 5.6 mmol/L. The percentages of participants reaching the primary endpoint of fasting self-monitored blood glucose ≤5.6 mmol/L without nocturnal hypoglycemia were 19.4% (INSIGHT) and 18.3% (EDITION). At week 12, 26.9% (INSIGHT) and 28.8% (EDITION) of participants achieved a glycated hemoglobin value of ≤7%. No differences in the incidence of hypoglycemia of any category were noted between algorithms. Participants in both arms of the study were much more satisfied with their new treatment as assessed by the Diabetes Treatment Satisfaction Questionnaire. Most health-care professionals (86%) preferred the INSIGHT over the EDITION algorithm. The frequency of adverse events was similar between algorithms. A patient-driven titration algorithm of 1 unit/day with GLA-300 is effective and comparable to the previously tested EDITION algorithm and is preferred by health-care professionals. Copyright © 2017 Diabetes Canada. Published by Elsevier Inc. All rights reserved.

  1. Stable fetal hemodynamics measured by Doppler flow after initiation of anti-hypertensive treatment with methyldopa in pregnant women with diabetes

    DEFF Research Database (Denmark)

    Pedersen, Berit Woetmann; Ringholm, Lene; Damm, Peter

    2016-01-01

     mg three times daily) was performed and the cerebro-placental ratio (CPR) was calculated. RESULTS: Methyldopa treatment was initiated at median 249 (range 192-260) gestational days, mainly due to gestational hypertension (n = 7). Blood pressure declined from 142 (112-156)/92 (76-103) mmHg before...... to 129 (108-144)/82 (75-90) mmHg after initiation of methyldopa treatment (p = 0.11 and 0.04 for systolic and diastolic blood pressure, respectively). There were no significant changes in the umbilical artery PI (0.82 (0.72-1.40) versus 0.87 (0.64-0.95), p = 0.62) or CPR (1.94 (0.96-2.33) versus 1.78 (1...

  2. Cancer Treatment Disparities in HIV-Infected Individuals in the United States

    Science.gov (United States)

    Suneja, Gita; Shiels, Meredith S.; Angulo, Rory; Copeland, Glenn E.; Gonsalves, Lou; Hakenewerth, Anne M.; Macomber, Kathryn E.; Melville, Sharon K.; Engels, Eric A.

    2014-01-01

    Purpose HIV-infected individuals with cancer have worse survival rates compared with their HIV-uninfected counterparts. One explanation may be differing cancer treatment; however, few studies have examined this. Patients and Methods We used HIV and cancer registry data from Connecticut, Michigan, and Texas to study adults diagnosed with non-Hodgkin's lymphoma, Hodgkin's lymphoma, or cervical, lung, anal, prostate, colorectal, or breast cancers from 1996 to 2010. We used logistic regression to examine associations between HIV status and cancer treatment, adjusted for cancer stage and demographic covariates. For a subset of local-stage cancers, we used logistic regression to assess the relationship between HIV status and standard treatment modality. We identified predictors of cancer treatment among individuals with both HIV and cancer. Results We evaluated 3,045 HIV-infected patients with cancer and 1,087,648 patients with cancer without HIV infection. A significantly higher proportion of HIV-infected individuals did not receive cancer treatment for diffuse large B-cell lymphoma (DLBCL; adjusted odds ratio [aOR], 1.67; 95% CI, 1.41 to 1.99), lung cancer (aOR, 2.18; 95% CI, 1.80 to 2.64), Hodgkin's lymphoma (aOR, 1.77; 95% CI, 1.33 to 2.37), prostate cancer (aOR, 1.79; 95% CI, 1.31 to 2.46), and colorectal cancer (aOR, 2.27; 95% CI, 1.38 to 3.72). HIV infection was associated with a lack of standard treatment modality for local-stage DLBCL (aOR, 2.02; 95% CI, 1.50 to 2.72), non–small-cell lung cancer (aOR, 2.43; 95% CI, 1.46 to 4.03), and colon cancer (aOR, 4.77; 95% CI, 1.76 to 12.96). Among HIV-infected individuals, factors independently associated with lack of cancer treatment included low CD4 count, male sex with injection drug use as mode of HIV exposure, age 45 to 64 years, black race, and distant or unknown cancer stage. Conclusion HIV-infected individuals are less likely to receive treatment for some cancers than uninfected people, which may affect survival

  3. Graphene Oxide by UV-Ozone Treatment as an Efficient Hole Extraction Layer for Highly Efficient and Stable Polymer Solar Cells.

    Science.gov (United States)

    Xia, Yingdong; Pan, Yufeng; Zhang, Haijuan; Qiu, Jian; Zheng, Yiting; Chen, Yonghua; Huang, Wei

    2017-08-09

    The hole extraction layer has a significant impact on the achievement of high-efficiency polymer solar cells (PSCs). Here, we report an efficient approach to direct UV-ozone treatment by larger device performance enhancement employing graphene oxide (GO). The dramatic performance enhancement of PSCs with the P3HT:PCBM blend as an active layer was demonstrated by the UV-ozone treatment of GO for 30 min: best power conversion efficiency (PCE) of 4.18%, fill factor of 0.63, J sc of 10.94 mA cm -2 , and V oc of 0.61 V, which are significantly higher than those of the untreated GO (1.82%) and highly comparable PEDOT:PSS-based PSCs (3.73%). In addition, PSCs with UV-ozone-treated GO showed a longer stability than PSCs with PEDOT:PSS. The significant enhancement of PCEs of PSCs can be attributed to the fact that ozone molecules can oxidize GO into CO 2 and leave highly conductive graphene particles. We suggest that this simple UV-ozone treatment can provide an efficient method for highly efficient GO hole extraction in high-performance PSCs.

  4. Fuzzy dynamic modelling and predictive control of a coagulation chemical dosing unit for water treatment plants

    OpenAIRE

    Oladipupo Bello; Yskandar Hamam; Karim Djouani

    2014-01-01

    In this paper, a fuzzy model predictive control (FMPC) strategy is proposed to regulate the output variables of a coagulation chemical dosing unit. A multiple-input, multiple-output (MIMO) process model in form of a linearised Takagi–Sugeno (T–S) fuzzy model is derived. The process model is obtained through subtractive clustering from the plant's data set. The MIMO model is described by a set of coupled multiple-input, single-output models (MISO). In the controller design, the T–S fuzzy model...

  5. Midodrine as adjunctive support for treatment of refractory hypotension in the intensive care unit: a multicenter, randomized, placebo controlled trial (the MIDAS trial).

    Science.gov (United States)

    Anstey, Matthew H; Wibrow, Bradley; Thevathasan, Tharusan; Roberts, Brigit; Chhangani, Khushi; Ng, Pauline Yeung; Levine, Alexander; DiBiasio, Alan; Sarge, Todd; Eikermann, Matthias

    2017-03-21

    Patients admitted to intensive care units (ICU) are often treated with intravenous (IV) vasopressors. Persistent hypotension and dependence on IV vasopressors in otherwise resuscitated patients lead to delay in discharge from ICU. Midodrine is an oral alpha-1 adrenergic agonist approved for treatment of symptomatic orthostatic hypotension. This trial aims to evaluate whether oral administration of midodrine is an effective adjunct to standard therapy to reduce the duration of IV vasopressor treatment, and allow earlier discharge from ICU and hospital. The MIDAS trial is an international, multicenter, randomized, double-blind, placebo-controlled clinical trial being conducted in the USA and Australia. We are targeting 120 patients. Adult patients admitted to the ICU who are resuscitated and otherwise stable on low dose IV vasopressors for at least 24 h will be considered for recruitment. Participants will be randomized to receive midodrine (20 mg) or placebo three times a day, in addition to standard care. The primary outcome is time (hours) from initiation of midodrine or placebo to discontinuation of IV vasopressors. Secondary outcomes include time (hours) from ICU admission to discharge readiness, ICU length of stay (LOS) (days), hospital LOS (days), rates of ICU readmission, and rates of adverse events related to midodrine administration. Midodrine is approved by the Food and Drug Administration (FDA) for the treatment of symptomatic orthostatic hypotension. In August 2010, FDA proposed to withdraw approval of midodrine because of lack of studies that verify the clinical benefit of the drug. We obtained Investigational New Drug (IND 113,330) approval to study its effects in critically ill patients who require IV vasopressors but are otherwise ready for discharge from the ICU. A pilot observational study in a cohort of surgical ICU patients showed that the rate of decline in vasopressor requirements increased after initiation of midodrine treatment. We

  6. Use of Transnational Services to Prevent Treatment Interruption in Tuberculosis-Infected Persons Who Leave the United States.

    Science.gov (United States)

    Tschampl, Cynthia A; Garnick, Deborah W; Zuroweste, Edward; Razavi, Moaven; Shepard, Donald S

    2016-03-01

    A major problem resulting from interrupted tuberculosis (TB) treatment is the development of drug-resistant TB, including multidrug-resistant TB (MDR TB), a more deadly and costly-to-treat form of the disease. Global health systems are not equipped to diagnose and treat the current burden of MDR TB. TB-infected foreign visitors and temporary US residents who leave the country during treatment can experience treatment interruption and, thus, are at greater risk for drug-resistant TB. Using epidemiologic and demographic data, we estimated TB incidence among this group, as well as the proportion of patients referred to transnational care-continuity and management services during relocation; each year, ≈2,827 visitors and temporary residents are at risk for TB treatment interruption, 222 (8%) of whom are referred for transnational services. Scale up of transnational services for persons at high risk for treatment interruption is possible and encouraged because of potential health gains and reductions in healthcare costs for the United States and receiving countries.

  7. Normal modified stable processes

    DEFF Research Database (Denmark)

    Barndorff-Nielsen, Ole Eiler; Shephard, N.

    2002-01-01

    This paper discusses two classes of distributions, and stochastic processes derived from them: modified stable (MS) laws and normal modified stable (NMS) laws. This extends corresponding results for the generalised inverse Gaussian (GIG) and generalised hyperbolic (GH) or normal generalised inverse...... Gaussian (NGIG) laws. The wider framework thus established provides, in particular, for added flexibility in the modelling of the dynamics of financial time series, of importance especially as regards OU based stochastic volatility models for equities. In the special case of the tempered stable OU process...

  8. Applications of stable isotopes

    International Nuclear Information System (INIS)

    Letolle, R.; Mariotti, A.; Bariac, T.

    1991-06-01

    This report reviews the historical background and the properties of stable isotopes, the methods used for their measurement (mass spectrometry and others), the present technics for isotope enrichment and separation, and at last the various present and foreseeable application (in nuclear energy, physical and chemical research, materials industry and research; tracing in industrial, medical and agronomical tests; the use of natural isotope variations for environmental studies, agronomy, natural resources appraising: water, minerals, energy). Some new possibilities in the use of stable isotope are offered. A last chapter gives the present state and forecast development of stable isotope uses in France and Europe

  9. ASSESSMENT OF ESTROGENIC ACTIVITY IN EFFLUENTS FROM SEWAGE TREATMENT PLANTS IN THE UNITED STATES

    Science.gov (United States)

    Newly developed molecular biology methods have been used for the measurement of estrogenic activity in source-biased studies of sewage treatment plants. Studies in Texas and New Mexico have shown the utility of the measurement of changes in vitellogenin gene expression in fathea...

  10. Predictors of Retention in Smoking Cessation Treatment among Latino Smokers in the Northeast United States

    Science.gov (United States)

    Lee, Christina S.; Hayes, Rashelle B.; McQuaid, Elizabeth L.; Borrelli, Belinda

    2010-01-01

    Introduction. Only one previous study on minority retention in smoking cessation treatment has been conducted (Nevid JS, Javier RA, Moulton JL III. "Factors predicting participant attrition in a community-based, culturally specific smoking cessation program for Hispanic smokers." "Health Psychol" 1996; 15: 226-29). We investigated predictors of…

  11. State-level prevalence of cigarette smoking and treatment advice, by disability status, United States, 2004.

    Science.gov (United States)

    Armour, Brian S; Campbell, Vincent A; Crews, John E; Malarcher, Ann; Maurice, Emmanuel; Richard, Roland A

    2007-10-01

    To our knowledge, no study has determined whether smoking prevalence is higher among people with disabilities than among people without disabilities across all U.S. states. Neither do we know whether people with disabilities and people without disabilities receive the same quality of advice about tobacco-cessation treatment from medical providers. We analyzed data from the 2004 Behavioral Risk Factor Surveillance System to estimate differences between people with and people without disabilities in smoking prevalence and the receipt of tobacco-cessation treatment advice from medical providers. We found that smoking prevalence for people with disabilities was approximately 50% higher than for people without disabilities. Smokers with disabilities were more likely than smokers without disabilities to have visited a medical provider at least once in the previous 12 months and to have received medical advice to quit. More than 40% of smokers with disabilities who were advised to quit, however, reported not being told about the types of tobacco-cessation treatment available. Ensuring that people with disabilities are included in state-based smoking cessation programs gives states an opportunity to eliminate health disparities and to improve the health and wellness of this group. Ways to reduce unmet preventive health care needs of people with disabilities include provider adoption of the Public Health Service's clinical practice guideline for treating tobacco use and dependence and the provision of smoking cessation services that include counseling and effective pharmaceutical treatment.

  12. Exchange Transfusion in the Treatment of Neonatal Septic Shock: A Ten-Year Experience in a Neonatal Intensive Care Unit

    OpenAIRE

    Pugni, Lorenza; Ronchi, Andrea; Bizzarri, Bianca; Consonni, Dario; Pietrasanta, Carlo; Ghirardi, Beatrice; Fumagalli, Monica; Ghirardello, Stefano; Mosca, Fabio

    2016-01-01

    Septic shock, occurring in about 1% of neonates hospitalized in neonatal intensive care unit (NICU), is a major cause of death in the neonatal period. In the 1980s and 90s, exchange transfusion (ET) was reported by some authors to be effective in the treatment of neonatal sepsis and septic shock. The main aim of this retrospective study was to compare the mortality rate of neonates with septic shock treated only with standard care therapy (ScT group) with the mortality rate of those treated w...

  13. House hold unit for the treatment of fluoride, iron, arsenic and microorganism contaminated drinking water.

    Science.gov (United States)

    Dhadge, Vijaykumar L; Medhi, Chitta Ranjan; Changmai, Murchana; Purkait, Mihir Kumar

    2018-05-01

    A first of its kind hybrid electrocoagulation-filtration prototype unit was fabricated for the removal of fluoride, iron, arsenic and microorganisms contaminated drinking water. The unit comprised of 3 chambers, chamber A consisting of an inlet for the water to be treated and an outlet for the treated water along with one block of aluminum electrodes. Chamber B consisted of ceramic membrane filtration assembly at the bottom over a metallic support which filters the flocs so produced in chamber A and chamber C consisting of space to collect the treated water. Operating parameters were maintained as current density of 625 A m -2 and an electrode distance of 0.005 m. Contaminated drinking water containing mixture of fluoride (10 mg L -1 ), iron (25 mg L -1 ), arsenic (200 μg L -1 ) and microorganisms (35 CFU ml -1 ) was used for the experiment. A removal of 98.74%, 95.65%, 93.2% and 100% were obtained for iron, arsenic, fluoride and microorganisms, respectively. The apparatus and method made it possible to efficiently treat contaminated drinking water to produce drinkable water as per WHO specification. By-products obtained from the electrocoagulation bath were analyzed using SEM, EDX and XRD and explained. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Irradiation as a quarantine treatment and the status in the United States and Hawaii

    Energy Technology Data Exchange (ETDEWEB)

    Moy, J.H. [Dept. of Food Science and Human Nutrition, Univ. of Hawaii, Honolulu, HI (United States)

    1998-12-31

    Finding an efficient and effective method to control fruit flies and other insect pests on tropical fruits is the prerequisite to sending fruits to international markets where fruit flies are unwanted. After ethylene dibromide was banned as a fumigant in the U.S. in 1984, papaya exports in Hawaii have been using two similar thermal treatments, either the vapor heat, or the high-temperature forced-air, as the disinfestation method. Time required for these thermal treatments is 5 to 6 hours and fruit quality problems are sometimes encountered. Other fruits would require different time-temperature regimes; yet not many fruits can tolerate the heat treatment. Irradiation, emerging as an alternative, efficacious disinfestation method, requires 15-20 min. in a commercial irradiator, and the quality of irradiated fruits is well preserved. Since April, 1995, more than 100,000 kg of untreated tropical fruits, mainly papaya, litchi, and starfruit, have been sent from Hawaii to the U.S. continent with a special permit by the Animal Plant Health Inspection Service (APHIS) of the U.S. Department of Agriculture (USDA), and irradiated at an irradiator near Chicago with a generic dose of 0.25 kGy. These fruits were test marketed with proper labeling in various supermarkets in the Midwest and other cities. Consumer acceptance of irradiated tropical fruits has been very favorable. In May, 1996, APHIS published a document describing policies, procedures, and regulations specifically related to irradiation as a phytosanitary treatment. In early July, 1998, USDA proposed a rule to allow more types of Hawaii-grown fruits to be shipped to the U.S. continent for radiation treatment. These include abiu, atemoya, longan, rambutan, sapodilla, green banana, and durian. To improve the export market potential, the Country of Hawaii is planning to build a small commercial irradiator in 1999 to treat various tropical fruits and possibly other products. (author)

  15. Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States

    Science.gov (United States)

    Bhadra, Arup K.; Altman, Roy; Dasa, Vinod; Myrick, Karen; Rosen, Jeffrey; Vad, Vijay; Vitanzo, Peter; Bruno, Michelle; Kleiner, Hillary; Just, Caryn

    2016-01-01

    Objective: A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria. Methods: The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios. Results: The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate. Conclusion: This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary—particularly in patient populations differentiated by OA severity—that may benefit the greatest from the use of HA injections for the treatment of knee OA. PMID:28618868

  16. [Nurses' knowledge of alcohol-related problems and their treatment: a comparison of nurses in general hospital and alcoholism treatment units].

    Science.gov (United States)

    Hisatomi, N; Ito, K; Nagashima, Y; Fujiwara, K; Yasuda, K; Ashizawa, T; Sato, M; Higuchi, S

    1998-12-01

    Nurses have the most contact with patients in the clinical settings, and they play an important role in the guidance and education of patients. Nurses' basic knowledge of alcohol-related problems greatly influences early discovery of and early intervention against alcohol-related problems in general units (GU). In a study undertaken mainly to understand the status of nurses' knowledge in GU, a survey was performed to compare the knowledge and attitude of nurses working in GU and those with working in units specializing in the treatment of alcoholism (AU). For reference, we used the results of separate surveys performed previously on the general population. The results showed that, compared with nurses in AU, nurses in GU (1) were more tolerant of drinking, but (2) were more stigmatic concerning alcoholism, and (3) had little knowledge concerning alcohol-related problems. Nurses in GU tended to have less knowledge about alcohol-related problems than the general population. Moreover, the knowledge of nurses in AU could not be considered sufficient. This study suggested the need for basic education concerning alcohol-related problems and their treatment aimed at nurses.

  17. [Efficacy of analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit].

    Science.gov (United States)

    Cai, Xiao-Fang; Zhang, Fu-Rong; Zhang, Long; Sun, Ji-Min; Li, Wen-Bin

    2017-11-01

    To compare the efficacy and safety of different analgesic and sedative treatments in children with mechanical ventilation in the pediatric intensive care unit (PICU). Eighty children with mechanical ventilation in the PICU who needed analgesic and sedative treatments were equally and randomly divided into midazolam group and remifentanil+midazolam group. The sedative and analgesic effects were assessed using the Ramsay Scale and the Face, Legs, Activity, Cry and Consolability (FLACC) Scale. The following indices were recorded for the two groups: vital signs, ventilator parameters, organ function, total doses of remifentanil and midazolam, duration of mechanical ventilation, length of PICU stay, PICU cost, and incidence of adverse events. Satisfactory sedation was achieved in the two groups, but the remifentanil+midazolam group had a significantly shorter time to analgesia and sedation than the midazolam group. The remifentanil+midazolam group had a significantly higher percentage of patients with grade 3-4 on the Ramsay Scale and a significantly lower dose of midazolam than the midazolam group (Pventilator tidal volume and transcutaneous oxygen saturation at 6 and 12 hours after treatment and significantly lower end-tidal carbon dioxide partial pressure at 6 and 12 hours after treatment (Pmechanical ventilation, and length of PICU stay than the midazolam group (Padverse events, and hepatic and renal functions before and after treatment between the two groups (P>0.05). Both groups showed a significant decrease in fasting blood glucose level after treatment (Pmechanical ventilation in the PICU, remifentanil+midazolam treatment can rapidly achieve analgesia and sedation, improve the effect of mechanical ventilation, and reduce the dose of sedative compared with midazolam alone, and is well tolerated.

  18. LITERATURE SURVEY FOR GROUNDWATER TREATMENT OPTIONS FOR NITRATE, IODINE-129 AND URANIUM 200-ZP-1 OPERABLE UNIT, HANFORD SITE

    International Nuclear Information System (INIS)

    BYRNES ME

    2008-01-01

    This literature review presents treatment options for nitrate, iodine-129, and uranium, which are present in groundwater at the 200-ZP-I Groundwater Operable Unit (OU) within the 200 West Area of the Hanford Site. The objective of this review is to determine available methods to treat or sequester these contaminants in place (i.e., in situ) or to pump-and-treat the groundwater aboveground (i.e., ex situ). This review has been conducted with emphasis on commercially available or field-tested technologies, but theoretical studies have, in some cases, been considered when no published field data exist. The initial scope of this literature review included only nitrate and iodine-I 29, but it was later expanded to include uranium. The focus of the literature review was weighted toward researching methods for treatment of nitrate and iodine-129 over uranium because of the relatively greater impact of those compounds identified at the 200-ZP-I OU

  19. LITERATURE SURVEY FOR GROUNDWATER TREATMENT OPTIONS FOR NITRATE IODINE-129 AND URANIUM 200-ZP-1 OPERABLE UNIT HANFORD SITE

    Energy Technology Data Exchange (ETDEWEB)

    BYRNES ME

    2008-06-05

    This literature review presents treatment options for nitrate, iodine-129, and uranium, which are present in groundwater at the 200-ZP-I Groundwater Operable Unit (OU) within the 200 West Area of the Hanford Site. The objective of this review is to determine available methods to treat or sequester these contaminants in place (i.e., in situ) or to pump-and-treat the groundwater aboveground (i.e., ex situ). This review has been conducted with emphasis on commercially available or field-tested technologies, but theoretical studies have, in some cases, been considered when no published field data exist. The initial scope of this literature review included only nitrate and iodine-I 29, but it was later expanded to include uranium. The focus of the literature review was weighted toward researching methods for treatment of nitrate and iodine-129 over uranium because of the relatively greater impact of those compounds identified at the 200-ZP-I OU.

  20. Analysing Stable Time Series

    National Research Council Canada - National Science Library

    Adler, Robert

    1997-01-01

    We describe how to take a stable, ARMA, time series through the various stages of model identification, parameter estimation, and diagnostic checking, and accompany the discussion with a goodly number...

  1. [Laser treatment for retinopathy of prematurity in neonatal intensive care units. Premature Eye Rescue Program].

    Science.gov (United States)

    Maka, Erika; Imre, László; Somogyvári, Zsolt; Németh, János

    2015-02-01

    Retinopathy of prematurity is a leading cause of childhood blindness around the world. The Department of Ophthalmology at the Semmelweis University and the Peter Cerny Neonatal Emergency and Ambulance Service started an innovative Premature Eye Rescue Program to reduce the non-essential transport of premature babies suffering from retinopathy of prematurity. During the first 5 years 186 eyes of 93 premature babies were treated at the bedside with stage 3 retinopathy of prematurity in the primary hospitals. In this first 5-years period the authors reduced the number of transports of premature babies for laser treatment; 93 children avoided the unnecessary transport, saving altogether a distance of 21,930 kilometers for children, as well as the ambulance service. The Premature Eye Rescue Program offers a good and effective alternative for treatment of retinopathy in the primary hospitals. The authors propose the national extension of this program.

  2. Characterization and constructive utilization of sludge produced in clari-flocculation unit of water treatment plant

    Science.gov (United States)

    Ahmad, Tarique; Ahmad, Kafeel; Alam, Mehtab

    2018-03-01

    All water treatment plants produce waste/residue amid the treatment of raw water. This study selectively investigates the clariflocculator sludge for its physicochemical characteristics and potential reuse options. Sieve analysis, XRF, SEM, XRD, FTIR, and TG-DTA instrumental techniques have been used to characterize the sludge sample. Results show that clariflocculator sludge contains about 78% fine sand having grain size range 150-75 μm. SiO2, Al2O3, Fe2O3 and CaO constitute the maximum percentage of chemical compounds present in the sludge and quartz is the main crystalline phase of the sludge. Recycling and reuse of this sludge, especially, as fine sand in preparing mortar, concrete mix and other civil engineering products would pave the way for constructive utilization with safe and sustainable sludge management strategies.

  3. Physician perceptions of pharmacologic treatment options for chorea associated with Huntington disease in the United States.

    Science.gov (United States)

    Sung, Victor W; Iyer, Ravi G; Gandhi, Sanjay K; Shah-Manek, Bijal; DiBonaventura, Marco; Abler, Victor; Claassen, Daniel O

    2018-04-01

    To survey neurologists and obtain clinical perceptions of tetrabenazine for the treatment of chorea in patients with Huntington disease (HD). Board-certified/board-eligible neurologists, in practice for ≥5 years, who had treated treat ≥3 HD patients in the past 2 years, were recruited from an online physician panel to participate in a cross-sectional, web-based survey. Respondents provided information about themselves, their practice, approaches to HD chorea management and perceptions of available treatments. Two hundred neurologists responded to the survey. Based on clinician responses, the most common reasons to treat chorea are impairment in activities of daily living (54%) and quality of life (41%). Although tetrabenazine was the only approved treatment for chorea in HD patients at the time of this analysis, it was only prescribed to ∼50% of patients with HD-related chorea. More than half of physicians perceive tetrabenazine as having minimal or no effectiveness in improving chorea. More than 40% of physicians consider tetrabenazine to be a non-optimal treatment, and 51% of physicians agree that they are unable to titrate to efficacious doses due to adverse side effects or tolerability concerns. Physicians report that side effects leading to dose interruptions (33%) and reductions (30%) occur in their patients "often" or "almost always". The most common side effects that led to insufficient dosing and disruptions in titration were sedation and somnolence (41%), depression (24%) and anxiety (22%). Many physicians who treat HD-related chorea report that tolerability issues with tetrabenazine impact their ability to effectively use tetrabenazine in their clinical practice.

  4. Pentobarbital withdrawal and treatment in an infant in the pediatric cardiac intensive care unit.

    Science.gov (United States)

    Weber, Garret M; Smerling, Arthur J; Saroyan, John M

    2013-02-01

    Withdrawal syndromes following administration of sedative and analgesic infusions represent a significant morbidity that is described increasingly in the pediatric critical care literature. However, there are few descriptions of pentobarbital withdrawal symptoms and their treatment in the pediatric population. We describe an infant receiving multiple sedative and analgesic medications, including pentobarbital, who was resistant to our institution's standard weaning protocol, but whose severe withdrawal symptoms responded dramatically to phenobarbital loading and maintenance. Copyright © 2013 Elsevier Inc. All rights reserved.

  5. Early detection and curative treatment of hepatocellular carcinoma: A cost-effectiveness analysis in France and in the United States.

    Science.gov (United States)

    Cadier, Benjamin; Bulsei, Julie; Nahon, Pierre; Seror, Olivier; Laurent, Alexis; Rosa, Isabelle; Layese, Richard; Costentin, Charlotte; Cagnot, Carole; Durand-Zaleski, Isabelle; Chevreul, Karine

    2017-04-01

    Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis. Patients outside clinical trials seldom benefit from evidence-based monitoring. The objective of this study was to estimate the cost-effectiveness of complying with HCC screening guidelines. The economic evaluation compared surveillance of patients with cirrhosis as recommended by the guidelines ("gold-standard monitoring") to "real-life monitoring" from the health care system perspective. A Markov model described the history of the disease and treatment course including current first-line curative treatment: liver resection, radiofrequency ablation (RFA), and liver transplantation. Transition probabilities were derived mainly from two French cohorts, CIRVIR and CHANGH. Costs were computed using French and U.S. tariffs. Effectiveness was measured in life years gained (LYG). An incremental cost-effectiveness ratio (ICER) was calculated for a 10-year horizon and tested with one-way and probabilistic sensitivity analyses. The cost difference between the two groups was $648 ($87,476 in the gold-standard monitoring group vs. $86,829 in the real-life monitoring group) in France and $11,965 ($93,795 vs. $81,829) in the United States. Survival increased by 0.37 years (7.18 vs. 6.81 years). The ICER was $1,754 per LYG in France and $32,415 per LYG in the United States. The health gain resulted from earlier diagnosis and access to first-line curative treatments, among which RFA provided the best value for money. Our results indicate that gold-standard monitoring for patients with cirrhosis is cost-effective, attributed to a higher probability of benefiting from a curative treatment and so a higher survival probability. (Hepatology 2017;65:1237-1248). © 2017 by the American Association for the Study of Liver Diseases.

  6. The biology, prevention, diagnosis and treatment of dental caries: scientific advances in the United States.

    Science.gov (United States)

    Zero, Domenick T; Fontana, Margherita; Martínez-Mier, E Angeles; Ferreira-Zandoná, Andréa; Ando, Masatoshi; González-Cabezas, Carlos; Bayne, Stephen

    2009-09-01

    Scientific advances in cariology in the past 150 years have led to the understanding that dental caries is a chronic, dietomicrobial, site-specific disease caused by a shift from protective factors favoring tooth remineralization to destructive factors leading to demineralization. Epidemiologic data indicate that caries has changed in the last century; it now is distributed unequally in the U.S. population. People who are minorities, homeless, migrants, children with disabilities and of lower socioeconomic status suffer from the highest prevalence and severity of dental caries. Scientific advances have led to improvements in the prevention, diagnosis and treatment of dental caries, but there is a need for new diagnostic tools and treatment methods. and Future management of dental caries requires early detection and risk assessment if the profession is to achieve timely and cost-effective prevention and treatment for those who need it most. Dental professionals look forward to the day when people of all ages and backgrounds view dental caries as a disease of the past.

  7. Treatment of chronic hepatitis C virus infection in the United States: some remaining obstacles.

    Science.gov (United States)

    Searson, Gloria; Engelson, Ellen S; Carriero, Damaris; Kotler, Donald P

    2014-05-01

    Hepatitis C infection is an important problem in inner city neighbourhoods, which suffer from multiple health disparities. Important factors in this population include alcoholism and substance abuse, mental illness and homelessness, which may be combined with mistrust, poor health literacy, limited access to healthcare and outright discrimination. Systemic barriers to effective care include a lack of capacity to provide comprehensive care, insufficient insurance coverage, poor coordination among caregivers and between caregivers and hospitals, as well as third party payers. These barriers affect real world treatment effectiveness as opposed to treatment efficacy, the latter reflecting the world of clinical trials. The components of effectiveness include efficacious medications, appropriate diagnosis and evaluation, recommendation for therapy, access to therapy, acceptance of the diagnosis and its implications by the patient and adherence to the recommended therapy. Very little attention has been given to assisting the patient to accept the diagnosis and adhere to therapy, i.e. care coordination. For this reason, care coordination is an area in which greater availability could lead to greater acceptance/adherence and greater treatment effectiveness. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Human ciliary neurotrophic factor-overexpressing stable bone marrow stromal cells in the treatment of a rat model of traumatic spinal cord injury.

    Science.gov (United States)

    Abbaszadeh, Hojjat-Allah; Tiraihi, Taki; Noori-Zadeh, Ali; Delshad, Ali Reza; Sadeghizade, Majid; Taheri, Taher

    2015-07-01

    Traumatic injury to the central nervous system (CNS) often causes motor dysfunctions. However, because of the CNS complexity and variability in the clinical presentations, efforts to repair damaged CNS tissue and restoring its functions are particularly demanding. On the other hand, recent progress in the regenerative therapy field have led to novel approaches for the treatment of traumatic CNS injury and renewed hopes to overcome the obstacles. It appears that the balance between neurite re-growth-inhibiting and neurite re-growth-inducing molecules determines the axonal re-growth fate. Neurotrophic factors can tilt this balance and indeed promote cell survival and axonal re-growth over neurodegeneration. One of the promising neurotrophic factors in this field is ciliary neurotrophic factor (CNTF). We transfected rat bone marrow stromal cells with a mammalian expression vector-inserted human CNTF gene through the use of a non-viral method to prepare human CNTF-overexpressing stem cells under ex vivo conditions. We transplanted these modified cells to the rat model of spinal cord traumatic injury to explore functional recovery after contusion induction. Our data from immunocytochemistry and behavioral tests showed that such cells can act as a powerful potential approach to treat traumatic CNS injuries because these modified cells improved the behavioral test scores in the rat model of spinal cord injury. CNTF-overexpressing bone marrow stromal cells can ameliorate spinal cord traumatic injury and can be used in the treatment of traumatic CNS injuries in the near future. Copyright © 2015 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  9. Deployment of independent method of culture to detect bacteria and archaean domains in drainage basin under the influence of uranium mining - ore treatment unit, Caldas/MG, Brazil

    International Nuclear Information System (INIS)

    Borba Junior, Palvo J.; Azevedo, Heliana de; Ronqui, Leilane Barbosa

    2011-01-01

    Bortolan reservoir (BR), part of the Ribeirao das Antas Hydrographic Sub-Basin, is a dam located in the Pocos de Caldas Plateau region and characterized by the reception of industrial and domestic residue discharge from the city of Pocos de Caldas. Another important dam, found within the same hydrographic sub-basin and the focus of many studies as well, is Antas reservoir (AR), situated on the proximities of a uranium mine (Brazilian Nuclear Industries Ore Treatment Unit - UTM/INB), and the receiver of treated radioactive effluents originated there. The UTM/INB Pit Mine (PM) is an artificial pond characterized by its acidity and elevated electrical conductivity, besides the presence of radioactive and stable metals. The focus of this study is to determine the phylogenetic classification of the Bacteria and Archaea domains, in addition to quantify the bacterial community at points PM, BR and AR, seeking to compare the data to results from other analyzed water bodies. These microorganisms can be determined with the use of molecular techniques that allow their phylogenetic identification, such as the Fluorescent in situ Hybridization (FISH) that detects the presence of specific organisms' DNA or RNA. In the FISH method, probes produced from each domain's DNA fragments are used (EUB338 and ARC915), allowing the identification of oligonucleotide sequences with a higher degree of similarity. The bacterial cells quantification is verified by the use of the DAPI (4-6-diamidino-2-phenylindole) stain, allowing the density calculation of the bacteria found in the samples from AR and BR, as well as from the PM. (author)

  10. Trends in the Prevalence, Awareness, Treatment, and Control of Hypertension Among Young Adults in the United States, 1999 to 2014.

    Science.gov (United States)

    Zhang, Yiyi; Moran, Andrew E

    2017-10-01

    Overall hypertension prevalence has not changed in the United States in recent decades although awareness, treatment, and control improved. However, hypertension epidemiology and its temporal trends may differ in younger adults compared with older adults. Our study included 41 331 participants ≥18 years of age from 8 National Health and Nutrition Examination Surveys (1999-2014) and estimated temporal trends of hypertension, awareness, treatment, and control among young adults (age, 18-39 years) compared with middle-age (age, 40-59 years) and older adults (age, ≥60 years). In 2013 to 2014, 7.3% of the US young adults had hypertension. During 1999 to 2014, young adults saw larger increases in hypertension awareness, treatment, and control than did older adults. However, all of these components of hypertension control were lower among young adults compared with middle-aged or older adults (74.7% younger versus 81.9% middle versus 88.4% older for awareness; 50.0% versus 70.3% versus 83.0% for treatment; and 40.2% versus 56.7% versus 54.4% for control). Worse hypertension awareness, treatment, and control in young adults overall were mostly driven by worse measures in young adult men compared with young adult women. More frequent healthcare visits by young adult women explained ≈28% of the sex-related difference in awareness, 60% of the difference in treatment, and 52% of the difference in control. These findings suggest that improved access to and engagement in medical care might improve hypertension control in young adults, particularly young adult men, and reduce life-time cardiovascular risk. © 2017 American Heart Association, Inc.

  11. Full Monte Carlo-Based Biologic Treatment Plan Optimization System for Intensity Modulated Carbon Ion Therapy on Graphics Processing Unit.

    Science.gov (United States)

    Qin, Nan; Shen, Chenyang; Tsai, Min-Yu; Pinto, Marco; Tian, Zhen; Dedes, Georgios; Pompos, Arnold; Jiang, Steve B; Parodi, Katia; Jia, Xun

    2018-01-01

    One of the major benefits of carbon ion therapy is enhanced biological effectiveness at the Bragg peak region. For intensity modulated carbon ion therapy (IMCT), it is desirable to use Monte Carlo (MC) methods to compute the properties of each pencil beam spot for treatment planning, because of their accuracy in modeling physics processes and estimating biological effects. We previously developed goCMC, a graphics processing unit (GPU)-oriented MC engine for carbon ion therapy. The purpose of the present study was to build a biological treatment plan optimization system using goCMC. The repair-misrepair-fixation model was implemented to compute the spatial distribution of linear-quadratic model parameters for each spot. A treatment plan optimization module was developed to minimize the difference between the prescribed and actual biological effect. We used a gradient-based algorithm to solve the optimization problem. The system was embedded in the Varian Eclipse treatment planning system under a client-server architecture to achieve a user-friendly planning environment. We tested the system with a 1-dimensional homogeneous water case and 3 3-dimensional patient cases. Our system generated treatment plans with biological spread-out Bragg peaks covering the targeted regions and sparing critical structures. Using 4 NVidia GTX 1080 GPUs, the total computation time, including spot simulation, optimization, and final dose calculation, was 0.6 hour for the prostate case (8282 spots), 0.2 hour for the pancreas case (3795 spots), and 0.3 hour for the brain case (6724 spots). The computation time was dominated by MC spot simulation. We built a biological treatment plan optimization system for IMCT that performs simulations using a fast MC engine, goCMC. To the best of our knowledge, this is the first time that full MC-based IMCT inverse planning has been achieved in a clinically viable time frame. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Association of antidepressant treatment with emergency admission to medical units for patients 65 years or older.

    Science.gov (United States)

    Ortuño, Noèlia; Cobo, Jesús; González, Espe; García, Imma; Ferrer, María-Dolores; Campos, Carmen; Planet, Núria; Oliva, Joan-Carles; Suárez, Mónica; Iglesias-Lepine, María-Luisa; García-Parés, Gemma

    There is increasing evidence relating the presence of depression in seniors and the risk of hospital admission in medical departments from the Emergency Services. To determine the impact of antidepressant treatment (ATD) as a protective factor for emergency hospitalization in older people. All patients aged 65 and over who required urgent attention for medical reasons at the Emergency Department of the Corporació Sanitària i Universitària Parc Taulí (Sabadell, Barcelona, Spain) for the period between January and October 2012 were included in the study. Sociodemographic variables, alcohol and tobacco use, medical history and psychopharmacological treatment were obtained. The necessary sample size was calculated and a simple randomization was performed. Subsequently, a descriptive statistical analysis and parametric tests were conducted. A total of 674 patients (53% women) were evaluated, with a mean age of 78.45 years, and 27.6% of the cases (71% women) were receiving ATD. Among the 333 admitted patients (50%), 83 individuals (24.6%) had previously received ATD; this contrasts with the 103 cases (30.6%) of prior ATD treatment among the patients who were not admitted. After comparative analysis, the relationship between previous use of ATD and being admitted to hospital was not statistically significant in our global sample. This relationship was only statistically significant among the group aged 75 and over (neg. sig. 0.012). In our study, ATD was associated with a decreased risk of hospital admission for urgent medical conditions in people aged 75 and over. Treating depression may protect the elderly against admission to the Emergency department and may potentially be a quality criterion in preventing complications in this population. Copyright © 2014 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Effect on treatment planning based on properties of Cobalt-60 stereotactic radiosurgery units

    International Nuclear Information System (INIS)

    Nakazawa, Hisato; Komori, Masataka; Uchiyama, Yukio; Hagiwara, Masahiro; Hayashi, Naoki

    2014-01-01

    The brand-new version of gamma knife, Perfexion, is equipped with an automatic collimator arrangement system that does not require manual collimator exchange and a couch-traveling system that is approximately ten times faster than Model C, so treatment time with multiple shots is assumed to remain within a clinically acceptable range. In this study, the treatment plans for Model C and Perfexion were compared from the viewpoint of number of shots, coverage, selectivity, conformity, and gradient in planning target volume (PTV) coverage. We enrolled 187 and 89 patients with vestibular schwannomas treated by Model C and Perfexion in the study. Treatment planning was created on a Leksell GammaPlan workstation. The mean PTV was 5.2 ml (range 0.1-18.4 ml) in Model C and 4.1 ml (range 0.1-32.1 ml) in Perfexion. The mean shot number for Model C and Perfexion was 11 (range 2-27) and 16 (range 1-41) at the isodose contour of 40-60%, respectively. The mean PTV coverage was 94% (range 73-100%) and 98% (range 91-100%), and the mean PTV selectivity was 83% (range 46-98%) and 87% (range 63-97%) for Model C and Perfexion, respectively. The mean conformity index was 1.15 (range 0.81-2.02) and 1.14 (range 0.97-1.57), and the mean gradient index was 2.82 (range 2.37-3.35) and 2.91 (range 2.55-4.48) for Model C and Perfexion, respectively. In Perfexion, better PTV coverage and selectivity were achieved by using an excessively large number of shots. In addition, the use of a small collimator in Perfexion produced a steeper dose gradient. Our comparative research demonstrated the greater clinical usefulness of Perfexion. (author)

  14. Cholesterol Screening and Treatment Practices and Preferences: A Survey of United States Pediatricians.

    Science.gov (United States)

    de Ferranti, Sarah D; Rodday, Angie Mae; Parsons, Susan K; Cull, William L; O'Connor, Karen G; Daniels, Stephen R; Leslie, Laurel K

    2017-06-01

    To determine pediatricians' practices, attitudes, and barriers regarding screening for and treatment of pediatric dyslipidemias in 9- to 11-year-olds and 17- to 21-year-olds. American Academy of Pediatrics (AAP) 2013-2014 Periodic Survey of a national, randomly selected sample of 1627 practicing AAP physicians. Pediatricians' responses were described and modeled. Of 614 (38%) respondents who met eligibility criteria, less than half (46%) were moderately/very knowledgeable about the 2008 AAP cholesterol statement; fewer were well-informed about 2011 National Heart, Lung, and Blood Institute Guidelines or 2007 US Preventive Service Task Force review (both 26%). Despite published recommendations, universal screening was not routine: 68% reported they never/rarely/sometimes screened healthy 9- to 11-year-olds. In contrast, more providers usually/most/all of the time screened based on family cardiovascular history (61%) and obesity (82%). Screening 17- to 21-year-olds was more common in all categories (P?Pediatricians uniformly provided lifestyle counseling but access to healthy food (81%), exercise (83%), and adherence to lifestyle recommendations (96%) were reported barriers. One-half of pediatricians (55%) reported a lack of local subspecialists. Although 62% and 89% believed statins were appropriate for children and adolescents with high low-density lipoprotein cholesterol (200?mg/dL) unresponsive to lifestyle, a minority initiated statins (8%, 21%). US pediatricians report lipid screening and treatment practices that are largely at odds with existing recommendations, likely because of lack of knowledge and conflicts among national guidelines, and concern about treatment efficacy and harms. Education regarding pediatric lipid disorders could promote guideline implementation. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. National trends in the treatment of diabetic nephropathy in the United States.

    Science.gov (United States)

    Ajiboye, O; Segal, J B

    2017-06-01

    The prevalence of diabetic nephropathy continues to rise and it remains a strong predictor of morbidity and mortality in diabetic patients. Patients diagnosed with diabetic nephropathy are actively excluded from most trials involving diabetic medications and it is important to understand the prescription patterns in this subset of patients with diabetes. Using the IMS Health's National Disease and Therapeutic Index, we analysed the medication prescription patterns for six classes of medications from 2010 to 2014 among patients, 35 years or older, with diabetic nephropathy. Annual office visits increased from 772 860 (95% confidence interval (CI), 755, 470-790, 249) in 2010 to 1 868 618 (95% CI, 1 834 422-1 902 814) in 2013 and declined to 830 596 (95% CI, 809 167-852 025) in 2014. Sulfonylureas and dipeptidyl peptidase-4 inhibitors (DPP-4 inhibitors) were the most frequently used of the four classes of diabetic medications included in this study. DPP-4 inhibitors use increased gradually and was used in 54% (95% CI 49-58) of treatment visits by the last quarter of 2014. Across these years, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (ACEIs and ARBs) were prescribed in the majority of treatment visits with peaks above 90%. However, there were some periods when utilization of these antihypertensives was low. Significant increases occurred in the uptake of new diabetic medications; DPP-4 inhibitors and SGLT-2 inhibitors and in the utilization of ACEIs and ARBs compared to the findings reported in other studies with increased complexity in the treatment of patients with diabetic nephropathy. Improved and continued used of these medications may be beneficial in improving patient outcomes. © 2017 John Wiley & Sons Ltd.

  16. Growth hormone treatment in the United States: demographic and diagnostic features of 2331 children.

    Science.gov (United States)

    August, G P; Lippe, B M; Blethen, S L; Rosenfeld, R G; Seelig, S A; Johanson, A J; Compton, P G; Frane, J W; McClellan, B H; Sherman, B M

    1990-06-01

    Demographic, diagnostic, and baseline clinical data were collected for a large cohort (N = 2331) of children who started treatment with biosynthetic human growth hormone (GH) between October 1985 and October 1987. Eighty-one percent met classic criteria for GH deficiency and were classified as having idiopathic GH deficiency (59%), organic GH deficiency (18%), or septo-optic dysplasia (4%). The remaining 19.8% had short stature of varied causes. Height standard deviation score at diagnosis, maximum GH response to stimulation, and heights of parents were examined according to gender, race, age at diagnosis, and previous treatment history. The predominance of boys in all subgroups except septooptic dysplasia, and the observation that girls with idiopathic GH deficiency were comparatively shorter than boys at diagnosis, suggest ascertainment bias. Black children with idiopathic GH deficiency were shorter than white children at diagnosis, and their low overall representation (6.0%) compared with their percentage in the at-risk population (12.9%) also suggest ascertainment bias among races. These data provide a profile of GH deficiency as it is currently defined and expose possible inherent biases in the diagnostic process. Now that GH supply is no longer limited, criteria for its use should be formulated to avoid apparent underascertainment or late diagnosis of GH deficiency in girls and black children.

  17. Traumatic Finger Amputation Treatment Preference among Hand Surgeons in the United States and Japan.

    Science.gov (United States)

    Shauver, Melissa J; Nishizuka, Takanobu; Hirata, Hitoshi; Chung, Kevin C

    2016-04-01

    Large geographic differences in procedure utilization draw into question its appropriate use. In Japan, replantation is frequent for even very distal finger amputations. In the United States, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences. The authors created a survey to assess experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter Study and to hand surgeons making podium presentations at the Thirty-Second Annual Meeting of the Central Japanese Society for Surgery of the Hand. One hundred percent of both groups responded. There were no significant differences in surgeon experience. Japanese surgeons were significantly more likely to recommend replantation in all scenarios, despite 62 percent ranking function 6 months after replantation as "poor." Japanese surgeons also rated the appearance of a hand with an amputated finger significantly poorer. Finally, Japanese surgeons were significantly more likely to report stigmatization against finger amputees. There is no study with a high level of evidence comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, such as that planned by the Finger Replantation and Amputation Multicenter Study, can provide evidence toward the appropriate use of replantation.

  18. ALTERNATIVE REMEDIATION TECHNOLOGY STUDY FOR GROUNDWATER TREATMENT AT 200-PO-1 OPERABLE UNIT AT HANFORD SITE

    Energy Technology Data Exchange (ETDEWEB)

    DADO MA

    2008-07-31

    This study focuses on the remediation methods and technologies applicable for use at 200-PO-I Groundwater Operable Unit (OU) at the Hanford Site. The 200-PO-I Groundwater au requires groundwater remediation because of the existence of contaminants of potential concern (COPC). A screening was conducted on alternative technologies and methods of remediation to determine which show the most potential for remediation of groundwater contaminants. The possible technologies were screened to determine which would be suggested for further study and which were not applicable for groundwater remediation. COPCs determined by the Hanford Site groundwater monitoring were grouped into categories based on properties linking them by remediation methods applicable to each COPC group. The screening considered the following criteria. (1) Determine if the suggested method or technology can be used for the specific contaminants found in groundwater and if the technology can be applied at the 200-PO-I Groundwater au, based on physical characteristics such as geology and depth to groundwater. (2) Evaluate screened technologies based on testing and development stages, effectiveness, implementability, cost, and time. This report documents the results of an intern research project conducted by Mathew Dado for Central Plateau Remediation in the Soil and Groundwater Remediation Project. The study was conducted under the technical supervision of Gloria Cummins and management supervision of Theresa Bergman and Becky Austin.

  19. Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?

    Science.gov (United States)

    Martínez Vieira, A; Docobo Durántez, F; Mena Robles, J; Durán Ferreras, I; Vázquez Monchul, J; López Bernal, F; Romero Vargas, E

    2004-07-01

    Analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. Eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service) from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. Group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017), inability to tolerate oral diet (p = 0.002), and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003). Outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results.

  20. Laparoscopic cholecystectomy in the treatment of biliary lithiasis: outpatient surgery or short stay unit?

    Directory of Open Access Journals (Sweden)

    A. Martínez Vieira

    Full Text Available Objective: analysis of clinical and surgical factors in a series of patients subjected to laparoscopic cholecystectomy in an outpatient unit and their relationship with time of discharge and patient acceptance. Patients and method: eighty one consecutive patients underwent to elective laparoscopic cholecystectomy during year 2002 within S.A.S. (Andalusian Health Service from a surgical waiting list. Retrospective and comparative study between two groups: group A includes patients discharged between 24 and 48 hours after intervention; group B includes patients discharged in less than 24 hours. We analyse the clinical and surgical characteristics and post-operative outcome of both groups of patients. Results: group A was composed of 53 patients and group B of 28 patients. Factors of clinical significance which determined discharge after 24 hours included: early post-surgical incidences or complications (p = 0.017, inability to tolerate oral diet (p = 0.002, and doubts and feelings insecurity of patients regarding discharge by traditional means 62.3% (p = 0.0003. Conclusions: outpatient laparoscopic cholecystectomy is a safe and reliable procedure with a high acceptance rate and few complications. Perhaps traditional culture has to be changed to obtain better results.

  1. Anesthesiologists' practice patterns for treatment of postoperative nausea and vomiting in the ambulatory Post Anesthesia Care Unit

    Directory of Open Access Journals (Sweden)

    Claybon Louis

    2006-06-01

    Full Text Available Abstract Background When patients are asked what they find most anxiety provoking about having surgery, the top concerns almost always include postoperative nausea and vomiting (PONV. Only until recently have there been any published recommendations, mostly derived from expert opinion, as to which regimens to use once a patient develops PONV. The goal of this study was to assess the responses to a written survey to address the following questions: 1 If no prophylaxis is administered to an ambulatory patient, what agent do anesthesiologists use for treatment of PONV in the ambulatory Post-Anesthesia Care Unit (PACU?; 2 Do anesthesiologists use non-pharmacologic interventions for PONV treatment?; and 3 If a PONV prophylaxis agent is administered during the anesthetic, do anesthesiologists choose an antiemetic in a different class for treatment? Methods A questionnaire with five short hypothetical clinical vignettes was mailed to 300 randomly selected USA anesthesiologists. The types of pharmacological and nonpharmacological interventions for PONV treatment were analyzed. Results The questionnaire was completed by 106 anesthesiologists (38% response rate, who reported that on average 52% of their practice was ambulatory. If a patient develops PONV and received no prophylaxis, 67% (95% CI, 62% – 79% of anesthesiologists reported they would administer a 5-HT3-antagonist as first choice for treatment, with metoclopramide and dexamethasone being the next two most common choices. 65% (95% CI, 55% – 74% of anesthesiologists reported they would also use non-pharmacologic interventions to treat PONV in the PACU, with an IV fluid bolus or nasal cannula oxygen being the most common. When PONV prophylaxis was given during the anesthetic, the preferred PONV treatment choice changed. Whereas 3%–7% of anesthesiologists would repeat dose metoclopramide, dexamethasone, or droperidol, 26% (95% confidence intervals, 18% – 36% of practitioners would re

  2. Chemical interactions study of antiretroviral drugs efavirenz and lamivudine concerning the development of stable fixed-dose combination formulations for AIDS treatment

    Energy Technology Data Exchange (ETDEWEB)

    Gomes, Elionai C. de L.; Mussel, Wagner N.; Resende, Jarbas M.; Yoshida, Maria I., E-mail: mirene@ufmg.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Instituto de Ciencias Exatas. Departamento de Quimica; Fialho, Silvia L.; Barbosa, Jamile; Fialho, Silvia L. [Fundacao Ezequiel Dias, Belo Horizonte, MG (Brazil)

    2013-04-15

    Lamivudine and efavirenz are among the most worldwide used drugs for acquired immune deficiency syndrome (AIDS) treatment. Solid state nuclear magnetic resonance (ssNMR), Fourier-transformed infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and thermo-optical analysis (TOA) were used to study possible interactions between these drugs, aiming the development of a fixed-dose drug combination. DSC and TOA have evidenced significant shifts on the melting points of both drugs in the mixture, which may be due to interaction between them. Although DSC and TOA results indicated incompatibility between the drugs, FTIR spectra were mostly unmodified due to overlapping peaks. The ssNMR analyses showed significant changes in chemical shifts values of the mixture when compared with spectra of pure drugs, especially in the signals relating to the deficient electron carbon atoms of both drugs. These results confirm the interactions suggested by DSC and TOA, which is probably due to acid-base interactions between electronegative and deficient electron atoms of both lamivudine and efavirenz. (author)

  3. Chemical interactions study of antiretroviral drugs efavirenz and lamivudine concerning the development of stable fixed-dose combination formulations for AIDS treatment

    International Nuclear Information System (INIS)

    Gomes, Elionai C. de L.; Mussel, Wagner N.; Resende, Jarbas M.; Yoshida, Maria I.

    2013-01-01

    Lamivudine and efavirenz are among the most worldwide used drugs for acquired immune deficiency syndrome (AIDS) treatment. Solid state nuclear magnetic resonance (ssNMR), Fourier-transformed infrared spectroscopy (FTIR), differential scanning calorimetry (DSC) and thermo-optical analysis (TOA) were used to study possible interactions between these drugs, aiming the development of a fixed-dose drug combination. DSC and TOA have evidenced significant shifts on the melting points of both drugs in the mixture, which may be due to interaction between them. Although DSC and TOA results indicated incompatibility between the drugs, FTIR spectra were mostly unmodified due to overlapping peaks. The ssNMR analyses showed significant changes in chemical shifts values of the mixture when compared with spectra of pure drugs, especially in the signals relating to the deficient electron carbon atoms of both drugs. These results confirm the interactions suggested by DSC and TOA, which is probably due to acid-base interactions between electronegative and deficient electron atoms of both lamivudine and efavirenz. (author)

  4. Monte Carlo calculations and measurements of absorbed dose per monitor unit for the treatment of uveal melanoma with proton therapy

    Energy Technology Data Exchange (ETDEWEB)

    Koch, Nicholas; Newhauser, Wayne D; Titt, Uwe; Starkschall, George [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030 (United States); Gombos, Dan [Section of Ophthalmology, Department of Head and Neck Surgery MDACC Unit 441 (United States); Coombes, Kevin [Graduate School of Biomedical Sciences, University of Texas Health Science Center, 6767 Bertner Avenue, Houston, TX 77030 (United States)], E-mail: kochn@musc.edu

    2008-03-21

    The treatment of uveal melanoma with proton radiotherapy has provided excellent clinical outcomes. However, contemporary treatment planning systems use simplistic dose algorithms that limit the accuracy of relative dose distributions. Further, absolute predictions of absorbed dose per monitor unit are not yet available in these systems. The purpose of this study was to determine if Monte Carlo methods could predict dose per monitor unit (D/MU) value at the center of a proton spread-out Bragg peak (SOBP) to within 1% on measured values for a variety of treatment fields relevant to ocular proton therapy. The MCNPX Monte Carlo transport code, in combination with realistic models for the ocular beam delivery apparatus and a water phantom, was used to calculate dose distributions and D/MU values, which were verified by the measurements. Measured proton beam data included central-axis depth dose profiles, relative cross-field profiles and absolute D/MU measurements under several combinations of beam penetration ranges and range-modulation widths. The Monte Carlo method predicted D/MU values that agreed with measurement to within 1% and dose profiles that agreed with measurement to within 3% of peak dose or within 0.5 mm distance-to-agreement. Lastly, a demonstration of the clinical utility of this technique included calculations of dose distributions and D/MU values in a realistic model of the human eye. It is possible to predict D/MU values accurately for clinical relevant range-modulated proton beams for ocular therapy using the Monte Carlo method. It is thus feasible to use the Monte Carlo method as a routine absolute dose algorithm for ocular proton therapy.

  5. Highly Stable Hierarchical Flower-like β-In2S3 Assembled from 2D Nanosheets with high Adsorption-Photodecolorization Activities for the Treatment of Wastewater

    Science.gov (United States)

    Cheng, Yang; Niu, Helin; Chen, Jingshuai; Song, Jiming; Mao, Changjie; Zhang, Shengyi; Chen, Changle; Gao, Yuanhao

    2017-05-01

    The hierarchical flower-like β-In2S3 catalyst assembled from 2D nanosheets was prepared using an organic-component depletion method utilizing inorganic-organic hybrids indium diethyldithiocarbamate (In-DDTC) as a single-source precursor. The crystallization, morphology and composition of the as-synthesized β-In2S3 were characterized by XRD, SEM, TEM, EDS and XPS, respectively. The β-In2S3 possessed high specific surface area of 134.1 m2 g-1, adsorption capacity of 195.5 mg g-1 for methylene blue, and extreme photodecolorization speed under visible light irradiation for the complete removal of methyl orange (MO) dye within 15 min and tetracycline within 60 min. Although methyl orange concentration decreased quickly, the total organic carbon (TOC) decreased slowly. UV-vis and mass spectrometry (MS) were applied to analyze the intermediates coming from the photodecolorization of MO. In order to estimate the roles of active species during the decolorization of MO, trapping experiments were conducted to determine the main active species during the decolorization process. The results indicated that . O2 - radicals and e-1 were the key intermediates. This enhanced activity was attributed to its unique structures assembled from 2D nanosheets with thickness of ca. 5-7 nm, leading to high specific surface area, wide range of pore size distribution and great efficiency in absorbing light and electron/hole separation. The hierarchical flower-like β-In2S3 demonstrated great advantages in the treatment of various wastewater pollutants including textile dyes and antibiotics.

  6. Trends in Risk Factors and Treatments in Patients With Stable Ischemic Heart Disease Seen at Cardiology Clinics Between 2006 and 2014.

    Science.gov (United States)

    Cordero, Alberto; Galve, Enrique; Bertomeu-Martínez, Vicente; Bueno, Héctor; Fácila, Lorenzo; Alegría, Eduardo; Cequier, Ángel; Ruiz, Emilio; González-Juanatey, José Ramón

    2016-04-01

    Chronic ischemic heart disease is the most prevalent of all cardiovascular diseases. Patients are at high risk of complications. In recent decades, changes may have occurred in the clinical characteristics of the disease, its treatment and control of risk factors. A direct comparison of 2 national registries of patients with chronic ischemic heart disease carried out in 2006 (n=1583) and 2014 (n=1110). We observed statistically significant differences between the 2 registries, with a higher percentage of men and smokers in the 2014 registry, but a lower prevalence of diabetes mellitus and hypertension. Heart failure and stroke were more prevalent in the 2006 registry. Patients in the 2014 registry had better results for lipid profile, blood glucose, creatinine, and glomerular filtration rate. We observed higher use of recommended drugs for secondary prevention and an increased percentage of patients receiving optimal medical therapy, from 32.5% to 49.5% (P<.01). Use of high-intensity statin doses also increased from 10.5% to 42.8% (P<.01). We found better control of some risk factors (improved dyslipidemia, heart rate, and blood glucose in patients with diabetes) but worse blood pressure control. The clinical profile of patients with chronic ischemic heart disease is similar in the 2 registries. There has been an improvement in patients' medical therapy and dyslipidemia control, blood glucose, and heart rate, but there is still much room for improvement in the control of other cardiovascular risk factors. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  7. Microalgae cultivation as tertiary unit operation for treatment of pharmaceutical wastewater associated with lipid production.

    Science.gov (United States)

    Hemalatha, Manupati; Venkata Mohan, S

    2016-09-01

    Microalgae based treatment was studied to polish sequential batch reactor (SBR) treated pharmaceutical wastewater under mixotrophic mode of operation with simultaneous biomass/lipid production. At the end of biomass growth phase (BGP), carbon removal efficiency was observed to be 73% along with good removal of nitrates (62%). Since microalgae assimilate nutrients from wastewater for growth, an increment in total biomass productivity (2.8g/l) was observed. Subjecting to nutrient stress phase (NSP), total lipid content of 17.2% with neutral lipids of 6.2% was observed under light condition. Contrarily, dark condition depicted total lipid content of 15.8% with neutral lipids constituting 6.5%. The nutrient stress in combination with light showed marked influence on the profile of saturated and unsaturated fatty acids. Integration of microalgae cultivation improves environmental sustainability and enables greener routes of biofuels and value added products synthesis in a biorefinery approach. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. The importance of early recognition and timely treatment of delirium in intensive care units

    Directory of Open Access Journals (Sweden)

    Stašević-Karličić Ivana

    2016-01-01

    Full Text Available Delirium is connected to bad short-term (the increase in hospital mortality rate and hospital days and long-term outcomes (disfunctionality, institutionalisation, cognitive damage and post hospital-release dementia. The objective of this study is to determine whether there are possible incompatibilities of treatment of delirium with the recommendations in the guides of good clinical practice from developed countries. The grounded method was used in the study. The so called principal sampling of 17 psychiatrists, anesthesiologists and registered nurses was conducted. Afterwards, the unstructured interviews with the selectees were conducted, transcribed and analyzed immediately through coding, category and concept detection. Having completed this, the theoretical sampling of new interview examinees was conducted. Their analysis enabled the concepts to be linked into a working theory and graphically displayed. The new sampling, the new interviews and their analysis were then continued interactively until the saturation of the working theory was achieved and the final version of the theory was formulated based on the findings reached through the interviews. Having completed the principal sampling and coding of the transcripts led the researches to the saturation of the theory through the separation of eight categories: A - Delirium as a sign of system infection, B - Therapy - Anaesthesiologists administer benzodiazepines, whereas psychiatrists administer antipsychotics, C - An inconspicuous onset of delirium is overlooked, D - Bleeding as the cause of delirium, E -Anticholinergics as a cause of delirium, F - Misunderstanding the nature of delirium by anaesthesiologists, G -Being aware that the patient is vitally endangered, and H - The nurses apply enhanced health care measures. Delirium is a syndrome which can be prevented in 30 -40% of cases (50. An etiological treatment would help avoid complicating delirium's clinical picture and would very much

  9. Case report of a near medical event in stereotactic radiotherapy due to improper units of measure from a treatment planning system.

    Science.gov (United States)

    Gladstone, D J; Li, S; Jarvis, L A; Hartford, A C

    2011-07-01

    The authors hereby notify the Radiation Oncology community of a potentially lethal error due to improper implementation of linear units of measure in a treatment planning system. The authors report an incident in which a patient was nearly mistreated during a stereotactic radiotherapy procedure due to inappropriate reporting of stereotactic coordinates by the radiation therapy treatment planning system in units of centimeter rather than in millimeter. The authors suggest a method to detect such errors during treatment planning so they are caught and corrected prior to the patient positioning for treatment on the treatment machine. Using pretreatment imaging, the authors found that stereotactic coordinates are reported with improper linear units by a treatment planning system. The authors have implemented a redundant, independent method of stereotactic coordinate calculation. Implementation of a double check of stereotactic coordinates via redundant, independent calculation is simple and accurate. Use of this technique will avoid any future error in stereotactic treatment coordinates due to improper linear units, transcription, or other similar errors. The authors recommend an independent double check of stereotactic treatment coordinates during the treatment planning process in order to avoid potential mistreatment of patients.

  10. Case report of a near medical event in stereotactic radiotherapy due to improper units of measure from a treatment planning system

    International Nuclear Information System (INIS)

    Gladstone, D. J.; Li, S.; Jarvis, L. A.; Hartford, A. C.

    2011-01-01

    Purpose: The authors hereby notify the Radiation Oncology community of a potentially lethal error due to improper implementation of linear units of measure in a treatment planning system. The authors report an incident in which a patient was nearly mistreated during a stereotactic radiotherapy procedure due to inappropriate reporting of stereotactic coordinates by the radiation therapy treatment planning system in units of centimeter rather than in millimeter. The authors suggest a method to detect such errors during treatment planning so they are caught and corrected prior to the patient positioning for treatment on the treatment machine. Methods: Using pretreatment imaging, the authors found that stereotactic coordinates are reported with improper linear units by a treatment planning system. The authors have implemented a redundant, independent method of stereotactic coordinate calculation. Results: Implementation of a double check of stereotactic coordinates via redundant, independent calculation is simple and accurate. Use of this technique will avoid any future error in stereotactic treatment coordinates due to improper linear units, transcription, or other similar errors. Conclusions: The authors recommend an independent double check of stereotactic treatment coordinates during the treatment planning process in order to avoid potential mistreatment of patients.

  11. Effect of a community-based delivery of intermittent preventive treatment of malaria in pregnancy on treatment seeking for malaria at health units in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony; Hansen, Kristian Schultz; Bygbjerg, Ib

    2008-01-01

    Background: The impact of intermittent preventive treatment (IPTp) on malaria in pregnancy is well known. However, in countries where this policy is implemented, poor access and low compliance have been widely reported. Novel approaches are needed to deliver this intervention. Objective: To assess...... whether traditional birth attendants, drug-shop vendors, community reproductive health workers and adolescent peer mobilizers can administer IPTp with sulphadoxine-pyrimethamine (SP) to pregnant women, reach those at greatest risk of malaria, and increase access and compliance with IPTp. Study design......: An intervention study compared the delivery of IPTp in the community with routine delivery of IPTp at health units. The primary outcome measures were the proportion of adolescents and primigravidae accessed, and the proportion of women who received two doses of SP. The study also assessed the effect...

  12. Radiotherapy pre-treatment dose validation: A second verification of monitor units (MU with a commercial software

    Directory of Open Access Journals (Sweden)

    Iqbal Al Amri

    2012-01-01

    Full Text Available Inversely planned intensity-modulated radiotherapy (IMRT and stereotactic small field radiotherapy should be verified before treatment execution. A second verification is carried out for planned treatments in IMRT and 3D conformal radiotherapy (3D-CRT using a monitor verification commercial dose calculation management software (DCMS. For the same reference point the ion-chamber measured doses are compared for IMRT plans. DCMS (Diamond computes dose based on modified Clarkson integration, accounting for multi-leaf collimators (MLC transmission and measured collimator scatter factors. DCMS was validated with treatment planning system (TPS (Eclipse 6.5 Version, Varian, USA separately. Treatment plans computed from TPS are exported to DCMS using DICOM interface. Doses are re-calculated at selected points for fields delivered to IMRT phantom (IBA Scanditronix Wellhofer in high-energy linac (Clinac 2300 CD, Varian. Doses measured at central axis, for the same points using CC13 (0.13 cc ion chamber with Dose 1 Electrometer (Scanditronix Wellhofer are compared with calculated data on DCMS and TPS. The data of 53 IMRT patients with fields ranging from 5 to 9 are reported. The computed dose for selected monitor units (MU by Diamond showed good agreement with planned doses by TPS. DCMS dose prediction matched well in 3D-CRT forward plans (0.8 ± 1.3%, n = 37 and in IMRT inverse plans (−0.1 ± 2.2%, n = 37. Ion chamber measurements agreed well with Eclipse planned doses (−2.1 ± 2.0%, n = 53 and re-calculated DCMS doses (−1.5 ± 2.6%, n = 37 in phantom. DCMS dose validation is in reasonable agreement with TPS. DCMS calculations corroborate well with ionometric measured doses in most of the treatment plans.

  13. Radiotherapy pre-treatment dose validation: A second verification of monitor units (MU) with a commercial software

    Science.gov (United States)

    Al Amri, Iqbal; Ravichandran, Ramamoorthy; Sivakumar, Somangili Satyamoorthi; Binukumar, Johnson Pichi; Davis, Chirayathmanjiyil Antony; Al Rahbi, Zakia; Al Shukeili, Khalsa; Al Kindi, Fatima

    2012-01-01

    Inversely planned intensity-modulated radiotherapy (IMRT) and stereotactic small field radiotherapy should be verified before treatment execution. A second verification is carried out for planned treatments in IMRT and 3D conformal radiotherapy (3D-CRT) using a monitor verification commercial dose calculation management software (DCMS). For the same reference point the ion-chamber measured doses are compared for IMRT plans. DCMS (Diamond) computes dose based on modified Clarkson integration, accounting for multi-leaf collimators (MLC) transmission and measured collimator scatter factors. DCMS was validated with treatment planning system (TPS) (Eclipse 6.5 Version, Varian, USA) separately. Treatment plans computed from TPS are exported to DCMS using DICOM interface. Doses are re-calculated at selected points for fields delivered to IMRT phantom (IBA Scanditronix Wellhofer) in high-energy linac (Clinac 2300 CD, Varian). Doses measured at central axis, for the same points using CC13 (0.13 cc) ion chamber with Dose 1 Electrometer (Scanditronix Wellhofer) are compared with calculated data on DCMS and TPS. The data of 53 IMRT patients with fields ranging from 5 to 9 are reported. The computed dose for selected monitor units (MU) by Diamond showed good agreement with planned doses by TPS. DCMS dose prediction matched well in 3D-CRT forward plans (0.8 ± 1.3%, n = 37) and in IMRT inverse plans (–0.1 ± 2.2%, n = 37). Ion chamber measurements agreed well with Eclipse planned doses (–2.1 ± 2.0%, n = 53) and re-calculated DCMS doses (–1.5 ± 2.6%, n = 37) in phantom. DCMS dose validation is in reasonable agreement with TPS. DCMS calculations corroborate well with ionometric measured doses in most of the treatment plans. PMID:23293456

  14. [Usefulness of a multidimensional self-administered questionnaire for the clinical management of a pain treatment unit].

    Science.gov (United States)

    Busquets, C; Ojeda, A; Torres, F; Faulí, A; Moreno, L A; Bogdanovich, A; Giménez-Milà, M; Hernández-Cera, C; Fàbregas, N; Videla, S

    2014-01-01

    To study the feasibility of a multidimensional self-administered questionnaire before the patient is seen at the first visit in a clinical Pain Treatment Unit (PTU) of a tertiary hospital, and its impact on the management of patients in the first visit. Cross-sectional study. Self-administered questionnaire that gathered: socio-demographic data, medical history of pain, pain perception (intensity and characteristics), comorbidity of pain and patient expectations of analgesic treatment ("What do you expect from our treatment? If we cannot resolve your pain, what level of pain would you be willing to live with?). A descriptive analysis was performed. A total of 293 consecutive patients (31% men, 69% women), mean age (SD) 62 (16) years-old, were included in 2011. All patients completed and returned the questionnaire before the first visit to the PTU. The questionnaire was completed fully and correctly by 80% (234, 95% CI: 75-84) of the patients, and the rest completed the questionnaire with some points unanswered. About 24% (70/293, 95% CI: 19-29) of the patients should not have been referred to the PTU [20% were not attended]. A small percentage (9%,26/293, 95% CI: 6-13) were evaluated as «urgent'» and visited over the following 7 days, with 19% (56/293, 95%CI: 15-24) being «preferential» (visited before 15 days) and 52% (152/293, 95% CI: 46-58) as «non-urgent/non-preferential» (visited before 60 days). Almost one third (30%, 87/293, 95% CI: 25-35) did not need a second visit to the PTU. Patient expectations: 21% expected complete pain relief and 64% would accept a lower pain intensity score of 4. The use of a multidimensional self-administered questionnaire before the first visit to a clinical Pain Treatment Unit of a tertiary hospital was a practicable and useful tool for the management of patients on the first visit. Likewise, the questionnaire provided information on the patient's perception of pain and the expectations concerning the analgesic treatment

  15. Calcium stable isotope geochemistry

    Energy Technology Data Exchange (ETDEWEB)

    Gausonne, Nikolaus [Muenster Univ. (Germany). Inst. fuer Mineralogie; Schmitt, Anne-Desiree [Strasbourg Univ. (France). LHyGeS/EOST; Heuser, Alexander [Bonn Univ. (Germany). Steinmann-Inst. fuer Geologie, Mineralogie und Palaeontologie; Wombacher, Frank [Koeln Univ. (Germany). Inst. fuer Geologie und Mineralogie; Dietzel, Martin [Technische Univ. Graz (Austria). Inst. fuer Angewandte Geowissenschaften; Tipper, Edward [Cambridge Univ. (United Kingdom). Dept. of Earth Sciences; Schiller, Martin [Copenhagen Univ. (Denmark). Natural History Museum of Denmark

    2016-08-01

    This book provides an overview of the fundamentals and reference values for Ca stable isotope research, as well as current analytical methodologies including detailed instructions for sample preparation and isotope analysis. As such, it introduces readers to the different fields of application, including low-temperature mineral precipitation and biomineralisation, Earth surface processes and global cycling, high-temperature processes and cosmochemistry, and lastly human studies and biomedical applications. The current state of the art in these major areas is discussed, and open questions and possible future directions are identified. In terms of its depth and coverage, the current work extends and complements the previous reviews of Ca stable isotope geochemistry, addressing the needs of graduate students and advanced researchers who want to familiarize themselves with Ca stable isotope research.

  16. Computer-aided analysis of star shot films for high-accuracy radiation therapy treatment units

    International Nuclear Information System (INIS)

    Depuydt, Tom; Verellen, Dirk; Leysen, Katrien; Vandevondel, Iwein; Poels, Kenneth; Reynders, Truus; Gevaert, Thierry; Duchateau, Michael; Tournel, Koen; Boussaer, Marlies; De Ridder, Mark; Penne, Rudi; Hrbacek, Jan; Lang, Stephanie; Cosentino, Dorian; Garibaldi, Cristina; Solberg, Timothy

    2012-01-01

    As mechanical stability of radiation therapy treatment devices has gone beyond sub-millimeter levels, there is a rising demand for simple yet highly accurate measurement techniques to support the routine quality control of these devices. A combination of using high-resolution radiosensitive film and computer-aided analysis could provide an answer. One generally known technique is the acquisition of star shot films to determine the mechanical stability of rotations of gantries and the therapeutic beam. With computer-aided analysis, mechanical performance can be quantified as a radiation isocenter radius size. In this work, computer-aided analysis of star shot film is further refined by applying an analytical solution for the smallest intersecting circle problem, in contrast to the gradient optimization approaches used until today. An algorithm is presented and subjected to a performance test using two different types of radiosensitive film, the Kodak EDR2 radiographic film and the ISP EBT2 radiochromic film. Artificial star shots with a priori known radiation isocenter size are used to determine the systematic errors introduced by the digitization of the film and the computer analysis. The estimated uncertainty on the isocenter size measurement with the presented technique was 0.04 mm (2σ) and 0.06 mm (2σ) for radiographic and radiochromic films, respectively. As an application of the technique, a study was conducted to compare the mechanical stability of O-ring gantry systems with C-arm-based gantries. In total ten systems of five different institutions were included in this study and star shots were acquired for gantry, collimator, ring, couch rotations and gantry wobble. It was not possible to draw general conclusions about differences in mechanical performance between O-ring and C-arm gantry systems, mainly due to differences in the beam–MLC alignment procedure accuracy. Nevertheless, the best performing O-ring system in this study, a BrainLab/MHI Vero

  17. The Reactivity of Stable Metallacyclobutenes and Vinylcarbenes

    OpenAIRE

    Holland, Ryan Lynn

    2016-01-01

    Chapter 1. Historical Development of Stable Metallacyclobutenes Fred Tebbe and co-workers synthesized the first stable metallacyclobutene complexes in the late 1970’s by treatment of an intermediate titanium methylene species – later popularized as the “Tebbe reagent” – with acetylenes. Robert Grubbs at Caltech further studied this system, using it to detail a degenerate metathesis reaction and to isolate a metallacyclobutane complex – which was implicated in the emerging field of alkene meta...

  18. Grey water treatment by a continuous process of an electrocoagulation unit and a submerged membrane bioreactor system

    KAUST Repository

    Bani-Melhem, Khalid

    2012-08-01

    This paper presents the performance of an integrated process consisting of an electro-coagulation (EC) unit and a submerged membrane bioreactor (SMBR) technology for grey water treatment. For comparison purposes, another SMBR process without electrocoagulation (EC) was operated in parallel with both processes operated under constant transmembrane pressure for 24. days in continuous operation mode. It was found that integrating EC process with SMBR (EC-SMBR) was not only an effective method for grey water treatment but also for improving the overall performance of the membrane filtration process. EC-SMBR process achieved up to 13% reduction in membrane fouling compared to SMBR without electrocoagulation. High average percent removals were attained by both processes for most wastewater parameters studied. The results demonstrated that EC-SMBR performance slightly exceeded that of SMBR for COD, turbidity, and colour. Both processes produced effluent free of suspended solids, and faecal coliforms were nearly (100%) removed in both processes. A substantial improvement was achieved in removal of phosphate in the EC-SMBR process. However, ammonia nitrogen was removed more effectively by the SMBR only. Accordingly, the electrolysis condition in the EC-SMBR process should be optimized so as not to impede biological treatment. © 2012 Elsevier B.V.

  19. Handling and treatment of low-level radioactive wastes from gaseous diffusion plants in the United States of America

    International Nuclear Information System (INIS)

    Wing, J.F.; Behrend, J.E.

    1984-01-01

    Gaseous diffusion plants in the United States of America currently generate very small quantities of low-level radioactive wastes. These wastes consist primarily of airborne effluent solid trapping media and liquid scrubber solutions, liquid effluent treatment sludges, waste oils and solvents, scrap metals and conventional combustible wastes such as floor sweepings, cleaning rags and shoe covers. In addition to waste emanating from current operations, large quantities of scrap metal generated during the Cascade Improvement Program are stored above ground at each of the diffusion plants. The radionuclides of primary concern are uranium and 99 Tc. Current radioactive waste treatment consists of uranium dissolution in weak acids followed by chemical precipitation and/or solvent extraction for uranium recovery. Current disposal operations consist of above ground storage of scrap metals, shallow land burial of inorganic solids and incineration of combustible wastes. With increased emphasis on reducing the potential for off-site radiological dose, several new treatment and disposal options are being studied and new projects are being planned. One project of particular interest involves the installation of a high temperature incinerator to thermally degrade hazardous organic wastes contaminated with low-level radioactive wastes. Other technologies being studied include fixation of uranium-bearing sludges in concrete before burial, decontamination of scrap metals by smelting and use of specially engineered centralized burial grounds. (author)

  20. “Appropriate Treatment” and Therapeutic Window in Spasticity Treatment with IncobotulinumtoxinA: From 100 to 1000 Units

    Directory of Open Access Journals (Sweden)

    Giancarlo Ianieri

    2018-03-01

    Full Text Available Many neurological diseases (ischemic and hemorrhagic stroke, multiple sclerosis, infant cerebral palsy, spinal cord injuries, traumatic brain injury, and other cerebrovascular disorders may cause muscle spasticity. Different therapeutic strategies have been proposed for the treatment of spasticity. One of the major treatments for tone modulation is botulinum toxin type A (BTX-A, performed in addition to other rehabilitation strategies based on individualized multidisciplinary programs aimed at achieving certain goals for each patient. Therapeutic plans must be precisely defined as they must balance the reduction of spastic hypertonia and retention of residual motor function. To perform and optimize the treatment, an accurate clinical and instrumental evaluation of spasticity is needed to determine how this symptom is invalidating and to choose the best doses, muscles and times of injection in each patient. We introduce an “appropriate treatment” and no “standard or high dosage treatment” concept based on our retrospective observational study on 120 patients lasting two years, according to the larger Therapeutic Index and Therapeutic Window of Incobotulinumtoxin A doses from 100 to 1000 units. We studied the efficiency and safety of this drug considering the clinical spasticity significance for specialist physicians and patients.

  1. Effects of introducing a critical path method to standardize treatment and nursing for early discharge from acute psychiatry unit.

    Science.gov (United States)

    Kusaka, Kazuyo; Kanoya, Yuka; Sato, Chifumi

    2006-01-01

    This research aimed to examine whether early discharge can be performed by nurses of a ward participating in the process of critical path method supporting with offer and evaluation of standard and efficient medical treatments and nursing cares. In order to enrich the system that performs hospitable medical treatment and nursing cares standardized at the psychiatry acute term and to prevent chronic, critical path method was introduced into the acute term ward, then the investigation for nursing job satisfaction that was important to establish critical path method was conducted. By introducing critical path method, it became possible to assess the patients in standard, and the subject of business or a system became clear towards early discharge. It became possible to tie up this subject to a future improvement. Consequently, as for comparison of the patient who applied the schedule table of critical path method at the first and second term, the latter decreased the average length of hospitalization period significantly. The satisfaction of the task requirement, which was important to maintain systems, was decreased by the introduction of critical path method but the score of autonomy in satisfaction increased significantly by the improvement of usage of critical path method. From these, it was suggested that the introduction of critical path method in the acute-care unit psychiatry had possibility to aim at standardization of treatment and nursing and patients' early discharge from hospitals.

  2. Occurrence of disinfection byproducts in United States wastewater treatment plant effluents

    KAUST Repository

    Krasner, Stuart W.

    2009-11-01

    Effluents from wastewater treatment plants (WWTPs) contain disinfection byproducts (DBPs) of health concern when the water is utilized downstream as a potable water supply. The pattern of DBP formation was strongly affected by whether or not the WWTP achieved good nitrification. Chlorine addition to poorly nitrified effluents formed low levels of halogenated DBPs, except for (in some cases) dihalogenated acetic acids, but often substantial amounts of N-nitrosodimethyamine (NDMA). Chlorination of well-nitrified effluent typically resulted in substantial formation of halogenated DBPs but much less NDMA. For example, on a median basis after chlorine addition, the well-nitrified effluents had 57 μg/L of trihalomethanes [THMs] and 3 ng/L of NDMA, while the poorly nitrified effluents had 2 μg/L of THMs and 11 ng/L of NDMA. DBPs with amino acid precursors (haloacetonitriles, haloacetaldehydes) formed at substantial levels after chlorination of well-nitrified effluent. The formation of halogenated DBPs but not that of NDMA correlated with the formation of THMs in WWTP effluents disinfected with free chlorine. However, THM formation did not correlate with the formation of other DBPs in effluents disinfected with chloramines. Because of the relatively high levels of bromide in treated wastewater, bromine incorporation was observed in various classes of DBPs. © 2009 American Chemical Society.

  3. A Cross-National Review of Evidence-Based Psychosocial Treatments for Children and Adolescents with Autistic Spectrum Disorders in the United Kingdom, Ireland, and United States

    Science.gov (United States)

    Robinson, Lee; Bond, Caroline

    2017-01-01

    The most thoroughly researched topic in relation to autistic spectrum disorders (ASDs) is the evaluation of interventions. Educational psychology in the United Kingdom and Ireland is the most closely allied profession to school psychology in the United States. In considering what is published by and for the profession, it is important to include…

  4. Disparities in uterine cancer epidemiology, treatment, and survival among African Americans in the United States.

    Science.gov (United States)

    Long, B; Liu, F W; Bristow, R E

    2013-09-01

    The objective of this article is to comprehensively review the scientific literature and summarize the available data regarding the outcome disparities of African American women with uterine cancer. Literature on disparities in uterine cancer was systematically reviewed using the PubMed search engine. Articles from 1992 to 2012 written in English were reviewed. Search terms included endometrial cancer, uterine cancer, racial disparities, and African American. Twenty-four original research articles with a total of 366,299 cases of endometrial cancer (337,597 Caucasian and 28,702 African American) were included. Compared to Caucasian women, African American women comprise 7% of new endometrial cancer cases, while accounting for approximately 14% of endometrial cancer deaths. They are diagnosed with later stage, higher-grade disease, and poorer prognostic histologic types compared to their Caucasian counterparts. They also suffer worse outcomes at every stage, grade, and for every histologic type. The cause of increased mortality is multifactorial. African American and white women have varying incidence of comorbid conditions, genetic susceptibility to malignancy, access to care and health coverage, and socioeconomic status; however, the most consistent contributors to incidence and mortality disparities are histology and socioeconomics. More robust genetic and molecular profile studies are in development to further explain histologic differences. Current studies suggest that histologic and socioeconomic factors explain much of the disparity in endometrial cancer incidence and mortality between white and African American patients. Treatment factors likely contributed historically to differences in mortality; however, studies suggest most women now receive equal care. Molecular differences may be an important factor to explain the racial inequities. Coupled with a sustained commitment to increasing access to appropriate care, on-going research in biologic mechanisms

  5. Antimicrobial selection and dosing in the treatment of wounds in the United Kingdom.

    Science.gov (United States)

    Ross, S E; Duz, M; Rendle, D I

    2016-11-01

    Antimicrobial stewardship within the veterinary profession is recognised by governing and professional bodies as being important; the attitudes and behaviour of veterinary surgeons merit investigation. To investigate levels of protected antimicrobial use and accuracy of antimicrobial dosing in a common clinical scenario in equine practice. Retrospective cohort study. Antimicrobial use was evaluated retrospectively in 113 cases subsequently referred to a single referral hospital for the treatment of limb wounds over a 20-month period. Antimicrobial classification (first-line, alternative or protected) was made according to guidelines produced by the British Equine Veterinary Association. These guidelines also served as the reference for recommended dose rates. Systemic antimicrobials were administered prior to referral in 94/113 (83.2%) horses, of which 8 (8.5%) received the protected third or fourth generation cephalosporins or fluoroquinolones. Forty-eight of 87 (55.2%) horses for which complete dosing data were available received antimicrobials at ≤90% of the recommended dose. Practitioners who held a postgraduate clinical qualification or worked in purely equine practice were no more or less likely to use protected antimicrobials (P = 0.06 and P = 0.64, respectively) or administer inadequate doses (P = 0.75 and P = 0.85, respectively). Veterinary surgeons with more experience were less likely to use protected antimicrobials (P<0.001); however, with the small case numbers, this finding should be interpreted with caution. Heavier horses were more likely to be under-dosed (P<0.002). This study highlights the administration of certain classes of antimicrobials in situations where their use is unlikely to be justified. If these findings reflect more general attitudes and behaviour then greater awareness of, and compliance with, recommendations for responsible antimicrobial use are required among equine practitioners. Bodyweight ought to be measured or estimated

  6. Comparison of treatment seeking compulsive buyers in Germany and the United States.

    Science.gov (United States)

    Mueller, Astrid; Mitchell, James E; Mertens, Christian; Mueller, Ulrike; Silbermann, Andrea; Burgard, Melissa; de Zwaan, Martina

    2007-07-01

    The aim of this pilot study was to compare a German (Bavaria) and an American (North Dakota) sample of women suffering from compulsive buying. Thirty-eight German and 39 American female compulsive buyers were screened with the Compulsive Buying Scale (CBS), and the Yale-Brown Obsessive Compulsive Scale-Shopping Version (Y-BOCS-SV) prior to entering a group treatment study. Psychiatric co-morbidity was assessed with the Structured Clinical Interview for DSM-IV Axis I disorders (SCID). There were no statistically significant differences between the German sample and the American sample with regard to age (mean 43.7 and 45 years, respectively), and with regard to the scores on the CBS and the Y-BOCS-SV. A high lifetime co-morbidity rate with Axis I disorders, especially mood disorders, anxiety disorders, substance use disorders, OCD, and binge eating disorder was detected in both samples. Almost all participants met criteria for at least one lifetime Axis I disorder. However, German compulsive buyers showed significantly higher current prevalence rates of any affective disorder, and higher current and lifetime prevalence rates of any anxiety disorder and somatoform disorder. In addition, German compulsive buyers were significantly more likely to have more than one Axis I disorder. The groups did not differ with regard to age and with regard to the severity of compulsive buying and showed a high co-morbidity with Axis I disorders. However, the German compulsive buying sample presented with significantly more psychiatric co-morbidity compared to the American sample. Further research is needed to provide a better understanding of this disorder in general and cross-culturally.

  7. Patient Preferences for Injectable Treatments for Multiple Sclerosis in the United States: A Discrete-Choice Experiment.

    Science.gov (United States)

    Poulos, Christine; Kinter, Elizabeth; Yang, Jui-Chen; Bridges, John F P; Posner, Joshua; Reder, Anthony T

    2016-04-01

    Patients' perceptions and experiences of medication efficacy, medication adverse events, dosing frequency, and dosing complexity have been found to influence adherence to injectable disease-modifying treatments (DMTs) in patients with multiple sclerosis (MS). The aim of this study was to quantify patient preferences for features of injectable DMTs for MS. Adult patients in the United States (US) with a self-reported diagnosis of MS completed an online discrete-choice experiment survey to assess preference for a number of features of a hypothetical injectable DMT. Patients chose hypothetical treatments in paired comparisons, where each treatment was described by features or attributes, including the number of years until disability progression, the number of relapses in the next 4 years, injection time, the frequency of injections, the occurrence of flu-like symptoms (FLS), and severity of injection-site reactions. Random-parameters logit regression parameters were used to calculate preference weights of attribute levels and the relative importance of changes in treatment features. Of the 205 patients who completed the survey, 192 provided sufficient data for analysis. The results indicated a broad range of tradeoffs that patients would be willing to make. With regard to this, the relative importance of an improvement in the number of years until disability progression from 1 to 2 (i.e., vertical distance between preference weights for these attribute levels) was 0.9 [95% confidence interval (CI) 0.5-1.2], the relative importance of this change was approximately equivalent to that of an improvement from 12 injections per month to two (mean 0.8, 95% CI 0.4-1.2), or approximately equivalent to a decrease from four to one relapses in the next 4 years (mean 0.8, 95% CI 0.5-1.2), or FLS 3 days after every injection to 3 days after some injections (mean 1.0, 95% CI 0.6-1.4). These results suggest that an improvement in treatment efficacy may be as important as a reduction

  8. What's in the 'treatment gap'? Ethnographic perspectives on addiction and global mental health from China, Russia, and the United States.

    Science.gov (United States)

    Bartlett, Nicholas; Garriott, William; Raikhel, Eugene

    2014-01-01

    Recent years have seen the emergence of a 'global mental health' agenda, focused on providing evidence-based interventions for mental illnesses in low- and middle-income countries. Anthropologists and cultural psychiatrists have engaged in vigorous debates about the appropriateness of this agenda. In this article, we reflect on these debates, drawing on ethnographic fieldwork on the management of substance use disorders in China, Russia, and the United States. We argue that the logic of 'treatment gaps,' which guides much research and intervention under the rubric of global mental health, partially obscures the complex assemblages of institutions, therapeutics, knowledges, and actors framing and managing addiction (as well as other mental health issues) in any particular setting.

  9. The Mortality Rate of Nosocomial Infection in Neonatal Intensive Care Unit (NICU of Taleghani Educational and Treatment Center, Tabriz, 2013

    Directory of Open Access Journals (Sweden)

    Parvin Abbasian

    2015-09-01

    Full Text Available Background and Objectives : Information about nosocomial infections (NIs is necessary for both appropriate management and establishment of preventative measures in hospitals. Neonates admitted to the Neonatal Intensive Care Unit (NICU are at high-risk of developing nosocomial infection. The aim of this study was to determine the mortality rate of nosocomial infections and the distribution of pathogens among newborns who were admitted to the neonatal intensive care unit in Taleghani educational and treatment center, Tabriz. Material and Methods : This was a cross-sectional study. The sampling method was census. The inclusion criteria were dead infants who developed signs of infection after 48 hours of hospitalization and those who had symptoms at the admission were excluded. Data were collected through hospital records and were analyzed using Excel software. Results: From 904 infants admitted to NICU, 39 (4.3% acquired hospital infection. Mortality from nosocomial infections in NICU was 20.5% that was 12% of the total deaths. Coagulase-negative staphylococcal Cook (37.5% and Escherichia coli (25% were the most commonly identified agents among dead neonates. Conclusion: For more reduction in nosocomial infection and its mortality rate, mercury hygiene principles and also optimizing bed spaces are recommended. ​

  10. Commercial Motor Vehicle Driver Obstructive Sleep Apnea Screening and Treatment in the United States: An Update and Recommendation Overview.

    Science.gov (United States)

    Colvin, Loretta J; Collop, Nancy A

    2016-01-01

    No regulatory mandate exists in the United States (U.S.) for comprehensive obstructive sleep apnea (OSA) risk assessment and stratification for commercial motor vehicle (CMV) drivers. Current Federal Motor Carrier Safety Administration (FMCSA) requirements are outdated and depend largely on subjective report, a less reliable strategy in an occupational setting. Without FMCSA standards, sleep specialists, occupational medical examiners and employers rely on a collection of medical consensus recommendations to establish standards of care. These recommendations advise OSA risk assessment through a combination of focused medical history, physical examination, questionnaires, and accident history, which increase OSA detection compared to current FMCSA standards. For those diagnosed with OSA, consensus-based risk stratification helps identify CMV drivers who may benefit from OSA treatment and establish minimum standards for assessing treatment efficacy and adherence. Unfortunately no consolidated recommendation exists; rather, publications span medical and governmental literature in a patchwork fashion that no longer fully reflect current practice due to subsequent advances in OSA diagnosis, treatment, and technology. Based on searches of medical literature, internet materials, and reference lists from existing publications, an overview and discussion of key published recommendations regarding OSA assessment and treatment in CMV operators is provided. Suggestions for incorporating these recommendations into clinical sleep medicine practice in the U.S. are presented. The challenge for sleep specialists is maintaining the delicate balance between recommendations impacting standard of care and associated medico-legal impact with stakeholder interests from medical, regulatory, industry and public perspectives while providing high quality and efficient care. © 2016 American Academy of Sleep Medicine.

  11. Evolutionary Stable Strategy

    Indian Academy of Sciences (India)

    2016-08-26

    Aug 26, 2016 ... Home; Journals; Resonance – Journal of Science Education; Volume 21; Issue 9. Evolutionary Stable Strategy: Application of Nash Equilibrium in Biology. General ... Using some examples of classical games, we show how evolutionary game theory can help understand behavioural decisions of animals.

  12. The Stable Concordance Genus

    OpenAIRE

    Kearney, M. Kate

    2013-01-01

    The concordance genus of a knot is the least genus of any knot in its concordance class. Although difficult to compute, it is a useful invariant that highlights the distinction between the three-genus and four-genus. In this paper we define and discuss the stable concordance genus of a knot, which describes the behavior of the concordance genus under connected sum.

  13. Manifolds admitting stable forms

    Czech Academy of Sciences Publication Activity Database

    Le, Hong-Van; Panák, Martin; Vanžura, Jiří

    2008-01-01

    Roč. 49, č. 1 (2008), s. 101-11 ISSN 0010-2628 R&D Projects: GA ČR(CZ) GP201/05/P088 Institutional research plan: CEZ:AV0Z10190503 Keywords : stable forms * automorphism groups Subject RIV: BA - General Mathematics

  14. Stable isotope studies

    International Nuclear Information System (INIS)

    Ishida, T.

    1992-01-01

    The research has been in four general areas: (1) correlation of isotope effects with molecular forces and molecular structures, (2) correlation of zero-point energy and its isotope effects with molecular structure and molecular forces, (3) vapor pressure isotope effects, and (4) fractionation of stable isotopes. 73 refs, 38 figs, 29 tabs

  15. Interactive Stable Ray Tracing

    DEFF Research Database (Denmark)

    Dal Corso, Alessandro; Salvi, Marco; Kolb, Craig

    2017-01-01

    Interactive ray tracing applications running on commodity hardware can suffer from objectionable temporal artifacts due to a low sample count. We introduce stable ray tracing, a technique that improves temporal stability without the over-blurring and ghosting artifacts typical of temporal post-pr...

  16. The stable subgroup graph

    Directory of Open Access Journals (Sweden)

    Behnaz Tolue

    2018-07-01

    Full Text Available In this paper we introduce stable subgroup graph associated to the group $G$. It is a graph with vertex set all subgroups of $G$ and two distinct subgroups $H_1$ and $H_2$ are adjacent if $St_{G}(H_1\\cap H_2\

  17. Treatment Recommendations for Single-Unit Crowns: Findings from The National Dental Practice-Based Research Network

    Science.gov (United States)

    McCracken, Michael S.; Louis, David R.; Litaker, Mark S.; Minyé, Helena M.; Mungia, Rahma; Gordan, Valeria V.; Marshall, Don G.; Gilbert, Gregg H.

    2016-01-01

    Background Objectives were to: (1) quantify practitioner variation in likelihood to recommend a crown; and (2) test whether certain dentist, practice, and clinical factors are significantly associated with this likelihood. Methods Dentists in the National Dental Practice-Based Research Network completed a questionnaire about indications for single-unit crowns. In four clinical scenarios, practitioners ranked their likelihood of recommending a single-unit crown. These responses were used to calculate a dentist-specific “Crown Factor” (CF; range 0–12). A higher score implies a higher likelihood to recommend a crown. Certain characteristics were tested for statistically significant associations with the CF. Results 1,777 of 2,132 eligible dentists responded (83%). Practitioners were most likely to recommend crowns for teeth that were fractured, cracked, endodontically-treated, or had a broken restoration. Practitioners overwhelmingly recommended crowns for posterior teeth treated endodontically (94%). Practice owners, Southwest practitioners, and practitioners with a balanced work load were more likely to recommend crowns, as were practitioners who use optical scanners for digital impressions. Conclusions There is substantial variation in the likelihood of recommending a crown. While consensus exists in some areas (posterior endodontic treatment), variation dominates in others (size of an existing restoration). Recommendations varied by type of practice, network region, practice busyness, patient insurance status, and use of optical scanners. Practical Implications Recommendations for crowns may be influenced by factors unrelated to tooth and patient variables. A concern for tooth fracture -- whether from endodontic treatment, fractured teeth, or large restorations -- prompted many clinicians to recommend crowns. PMID:27492046

  18. Treatment recommendations for single-unit crowns: Findings from The National Dental Practice-Based Research Network.

    Science.gov (United States)

    McCracken, Michael S; Louis, David R; Litaker, Mark S; Minyé, Helena M; Mungia, Rahma; Gordan, Valeria V; Marshall, Don G; Gilbert, Gregg H

    2016-11-01

    The objectives of this study were to quantify practitioner variation in likelihood to recommend a crown and test whether certain dentist, practice, and clinical factors are associated significantly with this likelihood. Dentists in The National Dental Practice-Based Research Network completed a questionnaire about indications for single-unit crowns. In 4 clinical scenarios, practitioners ranked their likelihood of recommending a single-unit crown. The authors used these responses to calculate a dentist-specific crown factor (range, 0-12). A higher score implied a higher likelihood of recommending a crown. The authors tested certain characteristics for statistically significant associations with the crown factor. A total of 1,777 of 2,132 eligible dentists (83%) responded. Practitioners were most likely to recommend crowns for teeth that were fractured, cracked, or endodontically treated or had a broken restoration. Practitioners overwhelmingly recommended crowns for posterior teeth treated endodontically (94%). Practice owners, practitioners in the Southwest, and practitioners with a balanced workload were more likely to recommend crowns, as were practitioners who used optical scanners for digital impressions. There is substantial variation in the likelihood of recommending a crown. Although consensus exists in some areas (posterior endodontic treatment), variation dominates in others (size of an existing restoration). Recommendations varied according to type of practice, network region, practice busyness, patient insurance status, and use of optical scanners. Recommendations for crowns may be influenced by factors unrelated to tooth and patient variables. A concern for tooth fracture-whether from endodontic treatment, fractured teeth, or large restorations-prompted many clinicians to recommend crowns. Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.

  19. Load leveling of the Tohoku Electric Power Co. Development of ice storage cold-water manufacturing unit/solid organic waste treatment equipment using midnight power for cold district; Tohoku Denryoku no fuka heijunka. Kori chikunetsu reisui seizo unit no kaihatsu, shin`ya denryoku riyo kanreichi muke kokei yuki haikibutsu shori sochi no kaihatsu

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-10-01

    An ice storage cold-water manufacturing unit that can manufacture cold water at a stable temperature near 0degC by using midnight power and a solid organic waste treatment facility were developed. The high-speed melting of ice is required to stabilize the cold-water temperature. Therefore, experimental investigation was performed. A piece of flake-shaped ice whose surface area and storage quality are balanced was used. A system that melts ice using the melting tank installed outside an icebox, and a high-speed melting system of ice based on the mixing unit installed in a melting tank were also used together. In the validation test of a prototype for smaller food factories, the following was confirmed. Manufacturing of cold water at about 1degC, amount of cooled water, stability of output water temperature for a change in water temperature, and good storage of ice in an icebox. In the prototype developed for a solid organic waste treatment facility, satisfactory performance was confirmed for following. Temperature in a fermenter when wastes were put, moisture content in a fermenter, pH value, net loss when the refuse of fish is put, and saving of an electricity rate. 6 figs., 2 tabs.

  20. Periodicity of the stable isotopes

    CERN Document Server

    Boeyens, J C A

    2003-01-01

    It is demonstrated that all stable (non-radioactive) isotopes are formally interrelated as the products of systematically adding alpha particles to four elementary units. The region of stability against radioactive decay is shown to obey a general trend based on number theory and contains the periodic law of the elements as a special case. This general law restricts the number of what may be considered as natural elements to 100 and is based on a proton:neutron ratio that matches the golden ratio, characteristic of biological and crystal growth structures. Different forms of the periodic table inferred at other proton:neutron ratios indicate that the electronic configuration of atoms is variable and may be a function of environmental pressure. Cosmic consequences of this postulate are examined. (author)

  1. Severe depression with Cotard’s phenomenon: treatment of a capacitated patient within the United Kingdom’s Mental Health Act 2007

    Directory of Open Access Journals (Sweden)

    Simon B. Menezes

    2013-02-01

    Full Text Available Treatment of Cotard’s syndrome with electroconvulsive therapy (ECT has been seen to be an effective treatment option when pharmacological options are not successful. Recent changes in the Mental Health Act 2007 used within the United Kingdom has resulted in clinicians unable to prescribe treatment for patients who have capacity but are not providing consent for treatment. We report a case of a patient in the UK with Cotard’s phenomenon and severe depression, where the only effective treatment of ECT was restricted due to changes in mental health law. The role of maintenance ECT as well as the ethical dilemma faced is discussed.

  2. Two-unit cantilevered resin-bonded fixed partial denture as a substitute for a prosthodontic-orthodontic treatment plan: a 5-year case report.

    Science.gov (United States)

    Emami, Elham; St-Georges, Annie; de Grandmont, Pierre

    2012-01-01

    In this case report, we describe the successful long-term treatment of a patient with dental agenesis. The initial treatment plan included an orthodontic phase to provide adequate space for replacing missing lateral incisors with implants. However, because of some complications encountered after 2 years of orthodontic treatment, a revised treatment plan was considered to achieve functional and esthetic goals. The patient was completely satisfied 5 years after being treated with two 2-unit cantilevered resin-bonded fixed partial dentures supported by the cuspids. This conservative treatment plan was cost-effective without having any significant biological cost.

  3. Experimental and Monte Carlo-based determination of the beam quality specifier for TomoTherapyHD treatment units.

    Science.gov (United States)

    Howitz, S; Schwedas, M; Wiezorek, T; Zink, K

    2017-10-12

    Reference dosimetry by means of clinical linear accelerators in high-energy photon fields requires the determination of the beam quality specifier TPR 20,10 , which characterizes the relative particle flux density of the photon beam. The measurement of TPR 20,10 has to be performed in homogenous photon beams of size 10×10cm 2 with a focus-detector distance of 100cm. These requirements cannot be fulfilled by TomoTherapy treatment units from Accuray. The TomoTherapy unit provides a flattening-filter-free photon fan beam with a maximum field width of 40cm and field lengths of 1.0cm, 2.5cm and 5.0cm at a focus-isocenter distance of 85cm. For the determination of the beam quality specifier from measurements under nonstandard reference conditions Sauer and Palmans proposed experiment-based fit functions. Moreover, Sauer recommends considering the impact of the flattening-filter-free beam on the measured data. To verify these fit functions, in the present study a Monte Carlo based model of the treatment head of a TomoTherapyHD unit was designed and commissioned with existing beam data of our clinical TomoTherapy machine. Depth dose curves and dose profiles were in agreement within 1.5% between experimental and Monte Carlo-based data. Based on the fit functions from Sauer and Palmans the beam quality specifier TPR 20,10 was determined from field sizes 5×5cm 2 , 10×5cm 2 , 20×5cm 2 and 40×5cm 2 based on dosimetric measurements and Monte Carlo simulations. The mean value from all experimental values of TPR 20,10 resulted in TPR 20,10 ¯=0.635±0.4%. The impact of the non-homogenous field due to the flattening-filter-free beam was negligible for field sizes below 20×5cm 2 . The beam quality specifier calculated by Monte Carlo simulations was TPR 20,10 =0.628 and TPR 20,10 =0.631 for two different calculation methods. The stopping power ratio water-to-air s w,a Δ directly depends on the beam quality specifier. The value determined from all experimental TPR 20,10 data

  4. Linking Low-Level Stable Isotope Fractionation to Expression of the Cytochrome P450 Monooxygenase-Encoding ethB Gene for Elucidation of Methyl tert-Butyl Ether Biodegradation in Aerated Treatment Pond Systems▿ †

    Science.gov (United States)

    Jechalke, Sven; Rosell, Mònica; Martínez-Lavanchy, Paula M.; Pérez-Leiva, Paola; Rohwerder, Thore; Vogt, Carsten; Richnow, Hans H.

    2011-01-01

    Multidimensional compound-specific stable isotope analysis (CSIA) was applied in combination with RNA-based molecular tools to characterize methyl tertiary (tert-) butyl ether (MTBE) degradation mechanisms occurring in biofilms in an aerated treatment pond used for remediation of MTBE-contaminated groundwater. The main pathway for MTBE oxidation was elucidated by linking the low-level stable isotope fractionation (mean carbon isotopic enrichment factor [ɛC] of −0.37‰ ± 0.05‰ and no significant hydrogen isotopic enrichment factor [ɛH]) observed in microcosm experiments to expression of the ethB gene encoding a cytochrome P450 monooxygenase able to catalyze the oxidation of MTBE in biofilm samples both from the microcosms and directly from the ponds. 16S rRNA-specific primers revealed the presence of a sequence 100% identical to that of Methylibium petroleiphilum PM1, a well-characterized MTBE degrader. However, neither expression of the mdpA genes encoding the alkane hydroxylase-like enzyme responsible for MTBE oxidation in this strain nor the related MTBE isotope fractionation pattern produced by PM1 could be detected, suggesting that this enzyme was not active in this system. Additionally, observed low inverse fractionation of carbon (ɛC of +0.11‰ ± 0.03‰) and low fractionation of hydrogen (ɛH of −5‰ ± 1‰) in laboratory experiments simulating MTBE stripping from an open surface water body suggest that the application of CSIA in field investigations to detect biodegradation may lead to false-negative results when volatilization effects coincide with the activity of low-fractionating enzymes. As shown in this study, complementary examination of expression of specific catabolic genes can be used as additional direct evidence for microbial degradation activity and may overcome this problem. PMID:21148686

  5. Rheological Properties of Commercially Available Hyaluronic Acid Products in the United States for the Treatment of Osteoarthritis Knee Pain

    Directory of Open Access Journals (Sweden)

    Mathew Nicholls

    2018-01-01

    Full Text Available Objective: The inconsistent results within the current literature regarding the efficacy of intra-articular-hyaluronic acid (IA-HA for the treatment of knee osteoarthritis (OA have been suggested to be due to intrinsic differences between individual HA products. The purpose of this investigation is to define the rheological differences between currently available HA products in the United States at the time of this study for the treatment of knee OA, which will help elaborate on the appropriateness of classifying HA products as a class opposed to as individual agents. Methods: The rheological parameters for Euflexxa, Orthovisc, Supartz, Monovisc, Synvisc, Synvisc-One, Gel-One, and Hyalgan were obtained with a TA AR 2000 EX Rheometer with a cone-plate geometry (40-mm plate diameter and a 2° cone angle at room temperature. Results: The bulk rheological parameters of the different products suggest molecular structures traversing the range of dilute solution (Hyalgan, Supartz, semidilute solution (Euflexxa, Orthovisc, entangled solutions (Monovisc, Synvisc, Synvisc-One, and even gel-like (Gel-One behavior. Conclusions: Due to the differences in rheological properties between IA-HA products, the universal assessment of these products as a class may not be appropriate. Instead, it may be more appropriate to assess each product individually. Future research should aim to link these differences in rheological properties to the differences in clinical efficacy seen across these IA-HA products.

  6. Rheological Properties of Commercially Available Hyaluronic Acid Products in the United States for the Treatment of Osteoarthritis Knee Pain.

    Science.gov (United States)

    Nicholls, Mathew; Manjoo, Ajay; Shaw, Peter; Niazi, Faizan; Rosen, Jeffrey

    2018-01-01

    The inconsistent results within the current literature regarding the efficacy of intra-articular-hyaluronic acid (IA-HA) for the treatment of knee osteoarthritis (OA) have been suggested to be due to intrinsic differences between individual HA products. The purpose of this investigation is to define the rheological differences between currently available HA products in the United States at the time of this study for the treatment of knee OA, which will help elaborate on the appropriateness of classifying HA products as a class opposed to as individual agents. The rheological parameters for Euflexxa, Orthovisc, Supartz, Monovisc, Synvisc, Synvisc-One, Gel-One, and Hyalgan were obtained with a TA AR 2000 EX Rheometer with a cone-plate geometry (40-mm plate diameter and a 2° cone angle) at room temperature. The bulk rheological parameters of the different products suggest molecular structures traversing the range of dilute solution (Hyalgan, Supartz), semidilute solution (Euflexxa, Orthovisc), entangled solutions (Monovisc, Synvisc, Synvisc-One), and even gel-like (Gel-One) behavior. Due to the differences in rheological properties between IA-HA products, the universal assessment of these products as a class may not be appropriate. Instead, it may be more appropriate to assess each product individually. Future research should aim to link these differences in rheological properties to the differences in clinical efficacy seen across these IA-HA products.

  7. Retrospective Review of Hydrochloric Acid Infusion for the Treatment of Metabolic Alkalosis in Surgical Intensive Care Unit Patients.

    Science.gov (United States)

    Guffey, Jason D; Haas, Curtis E; Crowley, Amber; Connor, Kathryn A; Kaufman, David C

    2018-01-01

    Older reports of use of hydrochloric acid (HCl) infusions for treatment of metabolic alkalosis document variable dosing strategies and risk. This study sought to characterize use of HCl infusions in surgical intensive care unit patients for the treatment of metabolic alkalosis. This retrospective review included patients who received a HCl infusion for >8 hours. The primary end point was to evaluate the utility of common acid-base equations for predicting HCl dose requirements. Secondary end points evaluated adverse effects, efficacy, duration of therapy, and total HCl dose needed to correct metabolic alkalosis. Data on demographics, potential causes of metabolic alkalosis, fluid volume, and duration of diuretics as well as laboratory data were collected. A total of 30 patients were included, and the average HCl infusion rate was 10.5 ± 3.7 mEq/h for an average of 29 ± 14.6 hours. Metabolic alkalosis was primarily diuretic-induced (n = 26). Efficacy was characterized by reduction in the median total serum CO 2 from 34 to 27 mM/L ( P metabolic alkalosis, and no serious adverse events were seen. In this clinical setting, the baseline chloride ion deficit and SIDa were not useful for prediction of total HCl dose requirement, and serial monitoring of response is recommended.

  8. Remifentanil analgesia during laser treatment for retinopathy of prematurity: a practical approach in neonatal intensive care unit.

    Science.gov (United States)

    Demirel, Nihal; Bas, Ahmet Y; Kavurt, Sumru; Celik, Istemi H; Yucel, Husniye; Turkbay, Dursun; Hekimoğlu, Emre; Koc, Orhan

    2014-11-01

    Retinopathy of prematurity (ROP) is a significant cause of childhood blindness. The aim of this study is to determine the feasibility of remifentanil analgesia during laser treatment of ROP performed in the neonatal intensive care unit (NICU). Remifentanil was infused continuously during the procedure starting with a dose of 0.2 µg/kg/min and increased gradually to 0.6 µg/kg/min to provide an adequate level of analgesia. We enrolled 64 infants. Remifentanil was infused continuously at a mean rate of 0.4 ± 0.1 μg/kg/min. No major adverse effects were observed except in two patients with reversible bradycardia and hypotension. Premature infant pain profile (PIPP) scores revealed no pain. Patients with bronchopulmonary dysplasia had similar remifentanil dosage, intubation duration, and extubation time. Remifentanil analgesia for ROP treatment performed in the NICU by pediatricians is a safe and effective modality. This modality offers a practical solution in hospitals without readily available pediatric anesthetists. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Incidence and Treatment Patterns in Hospitalizations for Malignant Spinal Cord Compression in the United States, 1998-2006

    International Nuclear Information System (INIS)

    Mak, Kimberley S.; Lee, Leslie K.; Mak, Raymond H.; Wang, Shuang; Pile-Spellman, John; Abrahm, Janet L.; Prigerson, Holly G.; Balboni, Tracy A.

    2011-01-01

    Purpose: To characterize patterns in incidence, management, and costs of malignant spinal cord compression (MSCC) hospitalizations in the United States, using population-based data. Methods and Materials: Using the Nationwide Inpatient Sample, an all-payer healthcare database representative of all U.S. hospitalizations, MSCC-related hospitalizations were identified for the period 1998-2006. Cases were combined with age-adjusted Surveillance, Epidemiology and End Results cancer death data to estimate annual incidence. Linear regression characterized trends in patient, treatment, and hospital characteristics, costs, and outcomes. Logistic regression was used to examine inpatient treatment (radiotherapy [RT], surgery, or neither) by hospital characteristics and year, adjusting for confounding. Results: We identified 15,367 MSCC-related cases, representing 75,876 hospitalizations. Lung cancer (24.9%), prostate cancer (16.2%), and multiple myeloma (11.1%) were the most prevalent underlying cancer diagnoses. The annual incidence of MSCC hospitalization among patients dying of cancer was 3.4%; multiple myeloma (15.0%), Hodgkin and non-Hodgkin lymphomas (13.9%), and prostate cancer (5.5%) exhibited the highest cancer-specific incidence. Over the study period, inpatient RT for MSCC decreased (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.61-0.81), whereas surgery increased (OR 1.48, 95% CI 1.17-1.84). Hospitalization costs for MSCC increased (5.3% per year, p < 0.001). Odds of inpatient RT were greater at teaching hospitals (OR 1.41, 95% CI 1.19-1.67), whereas odds of surgery were greater at urban institutions (OR 1.82, 95% CI 1.29-2.58). Conclusions: In the United States, patients dying of cancer have an estimated 3.4% annual incidence of MSCC requiring hospitalization. Inpatient management of MSCC varied over time and by hospital characteristics, with hospitalization costs increasing. Future studies are required to determine the impact of treatment patterns on MSCC

  10. Adherence to Treatment, Safety, Tolerance, and Effectiveness of Perindopril/Amlodipine Fixed-Dose Combination in Greek Patients with Hypertension and Stable Coronary Artery Disease: A Pan-Hellenic Prospective Observational Study of Daily Clinical Practice.

    Science.gov (United States)

    Liakos, Charalampos I; Papadopoulos, Dimitrios P; Kotsis, Vasilios T

    2017-10-01

    Initiation of antihypertensive therapy with a two-drug fixed-dose combination (FDC) in a single tablet may be recommended in patients at high risk of cardiovascular events to improve adherence and effectiveness. Preferred combinations include an angiotensin-converting enzyme inhibitor with a dihydropyridine calcium antagonist. This study assessed adherence to and the safety, tolerance, and effectiveness of the perindopril/amlodipine FDC in Greek patients with hypertension and stable coronary artery disease (CAD) over a 4-month period. A total of 1907 patients with hypertension and CAD (59.1% males) who had recently (≤2 weeks) commenced treatment with the perindopril/amlodipine FDC (5/5, 5/10, 10/5, or 10/10 mg) were studied at baseline and at 1 and 4 months. Adherence to treatment was assessed with the Morisky Medication-taking Adherence Scale (MMAS). Seven patients (0.4%) did not attend the scheduled visits. In total, 1607 (84.6%) patients received a constant treatment dose throughout the study. High adherence (MMAS score = 0) was reported by 1592 (83.6%), 1628 (85.7%), and 1477 (77.7%) patients at the second and the third visit and at both visits, respectively. Adverse reactions were reported by only 13 (0.7%) patients, were all minor, and did not result in treatment discontinuation. Office blood pressure (BP) was significantly decreased at the third visit (130.8 ± 8.4/78.2 ± 6.4 mmHg) compared with baseline (156.5 ± 15.0/89.9 ± 9.6 mmHg; p < 0.001), regardless of previous antihypertensive treatment. Patients with grade 1, 2, and 3 hypertension at baseline showed a reduction in BP of 19.3/9.4, 31.5/13.5, and 47.8/22.2 mmHg, respectively (p < 0.001). Uncontrolled hypertension (≥140/90 mmHg) was notably reduced from 90.3% at baseline to 18.5% at the third visit. The perindopril/amlodipine FDC is characterized by high adherence and effectiveness, regardless of previous treatment. Degree of BP reduction was related to baseline BP levels

  11. A comprehensive study on HDR brachytherapy treatments of cervical cancers: using the first Co-60 BEBIG Multisource Unit in Bangladesh

    Directory of Open Access Journals (Sweden)

    Naheed Rukhsana

    2011-07-01

    Full Text Available Purpose: The report presents an extraordinary synthesis of customer acceptance procedures (CAP, quality assurance tests (QA in the treatment of cervical cancer patients, using the first Co-60 Multisource Unit® in Bangladesh. The QA and commissioning required measurements and emergency tests verifying the functional limits of parameters acceptable for the new HDR afterloader. Acceptable limits were: 1 the deviation between specified and measured source strength: ± 3%; 2 the positional accuracy and uniformity: ± 1 mm; 3 the temporal accuracy (i.e. timer error and linearity and end error: ± 1% or 30 sec.; 4 treatment planning system (digitizer and localization software: ± 3% or 1 mm; 5 the distance from line to first dwell position and all the others: 5 mm and 10 mm (± 1 mm. Material and methods: Till February 2011, 47 patients were treated with HDR with more than 140 insertions applied. Amongst them, 12 patients were in stage IIB and IIIB, 22 were postoperative (IA and IB while the remaining 13 patients were with unknown stage. All the cases with stage IIB and IIIB received concurrent chemo-radiation and brachytherapy. Postoperative patients received EBRT (50 Gy and HDR according to the institutional protocol. CT scans were completed before HDR-plus planning with a good reproducibility (± 2% and were documented in repeating the plan for the same set up of a patient. Absorbed dose (Gy to a point P, at a distance of “r” in centimeters from a source of the Reference Air Kerma Rate (RAKR has been utilized for the QA of the source, where source strength measurement was accomplished. Results: All methods and analysis applicable to the QA and commissioning of Co-60 have been investigated and systematically analyzed, measured and documented before the treatment of a patient. Studies and safety requirements of this HDR remote afterloader were carried out. Acceptance and the QA were imperative to justify functionality and dependability in

  12. A comprehensive study on HDR brachytherapy treatments of cervical cancers: using the first Co-60 BEBIG Multisource Unit in Bangladesh.

    Science.gov (United States)

    Malik, Sadiq R; Banu, Parvin A; Rukhsana, Naheed

    2011-06-01

    The report presents an extraordinary synthesis of customer acceptance procedures (CAP), quality assurance tests (QA) in the treatment of cervical cancer patients, using the first Co-60 Multisource Unit ® in Bangladesh. The QA and commissioning required measurements and emergency tests verifying the functional limits of parameters acceptable for the new HDR afterloader. Acceptable limits were: 1) the deviation between specified and measured source strength: ± 3%; 2) the positional accuracy and uniformity: ± 1 mm; 3) the temporal accuracy (i.e. timer error and linearity and end error): ± 1% or 30 sec.; 4) treatment planning system (digitizer and localization software): ± 3% or 1 mm; 5) the distance from line to first dwell position and all the others: 5 mm and 10 mm (± 1 mm). Till February 2011, 47 patients were treated with HDR with more than 140 insertions applied. Amongst them, 12 patients were in stage IIB and IIIB, 22 were postoperative (IA and IB) while the remaining 13 patients were with unknown stage. All the cases with stage IIB and IIIB received concurrent chemo-radiation and brachytherapy. Postoperative patients received EBRT (50 Gy and HDR) according to the institutional protocol. CT scans were completed before HDR-plus planning with a good reproducibility (± 2%) and were documented in repeating the plan for the same set up of a patient. Absorbed dose (Gy) to a point P, at a distance of "r" in centimeters from a source of the Reference Air Kerma Rate (RAKR) has been utilized for the QA of the source, where source strength measurement was accomplished. All methods and analysis applicable to the QA and commissioning of Co-60 have been investigated and systematically analyzed, measured and documented before the treatment of a patient. Studies and safety requirements of this HDR remote afterloader were carried out. Acceptance and the QA were imperative to justify functionality and dependability in delivering the treatment. Implications of these studies

  13. Treatment Patterns and Associated Health Care Costs Before and After Treatment Initiation Among Pulmonary Arterial Hypertension Patients in the United States.

    Science.gov (United States)

    Burger, Charles D; Ozbay, A Burak; Lazarus, Howard M; Riehle, Ellen; Montejano, Leslie B; Lenhart, Gregory; White, R James

    2018-02-13

    Despite multiple treatment options, the prognosis of pulmonary arterial hypertension (PAH) remains poor. PAH patients experience a high economic burden due to comorbidities, hospitalizations, and medication costs. Although combination therapy has been shown to reduce hospitalizations, the relationship between treatment, health care utilization, and costs remains unclear. To provide a characterization of health care utilization and costs in real-world settings by comparing periods before and after initiating PAH-specific treatment. This retrospective study identified PAH patients in the Truven Health MarketScan Commercial and Medicare Supplemental Databases between 2010 and 2014 who initiated treatment with endothelin receptor antagonists (ERAs), phosphodiesterase-5 inhibitors (PDE-5Is), or soluble guanylate cyclase (sGC) stimulators. The index date was the date of the first PAH pharmacy claim. We included patients with ≥ 2 medical claims with diagnoses for PAH (ICD-9-CM: 416.0, 416.8) or PAH-related conditions and continuous enrollment in medical and pharmacy benefits for the 6 months before and after the index date. Treatment patterns were assessed at the drug class level (ERAs, PDE-5Is, sGC stimulators, and prostacyclins) from outpatient pharmacy claims during the 6-month post-index period. All-cause and PAH-related utilization and costs were measured. McNemar's and paired t-tests were used to compare patients' health care resource utilization and costs in the 6-month pre- and posttreatment periods. A total of 3,908 patients met the selection criteria. The study sample was 63% female with a mean age of 63 ± 15 years. Only 5% of patients began initial combination therapy for PAH, defined as claims for ≥ 2 medication classes within the first 30 days of treatment. Treatment interruption (≥ 30-day gap in days supply) of any PAH-specific medication was observed in 38% of patients. Compared with the 6-month pre-index period, the proportion of patients in the 6

  14. Antiretroviral regimen durability and success in treatment-naïve and treatment-experienced patients by year of treatment initiation, United States, 1996–2011

    Science.gov (United States)

    Sheth, Anandi N.; Ofotokun, Ighovwerha; Buchacz, Kate; Armon, Carl; Chmiel, Joan S.; Hart, Rachel L.D.; Baker, Rose; Brooks, John T.; Palella, Frank J.

    2015-01-01

    Background Although modern combination antiretroviral therapy (cART) regimens are better tolerated and less complex than earlier treatments, regimen modification or discontinuation remains a concern. Methods We studied HIV Outpatient Study (HOPS) participants who initiated first or second cART regimens during: 1996–1999, 2000–2003, 2004–2007 and 2008–2011. We analyzed regimen durability (time to regimen modification) and success (achieving undetectable plasma HIV RNA) for first and second cART regimens using Kaplan-Meier curves and log-rank tests, and examined factors associated with durability and success of first cART regimen using proportional hazards models. Results Durability of cART was progressively longer for cART regimens initiated in more recent periods: median first cART regimen durations were 1.0, 1.1, 2.1 and 4.6 years in 1996–1999, 2000–2003, 2004–2007 and 2008–2011, and median second cART durations were 0.9, 1.2, 2.8 and 3.9 years, respectively (both p<0.001). Comparing 1996–1999 and 2008–2011, the percentage of patients who achieved an undetectable HIV RNA within 6 months of first cART initiation increased from 65% to 81%, and from 63% to 80% on second cART (both p<0.001). Among patients initiating first cART during 2008–2011, black non-Hispanic/Latino race/ethnicity and ≥twice daily dosing were significantly associated with higher rates of regimen modification (p<0.05), and higher baseline HIV RNA levels were associated with failure to achieve an undetectable HIV RNA (p<0.001). Conclusions Among HIV-infected U.S. adults in routine HIV care, durability of first and second cART regimens and the likelihood of prompt virologic suppression increased during 1996–2011, coincident with the availability of more tolerable, less complex cART options. PMID:26334737

  15. Stable isotope analysis

    International Nuclear Information System (INIS)

    Tibari, Elghali; Taous, Fouad; Marah, Hamid

    2014-01-01

    This report presents results related to stable isotopes analysis carried out at the CNESTEN DASTE in Rabat (Morocco), on behalf of Senegal. These analyzes cover 127 samples. These results demonstrate that Oxygen-18 and Deuterium in water analysis were performed by infrared Laser spectroscopy using a LGR / DLT-100 with Autosampler. Also, the results are expressed in δ values (‰) relative to V-SMOW to ± 0.3 ‰ for oxygen-18 and ± 1 ‰ for deuterium.

  16. Applications of stable isotopes in clinical pharmacology

    Science.gov (United States)

    Schellekens, Reinout C A; Stellaard, Frans; Woerdenbag, Herman J; Frijlink, Henderik W; Kosterink, Jos G W

    2011-01-01

    This review aims to present an overview of the application of stable isotope technology in clinical pharmacology. Three main categories of stable isotope technology can be distinguished in clinical pharmacology. Firstly, it is applied in the assessment of drug pharmacology to determine the pharmacokinetic profile or mode of action of a drug substance. Secondly, stable isotopes may be used for the assessment of drug products or drug delivery systems by determination of parameters such as the bioavailability or the release profile. Thirdly, patients may be assessed in relation to patient-specific drug treatment; this concept is often called personalized medicine. In this article, the application of stable isotope technology in the aforementioned three areas is reviewed, with emphasis on developments over the past 25 years. The applications are illustrated with examples from clinical studies in humans. PMID:21801197

  17. Forensic Stable Isotope Biogeochemistry

    Science.gov (United States)

    Cerling, Thure E.; Barnette, Janet E.; Bowen, Gabriel J.; Chesson, Lesley A.; Ehleringer, James R.; Remien, Christopher H.; Shea, Patrick; Tipple, Brett J.; West, Jason B.

    2016-06-01

    Stable isotopes are being used for forensic science studies, with applications to both natural and manufactured products. In this review we discuss how scientific evidence can be used in the legal context and where the scientific progress of hypothesis revisions can be in tension with the legal expectations of widely used methods for measurements. Although this review is written in the context of US law, many of the considerations of scientific reproducibility and acceptance of relevant scientific data span other legal systems that might apply different legal principles and therefore reach different conclusions. Stable isotopes are used in legal situations for comparing samples for authenticity or evidentiary considerations, in understanding trade patterns of illegal materials, and in understanding the origins of unknown decedents. Isotope evidence is particularly useful when considered in the broad framework of physiochemical processes and in recognizing regional to global patterns found in many materials, including foods and food products, drugs, and humans. Stable isotopes considered in the larger spatial context add an important dimension to forensic science.

  18. Malaria Treatment (United States)

    Science.gov (United States)

    ... 1088) or fax (1-800-FDA-0178) The advantage to having your health care provider file the ... Parasitic Diseases and Malaria Email Recommend Tweet YouTube Instagram Listen Watch RSS ABOUT About CDC Jobs Funding ...

  19. Reengineering water treatment units for removal of Sr-90, I-129, Tc-99, and uranium from contaminated groundwater at the DOE's Savannah River Site

    International Nuclear Information System (INIS)

    Serkiz, S.M.

    2000-01-01

    The 33 years of active operation of the F- and H-Area Seepage Basins to dispose of liquid low-level radioactive waste at the Department of Energy's Savannah River Site has resulted in the contamination of the groundwater underlying these basins with a wide variety of radionuclides and stable metals. The current Resource Conservation and Recovery Act (RCRA) Part B permit requires the operation of a pump-and-treat system capable of (1) maintaining hydraulic control of a specified contaminated groundwater plume, (2) treatment of the extracted groundwater, and (3) reinjection of the treated water hydraulically upgradient of the basins. Two multimillion-dollar water treatment units (WTUs) were designed and built in 1997 and the basic design consists of (1) reverse osmosis concentration, (2) chemical addition, neutralization, precipitation, polymer addition, flocculation, and clarification of the reverse osmosis concentrate, and (3) final polishing of the clarified water by ion exchange (IX) and sorption. During startup of these units numerous process optimizations were identified and, therefore, the WTUs have been recently reengineered. A systematic approach of: (1) developing a technical baseline through laboratory studies, (2) scale-up and plant testing, (3) plant modification, and (4) system performance monitoring was the basis for reengineering the WTUs. Laboratory experiments were conducted in order to establish a technical baseline for further scale-up/plant testing and system modifications. These studies focused on the following three areas of the process: (1) contaminant removal during chemical addition, neutralization and precipitation, (2) solids separation by flocculation, coagulation, clarification, and filtration, and (3) contaminant polishing of the clarified liquid by IX/sorption. Using standard laboratory-scale jar tests, the influences of pH and Fe concentration on contaminant removal during precipitation/neutralization were evaluated. The results of

  20. Comparing Fr\\'echet and positive stable laws

    OpenAIRE

    Simon, Thomas

    2013-01-01

    Let ${\\bf L}$ be the unit exponential random variable and ${\\bf Z}_\\alpha$ the standard positive $\\alpha$-stable random variable. We prove that $\\{(1-\\alpha) \\alpha^{\\gamma_\\alpha} {\\bf Z}_\\alpha^{-\\gamma_\\alpha}, 0< \\alpha

  1. Back to the future: extended dialysis for treatment of acute kidney injury in the intensive care unit.

    Science.gov (United States)

    Kielstein, Jan T; Schiffer, Mario; Hafer, Carsten

    2010-01-01

    On September 11, 1945, Maria Schafstaat was the first patient who successfully underwent a dialysis treatment for acute kidney injury (AKI). The ingenious design of the first dialysis machine, made of cellophane tubing wrapped around a cylinder that rotated in a bath of fluid, together with the brave determination to treat patients with AKI, enabled the Dutch physician W.J. Kolff to save the life of the 67-year-old woman. By treating her for 690 minutes (i.e., 11.5 hours) with a blood flow rate of 116 ml/min, Kolff also set the coordinates of a renal replacement therapy that has enjoyed an unsurpassed renaissance over the last decade for treatment of severely ill patients with AKI in the intensive care unit (ICU). Prolonged dialysis time with low flow rates - these days, called extended dialysis (ED) - combines several advantages of both intermittent and continuous techniques, which makes it an ideal treatment method for ICU patients with AKI. This review summarizes our knowledge of this method, which is increasingly used in many centers worldwide. We reflect on prospective controlled studies in critically ill patients that have documented that small-solute clearance with ED is comparable with that of intermittent hemodialysis and continuous venovenous hemofiltration, as well as on studies showing that patients' cardiovascular stability during ED is similar to that with continuous renal replacement therapy. Furthermore, we report on logistic and economic advantages of this method. We share our view on how extended dialysis offers ample opportunity for a collaborative interaction between nephrologists and intensivists as the nephrology staff, enabling optimal treatment of complex critically ill patients by using the skill and knowledge of 2 indispensable specialties in the ICU. Lastly, we address the problem of ED intensity, which does not seem to have an impact on survival at higher doses, a finding that might be caused by the fact that we still adhere to dosing

  2. Highly scalable multichannel mesh electronics for stable chronic brain electrophysiology.

    Science.gov (United States)

    Fu, Tian-Ming; Hong, Guosong; Viveros, Robert D; Zhou, Tao; Lieber, Charles M

    2017-11-21

    Implantable electrical probes have led to advances in neuroscience, brain-machine interfaces, and treatment of neurological diseases, yet they remain limited in several key aspects. Ideally, an electrical probe should be capable of recording from large numbers of neurons across multiple local circuits and, importantly, allow stable tracking of the evolution of these neurons over the entire course of study. Silicon probes based on microfabrication can yield large-scale, high-density recording but face challenges of chronic gliosis and instability due to mechanical and structural mismatch with the brain. Ultraflexible mesh electronics, on the other hand, have demonstrated negligible chronic immune response and stable long-term brain monitoring at single-neuron level, although, to date, it has been limited to 16 channels. Here, we present a scalable scheme for highly multiplexed mesh electronics probes to bridge the gap between scalability and flexibility, where 32 to 128 channels per probe were implemented while the crucial brain-like structure and mechanics were maintained. Combining this mesh design with multisite injection, we demonstrate stable 128-channel local field potential and single-unit recordings from multiple brain regions in awake restrained mice over 4 mo. In addition, the newly integrated mesh is used to validate stable chronic recordings in freely behaving mice. This scalable scheme for mesh electronics together with demonstrated long-term stability represent important progress toward the realization of ideal implantable electrical probes allowing for mapping and tracking single-neuron level circuit changes associated with learning, aging, and neurodegenerative diseases. Copyright © 2017 the Author(s). Published by PNAS.

  3. Using simulated historical time series to prioritize fuel treatments on landscapes across the United States: The LANDFIRE prototype project

    Science.gov (United States)

    Keane, Robert E.; Rollins, Matthew; Zhu, Zhi-Liang

    2007-01-01

    Canopy and surface fuels in many fire-prone forests of the United States have increased over the last 70 years as a result of modern fire exclusion policies, grazing, and other land management activities. The Healthy Forest Restoration Act and National Fire Plan establish a national commitment to reduce fire hazard and restore fire-adapted ecosystems across the USA. The primary index used to prioritize treatment areas across the nation is Fire Regime Condition Class (FRCC) computed as departures of current conditions from the historical fire and landscape conditions. This paper describes a process that uses an extensive set of ecological models to map FRCC from a departure statistic computed from simulated time series of historical landscape composition. This mapping process uses a data-driven, biophysical approach where georeferenced field data, biogeochemical simulation models, and spatial data libraries are integrated using spatial statistical modeling to map environmental gradients that are then used to predict vegetation and fuels characteristics over space. These characteristics are then fed into a landscape fire and succession simulation model to simulate a time series of historical landscape compositions that are then compared to the composition of current landscapes to compute departure, and the FRCC values. Intermediate products from this process are then used to create ancillary vegetation, fuels, and fire regime layers that are useful in the eventual planning and implementation of fuel and restoration treatments at local scales. The complex integration of varied ecological models at different scales is described and problems encountered during the implementation of this process in the LANDFIRE prototype project are addressed.

  4. Carbapenem-resistant Klebsiella pneumoniae infections in a Greek intensive care unit: Molecular characterisation and treatment challenges.

    Science.gov (United States)

    Katsiari, Maria; Panagiota, Giakkoupi; Likousi, Sophia; Roussou, Zoi; Polemis, Michalis; Alkiviadis Vatopoulos, C; Evangelia Platsouka, D; Maguina, Asimina

    2015-06-01

    Acquisition of carbapenemase-producing Klebsiella pneumoniae (CP-Kp) strains poses a major threat to critically ill patients. The objectives of this study were to describe the epidemiology of CP-Kp isolates as well as the clinical outcome associated with the corresponding infections and to identify risk factors for mortality of intensive care unit (ICU) patients in a Greek hospital. A prospective, observational study was conducted in a nine-bed general ICU over a 2-year period (April 2010-March 2012). Imipenem-resistant K. pneumoniae isolates recovered from clinical samples of ICU patients were prospectively collected and studied for the presence of carbapenemases. Isolates were submitted to molecular typing using pulsed-field gel electrophoresis (PFGE). In total, 61 CP-Kp isolates (48 KPC-producers and 13 VIM-producers) were recovered from 58 ICU patients. The majority of KPC-producers were classified into a single PFGE type, indicating potent clonal dissemination. Among the 32 infected patients, bacteraemia was diagnosed in 16. Tigecycline+colistin was the most common combination antimicrobial regimen. Infection-attributable mortality was 43.8%. Regarding mortality risk factors, non-survivors were older (P=0.080), all of them presented with septic shock (P=0.010) and they had higher Sepsis-related Organ Failure Assessment (SOFA) scores at infection onset (P=0.004) compared with survivors. Appropriate definitive treatment and combination regimens were not associated with patient survival. In conclusion, CP-Kp infections are associated with limited treatment options and high in-hospital mortality. Effective measures for preventing dissemination of respective isolates in the hospital setting are required. Copyright © 2015 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.

  5. The relationship between ASSH membership and the treatment of distal radius fracture in the United States Medicare population.

    Science.gov (United States)

    Chung, Kevin C; Shauver, Melissa J; Yin, Huiying

    2011-08-01

    Internal fixation for distal radius fractures (DRFs) in the elderly has increased from 3% in 1997 to 17% in 2007. This increase has been uneven across regions of the United States. There is some evidence that patients treated by hand surgeons receive internal fixation at an increased rate and that hand surgeons might be driving the increased usage in regions where their presence is greatest. The specific aim of this study was to explore this relationship by analyzing Medicare beneficiaries treated by members of the American Society for Surgery of the Hand (ASSH). Surgeons who were members of ASSH in 2007 were matched with surgeons treating Medicare beneficiaries for DRFs in the same year. We then fit a series of multilevel models to estimate the proportion of total variance in internal fixation usage explained by ASSH membership status, patient demographic data, patient comorbidity, and/or type of fracture diagnosed. Beneficiaries treated by ASSH members received internal fixation significantly more often than beneficiaries who were treated by surgeons who were not ASSH members. ASSH member status accounts for 12% of the total variance in internal fixation utilization. Medicare beneficiaries who were treated by ASSH member surgeons receive internal fixation at a significantly higher rate than do patients of other physicians. When there is uncertainty about the optimal treatment for a condition, there is the possibility for specialty-related disparities. This specialty effect contributes to the national variations in the treatment of DRFs in the Medicare population. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  6. Treatment intensity and outcome of patients aged 80 and older in intensive care units: a multicenter matched-cohort study.

    Science.gov (United States)

    Boumendil, Ariane; Aegerter, Philippe; Guidet, Bertrand

    2005-01-01

    To determine whether patients aged 80 and older have similar treatment intensity to that of younger patients in the intensive care unit (ICU). Multicenter, matched-cohort study. Data were extracted from a multicenter database with 36 ICUs in the Paris area (France) during a 4-year period (1997-2000). Three thousand one hundred seventy-five patients aged 80 and older (oldest-old) were retrospectively matched to 3,175 patients aged 65 to 79 (young-old). The matching criteria were severity status on admission (+/-2) (assessed using a corrected Simplified Acute Physiology Score II leaving out age points), Charlson Comorbidity Index, type of admission (surgical vs medical), sex, admission to same ICU, and year of ICU admission. The underlying condition was classified using the McCabe classification. The functional status was assessed using the Knaus classification. The ICU workload was assessed using the OMEGA scoring system. Total and daily workload were lower in the oldest-old than in matched young-old patients. Estimated mean direct medical cost per stay was approximately 1,280 dollars lower for oldest-old patients. Older patients received less mechanical ventilation (adjusted odds ratio (AOR)=0.69, 95% confidence interval (CI)=0.61-0.78), less tracheostomy (AOR=0.37, 95% CI=0.28-0.50), and less renal support (AOR=0.52, 95% CI=0.41-0.66) than matched young-old patients. Oldest-old patients had a shorter length of ICU stay than matched young-old patients and the same length of post-ICU stay. Oldest-old patients receive less treatment in the ICU than young-old patients even after adjustment for severity of illness.

  7. Life-Sustaining Treatment Status at the Time of Death in a Japanese Pediatric Intensive Care Unit.

    Science.gov (United States)

    Suzuki, Fumiko; Takeuchi, Muneyuki; Tachibana, Kazuya; Isaka, Kanako; Inata, Yu; Kinouchi, Keiko

    2017-01-01

    Substantial variability exists among countries regarding the modes of death in pediatric intensive care units (PICUs). However, there is limited information on end-of-life care in Japanese PICUs. Thus, this study aimed to elucidate the characteristics of end-of-life care practice for children in a Japanese PICU. We examined life-sustaining treatment (LST) status at the time of death based on medical chart reviews from 2010 to 2014. All deaths were classified into 3 groups: limitation of LST (limitation group, death after withholding or withdrawal of LST or a do not attempt resuscitation order), no limitation of LST (no-limitation group, death following failed resuscitation attempts), or brain death (brain death group). Of the 62 patients who died, 44 (71%) had limitation of LST, 18 (29%) had no limitation of LST, and none had brain death. In the limitation group, the length of PICU stay was longer than that in the no-limitation group (13.5 vs 2.5 days; P = .01). The median time to death after the decision to limit LST was 2 days (interquartile range: 1-5.5 days), and 94% of the patients were on mechanical ventilation at the time of death in the limitation group. Although limiting LST was a common practice in end-of-life care in a Japanese PICU, a severe limitation of LST such as withdrawal from the ventilator was hardly practiced, and a considerable LST was still provided at the time of death.

  8. Organizing Publicly Funded Substance Use Disorder Treatment in the United States: Moving Toward a Service System Approach.

    Science.gov (United States)

    Padwa, Howard; Urada, Darren; Gauthier, Patrick; Rieckmann, Traci; Hurley, Brian; Crèvecouer-MacPhail, Desirée; Rawson, Richard A

    2016-10-01

    Historically, publicly funded substance use disorder (SUD) treatment services in the United States have been disorganized and inefficient. By reconfiguring and linking services to create systems of care-services, structures, and processes that are purposively interconnected to treat SUD systematically-health systems can transform discrete service components into cohesive service systems that comprehensively and efficiently treat SUDs. In this article we: (1) articulate the potential benefits of organizing publicly funded SUD services into systems of care; (2) review basic principles underlying theories of SUD system organization; (3) describe the mix and configuration of services needed to create comprehensive, integrated systems of publicly funded SUD care; (4) elucidate how patients can flow through systems of SUD services in a clinically sound and cost-efficient manner, and; (5) propose eight steps that can be taken to create systems of care by identifying and leveraging the strengths, assets, and capacities of SUD service providers already operating within their health care systems. In July 2015, the Centers for Medicare and Medicaid Services (CMS) announced opportunities for states to redesign their Medicaid-funded SUD service systems. This paper provides considerations for SUD system design and development. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Historical assessment of uranium release by the ore treatment unit - at Caldas, Minas Gerais, Brazil from 1999 to 2011

    International Nuclear Information System (INIS)

    Pereira, W.S.; Carmo, R.F.; Py Junior, D.A.

    2013-01-01

    The Ore Treatment Unit (OTU) is located at the source of three rivers: Ribeirao das Antas, Ribeirao do Soberbo and Corrego da Consulta. Each interface of installation with the environment, at the tree rivers, has been monitored for the release of radionuclides. At Ribeirao das Antas a weekly sample collection was made at point 014. At Ribeirao Soberbo there was a weekly sample collection at point 025, and at Corrego da Consulta a monthly collection was carried out at point 076. This work analyses the average annual releases of uranium from the historical series started in 1999 and ended in 2011. Points 014 and 025 showed average release of 0.12 Bq L -1 . Point 076 showed somewhat higher average release, 1.27 Bq L -1 . An Analysis Of Variance test (ANOVA) has been carried out to verify the existence of different means between these collecting points. The averages were considered statistically different. As a complementary analysis, the Student's t test was performed between the averages at considered points. Between points 014 and 025, the averages were considered identical. Between points 014 and 076, the average release at point 076 was considered higher than that at point 014. The same behavior was observed between points 025 and 076. The releases at point 076 were considered higher than those at point 025. Thus it can be concluded that releases at points 014 and 025 are identical and both are lower than releases at point 076. (author)

  10. Aggressive Fibromatosis: Evidence for a Stable Phase

    Directory of Open Access Journals (Sweden)

    Gillian Mitchell

    1998-01-01

    Full Text Available Purpose. Aggressive fibromatosis (AF is an uncommon locally infiltrating benign disease of soft tissue for which treatment comprises complete surgical resection. Radiotherapy can be given postoperatively if the margin is incompletely resected. If the tumour is inoperable radiotherapy provides an alternative treatment. Hormone therapy and cytotoxic chemotherapy have also been used for unresectable or recurrent disease. All treatment modalities carry an associated morbidity. We believe that the natural history of aggressive fibromatosis may include a period of stable disease without progression, during which time, treatment is not always necessary.

  11. Marginally Stable Nuclear Burning

    Science.gov (United States)

    Strohmayer, Tod E.; Altamirano, D.

    2012-01-01

    Thermonuclear X-ray bursts result from unstable nuclear burning of the material accreted on neutron stars in some low mass X-ray binaries (LMXBs). Theory predicts that close to the boundary of stability oscillatory burning can occur. This marginally stable regime has so far been identified in only a small number of sources. We present Rossi X-ray Timing Explorer (RXTE) observations of the bursting, high- inclination LMXB 4U 1323-619 that reveal for the first time in this source the signature of marginally stable burning. The source was observed during two successive RXTE orbits for approximately 5 ksec beginning at 10:14:01 UTC on March 28, 2011. Significant mHz quasi- periodic oscillations (QPO) at a frequency of 8.1 mHz are detected for approximately 1600 s from the beginning of the observation until the occurrence of a thermonuclear X-ray burst at 10:42:22 UTC. The mHz oscillations are not detected following the X-ray burst. The average fractional rms amplitude of the mHz QPOs is 6.4% (3 - 20 keV), and the amplitude increases to about 8% below 10 keV.This phenomenology is strikingly similar to that seen in the LMXB 4U 1636-53. Indeed, the frequency of the mHz QPOs in 4U 1323-619 prior to the X-ray burst is very similar to the transition frequency between mHz QPO and bursts found in 4U 1636-53 by Altamirano et al. (2008). These results strongly suggest that the observed QPOs in 4U 1323-619 are, like those in 4U 1636-53, due to marginally stable nuclear burning. We also explore the dependence of the energy spectrum on the oscillation phase, and we place the present observations within the context of the spectral evolution of the accretion-powered flux from the source.

  12. Application for verification of monitor units of the treatment planning system; Aplicacion para la verificacion de unidades monitor del sistema de planificacion de tratamientos

    Energy Technology Data Exchange (ETDEWEB)

    Suero Rodrigo, M. A.; Marques Fraguela, E.

    2011-07-01

    Current estimates algorithms achieve acceptable degree of accuracy. However, operate on the basis of un intuitive models. It is therefore necessary to verify the calculation of monitor units of the treatment planning system (PTS) with those obtained by other independent formalisms. To this end, we have developed an application based on factorization formalism that automates the calculation of dose.

  13. Simulating fuel treatment effects in dry forests of the western United States: testing the principles of a fire-safe forest

    Science.gov (United States)

    Morris C. Johnson; Maureen C Kennedy; David L. Peterson

    2011-01-01

    We used the Fire and Fuels Extension to the Forest Vegetation Simulator (FFE-FVS) to simulate fuel treatment effects on stands in low- to midelevation dry forests (e.g., ponderosa pine (Pinus ponderosa Dougl. ex. P. & C. Laws.) and Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) of the western United States. We...

  14. A community-based delivery system of intermittent preventive treatment of malaria in pregnancy and its effect on use of essential maternity care at health units in Uganda

    DEFF Research Database (Denmark)

    Mbonye, Anthony K; Bygbjerg, I C; Magnussen, Pascal

    2007-01-01

    Community delivery of intermittent preventive treatment of malaria in pregnancy (IPTp) is one potential option that could mitigate malaria in pregnancy. However, there is concern that this approach may lead to complacency among women with low access to essential care at health units. A non-random...

  15. 19 CFR 7.3 - Duty-free treatment of goods imported from insular possessions of the United States other than...

    Science.gov (United States)

    2010-04-01

    ... the goods: (A) Remained under the control of the customs authority of the foreign territory or country... 19 Customs Duties 1 2010-04-01 2010-04-01 false Duty-free treatment of goods imported from insular possessions of the United States other than Puerto Rico. 7.3 Section 7.3 Customs Duties U.S. CUSTOMS AND...

  16. The Treatment of the Holocaust in Textbooks: The Federal Republic of Germany, Israel, The United States of America. Holocaust Studies Series.

    Science.gov (United States)

    Braham, Randolph L., Ed.

    This book presents an overview of the treatment of the Holocaust in the textbooks used in the Federal Republic of Germany, Israel, and the United States. Selection of these three countries was based on historical, political, and state administration criteria. All three countries are democratic but vary in terms of history, heritage, and…

  17. A two-step crushed lava rock filter unit for grey water treatment at household level in an urban slum.

    Science.gov (United States)

    Katukiza, A Y; Ronteltap, M; Niwagaba, C B; Kansiime, F; Lens, P N L

    2014-01-15

    Decentralised grey water treatment in urban slums using low-cost and robust technologies offers opportunities to minimise public health risks and to reduce environmental pollution caused by the highly polluted grey water i.e. with a COD and N concentration of 3000-6000 mg L(-1) and 30-40 mg L(-1), respectively. However, there has been very limited action research to reduce the pollution load from uncontrolled grey water discharge by households in urban slums. This study was therefore carried out to investigate the potential of a two-step filtration process to reduce the grey water pollution load in an urban slum using a crushed lava rock filter, to determine the main filter design and operation parameters and the effect of intermittent flow on the grey water effluent quality. A two-step crushed lava rock filter unit was designed and implemented for use by a household in the Bwaise III slum in Kampala city (Uganda). It was monitored at a varying hydraulic loading rate (HLR) of 0.5-1.1 m d(-1) as well as at a constant HLR of 0.39 m d(-1). The removal efficiencies of COD, TP and TKN were, respectively, 85.9%, 58% and 65.5% under a varying HLR and 90.5%, 59.5% and 69%, when operating at a constant HLR regime. In addition, the log removal of Escherichia coli, Salmonella spp. and total coliforms was, respectively, 3.8, 3.2 and 3.9 under the varying HLR and 3.9, 3.5 and 3.9 at a constant HLR. The results show that the use of a two-step filtration process as well as a lower constant HLR increased the pollutant removal efficiencies. Further research is needed to investigate the feasibility of adding a tertiary treatment step to increase the nutrients and microorganisms removal from grey water. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Ebola Virus Disease and Pregnancy: A Retrospective Cohort Study of Patients Managed at 5 Ebola Treatment Units in West Africa.

    Science.gov (United States)

    Henwood, Patricia C; Bebell, Lisa M; Roshania, Reshma; Wolfman, Vanessa; Mallow, Michaela; Kalyanpur, Anushka; Levine, Adam C

    2017-07-15

    Reliable data are lacking on pregnancy outcomes during Ebola virus disease (EVD) epidemics. We aimed to characterize symptoms and outcomes among pregnant women admitted to Ebola treatment units (ETUs) with suspected and confirmed EVD to better inform obstetric management. We analyzed a retrospective cohort of reproductive-aged women presenting to 5 West African ETUs from September 2014 to September 2015. We compared clinical symptoms, risk of EVD diagnosis, and mortality between pregnant and nonpregnant women. Of 729 reproductive-aged women admitted to study ETUs, 44 (6%) reported pregnancy. Thirteen of 44 pregnant women (30%) tested EVD positive; 6 of 13 (46%) died. Pregnant women were less likely than nonpregnant women to report anorexia, asthenia, diarrhea, fever, myalgias/arthralgias, nausea, or vomiting (P < .05) at admission. Pregnant women with suspected EVD had the same risk, however, of laboratory-confirmed EVD (30% vs 24%, P = .38). While pregnant women with confirmed EVD had similar Ebola viral loads on presentation to nonpregnant women, as measured by initial cycle threshold (26.4 vs 23.2, P = .16), they were less likely to have myalgias/arthralgias (P< .001) and vomiting (P = .02). Both all-cause mortality (14% vs 19%, P = .39) and EVD-specific mortality (46% vs 54%, P = .60) were not significantly different between pregnant and nonpregnant women. Two neonates born live in the ETU died within 8 days. We find no evidence to support a difference in the risk of death between pregnant women with suspected or confirmed EVD compared to nonpregnant women. Limited data suggest poor fetal and neonatal outcomes in EVD-affected pregnancies. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

  19. [Treatment of pediatric lithiasis in the lithotripsy and endourology unit of "Hospital La Luz". Commented retrospective of our case series].

    Science.gov (United States)

    Orozco Fariñas, R; Iglesias Prieto, J I; Pellejero Pérez, P; Massarrah Halabi, J; Mancebo, J M; Pérez-Castro Ellendt, E

    2016-09-01

    The aim of the present article is to summarize the results we obtained treating children with urolithiasis over the last 30 years and to perform an analysis on the basis of the these results and relevant details according to national and international experience. Retrospective and descriptive statistical analysis of the 30 year experience in our clinics. The study was performed with a sample size of 178 children treated with urolithiasis that underwent 221 procedures. These procedures include ESWL, ureterorenoscopy (URS) and percutaneous nephrolithotomy (PCNL). We conclude in this study that ESWL in children was the most appropriate procedure for renal and proximal and middle-third ureteral lithiasis. Kidney stones measuring 2 to 3 cm can be treated without additional procedures or combined approaches. In contrast cystine stones caused the major problems for fragmentation. Moreover, the use of double J catheters increased the need for ESWL when catheter calcification occurred and endoscopic removal was impossible. The benefits of this method must be individually assessed both for the benefit of the temporary placement as well as for the expectation of permanence. We conclude that URS is the best choice for distal-third ureteral lithiasis and some cases of proximal and middle- third ureteral lithiasis. This enables for simultaneous treatments, ureteral dilatation and unexpected diagnoses. In particular, rigid ureteroscopy offers adjuvant options to ESWL with great therapeutic potential and easy handling. In consequence, to our good results and cost-benefit balance using ESWL and rigid URS (even combined), the use of flexible URS for renal lithiasis has been reduced. In general community units like ours, the combined PCNL has been indicated for particular complex cases, and open or laparoscopic surgery was not necessary in any case.

  20. Effectiveness of osteopathic manipulative treatment in neonatal intensive care units: protocol for a multicentre randomised clinical trial

    Science.gov (United States)

    Cerritelli, Francesco; Pizzolorusso, Gianfranco; Renzetti, Cinzia; D'Incecco, Carmine; Fusilli, Paola; Perri, Paolo Francesco; Tubaldi, Lucia; Barlafante, Gina

    2013-01-01

    Introduction Neonatal care has been considered as one of the first priorities for improving quality of life in children. In 2010, 10% of babies were born prematurely influencing national healthcare policies, economic action plans and political decisions. The use of complementary medicine has been applied to the care of newborns. One previous study documented the positive effect of osteopathic manipulative treatment (OMT) in reducing newborns’ length of stay (LOS). Aim of this multicentre randomised controlled trial is to examine the association between OMT and LOS across three neonatal intensive care units (NICUs). Methods and analysis 690 preterm infants will be recruited from three secondary and tertiary NICUs from north and central Italy and allocated into two groups, using permuted-block randomisation. The two groups will receive standard medical care and OMT will be applied, twice a week, to the experimental group only. Outcome assessors will be blinded of study design and group allocation. The primary outcome is the mean difference in days between discharge and entry. Secondary outcomes are difference in daily weight gain, number of episodes of vomit, regurgitation, stooling, use of enema, time to full enteral feeding and NICU costs. Statistical analyses will take into account the intention-to-treat method. Missing data will be handled using last observation carried forward (LOCF) imputation technique. Ethics and dissemination Written informed consent will be obtained from parents or legal guardians at study enrolment. The trial has been approved by the ethical committee of Macerata hospital (n°22/int./CEI/27239) and it is under review by the other regional ethics committees. Results Dissemination of results from this trial will be through scientific medical journals and conferences. Trial registration This trial has been registered at http://www.clinicaltrials.org (identifier NCT01645137). PMID:23430598

  1. Treatment for presumed BK polyomavirus nephropathy and risk of urinary tract cancers among kidney transplant recipients in the United States.

    Science.gov (United States)

    Gupta, Gaurav; Kuppachi, Sarat; Kalil, Roberto S; Buck, Christopher B; Lynch, Charles F; Engels, Eric A

    2018-01-01

    Recent case series describe detection of BK polyomavirus (BKV) in urinary tract cancers in kidney transplant recipients, suggesting that BKV could contribute to the development of these cancers. We assessed risk for urinary tract cancers in kidney recipients with or without treatment for presumed BKV nephropathy (tBKVN) using data from the United States Transplant Cancer Match Study (2003-2013). Among 55 697 included recipients, 2015 (3.6%) were reported with tBKVN. Relative to the general population, incidence was similarly elevated (approximately 4.5-fold) for kidney cancer in recipients with or without tBKVN, and incidence was not increased in either group for prostate cancer. In contrast, for invasive bladder cancer, incidence was more strongly elevated in recipients with versus without tBKVN (standardized incidence ratios 4.5 vs. 1.7; N = 48 cases), corresponding to an incidence rate ratio (IRR) of 2.9 (95% confidence interval [CI] 1.0-8.2), adjusted for sex, age, transplant year, and use of polyclonal antibody induction. As a result, recipients with tBKVN had borderline increased incidence for all urothelial cancers combined (renal pelvis, ureter, and bladder cancers: adjusted IRR 2.2, 95% CI 0.9-5.4; N = 89 cases). Together with reports describing BKV detection in tumor tissues, these results support an association between BKV and urothelial carcinogenesis among kidney transplant recipients. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  2. An independent monitor unit calculation by commercial software as a part of a radiotherapy treatment planning system quality control

    International Nuclear Information System (INIS)

    Nechvil, K.; Mynarik, J.

    2014-01-01

    For the independent calculation of the monitored unit (MU) the commercial software RadCalc (Lifeline Software Inc., Tyler TX) was used as the choice of some available similar programs. The program was configured and used to verify the doses calculated by commercially accessible planning system Eclipse version 8.6.17 (Varian Medical System Inc., Palo Alto). This system is being used during the clinical running for the creation of the treatment plans. The results of each plan were compared to the dose phantom measurements by the ionization chamber at the same point in which the calculation were done (Eclipse, RadCalc) - in the izocentre. TPS is configured by the beam data (PDD and OAR). Those beam data were exported and afterwards the same data were imported to the program RadCalc. The consistent and independent data between TPS and RadCalc were gained by this process. The reference conditions were set the identical in RadCalc as in TPS, so the consistency between TPS and RadCalc output factors has been achieved (Collimator Scatter Factor: Sc, Phantom Scatter Factor: Sp). Those output factors were also measured by the ionizing chamber in the water phantom and compared with the TPS. Based on the clinical data of the response to the doses, ICRU recommends ensuring the ability of dosimetric systems to deliver the doses with accuracy of at least 5%. Many factors, such as layout of anatomic structures, positioning of a patient, factors related to an accelerator (a dose calibration and mechanic parameters) cause random and systematic failures in a dose delivery. The source of some problems can be also caused by the system databases and relating information transfer; and the TPS containing besides other things other dose calculation algorithms. (authors)

  3. Treatment of depression with methylphenidate in patients difficult to wean from mechanical ventilation in the intensive care unit.

    Science.gov (United States)

    Rothenhäusler, H B; Ehrentraut, S; von Degenfeld, G; Weis, M; Tichy, M; Kilger, E; Stoll, C; Schelling, G; Kapfhammer, H P

    2000-10-01

    Mechanical ventilation is often required to support patients in the intensive care unit (ICU) with life-threatening cardiovascular, respiratory, or neuromuscular disorders. Occasionally, difficulties related to weaning patients from this support occur owing to depression. The traditional and newer-generation antidepressant drugs have a relatively long latency of response that interferes with rehabilitation attempts in the ICU. Psychostimulants such as methylphenidate show a rapid onset of antidepressant activity and a benign side effect profile. As consulting psychiatrists in the consultation-liaison service of a university hospital, we treated 7 patients with complex ICU courses presenting prolonged mechanical ventilation and psychomotor retardation associated with markedly depressed mood (DSM-IV criteria) by giving them methylphenidate. Methylphenidate was started on the first day at a dose of 2.5 mg p.o. in the morning and was increased by 2.5 mg each day with twice-a-day dosing in the morning and at noon until the patient responded or showed side effects. A maximum dose of 15 mg/day was not exceeded. Outcome evaluation was performed using the Clinical Global Impressions scale. Five (71 %) of 7 patients showed marked or moderate improvement in mood and activity within 3 to 4 days, and discontinuation of ventilator support was achieved within 8 to 14 days. Side effects with these 5 patients were not encountered. Of the remaining 2 patients (29%), 1 developed psychomotor agitation and anxiety within 4 days. Another patient showed only minimal improvement with regard to activity. Methylphenidate might be a rapidly effective and safe treatment for depression in difficult-to-wean patients hospitalized for life-threatening medical illness in the ICU. Implications for future research for this population of patients warrant formal randomized, prospective, clinical case-control evaluation.

  4. Patient-related factors and circumstances surrounding decisions to forego life-sustaining treatment, including intensive care unit admission refusal.

    Science.gov (United States)

    Reignier, Jean; Dumont, Romain; Katsahian, Sandrine; Martin-Lefevre, Laurent; Renard, Benoit; Fiancette, Maud; Lebert, Christine; Clementi, Eva; Bontemps, Frederic

    2008-07-01

    To assess decisions to forego life-sustaining treatment (LST) in patients too sick for intensive care unit (ICU) admission, comparatively to patients admitted to the ICU. Prospective observational cohort study. A medical-surgical ICU. Consecutive patients referred to the ICU during a one-yr period. None. Of 898 triaged patients, 147 were deemed too well to benefit from ICU admission. Decisions to forego LST were made in 148 of 666 (22.2%) admitted patients and in all 85 patients deemed too sick for ICU admission. Independent predictors of decisions to forego LST at ICU refusal rather than after ICU admission were: age; underlying disease; living in an institution; preexisting cognitive impairment; admission for medical reasons; and acute cardiac failure, acute central neurologic illness, or sepsis. Hospital mortality after decisions to forego LST was not significantly different in refused and admitted patients (77.5% vs. 86.5%; p = .1). Decisions to forego LST were made via telephone in 58.8% of refused patients and none of the admitted patients. Nurses caring for the patient had no direct contact with the ICU physicians for 62.3% of the decisions in refused patients, whereas meetings between nurses and physicians occurred in 70.3% of decisions to forego LST in the ICU. Patients or relatives were involved in 28.2% of decisions to forego LST at ICU refusal compared with 78.4% of decisions to forego LST in ICU patients (p refused patients (vs. none of admitted patients) and were associated with less involvement of nurses and relatives compared with decisions in admitted patients. Further work is needed to improve decisions to forego LST made under the distinctive circumstances of triage.

  5. Remarks on stable and quasi-stable k-strings at large N

    International Nuclear Information System (INIS)

    Armoni, A.; Shifman, M.

    2003-01-01

    We discuss k-strings in the large-N Yang-Mills theory and its supersymmetric extension. Whereas the tension of the bona fide (stable) QCD string is expected to depend only on the N-ality of the representation, tensions that depend on specific representation R are often reported in the lattice literature. In particular, adjoint strings are discussed and found in certain simulations. We clarify this issue by systematically exploiting the notion of the quasi-stable strings which becomes well-defined at large N. The quasi-stable strings with representation-dependent tensions decay, but the decay rate (per unit length per unit time) is suppressed as Λ 2 F(N) where F(N) falls off as a function of N. It can be determined on the case-by-case basis. The quasi-stable strings eventually decay into stable strings whose tension indeed depends only on the N-ality. We also briefly review large-N arguments showing why the Casimir formula for the string tension cannot be correct, and present additional arguments in favor of the sine formula. Finally, we comment on the relevance of our estimates to Euclidean lattice measurements

  6. Gender and the treatment of heart disease in older persons in the United States, France, and England: a comparative, population-based view of a clinical phenomenon.

    Science.gov (United States)

    Weisz, Daniel; Gusmano, Michael K; Rodwin, Victor G

    2004-08-01

    Gender disparities in the treatment of coronary artery disease (CAD) have been extensively documented in studies from the United States. However, they have been less well studied in other countries and, to our knowledge, have not been investigated at the more disaggregated spatial level of cities. This study tests the hypothesis that there is a common international pattern of gender disparity in the treatment of CAD in persons aged > or =65 years by analyzing data from the United States, France, and England and from their largest cities-New York City and its outer boroughs, Paris and its First Ring, and Greater London. This was an ecological study based on a retrospective analysis of comparable administrative data from government health databases for the 9 spatial units of analysis: the 3 countries, their 3 largest cities, and the urban cores of these 3 cities. A simple index was used to assess the relationship between treatment rates and a measure of CAD prevalence by gender among age-adjusted cohorts of patients. Differences in rates were examined by univariate analysis using the Student t test for statistical differences in mean values. Despite differences in health system characteristics, including health insurance coverage, availability of medical resources, and medical culture, we found consistent gender differences in rates of percutaneous transluminal coronary angioplasty and coronary artery bypass grafting across the 9 spatial units. The rate of interventional treatment in women with CAD was less than half that in men. This difference persisted after adjustment for the prevalence of heart disease. A consistent pattern of gender disparity in the interventional treatment of CAD was seen across 3 national health systems with known differences in patterns of medical practice. This finding is consistent with the results of clinical studies suggesting that gender disparities in the treatment of CAD are due at least in part to the underdiagnosis of CAD in women.

  7. Timber product implications of a program of mechanical fuel treatments applied on public timberland in the Western United States

    Science.gov (United States)

    Barbour R. James.; Xiaoping Zhou; Jeffrey P. Prestemon

    2008-01-01

    This study reports the results from a 5 year simulation of forest thinning intended to reduce fire hazard on publicly managed lands in the western United States. A state simulation model of interrelated timber markets was used to evaluate the timber product outputs. Approximately 84 million acres (34 million hectares), or 66% of total timberland in the western United...

  8. Likelihood of Treatment in a Coronary Care Unit for a First-Time Myocardial Infarction in Relation to Sex, Country of Birth and Socioeconomic Position in Sweden

    Science.gov (United States)

    Yang, Dong; James, Stefan; de Faire, Ulf; Alfredsson, Lars; Jernberg, Tomas; Moradi, Tahereh

    2013-01-01

    Objective To examine the relationship between sex, country of birth, level of education as an indicator of socioeconomic position, and the likelihood of treatment in a coronary care unit (CCU) for a first-time myocardial infarction. Design Nationwide register based study. Setting Sweden. Patients 199 906 patients (114 387 men and 85,519 women) of all ages who were admitted to hospital for first-time myocardial infarction between 2001 and 2009. Main outcome measures Admission to a coronary care unit due to myocardial infarction. Results Despite the observed increasing access to coronary care units over time, the proportion of women treated in a coronary care unit was 13% less than for men. As compared with men, the multivariable adjusted odds ratio among women was 0.80 (95% confidence interval 0.77 to 0.82). This lower proportion of women treated in a CCU varied by age and year of diagnosis and country of birth. Overall, there was no evidence of a difference in likelihood of treatment in a coronary care unit between Sweden-born and foreign-born patients. As compared with patients with high education, the adjusted odds ratio among patients with a low level of education was 0.93 (95% confidence interval 0.89 to 0.96). Conclusions Foreign-born and Sweden-born first-time myocardial infarction patients had equal opportunity of being treated in a coronary care unit in Sweden; this is in contrast to the situation in many other countries with large immigrant populations. However, the apparent lower rate of coronary care unit admission after first-time myocardial infarction among women and patients with low socioeconomic position warrants further investigation. PMID:23638036

  9. [Cooperative medical care by physicians of general hospitals and psychiatrists of an alcoholism treatment unit in Mie Prefecture].

    Science.gov (United States)

    Ino, A; Endo, T; Hirofuji, H; Takase, K; Watanabe, S

    2001-12-01

    Clinical practice of psychiatric liaison with physicians is the first step for an early treatment of alcohol dependence. Screening patients with alcohol dependence in general hospitals, carrying out intervention, and referring them to psychiatric specialists are running smoothly by the cooperation of member of the Mie Association for the Study of Alcohol-related Diseases. This association is being conducted by managers constituted of doctors, nurses, and medical social workers and the meeting is held every 6 months at district general hospitals to achieve three objectives; 1) evoking a sense of responsibility for alcoholic patients in the mind of general hospital staffs, 2) developing a network for psychiatric liaison with physicians to care patients of their alcohol dependence, and 3) keeping up activities of the association. We have already held the regular meeting 12 times, and prepared pamphlets for screening alcohol misuse and for early intervention. A course for learning skills of early intervention in this summer won the favor of participants. Through case conference of alcoholism and full accounts of the experiences given by recovered patients or their families, meeting attendants know patients' distress, families' sorrow, and their delight brought by the recovery, and are motivated to assist patients with alcohol dependence. Thus, "Spirit to Spirit" is a keyword to develop a network of the cooperative medical care for supporting patients with alcohol dependence. Referral of alcoholic patients to psychiatrists and/or psychiatric liaison therapy is promoted by a reliable, faithful, and face to face relationship between physicians and psychiatrists. Physicians' learning the skill for early intervention in alcohol dependence is followed by an increase in referral of patients to psychiatrists, and which suggests the importance of providing teaching and training of medical care for alcohol dependence to medical staffs including doctors of emergency care units

  10. Patterns and Predictors of Depression Treatment among Older Adults with Parkinson’s Disease and Depression in Ambulatory Care Settings in the United States

    Directory of Open Access Journals (Sweden)

    Sandipan Bhattacharjee

    2018-01-01

    Full Text Available Little is known regarding depression treatment patterns and predictors among older adults with comorbid Parkinson's disease and depression (dPD in the United States (US. The objective of this study was to assess the patterns and predictors of depression treatment among older adults with dPD in the US. We adopted a cross-sectional study design by pooling multiple-year data (2005–2011 from the National Ambulatory Medical Care Survey (NAMCS and the outpatient department of the National Hospital Ambulatory Medical Care Survey (NHAMCS. The final study sample consisted of visits by older adults with dPD. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariate logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Individuals with dPD and polypharmacy were 74% more likely to receive depression treatment (odds ratio = 1.743, 95% CI 1.376–2.209, while dPD subjects with comorbid chronic conditions were 44% less likely (odds ratio = 0.559, 95% CI 0.396–0.790 to receive depression treatment. Approximately six out of ten older adults with PD and depression received depression treatment. Treatment options for dPD are underutilized in routine clinical practice, and further research should explore how overall medical complexity presents a barrier to depression treatment.

  11. Formulation of stable protein powders by supercritical fluid drying

    NARCIS (Netherlands)

    Jovanović, N.

    2007-01-01

    Protein pharmaceuticals are potent drugs for the treatment of several chronic and life-threatening diseases. However, the complex and sensitive nature of protein molecules requires special attention in the development of stable dosage forms. Developing stable aqueous protein formulations is often a

  12. The Mortality Rate of Nosocomial Infection in Neonatal Intensive Care Unit (NICU) of Taleghani Educational and Treatment Center, Tabriz, 2013

    OpenAIRE

    Parvin Abbasian; Mariye Mahmoodi Yegane; Mina karimi; Faezeh Ahmadi; khadijeh Pazani; Zohreh Tahmasbi

    2015-01-01

    Background and Objectives : Information about nosocomial infections (NIs) is necessary for both appropriate management and establishment of preventative measures in hospitals. Neonates admitted to the Neonatal Intensive Care Unit (NICU) are at high-risk of developing nosocomial infection. The aim of this study was to determine the mortality rate of nosocomial infections and the distribution of pathogens among newborns who were admitted to the neonatal intensive care unit in Taleghani educatio...

  13. Correlates of Initiation of Treatment for Chronic Hepatitis C Infection in United States Veterans, 2004-2009.

    Directory of Open Access Journals (Sweden)

    Adi V Gundlapalli

    Full Text Available We describe the rates and predictors of initiation of treatment for chronic hepatitis C (HCV infection in a large cohort of HCV positive Veterans seen in U.S. Department of Veterans Affairs (VA facilities between January 1, 2004 and December 31, 2009. In addition, we identify the relationship between homelessness among these Veterans and treatment initiation. Univariate and multivariable Cox Proportional Hazards regression models with time-varying covariates were used to identify predictors of initiation of treatment with pegylated interferon alpha plus ribavirin. Of the 101,444 HCV treatment-naïve Veterans during the study period, rates of initiation of treatment among homeless and non-homeless Veterans with HCV were low and clinically similar (6.2% vs. 7.4%, p<0.0001. For all U.S. Veterans, being diagnosed with genotype 2 or 3, black or other/unknown race, having Medicare or other insurance increased the risk of treatment. Veterans with age ≥50 years, drug abuse, diabetes, and hemoglobin < 10 g/dL showed lower rates of treatment. Initiation of treatment for HCV in homeless Veterans is low; similar factors predicted initiation of treatment. Additionally, exposure to treatment with medications for diabetes predicted lower rates of treatment. As newer therapies become available for HCV, these results may inform further studies and guide strategies to increase treatment rates in all U.S. Veterans and those who experience homelessness.

  14. Perception of Problem Severity, Treatment Motivations, Experiences, and Long-Term Plans among Pregnant Women in a Detoxification Inpatient Unit

    Science.gov (United States)

    Jackson, Afton; Shannon, Lisa

    2013-01-01

    The purpose of this study was to examine pregnant women's substance use from initial use, to recognition of problem severity, motivations for treatment, and ultimately to treatment entry. The sample consisted of 114 pregnant women receiving inpatient detoxification treatment at the University of Kentucky Chandler Medical Center. Qualitative and…

  15. Delay in the Diagnosis of Stable Slipped Capital Femoral Epiphysis.

    Science.gov (United States)

    Hosseinzadeh, Pooya; Iwinski, Henry J; Salava, Jonathon; Oeffinger, Donna

    2017-01-01

    Delays in the diagnosis of stable slipped capital femoral epiphysis (SCFE) is common due to the vague symptomatology and the lack of awareness of this entity by healthcare providers. Delays in the diagnosis of this condition can lead to poor outcomes for the patients. This study was designed to identify factors that contributed to delays in the diagnosis or the treatment of patients with SCFE seen at our institution. A retrospective chart review of patients with the diagnosis of a stable SCFE who had undergone screw stabilization between 1989 and 2010 at our hospital was performed. For each patient, demographic data, the date of initial onset of symptoms, the date of the first visit to the medical provider, the type of provider seen initially (orthopaedic surgeon or not), the date of diagnosis of SCFE, the type of physician who made the diagnosis (orthopaedic surgeon or not), and the date of surgery were recorded. For each patient, the presenting symptom was recorded as hip, thigh, or knee pain. The effect of demographic data, presenting symptoms, and the type of initial provider seen on the delay to diagnosis was studied using 2 Cox models. A total of 149 patients with 196 stable SCFE were included. The average time from the first physician visit to diagnosis was 94 days in the group seen by a nonorthopaedic provider compared with an average of 2.9 days in the group seen by an orthopaedist (Pprovider versus 97% in the group seen by orthopaedic surgeons. It took significantly longer to be diagnosed with SCFE in patients who presented with initial knee pain (P=0.0097) compared with those who presented with hip pain at the initial visit. This study shows a significant delay in the diagnosis of SCFE in the United States, particularly in patients seen by nonorthopaedic providers initially. Level III-prognostic.

  16. Dynamical attraction to stable processes

    OpenAIRE

    Fisher, Albert M.; Talet, Marina

    2012-01-01

    We apply dynamical ideas within probability theory, proving an almost-sure invariance principle in log density for stable processes. The familiar scaling property (self-similarity) of the stable process has a stronger expression, that the scaling flow on Skorokhod path space is a Bernoulli flow. We prove that typical paths of a random walk with i.i.d. increments in the domain of attraction of a stable law can be paired with paths of a stable process so that, after applying a non-random regula...

  17. Rotationally Stable Screw-Anchor With Locked Trochanteric Stabilizing Plate Versus Proximal Femoral Nail Antirotation in the Treatment of AO/OTA 31A2.2 Fracture: A Biomechanical Evaluation.

    Science.gov (United States)

    Knobe, Matthias; Nagel, Philipp; Maier, Klaus-Jürgen; Gradl, Gertraud; Buecking, Benjamin; Sönmez, Tolga T; Modabber, Ali; Prescher, Andreas; Pape, Hans-Christoph

    2016-01-01

    Third-generation cephalomedullary nails currently represent the gold standard in the treatment of unstable trochanteric femur fractures. Recently, an extramedullary rotationally stable screw-anchor system (RoSA) has been developed. It was designed to combine the benefits of screw and blade and to improve stability using a locked trochanteric stabilizing plate (TSP). The purpose of this study was to compare the biomechanical behavior of RoSA/TSP and the proximal femoral nail antirotation (PFNA). Standardized AO/OTA 31A2.2 fractures were induced by an oscillating saw in 10 paired human specimens (n = 20; mean age = 85 years; range: 71-96 years). The fractures were stabilized by either the RoSA/TSP (Koenigsee Implants, Allendorf, Germany) or the PFNA (DePuy Synthes, Zuchwil, Switzerland). Femurs were positioned in 25 degrees of adduction and 10 degrees of posterior flexion and were cyclically loaded with axial sinusoidal pattern at 0.5 Hz, starting at 300 N, with stepwise increase by 300 N every 500 cycles until bone-implant failure occurred. After every load step, the samples were measured visually and radiographically. Femoral head migration was assessed. The stiffness at the load up to the clinically relevant load step of 1800 N (639 ± 378 N/mm (RoSA/TSP) vs. 673 ± 227 N/mm (PFNA); P = 0.542) was comparable, as was the failure load (3000 ± 787 N vs. 3780 ± 874 N; P = 0.059). Up to 1800 N, no femoral head rotation, head migration, or femoral neck shortening were observed either for RoSA/TSP or PFNA. Whereas failure of the PFNA subsumed fractures of the greater trochanter and the lateral wall, a posterior femoral neck fracture with a significantly increased femoral neck shortening (1.7 mm vs. 0 mm; P = 0.012) was the cause of failure with RoSA/TSP. This specific kind of failure was induced by a femoral neck weakening caused by the posterior TSP stabilizing screw. There was no significant difference in biomechanical properties between the RoSA/TSP and the PFNA for

  18. Epidemiology and hospital resources use in the treatment of ulcerative colitis at gastroenterology units in Spain (EPICURE study

    Directory of Open Access Journals (Sweden)

    Ignacio Marín-Jiménez

    2018-03-01

    Full Text Available Background and aim: Nationwide epidemiological data on ulcerative colitis (UC in Spain are lacking. The primary objective was to assess the epidemiology of UC at hospital gastroenterology units and the use of hospital resources (characteristics and facilities for the management of UC in Spain. Methods: A retrospective, multicenter, epidemiological, crosssectional study (EPICURE study analyzed data from hospital registries and records from UC patients admitted and treated in 2011 at a representative selection of Spanish sites. The prevalence of UC in gastroenterology units was calculated as the total UC patients divided by the total inhabitants covered by those sites. Incidence was defined as the number of new UC cases during 2011 divided by the total inhabitants covered by those sites. Results: In 2011, a total of 42,000 patients were attended for UC in gastroenterology units in Spain with a prevalence rate of 88.7 UC cases (95% CI: 69.6–106.0 per 100,000 inhabitants. The incidence rate was of 5.7 cases (95% CI: 1.2–10.8/100,000 inhabitants. Six percent of patients being attended for UC were hospitalized in the 58 units analyzed in 2011. There were 1075 hospitalizations related to UC in total (approximately 14 per gastroenterology unit; median hospital stay length: 8 days. Six out of 1000 UC patients underwent colectomy in 2011. Near one third (32.7% were emergency colectomies. Most hospitals had specific IBD units (87.9% and colorectal surgeons (93.1%. Conclusions: Our study provides the first national data on the prevalence and incidence of UC in gastroenterology units in Spain. Hospitalization and surgical burden associated with UC was low.

  19. The effects of living distantly from peritoneal dialysis units on peritonitis risk, microbiology, treatment and outcomes: a multi-centre registry study

    Directory of Open Access Journals (Sweden)

    Cho Yeoungjee

    2012-06-01

    Full Text Available Abstract Background The aim of the study was to determine whether distance between residence and peritoneal dialysis (PD unit influenced peritonitis occurrence, microbiology, treatment and outcomes. Methods The study included all patients receiving PD between 1/10/2003 and 31/12/2008, using ANZDATA Registry data. Results 365 (6% patients lived ≥100 km from their nearest PD unit (distant group, while 6183 (94% lived S. aureus peritonitis (adjusted odds ratio [OR] 1.64, 95% CI 1.09-2.47. Distant patients with first peritonitis episodes were less likely to be hospitalised (64% vs 73%, p = 0.008 and receive antifungal prophylaxis (4% vs 10%, p = 0.01, but more likely to receive vancomycin-based antibiotic regimens (52% vs 42%, p  Conclusions Living ≥100 km away from a PD unit was associated with increased risk of S. aureus peritonitis, modified approaches to peritonitis treatment and peritonitis outcomes that were comparable to, or better than patients living closer to a PD unit. Staphylococcal decolonisation should receive particular consideration in remote living patients.

  20. Comparison of change in coronary atherosclerosis in patients with stable versus unstable angina pectoris receiving statin therapy (from the Treatment With Statin on Atheroma Regression Evaluated by Intravascular Ultrasound With Virtual Histology [TRUTH] study).

    Science.gov (United States)

    Nozue, Tsuyoshi; Yamamoto, Shingo; Tohyama, Shinichi; Fukui, Kazuki; Umezawa, Shigeo; Onishi, Yuko; Kunishima, Tomoyuki; Sato, Akira; Nozato, Toshihiro; Miyake, Shogo; Takeyama, Youichi; Morino, Yoshihiro; Yamauchi, Takao; Muramatsu, Toshiya; Hibi, Kiyoshi; Terashima, Mitsuyasu; Michishita, Ichiro

    2013-04-01

    Although statin-induced regression in coronary atherosclerosis seems to be greater in patients with acute coronary syndrome than in those with stable coronary artery disease, no reports have examined this. The purpose of the present study was to compare the changes in coronary atherosclerosis in patients with stable versus unstable angina pectoris (AP). The effects of 8-month statin therapy on coronary atherosclerosis were evaluated using virtual histology intravascular ultrasound, and analyzable intravascular ultrasound data were obtained from 119 patients (83 patients with stable AP and 36 with unstable AP). A significant decrease in plaque volume was observed in patients with unstable AP (-2.2%, p = 0.02) but not in patients with stable AP. A significant increase in the necrotic-core component (0.30 mm(3)/mm, p = 0.009) was observed only in patients with unstable AP. Significant positive correlations were observed between the percentage of change in platelet-activating factor acetylhydrolase and the percentage of change in plaque volume (r = 0.346, p = 0.05) in patients with unstable AP. No significant correlations were observed in patients with stable AP. Multivariate regression analyses showed that a reduction in platelet-activating factor acetylhydrolase was associated with regression in coronary atherosclerosis, particularly of the fibrous component (β = 0.443, p = 0.003), in patients with unstable AP. In conclusion, regression of the coronary artery plaque volume was greater, although statin therapy did not halt the increases in plaque vulnerability, in patients with unstable AP compared to those with stable AP. A reduction in the serum platelet-activating factor acetylhydrolase level was associated with regression in coronary atherosclerosis, particularly the fibrous plaque volume, in patients with unstable AP. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. One-session treatment of specific phobias in youth: a randomized clinical trial in the United States and Sweden.

    Science.gov (United States)

    Ollendick, Thomas H; Ost, Lars-Göran; Reuterskiöld, Lena; Costa, Natalie; Cederlund, Rio; Sirbu, Cristian; Davis, Thompson E; Jarrett, Matthew A

    2009-06-01

    One hundred and ninety-six youth, ages 7-16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis free, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed. Copyright 2009 APA

  2. Cognitive behaviour therapy for chronic fatigue syndrome: Differences in treatment outcome between a tertiary treatment centre in the United Kingdom and the Netherlands

    NARCIS (Netherlands)

    Worm-Smeitink, M.; Nikolaus, S.; Goldsmith, K.; Wiborg, J.; Ali, S.; Knoop, H.; Chalder, T.

    2016-01-01

    Cognitive behaviour therapy (CBT) reduces fatigue and disability in chronic fatigue syndrome (CFS). However, outcomes vary between studies, possibly because of differences in patient characteristics, treatment protocols, diagnostic criteria and outcome measures. The objective was to compare outcomes

  3. The treatment of 'difficult' patients in a secure unit of a specialized psychiatric hospital : The patient's perspective

    NARCIS (Netherlands)

    N. Kool-Goudzwaard; Bauke van Koekkoek; C.J. Gamel; M. Bos; B. Meijel

    2012-01-01

    The aim of this study is to obtain insight, from a patient's perspective, into the results and essential components of treatment in specialist settings for so-called 'difficult' patients in mental health care. In cases where usual hospital treatment is not successful, a temporary transfer to

  4. The treatment of ‘difficult’ patients in a secure unit of a specialized psychiatric hospital: the patient's perspective

    NARCIS (Netherlands)

    C.J. Gamel; B. Koekkoek; prof Berno van Meijel; M. Bos; Nienke Kool

    2011-01-01

    The aim of this study is to obtain insight, from a patient's perspective, into the results and essential components of treatment in specialist settings for so-called ‘difficult’ patients in mental health care. In cases where usual hospital treatment is not successful, a temporary transfer to

  5. Quantifying the net economic benefits of mechanical wildfire hazard treatments on timberlands of the western United States

    Science.gov (United States)

    Jeffrey P. Prestemon; Karen L. Abt; James R. Barbour

    2012-01-01

    Mechanical treatment of vegetation is done on public and private lands for many possible reasons, including enhancing wildlife habitat, increasing timber growth of residual stands, and improving resistance to damaging pests. Few studies, however, have focused on the circumstances under which mechanical wildfire hazard reduction treatments can yield positive net...

  6. Using simulated historical time series to prioritize fuel treatments on landscapes across the United States: The LANDFIRE prototype project

    Science.gov (United States)

    Robert E. Keane; Matthew Rollins; Zhi-Liang Zhu

    2007-01-01

    Canopy and surface fuels in many fire-prone forests of the United States have increased over the last 70 years as a result of modern fire exclusion policies, grazing, and other land management activities. The Healthy Forest Restoration Act and National Fire Plan establish a national commitment to reduce fire hazard and restore fire-adapted ecosystems across the USA....

  7. Influence of pre-heat treatment and different light-curing units on Vickers hardness of a microhybrid composite resin

    Science.gov (United States)

    Saade, E. G.; Bandeca, M. C.; Rastelli, A. N. S.; Bagnato, V. S.; Porto-Neto, S. T.

    2009-06-01

    The aim of this study was to evaluate the hardness of a dental composite resin submitted to temperature changes before photo-activation with two light-curing unite (LCUs). Five samples (4 mm in diameter and 2 mm in thickness) for each group were made with pre-cure temperatures of 37, 54, and 60°C. The samples were photo-activated with a conventional quartz-tungsten-halogen (QTH) and blue LED LCUs during 40 s. The hardness Vickers test (VHN) was performed on the top and bottom surfaces of the samples. According to the interaction between light-curing unit and different pre-heating temperatures of composite resin, only the light-curing unit provided influences on the mean values of initial Vickers hardness. The light-curing unit based on blue LED showed hardness mean values more homogeneous between the top and bottom surfaces. The hardness mean values were not statistically significant difference for the pre-cure temperature used. According to these results, the pre-heating of the composite resin provide no influence on Vickers hardness mean values, however the blue LED showed a cure more homogeneous than QTH LCU.

  8. Infectious Disease (ID) Learning Unit: What the ID Clinician Needs to Know About Buprenorphine Treatment for Opioid Use Disorder

    OpenAIRE

    Westlake, Amanda A.; Eisenberg, Mark P.

    2016-01-01

    Abstract In the context of an escalating opioid epidemic, infectious disease clinicians increasingly treat the infectious complications of injection drug use. In this learning unit, we review the history, pharmacology, and clinical use of buprenorphine as maintenance therapy for opioid use disorder, and we describe the process by which clinicians can obtain a buprenorphine waiver.

  9. Management of invasive candidiasis and candidemia in adult non-neutropenic intensive care unit patients: Part II. Treatment.

    NARCIS (Netherlands)

    Guery, B.P.; Arendrup, M.C.; Auzinger, G.; Azoulay, E.; Borges Sa, M.; Johnson, E.M.; Muller, E.; Putensen, C.; Rotstein, C.; Sganga, G.; Venditti, M.; Zaragoza Crespo, R.; Kullberg, B.J.

    2009-01-01

    BACKGROUND: Invasive candidiasis and candidemia are frequently encountered in the nosocomial setting particularly in the intensive care unit (ICU). OBJECTIVE AND METHODS: To review the current management of invasive candidiasis and candidemia in non-neutropenic adult ICU patients based on a review

  10. Review of international early psychosis programmes and a model to overcome unique challenges to the treatment of early psychosis in the United States.

    Science.gov (United States)

    De Maio, Mara; Graham, Patricia; Vaughan, David; Haber, Lawrence; Madonick, Steven

    2015-02-01

    This article presents a literature review of treatments for first-episode psychosis throughout the world and describes the POTENTIAL (Patient-Oriented Treatment for Early or New onset schizophrenia To Initiate A Long-term recovery) Early Psychosis Programme in detail, explaining the model and the rationale, as well as the uniqueness of the programme. An international search was conducted for English articles using PubMed, PsycINFO and PsycARTICLES, as well as the reference lists of published studies and reviews. One article that is currently in press was included, which was not part of the original literature search. Inclusion criteria included any published or in press study focused upon treatment programmes for early psychosis. Out of the 62 articles collected, 27 publications met this criterion and were utilized. In addition to identifying clinical programmes, gaps in treatment for this population were identified. The primary method in the United States for the treatment of early psychosis is randomized trial for new pharmacological treatments where patients are research subjects. Although there are a multitude of both research and clinical programmes internationally, the few programmes that exist in the United States that focus upon first-episode psychosis are either research based or focus upon prodromal symptoms. Clinical programmes such as the POTENTIAL programme are nearly non-existent. Although the POTENTIAL programme has been successful both clinically and financially, there are still more strides to be taken to improve upon young adult services. Future development of the programme is continuing with the incorporation of outcome data and outreach into the community. © 2014 Wiley Publishing Asia Pty Ltd.

  11. The social context of tuberculosis treatment in urban risk groups in the United Kingdom: a qualitative interview study

    Directory of Open Access Journals (Sweden)

    Gillian M. Craig

    2015-03-01

    Conclusions: There is a need for integrated care across drug, alcohol, HIV, and homeless services in order to address the complex clinical co-morbidities and social needs that impact on the patient's ability to sustain a course of treatment.

  12. Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States.

    Science.gov (United States)

    Short, Vanessa L; Hand, Dennis J; MacAfee, Lauren; Abatemarco, Diane J; Terplan, Mishka

    2018-06-01

    To describe differences in geographic, demographic, treatment, and substance use characteristics by pharmacotherapy receipt among pregnant women entering publically funded treatment for opioid use disorder (OUD) in the United States. 1996 to 2014 Treatment Episode Data Set-Admissions data from pregnant admissions with OUD, defined as reporting opioids as the primary substance of use leading to the treatment episode, were analyzed for this cross-sectional study. The proportion of all pregnant admissions with OUD who received pharmacotherapy was calculated by year and U.S. census region. Trends across time were assessed using the Cochrane-Armitage Trend test. Associations between demographic, substance use, and treatment characteristics and pharmacotherapy receipt were assessed using Chi-square tests and multivariable logistic regression. The proportion of pregnant admissions where opioids were the primary substance of use increased from 16.9% to 41.6% during the study period, while the proportion of pregnant admissions with OUD who received pharmacotherapy remained relatively unchanged at around 50%. Overall, pharmacotherapy recipients were generally older and white, more likely to receive treatment in an outpatient setting, be self-referred, and report heroin as the primary substance, daily substance use, and intravenous drug use, and less likely to have a co-occurring psychiatric problem compared to those who did not receive pharmacotherapy. Regional differences in pharmacotherapy utilization exist; the South consistently had the fewest pregnant admissions with OUD receiving pharmacotherapy. Although the proportion of pregnant admissions to substance use treatment centers with OUD has increased since the mid-1990s, the proportion receiving pharmacotherapy has not changed. Significant variations in pharmacotherapy utilization exist by geography and demographic, substance use and treatment characteristics. Utilization of pharmacotherapy at publically funded

  13. TREATMENT COSTS EVALUATION FOR DRUG SUSCEPTIBLE AND DRUG RESISTANT TUBERCULOSIS PATIENTS IN THE UNITS OF TOMSK REGIONAL TB SERVICES

    Directory of Open Access Journals (Sweden)

    I. E. Gel'manova

    2016-01-01

    Full Text Available Basing on the data of capital expenses and current costs of Tomsk TB Service in 2011, prime costs of 1 month of treatment of a tuberculosis case in various units of TB Service were evaluated. The prime costs of treatment in the in-patient department as per the 1st, 2nd and 3rd regimens made 23,837 RUR per month and it was 89% higher than the cost of treatment in the day hospital (12,612 RUR, and by 173% higher than the treatment in the polyclinic (8,722 RUR, by 145% than treatment at home (9,717 RUR and by 91% than treatment within the Sputnik program (12,499 RUR. Treatment as per the 4th regimen turned out to be the most expensive in the in-patient hospital (29,880 RUR exceeding by 55% the treatment cost in the day center (19,336 RUR, by 112% – in the polyclinic (14,107 RUR, by 71% – treatment at home (17,512 RUR, and by 29% – Sputnik program (23,207 RUR.

  14. “Appropriate Treatment” and Therapeutic Window in Spasticity Treatment with IncobotulinumtoxinA: From 100 to 1000 Units

    OpenAIRE

    Giancarlo Ianieri; Riccardo Marvulli; Giulia Alessia Gallo; Pietro Fiore; Marisa Megna

    2018-01-01

    Many neurological diseases (ischemic and hemorrhagic stroke, multiple sclerosis, infant cerebral palsy, spinal cord injuries, traumatic brain injury, and other cerebrovascular disorders) may cause muscle spasticity. Different therapeutic strategies have been proposed for the treatment of spasticity. One of the major treatments for tone modulation is botulinum toxin type A (BTX-A), performed in addition to other rehabilitation strategies based on individualized multidisciplinary programs aimed...

  15. Recovery of cost of hospital and medical care and treatment furnished by the United States; delegation of authority. Final rule.

    Science.gov (United States)

    2010-03-01

    This rule amends Department of Justice regulations to increase the settlement and waiver authority delegated to heads of departments and agencies of the United States responsible for the furnishing of hospital, medical, surgical, or dental care. This change responds to the increase in medical costs since 1992, when the current level of delegated settlement and waiver authority was established, and will further the efficient operation of the government.

  16. Effect of a community-based delivery of intermittent preventive treatment of malaria in pregnancy on treatment seeking for malaria at health units in Uganda

    DEFF Research Database (Denmark)

    Mbonye, A K; Schultz Hansen, K; Bygbjerg, I C

    2008-01-01

    in the community had sought malaria treatment (70.3%), suggesting the possibility that the novel approach had a positive impact on care seeking for malaria. Similarly, utilization of antenatal care, insecticide-treated nets and delivery care by women in the community was high. The total costs per woman receiving...

  17. The passive straight leg raising test in the diagnosis and treatment of lumbar disc herniation: a survey of United kingdom osteopathic opinion and clinical practice.

    Science.gov (United States)

    Rebain, Richard; Baxter, G David; McDonough, Suzanne

    2003-08-01

    Postal questionnaire survey. To carry out a confidential postal survey of United Kingdom osteopaths in order to record and assess their use of the passive straight leg raising test in the diagnosis of, and choice of, manipulation for lumbar disc herniation. The study also sought to determine whether an association existed between osteopaths' manipulation of suspected lumbar disc herniation and their use of the straight leg raising test, the length of their working hours, and their use of manipulation for the treatment of other lumbar conditions. The literature is not agreed on important aspects of the straight leg raising test, or on the use of spinal manipulation for suspected lumbar disc herniation. This is thought to be the first study to investigate opinion and practice in a large group of spinal manipulators, in this case United Kingdom osteopaths. A questionnaire was sent to all 1030 United Kingdom osteopaths registered with the General Osteopathic Council in January 2000. It comprised four sections: personal characteristics, professional characteristics, background to low back pain cases, details of straight leg raising test understanding and use within the diagnosis and treatment of lumbar disc herniation. A response rate of 44% was achieved. United Kingdom osteopaths' opinions of low back pain and lumbar disc herniation clinical presentations, details of straight leg raising test mode of action, procedure, and interpretation were in keeping with the literature. Fifty-four percent of respondents sometimes employed manipulation in the treatment of lumbar disc herniation, but most of the others described the practice as "dangerous." The literature is similarly divided on the practice. Chi-square and Cramer V analysis implied that respondents were not influenced in choosing manipulation for lumbar disc herniation by their use of the straight leg raising test (chi2 = 4.002, df = 3, Cramer V = 0.0959, P = 0.261, alpha 0.05, n = 435). A moderate association

  18. Association between three different cognitive behavioral alcohol treatment programs and recidivism rates among male offenders: findings from the United Kingdom.

    Science.gov (United States)

    Needham, Marie; Gummerum, Michaela; Mandeville-Norden, Rebecca; Rakestrow-Dickens, Janine; Mewse, Avril; Barnes, Andrew; Hanoch, Yaniv

    2015-06-01

    Cognitive behavioral therapy-based alcohol treatment programs have been widely used to break the link between alcohol and crime. While evidence exists on the connection between alcohol and crime, there is little data that demonstrate the effectiveness of different alcohol treatment programs in reducing criminal behavior. We tested whether male offenders who participate in alcohol treatment programs show lower rates of recidivism than a matched offender group who did not participate in an alcohol prevention program. This is an observational matched case-control study. Participants were 564 male offenders with an alcohol problem related to offending. Participants were assigned by the courts to 1 of 3 alcohol treatment programs (141 offenders per treatment): Low Intensity Alcohol Program (LIAP), Alcohol Specified Activity Requirement, and Addressing Substance-Related Offending. A fourth matched group (n = 141) was not assigned to a program and served as a control group. Survival analysis was used to calculate participants' charged and reconviction rates over 4 time periods (0 to 3, 4 to 6, 7 to 9, and 10 to 12 months after completion of program or order). Offenders who did not participate in a program were more than twice as likely to be charged compared to offenders who participated in a program. Furthermore, offenders who did not participate in a program were over 2.5 times more likely to be reconvicted. Among the 3 alcohol treatment programs evaluated, the LIAP was the most cost-effective. Offenders enrolled in an alcohol treatment program showed a significant reduction in being charged with or reconvicted of a crime. With costs of keeping offenders in prison per year reaching close to £40,000 per offender per year (Mulheirn et al., 2010, www.smf.co.uk), assigning offenders to alcohol preventive programs-such as LIAP-are a promising way to reduce recidivism and reduce cost. Copyright © 2015 by the Research Society on Alcoholism.

  19. Shelf-Stable Food Safety

    Science.gov (United States)

    ... is an MRE? Is an MRE shelf stable? What foods are packaged in retort packages? What is aseptic ... type of package is used for aseptic processing? What foods are packaged in aseptic packages? Can I microwave ...

  20. Characteristics of patients attending for cognitive behavioural therapy at one UK specialist unit for dental phobia and outcomes of treatment.

    Science.gov (United States)

    Kani, E; Asimakopoulou, K; Daly, B; Hare, J; Lewis, J; Scambler, S; Scott, S; Newton, J T

    2015-11-27

    To describe the characteristics of patients attending a psychologist-led cognitive behavioural therapy (CBT) service for individuals with dental phobia and the outcomes of treatment. Analysis of routinely collected assessment and outcome data from 130 patients attending a single secondary service providing CBT for dental phobia. The patients comprised 99 women and 31 men, with an average age of 39.9 years (SD 14.8). Approximately 77% of the patients scored at levels suggestive of dental phobia on the Modified Dental Anxiety Scale (MDAS). Fear of dental injections and the dental drill were the most common high scoring items on the MDAS. Ninety four percent of patients reported one or more impacts of their mouth, teeth and gums on their life using the OHIP-14. A minority of patients had co-morbid psychological conditions - 36.9% had high levels of general anxiety and 12.3% had clinically significant levels of depression. Suicidal ideation was reported by 12% of patients and four (3%) reported recent intent to commit suicide. Of all patients referred 79% went on to have dental treatment without sedation and 6% had their dental treatment under sedation. The average number of CBT appointments required before a patient received dental treatment without sedation was five. CBT offers an effective technique for helping dentally anxious patients receive treatment without sedation. Those interested in running such services should be cognizant of the moderately high level of co-morbid psychological conditions in this group.

  1. Electronic gaming machines and gambling disorder: A cross-cultural comparison between treatment-seeking subjects from Brazil and the United States.

    Science.gov (United States)

    Medeiros, Gustavo C; Leppink, Eric W; Yaemi, Ana; Mariani, Mirella; Tavares, Hermano; Grant, Jon E

    2015-12-15

    The objective of this paper is to perform a cross-cultural comparison of gambling disorder (GD) due to electronic gaming machines (EGM), a form of gambling that may have a high addictive potential. Our goal is to investigate two treatment-seeking samples of adults collected in Brazil and the United States, countries with different socio-cultural backgrounds. This comparison may lead to a better understanding of cultural influences on GD. The total studied sample involved 733 treatment-seeking subjects: 353 men and 380 women (average age=45.80, standard deviation ±10.9). The Brazilian sample had 517 individuals and the American sample 216. Subjects were recruited by analogous strategies. We found that the Brazilian sample was younger, predominantly male, less likely to be Caucasian, more likely to be partnered, tended to have a faster progression from recreational gambling to GD, and were more likely to endorse chasing losses. This study demonstrated that there are significant differences between treatment-seeking samples of adults presenting GD due to EGM in Brazil and in the United States. These findings suggest that cultural aspects may have a relevant role in GD due to EGM. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Data regarding hydraulic fracturing distributions and treatment fluids, additives, proppants, and water volumes applied to wells drilled in the United States from 1947 through 2010

    Science.gov (United States)

    Gallegos, Tanya J.; Varela, Brian A.

    2015-01-01

    Comprehensive, published, and publicly available data regarding the extent, location, and character of hydraulic fracturing in the United States are scarce. The objective of this data series is to publish data related to hydraulic fracturing in the public domain. The spreadsheets released with this data series contain derivative datasets aggregated temporally and spatially from the commercial and proprietary IHS database of U.S. oil and gas production and well data (IHS Energy, 2011). These datasets, served in 21 spreadsheets in Microsoft Excel (.xlsx) format, outline the geographical distributions of hydraulic fracturing treatments and associated wells (including well drill-hole directions) as well as water volumes, proppants, treatment fluids, and additives used in hydraulic fracturing treatments in the United States from 1947 through 2010. This report also describes the data—extraction/aggregation processing steps, field names and descriptions, field types and sources. An associated scientific investigation report (Gallegos and Varela, 2014) provides a detailed analysis of the data presented in this data series and comparisons of the data and trends to the literature.

  3. Pharmaceuticals labelled with stable isotopes

    International Nuclear Information System (INIS)

    Krumbiegel, P.

    1986-11-01

    The relatively new field of pharmaceuticals labelled with stable isotopes is reviewed. Scientific, juridical, and ethical questions are discussed concerning the application of these pharmaceuticals in human medicine. 13 C, 15 N, and 2 H are the stable isotopes mainly utilized in metabolic function tests. Methodical contributions are given to the application of 2 H, 13 C, and 15 N pharmaceuticals showing new aspects and different states of development in the field under discussion. (author)

  4. Stable isotope research pool inventory

    International Nuclear Information System (INIS)

    1984-03-01

    This report contains a listing of electromagnetically separated stable isotopes which are available at the Oak Ridge National Laboratory for distribution for nondestructive research use on a loan basis. This inventory includes all samples of stable isotopes in the Research Materials Collection and does not designate whether a sample is out on loan or is in reprocessing. For some of the high abundance naturally occurring isotopes, larger amounts can be made available; for example, Ca-40 and Fe-56

  5. Sleep quality in treatment-seeking veterans of Operations Enduring Freedom and Iraqi Freedom: the role of cognitive coping strategies and unit cohesion.

    Science.gov (United States)

    Pietrzak, Robert H; Morgan, Charles A; Southwick, Steven M

    2010-11-01

    Sleep difficulties are common in individuals exposed to stress or trauma, and maladaptive cognitive coping strategies, such as worry and fear of losing vigilance, as well as low social support, may further impair sleep quality. This study examined the severity and correlates of sleep difficulties in a sample of treatment-seeking veterans of Operations Enduring Freedom and Iraqi Freedom (OEF-OIF). A total of 167 OEF-OIF veterans seeking behavioral or primary care services completed a questionnaire containing measures of sleep quality, combat exposure, psychopathology, fear of loss of vigilance, cognitive coping strategies, and unit and postdeployment social support within 1 year of returning from deployment. Mean Pittsburgh Sleep Quality Inventory scores in the full sample were indicative of severely impaired sleep. Posttraumatic stress disorder (PTSD) was associated with increased sleep difficulties, most notably sleep disturbances, daytime dysfunction, and sleep quality. Hierarchical regression analysis in the full sample revealed that PTSD symptoms and scores on measures of worry and fear of loss of vigilance were positively associated with sleep difficulties and that scores on a measure of unit member support were negatively associated with sleep difficulties. Among veterans with PTSD, fear of loss of vigilance was positively associated with sleep difficulties and cognitive distraction and unit member support were negatively associated with sleep difficulties. Treatment-seeking OEF-OIF veterans report severe sleep difficulties, with more pronounced impairment in veterans with PTSD. The results of this study suggest that interventions to mitigate worry and fear of loss of vigilance and to enhance perceived unit member support may be helpful in reducing sleep difficulties following return from deployment in this population. Copyright © 2010 Elsevier Inc. All rights reserved.

  6. Efficacy of Elimination of Pasteurella pneumotropica from a Mouse Specific Pathogen-Free Barrier Breeding Unit through Treatment with Enrofloxacin

    DEFF Research Database (Denmark)

    Østergaard, Grete; Arnorsdottir, Stefania Embla; Schumacher-Petersen, Camilla

    2010-01-01

    and administered in drinking water based on an assumed daily water intake of 150 mL/kg body weight. Prior to treatment, all imports of mice (caesarean section or embryo transfer) were stopped. The populations of the various mouse strains bred in the barrier were minimized. Measures were taken to ensure there would......, and enrofloxacin (EF) was chosen as the most appropriate antibiotic to treat this infection. Various doses of EF were tested for toxic effects on NMRI-mice prior to the treatment, and since no negative effects of EF, regardlessof dose tested, were observed, the highest dose of 150 mg/kg body weight was chosen...

  7. A Point Source of a Different Color: Identifying a Gap in United States Regulatory Policy for “Green” CSO Treatment Using Constructed Wetlands

    Directory of Open Access Journals (Sweden)

    Zeno F. Levy

    2014-04-01

    Full Text Available Up to 850 billion gallons of untreated combined sewer overflow (CSO is discharged into waters of the United States each year. Recent changes in CSO management policy support green infrastructure (GI technologies as “front of the pipe” approaches to discharge mitigation by detention/reduction of urban stormwater runoff. Constructed wetlands for CSO treatment have been considered among suites of GI solutions. However, these wetlands differ fundamentally from other GI technologies in that they are “end of the pipe” treatment systems that discharge from a point source, and are therefore regulated in the U.S. under the National Pollution Discharge Elimination System (NPDES. We use a comparative regulatory analysis to examine the U.S. policy framework for CSO treatment wetlands. We find in all cases that permitting authorities have used best professional judgment to determine effluent limits and compliance monitoring requirements, referencing technology and water quality-based standards originally developed for traditional “grey” treatment systems. A qualitative comparison with Europe shows less stringent regulatory requirements, perhaps due to institutionalized design parameters. We recommend that permitting authorities develop technical guidance documents for evaluation of “green” CSO treatment systems that account for their unique operational concerns and benefits with respect to sustainable development.

  8. The impact of probiotics (Lactobacillus reuteri Protectis on the treatment, course and outcome of premature infants in the Intensive Care Unit in Mostar

    Directory of Open Access Journals (Sweden)

    Marjana Jerković Raguž

    2016-09-01

    Full Text Available Aim: The aim of this study was to analyse the treatment, course and outcome of premature infants treated with probiotics (Lactobacillus reuteri Protectis in the Intensive Care Unit (ICU. Study design: This retrospective cohort study included 100 preterm infants of gestational age up to 30-34 + 6/7 weeks. The first group of infants who were given probiotics in their dairy meal in the course of their medical treatment during hospitalization in the year 2014 were compared to a second group of infants who did not receive probiotics in the year 2013.Results: A statistically significant difference in the number of days of treatment in the ICU (p < 0.05, administration of ranitidine (p < 0.05 and feeding intolerance (p < 0.05 was found between the two groups of preterm infants. No statistically significant differences were found in the other variables under study.Conclusion: Probiotics probably have a positive effect on the course and outcome of treatment of premature infants in the ICU. Our newborns who received probiotics spent shorter time in intensive care, they began full peroral intake of milk sooner and received antiulcer medicine for shorter time, which is an important step towards the improvement of treatment outcome in premature infants.

  9. Evaluation and diffusion of excimer laser treatment of myopia in the United States and in the Netherlands

    NARCIS (Netherlands)

    Vondeling, H.; Rosendal, H.; Banta, D.

    1995-01-01

    Excimer laser photorefractive keratectomy (PRK) is an experimental treatment to correct myopia (short-sightedness) that is diffusing into use without convincing evidence of safety and efficacy. It has been claimed that PRK may render conventional methods of correcting myopia, such as wearing glasses

  10. The social context of tuberculosis treatment in urban risk groups in the United Kingdom: a qualitative interview study.

    Science.gov (United States)

    Craig, Gillian M; Zumla, Alimuddin

    2015-03-01

    There is scant qualitative research into the experiences of tuberculosis (TB) treatment in urban risk groups with complex health and social needs in the UK. This study aimed to describe the social context of adherence to treatment in marginalized groups attending a major TB centre in London. A qualitative cross-sectional study was performed using semi-structured interviews with patients receiving treatment for TB. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions. There were 17 participants; the majority were homeless and had complex medical and social needs, including drug and alcohol use or immigration problems affecting entitlement to social welfare. Participants rarely actively chose not to take their medication, but described a number of social and institutional barriers to adherence and their need for practical support. Many struggled with the physical aspects of taking medication and the side effects. Participants receiving directly observed therapy (DOT) reported both positive and negative experiences, reflecting the type of DOT provider and culture of the organization. There is a need for integrated care across drug, alcohol, HIV, and homeless services in order to address the complex clinical co-morbidities and social needs that impact on the patient's ability to sustain a course of treatment. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Treatment of Moderately Intellectually Disabled Delinquent Youth in a Dutch Juvenile Justice Facility with Closed and Open Units

    Science.gov (United States)

    Lodewijks, Henny P. B.

    2011-01-01

    This article will focus on a juvenile justice facility in the Netherlands, targeted at moderately intellectually disabled juveniles, who are sentenced because of serious crimes. All of the juveniles have a disruptive disorder (conduct disorder or oppositional defiant disorder) and 70% have comorbid psychiatric classifications. Treatment amounts to…

  12. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review

    DEFF Research Database (Denmark)

    Nielsen, R M; Olsen, K S; Lauritsen, Anne Øberg

    2014-01-01

    of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma. CONCLUSION: Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly...

  13. [Current status of day care units where rheumatology treatments are administered in the autonomous community of Valencia].

    Science.gov (United States)

    Román Ivorra, José A; Gómez-Salazar, José Rosas; Calvo Catalá, Javier

    2010-01-01

    To evaluate and characterize the current status of the Rheumatology Day Hospital Care units in the Autonomous Community of Valencia. A structured brainstorming meeting was organized with 12 rheumatologists and a nurse and, after that, a questionnaire was sent to 20 rheumatologists to know more about the centers. Variability was found in the services that the day care units have for their own operation and for patient care. Rheumatologists place more importance on having some services that are not present in all centers at the moment: specialized nursing, quick drug delivery from the pharmacy and administration supervision by a rheumatologist. The following deficiencies were identified: sharing the workspaces with other specialties, drug delivery delays from the pharmacy, few resources (few spaces, few locations and little time for drug administration), lack of specialized nursing, lack of some services for patients (i.e. hot-line telephone service or patient education), few clinical sessions and lack of some procedures. It is necessary to establish measures that lead to the resolution of deficiencies and improve the services offered to patients. Copyright © 2009 Elsevier España, S.L. All rights reserved.

  14. A discrete event simulation model to evaluate the use of community services in the treatment of patients with Parkinson's disease in the United Kingdom.

    Science.gov (United States)

    Lebcir, Reda; Demir, Eren; Ahmad, Raheelah; Vasilakis, Christos; Southern, David

    2017-01-18

    The number of people affected by Parkinson's disease (PD) is increasing in the United Kingdom driven by population ageing. The treatment of the disease is complex, resource intensive and currently there is no known cure to PD. The National Health Service (NHS), the public organisation delivering healthcare in the UK, is under financial pressures. There is a need to find innovative ways to improve the operational and financial performance of treating PD patients. The use of community services is a new and promising way of providing treatment and care to PD patients at reduced cost than hospital care. The aim of this study is to evaluate the potential operational and financial benefits, which could be achieved through increased integration of community services in the delivery of treatment and care to PD patients in the UK without compromising care quality. A Discrete Event Simulation model was developed to represent the PD care structure including patients' pathways, treatment modes, and the mix of resources required to treat PD patients. The model was parametrised with data from a large NHS Trust in the UK and validated using information from the same trust. Four possible scenarios involving increased use of community services were simulated on the model. Shifting more patients with PD from hospital treatment to community services will reduce the number of visits of PD patients to hospitals by about 25% and the number of PD doctors and nurses required to treat these patients by around 32%. Hospital based treatment costs overall should decrease by 26% leading to overall savings of 10% in the total cost of treating PD patients. The simulation model was useful in predicting the effects of increased use of community services on the performance of PD care delivery. Treatment policies need to reflect upon and formalise the use of community services and integrate these better in PD care. The advantages of community services need to be effectively shared with PD patients

  15. Increases in fluoroquinolone-resistant Neisseria gonorrhoeae among men who have sex with men--United States, 2003, and revised recommendations for gonorrhea treatment, 2004.

    Science.gov (United States)

    2004-04-30

    In the United States, an estimated 700,000-800,000 persons are infected with Neisseria gonorrhoeae each year. Since 1993, CDC has recommended use of fluoroquinolones (i.e., ciprofloxacin, floxacin, or levofloxacin) for gonorrhea treatment. Fluoroquinolone therapy is used frequently because it is an inexpensive, oral, and single-dose therapy. However, because of increased prevalence of fluoroquinolone-resistant N. gonorrhoeae (QRNG) in Asia, the Pacific Islands (including Hawaii), and California, fluoroquinolones are no longer recommended for treating gonorrhea acquired in those locations. This report describes increases in QRNG among men who have sex with men (MSM) in Massachusetts, New York City, and 30 sites surveyed by the Gonococcal Isolate Surveillance Project (GISP) during 2003. CDC recommends that clinicians no longer use fluoroquinolones as a first-line treatment for gonorrhea in MSM.

  16. Stable Boundary Layer Education (STABLE) Final Campaign Summary

    Energy Technology Data Exchange (ETDEWEB)

    Turner, David D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-03-01

    The properties of, and the processes that occur in, the nocturnal stable boundary layer are not well understood, making it difficult to represent adequately in numerical models. The nocturnal boundary layer often is characterized by a temperature inversion and, in the Southern Great Plains region, a low-level jet. To advance our understanding of the nocturnal stable boundary layer, high temporal and vertical resolution data on the temperature and wind properties are needed, along with both large-eddy simulation and cloud-resolving modeling.

  17. Economic evaluation of biologic therapies for the treatment of moderate to severe psoriasis in the United States.

    Science.gov (United States)

    Anis, Aslam H; Bansback, Nick; Sizto, Sonia; Gupta, Shiraz R; Willian, Mary K; Feldman, Steve R

    2011-04-01

    New biologic therapies are available for moderate to severe psoriasis. To determine the most cost-effective sequence of biologic treatments. Through modeling of the clinical pathway of biologic agents, adalimumab, alefacept, efalizumab, etanercept, and infliximab, the costs and benefits (quality-adjusted life-years [QALYs]) were determined. A decision rule determined the optimal treatment sequence comparing costs and QALYs. While infliximab was found to provide the most incremental QALY and etanercept was found to be the least costly, on balance, the incremental cost-effectiveness ratio of adalimumab was the most favorable (ICER = $544/QALY). Consequently, the optimal sequence would begin with adalimumab and be followed by etanercept, infliximab, efalizumab, and alefacept, respectively. The limitations of this study are that evidence was based on indirect comparisons of biologic effectiveness, and toxicities were not included in the model. In consideration of cost-effectiveness in prescribing biologics for moderate to severe psoriasis, the optimal sequence would begin with adalimumab.

  18. Efficacy of Elimination of Pasteurella pneumotropica from a Mouse Specific Pathogen-Free Barrier Breeding Unit through Treatment with Enrofloxacin

    DEFF Research Database (Denmark)

    Østergaard, Grete; Arnorsdottir, Stefania Embla; Schumacher-Petersen, Camilla

    2010-01-01

    for 48 h. Colonies with suspect morphology were incubated on blood agar plates and MacConkey agar plates. Isolates growing on blood agar, but not on MacConkey, were tested for cytochromoxidase activity. Oxidase-positive colonies were grown in Heart Infusion Broth for motility testing and indol testing......, and enrofloxacin (EF) was chosen as the most appropriate antibiotic to treat this infection. Various doses of EF were tested for toxic effects on NMRI-mice prior to the treatment, and since no negative effects of EF, regardlessof dose tested, were observed, the highest dose of 150 mg/kg body weight was chosen...... and administered in drinking water based on an assumed daily water intake of 150 mL/kg body weight. Prior to treatment, all imports of mice (caesarean section or embryo transfer) were stopped. The populations of the various mouse strains bred in the barrier were minimized. Measures were taken to ensure there would...

  19. Role of partial laryngectomy after irradiation in the treatment of laryngeal cancer: A view from the United Kingdom

    Energy Technology Data Exchange (ETDEWEB)

    Shaw, H.J. (Royal Marsden Hospital, London (England))

    1991-04-01

    This retrospective study evaluates the use of conservation surgical salvage techniques in cases of early (T1 and T2) laryngeal cancer after full-dose external irradiation. Fifty patients in one London hospital and 68 patients in another were studied for the period 1963 to 1988. Treatment policy directed that the majority of limited glottic and supraglottic tumors should be treated initially by external irradiation. The small number of glottic treatment failures had a good chance of salvage by vertical partial laryngectomy if recurrence or a new primary was detected early. Recurrence of supraglottic cancer was salvaged occasionally by horizontal partial laryngectomy if strict indications were observed. Total laryngectomy remained the final minority salvage option.

  20. Thermal aggregation behaviour of soy protein: characteristics of different polypeptides and sub-units.

    Science.gov (United States)

    He, Xiu-Ting; Yuan, De-Bao; Wang, Jin-Mei; Yang, Xiao-Quan

    2016-03-15

    Due to the differences in structure and composition of glycinin and β-conglycinin, they exhibit different characteristics during heat treatment. In present study, the thermal aggregation behaviour of glycinin, β-conglycinin and their isolated sub-units was investigated at pH 7.0. Acidic polypeptides, basic polypeptides, αα' and β sub-units of soy protein were denatured during the isolation process. The degree of aggregation of protein fractions after heat treatment was in the order: denatured basic polypeptides > native glycinin > denatured β sub-unit > native β-conglycinin > denatured acidic polypeptides > denatured αα' sub-units. Glycinin, β-conglycinin, acidic polypeptides and αα'/β sub-units exhibited different changing trends of surface hydrophobicity with increasing temperature. The αα' sub-units showed higher ability to suppress thermal aggregation of basic polypeptides than β sub-units during heat treatment. The β sub-units were shown to form soluble aggregates with glycinin after heating. The interaction mechanism of αα' and β sub-units heated with basic polypeptides was proposed. For the β sub-units-basic polypeptides mixed system, more hydrophobic chains were binding together and buried inside during heat treatment, which resulted in lower surface hydrophobicity. The αα' sub-units-basic polypeptides mixed system was considered to be a stable system with higher surface hydrophobicity after being heated. © 2015 Society of Chemical Industry.

  1. Condensate treatment in BWR circuits by filter demineralizer units using powdered ion exchange resin at medium and high temperature

    International Nuclear Information System (INIS)

    De Martino, R.

    1983-01-01

    Considering the radiation build-up in some BWR reactors, we make a correlation between this phenomenon and the condensate purification system applied and the point of its utilization into the circuits. The application temperature of such a plant seems to have a very important role on the equilibria of metals contained in the reactor water and on the oxide composition. The efficiency of the condensate polishing system and the corrosion control are the most interesting objectives to achieve and to maintain, to control and regulate the physical and chemical process in the feedwater and in the reactor water. Up to date the technology owns major knowledge and a consistent know-how on using chemical products in order to increase the condensate polishing system efficiency. It is also considered a typical parallel case of a conventional power station and a secondary system of BWR units. (author)

  2. The ETHICA study (part I): elderly's thoughts about intensive care unit admission for life-sustaining treatments.

    Science.gov (United States)

    Philippart, F; Vesin, A; Bruel, C; Kpodji, A; Durand-Gasselin, B; Garçon, P; Levy-Soussan, M; Jagot, J L; Calvo-Verjat, N; Timsit, J F; Misset, B; Garrouste-Orgeas, M

    2013-09-01

    To assess preferences among individuals aged ≥80 years for a future hypothetical critical illness requiring life-sustaining treatments. Observational cohort study of consecutive community-dwelling elderly individuals previously hospitalised in medical or surgical wards and of volunteers residing in nursing homes or assisted-living facilities. The participants were interviewed at their place of residence after viewing films of scenarios involving the use of non-invasive mechanical ventilation (NIV), invasive mechanical ventilation (IMV), and renal replacement therapy after a period of invasive mechanical ventilation (RRT after IMV). Demographic, clinical, and quality-of-life data were collected. Participants chose among four responses regarding life-sustaining treatments: consent, refusal, no opinion, and letting the physicians decide. The sample size was 115 and the response rate 87 %. Mean participant age was 84.8 ± 3.5 years, 68 % were female, and 81 % and 71 % were independent for instrumental activities and activities of daily living, respectively. Refusal rates among the elderly were 27 % for NIV, 43 % for IMV, and 63 % for RRT (after IMV). Demographic characteristics associated with refusal were married status for NIV [relative risk (RR), 2.9; 95 % confidence interval (95 %CI), 1.5-5.8; p = 0.002] and female gender for IMV (RR, 2.4; 95 %CI, 1.2-4.5; p = 0.01) and RRT (after IMV) (RR, 2.7; 95 %CI, 1.4-5.2; p = 0.004). Quality of life was associated with choices regarding all three life-sustaining treatments. Independent elderly individuals were rather reluctant to accept life-sustaining treatments, especially IMV and RRT (after IMV). Their quality of life was among the determinants of their choices.

  3. Treatment and follow-up results of children with electrical burn who observed in burn intensive care unit

    Directory of Open Access Journals (Sweden)

    Çiğdem Aliosmanoğlu

    2011-06-01

    Full Text Available Electrical burns are infrequent relative to other injuries, but they are associated with high morbidity and mortality. The aim of this study was to assess management and follow-up results of pediatric patients’ who observed in intensive care unit and also review the precautions for preventing electrical burns.Materials and methods: Totally 22 patients aged under 17 years who were observed in the burn intensive care unit of Şanlıurfa Education and Research Hospital during the period between July 2009-October 2010. Cases were investigated retrospectively. The patients’ age, gender, total burn surface area, length of stay in hospital, musculo-skeletal system complication, cardiovascular system complication, kidney damage and attempts were recorded.Results: Of the 22 cases, 19 (86.3% were male and 3 (13.7% were female. The mean age of the patients was 11.5 years. In 10 (45.4% children burns were occurred in workplace and working area and 12 (54.6% were occurred in the home environment. Depth of burns were third degree in 10 (45.4% children and second degree in 12 (54.6%. The mean percentage of burn surface area was 25.9%. The mean length of stay in hospital was 17 days. Debridement and grafting were performed to 12 (54.6% cases and 10 (45.4% children were treated with dressings. No patient had increased creatinine kinase levels, oliguria, myoglobuinuria and arrhythmia. The mean hospitalization time was 17 days.Conclusion: Nearly half of patients underwent debridement plus grafting. None of our patients developed renal failure other severe system dysfunction.

  4. Managing Maternal Substance Use in the Perinatal Period: Current Concerns and Treatment Approaches in the United States and Australia

    Directory of Open Access Journals (Sweden)

    Lucinda Burns

    2016-01-01

    Full Text Available Substance use in pregnancy can have adverse effects on mother and fetus alike. Australia and the US are countries with high levels of substance use and policies advising abstinence, although the Australian approach occurs within a broader framework of harm minimization. Less attention has been paid to treatment of the mothers' substance use and what is considered gold standard. This is despite evidence that prior substance use in pregnancy is the most important factor in predicting future substance use in pregnancy. This paper draws together information from both the peer-reviewed and gray literature to provide a contemporary overview of patterns and outcomes of the three main drugs, alcohol, tobacco, and cannabis, used in Australia and the US during pregnancy and discusses what are considered gold standard screening and treatment approaches for these substances. This paper does not set out to be a comprehensive review of the area but rather aims to provide a concise summary of current guidelines for policy makers and practitioners who provide treatment for women who use substances in pregnancy.

  5. Treatment patterns of chronic obstructive pulmonary disease in employed adults in the United States

    Directory of Open Access Journals (Sweden)

    Diette GB

    2015-02-01

    Full Text Available Gregory B Diette,1 Anand A Dalal,2 Anna O D’Souza,3 Orsolya E Lunacsek,3 Saurabh P Nagar2 1Johns Hopkins University, Baltimore, MD, 2GlaxoSmithKline, Research Triangle Park, NC, 3Xcenda, Palm Harbor, FL, USA Background: This study evaluated patterns of pharmacotherapy in chronic obstructive pulmonary disease (COPD as they relate to recommended guidelines in a prevalent COPD patient population with employer-sponsored health insurance in the US.Methods: Health care claims data from 2007 and 2008 were retrospectively analyzed for the study population defined as patients aged 40 years and older, continuously enrolled during the study period, and having at least one inpatient or one emergency department (ED visit, or at least two outpatient claims coded with COPD (International Classification of Diseases, 9th Revision, Clinical Modification code 491.xx, 492.xx, 496.xx. Rates of any pharmacotherapy (both maintenance and reliever, long-acting maintenance pharmacotherapy in patients with an exacerbation history, and short-term treatment of acute exacerbations of COPD were evaluated in the overall population, newly diagnosed, and previously diagnosed patients (including maintenance-naïve and maintenance-experienced. Stratified analyses were also conducted by age group (40–64 years, ≥65 years and physician specialty.Results: A total of 55,361 patients met study criteria of whom 39% were newly diagnosed. The mean age was 66 years, and 46% were male. Three-fourths (74% of all COPD patients had some pharmacotherapy (maintenance or reliever with less than half (45% being treated with maintenance medications. The combination of an inhaled corticosteroid and a long-acting beta-agonist was the most prevalent drug class for maintenance treatment followed by tiotropium. Only 64% of patients with an exacerbation history had a prescription for a long-acting maintenance medication, and short-term treatment with oral corticosteroids or antibiotics was

  6. Extracorporeal shock wave lithotripsy in the treatment of ureteric stones: Experience from Twam Hospital, United Arab Emirates

    International Nuclear Information System (INIS)

    Ghafoor, M.; Halim, A.

    2002-01-01

    The optimal treatment of ureteric stones, especially the lower ureteric stone, remains controversial. The purpose of this study was to evaluate the role of extracorporeal shock wave lithotripsy (ESWL) in the management of ureteric stones. A total of 99 patients with ureteric stones at different levels were treated with ESWL from 1994 through 1998 at our hospital. All patients were treated using Siemen Lithostar-II Plus Lithotripter. Of 99 patients, 22 were excluded from the study because they had no follow-up records of their stone-free status. The clearance rates for ureteric stones of the other 79 patients treated were stratified according to the site, size and the number of treatment sessions required per stone. The stone size was determined by the widest diameters. Based on stone size, the patients were divided into two groups: A ( 1 0 mm) and B (11-20 mm). The overall all clearance rate for ureteric stones treated with ESWL, irrespective of its site and size, was 78.5%. The overall clearance rate for size A (<-10 mm) stone was 82% and size B (11-20 mm) was 58% regardless of the site of the stone in the ureter. A total of 17 upper ureteric stones were treated with ESWL. The overall clearance rate for upper ureteric stones was 94%. Thirteen patients with mid-ureteric stones were treated with ESWL. The overall clearance rate for the lower ureteric stones was 69.3%. ESWL is safe, effective, noninvasive and a convenient way of treatment for all ureteric stones. The clearance rate for stones in the upper and mid-ureter is above 90%. ESWL being an outpatient procedure without ant need for anesthesia or any pretreatment intervention. It should be considered as the first line of treatment for all stones in the upper and mid-ureter. The clearance for small stones (<1 mm) in the lower third of ureter was 73.8% in our study and for these, ESWL may be considered as a primary therapy. For stones larger than 10 mm in the distal third of ureter, the clearance rate was low

  7. Adherence of mentally stable patients to antipsychotic medications ...

    African Journals Online (AJOL)

    The results of this study indicated that participants shared same viewpoints related to aspects of adherence to antipsychotic treatment; the mentally stable patients have knowledge related to the causes of mental illness; poor adherence to antipsychotic treatment results from the health seeking behaviour of the patients.

  8. Development of a Faith-Based Mental Health Literacy Program to Improve Treatment Engagement Among Caribbean Latinos in the Northeastern United States of America.

    Science.gov (United States)

    Caplan, Susan; Cordero, Carolyn

    2015-01-01

    Depression is one of the leading causes of years lived with disability (YLDs) worldwide. Although depression can be successfully treated, 75% of Americans do not receive care. Treatment rates among Latinos immigrants are significantly lower than non-immigrant Latinos and non-Hispanic Whites. Known factors for mental health-care disparities such as poverty, insurance coverage, language barriers, and access to specialty mental health services in Latino neighborhoods do not fully explain the differences in treatment rates. Significant, but poorly understood factors influencing depression treatment among Latinos in the United States are lack of culturally congruent care, low mental health literacy, and stigma. Even though churches are a major source of health information, social and spiritual support for Latinos, the conceptualization of culturally congruent care rarely addresses religious beliefs. Therefore, one strategy to reduce disparities in depression treatment is to partner with churches to address faith-based stigma. Community-based participatory research is recognized as a methodology particularly well suited for creating successful culturally targeted interventions. The purpose of this article is to describe the process of creating a faith-based mental health literacy intervention in the Caribbean Latino community using the principles of community-based participatory research. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. Comparing Fréchet and positive stable laws

    OpenAIRE

    Simon, Thomas

    2014-01-01

    To appear in Electronic Journal of Probability; Let ${\\bf L}$ be the unit exponential random variable and ${\\bf Z}_\\alpha$ the standard positive $\\alpha$-stable random variable. We prove that $\\{(1-\\alpha) \\alpha^{\\gamma_\\alpha} {\\bf Z}_\\alpha^{-\\gamma_\\alpha}, 0< \\alpha

  10. Comparing adult cannabis treatment-seekers enrolled in a clinical trial with national samples of cannabis users in the United States.

    Science.gov (United States)

    McClure, Erin A; King, Jacqueline S; Wahle, Aimee; Matthews, Abigail G; Sonne, Susan C; Lofwall, Michelle R; McRae-Clark, Aimee L; Ghitza, Udi E; Martinez, Melissa; Cloud, Kasie; Virk, Harvir S; Gray, Kevin M

    2017-07-01

    Cannabis use rates are increasing among adults in the United States (US) while the perception of harm is declining. This may result in an increased prevalence of cannabis use disorder and the need for more clinical trials to evaluate efficacious treatment strategies. Clinical trials are the gold standard for evaluating treatment, yet study samples are rarely representative of the target population. This finding has not yet been established for cannabis treatment trials. This study compared demographic and cannabis use characteristics of a cannabis cessation clinical trial sample (run through National Drug Abuse Treatment Clinical Trials Network) with three nationally representative datasets from the US; 1) National Survey on Drug Use and Health, 2) National Epidemiologic Survey on Alcohol and Related Conditions-III, and 3) Treatment: Episodes Data Set - Admissions. Comparisons were made between the clinical trial sample and appropriate cannabis using sub-samples from the national datasets, and propensity scores were calculated to determine the degree of similarity between samples. showed that the clinical trial sample was significantly different from all three national datasets, with the clinical trial sample having greater representation among older adults, African Americans, Hispanic/Latinos, adults with more education, non-tobacco users, and daily and almost daily cannabis users. These results are consistent with previous studies of other substance use disorder populations and extend sample representation issues to a cannabis use disorder population. This illustrates the need to ensure representative samples within cannabis treatment clinical trials to improve the generalizability of promising findings. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. The management of pemphigus vulgaris in a burn intensive care unit: a case report and treatment review.

    Science.gov (United States)

    Miletta, Nathanial; Miller, Mary E; Lam, Thomas; Chung, Kevin K; Hivnor, Chad

    2014-01-01

    Pemphigus vulgaris is a rare, potentially fatal, autoimmune blistering disease of the skin and mucous membranes. Treatment of this disease is problematic because of a lack of high-grade, evidence-based recommendations, the side-effect profiles of the therapies available, and the extensive supportive care that afflicted patients require. The authors present the unfortunate course of a patient with severe pemphigus vulgaris who was admitted to the U.S. Army Institute of Surgical Research Burn Center, to demonstrate the potential complications of therapy. Given the patient's complex course, the authors reviewed the literature and share in this article the most up-to-date treatment recommendations for patients with pemphigus vulgaris. The authors' review of the literature supports using conventional therapy consisting of high-dose corticosteroids and an adjuvant immunosuppressant for mild to moderate cases of pemphigus vulgaris. The immunosuppresants recommended are mycophenolate mofetil, azathioprine, and cyclophosphamide, in order of preference, based on their side-effect profiles and steroid-sparing effects. For severe or recalcitrant cases of pemphigus vulgaris, the authors recommend adding rituximab as early as possible. If increased risk of infection is of particular concern, the use of intravenous immunoglobulin in place of rituximab is advised.

  12. Physician experiences and preferences in the treatment of HR+/HER2− metastatic breast cancer in the United States: a physician survey

    International Nuclear Information System (INIS)

    Lin, Peggy L.; Hao, Yanni; Xie, Jipan; Li, Nanxin; Zhong, Yichen; Zhou, Zhou; Signorovitch, James E.; Wu, Eric Q.

    2015-01-01

    Sequential endocrine therapy (ET) is recommended for postmenopausal women with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2−) metastatic breast cancer (mBC) and without visceral symptoms. Chemotherapy (CT) can be considered after sequential ETs, but is associated with adverse side effects. We assessed physicians' preferences and self-reported prescribing patterns for ET and CT in the treatment of HR+/HER2− mBC at community practices in the United States. Community-based oncologists/hematologists from a nationwide online panel who treated postmenopausal women with HR+/HER2− mBC were invited to complete a survey, blinded to the identity of study sponsor. Treatment preferences were collected by treatment class of ET-based regimens versus CT and by agent for postmenopausal HR+/HER2− mBC patients after prior nonsteroidal aromatase inhibitor use in the adjuvant or mBC setting. Among 213 physicians who completed the survey, 78% were male, 71% were based in small/intermediate practices (2–9 oncologists/subspecialists), 55% had >10 years of experience, and 58% referred to the National Comprehensive Cancer Network Guidelines when treating mBC. Among first-line ETs, anastrozole was the most frequently used treatment (35%), followed by everolimus-based (EVE, 34%) and fulvestrant-based (FUL, 15%) therapy. After first-line ET, the most preferred second- and third-line treatments were ET monotherapy (48% and 39%), ET combination therapy (31% and 19%), and CT monotherapy (13% and 30%). Comparing EVE versus FUL, physicians preferred EVE in all lines but first line. Efficacy was the most important consideration for treatment choice. Physicians prescribed CT in early lines mainly because of visceral symptoms. This survey of treatment patterns for HR+/HER2− mBC in community practice suggested that after first-line ET, ET mono- or combination therapy was commonly used for the second- and third-line treatments and CT

  13. Racial Disparities in Treatment Rates for Chronic Hepatitis C: Analysis of a Population-Based Cohort of 73,665 Patients in the United States.

    Science.gov (United States)

    Vutien, Philip; Hoang, Joseph; Brooks, Louis; Nguyen, Nghia H; Nguyen, Mindie H

    2016-05-01

    Chronic hepatitis C (CHC) disproportionately affects racial minorities in the United States (US). Although prior studies have reported lower treatment rates in Blacks than in Caucasians, the rates of other minorities remain understudied. We aimed to examine antiviral treatment rates by race and to evaluate the effect of other demographic, medical, and psychiatric factors on treatment rates. We performed a population-based study of adult CHC patients identified via ICD-9CM query from OptumInsight's Data Mart from January 2009 to December 2013. Antiviral treatment was defined by pharmaceutical claims for interferon and/or pegylated-interferon. A total of 73,665 insured patients were included: 51,282 Caucasians, 10,493 Blacks, 8679 Hispanics, and 3211 Asians. Caucasians had the highest treatment rate (10.7%) followed by Blacks (8.8%), Hispanics (8.8%), and Asians (7.9%, P < .001). Hispanics had the highest cirrhosis rates compared with Caucasians, Blacks, and Asians (20.7% vs 18.3%, 17.1%, and 14.3%, respectively). Caucasians were the most likely to have a psychiatric comorbidity (20.1%) and Blacks the most likely to have a medical comorbidity (44%). Asians were the least likely to have a psychiatric (6.4%) or medical comorbidity (26.9%). On multivariate analysis, racial minority was a significant predictor of nontreatment with odds ratios of 0.82 [confidence interval (CI): 0.74-0.90] for Blacks, 0.87 (CI: 0.78-0.96) for Hispanics, and 0.73 (CI: 0.62-0.86) for Asians versus Caucasians. Racial minorities had lower treatment rates than Caucasians. Despite fewer medical and psychiatric comorbidities and higher incomes and educational levels, Asians had the lowest treatment rates. Hispanics also had lower treatment rates than Caucasians despite having higher rates of cirrhosis. Future studies should aim to identify underlying racial-related barriers to hepatitis C virus treatment besides socioeconomic status and medical or psychiatric comorbidities.

  14. Survival Impact of Increasing Time to Treatment Initiation for Patients With Head and Neck Cancer in the United States.

    Science.gov (United States)

    Murphy, Colin T; Galloway, Thomas J; Handorf, Elizabeth A; Egleston, Brian L; Wang, Lora S; Mehra, Ranee; Flieder, Douglas B; Ridge, John A

    2016-01-10

    To estimate the overall survival (OS) impact from increasing time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC). Using the National Cancer Data Base (NCDB), we examined patients who received curative therapy for the following sites: oral tongue, oropharynx, larynx, and hypopharynx. TTI was the number of days from diagnosis to initiation of curative treatment. The effect of TTI on OS was determined by using Cox regression models (MVA). Recursive partitioning analysis (RPA) identified TTI thresholds via conditional inference trees to estimate the greatest differences in OS on the basis of randomly selected training and validation sets, and repeated this 1,000 times to ensure robustness of TTI thresholds. A total of 51,655 patients were included. On MVA, TTI of 61 to 90 days versus less than 30 days (hazard ratio [HR], 1.13; 95% CI, 1.08 to 1.19) independently increased mortality risk. TTI of 67 days appeared as the optimal threshold on the training RPA, statistical significance was confirmed in the validation set (P < .001), and the 67-day TTI was the optimal threshold in 54% of repeated simulations. Overall, 96% of simulations validated two optimal TTI thresholds, with ranges of 46 to 52 days and 62 to 67 days. The median OS for TTI of 46 to 52 days or fewer versus 53 to 67 days versus greater than 67 days was 71.9 months (95% CI, 70.3 to 73.5 months) versus 61 months (95% CI, 57 to 66.1 months) versus 46.6 months (95% CI, 42.8 to 50.7 months), respectively (P < .001). In the most recent year with available data (2011), 25% of patients had TTI of greater than 46 days. TTI independently affects survival. One in four patients experienced treatment delay. TTI of greater than 46 to 52 days introduced an increased risk of death that was most consistently detrimental beyond 60 days. Prolonged TTI is currently affecting survival. © 2015 by American Society of Clinical Oncology.

  15. Increase in white cell and neutrophil counts during the first eighteen weeks of treatment with clozapine in patients admitted to a long-term psychiatric care inpatient unit.

    Science.gov (United States)

    Capllonch, Adrián; de Pablo, Silvia; de la Torre, Alberto; Morales, Ignacio

    Clozapine is an antipsychotic drug that has shown to be more effective than other antipsychotics in the treatment of schizophrenia, but its use is limited due to its side effects, particularly by the risk of causing agranulocytosis. A study was made on the variations in white cell and neutrophil counts in patients treated with clozapine in a Long-term Psychiatric Unit. A retrospective observational study was conducted with a sample of women of our long-term psychiatric care unit who had been treated with clozapine. A study was made on the variations in white cell and neutrophil counts during the first 18 weeks of treatment, as well as the onset of leukopenia, neutropenia, agranulocytosis, and the influence of concomitant drugs. The study included 55 patients on treatment with clozapine. The incidence rate of neutropenia was 1.82% (95% CI; 0.05-10.13). The incidence rate of leukopenia and agranulocytosis was 0%. An increase in white cell and neutrophil counts from baseline to week 3-4 was observed. Only small variations were observed after this time, but the counts remained higher than the initial values. These changes were statistically significant in the white cell count: One-way repeated ANOVA with Greenhouse-Geisser correction F (11.47, 37) = 2.114 (P= .011); and in neutrophils: One-way repeated ANOVA with Greenhouse-Geisser correction F (10.3, 37)=3.312 (P=.0002), and MANOVA F (18, 37)=2.693 (P=.005), ŋ 2 P =0.567. The influence of concomitant drugs (lithium, valproic and biperiden) was not significant on the overall increase found in white cells or neutrophils (MANOVA). Copyright © 2016 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Treatment

    Directory of Open Access Journals (Sweden)

    Safaa M. Raghab

    2013-08-01

    The main goal of this study is to utilize a natural low cost material “as an accelerator additive to enhance the chemical treatment process using Alum coagulant and the accelerator substances were Perlite and Bentonite. The performance of the chemical treatment was enhanced using the accelerator substances with 90 mg/l Alum as a constant dose. Perlite gave better performance than the Bentonite effluent. The removal ratio for conductivity, turbidity, BOD and COD for Perlite was 86.7%, 87.4%, 89.9% and 92.8% respectively, and for Bentonite was 83.5%, 85.0%, 86.5% and 85.0% respectively at the same concentration of 40 mg/l for each.

  17. The potential role of herbal medicines in the treatment of chronic stable angina pectoris: a review of key herbs, and as illustration, exploration of the Chinese herbal medicine approach

    Directory of Open Access Journals (Sweden)

    O'Brien KA

    2012-12-01

    Full Text Available Kylie A O'Brien,1,2 Luis Vitetta31Deakin University, Melbourne, Victoria, Australia; 2Monash Medical School, Prahran, Victoria, Australia; 3The University of Queensland, School of Medicine, Centre for Integrative Clinical and Molecular Medicine at the Princess Alexandra Hospital, Brisbane, Queensland, AustraliaAbstract: Herbal medicines have been used for centuries within different cultures to treat cardiovascular disease, including stable angina pectoris. However, the use of herbs varies within traditions of natural medicine, and how they are understood to work in systems such as Chinese medicine, for example, is vastly different from the pharmaceutical model that seeks to reduce herbs to their active constituents. This review first discusses, individually, key herbs used within Western, Indian, and Chinese herbalism to treat stable angina pectoris and their main active constituents and pharmacological actions. The second part of the paper then specifically explores how angina is treated traditionally with Chinese herbal medicine, a unique approach to the understanding of health and illness underpinned by philosophies and theories that describe the physiological functioning and pathological changes in the body in terms very different from those of biomedicine. A foundational account of the guiding theories of Chinese medicine is followed by a description of the cardiovascular system and the etiology and pathogenesis of angina from the Chinese medical perspective. This forms the basis for understanding the rationale for construction of Chinese herbal medicinal formulae for treating angina pectoris. The scientific evidence of the efficacy of some Chinese herbal formulae is discussed.Keywords: herbs, herbal medicine, Chinese herbal medicine, angina pectoris, cardiovascular

  18. An ecological study of skin biopsies and skin cancer treatment procedures in the United States Medicare population, 2000 to 2015.

    Science.gov (United States)

    Wang, David M; Morgan, Frederick C; Besaw, Robert J; Schmults, Chrysalyne D

    2018-01-01

    Analyses of skin cancer procedures adjusted for population changes are needed. To describe trends in skin cancer-related biopsies and procedures in Medicare beneficiaries. An ecological study of Medicare claims for skin biopsies and skin cancer procedures in 2000 to 2015. Biopsies increased 142%, and skin cancer procedures increased 56%. Mohs micrographic surgery (MMS) utilization increased on the head/neck, hands/feet, and genitalia (increasing from 11% to 27% of all treatment procedures) but was low on the trunk/extremities (increasing from 1% to 4%). Adjusted for increased Medicare enrollment (+36%) between 2000 and 2015, the number of biopsies and MMS procedures performed per 1000 beneficiaries increased (from 56 to 99 and from 5 to 15, respectively), whereas the number of excisions and destructions changed minimally (from 18 to 16 and from 19 to 18, respectively). Growth in biopsies and MMS procedures slowed between each time period studied: 4.3 additional biopsies per year and 0.9 additional MMS procedures per year per 1000 beneficiaries between 2000 and 2007, 2.2 and 0.5 more between 2008 and 2011, and 0.5 and 0.3 more between 2012 and 2015, respectively. Medicare claims-level data do not provide patient-level or nonsurgical treatment information. The increased number of skin cancer procedures performed was largely the result of Medicare population growth over time. MMS utilization increased primarily on high- and medium-risk and functionally and cosmetically significant locations where tissue sparing and maximizing cure are critical. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  19. Hypertension and treatment outcomes in Palestine refugees in United Nations Relief and Works Agency primary health care clinics in Jordan.

    Science.gov (United States)

    Khader, A; Farajallah, L; Shahin, Y; Hababeh, M; Abu-Zayed, I; Zachariah, R; Kochi, A; Kapur, A; Harries, A D; Shaikh, I; Seita, A

    2014-10-01

    In six United Nations Relief and Works Agency (UNRWA) primary health care clinics in Jordan serving Palestine refugees diagnosed with hypertension, to determine the number, characteristics, programme outcomes and measures of disease control for those registered up to 30 June, 2013, and in those who attended clinic in the second quarter of 2013, the prevalence of disease-related complications between those with hypertension only and hypertension combined with diabetes mellitus. Retrospective cohort study with programme and outcome data collected and analysed using E-Health. There were 18 881 patients registered with hypertension with females (64%) and persons aged ≥ 40 years (87%) predominating. At baseline, cigarette smoking was recorded in 17%, physical inactivity in 48% and obesity in 71% of patients. 77% of all registered patients attended clinic in the second quarter of 2013; of these, 50% had hypertension and diabetes and 50% had hypertension alone; 9% did not attend the clinics and 10% were lost to follow-up. Amongst those attending clinic, 92% had their blood pressure measured, of whom 83% had blood pressure <140/90 mm Hg. There were significantly more patients with hypertension and diabetes (N = 966, 13%) who had disease-related complications than patients who had hypertension alone (N = 472, 6%) [OR 2.2, 95% CI 2.0-2.5], and these differences were found for both males [18% vs. 10%, OR 1.9, 95% CI 1.6-2.2] and females [11% vs. 5%, OR 2.4, 95% CI 2.1-2.9]. Large numbers of Palestine refugees are being registered and treated for hypertension in UNRWA primary health care clinics in Jordan. Cohort analysis and E-Health can be used to regularly assess caseload, programme outcomes, clinic performance, blood pressure control and cumulative prevalence of disease-related complications. Current challenges include the need to increase clinic attendance and attain better control of blood pressure. © 2014 John Wiley & Sons Ltd.

  20. SU-E-J-70: Feasibility Study of Dynamic Arc and IMRT Treatment Plans Utilizing Vero Treatment Unit and IPlan Planning Computer for SRS/FSRT Brain Cancer Patients

    International Nuclear Information System (INIS)

    Huh, S; Lee, S; Dagan, R; Malyapa, R; Mendenhall, N; Mendenhall, W; Ho, M; Hough, D; Yam, M; Li, Z

    2014-01-01

    Purpose: To investigate the feasibility of utilizing Dynamic Arc (DA) and IMRT with 5mm MLC leaf of VERO treatment unit for SRS/FSRT brain cancer patients with non-invasive stereotactic treatments. The DA and IMRT plans using the VERO unit (BrainLab Inc, USA) are compared with cone-based planning and proton plans to evaluate their dosimetric advantages. Methods: The Vero treatment has unique features like no rotational or translational movements of the table during treatments, Dynamic Arc/IMRT, tracking of IR markers, limitation of Ring rotation. Accuracies of the image fusions using CBCT, orthogonal x-rays, and CT are evaluated less than ∼ 0.7mm with a custom-made target phantom with 18 hidden targets. 1mm margin is given to GTV to determine PTV for planning constraints considering all the uncertainties of planning computer and mechanical uncertainties of the treatment unit. Also, double-scattering proton plans with 6F to 9F beams and typical clinical parameters, multiple isocenter plans with 6 to 21 isocenters, and DA/IMRT plans are evaluated to investigate the dosimetric advantages of the DA/IMRT for complex shape of targets. Results: 3 Groups of the patients are divided: (1) Group A (complex target shape), CI's are same for IMRT, and DGI of the proton plan are better by 9.5% than that of the IMRT, (2) Group B, CI of the DA plans (1.91+/−0.4) are better than cone-based plan, while DGI of the DA plan is 4.60+/−1.1 is better than cone-based plan (5.32+/−1.4), (3) Group C (small spherical targets), CI of the DA and cone-based plans are almost the same. Conclusion: For small spherical targets, cone-based plans are superior to other 2 plans: DS proton and DA plans. For complex or irregular plans, dynamic and IMRT plans are comparable to cone-based and proton plans for complex targets

  1. Monitoring of stable glaucoma patients

    NARCIS (Netherlands)

    K.M. Holtzer-Goor (Kim); N.S. Klazinga (Niek); M.A. Koopmanschap (Marc); H.G. Lemij (Hans); T. Plochg; E. van Sprundel (Esther)

    2010-01-01

    textabstractA high workload for ophthalmologists and long waiting lists for patients challenge the organization of ophthalmic care. Tasks that require less specialized skills, like the monitoring of stable (well controlled) glaucoma patients could be substituted from ophthalmologists to other

  2. Experimental Study of Advanced Treatment of Coking Wastewater Using MBR-RO Combined Process

    Science.gov (United States)

    Zhang, Lei; Hwang, Jiannyang; Leng, Ting; Xue, Gaifeng; Chang, Hongbing

    A membrane bioreactor-reverse osmosis (MBR-RO) combined process was used for advanced treatment of coking wastewater from secondary biological treatment. MBR and RO units' treatment efficiency for the pollution removal were conducted, and effects of raw water conductivity and trans-membrane pressure on water yield and desalination rate in RO unit were investigated in detail. The experimental results proved that MBR-RO combined process ran steadily with good treatment effect, which could obtain stable effluent water quality and met the requirement of "Design Criterion of the Industrial Circulating Cooling Water Treatment" (GB 50050-2007).

  3. Treatment and Survival of Small-bowel Adenocarcinoma in the United States: A Comparison With Colon Cancer.

    Science.gov (United States)

    Young, John I; Mongoue-Tchokote, Solange; Wieghard, Nicole; Mori, Motomi; Vaccaro, Gina M; Sheppard, Brett C; Tsikitis, Vassilki L

    2016-04-01

    Small-bowel adenocarcinoma is rare and fatal. Because of data paucity, there is a tendency to extrapolate treatment from colon cancer, particularly in the adjuvant stetting. The purpose of this study was to evaluate the current surgical and adjuvant treatments of small-bowel adenocarcinoma and compare with colon cancer. This was a retrospective cohort study. The linked Surveillance, Epidemiology, and End Results and Medicare database was used at a tertiary referral hospital. Patients with small-bowel adenocarcinoma and colon cancer identified from 1992 to 2010, using International Classification of Diseases for Oncology, 3 Revision, site, behavior, and histology codes were included. Overall survival and cancer-specific survival were estimated using the Kaplan-Meier method and competing risk analysis. A total of 2123 patients with small-bowel adenocarcinoma and 248,862 patients with colon cancer were identified. Five-year overall survival rates for patients with small-bowel adenocarcinoma and colon cancer were 34.9% and 51.5% (p bowel adenocarcinoma (73.0%) underwent surgery, compared with 177,017 patients with colon cancer (71.1%). The proportion of patients who received chemotherapy was similar, at 21.3% for small bowel and 20.0% for colon. In contrast to colon cancer, chemotherapy did not improve overall or cancer-specific survival for patients with small-bowel adenocarcinoma, regardless of stage. Predictors of poor survival for small-bowel adenocarcinoma on multivariate analysis included advanced age, black race, advanced stage, poor tumor differentiation, high comorbidity index, and distal location. Chemotherapy did not confer additional survival benefit compared with surgery alone (HR, 1.04 (95% CI, 0.90-1.22)). This was a retrospective review. The reliance on Medicare data limited granularity and may have affected the generalizability of the results. The prognosis for small-bowel adenocarcinoma is worse than that for colon cancer, and only surgery improves

  4. [Study of erythromycin and metoclopramide in treatment of feeding intolerance of critically ill patients in intensive care unit].

    Science.gov (United States)

    Lu, Nian-Fang; Zheng, Rui-Qiang; Lin, Hua; Yang, De-Gang; Chen, Qi-Hong; Shao, Jun; Yu, Jiang-Quan

    2010-01-01

    To compare the effect of erythromycin and metoclopramide on feeding intolerance of critically ill patients in intensive care unit (ICU). One hundred and fifty-two critically ill patients in ICU who needed early enteral nutrition exceeding 7 days between January 2007 and January 2009 were included in the study. The patients were randomly divided into three groups: erythromycin group (200 mg intravenous drip, once every 12 hours), metoclopramide group (10 mg intravenous injection, once every 8 hours), and combination therapy group. The whole experiment was carried out for 7 days. Residual gastric volume was aspirated and measured every day at 03:00, 09:00, 15:00 and 21:00. The daily mean gastric residual volume was compared. At the same time, the daily effectiveness of erythromycin and metoclopramide on the success of feeding was also compared. The factors associated with a poor response to prokinetic therapy were looked for. The daily gastric residual volume in the combination therapy group was smallest, the maximum was (40+/-8) ml; the maximum of gastric residual volume in erythromycin group was (42+/-7) ml; the maximum of gastric residual volume in metoclopramide group was (59+/-8) ml (Psuccessful rate of feeding was highest in the combination therapy group, and it was as high as 97.4%, the erythromycin group ranked the second (90.0%), and that of the metoclopramide group was lowest (89.5%, PFactors that were associated with a poor response to prokinetic therapy was high pretreatment 24-hour gastric residual volume (r=-0.584, P=0.000), high blood sugar level (r=-0.345, P=0.029), a high acute physiology and chronic health evaluation II (APACHEII) score (r=-0.437, P=0.005), and requirement for inotropic drug support (r=-0.389, P=0.041). Low dose of erythromycin could improve the successful rate of feeding in critically ill patients in ICU. The combined administration of erythromycin and metoclopramide was more effective. Its side effect was minimal.

  5. Use of indium and rare-earths activable tracers for the evaluation of the hydraulic performance of wastewater treatment units

    Energy Technology Data Exchange (ETDEWEB)

    Alvarenga, Gilmara Lucia Souza; Barreto, Alberto Avelar; Pinto, Amenonia Maria Ferreira; Moreira, Rubens Martins, E-mail: gil_lsa@yahoo.com.br, E-mail: aab@cdtn.br, E-mail: amfp@cdtn.br, E-mail: rubens@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Silva, Lauris Lucia da, E-mail: laurislsilva@yahoo.com.br [Universidade Federal de Minas Gerais (DQ/UFMG), Minas Gerais, MG (Brazil). Dept. de Quimica

    2013-07-01

    Efforts aimed at going deeper into the understanding of the purification processes of contaminated waters and at the optimization of both the technological and economic performance of such processes have been developed following the introduction of innovative wastewater treatment processes. Among the several wastewater depuration processes, this study focuses physical aspects of systems known as artificial wetlands and a special version of the anaerobic biological reactor. This biological reactor is of the upflow anaerobic sludge blanket (UASB) type, which is increasingly being utilized for the processing of urban wastewater. However, its effluent eventually needs some polishing to be performed at an artificial wetland stage. The hydrodynamic performances of both a special version of the UASB and a vegetated wetland have been studied using the tracer methodology, based on the impulse response of these systems. Both radioactive and activable tracers have been employed and had their information analyzed by appropriate software. Comments are presented on the advantages of the activable tracers. The results thus obtained have demonstrated the potential of the application of activable tracers in the experimental research of either natural or artificial hydraulic systems. (author)

  6. Use of indium and rare-earths activable tracers for the evaluation of the hydraulic performance of wastewater treatment units

    International Nuclear Information System (INIS)

    Alvarenga, Gilmara Lucia Souza; Barreto, Alberto Avelar; Pinto, Amenonia Maria Ferreira; Moreira, Rubens Martins; Silva, Lauris Lucia da

    2013-01-01

    Efforts aimed at going deeper into the understanding of the purification processes of contaminated waters and at the optimization of both the technological and economic performance of such processes have been developed following the introduction of innovative wastewater treatment processes. Among the several wastewater depuration processes, this study focuses physical aspects of systems known as artificial wetlands and a special version of the anaerobic biological reactor. This biological reactor is of the upflow anaerobic sludge blanket (UASB) type, which is increasingly being utilized for the processing of urban wastewater. However, its effluent eventually needs some polishing to be performed at an artificial wetland stage. The hydrodynamic performances of both a special version of the UASB and a vegetated wetland have been studied using the tracer methodology, based on the impulse response of these systems. Both radioactive and activable tracers have been employed and had their information analyzed by appropriate software. Comments are presented on the advantages of the activable tracers. The results thus obtained have demonstrated the potential of the application of activable tracers in the experimental research of either natural or artificial hydraulic systems. (author)

  7. Fate of Parabens and Their Metabolites in Two Wastewater Treatment Plants in New York State, United States.

    Science.gov (United States)

    Wang, Wei; Kannan, Kurunthachalam

    2016-02-02

    Little is known about the occurrence and fate of parabens and their metabolites in wastewater treatment plants (WWTPs). In this study, mass loadings, removal efficiencies, and environmental emission of six parabens, four of their metabolites (4-hydroxy benzoate, 3,4-dihydroxy benzoate, methyl-protocatechuate, and ethyl-protocatechuate) and benzoic acid were studied based on the concentrations determined in wastewater influent, primary effluent, final effluent, suspended particulate matter (SPM), and sludge collected from two WWTPs (denoted as WWTP(A) and WWTP(B)) in the Albany area of New York State. The median respective concentrations of sum of parabens (Σparabens = 6 parent compounds) and paraben-metabolites (Σmetabolites = 4 metabolites) were 73.1-158 and 5460-10,000 ng/L in influents, and 1.96-5.57 and 2060-2550 ng/L in final effluents. The concentrations of Σmetabolites were significantly higher than those of Σparabens in sludge and SPM. The removal efficiencies for parabens (89.6-99.9%) were higher than those for their metabolites (25.9-90.6%). The respective mass loadings of parabens and their metabolites were 46.3 and 6210 mg/d/1000 people for WWTP(A) and 176 and 63,100 mg/d/1000 people for WWTP(B). The environmental emission of parabens and their metabolites through WWTP discharges was 4.85-6.16 and 1270-2050 mg/d/1000 people, respectively.

  8. The Search for Stable, Massive, Elementary Particles

    International Nuclear Information System (INIS)

    Kim, Peter C.

    2001-01-01

    In this paper we review the experimental and observational searches for stable, massive, elementary particles other than the electron and proton. The particles may be neutral, may have unit charge or may have fractional charge. They may interact through the strong, electromagnetic, weak or gravitational forces or through some unknown force. The purpose of this review is to provide a guide for future searches--what is known, what is not known, and what appear to be the most fruitful areas for new searches. A variety of experimental and observational methods such as accelerator experiments, cosmic ray studies, searches for exotic particles in bulk matter and searches using astrophysical observations is included in this review

  9. Current Status of Spent Fast Reactor Fuel Reprocessing and Waste Treatment in Various Countries: United States of America

    International Nuclear Information System (INIS)

    2011-01-01

    Due to the previous strategic US decision on treating SNF as waste and not pursuing the reprocessing option, development work for the FR fuel cycle was only performed in a few laboratories, although interest is now increasing again. ORNL together with ANL have been influential in promoting the wider use of centrifugal contactors (favoured due to the high fissile content and decay power of FR fuel materials), associated remote handling systems and hardware prototypes for most unit operations in the reprocessing conceptual designs in the context of their development of the Consolidated Fuel Reprocessing Program. There is limited experience with reprocessing tests on the Fast Flux Text Facility (FFTF) MOX fuel. ORNL has undertaken small tests on laboratory scale dissolution and solvent extraction of MOX fuel irradiated to 220 GW/t HM burnup at around 2 kg batch scale [180-186]. The initiative called the breeder reprocessing engineering test (BRET) was started in the 1980s with a focus on the developmental activity of the US DOE to demonstrate breeder fuel reprocessing technology while closing the fuel cycle for the FFTF. The process was supposed to be installed at the existing Fuels and Materials Examination Facility (FMEF) at the Hanford Site, Richland, Washington. The major objectives of BRET were to: - Develop and demonstrate reprocessing technology and systems for breeder fuel; - Close the fuel cycle for the FFTF; - Provide an integrated test of breeder reactor fuel cycle technology - reprocessing, safeguards and waste management. The quest for pyrochemical alternatives to aqueous reprocessing has been under way in the USA since the late 1950s. Approaches examined at various levels of development and for a variety of fuels include alloy melting, FP volatilization and adsorption, fluoride and chloride volatility methods, redox solvent extractions between liquid salt and metal phases, precipitation and fractional crystallization, and electrowinning and electro

  10. Cost-effectiveness analysis of abobotulinumtoxinA for the treatment of cervical dystonia in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Muthukumar M

    2017-04-01

    Full Text Available Madhusubramanian Muthukumar,1 Kamal Desai,1 Seye Abogunrin,2 Timothy Harrower,3 Sylvie Gabriel,4 Jerome Dinet5 1Modelling and Simulation, 2Meta Research, Evidera, London, 3Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; 4Global Market Access and Pricing, 5Health Economics and Outcomes Research (Global, Ipsen Pharma, Boulogne-Billancourt, France Background: Cervical dystonia (CD involves painful involuntary contraction of the neck and shoulder muscles and abnormal posture in middle-aged adults. Botulinum neurotoxin type A (BoNT-A is effective in treating CD but little is known about its associated cost-effectiveness.Objective: To evaluate the cost-effectiveness of abobotulinumtoxinA for treating CD from the UK payer perspective.Methods: A Markov model was developed to evaluate the cost-effectiveness of abobotulinumtoxinA versus best supportive care (BSC in CD, with a lifetime horizon and health states for response, nonresponse, secondary nonresponse, and BSC in patients with CD (mean age: 53 years; 37% male. Clinical improvement measured using Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS was mapped to utility using data from a randomized trial of abobotulinumtoxinA. Health care resource use, costs, and other inputs were from the British National Formulary, Personal Social Services Research Unit, published literature, or expert opinion. Costs and outcomes were discounted at 3.5% per annum.Results: In the base case, the incremental lifetime quality-adjusted life-years (QALYs gained from abobotulinumtoxinA arm versus BSC was 0.253 per patient, whereas the incremental cost was £7,160, leading to an incremental cost-effectiveness ratio (ICER of £30,468 per QALY. One-way sensitivity analyses showed that these results were sensitive to the proportion of responders to abobotulinumtoxinA at first injection, duration between injections, the number of reinjections allowed among primary nonresponders, and any difference in

  11. Analysis of print news media framing of ketamine treatment in the United States and Canada from 2000 to 2015.

    Directory of Open Access Journals (Sweden)

    Melvyn W B Zhang

    Full Text Available There are multifaceted views on the use of ketamine, a potentially addictive substance, to treat mental health problems. The past 15 years have seen growing media coverage of ketamine for medical and other purposes. This study examined the print news media coverage of medical and other uses of ketamine in North America to determine orientations and trends over time.Print newspaper coverage of ketamine from 2000 to 2015 was reviewed, resulting in 43 print news articles from 28 North American newspapers. A 55-item structured coding instrument was applied to assess news reports of ketamine. Items captured negative and positive aspects, therapeutic use of ketamine, and adverse side effects. Chi-squares tested for changes in trends over time.In the 15-year reviewed period, the three most frequent themes related to ketamine were: abuse (68.2%, legal status (34.1%, and clinical use in anesthesia (31.8%. There was significant change in trends during two periods (2000-2007 and 2008-2015. In 2008-2015, print news media articles were significantly more likely to encourage clinical use of ketamine to treat depression (p = 0.002, to treat treatment resistant depression (p = 0.043, and to claim that ketamine is more effective than conventional antidepressants (p = 0.043.Our review found consistent positive changes in the portrayals of ketamine by the print news media as a therapeutic antidepressant that mirror the recent scientific publications. These changes in news media reporting might influence the popularity of ketamine use to treat clinical depression. Guidance is required for journalists on objective reporting of medical research findings, including limitations of current research evidence and potential risks of ketamine.

  12. Cost-effectiveness of elbasvir/grazoprevir use in treatment-naive and treatment-experienced patients with hepatitis C virus genotype 1 infection and chronic kidney disease in the United States.

    Science.gov (United States)

    Elbasha, E; Greaves, W; Roth, D; Nwankwo, C

    2017-04-01

    Among patients with chronic kidney disease (CKD) in the United States, HCV infection causes significant morbidity and mortality and results in substantial healthcare costs. A once-daily oral regimen of elbasvir/grazoprevir (EBR/GZR) for 12 weeks was found to be a safe and efficacious treatment for HCV in patients with CKD. We evaluated the cost-effectiveness of EBR/GZR in treatment-naïve and treatment-experienced CKD patients compared with no treatment (NoTx) and pegylated interferon plus ribavirin (peg-IFN/RBV) using a computer-based model of the natural history of chronic HCV genotype 1 infection, CKD and liver disease. Data on baseline characteristics of the simulated patients were obtained from NHANES, 2000-2010. Model inputs were estimated from published studies. Cost of treatment with EBR/GZR and peg-INF/RBV were based on wholesale acquisition cost. All costs were from a third-party payer perspective and were expressed in 2015 U.S. dollars. We estimated lifetime incidence of liver-related complications, liver transplantation, kidney transplantation, end-stage live disease mortality and end-stage renal disease mortality; lifetime quality-adjusted life years (QALY); and incremental cost-utility ratios (ICUR). The model predicted that EBR/GZR will significantly reduce the incidence of liver-related complications and prolong life in patients with chronic HCV genotype 1 infection and CKD compared with NoTx or use of peg-IFN/RBV. EBR/GZR-based regimens resulted in higher average remaining QALYs and higher costs (11.5716, $191 242) compared with NoTx (8.9199, $156 236) or peg-INF/RBV (10.2857, $186 701). Peg-IFN/RBV is not cost-effective, and the ICUR of EBR/GZR compared with NoTx was $13 200/QALY. Treatment of a patient on haemodialysis with EBR/GZR resulted in a higher ICUR ($217 000/QALY). Assuming a threshold of $100 000 per QALY gained for cost-effectiveness, use of elbasvir/grazoprevir to treat an average patient with CKD can be considered cost

  13. Food irradiation in the United States: irradiation as a phytosanitary treatment for fresh fruits and vegetables and for the control of microorganisms in meat and poultry

    International Nuclear Information System (INIS)

    Ross, Ralph T.; Engeljohn, Dan

    2000-01-01

    Recently there has been a renewed focus on food irradiation in the United States (US) for the disinfestation of fresh fruits and vegetables to eliminate pests from imported agricultural commodities that could threaten the economic viability of American agriculture and for the control of bacterium E. coli 0157:H7 in beef, a pathogen that threatens the safety of the US domestic food supply. In January 1999 USDA/APHIS published in the Federal Register a rule which authorized irradiation as a guarantee treatment for papayas for movement from Hawaii to the US mainland. This treatment was never used for a number of reasons. However, in December, 1993, the US Environmental Protection Agency (EPA) published its final rule to terminate production and consumption of methyl bromide, the only remaining broad spectrum fumigant for disinfesting agricultural commodities for pests of quarantine significance on imported and exported commodities. With increased global trade pressures and the possible loss of methyl bromide as a fumigant for regulatory pests treatment made it imperative that practical treatment options be explored including irradiation. In May 1996, USDA/APHIS published a Notice of Policy which sets forth a policy statement that share positions and policies of USDA concerning the use of irradiation as a phytosanitary treatment. Subsequently in July, 1997, USDA/APHIS amended its Hawaiian regulation by increasing the dose required for papayas intended for interstate movement and by allowing carambolas and litchis also to move interstate as well. Fruits from Hawaii to the US mainland are currently being irradiated and distributed in commerce throughout the US Irradiation treatments now afford movement of many exotic fruits to the US mainland that could not be done earlier due to the lack of available treatment methods. To help combat this potential public health problem, the US Food and Drug Administration (FDA) approved treating red meat products. This process has been

  14. Food irradiation in the United States: irradiation as a phytosanitary treatment for fresh fruits and vegetables and for the control of microorganisms in meat and poultry

    Science.gov (United States)

    Ross, Ralph T.; Engeljohn, Dan

    2000-03-01

    Recently there has been a renewed focus on food irradiation in the United States (US) for the disinfestation of fresh fruits and vegetables to eliminate pests from imported agricultural commodities that could threaten the economic viability of American agriculture and for the control of bacterium E. coli 0157:H7 in beef, a pathogen that threatens the safety of the US domestic food supply. In January 1999 USDA/APHIS published in the Federal Register a rule which authorized irradiation as a guarantee treatment for papayas for movement from Hawaii to the US mainland. This treatment was never used for a number of reasons. However, in December, 1993, the US Environmental Protection Agency (EPA) published its final rule to terminate production and consumption of methyl bromide, the only remaining broad spectrum fumigant for disinfesting agricultural commodities for pests of quarantine significance on imported and exported commodities. With increased global trade pressures and the possible loss of methyl bromide as a fumigant for regulatory pests treatment made it imperative that practical treatment options be explored including irradiation. In May 1996, USDA/APHIS published a Notice of Policy which sets forth a policy statement that share positions and policies of USDA concerning the use of irradiation as a phytosanitary treatment. Subsequently in July, 1997, USDA/APHIS amended its Hawaiian regulation by increasing the dose required for papayas intended for interstate movement and by allowing carambolas and litchis also to move interstate as well. Fruits from Hawaii to the US mainland are currently being irradiated and distributed in commerce throughout the US Irradiation treatments now afford movement of many exotic fruits to the US mainland that could not be done earlier due to the lack of available treatment methods. To help combat this potential public health problem, the US Food and Drug Administration (FDA) approved treating red meat products. This process has been

  15. Efeitos da fisioterapia aquática na dor e no estado de sono e vigília de recém-nascidos pré-termo estáveis internados em unidade de terapia intensiva neonatal Effect of aquatic physical therapy on pain and state of sleep and wakefulness among stable preterm newborns in neonatal intensive care units

    Directory of Open Access Journals (Sweden)

    Carine Vignochi

    2010-06-01

    Full Text Available OBJETIVOS: Avaliar os efeitos da fisioterapia aquática na dor e no ciclo de sono e vigília de bebês prematuros estáveis hospitalizados. MÉTODOS: A pesquisa caracterizou-se como ensaio clínico não controlado de séries temporais. Foram incluídos 12 recém-nascidos clinicamente estáveis com idade gestacional inferior a 36 semanas internados em unidade de terapia intensiva neonatal. Após serem selecionados, os recém-nascidos foram colocados no meio líquido, onde foi iniciada a fisioterapia aquática, com duração de 10 minutos, na qual foram realizados movimentos que estimulam as posturas flexoras e a organização postural. Foram avaliados os ciclos sono e vigília por meio da escala de avaliação do ciclo de sono e vigília adaptada de Brazelton (1973*, a presença de sinais de dor por meio da escala Sistema de Codificação da Atividade Facial Neonatal (NFCS, além de parâmetros fisiológicos. RESULTADOS: Em relação aos estados de sono e vigília, antes da fisioterapia, os recém-nascidos apresentaram comportamentos que variaram entre totalmente acordados, com movimentos corporais vigorosos e choro. Após a fisioterapia, os estados de sono variaram entre sono leve com olhos fechados e algum movimento corporal. Esses valores apresentaram diferenças estatisticamente significativas (pOBJECTIVES: To evaluate the effects of aquatic physical therapy on pain and on the cycle of sleep and wakefulness among stable hospitalized premature infants. METHODS: This study was characterized as an uncontrolled clinical trial on a time series and included 12 clinically stable newborns of gestational age less than 36 weeks who were hospi